NUR 242 – buddle EXAM – MEDICAL-SURGICAL NURSING
CONCEPTS EXAM with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Fluid, Electrolyte, and Acid-Base Imbalances in Critical Care
2. Cardiovascular Pathophysiology, Hemodynamic Monitoring, and Pharmacotherapy
3. Respiratory Failure, Mechanical Ventilation, and Acute Pulmonary Disorders
4. Neurological Assessment, Intracranial Pressure Management, and Acute Stroke Care
5. Renal, Endocrine, Gastrointestinal, and Multisystem Critical Care Management
1. A 58-year-old male is admitted to the intensive care unit following a severe motor vehicle crash.
Initial laboratory findings reveal serum sodium of 118 mEq/L, serum osmolality of 245
mOsm/kg, urine osmolality of 550 mOsm/kg, and a urinary sodium of 65 mEq/L. The patient is
clinically euvolemic with no peripheral edema or jugular venous distention. Which underlying
condition is most consistent with these clinical findings?
A. Decompensated cirrhosis with portal hypertension
B. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C. Central diabetes insipidus secondary to head trauma
D. Severe hypovolemic dehydration from hemorrhage
CORRECT ANSWER : B
Rationale: SIADH is characterized by hypotonic euvolemic hyponatremia, high urine osmolality
relative to serum osmolality, and inappropriately elevated urinary sodium. Option A presents
with hypervolemic hyponatremia due to total body sodium and water overload. Option C causes
hypernatremia and dilute polyuria, not concentrated hyponatremia. Option D presents with
hypovolemic signs like dry mucous membranes and tachycardia.
2. A 64-year-old female with a history of heart failure is admitted with acute decompensated heart
failure exacerbation. She exhibits severe dyspnea, crackles halfway up bilateral lung fields, a
, third heart sound (S3), and pitting lower extremity edema. Her blood pressure is 165/95 mmHg,
and heart rate is 110 bpm. Which initial intravenous pharmacological intervention is indicated to
rapidly reduce preload and myocardial oxygen demand?
A. Metoprolol tartrate bolus
B. Furosemide intravenous push
C. Normal saline fluid bolus infusion
D. Intravenous milrinone infusion
CORRECT ANSWER : B
Rationale: Acute decompensated heart failure with volume overload requires rapid preload
reduction via loop diuretics such as intravenous furosemide. Option A can precipitate acute
decompensation if given during acute fluid overload. Option C will worsen pulmonary
congestion. Option D is an inotrope reserved for refractory cardiogenic shock with low output,
not hypertensive heart failure.
3. A 45-year-old male is recovering on the surgical floor following a subtotal gastrectomy. On
postoperative day three, he complains of sudden, severe, knife-like upper abdominal pain that
radiates to his back. Assessment reveals a rigid, board-like abdomen, absent bowel sounds, and a
temperature of 38.9°C. Which diagnostic imaging modality is most definitive for confirming an
anastomotic leak or hollow viscus perforation?
A. Plain abdominal radiograph in the supine position only
B. Computed tomography (CT) scan of the abdomen and pelvis with water-soluble oral
and IV contrast
C. Right upper quadrant abdominal ultrasound
D. Magnetic resonance cholangiopancreatography (MRCP)
CORRECT ANSWER : B
Rationale: Abdominal CT with water-soluble contrast is the gold standard for identifying
postoperative anastomotic leaks, micro-perforations, and localized fluid collections. Option A
has low sensitivity for subtle leaks. Option C evaluates biliary ductal structures and gallbladder
pathology. Option D evaluates the biliary and pancreatic ducts, not acute postoperative bowel
perforations.
4. A 70-year-old male with a history of chronic obstructive pulmonary disease (COPD) is admitted
with acute respiratory distress. Arterial blood gas (ABG) analysis on room air reveals: pH 7.31,
, PaCO2 65 mmHg, PaO2 52 mmHg, and HCO3 32 mEq/L. How should the nurse interpret these
laboratory values?
