NSG 3800: MedSurg II Practice Exam
Complete 250 Multiple-Choice Questions with Rationales
Question 1: A nurse is caring for a client with Acute Respiratory Distress Syndrome (ARDS) on a
ventilator. The provider adds 10 cm H2O of Positive End-Expiratory Pressure (PEEP). Which
assessment finding indicates a common complication of high PEEP?
A. Increased cardiac output
B. Decreased blood pressure
C. Improved lung compliance
D. Decreased intracranial pressure
Correct Answer: B. Decreased blood pressure
Rationale: High levels of PEEP increase intrathoracic pressure, which can compress the vena cava and decrease
venous return (preload) to the heart. This leads to a decrease in cardiac output and a subsequent drop in blood
pressure.
Question 2: A client with chronic kidney disease (CKD) has a serum potassium level of 7.2 mEq/L and
EKG changes. Which medication should the nurse expect to administer first to stabilize the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Regular Insulin and Dextrose
C. Calcium Gluconate
D. Furosemide
Correct Answer: C. Calcium Gluconate
Rationale: Calcium Gluconate is the first-line treatment for life-threatening hyperkalemia with EKG changes. It does
not lower potassium but antagonizes the effects of potassium on the myocardium, preventing cardiac arrest.
Question 3: The nurse is monitoring a client's Mean Arterial Pressure (MAP). The client's blood
pressure is 90/60 mmHg. What is the calculated MAP?
A. 60 mmHg
B. 70 mmHg
C. 75 mmHg
D. 80 mmHg
Correct Answer: B. 70 mmHg
Rationale: MAP is calculated as [(2 x Diastolic) + Systolic] / 3. For 90/60: [(2 x 60) + 90] / 3 = [120 + 90] / 3 = 210 /
3 = 70 mmHg.
,Question 4: Which clinical finding is most characteristic of the 'cold' or late phase of septic shock?
A. Warm, flushed skin
B. High cardiac output
C. Cool, clammy skin and metabolic acidosis
D. Increased urine output
Correct Answer: C. Cool, clammy skin and metabolic acidosis
Rationale: In the late or cold phase of septic shock, compensatory mechanisms fail. Cardiac output drops, tissue
perfusion is severely compromised leading to lactic acidosis, and the skin becomes cool and mottled.
Question 5: A client with a T4 spinal cord injury reports a severe, throbbing headache and blurred
vision. The BP is 195/105 mmHg. What is the nurse's priority action?
A. Administer a PRN dose of hydralazine
B. Perform a digital rectal exam to check for impaction
C. Raise the head of the bed to 90 degrees
D. Catheterize the client immediately
Correct Answer: C. Raise the head of the bed to 90 degrees
Rationale: Raising the head of the bed is the immediate priority to utilize gravity to help lower the blood pressure
while the nurse identifies the noxious stimulus (like a full bladder) causing Autonomic Dysreflexia.
Question 6: A client with cirrhosis and esophageal varices is prescribed Octreotide. What is the
primary purpose of this medication in this context?
A. To reduce ammonia levels
B. To decrease portal venous pressure
C. To prevent gastric ulcers
D. To treat hypoprothrombinemia
Correct Answer: B. To decrease portal venous pressure
Rationale: Octreotide causes splanchnic vasoconstriction, which reduces the pressure in the portal venous system.
This is critical for stopping or preventing bleeding from esophageal varices.
,Question 7: A nurse is assessing a client with a chest tube and notes the water level in the water-seal
chamber fluctuates with the client's breathing. What should the nurse do?
A. Notify the physician of a potential leak
B. Check for kinks in the tubing
C. Document this as a normal finding (tidaling)
D. Increase the suction pressure
Correct Answer: C. Document this as a normal finding (tidaling)
Rationale: Tidaling is the normal rise and fall of the water level in the water-seal chamber with respiration,
indicating that the chest tube is patent and responding to intrapleural pressure changes.
Question 8: Which diagnostic finding is the 'gold standard' for confirming a diagnosis of Myasthenia
Gravis?
A. Positive Tensilon (Edrophonium) test
B. Elevated CK-MB
C. Decreased CSF glucose
D. Positive Brudzinski's sign
Correct Answer: A. Positive Tensilon (Edrophonium) test
Rationale: The Tensilon test involves administering edrophonium, which prevents the breakdown of acetylcholine.
A brief, significant improvement in muscle strength is a positive result confirming Myasthenia Gravis.
