MEDICAL-SURGICAL NURSING
COMPREHENSIVE EXAMINATION
QUESTIONS AND ANSWERS
1. A client presents to the emergency department with a serum potassium level of 6.5 mEq/L.
Which electrocardiogram (ECG) change should the nurse expect to observe?
A. Prominent U waves
B. Tall, peaked T waves
C. Prolonged PR interval
D. ST-segment depression
Answer: B
Conceptual Explanation: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests on
an ECG as tall, peaked T waves, widened QRS complexes, and eventually the loss of P waves.
Prominent U waves are associated with hypokalemia.
2. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via nasal
cannula at 2 L/min. Which finding most concerns the nurse?
A. Respiratory rate of 22 breaths/min
B. Client appears somnolent and difficult to arouse
,C. Oxygen saturation of 89% on pulse oximetry
D. Presence of a productive cough with clear sputum
Answer: B
Conceptual Explanation: In patients with COPD, excessive oxygen administration can
suppress the hypoxic drive, leading to CO2 retention (narcosis). Somnolence and decreased
level of consciousness are signs of respiratory failure and CO2 toxicity.
3. Which clinical manifestation should the nurse prioritize when assessing a patient for a
suspected fat embolism following a femur fracture?
A. Petechiae over the chest and neck
B. Pain level of 8/10 at the fracture site
C. Ecchymosis in the distal extremity
D. Decreased pedal pulses
Answer: A
Conceptual Explanation: While respiratory distress and confusion are early signs, the
presence of petechiae over the chest, neck, and axilla is a classic, distinguishing sign of fat
embolism syndrome, which differentiates it from a pulmonary embolism.
, 4. A client is recovering from a thyroidectomy. The nurse notes the client has developed
tremors and a positive Chvostek’s sign. Which medication should the nurse anticipate
administering?
A. Calcium gluconate
B. Potassium chloride
C. Magnesium sulfate
D. Sodium bicarbonate
Answer: A
Conceptual Explanation: A positive Chvostek’s sign (facial twitching) indicates
hypocalcemia, a potential complication of thyroidectomy if the parathyroid glands are
accidentally damaged or removed. IV calcium gluconate is the standard treatment.
5. When caring for a patient with an arteriovenous (AV) fistula in the left arm for
hemodialysis, which action by the nurse is essential?
A. Measure blood pressure in the left arm every 4 hours
B. Draw routine lab samples from the fistula to ensure accuracy
C. Palpate for a thrill and auscultate for a bruit over the site
D. Keep the left arm in a dependent position to improve flow
Answer: C
COMPREHENSIVE EXAMINATION
QUESTIONS AND ANSWERS
1. A client presents to the emergency department with a serum potassium level of 6.5 mEq/L.
Which electrocardiogram (ECG) change should the nurse expect to observe?
A. Prominent U waves
B. Tall, peaked T waves
C. Prolonged PR interval
D. ST-segment depression
Answer: B
Conceptual Explanation: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests on
an ECG as tall, peaked T waves, widened QRS complexes, and eventually the loss of P waves.
Prominent U waves are associated with hypokalemia.
2. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via nasal
cannula at 2 L/min. Which finding most concerns the nurse?
A. Respiratory rate of 22 breaths/min
B. Client appears somnolent and difficult to arouse
,C. Oxygen saturation of 89% on pulse oximetry
D. Presence of a productive cough with clear sputum
Answer: B
Conceptual Explanation: In patients with COPD, excessive oxygen administration can
suppress the hypoxic drive, leading to CO2 retention (narcosis). Somnolence and decreased
level of consciousness are signs of respiratory failure and CO2 toxicity.
3. Which clinical manifestation should the nurse prioritize when assessing a patient for a
suspected fat embolism following a femur fracture?
A. Petechiae over the chest and neck
B. Pain level of 8/10 at the fracture site
C. Ecchymosis in the distal extremity
D. Decreased pedal pulses
Answer: A
Conceptual Explanation: While respiratory distress and confusion are early signs, the
presence of petechiae over the chest, neck, and axilla is a classic, distinguishing sign of fat
embolism syndrome, which differentiates it from a pulmonary embolism.
, 4. A client is recovering from a thyroidectomy. The nurse notes the client has developed
tremors and a positive Chvostek’s sign. Which medication should the nurse anticipate
administering?
A. Calcium gluconate
B. Potassium chloride
C. Magnesium sulfate
D. Sodium bicarbonate
Answer: A
Conceptual Explanation: A positive Chvostek’s sign (facial twitching) indicates
hypocalcemia, a potential complication of thyroidectomy if the parathyroid glands are
accidentally damaged or removed. IV calcium gluconate is the standard treatment.
5. When caring for a patient with an arteriovenous (AV) fistula in the left arm for
hemodialysis, which action by the nurse is essential?
A. Measure blood pressure in the left arm every 4 hours
B. Draw routine lab samples from the fistula to ensure accuracy
C. Palpate for a thrill and auscultate for a bruit over the site
D. Keep the left arm in a dependent position to improve flow
Answer: C