A. Uncompensated metabolic acidosis with hypoxemia
B. Compensated respiratory acidosis with severe hypoxemia
C. Acute respiratory alkalosis with hyperventilation
D. Partially compensated metabolic alkalosis
CORRECT ANSWER : B
Rationale: The low pH combined with elevated PaCO2 indicates respiratory acidosis, while the
elevated HCO3 demonstrates renal metabolic compensation; the PaO2 of 52 mmHg reflects
severe hypoxemia. Option A requires a low bicarbonate level. Option C requires a high pH and
low PaCO2. Option D requires a primary elevated pH and high bicarbonate.
5. A 52-year-old female is admitted to the neurological intensive care unit following an aneurysmal
subarachnoid hemorrhage. On postoperative day six, she experiences acute onset of expressive
aphasia and right-sided hemiparesis. Transcranial Doppler ultrasound reveals significantly
elevated middle cerebral artery velocities. What is the primary medical therapy initiated to
prevent or treat this secondary complication?
A. Prophylactic intravenous broad-spectrum antibiotics
B. Oral nimodipine administration and maintenance of induced hypertension/ euvolemia
C. Immediate administration of high-dose loop diuretics to lower intracranial pressure
D. Therapeutic hypothermia protocol targeting 32°C
CORRECT ANSWER : B
Rationale: Cerebral vasospasm is a major complication 4-14 days post-subarachnoid
hemorrhage, treated with the calcium channel blocker nimodipine and triple-H therapy
(hypertension, hypervolemia, hemodilution). Option A treats infectious meningitis. Option C
risks lowering cerebral perfusion pressure. Option D is used for post-cardiac arrest cerebral
protection.
6. A 60-year-old male with end-stage renal disease misses three consecutive dialysis sessions and
presents with severe generalized weakness and peaked T waves on his electrocardiogram (ECG).
Serum potassium is 7.2 mEq/L. What is the priority immediate pharmacological intervention to
protect the myocardium from lethal arrhythmias?
A. Intravenous regular insulin combined with 50% dextrose
, B. Intravenous calcium gluconate administration
C. Oral sodium polystyrene sulfonate suspension
D. Immediate initiation of hemodialysis without medication
CORRECT ANSWER : B
Rationale: Intravenous calcium gluconate stabilizes the cardiac cell membrane against
hyperkalemic depolarization and prevents lethal arrhythmias, though it does not lower serum
potassium. Options A and C lower serum potassium but have slower onset than membrane
stabilization. Option D is definitive but preparation takes time.
7. A 34-year-old female with a 10-year history of Graves' disease is brought to the emergency
department in thyroid storm. Her vital signs are: temperature 40.1°C, heart rate 162 bpm (atrial
fibrillation), blood pressure 180/90 mmHg, and she is delirious. Which combination of
medications represents the correct initial medical management?
A. Levothyroxine and low-dose aspirin
B. Propylthiouracil (PTU), beta-blockers (e.g., propranolol), and iodine solution (Lugol's)
C. Radioactive iodine ablation and loop diuretics
D. Methimazole and oral calcium supplements
CORRECT ANSWER : B
Rationale: Thyroid storm is managed by blocking hormone synthesis with PTU, inhibiting
hormone release with iodine, controlling adrenergic symptoms with beta-blockers, and
supportive cooling. Option A worsens hyperthyroidism. Option C takes weeks to work. Option D
lacks iodine therapy and immediate symptom control.
8. A 55-year-old male is admitted with severe acute pancreatitis secondary to gallstones. On the
second day of hospitalization, he develops progressive tachypnea, intercostal retractions, and
cyanosis. Arterial blood gas reveals a PaO2 of 55 mmHg on 60% Venturi mask. Chest
radiograph shows diffuse bilateral infiltrates. Pulmonary capillary wedge pressure is normal (10
mmHg). What is the primary pathophysiological mechanism of this condition?
