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WEST COAST UNIVERSITY NURS 201 – MEDICAL-
SURGICAL NURSING COMPREHENSIVE PRACTICE
EXAM 2 QUESTIONS WITH ANSWERS AND
RATIONALES |100% PASS |GRADED A+ 2026/27
1. The nurse is caring for a client with chronic obstructive pulmonary
disease (COPD). Which nursing intervention is the priority?
a) Administer oxygen at 4 L/min via nasal cannula
b) Encourage coughing and deep breathing
c) Position the client in a high-Fowler's position
d) Administer bronchodilators as ordered
Verified Answer: c
Rationale: The priority intervention for a client with COPD is
positioning to facilitate breathing. High-Fowler's position (sitting
upright) promotes lung expansion and helps the client use accessory
muscles effectively. Oxygen should be administered at low flow (1-2
L/min) because COPD clients rely on hypoxic drive. Coughing, deep
breathing, and bronchodilators are important but not the immediate
priority.
2. A client with diabetes mellitus has a blood glucose level of 350 mg/dL
and is experiencing Kussmaul respirations. The nurse should suspect:
a) Hypoglycemia
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b) Diabetic ketoacidosis (DKA)
c) Hyperosmolar hyperglycemic state (HHS)
d) Lactic acidosis
Verified Answer: b
Rationale: Kussmaul respirations (deep, rapid breathing) are a
compensatory mechanism for metabolic acidosis seen in diabetic
ketoacidosis (DKA). DKA is characterized by hyperglycemia (> 250
mg/dL), ketosis, and metabolic acidosis. HHS also has hyperglycemia
but without significant ketosis or acidosis. Hypoglycemia causes
sweating, tremors, and confusion.
3. The nurse is caring for a client who had a myocardial infarction (MI)
24 hours ago. Which cardiac enzyme is most specific for myocardial
damage?
a) Creatine kinase (CK-MB)
b) Troponin I
c) Lactate dehydrogenase (LDH)
d) Myoglobin
Verified Answer: b
Rationale: Troponin I and T are the most specific and sensitive cardiac
biomarkers for myocardial damage. Troponin levels rise within 3-4
hours of MI and remain elevated for up to 10-14 days. CK-MB is less
specific and can be elevated in skeletal muscle injury. LDH is non-
specific. Myoglobin is less specific and rises earlier but also clears
faster.
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4. A client with heart failure is prescribed furosemide (Lasix). Which
electrolyte imbalance is a priority to monitor?
a) Hyperkalemia
b) Hyponatremia
c) Hypokalemia
d) Hypercalcemia
Verified Answer: c
Rationale: Furosemide is a loop diuretic that causes potassium loss
(hypokalemia). Hypokalemia can lead to cardiac arrhythmias, especially
in clients taking digoxin. Hyponatremia can also occur but hypokalemia
is the priority. Hyperkalemia is not caused by furosemide; it is
associated with potassium-sparing diuretics (e.g., spironolactone).
5. The nurse is caring for a client who is 2 days post-operative following
a total hip replacement. Which intervention is essential to prevent
dislocation?
a) Keep the hips in an adducted position
b) Use a pillow between the legs when turning
c) Encourage the client to cross their legs
d) Apply heat to the surgical site
Verified Answer: b
Rationale: After total hip replacement, the hip should be kept in
abduction (not adduction) to prevent dislocation. A pillow between the
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legs when turning, positioning, or logrolling maintains abduction.
Crossing legs and adduction are contraindicated. Heat application is not
directly related to preventing dislocation.
6. The nurse is assessing a client with acute pancreatitis. Which pain
management strategy is most effective?
a) Oral NSAIDs
b) Opioid analgesics intravenously
c) Topical analgesics
d) Anti-inflammatory creams
Verified Answer: b
Rationale: Pain in acute pancreatitis is severe and often requires
intravenous opioid analgesics (e.g., morphine, hydromorphone). Oral
medications are not absorbed well because of the inflammatory process
and NPO status. NSAIDs and topical analgesics are not effective for this
type of pain.
