NUR 209 MED SURG 2 FINAL
EXAMINATION QUESTIONS AND
ANSWERS
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes that the PaO2 remains low despite an FiO2 of 80%. Which
physiological phenomenon explains this finding?
A. Increased lung compliance
B. Increased dead space ventilation
C. Alveolar hyperventilation
D. Right-to-left intrapulmonary shunting
Answer: D
Conceptual Explanation: In ARDS, fluid-filled or collapsed alveoli lead to intrapulmonary
shunting, where blood passes through the lungs without being oxygenated, resulting in
refractory hypoxemia.
,2. A client is admitted with a diagnosis of Acute Kidney Injury (AKI). The nurse observes the
client’s potassium level is 6.8 mEq/L and the ECG shows peaked T waves. Which medication
should the nurse prioritize to protect the myocardium?
A. Calcium Gluconate
B. Regular Insulin with D50
C. Sodium Polystyrene Sulfonate
D. Sodium Bicarbonate
Answer: A
Conceptual Explanation: While insulin and Kayexalate help lower potassium, Calcium
Gluconate is the priority to stabilize the myocardial cell membrane and prevent life-
threatening arrhythmias.
3. The nurse is caring for a patient in the ICU who has a Pulmonary Artery Catheter. The
patient’s Pulmonary Artery Wedge Pressure (PAWP) is 22 mmHg. Which clinical condition is
most consistent with this finding?
A. Hypovolemic shock
B. Right-sided heart failure
C. Left-sided heart failure
D. Dehydration
Answer: C
, Conceptual Explanation: Normal PAWP is 4-12 mmHg. An elevated PAWP (22 mmHg)
indicates increased left ventricular end-diastolic pressure, common in left-sided heart
failure or fluid overload.
4. Following a thyroidectomy, a patient develops laryngeal stridor and muscle tingling in the
fingers. Which action should the nurse take first?
A. Check for a positive Chvostek sign
B. Prepare for emergency tracheostomy
C. Assess the surgical dressing for bleeding
D. Administer intravenous Calcium Gluconate
Answer: D
Conceptual Explanation: Stridor and tingling suggest hypocalcemia due to accidental
parathyroid removal. IV Calcium Gluconate is necessary to treat tetany and prevent airway
obstruction.
5. A patient with a history of liver cirrhosis presents with altered mental status and asterixis.
Which lab value does the nurse anticipate will be elevated?
A. Ammonia
B. Bilirubin
C. Albumin
D. Prothrombin Time
EXAMINATION QUESTIONS AND
ANSWERS
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes that the PaO2 remains low despite an FiO2 of 80%. Which
physiological phenomenon explains this finding?
A. Increased lung compliance
B. Increased dead space ventilation
C. Alveolar hyperventilation
D. Right-to-left intrapulmonary shunting
Answer: D
Conceptual Explanation: In ARDS, fluid-filled or collapsed alveoli lead to intrapulmonary
shunting, where blood passes through the lungs without being oxygenated, resulting in
refractory hypoxemia.
,2. A client is admitted with a diagnosis of Acute Kidney Injury (AKI). The nurse observes the
client’s potassium level is 6.8 mEq/L and the ECG shows peaked T waves. Which medication
should the nurse prioritize to protect the myocardium?
A. Calcium Gluconate
B. Regular Insulin with D50
C. Sodium Polystyrene Sulfonate
D. Sodium Bicarbonate
Answer: A
Conceptual Explanation: While insulin and Kayexalate help lower potassium, Calcium
Gluconate is the priority to stabilize the myocardial cell membrane and prevent life-
threatening arrhythmias.
3. The nurse is caring for a patient in the ICU who has a Pulmonary Artery Catheter. The
patient’s Pulmonary Artery Wedge Pressure (PAWP) is 22 mmHg. Which clinical condition is
most consistent with this finding?
A. Hypovolemic shock
B. Right-sided heart failure
C. Left-sided heart failure
D. Dehydration
Answer: C
, Conceptual Explanation: Normal PAWP is 4-12 mmHg. An elevated PAWP (22 mmHg)
indicates increased left ventricular end-diastolic pressure, common in left-sided heart
failure or fluid overload.
4. Following a thyroidectomy, a patient develops laryngeal stridor and muscle tingling in the
fingers. Which action should the nurse take first?
A. Check for a positive Chvostek sign
B. Prepare for emergency tracheostomy
C. Assess the surgical dressing for bleeding
D. Administer intravenous Calcium Gluconate
Answer: D
Conceptual Explanation: Stridor and tingling suggest hypocalcemia due to accidental
parathyroid removal. IV Calcium Gluconate is necessary to treat tetany and prevent airway
obstruction.
5. A patient with a history of liver cirrhosis presents with altered mental status and asterixis.
Which lab value does the nurse anticipate will be elevated?
A. Ammonia
B. Bilirubin
C. Albumin
D. Prothrombin Time
