GALEN NUR 242 EXAM 2 () | MED-
SURG NURSING | (A+ GUARANTEE) | PDF
Here is a Medical-Surgical Nursing (NUR 242) practice exam covering core concepts typically
assessed in Exam 2.
Table of Contents
1. Section 1: Endocrine Systems & Disorders
2. Section 2: Gastrointestinal & Hepatic Systems
3. Section 3: Renal & Electrolyte Management
4. Section 4: Advanced Respiratory Nursing
5. Section 5: Cardiovascular & Vascular Systems
Section 1: Endocrine Systems & Disorders
Question 1
A nurse is caring for a client admitted with Diabetic Ketoacidosis (DKA). Which of the
following arterial blood gas (ABG) results should the nurse expect?
• A. pH 7.48, PaCO2 32 mmHg, HCO3− 24 mEq/L
• B. pH 7.28, PaCO2 30 mmHg, HCO3− 16 mEq/L
• C. pH 7.31, PaCO2 50 mmHg, HCO3− 28 mEq/L
• D. pH 7.50, PaCO2 48 mmHg, HCO3− 34 mEq/L
• Correct Answer: B
• Rationale: DKA produces metabolic acidosis due to ketone accumulation. A pH below
7.35 and HCO− 3 below 22 mEq/L indicate metabolic acidosis. The lowered PaCO2 (30
mmHg) demonstrates respiratory compensation via Kussmaul respirations (deep, rapid
breathing attempting to blow off excess CO2 ).
Question 2
A nurse is providing discharge instructions to a client newly diagnosed with primary adrenal
insufficiency (Addison's disease). Which instruction is most critical to include?
• A. Restrict daily fluid intake to under 1.5 liters.
, • B. Double or triple steroid doses during periods of severe illness or stress.
• C. Take glucocorticoid medications at bedtime to prevent gastric irritation.
• D. Maintain a strict low-sodium diet to avoid fluid overload.
• Correct Answer: B
• Rationale: Patients with Addison's disease lack endogenous cortisol production. During
stress, infection, or surgery, normal body demands increase; failure to increase steroid
intake can precipitate a life-threatening Addisonian crisis (hypotension, hyponatremia,
hypoglycemia, hyperkalemia). Daily steroids are typically taken in the morning to mimic
natural circadian rhythms.
Question 3
A client who underwent a total thyroidectomy 12 hours ago reports numbness and tingling
around the mouth and in the fingertips. Which diagnostic test or sign should the nurse evaluate
first?
• A. Kernig's sign
• B. Trousseau's sign
• C. Babinski reflex
• D. Romberg test
• Correct Answer: B
• Rationale: Numbness and tingling (paresthesia) are early symptoms of hypocalcemia, a
potential complication of accidental parathyroid gland removal or damage during
thyroidectomy. Trousseau's sign (carpopedal spasm induced by inflating a blood pressure
cuff) and Chvostek's sign assess for neuromuscular excitability caused by low serum
calcium.
Section 2: Gastrointestinal & Hepatic Systems
Question 4
A nurse is assessing a client with acute pancreatitis. Which physical assessment finding indicates
retroperitoneal hemorrhage?
• A. Blumberg's sign
• B. Murphy's sign
• C. Grey Turner's sign
• D. Rovsing's sign
, • Correct Answer: C
• Rationale: Grey Turner's sign is blue-red or brownish discoloration of the flanks caused
by retroperitoneal bleeding in severe acute pancreatitis. Cullen's sign is ecchymosis
around the umbilicus. Murphy's sign indicates acute cholecystitis, while Rovsing's and
Blumberg's signs indicate appendicitis/peritonitis.
Question 5
A client with end-stage liver cirrhosis develops hepatic encephalopathy. The nurse anticipates
administering lactulose. Which outcome indicates the medication is effective?
• A. The client has 3 to 4 soft stools per day and improved mental clarity.
• B. Serum bilirubin level drops below 1.2 mg/dL.
• C. Serum potassium increases to 4.5 mEq/L.
• D. Prothrombin time decreases to baseline.
• Correct Answer: A
• Rationale: Lactulose lowers serum ammonia levels by trapping ammonia in the gut and
promoting its excretion via loose bowel movements. Therapeutic efficacy is evidenced by
improved neurological status (reduced confusion/asterixis) and achieving 2 to 4 soft
stools per day.
Question 6
A nurse is caring for a client with a small bowel obstruction. Which clinical manifestation should
the nurse expect?
• A. Severe metabolic alkalosis and rapid profuse vomiting
• B. Low-grade fever with blood-tinged diarrhea
• C. Constant, dull lower abdominal ache with absolute constipation
• D. Steatorrhea and hyperactive bowel sounds in all four quadrants
• Correct Answer: A
• Rationale: Small bowel obstructions characteristically present with rapid-onset colicky
abdominal pain, upper abdominal distension, and frequent, profuse vomiting. Loss of
gastric hydrochloric acid through vomiting leads to metabolic alkalosis.
