NUR 209 MEDICAL-SURGICAL NURSING
2 - ADVANCED PRACTICE QUESTIONS
AND ANSWERS
1. A patient with Diabetic Ketoacidosis (DKA) has a serum glucose of 600 mg/dL and a pH of
7.20. Which intravenous fluid transition is most appropriate when the glucose reaches 250
mg/dL?
A. Add 5% Dextrose to the current IV solution
B. Switch to 0.45% Normal Saline only
C. Stop the insulin infusion immediately
D. Bolus 10 units of Regular Insulin
Answer: A
Conceptual Explanation: When blood glucose reaches 250 mg/dL in DKA management,
dextrose is added to the IV fluids to prevent hypoglycemia and cerebral edema while the
insulin infusion continues to resolve the acidosis.
,2. Which arterial blood gas (ABG) result is most indicative of a patient in the early stages of
Acute Respiratory Distress Syndrome (ARDS)?
A. pH 7.35, PaO2 95, PaCO2 40
B. pH 7.25, PaO2 80, PaCO2 60
C. pH 7.30, PaO2 55, PaCO2 55
D. pH 7.48, PaO2 62, PaCO2 30
Answer: D
Conceptual Explanation: Early ARDS often presents with respiratory alkalosis (high pH,
low PaCO2) due to hyperventilation in response to initial hypoxemia.
3. A patient with a traumatic brain injury (TBI) exhibits Cushing’s Triad. Which of the
following sets of vital signs is consistent with this finding?
A. BP 200/110, HR 110, Cheyne-Stokes respirations
B. BP 90/60, HR 120, rapid respirations
C. BP 120/80, HR 80, regular respirations
D. BP 160/60, HR 50, irregular respirations
Answer: D
Conceptual Explanation: Cushing’s Triad consists of widened pulse pressure (increased
systolic BP), bradycardia, and irregular/decreased respirations, indicating late-stage
increased intracranial pressure.
, 4. A patient with Chronic Kidney Disease (CKD) has a potassium level of 6.8 mEq/L and EKG
changes. Which medication is the priority to stabilize the cardiac membrane?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Regular Insulin and Dextrose
C. Calcium Gluconate
D. Sodium Bicarbonate
Answer: C
Conceptual Explanation: Calcium Gluconate does not lower potassium, but it is the
priority because it antagonizes the effect of hyperkalemia on the myocardium, preventing
lethal arrhythmias.
5. In the management of Septic Shock, which hemodynamic parameter is the primary target
for fluid resuscitation according to the Surviving Sepsis Campaign?
A. Heart Rate < 100 bpm
B. Mean Arterial Pressure (MAP) > 65 mmHg
C. Central Venous Pressure (CVP) of 2 mmHg
D. Systolic Blood Pressure > 120 mmHg
Answer: B
Conceptual Explanation: The primary goal for initial fluid resuscitation in septic shock is
maintaining a MAP of at least 65 mmHg to ensure adequate organ perfusion.
2 - ADVANCED PRACTICE QUESTIONS
AND ANSWERS
1. A patient with Diabetic Ketoacidosis (DKA) has a serum glucose of 600 mg/dL and a pH of
7.20. Which intravenous fluid transition is most appropriate when the glucose reaches 250
mg/dL?
A. Add 5% Dextrose to the current IV solution
B. Switch to 0.45% Normal Saline only
C. Stop the insulin infusion immediately
D. Bolus 10 units of Regular Insulin
Answer: A
Conceptual Explanation: When blood glucose reaches 250 mg/dL in DKA management,
dextrose is added to the IV fluids to prevent hypoglycemia and cerebral edema while the
insulin infusion continues to resolve the acidosis.
,2. Which arterial blood gas (ABG) result is most indicative of a patient in the early stages of
Acute Respiratory Distress Syndrome (ARDS)?
A. pH 7.35, PaO2 95, PaCO2 40
B. pH 7.25, PaO2 80, PaCO2 60
C. pH 7.30, PaO2 55, PaCO2 55
D. pH 7.48, PaO2 62, PaCO2 30
Answer: D
Conceptual Explanation: Early ARDS often presents with respiratory alkalosis (high pH,
low PaCO2) due to hyperventilation in response to initial hypoxemia.
3. A patient with a traumatic brain injury (TBI) exhibits Cushing’s Triad. Which of the
following sets of vital signs is consistent with this finding?
A. BP 200/110, HR 110, Cheyne-Stokes respirations
B. BP 90/60, HR 120, rapid respirations
C. BP 120/80, HR 80, regular respirations
D. BP 160/60, HR 50, irregular respirations
Answer: D
Conceptual Explanation: Cushing’s Triad consists of widened pulse pressure (increased
systolic BP), bradycardia, and irregular/decreased respirations, indicating late-stage
increased intracranial pressure.
, 4. A patient with Chronic Kidney Disease (CKD) has a potassium level of 6.8 mEq/L and EKG
changes. Which medication is the priority to stabilize the cardiac membrane?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Regular Insulin and Dextrose
C. Calcium Gluconate
D. Sodium Bicarbonate
Answer: C
Conceptual Explanation: Calcium Gluconate does not lower potassium, but it is the
priority because it antagonizes the effect of hyperkalemia on the myocardium, preventing
lethal arrhythmias.
5. In the management of Septic Shock, which hemodynamic parameter is the primary target
for fluid resuscitation according to the Surviving Sepsis Campaign?
A. Heart Rate < 100 bpm
B. Mean Arterial Pressure (MAP) > 65 mmHg
C. Central Venous Pressure (CVP) of 2 mmHg
D. Systolic Blood Pressure > 120 mmHg
Answer: B
Conceptual Explanation: The primary goal for initial fluid resuscitation in septic shock is
maintaining a MAP of at least 65 mmHg to ensure adequate organ perfusion.