A. Left ventricular systolic pump failure leading to pulmonary venous congestion
B. Increased alveolar-capillary membrane permeability leading to non-cardiogenic
pulmonary edema
C. Massive aspiration of gastric contents due to depressed gag reflex
CONCEPTS EXAM with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Fluid, Electrolyte, and Acid-Base Imbalances in Critical Care
2. Cardiovascular Pathophysiology, Hemodynamic Monitoring, and Pharmacotherapy
3. Respiratory Failure, Mechanical Ventilation, and Acute Pulmonary Disorders
4. Neurological Assessment, Intracranial Pressure Management, and Acute Stroke Care
5. Renal, Endocrine, Gastrointestinal, and Multisystem Critical Care Management
1. A 58-year-old male is admitted to the intensive care unit following a severe motor vehicle crash.
Initial laboratory findings reveal serum sodium of 118 mEq/L, serum osmolality of 245
mOsm/kg, urine osmolality of 550 mOsm/kg, and a urinary sodium of 65 mEq/L. The patient is
clinically euvolemic with no peripheral edema or jugular venous distention. Which underlying
condition is most consistent with these clinical findings?
A. Decompensated cirrhosis with portal hypertension
B. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C. Central diabetes insipidus secondary to head trauma
D. Severe hypovolemic dehydration from hemorrhage
CORRECT ANSWER : B
Rationale: SIADH is characterized by hypotonic euvolemic hyponatremia, high urine osmolality
relative to serum osmolality, and inappropriately elevated urinary sodium. Option A presents
with hypervolemic hyponatremia due to total body sodium and water overload. Option C causes
hypernatremia and dilute polyuria, not concentrated hyponatremia. Option D presents with
hypovolemic signs like dry mucous membranes and tachycardia.
2. A 64-year-old female with a history of heart failure is admitted with acute decompensated heart
failure exacerbation. She exhibits severe dyspnea, crackles halfway up bilateral lung fields, a
, third heart sound (S3), and pitting lower extremity edema. Her blood pressure is 165/95 mmHg,
and heart rate is 110 bpm. Which initial intravenous pharmacological intervention is indicated to
rapidly reduce preload and myocardial oxygen demand?
A. Metoprolol tartrate bolus
B. Furosemide intravenous push
C. Normal saline fluid bolus infusion
D. Intravenous milrinone infusion
CORRECT ANSWER : B
Rationale: Acute decompensated heart failure with volume overload requires rapid preload
reduction via loop diuretics such as intravenous furosemide. Option A can precipitate acute
decompensation if given during acute fluid overload. Option C will worsen pulmonary
congestion. Option D is an inotrope reserved for refractory cardiogenic shock with low output,
not hypertensive heart failure.
3. A 45-year-old male is recovering on the surgical floor following a subtotal gastrectomy. On
postoperative day three, he complains of sudden, severe, knife-like upper abdominal pain that
radiates to his back. Assessment reveals a rigid, board-like abdomen, absent bowel sounds, and a
temperature of 38.9°C. Which diagnostic imaging modality is most definitive for confirming an
anastomotic leak or hollow viscus perforation?
A. Plain abdominal radiograph in the supine position only
B. Computed tomography (CT) scan of the abdomen and pelvis with water-soluble oral
and IV contrast
C. Right upper quadrant abdominal ultrasound
D. Magnetic resonance cholangiopancreatography (MRCP)
CORRECT ANSWER : B
Rationale: Abdominal CT with water-soluble contrast is the gold standard for identifying
postoperative anastomotic leaks, micro-perforations, and localized fluid collections. Option A
has low sensitivity for subtle leaks. Option C evaluates biliary ductal structures and gallbladder
pathology. Option D evaluates the biliary and pancreatic ducts, not acute postoperative bowel
perforations.
4. A 70-year-old male with a history of chronic obstructive pulmonary disease (COPD) is admitted
with acute respiratory distress. Arterial blood gas (ABG) analysis on room air reveals: pH 7.31,
, PaCO2 65 mmHg, PaO2 52 mmHg, and HCO3 32 mEq/L. How should the nurse interpret these
laboratory values?
