BSN Advanced Medical-Surgical Nursing Final Exam
Practice Questions 2026 UPDATED ACTUAL Questions and
CORRECT Answers
1. A client presents with a pH of 7.28, PaCO2 of 50 mmHg, and HCO3 of 24
mEq/L. Which acid-base imbalance does this represent?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: A pH below 7.35 indicates acidosis. The elevated PaCO2 indicates a respiratory
cause, while the normal bicarbonate indicates no compensation has occurred yet.
2. A nurse is assessing a client taking Digoxin. Which finding would most likely
indicate Digoxin toxicity?
A. Hypertension
B. Increased appetite
C. Visual disturbances such as yellow halos
D. Tachycardia
Answer: C
Rationale: Common signs of digoxin toxicity include gastrointestinal upset
(nausea/vomiting) and visual changes like blurred vision or yellow-green halos.
,3. Which clinical manifestation is part of Cushing’s Triad, indicating increased
intracranial pressure?
A. Tachycardia
B. Hypotension
C. Narrowed pulse pressure
D. Bradycardia
Answer: D
Rationale: Cushing’s Triad consists of bradycardia, hypertension with a widening pulse
pressure, and irregular respirations.
4. Which cardiac biomarker is most specific for diagnosing a myocardial
infarction?
A. CK-MB
B. Myoglobin
C. C-reactive protein
D. Troponin I
Answer: D
Rationale: Troponin I is highly specific to cardiac muscle and remains elevated for several
days after an MI, making it the gold standard for diagnosis.
5. In the early compensatory stage of hypovolemic shock, what is a primary
clinical finding?
A. Hypotension
B. Cold, cyanotic skin
C. Tachycardia
D. Anuria
Answer: C
Rationale: During early shock, the body compensates by increasing the heart rate
(tachycardia) and vasoconstriction to maintain cardiac output and blood pressure.
, 6. What is the primary purpose of Positive End-Expiratory Pressure (PEEP) in a
patient with ARDS?
A. To decrease the risk of barotrauma
B. To prevent alveolar collapse at the end of expiration
C. To increase the fraction of inspired oxygen
D. To drain secretions from the lower lobes
Answer: B
Rationale: PEEP provides pressure at the end of expiration to keep alveoli open, improving
gas exchange and oxygenation in ARDS patients.
7. Which respiratory pattern is typically observed in a patient with Diabetic
Ketoacidosis (DKA)?
A. Kussmaul respirations
B. Biot’s respirations
C. Cheyne-Stokes
D. Apneustic breathing
Answer: A
Rationale: Kussmaul respirations are deep, rapid breaths that the body uses to blow off
excess CO2 to compensate for metabolic acidosis in DKA.
8. A client with SIADH is likely to exhibit which of the following laboratory
results?
A. Serum sodium of 150 mEq/L
B. Serum osmolality of 310 mOsm/kg
C. Serum sodium of 125 mEq/L
D. Urine specific gravity of 1.001
Answer: C
Rationale: SIADH causes excessive water retention, leading to dilutional hyponatremia
(low serum sodium) and concentrated urine.
Practice Questions 2026 UPDATED ACTUAL Questions and
CORRECT Answers
1. A client presents with a pH of 7.28, PaCO2 of 50 mmHg, and HCO3 of 24
mEq/L. Which acid-base imbalance does this represent?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: A pH below 7.35 indicates acidosis. The elevated PaCO2 indicates a respiratory
cause, while the normal bicarbonate indicates no compensation has occurred yet.
2. A nurse is assessing a client taking Digoxin. Which finding would most likely
indicate Digoxin toxicity?
A. Hypertension
B. Increased appetite
C. Visual disturbances such as yellow halos
D. Tachycardia
Answer: C
Rationale: Common signs of digoxin toxicity include gastrointestinal upset
(nausea/vomiting) and visual changes like blurred vision or yellow-green halos.
,3. Which clinical manifestation is part of Cushing’s Triad, indicating increased
intracranial pressure?
A. Tachycardia
B. Hypotension
C. Narrowed pulse pressure
D. Bradycardia
Answer: D
Rationale: Cushing’s Triad consists of bradycardia, hypertension with a widening pulse
pressure, and irregular respirations.
4. Which cardiac biomarker is most specific for diagnosing a myocardial
infarction?
A. CK-MB
B. Myoglobin
C. C-reactive protein
D. Troponin I
Answer: D
Rationale: Troponin I is highly specific to cardiac muscle and remains elevated for several
days after an MI, making it the gold standard for diagnosis.
5. In the early compensatory stage of hypovolemic shock, what is a primary
clinical finding?
A. Hypotension
B. Cold, cyanotic skin
C. Tachycardia
D. Anuria
Answer: C
Rationale: During early shock, the body compensates by increasing the heart rate
(tachycardia) and vasoconstriction to maintain cardiac output and blood pressure.
, 6. What is the primary purpose of Positive End-Expiratory Pressure (PEEP) in a
patient with ARDS?
A. To decrease the risk of barotrauma
B. To prevent alveolar collapse at the end of expiration
C. To increase the fraction of inspired oxygen
D. To drain secretions from the lower lobes
Answer: B
Rationale: PEEP provides pressure at the end of expiration to keep alveoli open, improving
gas exchange and oxygenation in ARDS patients.
7. Which respiratory pattern is typically observed in a patient with Diabetic
Ketoacidosis (DKA)?
A. Kussmaul respirations
B. Biot’s respirations
C. Cheyne-Stokes
D. Apneustic breathing
Answer: A
Rationale: Kussmaul respirations are deep, rapid breaths that the body uses to blow off
excess CO2 to compensate for metabolic acidosis in DKA.
8. A client with SIADH is likely to exhibit which of the following laboratory
results?
A. Serum sodium of 150 mEq/L
B. Serum osmolality of 310 mOsm/kg
C. Serum sodium of 125 mEq/L
D. Urine specific gravity of 1.001
Answer: C
Rationale: SIADH causes excessive water retention, leading to dilutional hyponatremia
(low serum sodium) and concentrated urine.
