[AVN 2035 MED SURG 3 MIDTERM EXAM] – EXAM-STYLE QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST
1. A client with a history of chronic obstructive pulmonary disease is admitted with acute respiratory
distress. Arterial blood gas results reveal a pH of 7.28, PaCO2 of 68 mmHg, and HCO3- of 26 mEq/L.
Which intervention should the nurse anticipate being most beneficial for this client?
A. Administration of intravenous sodium bicarbonate
B. Initiation of non-invasive positive pressure ventilation
C. Administration of a high-flow oxygen via non-rebreather mask
D. Placement in a prone position for 30 minutes
Correct Answer: B. Initiation of non-invasive positive pressure ventilation
Rationale: The ABG results indicate acute respiratory acidosis without metabolic compensation, as the pH is
low, PaCO2 is elevated, and the HCO3- is within the normal range. Non-invasive positive pressure ventilation,
such as BiPAP, is the first-line intervention for acute hypercapnic respiratory failure in COPD patients as it
supports alveolar ventilation, improves gas exchange, and reduces the work of breathing. Sodium bicarbonate is
not indicated for this type of acidosis. High-flow oxygen without ventilatory support can worsen respiratory
depression. Prone positioning is a therapy for ARDS, not the primary treatment for acute hypercapnic
respiratory failure.
,2. A client is newly diagnosed with type 1 diabetes mellitus. The nurse is providing education on insulin
administration. Which statement by the client indicates a correct understanding of the proper storage of
unopened vials of insulin?
A. "I will keep my unopened vials of insulin in the freezer."
B. "I can store my unopened vials of insulin at room temperature."
C. "Unopened vials of insulin should be kept in the refrigerator."
D. "Exposure to light will not affect the insulin's effectiveness."
Correct Answer: C. Unopened vials of insulin should be kept in the refrigerator.
Rationale: Unopened vials of insulin must be stored in a refrigerator at a temperature between 36°F and 46°F
(2°C and 8°C) to maintain their potency until their expiration date. Storing insulin in the freezer will destroy its
effectiveness, as the insulin protein will denature. While opened vials can be kept at room temperature for up to
28 days, unopened vials require refrigeration to ensure stability. Direct light and extreme heat can degrade
insulin, so it should be protected from both.
3. A nurse is caring for a client two days post-operative following a total abdominal hysterectomy. The
client reports sudden sharp pain in the right calf and shortness of breath. Which action should the nurse
take first?
A. Administer the prescribed PRN analgesic for the calf pain.
B. Apply a warm compress to the client's right calf.
,C. Assess the client's oxygen saturation and respiratory rate.
D. Encourage the client to ambulate to promote venous return.
Correct Answer: C. Assess the client's oxygen saturation and respiratory rate.
Rationale: The client's symptoms are classic for a pulmonary embolism, which is a life-threatening complication
of deep vein thrombosis. The nurse's priority is to first assess and stabilize the client's respiratory status by
checking oxygen saturation and respiratory rate. Ambulating could dislodge a clot, warm compresses do not
address the emergent nature of the situation, and administering an analgesic would be an inappropriate action
that could mask the severity of the respiratory symptoms before completing a comprehensive assessment.
4. A client with heart failure is prescribed furosemide. The nurse is monitoring for adverse effects. Which
laboratory value is most important to monitor when caring for a client receiving this medication?
A. Serum creatinine
B. Serum potassium
C. Serum sodium
D. Serum calcium
Correct Answer: B. Serum potassium
Rationale: Furosemide is a loop diuretic that blocks the reabsorption of sodium and chloride in the ascending
loop of Henle, leading to increased excretion of potassium in the distal tubule. The resultant hypokalemia can
precipitate cardiac dysrhythmias, particularly in clients with heart failure who may already have an increased
, risk. While serum creatinine, sodium, and calcium are also monitored, potassium levels are the most critical due
to the direct impact on cardiac electrical activity and the client's underlying condition.
5. A client is receiving a blood transfusion of packed red blood cells. Fifteen minutes after the infusion
begins, the client reports chills and low back pain. The nurse's priority action is to:
A. Slow the infusion rate and monitor the client.
B. Administer an antihistamine as a pre-medication.
C. Stop the transfusion and infuse normal saline.
D. Reassure the client that these are expected side effects.
Correct Answer: C. Stop the transfusion and infuse normal saline.
Rationale: The client is exhibiting signs of an acute hemolytic transfusion reaction, including chills and low back
pain. The immediate and priority action is to stop the transfusion to prevent further infusion of the
incompatible blood. The IV line must be kept open with normal saline to maintain vascular access. Slowing the
infusion or administering an antihistamine would be dangerous and is not the standard of care. Reassuring the
client is dismissive and does not address the life-threatening situation.
6. A nurse is preparing to administer 500 mL of 0.9% normal saline to a client with dehydration over 4
hours. The drop factor of the IV tubing is 15 gtt/mL. The nurse should set the IV flow rate to how many
drops per minute?
