NRSG 110 Final Exam V1 | NRSG 110
Medical Surgical Nursing II | Actual Q&A
with Rationale (NRSG110 Final Exam) | Ivy
Tech
1. A nurse is interpreting the arterial blood gas (ABG) results for a client with chronic
obstructive pulmonary disease (COPD). The results are: pH 7.32, PaCO2 52 mmHg, and HCO3
24 mEq/L. Which acid-base imbalance does this represent?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Correct Answer: A
The pH is below 7.35, indicating acidosis, while the PaCO2 is above 45 mmHg, indicating a
respiratory cause. Since the bicarbonate level remains within the normal range of 22 to 26
mEq/L, the condition is not yet compensated. The nurse should focus on improving the
client’s ventilation to facilitate the removal of excess carbon dioxide.
2. A client is admitted with a diagnosis of acute myocardial infarction. Which laboratory value
should the nurse monitor as the most specific indicator of myocardial injury?
A. Creatine kinase (CK-MB)
,B. Troponin I
C. Myoglobin
D. Lactate dehydrogenase (LDH)
Correct Answer: B
Troponin I is a highly specific cardiac marker that rises within 3 to 6 hours of myocardial
damage and remains elevated for several days. While CK-MB also rises with heart damage,
it is less specific than Troponin because it can be influenced by skeletal muscle injury.
Myoglobin rises quickly but lacks the specificity required to definitively diagnose a
myocardial infarction on its own.
3. The nurse is preparing to administer digoxin to a client with heart failure. Which
assessment finding should lead the nurse to withhold the medication and notify the
provider?
A. Blood pressure 110/70 mmHg
B. Respiratory rate of 18 breaths per minute
C. Apical pulse of 52 beats per minute
D. Serum potassium level of 4.2 mEq/L
Correct Answer: C
Digoxin is a cardiac glycoside that slows the heart rate and increases the force of
contraction. Before administration, the nurse must assess the apical pulse for one full
,minute; if the rate is below 60 beats per minute, the dose is generally withheld.
Bradycardia is a common sign of digoxin toxicity and requires immediate medical
evaluation.
4. A client with type 1 diabetes mellitus is found unconscious with a blood glucose level of 45
mg/dL. Which action should the nurse take first?
A. Administer 15 grams of oral carbohydrates
B. Recheck the blood glucose level in 15 minutes
C. Administer Glucagon 1 mg intramuscularly
D. Initiate an insulin drip at 0.1 units/kg/hr
Correct Answer: C
Because the client is unconscious and unable to swallow safely, oral carbohydrates are
contraindicated due to the risk of aspiration. Glucagon is the emergency treatment of
choice to rapidly raise blood glucose by stimulating the liver to release stored glycogen.
Once the client regains consciousness, the nurse should provide a snack containing
complex carbohydrates and protein.
5. A nurse is caring for a client who is post-operative following a thyroidectomy. The client
reports numbness and tingling around the mouth and in the fingertips. Which medication
should the nurse anticipate administering?
A. Levothyroxine
B. Potassium chloride
, C. Calcium gluconate
D. Magnesium sulfate
Correct Answer: C
Numbness and tingling around the mouth (circumoral paresthesia) and fingertips are
early signs of hypocalcemia, which can occur if the parathyroid glands are accidentally
damaged during a thyroidectomy. The nurse should assess for positive Chvostek’s and
Trousseau’s signs to further confirm the deficiency. Intravenous calcium gluconate is the
standard treatment to rapidly restore serum calcium levels and prevent tetany.
6. A nurse is assessing a client who has sustained a right-sided stroke (Cerebrovascular
Accident). Which clinical manifestations should the nurse expect to observe?
