NUR 209 MEDICAL SURGICAL NURSING
II EXAM 2 COMPREHENSIVE
PRACTICE QUESTIONS AND ANSWERS
1. A client with type 1 diabetes is admitted with Kussmaul respirations and a fruity breath
odor. Which arterial blood gas (ABG) result should the nurse anticipate?
A. pH 7.50, HCO3 28 mEq/L
B. pH 7.30, HCO3 16 mEq/L
C. pH 7.32, PaCO2 52 mmHg
D. pH 7.48, PaCO2 30 mmHg
Answer: B
Conceptual Explanation: Deep, rapid respirations (Kussmaul) and fruity breath are classic
signs of Diabetic Ketoacidosis (DKA), which presents as metabolic acidosis (low pH and low
bicarbonate).
2. The nurse is caring for a client with Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which laboratory finding requires immediate intervention?
A. Serum sodium 122 mEq/L
B. Hematocrit 38%
,C. Urine specific gravity 1.030
D. Serum osmolality 275 mOsm/kg
Answer: A
Conceptual Explanation: SIADH causes excessive water retention leading to dilutional
hyponatremia. A sodium level of 122 mEq/L is critically low and increases the risk of
seizures and cerebral edema.
3. A client is diagnosed with Myxedema Coma. Which nursing intervention is the highest
priority?
A. Maintaining a patent airway
B. Administering IV levothyroxine
C. Providing warm blankets for hypothermia
D. Monitoring hourly urine output
Answer: A
Conceptual Explanation: Myxedema coma is a life-threatening form of hypothyroidism.
Airway management is the top priority (ABC) due to potential respiratory failure and
macroglossia.
4. Which clinical manifestation should the nurse expect to find in a client experiencing a
Thyroid Storm?
A. Bradycardia and constipation
, B. Hypotension and hypothermia
C. Hyperpyrexia and extreme tachycardia
D. Lethargy and weight gain
Answer: C
Conceptual Explanation: Thyroid storm is a severe hypermetabolic state characterized by
high fever (hyperpyrexia), tachycardia, hypertension, and tremors.
5. A client with Pheochromocytoma is admitted. Which assessment should the nurse avoid to
prevent a hypertensive crisis?
A. Checking blood pressure every 15 minutes
B. Auscultating bowel sounds
C. Palpating the abdomen
D. Obtaining a 24-hour urine collection
Answer: C
Conceptual Explanation: In pheochromocytoma, abdominal palpation can trigger the
sudden release of catecholamines from the tumor, leading to severe hypertension.
6. A nurse is providing discharge teaching for a client with Addison’s disease. Which
instruction is most critical?
A. Carry an emergency kit with injectable hydrocortisone
B. Limit fluid intake to 1 liter per day
II EXAM 2 COMPREHENSIVE
PRACTICE QUESTIONS AND ANSWERS
1. A client with type 1 diabetes is admitted with Kussmaul respirations and a fruity breath
odor. Which arterial blood gas (ABG) result should the nurse anticipate?
A. pH 7.50, HCO3 28 mEq/L
B. pH 7.30, HCO3 16 mEq/L
C. pH 7.32, PaCO2 52 mmHg
D. pH 7.48, PaCO2 30 mmHg
Answer: B
Conceptual Explanation: Deep, rapid respirations (Kussmaul) and fruity breath are classic
signs of Diabetic Ketoacidosis (DKA), which presents as metabolic acidosis (low pH and low
bicarbonate).
2. The nurse is caring for a client with Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which laboratory finding requires immediate intervention?
A. Serum sodium 122 mEq/L
B. Hematocrit 38%
,C. Urine specific gravity 1.030
D. Serum osmolality 275 mOsm/kg
Answer: A
Conceptual Explanation: SIADH causes excessive water retention leading to dilutional
hyponatremia. A sodium level of 122 mEq/L is critically low and increases the risk of
seizures and cerebral edema.
3. A client is diagnosed with Myxedema Coma. Which nursing intervention is the highest
priority?
A. Maintaining a patent airway
B. Administering IV levothyroxine
C. Providing warm blankets for hypothermia
D. Monitoring hourly urine output
Answer: A
Conceptual Explanation: Myxedema coma is a life-threatening form of hypothyroidism.
Airway management is the top priority (ABC) due to potential respiratory failure and
macroglossia.
4. Which clinical manifestation should the nurse expect to find in a client experiencing a
Thyroid Storm?
A. Bradycardia and constipation
, B. Hypotension and hypothermia
C. Hyperpyrexia and extreme tachycardia
D. Lethargy and weight gain
Answer: C
Conceptual Explanation: Thyroid storm is a severe hypermetabolic state characterized by
high fever (hyperpyrexia), tachycardia, hypertension, and tremors.
5. A client with Pheochromocytoma is admitted. Which assessment should the nurse avoid to
prevent a hypertensive crisis?
A. Checking blood pressure every 15 minutes
B. Auscultating bowel sounds
C. Palpating the abdomen
D. Obtaining a 24-hour urine collection
Answer: C
Conceptual Explanation: In pheochromocytoma, abdominal palpation can trigger the
sudden release of catecholamines from the tumor, leading to severe hypertension.
6. A nurse is providing discharge teaching for a client with Addison’s disease. Which
instruction is most critical?
A. Carry an emergency kit with injectable hydrocortisone
B. Limit fluid intake to 1 liter per day
