NUR 242 PRACTICE EXAM 2 -
ADVANCED MEDICAL-SURGICAL
NURSING QUESTIONS & VERIFIED
ANSWERS | GALEN COLLEGE (A+
GUARANTEE)
1. A client is admitted with Acute Respiratory Distress Syndrome (ARDS). Which
pathophysiological change is most characteristic of the exudative phase of ARDS?
A. Formation of hyaline membranes and interstitial edema
B. Proliferation of Type II pneumocytes and fibroblast infiltration
C. Destruction of the alveolar-capillary membrane by collagen
D. Resolution of pulmonary edema and restoration of surfactant
Answer: A
Conceptual Explanation: In the exudative phase (24-48 hours), inflammatory mediators
cause damage to the alveolar-capillary membrane, leading to fluid shifts into the alveoli
and the formation of hyaline membranes, which severely impair gas exchange.
2. A patient with Chronic Kidney Disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which cardiac monitor finding should the nurse prioritize as the most immediate threat?
A. Peaked T waves and widened QRS complex
,B. ST-segment depression
C. Prominent U waves
D. Prolonged PR interval only
Answer: A
Conceptual Explanation: Hyperkalemia (K > 5.0) causes tall, peaked T waves. As levels
rise towards 7.0, the QRS widens, indicating a high risk for ventricular fibrillation or
cardiac arrest.
3. The nurse is caring for a client with a Chest Tube to treat a tension pneumothorax. Which
finding in the water-seal chamber requires immediate intervention?
A. Continuous bubbling in the water-seal chamber
B. Intermittent bubbling during expiration
C. Tidaling with the client’s respirations
D. Fluid level at the 2 cm mark
Answer: A
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak in the system or the patient’s pleural space, preventing the re-expansion of the lung.
4. A patient is receiving a continuous infusion of Heparin for a Pulmonary Embolism. The aPTT
is 110 seconds (Control: 35 seconds). Which action should the nurse take first?
A. Increase the infusion rate by 10%
, B. Continue the infusion and re-check in 4 hours
C. Stop the infusion and notify the healthcare provider
D. Administer Vitamin K intramuscularly
Answer: C
Conceptual Explanation: The therapeutic range for aPTT is typically 1.5 to 2.5 times the
control. An aPTT of 110 is significantly above the range, putting the patient at high risk for
hemorrhage.
5. A client with Addison’s disease is admitted for an elective surgery. Which medication order
does the nurse anticipate being most critical during the perioperative period?
A. Insulin glargine
B. Oral fludrocortisone
C. Intravenous hydrocortisone
D. Potassium-sparing diuretics
Answer: C
Conceptual Explanation: Surgery is a major stressor. Clients with Addison’s disease
cannot produce cortisol, so they require ‘stress doses’ of IV corticosteroids to prevent
Addisonian crisis (circulatory collapse).
6. Which clinical manifestation is a hallmark sign of Thyroid Storm (Thyrotoxic Crisis)?
A. Hypothermia and bradycardia
ADVANCED MEDICAL-SURGICAL
NURSING QUESTIONS & VERIFIED
ANSWERS | GALEN COLLEGE (A+
GUARANTEE)
1. A client is admitted with Acute Respiratory Distress Syndrome (ARDS). Which
pathophysiological change is most characteristic of the exudative phase of ARDS?
A. Formation of hyaline membranes and interstitial edema
B. Proliferation of Type II pneumocytes and fibroblast infiltration
C. Destruction of the alveolar-capillary membrane by collagen
D. Resolution of pulmonary edema and restoration of surfactant
Answer: A
Conceptual Explanation: In the exudative phase (24-48 hours), inflammatory mediators
cause damage to the alveolar-capillary membrane, leading to fluid shifts into the alveoli
and the formation of hyaline membranes, which severely impair gas exchange.
2. A patient with Chronic Kidney Disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which cardiac monitor finding should the nurse prioritize as the most immediate threat?
A. Peaked T waves and widened QRS complex
,B. ST-segment depression
C. Prominent U waves
D. Prolonged PR interval only
Answer: A
Conceptual Explanation: Hyperkalemia (K > 5.0) causes tall, peaked T waves. As levels
rise towards 7.0, the QRS widens, indicating a high risk for ventricular fibrillation or
cardiac arrest.
3. The nurse is caring for a client with a Chest Tube to treat a tension pneumothorax. Which
finding in the water-seal chamber requires immediate intervention?
A. Continuous bubbling in the water-seal chamber
B. Intermittent bubbling during expiration
C. Tidaling with the client’s respirations
D. Fluid level at the 2 cm mark
Answer: A
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak in the system or the patient’s pleural space, preventing the re-expansion of the lung.
4. A patient is receiving a continuous infusion of Heparin for a Pulmonary Embolism. The aPTT
is 110 seconds (Control: 35 seconds). Which action should the nurse take first?
A. Increase the infusion rate by 10%
, B. Continue the infusion and re-check in 4 hours
C. Stop the infusion and notify the healthcare provider
D. Administer Vitamin K intramuscularly
Answer: C
Conceptual Explanation: The therapeutic range for aPTT is typically 1.5 to 2.5 times the
control. An aPTT of 110 is significantly above the range, putting the patient at high risk for
hemorrhage.
5. A client with Addison’s disease is admitted for an elective surgery. Which medication order
does the nurse anticipate being most critical during the perioperative period?
A. Insulin glargine
B. Oral fludrocortisone
C. Intravenous hydrocortisone
D. Potassium-sparing diuretics
Answer: C
Conceptual Explanation: Surgery is a major stressor. Clients with Addison’s disease
cannot produce cortisol, so they require ‘stress doses’ of IV corticosteroids to prevent
Addisonian crisis (circulatory collapse).
6. Which clinical manifestation is a hallmark sign of Thyroid Storm (Thyrotoxic Crisis)?
A. Hypothermia and bradycardia
