Exam 4: NUR 209 Medical-Surgical Nursing II
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Content Focus :
Advanced Neuro-Trauma, Stroke Rehabilitation & Critical Care Respiratory Emergencies
Q1: A 68-year-old male with sepsis develops severe hypoxemia refractory to 100% oxygen. His
chest X-ray shows bilateral diffuse infiltrates. Which finding confirms ARDS?
A. PaO2/FiO2 ratio of 180 mmHg
B. PaO2/FiO2 ratio of 320 mmHg
C. Pulmonary capillary wedge pressure of 22 mmHg
D. PaCO2 of 50 mmHg with respiratory acidosis
Correct Answer: A
Rationale: Correct because the Berlin definition of ARDS requires severe refractory hypoxemia
with a PaO2/FiO2 ratio below 300 mmHg, and a ratio below 200 indicates moderate ARDS. This
patient's bilateral infiltrates and hypoxemia refractory to high oxygen concentrations are classic
radiographic and clinical findings. A PCWP below 18 mmHg excludes cardiac failure as the
cause, confirming ARDS rather than cardiogenic pulmonary edema.
Q2: A 24-year-old male is brought to the ED after a motorcycle accident. He was unconscious
for 2 minutes, then awake and oriented for 30 minutes, and is now becoming increasingly
lethargic with a fixed dilated right pupil. Which condition should the nurse suspect?
A. Subdural hematoma from venous bleeding
B. Subarachnoid hemorrhage from aneurysm rupture
C. Intracerebral hemorrhage from hypertension
D. Epidural hematoma from arterial bleeding
Correct Answer: D
, Rationale: Correct because epidural hematoma classically presents with head trauma followed
by a brief loss of consciousness, a lucid interval, and rapid deterioration as arterial bleeding
expands under high pressure. This patient's fixed dilated pupil indicates uncal herniation with
oculomotor nerve compression from rapidly increasing intracranial pressure. Epidural hematoma
is a neurosurgical emergency requiring immediate surgical evacuation via burr holes or
craniotomy.
Q3: A 45-year-old male presents with severe boring epigastric pain radiating to his back, nausea,
and vomiting. He has a history of heavy alcohol use. Which laboratory finding is most specific
for the suspected diagnosis?
A. Elevated serum amylase
B. Elevated alkaline phosphatase
C. Elevated serum lipase
D. Elevated direct bilirubin
Correct Answer: C
Rationale: Correct because serum lipase is more specific for acute pancreatitis than amylase, as
lipase remains elevated longer and is less affected by salivary gland disorders or intestinal
pathology. This patient's severe epigastric pain radiating to the back in the context of alcohol
abuse is the classic presentation for acute pancreatitis. Elevated lipase confirms pancreatic
enzyme auto-digestion and inflammation.
Q4: A 30-year-old female sustained a basilar skull fracture 24 hours ago. The nurse notices clear
fluid draining from her right nostril. Which test should the nurse use to differentiate CSF from
nasal secretions?
A. Test fluid for protein content
B. Test fluid with a glucose test strip
C. Check for blood-tinged appearance only
D. Measure specific gravity of the fluid
Correct Answer: B
Rationale: Correct because cerebrospinal fluid contains glucose, and a positive glucose test on
draining fluid strongly suggests CSF rhinorrhea rather than normal nasal secretions. This finding
in a patient with basilar skull fracture indicates a dural tear with CSF leak requiring careful
management. The halo sign and beta-2 transferrin are additional confirmatory tests, but glucose
testing provides rapid bedside differentiation.
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Content Focus :
Advanced Neuro-Trauma, Stroke Rehabilitation & Critical Care Respiratory Emergencies
Q1: A 68-year-old male with sepsis develops severe hypoxemia refractory to 100% oxygen. His
chest X-ray shows bilateral diffuse infiltrates. Which finding confirms ARDS?
A. PaO2/FiO2 ratio of 180 mmHg
B. PaO2/FiO2 ratio of 320 mmHg
C. Pulmonary capillary wedge pressure of 22 mmHg
D. PaCO2 of 50 mmHg with respiratory acidosis
Correct Answer: A
Rationale: Correct because the Berlin definition of ARDS requires severe refractory hypoxemia
with a PaO2/FiO2 ratio below 300 mmHg, and a ratio below 200 indicates moderate ARDS. This
patient's bilateral infiltrates and hypoxemia refractory to high oxygen concentrations are classic
radiographic and clinical findings. A PCWP below 18 mmHg excludes cardiac failure as the
cause, confirming ARDS rather than cardiogenic pulmonary edema.
Q2: A 24-year-old male is brought to the ED after a motorcycle accident. He was unconscious
for 2 minutes, then awake and oriented for 30 minutes, and is now becoming increasingly
lethargic with a fixed dilated right pupil. Which condition should the nurse suspect?
A. Subdural hematoma from venous bleeding
B. Subarachnoid hemorrhage from aneurysm rupture
C. Intracerebral hemorrhage from hypertension
D. Epidural hematoma from arterial bleeding
Correct Answer: D
, Rationale: Correct because epidural hematoma classically presents with head trauma followed
by a brief loss of consciousness, a lucid interval, and rapid deterioration as arterial bleeding
expands under high pressure. This patient's fixed dilated pupil indicates uncal herniation with
oculomotor nerve compression from rapidly increasing intracranial pressure. Epidural hematoma
is a neurosurgical emergency requiring immediate surgical evacuation via burr holes or
craniotomy.
Q3: A 45-year-old male presents with severe boring epigastric pain radiating to his back, nausea,
and vomiting. He has a history of heavy alcohol use. Which laboratory finding is most specific
for the suspected diagnosis?
A. Elevated serum amylase
B. Elevated alkaline phosphatase
C. Elevated serum lipase
D. Elevated direct bilirubin
Correct Answer: C
Rationale: Correct because serum lipase is more specific for acute pancreatitis than amylase, as
lipase remains elevated longer and is less affected by salivary gland disorders or intestinal
pathology. This patient's severe epigastric pain radiating to the back in the context of alcohol
abuse is the classic presentation for acute pancreatitis. Elevated lipase confirms pancreatic
enzyme auto-digestion and inflammation.
Q4: A 30-year-old female sustained a basilar skull fracture 24 hours ago. The nurse notices clear
fluid draining from her right nostril. Which test should the nurse use to differentiate CSF from
nasal secretions?
A. Test fluid for protein content
B. Test fluid with a glucose test strip
C. Check for blood-tinged appearance only
D. Measure specific gravity of the fluid
Correct Answer: B
Rationale: Correct because cerebrospinal fluid contains glucose, and a positive glucose test on
draining fluid strongly suggests CSF rhinorrhea rather than normal nasal secretions. This finding
in a patient with basilar skull fracture indicates a dural tear with CSF leak requiring careful
management. The halo sign and beta-2 transferrin are additional confirmatory tests, but glucose
testing provides rapid bedside differentiation.
