NUR242 MEDICAL-SURGICAL NURSING
EXAM STUDY GUIDE 2026/2027
1. A patient is admitted with a suspected diagnosis of Acute Respiratory Distress Syndrome
(ARDS). Which clinical manifestation is considered the hallmark sign of this condition?
A. Respiratory alkalosis on arterial blood gas (ABG)
B. Increased pulmonary artery wedge pressure (PAWP)
C. Presence of a productive cough with pink, frothy sputum
D. Refractory hypoxemia despite high concentrations of oxygen
Answer: D
Conceptual Explanation: Refractory hypoxemia, where the patient’s arterial oxygen
saturation does not improve even with supplemental high-flow oxygen, is the hallmark of
ARDS. Pink frothy sputum is more common in pulmonary edema related to heart failure.
2. Which arterial blood gas (ABG) result is most indicative of a patient in the early stages of a
massive pulmonary embolism?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.32, PaCO2 38, HCO3 18
,C. pH 7.48, PaCO2 30, HCO3 23
D. pH 7.50, PaCO2 40, HCO3 30
Answer: C
Conceptual Explanation: Early pulmonary embolism typically causes tachypnea, which
leads to the blowing off of CO2, resulting in respiratory alkalosis (high pH, low PaCO2).
3. A nurse is caring for a patient with Cushing’s syndrome. Which of the following electrolyte
imbalances should the nurse expect to find?
A. Hypoglycemia and Hyponatremia
B. Hypernatremia and Hypokalemia
C. Hyperkalemia and Hypocalcemia
D. Hypomagnesemia and Hypercalcemia
Answer: B
Conceptual Explanation: Cushing’s syndrome involves excess cortisol, which has
mineralocorticoid effects leading to sodium retention (hypernatremia) and potassium
excretion (hypokalemia).
4. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen therapy.
Why is it critical for the nurse to avoid high concentrations of oxygen in this patient?
A. It causes oxygen toxicity and pulmonary fibrosis
B. It leads to metabolic acidosis due to CO2 retention
, C. It eliminates the hypoxic drive to breathe
D. It increases the risk of pneumothorax
Answer: C
Conceptual Explanation: In chronic CO2 retainers (COPD), the stimulus to breathe shifts
from high CO2 levels to low oxygen levels (hypoxic drive). Providing too much oxygen can
suppress this drive, leading to respiratory arrest.
5. When assessing a patient with right-sided heart failure, which finding is the nurse most
likely to observe?
A. Pulmonary crackles and wheezing
B. Paroxysmal nocturnal dyspnea
C. Jugular venous distention (JVD)
D. Orthopnea and cough
Answer: C
Conceptual Explanation: Right-sided heart failure causes systemic venous congestion,
leading to JVD, peripheral edema, and hepatomegaly. The other options are signs of left-
sided heart failure.
6. Which medication is considered the gold standard for treating an acute asthma attack?
A. Albuterol (Proventil)
B. Salmeterol (Serevent)
EXAM STUDY GUIDE 2026/2027
1. A patient is admitted with a suspected diagnosis of Acute Respiratory Distress Syndrome
(ARDS). Which clinical manifestation is considered the hallmark sign of this condition?
A. Respiratory alkalosis on arterial blood gas (ABG)
B. Increased pulmonary artery wedge pressure (PAWP)
C. Presence of a productive cough with pink, frothy sputum
D. Refractory hypoxemia despite high concentrations of oxygen
Answer: D
Conceptual Explanation: Refractory hypoxemia, where the patient’s arterial oxygen
saturation does not improve even with supplemental high-flow oxygen, is the hallmark of
ARDS. Pink frothy sputum is more common in pulmonary edema related to heart failure.
2. Which arterial blood gas (ABG) result is most indicative of a patient in the early stages of a
massive pulmonary embolism?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.32, PaCO2 38, HCO3 18
,C. pH 7.48, PaCO2 30, HCO3 23
D. pH 7.50, PaCO2 40, HCO3 30
Answer: C
Conceptual Explanation: Early pulmonary embolism typically causes tachypnea, which
leads to the blowing off of CO2, resulting in respiratory alkalosis (high pH, low PaCO2).
3. A nurse is caring for a patient with Cushing’s syndrome. Which of the following electrolyte
imbalances should the nurse expect to find?
A. Hypoglycemia and Hyponatremia
B. Hypernatremia and Hypokalemia
C. Hyperkalemia and Hypocalcemia
D. Hypomagnesemia and Hypercalcemia
Answer: B
Conceptual Explanation: Cushing’s syndrome involves excess cortisol, which has
mineralocorticoid effects leading to sodium retention (hypernatremia) and potassium
excretion (hypokalemia).
4. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen therapy.
Why is it critical for the nurse to avoid high concentrations of oxygen in this patient?
A. It causes oxygen toxicity and pulmonary fibrosis
B. It leads to metabolic acidosis due to CO2 retention
, C. It eliminates the hypoxic drive to breathe
D. It increases the risk of pneumothorax
Answer: C
Conceptual Explanation: In chronic CO2 retainers (COPD), the stimulus to breathe shifts
from high CO2 levels to low oxygen levels (hypoxic drive). Providing too much oxygen can
suppress this drive, leading to respiratory arrest.
5. When assessing a patient with right-sided heart failure, which finding is the nurse most
likely to observe?
A. Pulmonary crackles and wheezing
B. Paroxysmal nocturnal dyspnea
C. Jugular venous distention (JVD)
D. Orthopnea and cough
Answer: C
Conceptual Explanation: Right-sided heart failure causes systemic venous congestion,
leading to JVD, peripheral edema, and hepatomegaly. The other options are signs of left-
sided heart failure.
6. Which medication is considered the gold standard for treating an acute asthma attack?
A. Albuterol (Proventil)
B. Salmeterol (Serevent)