A. 21 gtt/min
DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST
1. A client with a history of chronic obstructive pulmonary disease is admitted with acute respiratory
distress. Arterial blood gas results reveal a pH of 7.28, PaCO2 of 68 mmHg, and HCO3- of 26 mEq/L.
Which intervention should the nurse anticipate being most beneficial for this client?
A. Administration of intravenous sodium bicarbonate
B. Initiation of non-invasive positive pressure ventilation
C. Administration of a high-flow oxygen via non-rebreather mask
D. Placement in a prone position for 30 minutes
Correct Answer: B. Initiation of non-invasive positive pressure ventilation
Rationale: The ABG results indicate acute respiratory acidosis without metabolic compensation, as the pH is
low, PaCO2 is elevated, and the HCO3- is within the normal range. Non-invasive positive pressure ventilation,
such as BiPAP, is the first-line intervention for acute hypercapnic respiratory failure in COPD patients as it
supports alveolar ventilation, improves gas exchange, and reduces the work of breathing. Sodium bicarbonate is
not indicated for this type of acidosis. High-flow oxygen without ventilatory support can worsen respiratory
depression. Prone positioning is a therapy for ARDS, not the primary treatment for acute hypercapnic
respiratory failure.
,2. A client is newly diagnosed with type 1 diabetes mellitus. The nurse is providing education on insulin
administration. Which statement by the client indicates a correct understanding of the proper storage of
unopened vials of insulin?
A. "I will keep my unopened vials of insulin in the freezer."
B. "I can store my unopened vials of insulin at room temperature."
C. "Unopened vials of insulin should be kept in the refrigerator."
D. "Exposure to light will not affect the insulin's effectiveness."
Correct Answer: C. Unopened vials of insulin should be kept in the refrigerator.
Rationale: Unopened vials of insulin must be stored in a refrigerator at a temperature between 36°F and 46°F
(2°C and 8°C) to maintain their potency until their expiration date. Storing insulin in the freezer will destroy its
effectiveness, as the insulin protein will denature. While opened vials can be kept at room temperature for up to
28 days, unopened vials require refrigeration to ensure stability. Direct light and extreme heat can degrade
insulin, so it should be protected from both.
3. A nurse is caring for a client two days post-operative following a total abdominal hysterectomy. The
client reports sudden sharp pain in the right calf and shortness of breath. Which action should the nurse
take first?
A. Administer the prescribed PRN analgesic for the calf pain.
B. Apply a warm compress to the client's right calf.
,C. Assess the client's oxygen saturation and respiratory rate.
D. Encourage the client to ambulate to promote venous return.
Correct Answer: C. Assess the client's oxygen saturation and respiratory rate.
Rationale: The client's symptoms are classic for a pulmonary embolism, which is a life-threatening complication
of deep vein thrombosis. The nurse's priority is to first assess and stabilize the client's respiratory status by
checking oxygen saturation and respiratory rate. Ambulating could dislodge a clot, warm compresses do not
address the emergent nature of the situation, and administering an analgesic would be an inappropriate action
that could mask the severity of the respiratory symptoms before completing a comprehensive assessment.
4. A client with heart failure is prescribed furosemide. The nurse is monitoring for adverse effects. Which
laboratory value is most important to monitor when caring for a client receiving this medication?
A. Serum creatinine
B. Serum potassium
C. Serum sodium
D. Serum calcium
Correct Answer: B. Serum potassium
Rationale: Furosemide is a loop diuretic that blocks the reabsorption of sodium and chloride in the ascending
loop of Henle, leading to increased excretion of potassium in the distal tubule. The resultant hypokalemia can
precipitate cardiac dysrhythmias, particularly in clients with heart failure who may already have an increased
, risk. While serum creatinine, sodium, and calcium are also monitored, potassium levels are the most critical due
to the direct impact on cardiac electrical activity and the client's underlying condition.
5. A client is receiving a blood transfusion of packed red blood cells. Fifteen minutes after the infusion
begins, the client reports chills and low back pain. The nurse's priority action is to:
A. Slow the infusion rate and monitor the client.
B. Administer an antihistamine as a pre-medication.
C. Stop the transfusion and infuse normal saline.
D. Reassure the client that these are expected side effects.
Correct Answer: C. Stop the transfusion and infuse normal saline.
Rationale: The client is exhibiting signs of an acute hemolytic transfusion reaction, including chills and low back
pain. The immediate and priority action is to stop the transfusion to prevent further infusion of the
incompatible blood. The IV line must be kept open with normal saline to maintain vascular access. Slowing the
infusion or administering an antihistamine would be dangerous and is not the standard of care. Reassuring the
client is dismissive and does not address the life-threatening situation.
6. A nurse is preparing to administer 500 mL of 0.9% normal saline to a client with dehydration over 4
hours. The drop factor of the IV tubing is 15 gtt/mL. The nurse should set the IV flow rate to how many
drops per minute?
A. 21 gtt/min
