COMPLEX MED SURG EXAM 2026 FINAL
PAPER QUESTIONS AND SOLUTIONS
◉ Dobutamine. Answer: agents strengthen cardiac contraction,
increase cardiac output, inotropic drug
◉ Vasopressors. Answer: they cause vasoconstriction, increase MAP,
dopamine is most common, norepinephrine (levofed), vasopressin
(used in conjunction with other vasopressors)
◉ Epinephrine. Answer: bronchodilator, increase HR and cardiac
output, first line drug in anaphylactic shock, first line code drug
◉ Metabolic acidosis. Answer: low pH, low bicarbonate
◉ Metabolic acidosis causes. Answer: direct loss of bicarb from
diarrhea, lower GI fistulas, renal failure, excessive administration of
chloride
◉ High anion gap. Answer: determined by subtracting the total
measured anions from the major measured cation, means there is
extra acid in the body
,◉ High anion causes and normal range. Answer: excessive
accumulation of acid due to ketoacidosis, lactic acidosis, late
salicylate poisoning, uremia 8-12
◉ Metabolic acidosis s/s. Answer: headache, confusion, drowsiness,
increased kussmaul's respirations, nausea, abd pain, weakness,
dysrhythmias, causes an increased concentration of ionized calcium
and potassium in the ECF; magnesium levels may decrease
◉ Metabolic acidosis treatment. Answer: bicarbonate may be given
for severe acidosis less than 7.1, as metabolic acidosis is corrected,
K+ shifts back into the intracellular space, can lead to hypokalemia,
treat underlying causes first, then replace fluids and electrolytes
◉ Metabolic alkalosis. Answer: high pH, high bicarb
◉ Metabolic alkalosis causes. Answer: hypokalemia (diuretics), over
administration of bicarb solutions, vomiting, gastric suction (cause
you to lose your acids)
◉ Metabolic alkalosis s/s. Answer: low calcium: numbness and
tingling around the mouth, fingers, and toes; trousseau's and
chvostek's sign, and mucles spasms, tetany, decreased respiratory
rate, confusion, seizures, low potassium, low chloride, low ionized
calcium
,◉ Metabolic alkalosis treatment. Answer: restore normal fluid
volume, replace electrolytes, treat underlying cause, chloride
promotes renal excretion of bicarb, severe alkalosis: ammonium
chloride (acidifying solution)
◉ Respiratory acidosis. Answer: Low pH, High CO2
◉ Respiratory acidosis causes. Answer: acute or chronic lung
disease, narcotic overdose, airway obstruction, neuromuscular
disease
◉ Respiratory acidosis s/s. Answer: acute: headache, warm flushed
skin, blurred vision, irritability, AMS, decreased LOC, cardiac arrest,
chronic: weakness, dull headache, sleep disturbances, impaired
memory, personality changes, hypochloremia, be careful w/over
correcting chronic COPD patients because that is their drive to
breathe
◉ Respiratory acidosis treatment. Answer: dependent on cause,
bronchodilators, naloxone to reverse narcotics, pulmonary hygiene,
adequate hydration, cautious use of supplemental oxyten w/COPD
pt's, may require intubation and mechanical ventilation
◉ Respiratory alkalosis. Answer: high ph, low CO2
, ◉ Respiratory alkalosis causes. Answer: anxiety w/hyperventilation,
improper mechanical ventilator settings, high fever, hypoxia, gram-
negative sepsis, early salicylate overdose
◉ Respiratory alkalosis s/s. Answer: light-headedness, feeling of
panic, difficulty concentrating, seizures, loss of consciousness, low
ionized calcium signs of hypocalcemia: Chvostek's and trousseau's
signs, tetany
◉ Respiratory alkalosis treatment. Answer: sedative for anxiety,
correct underlying problem (correct vent settings), oxygen if
hypoxia is causing hyperventilation, do not need o2 if their sats are
normal
◉ Shock. Answer: life threatening condition in which tissue
perfusion is inadequate to deliver oxygen and nutrients to support
vital organs and cellular function, can develop rapidly or slowly
depending on the cause, older adults have reduced compensatory
mechanisms and move through the stages more quickly, slow shock
could be dehydration, fast shock can be caused by hemorrhage
◉ Types of shock. Answer: cardiogenic, hypovolemic-losing fluids,
obstructive-mechanical blockage such as PE, distributive-
