NUR242 MEDICAL-SURGICAL NURSING
MASTERY EXAM PREP
1. A patient with a T6 spinal cord injury reports a severe, throbbing headache and nasal
congestion. The nurse notes a blood pressure of 188/96 mmHg and bradycardia. What is the
priority nursing action?
A. Administer an antihypertensive medication as ordered
B. Assess the patient for bladder distension or fecal impaction
C. Place the patient in a high-Fowler’s position
D. Notify the healthcare provider immediately
Answer: C
Conceptual Explanation: The patient is exhibiting signs of autonomic dysreflexia. The first
and most immediate intervention is to sit the patient up (high-Fowler’s) to help lower
blood pressure through orthostatic changes before identifying the trigger.
2. A patient taking Digoxin for heart failure reports blurred vision and seeing yellow-green
halos. Which action should the nurse take first?
A. Request a serum digoxin level and electrolyte panel
,B. Obtain an apical pulse for 60 seconds
C. Administer the next dose as scheduled
D. Assess the patient’s respiratory rate
Answer: A
Conceptual Explanation: Visual changes such as yellow-green halos are classic signs of
digoxin toxicity. The nurse must verify serum levels and check for hypokalemia, which
exacerbates toxicity.
3. Which arterial blood gas (ABG) result is most consistent with a patient experiencing an
acute exacerbation of COPD?
A. pH 7.50, PaCO2 45, HCO3 32
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.28, PaCO2 40, HCO3 18
D. pH 7.32, PaCO2 58, HCO3 26
Answer: D
Conceptual Explanation: COPD exacerbations typically lead to respiratory acidosis due to
CO2 retention. pH 7.32 (acidic) and PaCO2 58 (high) indicate respiratory acidosis.
4. A patient is admitted with Diabetic Ketoacidosis (DKA). Which IV fluid should the nurse
expect to administer first?
A. 0.45% Normal Saline
, B. Dextrose 5% in 0.9% Normal Saline
C. 0.9% Normal Saline
D. Dextrose 5% in Water
Answer: C
Conceptual Explanation: In DKA, the initial priority is to restore extracellular fluid
volume and maintain perfusion using an isotonic solution like 0.9% Normal Saline.
5. A patient with Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) differs from a
patient with DKA because the patient with HHNS:
A. Has enough endogenous insulin to prevent ketosis
B. Requires higher doses of insulin to correct hyperglycemia
C. Presents with Kussmaul respirations and fruity breath
D. Exhibits a faster onset of symptoms over a few hours
Answer: A
Conceptual Explanation: HHNS occurs typically in Type 2 diabetics who have enough
insulin to prevent the breakdown of fats into ketones, but not enough to prevent severe
hyperglycemia.
6. The nurse is assessing a patient following a thyroidectomy. Which finding requires
immediate intervention?
A. Pain at the incision site rated 5/10
MASTERY EXAM PREP
1. A patient with a T6 spinal cord injury reports a severe, throbbing headache and nasal
congestion. The nurse notes a blood pressure of 188/96 mmHg and bradycardia. What is the
priority nursing action?
A. Administer an antihypertensive medication as ordered
B. Assess the patient for bladder distension or fecal impaction
C. Place the patient in a high-Fowler’s position
D. Notify the healthcare provider immediately
Answer: C
Conceptual Explanation: The patient is exhibiting signs of autonomic dysreflexia. The first
and most immediate intervention is to sit the patient up (high-Fowler’s) to help lower
blood pressure through orthostatic changes before identifying the trigger.
2. A patient taking Digoxin for heart failure reports blurred vision and seeing yellow-green
halos. Which action should the nurse take first?
A. Request a serum digoxin level and electrolyte panel
,B. Obtain an apical pulse for 60 seconds
C. Administer the next dose as scheduled
D. Assess the patient’s respiratory rate
Answer: A
Conceptual Explanation: Visual changes such as yellow-green halos are classic signs of
digoxin toxicity. The nurse must verify serum levels and check for hypokalemia, which
exacerbates toxicity.
3. Which arterial blood gas (ABG) result is most consistent with a patient experiencing an
acute exacerbation of COPD?
A. pH 7.50, PaCO2 45, HCO3 32
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.28, PaCO2 40, HCO3 18
D. pH 7.32, PaCO2 58, HCO3 26
Answer: D
Conceptual Explanation: COPD exacerbations typically lead to respiratory acidosis due to
CO2 retention. pH 7.32 (acidic) and PaCO2 58 (high) indicate respiratory acidosis.
4. A patient is admitted with Diabetic Ketoacidosis (DKA). Which IV fluid should the nurse
expect to administer first?
A. 0.45% Normal Saline
, B. Dextrose 5% in 0.9% Normal Saline
C. 0.9% Normal Saline
D. Dextrose 5% in Water
Answer: C
Conceptual Explanation: In DKA, the initial priority is to restore extracellular fluid
volume and maintain perfusion using an isotonic solution like 0.9% Normal Saline.
5. A patient with Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) differs from a
patient with DKA because the patient with HHNS:
A. Has enough endogenous insulin to prevent ketosis
B. Requires higher doses of insulin to correct hyperglycemia
C. Presents with Kussmaul respirations and fruity breath
D. Exhibits a faster onset of symptoms over a few hours
Answer: A
Conceptual Explanation: HHNS occurs typically in Type 2 diabetics who have enough
insulin to prevent the breakdown of fats into ketones, but not enough to prevent severe
hyperglycemia.
6. The nurse is assessing a patient following a thyroidectomy. Which finding requires
immediate intervention?
A. Pain at the incision site rated 5/10