7. A client is diagnosed with bacterial pneumonia. The nurse would
expect which finding on assessment?
a) Dry, non-productive cough
b) Fine crackles over the affected area
c) Clear lung sounds
d) Wheezing throughout the lung fields
Verified Answer: b
WEST COAST UNIVERSITY NURS 201 – MEDICAL-
SURGICAL NURSING COMPREHENSIVE PRACTICE
EXAM 2 QUESTIONS WITH ANSWERS AND
RATIONALES |100% PASS |GRADED A+ 2026/27
1. The nurse is caring for a client with chronic obstructive pulmonary
disease (COPD). Which nursing intervention is the priority?
a) Administer oxygen at 4 L/min via nasal cannula
b) Encourage coughing and deep breathing
c) Position the client in a high-Fowler's position
d) Administer bronchodilators as ordered
Verified Answer: c
Rationale: The priority intervention for a client with COPD is
positioning to facilitate breathing. High-Fowler's position (sitting
upright) promotes lung expansion and helps the client use accessory
muscles effectively. Oxygen should be administered at low flow (1-2
L/min) because COPD clients rely on hypoxic drive. Coughing, deep
breathing, and bronchodilators are important but not the immediate
priority.
2. A client with diabetes mellitus has a blood glucose level of 350 mg/dL
and is experiencing Kussmaul respirations. The nurse should suspect:
a) Hypoglycemia
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b) Diabetic ketoacidosis (DKA)
c) Hyperosmolar hyperglycemic state (HHS)
d) Lactic acidosis
Verified Answer: b
Rationale: Kussmaul respirations (deep, rapid breathing) are a
compensatory mechanism for metabolic acidosis seen in diabetic
ketoacidosis (DKA). DKA is characterized by hyperglycemia (> 250
mg/dL), ketosis, and metabolic acidosis. HHS also has hyperglycemia
but without significant ketosis or acidosis. Hypoglycemia causes
sweating, tremors, and confusion.
3. The nurse is caring for a client who had a myocardial infarction (MI)
24 hours ago. Which cardiac enzyme is most specific for myocardial
damage?
a) Creatine kinase (CK-MB)
b) Troponin I
c) Lactate dehydrogenase (LDH)
d) Myoglobin
Verified Answer: b
Rationale: Troponin I and T are the most specific and sensitive cardiac
biomarkers for myocardial damage. Troponin levels rise within 3-4
hours of MI and remain elevated for up to 10-14 days. CK-MB is less
specific and can be elevated in skeletal muscle injury. LDH is non-
specific. Myoglobin is less specific and rises earlier but also clears
faster.
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4. A client with heart failure is prescribed furosemide (Lasix). Which
electrolyte imbalance is a priority to monitor?
a) Hyperkalemia
b) Hyponatremia
c) Hypokalemia
d) Hypercalcemia
Verified Answer: c
Rationale: Furosemide is a loop diuretic that causes potassium loss
(hypokalemia). Hypokalemia can lead to cardiac arrhythmias, especially
in clients taking digoxin. Hyponatremia can also occur but hypokalemia
is the priority. Hyperkalemia is not caused by furosemide; it is
associated with potassium-sparing diuretics (e.g., spironolactone).
5. The nurse is caring for a client who is 2 days post-operative following
a total hip replacement. Which intervention is essential to prevent
dislocation?
a) Keep the hips in an adducted position
b) Use a pillow between the legs when turning
c) Encourage the client to cross their legs
d) Apply heat to the surgical site
Verified Answer: b
Rationale: After total hip replacement, the hip should be kept in
abduction (not adduction) to prevent dislocation. A pillow between the
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legs when turning, positioning, or logrolling maintains abduction.
Crossing legs and adduction are contraindicated. Heat application is not
directly related to preventing dislocation.
6. The nurse is assessing a client with acute pancreatitis. Which pain
management strategy is most effective?
a) Oral NSAIDs
b) Opioid analgesics intravenously
c) Topical analgesics
d) Anti-inflammatory creams
Verified Answer: b
Rationale: Pain in acute pancreatitis is severe and often requires
intravenous opioid analgesics (e.g., morphine, hydromorphone). Oral
medications are not absorbed well because of the inflammatory process
and NPO status. NSAIDs and topical analgesics are not effective for this
type of pain.
7. A client is diagnosed with bacterial pneumonia. The nurse would
expect which finding on assessment?
a) Dry, non-productive cough
b) Fine crackles over the affected area
c) Clear lung sounds
d) Wheezing throughout the lung fields
Verified Answer: b
