NRSG 110 Final Exam V3 | NRSG 110
Medical Surgical Nursing II | Actual Q&A
with Rationale (NRSG110 Final Exam) | Ivy
Tech
1. A client is admitted to the emergency department with suspected Diabetic Ketoacidosis
(DKA). Which clinical manifestations should the nurse expect to find during the assessment?
A. Bradypnea and hypertension
B. Severe peripheral edema and weight gain
C. Profuse diaphoresis and tremors
D. Increased urinary output and bradycardia
E. Kussmaul respirations and fruity breath odor
F. Hypoglycemia and metabolic alkalosis
Correct Answer: E
Diabetic Ketoacidosis presents with characteristic Kussmaul respirations, which are deep
and rapid, as the body attempts to blow off CO2 to compensate for metabolic acidosis. The
fruity breath odor is caused by the presence of acetone, a byproduct of ketone production.
These clinical signs are critical for identifying DKA in a patient presenting with high blood
glucose levels.
,2. The nurse is reviewing the arterial blood gas (ABG) results for a client with chronic
obstructive pulmonary disease (COPD): pH 7.32, PaCO2 55 mm Hg, HCO3 28 mEq/L. How
should the nurse interpret these findings?
A. Metabolic acidosis, fully compensated
B. Respiratory alkalosis, uncompensated
C. Respiratory acidosis, partially compensated
D. Metabolic alkalosis, partially compensated
Correct Answer: C
A pH of 7.32 indicates acidosis (normal 7.35-7.45). The PaCO2 of 55 mm Hg is elevated
(normal 35-45), suggesting a respiratory cause, while the elevated HCO3 of 28 mEq/L
indicates the kidneys are trying to compensate (normal 22-26). Since the pH has not yet
returned to the normal range, it is considered partially compensated respiratory acidosis.
3. A nurse is caring for a client who is 24 hours postoperative following a total hip
arthroplasty. Which of the following findings should the nurse prioritize and report to the
healthcare provider immediately?
A. Incisional pain rated at 6 on a scale of 0 to 10
B. Hemoglobin level of 11.5 g/dL
C. Serosanguinous drainage on the surgical dressing
D. Sudden onset of shortness of breath and chest pain
, Correct Answer: D
Sudden onset of shortness of breath and chest pain in a postoperative orthopedic patient
is highly suggestive of a pulmonary embolism (PE). This is a life-threatening complication
that requires immediate medical intervention and diagnostic testing. Other findings like
incisional pain and moderate drainage are expected after this type of surgery.
4. A client with Hyperthyroidism is scheduled for a subtotal thyroidectomy. Which medication
does the nurse expect to administer preoperatively to reduce the vascularity of the thyroid
gland?
A. Levothyroxine
B. Propylthiouracil (PTU)
C. Lugol’s solution (potassium iodide)
D. Amiodarone
Correct Answer: C
Lugol’s solution, or iodine preparations, are administered preoperatively to clients with
hyperthyroidism to decrease the size and vascularity of the gland. This reduces the risk of
excessive bleeding during the surgical procedure. It is usually given for 10 to 14 days
before surgery.
5. When assessing a client with right-sided heart failure, which clinical finding is the nurse
most likely to observe?
A. Crackles in the lungs and dyspnea
Medical Surgical Nursing II | Actual Q&A
with Rationale (NRSG110 Final Exam) | Ivy
Tech
1. A client is admitted to the emergency department with suspected Diabetic Ketoacidosis
(DKA). Which clinical manifestations should the nurse expect to find during the assessment?
A. Bradypnea and hypertension
B. Severe peripheral edema and weight gain
C. Profuse diaphoresis and tremors
D. Increased urinary output and bradycardia
E. Kussmaul respirations and fruity breath odor
F. Hypoglycemia and metabolic alkalosis
Correct Answer: E
Diabetic Ketoacidosis presents with characteristic Kussmaul respirations, which are deep
and rapid, as the body attempts to blow off CO2 to compensate for metabolic acidosis. The
fruity breath odor is caused by the presence of acetone, a byproduct of ketone production.
These clinical signs are critical for identifying DKA in a patient presenting with high blood
glucose levels.
,2. The nurse is reviewing the arterial blood gas (ABG) results for a client with chronic
obstructive pulmonary disease (COPD): pH 7.32, PaCO2 55 mm Hg, HCO3 28 mEq/L. How
should the nurse interpret these findings?
A. Metabolic acidosis, fully compensated
B. Respiratory alkalosis, uncompensated
C. Respiratory acidosis, partially compensated
D. Metabolic alkalosis, partially compensated
Correct Answer: C
A pH of 7.32 indicates acidosis (normal 7.35-7.45). The PaCO2 of 55 mm Hg is elevated
(normal 35-45), suggesting a respiratory cause, while the elevated HCO3 of 28 mEq/L
indicates the kidneys are trying to compensate (normal 22-26). Since the pH has not yet
returned to the normal range, it is considered partially compensated respiratory acidosis.
3. A nurse is caring for a client who is 24 hours postoperative following a total hip
arthroplasty. Which of the following findings should the nurse prioritize and report to the
healthcare provider immediately?
A. Incisional pain rated at 6 on a scale of 0 to 10
B. Hemoglobin level of 11.5 g/dL
C. Serosanguinous drainage on the surgical dressing
D. Sudden onset of shortness of breath and chest pain
, Correct Answer: D
Sudden onset of shortness of breath and chest pain in a postoperative orthopedic patient
is highly suggestive of a pulmonary embolism (PE). This is a life-threatening complication
that requires immediate medical intervention and diagnostic testing. Other findings like
incisional pain and moderate drainage are expected after this type of surgery.
4. A client with Hyperthyroidism is scheduled for a subtotal thyroidectomy. Which medication
does the nurse expect to administer preoperatively to reduce the vascularity of the thyroid
gland?
A. Levothyroxine
B. Propylthiouracil (PTU)
C. Lugol’s solution (potassium iodide)
D. Amiodarone
Correct Answer: C
Lugol’s solution, or iodine preparations, are administered preoperatively to clients with
hyperthyroidism to decrease the size and vascularity of the gland. This reduces the risk of
excessive bleeding during the surgical procedure. It is usually given for 10 to 14 days
before surgery.
5. When assessing a client with right-sided heart failure, which clinical finding is the nurse
most likely to observe?
A. Crackles in the lungs and dyspnea
