MEDICAL SURGICAL NURSING II -
EXAM 2 COMPREHENSIVE PRACTICE
QUESTIONS AND ANSWERS
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical
ventilation with high PEEP. Which assessment finding most urgently indicates a complication
of high PEEP?
A. Respiratory rate of 24 breaths per minute
B. Oxygen saturation increasing from 88% to 92%
C. Audible crackles in the lung bases
D. Blood pressure drop from 120/80 to 90/60 mmHg
Answer: D
Conceptual Explanation: High Positive End-Expiratory Pressure (PEEP) can increase
intrathoracic pressure, leading to decreased venous return and cardiac output, manifested
by hypotension.
2. Which arterial blood gas (ABG) result is most indicative of partially compensated
respiratory acidosis?
A. pH 7.32, PaCO2 50, HCO3 24
,B. pH 7.31, PaCO2 52, HCO3 30
C. pH 7.36, PaCO2 48, HCO3 28
D. pH 7.48, PaCO2 30, HCO3 20
Answer: B
Conceptual Explanation: In partially compensated respiratory acidosis, the pH is still
acidic (<7.35), the PaCO2 is high (>45), and the HCO3 is high (>26) to attempt
compensation.
3. A patient with a spinal cord injury at T4 reports a severe throbbing headache and nasal
congestion. Their BP is 190/110 mmHg. What is the nurse’s priority action?
A. Place the patient in a high-Fowler’s position
B. Administer PRN antihypertensive medication
C. Perform a bladder scan immediately
D. Assess for a fecal impaction
Answer: A
Conceptual Explanation: The symptoms suggest Autonomic Dysreflexia. The first priority
is to sit the patient upright to help lower blood pressure through orthostatic changes
before identifying the cause.
, 4. A patient is admitted with Diabetic Ketoacidosis (DKA). Which laboratory value would the
nurse expect to normalize first with effective treatment?
A. Arterial pH
B. Blood Glucose level
C. Serum Potassium
D. Serum Bicarbonate
Answer: B
Conceptual Explanation: In DKA, blood glucose typically clears much faster than the
metabolic acidosis (bicarbonate and pH) is corrected.
5. A patient has a total body surface area (TBSA) burn of 40% and weighs 70 kg. Using the
Parkland formula (4mL/kg/TBSA), calculate the total fluid for the first 8 hours.
A. 11,200 mL
B. 8,400 mL
C. 2,800 mL
D. 5,600 mL
Answer: D
Conceptual Explanation: Total fluid = 4mL x 70kg x 40 = 11,200 mL for 24 hours. The first
half (5,600 mL) must be given in the first 8 hours.
EXAM 2 COMPREHENSIVE PRACTICE
QUESTIONS AND ANSWERS
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical
ventilation with high PEEP. Which assessment finding most urgently indicates a complication
of high PEEP?
A. Respiratory rate of 24 breaths per minute
B. Oxygen saturation increasing from 88% to 92%
C. Audible crackles in the lung bases
D. Blood pressure drop from 120/80 to 90/60 mmHg
Answer: D
Conceptual Explanation: High Positive End-Expiratory Pressure (PEEP) can increase
intrathoracic pressure, leading to decreased venous return and cardiac output, manifested
by hypotension.
2. Which arterial blood gas (ABG) result is most indicative of partially compensated
respiratory acidosis?
A. pH 7.32, PaCO2 50, HCO3 24
,B. pH 7.31, PaCO2 52, HCO3 30
C. pH 7.36, PaCO2 48, HCO3 28
D. pH 7.48, PaCO2 30, HCO3 20
Answer: B
Conceptual Explanation: In partially compensated respiratory acidosis, the pH is still
acidic (<7.35), the PaCO2 is high (>45), and the HCO3 is high (>26) to attempt
compensation.
3. A patient with a spinal cord injury at T4 reports a severe throbbing headache and nasal
congestion. Their BP is 190/110 mmHg. What is the nurse’s priority action?
A. Place the patient in a high-Fowler’s position
B. Administer PRN antihypertensive medication
C. Perform a bladder scan immediately
D. Assess for a fecal impaction
Answer: A
Conceptual Explanation: The symptoms suggest Autonomic Dysreflexia. The first priority
is to sit the patient upright to help lower blood pressure through orthostatic changes
before identifying the cause.
, 4. A patient is admitted with Diabetic Ketoacidosis (DKA). Which laboratory value would the
nurse expect to normalize first with effective treatment?
A. Arterial pH
B. Blood Glucose level
C. Serum Potassium
D. Serum Bicarbonate
Answer: B
Conceptual Explanation: In DKA, blood glucose typically clears much faster than the
metabolic acidosis (bicarbonate and pH) is corrected.
5. A patient has a total body surface area (TBSA) burn of 40% and weighs 70 kg. Using the
Parkland formula (4mL/kg/TBSA), calculate the total fluid for the first 8 hours.
A. 11,200 mL
B. 8,400 mL
C. 2,800 mL
D. 5,600 mL
Answer: D
Conceptual Explanation: Total fluid = 4mL x 70kg x 40 = 11,200 mL for 24 hours. The first
half (5,600 mL) must be given in the first 8 hours.
