NUR 242 EXAM 3 (2027) - MED-SURG
NURSING QUESTIONS AND ANSWERS
1. A patient with chronic obstructive pulmonary disease (COPD) presents with a pH of 7.30,
PaCO2 of 58 mmHg, and HCO3 of 30 mEq/L. Which acid-base imbalance is occurring?
A. Partially compensated metabolic alkalosis
B. Uncompensated metabolic acidosis
C. Fully compensated respiratory acidosis
D. Partially compensated respiratory acidosis
Answer: D
Conceptual Explanation: The pH is acidic (below 7.35), the PaCO2 is high (respiratory
component), and the HCO3 is elevated as the kidneys attempt to compensate, but since the
pH is not within normal range, it is partially compensated.
2. When assessing a patient with a chest tube, the nurse notes continuous bubbling in the
water-seal chamber. What is the priority action?
A. Check the system for an air leak
B. Document the finding as normal
C. Increase the suction to 40 cm H2O
,D. Clamp the chest tube near the insertion site
Answer: A
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak in the drainage system or from the patient. Intermittent bubbling during expiration is
normal in a patient with a pneumothorax.
3. Which oxygen delivery device should the nurse use for a patient with COPD who requires a
specific, precise concentration of oxygen?
C. Simple face mask
A. Nasal cannula
B. Venturi mask
D. Non-rebreather mask
Answer: B
Conceptual Explanation: The Venturi mask is the most accurate device for delivering
precise oxygen concentrations, which is critical for COPD patients to avoid suppressing
their hypoxic drive.
4. A patient in the early stages of Acute Respiratory Distress Syndrome (ARDS) is experiencing
refractory hypoxemia. Which position is most beneficial?
A. High-Fowler’s position
B. Supine position
, C. Prone position
D. Semi-Fowler’s position
Answer: C
Conceptual Explanation: Prone positioning improves oxygenation in ARDS by recruiting
collapsed alveoli in the posterior lung segments and improving ventilation-perfusion
matching.
5. A patient is suspected of having a Pulmonary Embolism (PE). Which diagnostic test is
considered the ‘gold standard’ for confirmation?
A. Arterial Blood Gas (ABG)
B. Chest X-ray
C. D-dimer assay
D. Computed Tomographic Pulmonary Angiography (CTPA)
Answer: D
Conceptual Explanation: CTPA is the most commonly used and definitive diagnostic tool
for PE. D-dimer is a screening tool but not confirmatory.
6. What is the priority nursing action when a ventilator’s high-pressure alarm sounds?
A. Assess for a kink in the tubing or the patient biting the tube
B. Check for a disconnection in the circuit
C. Silence the alarm and wait for the respiratory therapist
NURSING QUESTIONS AND ANSWERS
1. A patient with chronic obstructive pulmonary disease (COPD) presents with a pH of 7.30,
PaCO2 of 58 mmHg, and HCO3 of 30 mEq/L. Which acid-base imbalance is occurring?
A. Partially compensated metabolic alkalosis
B. Uncompensated metabolic acidosis
C. Fully compensated respiratory acidosis
D. Partially compensated respiratory acidosis
Answer: D
Conceptual Explanation: The pH is acidic (below 7.35), the PaCO2 is high (respiratory
component), and the HCO3 is elevated as the kidneys attempt to compensate, but since the
pH is not within normal range, it is partially compensated.
2. When assessing a patient with a chest tube, the nurse notes continuous bubbling in the
water-seal chamber. What is the priority action?
A. Check the system for an air leak
B. Document the finding as normal
C. Increase the suction to 40 cm H2O
,D. Clamp the chest tube near the insertion site
Answer: A
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak in the drainage system or from the patient. Intermittent bubbling during expiration is
normal in a patient with a pneumothorax.
3. Which oxygen delivery device should the nurse use for a patient with COPD who requires a
specific, precise concentration of oxygen?
C. Simple face mask
A. Nasal cannula
B. Venturi mask
D. Non-rebreather mask
Answer: B
Conceptual Explanation: The Venturi mask is the most accurate device for delivering
precise oxygen concentrations, which is critical for COPD patients to avoid suppressing
their hypoxic drive.
4. A patient in the early stages of Acute Respiratory Distress Syndrome (ARDS) is experiencing
refractory hypoxemia. Which position is most beneficial?
A. High-Fowler’s position
B. Supine position
, C. Prone position
D. Semi-Fowler’s position
Answer: C
Conceptual Explanation: Prone positioning improves oxygenation in ARDS by recruiting
collapsed alveoli in the posterior lung segments and improving ventilation-perfusion
matching.
5. A patient is suspected of having a Pulmonary Embolism (PE). Which diagnostic test is
considered the ‘gold standard’ for confirmation?
A. Arterial Blood Gas (ABG)
B. Chest X-ray
C. D-dimer assay
D. Computed Tomographic Pulmonary Angiography (CTPA)
Answer: D
Conceptual Explanation: CTPA is the most commonly used and definitive diagnostic tool
for PE. D-dimer is a screening tool but not confirmatory.
6. What is the priority nursing action when a ventilator’s high-pressure alarm sounds?
A. Assess for a kink in the tubing or the patient biting the tube
B. Check for a disconnection in the circuit
C. Silence the alarm and wait for the respiratory therapist
