NUR 242 MEDICAL-SURGICAL NURSING
PRACTICE EXAM QUESTIONS AND
ANSWERS
1. A client with chronic obstructive pulmonary disease (COPD) presents with increased
dyspnea and a pulse oximetry reading of 88% on room air. Which acid-base imbalance is this
client most at risk for developing?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Conceptual Explanation: COPD causes chronic airflow obstruction and CO2 retention.
When ventilation is compromised, CO2 levels rise, leading to respiratory acidosis.
2. Which assessment finding should the nurse prioritize in a client who is 4 hours post-
thyroidectomy?
A. Hoarseness when speaking
,B. Pain at the incision site rated 6/10
C. Laryngeal stridor and respiratory distress
D. Nausea and one episode of vomiting
Answer: C
Conceptual Explanation: Laryngeal stridor indicates airway obstruction, possibly due to
edema or hypocalcemia (tetany), and is a life-threatening emergency post-thyroidectomy.
3. A nurse is caring for a client with Addisonian crisis. Which provider order should the nurse
implement first?
A. Administer oral fludrocortisone
B. Teach the client about long-term steroid therapy
C. Obtain a 12-lead ECG
D. Start an IV infusion of 0.9% Normal Saline and Hydrocortisone sodium succinate
Answer: D
Conceptual Explanation: Addisonian crisis is a life-threatening emergency characterized
by hypotension and vascular collapse. IV fluids and rapid steroid replacement are the
priorities.
4. A client is diagnosed with Acute Respiratory Distress Syndrome (ARDS). The nurse
understands that the primary pathophysiology of ARDS involves:
A. Bronchoconstriction caused by histamine release
, B. Decreased pulmonary vascular resistance
C. Excessive surfactant production
D. Increased alveolar-capillary membrane permeability
Answer: D
Conceptual Explanation: ARDS is characterized by damage to the alveolar-capillary
membrane, leading to increased permeability, non-cardiogenic pulmonary edema, and
refractory hypoxemia.
5. The nurse is monitoring a client receiving a blood transfusion. After 15 minutes, the client
reports back pain and chills. What is the priority nursing action?
A. Slow the infusion rate and call the provider
B. Administer diphenhydramine as ordered
C. Check the client’s temperature and blood pressure
D. Stop the transfusion and disconnect the tubing at the hub
Answer: D
Conceptual Explanation: Back pain and chills are signs of a hemolytic reaction. The
transfusion must be stopped immediately, and the line should be disconnected to prevent
further incompatible blood from entering the client.
PRACTICE EXAM QUESTIONS AND
ANSWERS
1. A client with chronic obstructive pulmonary disease (COPD) presents with increased
dyspnea and a pulse oximetry reading of 88% on room air. Which acid-base imbalance is this
client most at risk for developing?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Conceptual Explanation: COPD causes chronic airflow obstruction and CO2 retention.
When ventilation is compromised, CO2 levels rise, leading to respiratory acidosis.
2. Which assessment finding should the nurse prioritize in a client who is 4 hours post-
thyroidectomy?
A. Hoarseness when speaking
,B. Pain at the incision site rated 6/10
C. Laryngeal stridor and respiratory distress
D. Nausea and one episode of vomiting
Answer: C
Conceptual Explanation: Laryngeal stridor indicates airway obstruction, possibly due to
edema or hypocalcemia (tetany), and is a life-threatening emergency post-thyroidectomy.
3. A nurse is caring for a client with Addisonian crisis. Which provider order should the nurse
implement first?
A. Administer oral fludrocortisone
B. Teach the client about long-term steroid therapy
C. Obtain a 12-lead ECG
D. Start an IV infusion of 0.9% Normal Saline and Hydrocortisone sodium succinate
Answer: D
Conceptual Explanation: Addisonian crisis is a life-threatening emergency characterized
by hypotension and vascular collapse. IV fluids and rapid steroid replacement are the
priorities.
4. A client is diagnosed with Acute Respiratory Distress Syndrome (ARDS). The nurse
understands that the primary pathophysiology of ARDS involves:
A. Bronchoconstriction caused by histamine release
, B. Decreased pulmonary vascular resistance
C. Excessive surfactant production
D. Increased alveolar-capillary membrane permeability
Answer: D
Conceptual Explanation: ARDS is characterized by damage to the alveolar-capillary
membrane, leading to increased permeability, non-cardiogenic pulmonary edema, and
refractory hypoxemia.
5. The nurse is monitoring a client receiving a blood transfusion. After 15 minutes, the client
reports back pain and chills. What is the priority nursing action?
A. Slow the infusion rate and call the provider
B. Administer diphenhydramine as ordered
C. Check the client’s temperature and blood pressure
D. Stop the transfusion and disconnect the tubing at the hub
Answer: D
Conceptual Explanation: Back pain and chills are signs of a hemolytic reaction. The
transfusion must be stopped immediately, and the line should be disconnected to prevent
further incompatible blood from entering the client.