A. Uncompensated metabolic acidosis with hypoxemia
B. Compensated respiratory acidosis with severe hypoxemia
C. Acute respiratory alkalosis with hyperventilation
D. Partially compensated metabolic alkalosis
CORRECT ANSWER : B
Rationale: The low pH combined with elevated PaCO2 indicates respiratory acidosis, while the
elevated HCO3 demonstrates renal metabolic compensation; the PaO2 of 52 mmHg reflects
severe hypoxemia. Option A requires a low bicarbonate level. Option C requires a high pH and
low PaCO2. Option D requires a primary elevated pH and high bicarbonate.
5. A 52-year-old female is admitted to the neurological intensive care unit following an aneurysmal
subarachnoid hemorrhage. On postoperative day six, she experiences acute onset of expressive
aphasia and right-sided hemiparesis. Transcranial Doppler ultrasound reveals significantly
elevated middle cerebral artery velocities. What is the primary medical therapy initiated to
prevent or treat this secondary complication?
A. Prophylactic intravenous broad-spectrum antibiotics
B. Oral nimodipine administration and maintenance of induced hypertension/ euvolemia
C. Immediate administration of high-dose loop diuretics to lower intracranial pressure
D. Therapeutic hypothermia protocol targeting 32°C
CORRECT ANSWER : B
Rationale: Cerebral vasospasm is a major complication 4-14 days post-subarachnoid
hemorrhage, treated with the calcium channel blocker nimodipine and triple-H therapy
(hypertension, hypervolemia, hemodilution). Option A treats infectious meningitis. Option C
risks lowering cerebral perfusion pressure. Option D is used for post-cardiac arrest cerebral
protection.
6. A 60-year-old male with end-stage renal disease misses three consecutive dialysis sessions and
presents with severe generalized weakness and peaked T waves on his electrocardiogram (ECG).
Serum potassium is 7.2 mEq/L. What is the priority immediate pharmacological intervention to
protect the myocardium from lethal arrhythmias?
A. Intravenous regular insulin combined with 50% dextrose
, B. Intravenous calcium gluconate administration
C. Oral sodium polystyrene sulfonate suspension
D. Immediate initiation of hemodialysis without medication
CORRECT ANSWER : B
Rationale: Intravenous calcium gluconate stabilizes the cardiac cell membrane against
hyperkalemic depolarization and prevents lethal arrhythmias, though it does not lower serum
potassium. Options A and C lower serum potassium but have slower onset than membrane
stabilization. Option D is definitive but preparation takes time.
7. A 34-year-old female with a 10-year history of Graves' disease is brought to the emergency
department in thyroid storm. Her vital signs are: temperature 40.1°C, heart rate 162 bpm (atrial
fibrillation), blood pressure 180/90 mmHg, and she is delirious. Which combination of
medications represents the correct initial medical management?
A. Levothyroxine and low-dose aspirin
B. Propylthiouracil (PTU), beta-blockers (e.g., propranolol), and iodine solution (Lugol's)
C. Radioactive iodine ablation and loop diuretics
D. Methimazole and oral calcium supplements
CORRECT ANSWER : B
Rationale: Thyroid storm is managed by blocking hormone synthesis with PTU, inhibiting
hormone release with iodine, controlling adrenergic symptoms with beta-blockers, and
supportive cooling. Option A worsens hyperthyroidism. Option C takes weeks to work. Option D
lacks iodine therapy and immediate symptom control.
8. A 55-year-old male is admitted with severe acute pancreatitis secondary to gallstones. On the
second day of hospitalization, he develops progressive tachypnea, intercostal retractions, and
cyanosis. Arterial blood gas reveals a PaO2 of 55 mmHg on 60% Venturi mask. Chest
radiograph shows diffuse bilateral infiltrates. Pulmonary capillary wedge pressure is normal (10
mmHg). What is the primary pathophysiological mechanism of this condition?
A. Left ventricular systolic pump failure leading to pulmonary venous congestion
B. Increased alveolar-capillary membrane permeability leading to non-cardiogenic
pulmonary edema
C. Massive aspiration of gastric contents due to depressed gag reflex
