GALEN NUR 283 COMP 2 ADVANCED
MEDICAL-SURGICAL NURSING EXAM
1. A patient with Diabetic Ketoacidosis (DKA) is receiving an insulin infusion. The nurse notes
the blood glucose has dropped to 250 mg/dL. Which action should the nurse take next?
A. Discontinue the insulin infusion immediately.
B. Administer a bolus of 50% dextrose.
C. Increase the insulin infusion rate to clear ketones.
D. Change the IV fluid to include 5% dextrose.
Answer: D
Conceptual Explanation: When glucose reaches 250 mg/dL in DKA, dextrose is added to
IV fluids to prevent hypoglycemia and allow continued insulin administration to resolve
ketosis.
2. Which clinical manifestation is a hallmark sign of Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)?
A. Increased serum osmolality
B. Excessive dilute urine output
,C. Severe dehydration and thirst
D. Low serum sodium levels (hyponatremia)
Answer: D
Conceptual Explanation: SIADH involves excessive ADH, leading to water retention,
hemodilution, and dilutional hyponatremia.
3. A patient presents with a blood pressure of 80/40 mmHg, heart rate of 120 bpm, and a
Central Venous Pressure (CVP) of 2 mmHg. Which type of shock is most likely?
A. Cardiogenic shock
B. Septic shock
C. Neurogenic shock
D. Hypovolemic shock
Answer: D
Conceptual Explanation: Low blood pressure, tachycardia, and low CVP (normal 2-8
mmHg) indicate low intravascular volume typical of hypovolemic shock.
4. In a patient with Acute Respiratory Distress Syndrome (ARDS), what is the primary purpose
of using Positive End-Expiratory Pressure (PEEP)?
A. To decrease the fraction of inspired oxygen (FiO2).
B. To increase the respiratory rate.
C. To reduce the risk of barotrauma.
, D. To prevent alveolar collapse at the end of expiration.
Answer: D
Conceptual Explanation: PEEP maintains pressure in the lungs at the end of expiration to
keep alveoli open and improve gas exchange.
5. A nurse is caring for a patient with a T4 spinal cord injury. The patient reports a sudden
pounding headache and has a BP of 190/100 mmHg. What is the priority nursing action?
A. Administer an antihypertensive medication.
B. Place the patient in a supine position.
C. Check the patient for bladder distension.
D. Notify the physician immediately.
Answer: C
Conceptual Explanation: These are signs of Autonomic Dysreflexia. The priority is to
remove the triggering stimulus, most commonly a distended bladder.
6. Which EKG rhythm is characterized by a ‘sawtooth’ appearance of P waves?
A. Atrial Flutter
B. Ventricular Tachycardia
C. Atrial Fibrillation
D. Third-degree AV block
MEDICAL-SURGICAL NURSING EXAM
1. A patient with Diabetic Ketoacidosis (DKA) is receiving an insulin infusion. The nurse notes
the blood glucose has dropped to 250 mg/dL. Which action should the nurse take next?
A. Discontinue the insulin infusion immediately.
B. Administer a bolus of 50% dextrose.
C. Increase the insulin infusion rate to clear ketones.
D. Change the IV fluid to include 5% dextrose.
Answer: D
Conceptual Explanation: When glucose reaches 250 mg/dL in DKA, dextrose is added to
IV fluids to prevent hypoglycemia and allow continued insulin administration to resolve
ketosis.
2. Which clinical manifestation is a hallmark sign of Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)?
A. Increased serum osmolality
B. Excessive dilute urine output
,C. Severe dehydration and thirst
D. Low serum sodium levels (hyponatremia)
Answer: D
Conceptual Explanation: SIADH involves excessive ADH, leading to water retention,
hemodilution, and dilutional hyponatremia.
3. A patient presents with a blood pressure of 80/40 mmHg, heart rate of 120 bpm, and a
Central Venous Pressure (CVP) of 2 mmHg. Which type of shock is most likely?
A. Cardiogenic shock
B. Septic shock
C. Neurogenic shock
D. Hypovolemic shock
Answer: D
Conceptual Explanation: Low blood pressure, tachycardia, and low CVP (normal 2-8
mmHg) indicate low intravascular volume typical of hypovolemic shock.
4. In a patient with Acute Respiratory Distress Syndrome (ARDS), what is the primary purpose
of using Positive End-Expiratory Pressure (PEEP)?
A. To decrease the fraction of inspired oxygen (FiO2).
B. To increase the respiratory rate.
C. To reduce the risk of barotrauma.
, D. To prevent alveolar collapse at the end of expiration.
Answer: D
Conceptual Explanation: PEEP maintains pressure in the lungs at the end of expiration to
keep alveoli open and improve gas exchange.
5. A nurse is caring for a patient with a T4 spinal cord injury. The patient reports a sudden
pounding headache and has a BP of 190/100 mmHg. What is the priority nursing action?
A. Administer an antihypertensive medication.
B. Place the patient in a supine position.
C. Check the patient for bladder distension.
D. Notify the physician immediately.
Answer: C
Conceptual Explanation: These are signs of Autonomic Dysreflexia. The priority is to
remove the triggering stimulus, most commonly a distended bladder.
6. Which EKG rhythm is characterized by a ‘sawtooth’ appearance of P waves?
A. Atrial Flutter
B. Ventricular Tachycardia
C. Atrial Fibrillation
D. Third-degree AV block