Question 9: A nurse is caring for a client with Acute Respiratory Distress Syndrome (ARDS) on a
ventilator. The provider adds 10 cm H2O of Positive End-Expiratory Pressure (PEEP). Which
assessment finding indicates a common complication of high PEEP?
A. Increased cardiac output
B. Decreased blood pressure
C. Improved lung compliance
D. Decreased intracranial pressure
Correct Answer: B. Decreased blood pressure
Rationale: High levels of PEEP increase intrathoracic pressure, which can compress the vena cava and decrease
venous return (preload) to the heart. This leads to a decrease in cardiac output and a subsequent drop in blood
pressure.
, Question 10: A client with chronic kidney disease (CKD) has a serum potassium level of 7.2 mEq/L
and EKG changes. Which medication should the nurse expect to administer first to stabilize the
heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Regular Insulin and Dextrose
C. Calcium Gluconate
D. Furosemide
Correct Answer: C. Calcium Gluconate
Rationale: Calcium Gluconate is the first-line treatment for life-threatening hyperkalemia with EKG changes. It does
not lower potassium but antagonizes the effects of potassium on the myocardium, preventing cardiac arrest.
Question 11: The nurse is monitoring a client's Mean Arterial Pressure (MAP). The client's blood
pressure is 90/60 mmHg. What is the calculated MAP?
A. 60 mmHg
B. 70 mmHg
C. 75 mmHg
D. 80 mmHg
Correct Answer: B. 70 mmHg
Rationale: MAP is calculated as [(2 x Diastolic) + Systolic] / 3. For 90/60: [(2 x 60) + 90] / 3 = [120 + 90] / 3 = 210 /
3 = 70 mmHg.
Question 12: Which clinical finding is most characteristic of the 'cold' or late phase of septic shock?
A. Warm, flushed skin
B. High cardiac output
C. Cool, clammy skin and metabolic acidosis
D. Increased urine output
Correct Answer: C. Cool, clammy skin and metabolic acidosis
Rationale: In the late or cold phase of septic shock, compensatory mechanisms fail. Cardiac output drops, tissue
perfusion is severely compromised leading to lactic acidosis, and the skin becomes cool and mottled.
Complete 250 Multiple-Choice Questions with Rationales
Question 1: A nurse is caring for a client with Acute Respiratory Distress Syndrome (ARDS) on a
ventilator. The provider adds 10 cm H2O of Positive End-Expiratory Pressure (PEEP). Which
assessment finding indicates a common complication of high PEEP?
A. Increased cardiac output
B. Decreased blood pressure
C. Improved lung compliance
D. Decreased intracranial pressure
Correct Answer: B. Decreased blood pressure
Rationale: High levels of PEEP increase intrathoracic pressure, which can compress the vena cava and decrease
venous return (preload) to the heart. This leads to a decrease in cardiac output and a subsequent drop in blood
pressure.
Question 2: A client with chronic kidney disease (CKD) has a serum potassium level of 7.2 mEq/L and
EKG changes. Which medication should the nurse expect to administer first to stabilize the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Regular Insulin and Dextrose
C. Calcium Gluconate
D. Furosemide
Correct Answer: C. Calcium Gluconate
Rationale: Calcium Gluconate is the first-line treatment for life-threatening hyperkalemia with EKG changes. It does
not lower potassium but antagonizes the effects of potassium on the myocardium, preventing cardiac arrest.
Question 3: The nurse is monitoring a client's Mean Arterial Pressure (MAP). The client's blood
pressure is 90/60 mmHg. What is the calculated MAP?
A. 60 mmHg
B. 70 mmHg
C. 75 mmHg
D. 80 mmHg
Correct Answer: B. 70 mmHg
Rationale: MAP is calculated as [(2 x Diastolic) + Systolic] / 3. For 90/60: [(2 x 60) + 90] / 3 = [120 + 90] / 3 = 210 /
3 = 70 mmHg.
,Question 4: Which clinical finding is most characteristic of the 'cold' or late phase of septic shock?
A. Warm, flushed skin
B. High cardiac output
C. Cool, clammy skin and metabolic acidosis
D. Increased urine output
Correct Answer: C. Cool, clammy skin and metabolic acidosis
Rationale: In the late or cold phase of septic shock, compensatory mechanisms fail. Cardiac output drops, tissue
perfusion is severely compromised leading to lactic acidosis, and the skin becomes cool and mottled.
