MEDICAL SURGICAL NURSING II
EXAM 2 QUESTIONS AND ANSWERS
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. The nurse notes the patient’s SpO2 is 89% and the patient is experiencing
mild dyspnea. What is the most appropriate nursing action?
A. Increase the oxygen flow rate to 4 L/min immediately.
B. Prepare the patient for immediate endotracheal intubation.
C. Maintain the current oxygen rate and continue to monitor the patient.
D. Switch the patient to a non-rebreather mask at 15 L/min.
Answer: C
Conceptual Explanation: In COPD patients, the drive to breathe is often triggered by low
oxygen levels (hypoxic drive). Increasing oxygen too much can suppress this drive. An
SpO2 of 88-92% is often the target range for these patients.
2. The nurse is caring for a patient who had a subtotal thyroidectomy 6 hours ago. The
patient reports numbness and tingling in the fingers and around the mouth. Which action
should the nurse take first?
A. Assess for Chvostek’s sign.
,B. Check the patient’s blood pressure and heart rate.
C. Administer the prescribed PRN analgesic.
D. Encourage the patient to use the incentive spirometer.
Answer: A
Conceptual Explanation: Numbness and tingling are early signs of hypocalcemia, which
can occur if the parathyroid glands are accidentally damaged or removed during thyroid
surgery. Chvostek’s sign helps confirm hypocalcemia.
3. A patient with a history of atrial fibrillation is prescribed warfarin. Which laboratory result
indicates that the medication is within the therapeutic range?
A. International Normalized Ratio (INR) of 2.5.
B. Platelet count of 150,000/mm3.
C. Activated partial thromboplastin time (aPTT) of 60 seconds.
D. Prothrombin time (PT) of 11 seconds.
Answer: A
Conceptual Explanation: For a patient on warfarin for atrial fibrillation, the therapeutic
INR range is typically between 2.0 and 3.0. aPTT is used to monitor heparin.
4. Which assessment finding in a patient with left-sided heart failure requires immediate
intervention by the nurse?
A. Pitting edema in both ankles.
, B. Crackles heard mid-way up the posterior chest wall.
C. Weight gain of 1 lb (0.5 kg) in 24 hours.
D. Patient reporting fatigue after walking to the bathroom.
Answer: B
Conceptual Explanation: Crackles indicate pulmonary edema, a life-threatening
complication of left-sided heart failure where fluid backs up into the lungs, compromising
gas exchange.
5. A patient is admitted with a diagnosis of Cushing’s syndrome. Which clinical manifestation
should the nurse expect to find?
A. Hypotension and tachycardia.
B. Hyperkalemia and weight loss.
C. Trunkal obesity and a ‘buffalo hump’.
D. Increased skin thickness and pallor.
Answer: C
Conceptual Explanation: Cushing’s syndrome results from excessive cortisol, leading to
fat redistribution (moon face, buffalo hump, trunkal obesity), hypertension, and
hyperglycemia.
EXAM 2 QUESTIONS AND ANSWERS
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. The nurse notes the patient’s SpO2 is 89% and the patient is experiencing
mild dyspnea. What is the most appropriate nursing action?
A. Increase the oxygen flow rate to 4 L/min immediately.
B. Prepare the patient for immediate endotracheal intubation.
C. Maintain the current oxygen rate and continue to monitor the patient.
D. Switch the patient to a non-rebreather mask at 15 L/min.
Answer: C
Conceptual Explanation: In COPD patients, the drive to breathe is often triggered by low
oxygen levels (hypoxic drive). Increasing oxygen too much can suppress this drive. An
SpO2 of 88-92% is often the target range for these patients.
2. The nurse is caring for a patient who had a subtotal thyroidectomy 6 hours ago. The
patient reports numbness and tingling in the fingers and around the mouth. Which action
should the nurse take first?
A. Assess for Chvostek’s sign.
,B. Check the patient’s blood pressure and heart rate.
C. Administer the prescribed PRN analgesic.
D. Encourage the patient to use the incentive spirometer.
Answer: A
Conceptual Explanation: Numbness and tingling are early signs of hypocalcemia, which
can occur if the parathyroid glands are accidentally damaged or removed during thyroid
surgery. Chvostek’s sign helps confirm hypocalcemia.
3. A patient with a history of atrial fibrillation is prescribed warfarin. Which laboratory result
indicates that the medication is within the therapeutic range?
A. International Normalized Ratio (INR) of 2.5.
B. Platelet count of 150,000/mm3.
C. Activated partial thromboplastin time (aPTT) of 60 seconds.
D. Prothrombin time (PT) of 11 seconds.
Answer: A
Conceptual Explanation: For a patient on warfarin for atrial fibrillation, the therapeutic
INR range is typically between 2.0 and 3.0. aPTT is used to monitor heparin.
4. Which assessment finding in a patient with left-sided heart failure requires immediate
intervention by the nurse?
A. Pitting edema in both ankles.
, B. Crackles heard mid-way up the posterior chest wall.
C. Weight gain of 1 lb (0.5 kg) in 24 hours.
D. Patient reporting fatigue after walking to the bathroom.
Answer: B
Conceptual Explanation: Crackles indicate pulmonary edema, a life-threatening
complication of left-sided heart failure where fluid backs up into the lungs, compromising
gas exchange.
5. A patient is admitted with a diagnosis of Cushing’s syndrome. Which clinical manifestation
should the nurse expect to find?
A. Hypotension and tachycardia.
B. Hyperkalemia and weight loss.
C. Trunkal obesity and a ‘buffalo hump’.
D. Increased skin thickness and pallor.
Answer: C
Conceptual Explanation: Cushing’s syndrome results from excessive cortisol, leading to
fat redistribution (moon face, buffalo hump, trunkal obesity), hypertension, and
hyperglycemia.
