NUR 209 MEDICAL SURGICAL NURSING
II COMPREHENSIVE FINAL EXAM
QUESTIONS AND ANSWERS
1. A patient is admitted with a suspected pulmonary embolism. Which diagnostic test is
considered the gold standard for definitive diagnosis, despite being invasive?
A. Chest X-ray
B. Pulmonary angiography
C. D-dimer assay
D. Ventilation-perfusion (V/Q) scan
Answer: B
Conceptual Explanation: Pulmonary angiography is the most definitive diagnostic tool for
PE, although CT pulmonary angiography (CTPA) is more commonly used in practice due to
being less invasive.
2. A nurse is caring for a patient in the ICU who has been on a mechanical ventilator for 48
hours. The high-pressure alarm sounds. Which action should the nurse take first?
A. Check for a leak in the cuff
B. Increase the oxygen concentration
,C. Silence the alarm and monitor the patient
D. Assess the patient for the need for suctioning
Answer: D
Conceptual Explanation: High-pressure alarms are triggered by increased resistance,
often caused by secretions, biting the tube, or kinks. Suctioning addresses secretions, a
common cause.
3. Which arterial blood gas (ABG) result would the nurse expect to see in a patient with early-
stage Acute Respiratory Distress Syndrome (ARDS)?
A. pH 7.30, PaCO2 52, HCO3 24
B. pH 7.35, PaCO2 40, HCO3 24
C. pH 7.48, PaCO2 30, HCO3 22
D. pH 7.20, PaCO2 60, HCO3 28
Answer: C
Conceptual Explanation: Early ARDS typically presents with respiratory alkalosis (high
pH, low CO2) due to hyperventilation as the body tries to compensate for hypoxia.
4. A patient with a T6 spinal cord injury reports a sudden, severe headache and is found to
have a blood pressure of 190/100 mmHg. What is the priority nursing intervention?
A. Place the patient in a sitting position
B. Administer PRN antihypertensive medication
, C. Check the patient’s bladder for distension
D. Perform a digital rectal exam
Answer: A
Conceptual Explanation: The patient is showing signs of autonomic dysreflexia. The first
action is to sit the patient upright to lower blood pressure via orthostatic effect before
finding the stimulus.
5. In the hyperdynamic (early) phase of septic shock, which clinical finding is the nurse most
likely to observe?
A. Increased cardiac output
B. Bradycardia
C. Cool, clammy skin
D. Hypoventilation
Answer: A
Conceptual Explanation: Early septic shock (warm phase) is characterized by
vasodilation, warm skin, and an increase in cardiac output despite low systemic vascular
resistance.
II COMPREHENSIVE FINAL EXAM
QUESTIONS AND ANSWERS
1. A patient is admitted with a suspected pulmonary embolism. Which diagnostic test is
considered the gold standard for definitive diagnosis, despite being invasive?
A. Chest X-ray
B. Pulmonary angiography
C. D-dimer assay
D. Ventilation-perfusion (V/Q) scan
Answer: B
Conceptual Explanation: Pulmonary angiography is the most definitive diagnostic tool for
PE, although CT pulmonary angiography (CTPA) is more commonly used in practice due to
being less invasive.
2. A nurse is caring for a patient in the ICU who has been on a mechanical ventilator for 48
hours. The high-pressure alarm sounds. Which action should the nurse take first?
A. Check for a leak in the cuff
B. Increase the oxygen concentration
,C. Silence the alarm and monitor the patient
D. Assess the patient for the need for suctioning
Answer: D
Conceptual Explanation: High-pressure alarms are triggered by increased resistance,
often caused by secretions, biting the tube, or kinks. Suctioning addresses secretions, a
common cause.
3. Which arterial blood gas (ABG) result would the nurse expect to see in a patient with early-
stage Acute Respiratory Distress Syndrome (ARDS)?
A. pH 7.30, PaCO2 52, HCO3 24
B. pH 7.35, PaCO2 40, HCO3 24
C. pH 7.48, PaCO2 30, HCO3 22
D. pH 7.20, PaCO2 60, HCO3 28
Answer: C
Conceptual Explanation: Early ARDS typically presents with respiratory alkalosis (high
pH, low CO2) due to hyperventilation as the body tries to compensate for hypoxia.
4. A patient with a T6 spinal cord injury reports a sudden, severe headache and is found to
have a blood pressure of 190/100 mmHg. What is the priority nursing intervention?
A. Place the patient in a sitting position
B. Administer PRN antihypertensive medication
, C. Check the patient’s bladder for distension
D. Perform a digital rectal exam
Answer: A
Conceptual Explanation: The patient is showing signs of autonomic dysreflexia. The first
action is to sit the patient upright to lower blood pressure via orthostatic effect before
finding the stimulus.
5. In the hyperdynamic (early) phase of septic shock, which clinical finding is the nurse most
likely to observe?
A. Increased cardiac output
B. Bradycardia
C. Cool, clammy skin
D. Hypoventilation
Answer: A
Conceptual Explanation: Early septic shock (warm phase) is characterized by
vasodilation, warm skin, and an increase in cardiac output despite low systemic vascular
resistance.
