NUR242 MEDICAL-SURGICAL NURSING
COMPREHENSIVE EXAM (LATEST
2026/2027)
1. A client with a head injury exhibits a blood pressure of 190/60 mmHg, a heart rate of 48
beats/min, and an irregular respiratory pattern. Which condition does the nurse suspect?
A. Hypovolemic shock
B. Pulmonary embolism
C. Autonomic dysreflexia
D. Cushing’s triad due to increased intracranial pressure
Answer: D
Conceptual Explanation: Cushing’s triad consists of bradycardia, hypertension with a
widening pulse pressure, and irregular respirations, indicating late-stage increased
intracranial pressure.
2. A patient’s arterial blood gas (ABG) results are: pH 7.28, PaCO2 50 mmHg, and HCO3 24
mEq/L. How should the nurse interpret these findings?
A. Metabolic Acidosis
,B. Respiratory Alkalosis
C. Compensated Metabolic Alkalosis
D. Uncompensated Respiratory Acidosis
Answer: D
Conceptual Explanation: The pH is acidic (<7.35), the PaCO2 is high (>45 mmHg), and the
HCO3 is normal, indicating an uncompensated respiratory origin.
3. During the first 24 hours after a major burn injury, which intravenous fluid is most
commonly used for resuscitation?
A. 0.45% Normal Saline
B. 5% Dextrose in Water
C. Lactated Ringer’s
D. Total Parenteral Nutrition
Answer: C
Conceptual Explanation: Lactated Ringer’s is the fluid of choice for burn resuscitation
because its composition most closely resembles plasma and helps maintain electrolyte
balance.
4. A client with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L. Which
electrocardiogram (ECG) change is the nurse most likely to observe?
A. U waves
, B. Prolonged QT interval
C. ST-segment depression
D. Tall, peaked T waves
Answer: D
Conceptual Explanation: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests as
tall, peaked T waves on an ECG.
5. Which assessment finding is a hallmark sign of a tension pneumothorax?
A. Tracheal deviation toward the affected side
B. Resonance on percussion of the affected side
C. Tracheal deviation to the unaffected side
D. Increased breath sounds on the affected side
Answer: C
Conceptual Explanation: In a tension pneumothorax, air buildup causes a mediastinal
shift, pushing the trachea toward the opposite (unaffected) side.
6. A patient is admitted with suspected Diabetic Ketoacidosis (DKA). Which clinical finding
supports this diagnosis over Hyperglycemic Hyperosmolar State (HHS)?
A. Blood glucose of 650 mg/dL
B. Negative urine ketones
COMPREHENSIVE EXAM (LATEST
2026/2027)
1. A client with a head injury exhibits a blood pressure of 190/60 mmHg, a heart rate of 48
beats/min, and an irregular respiratory pattern. Which condition does the nurse suspect?
A. Hypovolemic shock
B. Pulmonary embolism
C. Autonomic dysreflexia
D. Cushing’s triad due to increased intracranial pressure
Answer: D
Conceptual Explanation: Cushing’s triad consists of bradycardia, hypertension with a
widening pulse pressure, and irregular respirations, indicating late-stage increased
intracranial pressure.
2. A patient’s arterial blood gas (ABG) results are: pH 7.28, PaCO2 50 mmHg, and HCO3 24
mEq/L. How should the nurse interpret these findings?
A. Metabolic Acidosis
,B. Respiratory Alkalosis
C. Compensated Metabolic Alkalosis
D. Uncompensated Respiratory Acidosis
Answer: D
Conceptual Explanation: The pH is acidic (<7.35), the PaCO2 is high (>45 mmHg), and the
HCO3 is normal, indicating an uncompensated respiratory origin.
3. During the first 24 hours after a major burn injury, which intravenous fluid is most
commonly used for resuscitation?
A. 0.45% Normal Saline
B. 5% Dextrose in Water
C. Lactated Ringer’s
D. Total Parenteral Nutrition
Answer: C
Conceptual Explanation: Lactated Ringer’s is the fluid of choice for burn resuscitation
because its composition most closely resembles plasma and helps maintain electrolyte
balance.
4. A client with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L. Which
electrocardiogram (ECG) change is the nurse most likely to observe?
A. U waves
, B. Prolonged QT interval
C. ST-segment depression
D. Tall, peaked T waves
Answer: D
Conceptual Explanation: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests as
tall, peaked T waves on an ECG.
5. Which assessment finding is a hallmark sign of a tension pneumothorax?
A. Tracheal deviation toward the affected side
B. Resonance on percussion of the affected side
C. Tracheal deviation to the unaffected side
D. Increased breath sounds on the affected side
Answer: C
Conceptual Explanation: In a tension pneumothorax, air buildup causes a mediastinal
shift, pushing the trachea toward the opposite (unaffected) side.
6. A patient is admitted with suspected Diabetic Ketoacidosis (DKA). Which clinical finding
supports this diagnosis over Hyperglycemic Hyperosmolar State (HHS)?
A. Blood glucose of 650 mg/dL
B. Negative urine ketones
