NUR 209 ADVANCED MED SURG II
QUESTIONS AND ANSWERS
1. A patient with a traumatic brain injury (TBI) exhibits a blood pressure of 180/60 mmHg, a
pulse of 48 beats/min, and irregular respirations. Which pathophysiology is occurring?
A. Hypovolemic shock resulting from internal hemorrhage
B. Septic shock from a secondary infection
C. Autonomic dysreflexia due to spinal cord stimulation
D. Cushing’s triad indicative of increased intracranial pressure
Answer: D
Conceptual Explanation: Cushing’s triad consists of bradycardia, hypertension with a
widening pulse pressure, and irregular respirations, signaling late-stage increased
intracranial pressure.
2. Which arterial blood gas (ABG) result is most consistent with a patient in early stages of
acute respiratory distress syndrome (ARDS)?
A. pH 7.30, PaCO2 55, HCO3 26
B. pH 7.25, PaCO2 60, HCO3 28
,C. pH 7.35, PaCO2 40, HCO3 22
D. pH 7.48, PaCO2 30, HCO3 24
Answer: D
Conceptual Explanation: Early ARDS often presents with respiratory alkalosis (high pH,
low PaCO2) due to hyperventilation as the body attempts to compensate for hypoxemia.
3. A patient is admitted with Diabetic Ketoacidosis (DKA). The nurse notes a potassium level
of 3.2 mEq/L. Which action should the nurse take before starting an intravenous insulin
infusion?
A. Administer the insulin bolus immediately to lower blood glucose.
B. Repeat the lab draw to confirm the result.
C. Notify the provider and ensure potassium replacement is initiated.
D. Start the insulin infusion at a lower rate.
Answer: C
Conceptual Explanation: Insulin shifts potassium into the cells. If a patient is already
hypokalemic, starting insulin will further drop potassium levels, potentially causing life-
threatening arrhythmias.
4. In a patient with Acute Renal Failure, which ECG change is most indicative of
hyperkalemia?
A. ST-segment depression
, B. Tall, peaked T waves
C. Prominent U waves
D. Prolonged QT interval
Answer: B
Conceptual Explanation: Hyperkalemia classically causes tall, peaked T waves, followed
by PR interval prolongation and QRS widening as levels rise.
5. A patient who underwent a thyroidectomy 12 hours ago reports tingling in their fingertips
and around their mouth. What is the priority nursing intervention?
A. Assess the surgical site for bleeding.
B. Administer a sedative to reduce anxiety.
C. Check the patient’s serum calcium level.
D. Encourage the patient to cough and deep breathe.
Answer: C
Conceptual Explanation: Tingling (paresthesia) is a sign of hypocalcemia, which can occur
if the parathyroid glands are accidentally damaged or removed during a thyroidectomy.
6. Which clinical manifestation is a hallmark sign of Cardiogenic Shock that distinguishes it
from Hypovolemic Shock?
A. Increased Pulmonary Artery Wedge Pressure (PAWP)
B. Tachycardia and hypotension
QUESTIONS AND ANSWERS
1. A patient with a traumatic brain injury (TBI) exhibits a blood pressure of 180/60 mmHg, a
pulse of 48 beats/min, and irregular respirations. Which pathophysiology is occurring?
A. Hypovolemic shock resulting from internal hemorrhage
B. Septic shock from a secondary infection
C. Autonomic dysreflexia due to spinal cord stimulation
D. Cushing’s triad indicative of increased intracranial pressure
Answer: D
Conceptual Explanation: Cushing’s triad consists of bradycardia, hypertension with a
widening pulse pressure, and irregular respirations, signaling late-stage increased
intracranial pressure.
2. Which arterial blood gas (ABG) result is most consistent with a patient in early stages of
acute respiratory distress syndrome (ARDS)?
A. pH 7.30, PaCO2 55, HCO3 26
B. pH 7.25, PaCO2 60, HCO3 28
,C. pH 7.35, PaCO2 40, HCO3 22
D. pH 7.48, PaCO2 30, HCO3 24
Answer: D
Conceptual Explanation: Early ARDS often presents with respiratory alkalosis (high pH,
low PaCO2) due to hyperventilation as the body attempts to compensate for hypoxemia.
3. A patient is admitted with Diabetic Ketoacidosis (DKA). The nurse notes a potassium level
of 3.2 mEq/L. Which action should the nurse take before starting an intravenous insulin
infusion?
A. Administer the insulin bolus immediately to lower blood glucose.
B. Repeat the lab draw to confirm the result.
C. Notify the provider and ensure potassium replacement is initiated.
D. Start the insulin infusion at a lower rate.
Answer: C
Conceptual Explanation: Insulin shifts potassium into the cells. If a patient is already
hypokalemic, starting insulin will further drop potassium levels, potentially causing life-
threatening arrhythmias.
4. In a patient with Acute Renal Failure, which ECG change is most indicative of
hyperkalemia?
A. ST-segment depression
, B. Tall, peaked T waves
C. Prominent U waves
D. Prolonged QT interval
Answer: B
Conceptual Explanation: Hyperkalemia classically causes tall, peaked T waves, followed
by PR interval prolongation and QRS widening as levels rise.
5. A patient who underwent a thyroidectomy 12 hours ago reports tingling in their fingertips
and around their mouth. What is the priority nursing intervention?
A. Assess the surgical site for bleeding.
B. Administer a sedative to reduce anxiety.
C. Check the patient’s serum calcium level.
D. Encourage the patient to cough and deep breathe.
Answer: C
Conceptual Explanation: Tingling (paresthesia) is a sign of hypocalcemia, which can occur
if the parathyroid glands are accidentally damaged or removed during a thyroidectomy.
6. Which clinical manifestation is a hallmark sign of Cardiogenic Shock that distinguishes it
from Hypovolemic Shock?
A. Increased Pulmonary Artery Wedge Pressure (PAWP)
B. Tachycardia and hypotension
