NUR 242 MEDICAL-SURGICAL NURSING
FINAL EXAM PREP QUESTIONS AND
ANSWERS
1. A patient’s arterial blood gas (ABG) results are: pH 7.28, PaCO2 55 mmHg, and HCO3 26
mEq/L. Which acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Conceptual Explanation: The pH is below 7.35 (acidosis) and the PaCO2 is above 45
mmHg (respiratory cause). The HCO3 is within the normal range, indicating no
compensation yet.
2. A client with a 40% total body surface area burn weighs 70 kg. Using the Parkland formula
(4mL/kg/%TBSA), how much lactated Ringer’s should be administered in the first 8 hours?
A. 5,600 mL
,B. 2,800 mL
C. 11,200 mL
D. 1,400 mL
Answer: A
Conceptual Explanation: Total fluid = 4mL x 70kg x 40 = 11,200 mL. Half of the total
(5,600 mL) is given in the first 8 hours, and the other half over the remaining 16 hours.
3. A patient with a spinal cord injury at T4 reports a severe headache and nasal congestion.
The blood pressure is 190/100 mmHg. What is the nurse’s priority action?
A. Administer PRN antihypertensives
B. Place the patient in a flat supine position
C. Notify the healthcare provider immediately
D. Assess the patient for bladder distention
Answer: D
Conceptual Explanation: These are signs of autonomic dysreflexia. The priority is to sit
the patient up and then identify and remove the noxious stimulus, most commonly a
distended bladder.
4. Which assessment finding in a patient with Diabetic Ketoacidosis (DKA) requires immediate
intervention?
A. Blood glucose of 350 mg/dL
, B. Potassium level of 2.8 mEq/L
C. Fruity breath odor
D. Kussmaul respirations
Answer: B
Conceptual Explanation: Hypokalemia is life-threatening due to the risk of cardiac
arrhythmias. While other findings are expected in DKA, severe hypokalemia must be
addressed before or during insulin therapy.
5. A client in a leg cast reports increasing pain that is not relieved by morphine. The nurse
notes the toes are pale and have a capillary refill of 5 seconds. What should the nurse
suspect?
A. Compartment syndrome
B. Deep vein thrombosis
C. Osteomyelitis
D. Fat embolism syndrome
Answer: A
Conceptual Explanation: Unrelieved pain and delayed capillary refill are classic signs of
compartment syndrome, a surgical emergency requiring pressure relief.
FINAL EXAM PREP QUESTIONS AND
ANSWERS
1. A patient’s arterial blood gas (ABG) results are: pH 7.28, PaCO2 55 mmHg, and HCO3 26
mEq/L. Which acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Conceptual Explanation: The pH is below 7.35 (acidosis) and the PaCO2 is above 45
mmHg (respiratory cause). The HCO3 is within the normal range, indicating no
compensation yet.
2. A client with a 40% total body surface area burn weighs 70 kg. Using the Parkland formula
(4mL/kg/%TBSA), how much lactated Ringer’s should be administered in the first 8 hours?
A. 5,600 mL
,B. 2,800 mL
C. 11,200 mL
D. 1,400 mL
Answer: A
Conceptual Explanation: Total fluid = 4mL x 70kg x 40 = 11,200 mL. Half of the total
(5,600 mL) is given in the first 8 hours, and the other half over the remaining 16 hours.
3. A patient with a spinal cord injury at T4 reports a severe headache and nasal congestion.
The blood pressure is 190/100 mmHg. What is the nurse’s priority action?
A. Administer PRN antihypertensives
B. Place the patient in a flat supine position
C. Notify the healthcare provider immediately
D. Assess the patient for bladder distention
Answer: D
Conceptual Explanation: These are signs of autonomic dysreflexia. The priority is to sit
the patient up and then identify and remove the noxious stimulus, most commonly a
distended bladder.
4. Which assessment finding in a patient with Diabetic Ketoacidosis (DKA) requires immediate
intervention?
A. Blood glucose of 350 mg/dL
, B. Potassium level of 2.8 mEq/L
C. Fruity breath odor
D. Kussmaul respirations
Answer: B
Conceptual Explanation: Hypokalemia is life-threatening due to the risk of cardiac
arrhythmias. While other findings are expected in DKA, severe hypokalemia must be
addressed before or during insulin therapy.
5. A client in a leg cast reports increasing pain that is not relieved by morphine. The nurse
notes the toes are pale and have a capillary refill of 5 seconds. What should the nurse
suspect?
A. Compartment syndrome
B. Deep vein thrombosis
C. Osteomyelitis
D. Fat embolism syndrome
Answer: A
Conceptual Explanation: Unrelieved pain and delayed capillary refill are classic signs of
compartment syndrome, a surgical emergency requiring pressure relief.