neurogenic, septic, anaphylactic
PAPER QUESTIONS AND SOLUTIONS
◉ Dobutamine. Answer: agents strengthen cardiac contraction,
increase cardiac output, inotropic drug
◉ Vasopressors. Answer: they cause vasoconstriction, increase MAP,
dopamine is most common, norepinephrine (levofed), vasopressin
(used in conjunction with other vasopressors)
◉ Epinephrine. Answer: bronchodilator, increase HR and cardiac
output, first line drug in anaphylactic shock, first line code drug
◉ Metabolic acidosis. Answer: low pH, low bicarbonate
◉ Metabolic acidosis causes. Answer: direct loss of bicarb from
diarrhea, lower GI fistulas, renal failure, excessive administration of
chloride
◉ High anion gap. Answer: determined by subtracting the total
measured anions from the major measured cation, means there is
extra acid in the body
,◉ High anion causes and normal range. Answer: excessive
accumulation of acid due to ketoacidosis, lactic acidosis, late
salicylate poisoning, uremia 8-12
◉ Metabolic acidosis s/s. Answer: headache, confusion, drowsiness,
increased kussmaul's respirations, nausea, abd pain, weakness,
dysrhythmias, causes an increased concentration of ionized calcium
and potassium in the ECF; magnesium levels may decrease
◉ Metabolic acidosis treatment. Answer: bicarbonate may be given
for severe acidosis less than 7.1, as metabolic acidosis is corrected,
K+ shifts back into the intracellular space, can lead to hypokalemia,
treat underlying causes first, then replace fluids and electrolytes
◉ Metabolic alkalosis. Answer: high pH, high bicarb
◉ Metabolic alkalosis causes. Answer: hypokalemia (diuretics), over
administration of bicarb solutions, vomiting, gastric suction (cause
you to lose your acids)
◉ Metabolic alkalosis s/s. Answer: low calcium: numbness and
tingling around the mouth, fingers, and toes; trousseau's and
chvostek's sign, and mucles spasms, tetany, decreased respiratory
rate, confusion, seizures, low potassium, low chloride, low ionized
calcium
,◉ Metabolic alkalosis treatment. Answer: restore normal fluid
volume, replace electrolytes, treat underlying cause, chloride
promotes renal excretion of bicarb, severe alkalosis: ammonium
chloride (acidifying solution)
◉ Respiratory acidosis. Answer: Low pH, High CO2
◉ Respiratory acidosis causes. Answer: acute or chronic lung
disease, narcotic overdose, airway obstruction, neuromuscular
disease
◉ Respiratory acidosis s/s. Answer: acute: headache, warm flushed
skin, blurred vision, irritability, AMS, decreased LOC, cardiac arrest,
chronic: weakness, dull headache, sleep disturbances, impaired
memory, personality changes, hypochloremia, be careful w/over
correcting chronic COPD patients because that is their drive to
breathe
◉ Respiratory acidosis treatment. Answer: dependent on cause,
bronchodilators, naloxone to reverse narcotics, pulmonary hygiene,
adequate hydration, cautious use of supplemental oxyten w/COPD
pt's, may require intubation and mechanical ventilation
◉ Respiratory alkalosis. Answer: high ph, low CO2
, ◉ Respiratory alkalosis causes. Answer: anxiety w/hyperventilation,
improper mechanical ventilator settings, high fever, hypoxia, gram-
negative sepsis, early salicylate overdose
◉ Respiratory alkalosis s/s. Answer: light-headedness, feeling of
panic, difficulty concentrating, seizures, loss of consciousness, low
ionized calcium signs of hypocalcemia: Chvostek's and trousseau's
signs, tetany
◉ Respiratory alkalosis treatment. Answer: sedative for anxiety,
correct underlying problem (correct vent settings), oxygen if
hypoxia is causing hyperventilation, do not need o2 if their sats are
normal
◉ Shock. Answer: life threatening condition in which tissue
perfusion is inadequate to deliver oxygen and nutrients to support
vital organs and cellular function, can develop rapidly or slowly
depending on the cause, older adults have reduced compensatory
mechanisms and move through the stages more quickly, slow shock
could be dehydration, fast shock can be caused by hemorrhage
◉ Types of shock. Answer: cardiogenic, hypovolemic-losing fluids,
obstructive-mechanical blockage such as PE, distributive-
neurogenic, septic, anaphylactic
