MEDICAL-SURGICAL NURSING EXAM 4
QUESTIONS AND ANSWERS
1. A patient presents with a pH of 7.30, PaCO2 of 52 mmHg, and HCO3 of 24 mEq/L. Which
acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
indicates a respiratory cause, while the normal HCO3 shows no compensation yet.
2. Which clinical manifestation is most characteristic of a patient experiencing left-sided heart
failure?
A. Jugular venous distention
B. Peripheral edema
C. Hepatosplenomegaly
,D. Crackles in the lungs
Answer: D
Conceptual Explanation: Left-sided heart failure leads to pulmonary congestion, causing
respiratory symptoms like crackles and dyspnea. The other options are signs of right-sided
heart failure.
3. A nurse is caring for a patient with a suspected Pulmonary Embolism (PE). Which diagnostic
test is considered the gold standard for confirmation?
A. Chest X-ray
B. D-dimer assay
C. CT Pulmonary Angiography (CTPA)
D. Arterial Blood Gas (ABG)
Answer: C
Conceptual Explanation: While D-dimer is a screening tool, CTPA is the preferred and
most definitive diagnostic imaging for PE in the clinical setting.
4. What is the primary goal of administering a thrombolytic agent to a patient experiencing
an ischemic stroke?
A. To lower blood pressure
B. To prevent further clot formation
C. To dissolve the existing clot and restore blood flow
, D. To reduce cerebral edema
Answer: C
Conceptual Explanation: Thrombolytics like tPA work by dissolving the fibrin in the clot
that is obstructing cerebral blood flow.
5. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen via nasal
cannula. Why is it critical to maintain the flow rate at 2-3 L/min?
A. To prevent oxygen toxicity
B. To avoid CO2 narcosis through hyperventilation
C. To prevent drying of the nasal mucosa
D. To maintain the patient’s hypoxic drive to breathe
Answer: D
Conceptual Explanation: In some COPD patients, the drive to breathe is triggered by low
oxygen levels (hypoxic drive) rather than high CO2. Excess oxygen can suppress this drive.
6. Which laboratory value is the most sensitive indicator of renal function in a patient with
Acute Kidney Injury (AKI)?
A. Blood Urea Nitrogen (BUN)
B. Urine Specific Gravity
C. Serum Creatinine
D. Serum Potassium
QUESTIONS AND ANSWERS
1. A patient presents with a pH of 7.30, PaCO2 of 52 mmHg, and HCO3 of 24 mEq/L. Which
acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
indicates a respiratory cause, while the normal HCO3 shows no compensation yet.
2. Which clinical manifestation is most characteristic of a patient experiencing left-sided heart
failure?
A. Jugular venous distention
B. Peripheral edema
C. Hepatosplenomegaly
,D. Crackles in the lungs
Answer: D
Conceptual Explanation: Left-sided heart failure leads to pulmonary congestion, causing
respiratory symptoms like crackles and dyspnea. The other options are signs of right-sided
heart failure.
3. A nurse is caring for a patient with a suspected Pulmonary Embolism (PE). Which diagnostic
test is considered the gold standard for confirmation?
A. Chest X-ray
B. D-dimer assay
C. CT Pulmonary Angiography (CTPA)
D. Arterial Blood Gas (ABG)
Answer: C
Conceptual Explanation: While D-dimer is a screening tool, CTPA is the preferred and
most definitive diagnostic imaging for PE in the clinical setting.
4. What is the primary goal of administering a thrombolytic agent to a patient experiencing
an ischemic stroke?
A. To lower blood pressure
B. To prevent further clot formation
C. To dissolve the existing clot and restore blood flow
, D. To reduce cerebral edema
Answer: C
Conceptual Explanation: Thrombolytics like tPA work by dissolving the fibrin in the clot
that is obstructing cerebral blood flow.
5. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen via nasal
cannula. Why is it critical to maintain the flow rate at 2-3 L/min?
A. To prevent oxygen toxicity
B. To avoid CO2 narcosis through hyperventilation
C. To prevent drying of the nasal mucosa
D. To maintain the patient’s hypoxic drive to breathe
Answer: D
Conceptual Explanation: In some COPD patients, the drive to breathe is triggered by low
oxygen levels (hypoxic drive) rather than high CO2. Excess oxygen can suppress this drive.
6. Which laboratory value is the most sensitive indicator of renal function in a patient with
Acute Kidney Injury (AKI)?
A. Blood Urea Nitrogen (BUN)
B. Urine Specific Gravity
C. Serum Creatinine
D. Serum Potassium