Question 5: A client with a T4 spinal cord injury reports a severe, throbbing headache and blurred
vision. The BP is 195/105 mmHg. What is the nurse's priority action?
A. Administer a PRN dose of hydralazine
B. Perform a digital rectal exam to check for impaction
C. Raise the head of the bed to 90 degrees
D. Catheterize the client immediately
Correct Answer: C. Raise the head of the bed to 90 degrees
Rationale: Raising the head of the bed is the immediate priority to utilize gravity to help lower the blood pressure
while the nurse identifies the noxious stimulus (like a full bladder) causing Autonomic Dysreflexia.
Question 6: A client with cirrhosis and esophageal varices is prescribed Octreotide. What is the
primary purpose of this medication in this context?
A. To reduce ammonia levels
B. To decrease portal venous pressure
C. To prevent gastric ulcers
D. To treat hypoprothrombinemia
Correct Answer: B. To decrease portal venous pressure
Rationale: Octreotide causes splanchnic vasoconstriction, which reduces the pressure in the portal venous system.
This is critical for stopping or preventing bleeding from esophageal varices.
,Question 7: A nurse is assessing a client with a chest tube and notes the water level in the water-seal
chamber fluctuates with the client's breathing. What should the nurse do?
A. Notify the physician of a potential leak
B. Check for kinks in the tubing
C. Document this as a normal finding (tidaling)
D. Increase the suction pressure
Correct Answer: C. Document this as a normal finding (tidaling)
Rationale: Tidaling is the normal rise and fall of the water level in the water-seal chamber with respiration,
indicating that the chest tube is patent and responding to intrapleural pressure changes.
Question 8: Which diagnostic finding is the 'gold standard' for confirming a diagnosis of Myasthenia
Gravis?
A. Positive Tensilon (Edrophonium) test
B. Elevated CK-MB
C. Decreased CSF glucose
D. Positive Brudzinski's sign
Correct Answer: A. Positive Tensilon (Edrophonium) test
Rationale: The Tensilon test involves administering edrophonium, which prevents the breakdown of acetylcholine.
A brief, significant improvement in muscle strength is a positive result confirming Myasthenia Gravis.
Question 9: A nurse is caring for a client with Acute Respiratory Distress Syndrome (ARDS) on a
ventilator. The provider adds 10 cm H2O of Positive End-Expiratory Pressure (PEEP). Which
assessment finding indicates a common complication of high PEEP?
A. Increased cardiac output
B. Decreased blood pressure
C. Improved lung compliance
D. Decreased intracranial pressure
Correct Answer: B. Decreased blood pressure
Rationale: High levels of PEEP increase intrathoracic pressure, which can compress the vena cava and decrease
venous return (preload) to the heart. This leads to a decrease in cardiac output and a subsequent drop in blood
pressure.
, Question 10: A client with chronic kidney disease (CKD) has a serum potassium level of 7.2 mEq/L
and EKG changes. Which medication should the nurse expect to administer first to stabilize the
heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Regular Insulin and Dextrose
C. Calcium Gluconate
D. Furosemide
Correct Answer: C. Calcium Gluconate
Rationale: Calcium Gluconate is the first-line treatment for life-threatening hyperkalemia with EKG changes. It does
not lower potassium but antagonizes the effects of potassium on the myocardium, preventing cardiac arrest.
Question 11: The nurse is monitoring a client's Mean Arterial Pressure (MAP). The client's blood
pressure is 90/60 mmHg. What is the calculated MAP?
A. 60 mmHg
B. 70 mmHg
C. 75 mmHg
D. 80 mmHg
Correct Answer: B. 70 mmHg
Rationale: MAP is calculated as [(2 x Diastolic) + Systolic] / 3. For 90/60: [(2 x 60) + 90] / 3 = [120 + 90] / 3 = 210 /
3 = 70 mmHg.
Question 12: Which clinical finding is most characteristic of the 'cold' or late phase of septic shock?
A. Warm, flushed skin
B. High cardiac output
C. Cool, clammy skin and metabolic acidosis
D. Increased urine output
Correct Answer: C. Cool, clammy skin and metabolic acidosis
Rationale: In the late or cold phase of septic shock, compensatory mechanisms fail. Cardiac output drops, tissue
perfusion is severely compromised leading to lactic acidosis, and the skin becomes cool and mottled.