Section 3: Renal & Electrolyte Management
Question 7
SURG NURSING | (A+ GUARANTEE) | PDF
Here is a Medical-Surgical Nursing (NUR 242) practice exam covering core concepts typically
assessed in Exam 2.
Table of Contents
1. Section 1: Endocrine Systems & Disorders
2. Section 2: Gastrointestinal & Hepatic Systems
3. Section 3: Renal & Electrolyte Management
4. Section 4: Advanced Respiratory Nursing
5. Section 5: Cardiovascular & Vascular Systems
Section 1: Endocrine Systems & Disorders
Question 1
A nurse is caring for a client admitted with Diabetic Ketoacidosis (DKA). Which of the
following arterial blood gas (ABG) results should the nurse expect?
• A. pH 7.48, PaCO2 32 mmHg, HCO3− 24 mEq/L
• B. pH 7.28, PaCO2 30 mmHg, HCO3− 16 mEq/L
• C. pH 7.31, PaCO2 50 mmHg, HCO3− 28 mEq/L
• D. pH 7.50, PaCO2 48 mmHg, HCO3− 34 mEq/L
• Correct Answer: B
• Rationale: DKA produces metabolic acidosis due to ketone accumulation. A pH below
7.35 and HCO− 3 below 22 mEq/L indicate metabolic acidosis. The lowered PaCO2 (30
mmHg) demonstrates respiratory compensation via Kussmaul respirations (deep, rapid
breathing attempting to blow off excess CO2 ).
Question 2
A nurse is providing discharge instructions to a client newly diagnosed with primary adrenal
insufficiency (Addison's disease). Which instruction is most critical to include?
• A. Restrict daily fluid intake to under 1.5 liters.
, • B. Double or triple steroid doses during periods of severe illness or stress.
• C. Take glucocorticoid medications at bedtime to prevent gastric irritation.
• D. Maintain a strict low-sodium diet to avoid fluid overload.
• Correct Answer: B
• Rationale: Patients with Addison's disease lack endogenous cortisol production. During
stress, infection, or surgery, normal body demands increase; failure to increase steroid
intake can precipitate a life-threatening Addisonian crisis (hypotension, hyponatremia,
hypoglycemia, hyperkalemia). Daily steroids are typically taken in the morning to mimic
natural circadian rhythms.
Question 3
A client who underwent a total thyroidectomy 12 hours ago reports numbness and tingling
around the mouth and in the fingertips. Which diagnostic test or sign should the nurse evaluate
first?
• A. Kernig's sign
• B. Trousseau's sign
• C. Babinski reflex
• D. Romberg test
• Correct Answer: B
• Rationale: Numbness and tingling (paresthesia) are early symptoms of hypocalcemia, a
potential complication of accidental parathyroid gland removal or damage during
thyroidectomy. Trousseau's sign (carpopedal spasm induced by inflating a blood pressure
cuff) and Chvostek's sign assess for neuromuscular excitability caused by low serum
calcium.
Section 2: Gastrointestinal & Hepatic Systems
Question 4
A nurse is assessing a client with acute pancreatitis. Which physical assessment finding indicates
retroperitoneal hemorrhage?
• A. Blumberg's sign
• B. Murphy's sign
• C. Grey Turner's sign
• D. Rovsing's sign
, • Correct Answer: C
• Rationale: Grey Turner's sign is blue-red or brownish discoloration of the flanks caused
by retroperitoneal bleeding in severe acute pancreatitis. Cullen's sign is ecchymosis
around the umbilicus. Murphy's sign indicates acute cholecystitis, while Rovsing's and
Blumberg's signs indicate appendicitis/peritonitis.
Question 5
A client with end-stage liver cirrhosis develops hepatic encephalopathy. The nurse anticipates
administering lactulose. Which outcome indicates the medication is effective?
• A. The client has 3 to 4 soft stools per day and improved mental clarity.
• B. Serum bilirubin level drops below 1.2 mg/dL.
• C. Serum potassium increases to 4.5 mEq/L.
• D. Prothrombin time decreases to baseline.
• Correct Answer: A
• Rationale: Lactulose lowers serum ammonia levels by trapping ammonia in the gut and
promoting its excretion via loose bowel movements. Therapeutic efficacy is evidenced by
improved neurological status (reduced confusion/asterixis) and achieving 2 to 4 soft
stools per day.
Question 6
A nurse is caring for a client with a small bowel obstruction. Which clinical manifestation should
the nurse expect?
• A. Severe metabolic alkalosis and rapid profuse vomiting
• B. Low-grade fever with blood-tinged diarrhea
• C. Constant, dull lower abdominal ache with absolute constipation
• D. Steatorrhea and hyperactive bowel sounds in all four quadrants
• Correct Answer: A
• Rationale: Small bowel obstructions characteristically present with rapid-onset colicky
abdominal pain, upper abdominal distension, and frequent, profuse vomiting. Loss of
gastric hydrochloric acid through vomiting leads to metabolic alkalosis.
Section 3: Renal & Electrolyte Management
Question 7
