NUR 242 EXAM 3: ADVANCED MED-
SURG NURSING (RESPIRATORY,
RENAL, AND ENDOCRINE) QUESTIONS
AND ANSWERS
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes a sudden drop in SpO2 and absent breath sounds on the right
side. What is the priority nursing action?
A. Notify the provider and prepare for chest tube insertion
B. Increase the FiO2 to 100%
C. Suction the endotracheal tube
D. Obtain an arterial blood gas (ABG) sample
Answer: A
Conceptual Explanation: Absent breath sounds and sudden desaturation in a ventilated
ARDS patient suggest a tension pneumothorax, a common complication of high PEEP.
Immediate decompression is the priority.
,2. Which ABG result is most consistent with a patient experiencing a severe exacerbation of
COPD with CO2 retention?
A. pH 7.48, PaCO2 30, HCO3 22
B. pH 7.32, PaCO2 55, HCO3 28
C. pH 7.30, PaCO2 35, HCO3 18
D. pH 7.50, PaCO2 40, HCO3 32
Answer: B
Conceptual Explanation: COPD exacerbations lead to respiratory acidosis (low pH, high
PaCO2). The elevated HCO3 (28) indicates partial compensation by the kidneys.
3. A patient with Chronic Kidney Disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which medication should the nurse expect to administer first to protect the heart?
A. Sodium polystyrene sulfonate
B. Furosemide
C. Regular insulin and D50
D. Calcium gluconate
Answer: D
Conceptual Explanation: While insulin and sodium polystyrene sulfonate lower
potassium, calcium gluconate is administered first in severe hyperkalemia to stabilize the
myocardial cell membrane and prevent arrhythmias.
, 4. A patient is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
Which laboratory finding should the nurse anticipate?
A. Serum osmolality 310 mOsm/kg
B. Serum sodium 128 mEq/L
C. Urine specific gravity 1.002
D. Hematocrit 55%
Answer: B
Conceptual Explanation: SIADH involves excessive ADH, leading to water retention and
dilutional hyponatremia. Serum sodium will be low, and urine will be highly concentrated.
5. Following a thyroidectomy, a patient develops muscle spasms and a positive Chvostek’s
sign. Which medication does the nurse prepare to administer?
A. Potassium chloride
B. Levothyroxine
C. Magnesium sulfate
D. Calcium gluconate
Answer: D
Conceptual Explanation: These are signs of hypocalcemia, likely due to accidental
removal or damage to the parathyroid glands during surgery.
SURG NURSING (RESPIRATORY,
RENAL, AND ENDOCRINE) QUESTIONS
AND ANSWERS
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes a sudden drop in SpO2 and absent breath sounds on the right
side. What is the priority nursing action?
A. Notify the provider and prepare for chest tube insertion
B. Increase the FiO2 to 100%
C. Suction the endotracheal tube
D. Obtain an arterial blood gas (ABG) sample
Answer: A
Conceptual Explanation: Absent breath sounds and sudden desaturation in a ventilated
ARDS patient suggest a tension pneumothorax, a common complication of high PEEP.
Immediate decompression is the priority.
,2. Which ABG result is most consistent with a patient experiencing a severe exacerbation of
COPD with CO2 retention?
A. pH 7.48, PaCO2 30, HCO3 22
B. pH 7.32, PaCO2 55, HCO3 28
C. pH 7.30, PaCO2 35, HCO3 18
D. pH 7.50, PaCO2 40, HCO3 32
Answer: B
Conceptual Explanation: COPD exacerbations lead to respiratory acidosis (low pH, high
PaCO2). The elevated HCO3 (28) indicates partial compensation by the kidneys.
3. A patient with Chronic Kidney Disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which medication should the nurse expect to administer first to protect the heart?
A. Sodium polystyrene sulfonate
B. Furosemide
C. Regular insulin and D50
D. Calcium gluconate
Answer: D
Conceptual Explanation: While insulin and sodium polystyrene sulfonate lower
potassium, calcium gluconate is administered first in severe hyperkalemia to stabilize the
myocardial cell membrane and prevent arrhythmias.
, 4. A patient is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
Which laboratory finding should the nurse anticipate?
A. Serum osmolality 310 mOsm/kg
B. Serum sodium 128 mEq/L
C. Urine specific gravity 1.002
D. Hematocrit 55%
Answer: B
Conceptual Explanation: SIADH involves excessive ADH, leading to water retention and
dilutional hyponatremia. Serum sodium will be low, and urine will be highly concentrated.
5. Following a thyroidectomy, a patient develops muscle spasms and a positive Chvostek’s
sign. Which medication does the nurse prepare to administer?
A. Potassium chloride
B. Levothyroxine
C. Magnesium sulfate
D. Calcium gluconate
Answer: D
Conceptual Explanation: These are signs of hypocalcemia, likely due to accidental
removal or damage to the parathyroid glands during surgery.