A. Right-sided hemiplegia
B. Aphasia and cautious behavior
C. Slow, cautious performance and anxiety
D. Impaired speech and language comprehension
E. Impulsivity and left-sided neglect
F. Right-sided visual field deficits
Correct Answer: E
Clients with right-sided brain damage typically exhibit left-sided hemiplegia and spatial-
perceptual deficits, including left-sided neglect. They are often characterized by
Medical Surgical Nursing II | Actual Q&A
with Rationale (NRSG110 Final Exam) | Ivy
Tech
1. A nurse is interpreting the arterial blood gas (ABG) results for a client with chronic
obstructive pulmonary disease (COPD). The results are: pH 7.32, PaCO2 52 mmHg, and HCO3
24 mEq/L. Which acid-base imbalance does this represent?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Correct Answer: A
The pH is below 7.35, indicating acidosis, while the PaCO2 is above 45 mmHg, indicating a
respiratory cause. Since the bicarbonate level remains within the normal range of 22 to 26
mEq/L, the condition is not yet compensated. The nurse should focus on improving the
client’s ventilation to facilitate the removal of excess carbon dioxide.
2. A client is admitted with a diagnosis of acute myocardial infarction. Which laboratory value
should the nurse monitor as the most specific indicator of myocardial injury?
A. Creatine kinase (CK-MB)
,B. Troponin I
C. Myoglobin
D. Lactate dehydrogenase (LDH)
Correct Answer: B
Troponin I is a highly specific cardiac marker that rises within 3 to 6 hours of myocardial
damage and remains elevated for several days. While CK-MB also rises with heart damage,
it is less specific than Troponin because it can be influenced by skeletal muscle injury.
Myoglobin rises quickly but lacks the specificity required to definitively diagnose a
myocardial infarction on its own.
3. The nurse is preparing to administer digoxin to a client with heart failure. Which
assessment finding should lead the nurse to withhold the medication and notify the
provider?
A. Blood pressure 110/70 mmHg
B. Respiratory rate of 18 breaths per minute
C. Apical pulse of 52 beats per minute
D. Serum potassium level of 4.2 mEq/L
Correct Answer: C
Digoxin is a cardiac glycoside that slows the heart rate and increases the force of
contraction. Before administration, the nurse must assess the apical pulse for one full
,minute; if the rate is below 60 beats per minute, the dose is generally withheld.
Bradycardia is a common sign of digoxin toxicity and requires immediate medical
evaluation.
4. A client with type 1 diabetes mellitus is found unconscious with a blood glucose level of 45
mg/dL. Which action should the nurse take first?
A. Administer 15 grams of oral carbohydrates
B. Recheck the blood glucose level in 15 minutes
C. Administer Glucagon 1 mg intramuscularly
D. Initiate an insulin drip at 0.1 units/kg/hr
Correct Answer: C
Because the client is unconscious and unable to swallow safely, oral carbohydrates are
contraindicated due to the risk of aspiration. Glucagon is the emergency treatment of
choice to rapidly raise blood glucose by stimulating the liver to release stored glycogen.
Once the client regains consciousness, the nurse should provide a snack containing
complex carbohydrates and protein.
5. A nurse is caring for a client who is post-operative following a thyroidectomy. The client
reports numbness and tingling around the mouth and in the fingertips. Which medication
should the nurse anticipate administering?
A. Levothyroxine
B. Potassium chloride
, C. Calcium gluconate
D. Magnesium sulfate
Correct Answer: C
Numbness and tingling around the mouth (circumoral paresthesia) and fingertips are
early signs of hypocalcemia, which can occur if the parathyroid glands are accidentally
damaged during a thyroidectomy. The nurse should assess for positive Chvostek’s and
Trousseau’s signs to further confirm the deficiency. Intravenous calcium gluconate is the
standard treatment to rapidly restore serum calcium levels and prevent tetany.
6. A nurse is assessing a client who has sustained a right-sided stroke (Cerebrovascular
Accident). Which clinical manifestations should the nurse expect to observe?
A. Right-sided hemiplegia
B. Aphasia and cautious behavior
C. Slow, cautious performance and anxiety
D. Impaired speech and language comprehension
E. Impulsivity and left-sided neglect
F. Right-sided visual field deficits
Correct Answer: E
Clients with right-sided brain damage typically exhibit left-sided hemiplegia and spatial-
perceptual deficits, including left-sided neglect. They are often characterized by
