NUR 242 FINAL EXAM: MED-SURG
NURSING QUESTIONS AND ANSWERS
1. A patient is admitted with a pH of 7.30, a PaCO2 of 52 mmHg, and an HCO3 of 24 mEq/L.
Which acid-base imbalance is the patient experiencing?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Answer: A
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
indicates a respiratory cause. Since the HCO3 is within the normal range (22-26), it is
uncompensated respiratory acidosis.
2. Which clinical manifestation is most characteristic of right-sided heart failure?
A. Crackles in the lungs
B. Orthopnea
C. Jugular venous distention
D. Dyspnea on exertion
,Answer: C
Conceptual Explanation: Right-sided heart failure causes systemic congestion, leading to
jugular venous distention, peripheral edema, and hepatomegaly. The other options are
signs of left-sided heart failure.
3. When caring for a patient with Diabetic Ketoacidosis (DKA), which intervention should the
nurse prioritize first?
A. Administering IV potassium
B. Starting a continuous insulin infusion
C. Administering sodium bicarbonate
D. Infusing 0.9% Normal Saline
Answer: D
Conceptual Explanation: Fluid resuscitation is the first priority in DKA to restore
circulatory volume and perfusion before starting insulin therapy, which can shift water into
cells and worsen hypotension.
4. A patient with a head injury exhibits Cushing’s Triad. Which set of vital signs does the nurse
expect to see?
A. Tachycardia, hypotension, and tachypnea
B. Bradycardia, hypertension with widening pulse pressure, and irregular respirations
C. Bradycardia, hypotension, and Cheyne-Stokes respirations
, D. Tachycardia, hypertension, and Kussmaul respirations
Answer: B
Conceptual Explanation: Cushing’s Triad is a late sign of increased intracranial pressure
characterized by bradycardia, hypertension (specifically widening pulse pressure), and
irregular respirations.
5. Which dietary instruction is essential for a patient with Chronic Kidney Disease (CKD) who
is not yet on dialysis?
A. Increase protein intake to promote tissue repair
B. Consume high amounts of magnesium-rich foods
C. Increase fluid intake to at least 3 liters per day
D. Restrict sodium, potassium, and phosphorus
Answer: D
Conceptual Explanation: In CKD, the kidneys cannot effectively excrete sodium,
potassium, and phosphorus, requiring restriction. Protein is also usually limited to reduce
nitrogenous waste.
6. A nurse is monitoring a patient receiving a blood transfusion. The patient reports chills and
back pain 15 minutes into the infusion. What is the nurse’s first action?
A. Slow the infusion rate and call the provider
B. Administer PRN acetaminophen
NURSING QUESTIONS AND ANSWERS
1. A patient is admitted with a pH of 7.30, a PaCO2 of 52 mmHg, and an HCO3 of 24 mEq/L.
Which acid-base imbalance is the patient experiencing?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Answer: A
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
indicates a respiratory cause. Since the HCO3 is within the normal range (22-26), it is
uncompensated respiratory acidosis.
2. Which clinical manifestation is most characteristic of right-sided heart failure?
A. Crackles in the lungs
B. Orthopnea
C. Jugular venous distention
D. Dyspnea on exertion
,Answer: C
Conceptual Explanation: Right-sided heart failure causes systemic congestion, leading to
jugular venous distention, peripheral edema, and hepatomegaly. The other options are
signs of left-sided heart failure.
3. When caring for a patient with Diabetic Ketoacidosis (DKA), which intervention should the
nurse prioritize first?
A. Administering IV potassium
B. Starting a continuous insulin infusion
C. Administering sodium bicarbonate
D. Infusing 0.9% Normal Saline
Answer: D
Conceptual Explanation: Fluid resuscitation is the first priority in DKA to restore
circulatory volume and perfusion before starting insulin therapy, which can shift water into
cells and worsen hypotension.
4. A patient with a head injury exhibits Cushing’s Triad. Which set of vital signs does the nurse
expect to see?
A. Tachycardia, hypotension, and tachypnea
B. Bradycardia, hypertension with widening pulse pressure, and irregular respirations
C. Bradycardia, hypotension, and Cheyne-Stokes respirations
, D. Tachycardia, hypertension, and Kussmaul respirations
Answer: B
Conceptual Explanation: Cushing’s Triad is a late sign of increased intracranial pressure
characterized by bradycardia, hypertension (specifically widening pulse pressure), and
irregular respirations.
5. Which dietary instruction is essential for a patient with Chronic Kidney Disease (CKD) who
is not yet on dialysis?
A. Increase protein intake to promote tissue repair
B. Consume high amounts of magnesium-rich foods
C. Increase fluid intake to at least 3 liters per day
D. Restrict sodium, potassium, and phosphorus
Answer: D
Conceptual Explanation: In CKD, the kidneys cannot effectively excrete sodium,
potassium, and phosphorus, requiring restriction. Protein is also usually limited to reduce
nitrogenous waste.
6. A nurse is monitoring a patient receiving a blood transfusion. The patient reports chills and
back pain 15 minutes into the infusion. What is the nurse’s first action?
A. Slow the infusion rate and call the provider
B. Administer PRN acetaminophen
