NUR 242 MEDICAL-SURGICAL NURSING
EXAM PREP QUESTIONS AND
ANSWERS
1. A nurse is caring for a patient who has a chest tube following a lobectomy. The nurse notes
that the water seal chamber is fluctuating with the patient’s respirations. Which action
should the nurse take first?
A. Check for a leak in the system.
B. Document the finding as a normal occurrence.
C. Notify the healthcare provider immediately.
D. Milk the tubing to clear any potential clots.
Answer: B
Conceptual Explanation: Fluctuation in the water seal chamber (tidaling) is a normal
finding and indicates that the system is patent and responding to intrapleural pressure
changes.
,2. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which of the following orders should the nurse prioritize?
A. Administering sodium polystyrene sulfonate orally.
B. Preparing the patient for emergency hemodialysis.
C. Initiating a continuous infusion of regular insulin and dextrose.
D. Instructing the patient on a low-potassium diet.
Answer: C
Conceptual Explanation: Hyperkalemia above 6.5 mEq/L is a medical emergency. Insulin
drives potassium into the cells, and dextrose prevents hypoglycemia, providing the fastest
temporary reduction in serum potassium levels.
3. Which clinical manifestation is most characteristic of a patient experiencing an Addisonian
crisis?
A. Weight gain and moon face.
B. Hypertension and bradycardia.
C. Hyperglycemia and peripheral edema.
D. Severe hypotension and tachycardia.
Answer: D
, Conceptual Explanation: An Addisonian crisis is a life-threatening deficiency of
glucocorticoids and mineralocorticoids, leading to profound hypotension, vascular collapse,
and shock.
4. A nurse is assessing a patient with a suspected tension pneumothorax. Which finding
requires the most immediate intervention?
A. Muffled heart sounds and jugular vein distention.
B. Crepitus felt upon palpation of the chest wall.
C. Tracheal deviation toward the unaffected side.
D. Decreased breath sounds on the affected side.
Answer: C
Conceptual Explanation: Tracheal deviation is a late and critical sign of tension
pneumothorax, indicating severe mediastinal shift that can lead to obstructive shock.
5. A patient is admitted with Acute Pancreatitis. Which laboratory value should the nurse
expect to be significantly elevated?
A. Serum Calcium
B. Serum Amylase
C. Serum Albumin
D. Hemoglobin
Answer: B
EXAM PREP QUESTIONS AND
ANSWERS
1. A nurse is caring for a patient who has a chest tube following a lobectomy. The nurse notes
that the water seal chamber is fluctuating with the patient’s respirations. Which action
should the nurse take first?
A. Check for a leak in the system.
B. Document the finding as a normal occurrence.
C. Notify the healthcare provider immediately.
D. Milk the tubing to clear any potential clots.
Answer: B
Conceptual Explanation: Fluctuation in the water seal chamber (tidaling) is a normal
finding and indicates that the system is patent and responding to intrapleural pressure
changes.
,2. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which of the following orders should the nurse prioritize?
A. Administering sodium polystyrene sulfonate orally.
B. Preparing the patient for emergency hemodialysis.
C. Initiating a continuous infusion of regular insulin and dextrose.
D. Instructing the patient on a low-potassium diet.
Answer: C
Conceptual Explanation: Hyperkalemia above 6.5 mEq/L is a medical emergency. Insulin
drives potassium into the cells, and dextrose prevents hypoglycemia, providing the fastest
temporary reduction in serum potassium levels.
3. Which clinical manifestation is most characteristic of a patient experiencing an Addisonian
crisis?
A. Weight gain and moon face.
B. Hypertension and bradycardia.
C. Hyperglycemia and peripheral edema.
D. Severe hypotension and tachycardia.
Answer: D
, Conceptual Explanation: An Addisonian crisis is a life-threatening deficiency of
glucocorticoids and mineralocorticoids, leading to profound hypotension, vascular collapse,
and shock.
4. A nurse is assessing a patient with a suspected tension pneumothorax. Which finding
requires the most immediate intervention?
A. Muffled heart sounds and jugular vein distention.
B. Crepitus felt upon palpation of the chest wall.
C. Tracheal deviation toward the unaffected side.
D. Decreased breath sounds on the affected side.
Answer: C
Conceptual Explanation: Tracheal deviation is a late and critical sign of tension
pneumothorax, indicating severe mediastinal shift that can lead to obstructive shock.
5. A patient is admitted with Acute Pancreatitis. Which laboratory value should the nurse
expect to be significantly elevated?
A. Serum Calcium
B. Serum Amylase
C. Serum Albumin
D. Hemoglobin
Answer: B
