NUR 209 MED SURG 2 ADVANCED
CLINICAL CONCEPTS. EXAM
QUESTIONS AND ANSWERS
1. A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated
with high PEEP settings. Which assessment finding requires immediate intervention?
A. Scattered wheezing in the bilateral bases
B. Oxygen saturation of 92% on 60% FiO2
C. Respiratory rate of 22 breaths per minute
D. Mean arterial pressure (MAP) of 58 mmHg
Answer: D
Conceptual Explanation: High levels of PEEP increase intrathoracic pressure, which can
decrease venous return to the heart, leading to decreased cardiac output and hypotension
(MAP < 65 mmHg).
2. A patient is admitted with a suspected pheochromocytoma. Which action by the nurse is
most appropriate during the physical assessment?
A. Palpate the abdomen deeply to check for masses
,B. Monitor for significant weight gain
C. Assess for a positive Trousseau’s sign
D. Avoid palpating the abdomen
Answer: D
Conceptual Explanation: In patients with pheochromocytoma, abdominal palpation
should be avoided as it can trigger the release of catecholamines, leading to a hypertensive
crisis.
3. The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). Which
laboratory result is the most critical for the nurse to report?
A. BUN 40 mg/dL
C. Potassium 6.2 mEq/L
B. Creatinine 2.5 mg/dL
D. Calcium 8.8 mg/dL
Answer: C
Conceptual Explanation: Hyperkalemia (K+ > 5.0) is a life-threatening complication of
AKI that can lead to lethal cardiac arrhythmias; 6.2 is critically high.
4. Following a thyroidectomy, a patient develops laryngeal nerve damage. Which clinical
manifestation should the nurse anticipate?
A. Tetany
, B. Hoarseness
C. Hypercalcemia
D. Tachycardia
Answer: B
Conceptual Explanation: Hoarseness or a weak voice is a classic sign of laryngeal nerve
damage following thyroid surgery. Tetany and hypercalcemia are related to parathyroid
issues.
5. A patient is receiving a continuous intravenous infusion of nitroprusside for a hypertensive
crisis. The nurse should monitor for which toxicity?
A. Digoxin toxicity
B. Ototoxicity
C. Magnesium toxicity
D. Cyanide toxicity
Answer: D
Conceptual Explanation: Nitroprusside is metabolized into thiocyanate and cyanide.
Prolonged use or high doses can lead to cyanide poisoning.
6. Which assessment finding in a patient with a traumatic brain injury (TBI) is the earliest sign
of increased intracranial pressure (ICP)?
A. Cushing’s triad
CLINICAL CONCEPTS. EXAM
QUESTIONS AND ANSWERS
1. A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated
with high PEEP settings. Which assessment finding requires immediate intervention?
A. Scattered wheezing in the bilateral bases
B. Oxygen saturation of 92% on 60% FiO2
C. Respiratory rate of 22 breaths per minute
D. Mean arterial pressure (MAP) of 58 mmHg
Answer: D
Conceptual Explanation: High levels of PEEP increase intrathoracic pressure, which can
decrease venous return to the heart, leading to decreased cardiac output and hypotension
(MAP < 65 mmHg).
2. A patient is admitted with a suspected pheochromocytoma. Which action by the nurse is
most appropriate during the physical assessment?
A. Palpate the abdomen deeply to check for masses
,B. Monitor for significant weight gain
C. Assess for a positive Trousseau’s sign
D. Avoid palpating the abdomen
Answer: D
Conceptual Explanation: In patients with pheochromocytoma, abdominal palpation
should be avoided as it can trigger the release of catecholamines, leading to a hypertensive
crisis.
3. The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). Which
laboratory result is the most critical for the nurse to report?
A. BUN 40 mg/dL
C. Potassium 6.2 mEq/L
B. Creatinine 2.5 mg/dL
D. Calcium 8.8 mg/dL
Answer: C
Conceptual Explanation: Hyperkalemia (K+ > 5.0) is a life-threatening complication of
AKI that can lead to lethal cardiac arrhythmias; 6.2 is critically high.
4. Following a thyroidectomy, a patient develops laryngeal nerve damage. Which clinical
manifestation should the nurse anticipate?
A. Tetany
, B. Hoarseness
C. Hypercalcemia
D. Tachycardia
Answer: B
Conceptual Explanation: Hoarseness or a weak voice is a classic sign of laryngeal nerve
damage following thyroid surgery. Tetany and hypercalcemia are related to parathyroid
issues.
5. A patient is receiving a continuous intravenous infusion of nitroprusside for a hypertensive
crisis. The nurse should monitor for which toxicity?
A. Digoxin toxicity
B. Ototoxicity
C. Magnesium toxicity
D. Cyanide toxicity
Answer: D
Conceptual Explanation: Nitroprusside is metabolized into thiocyanate and cyanide.
Prolonged use or high doses can lead to cyanide poisoning.
6. Which assessment finding in a patient with a traumatic brain injury (TBI) is the earliest sign
of increased intracranial pressure (ICP)?
A. Cushing’s triad
