NUR 209 MEDICAL-SURGICAL NURSING
2 ADVANCED CONCEPTS. EXAM
QUESTIONS AND ANSWERS
1. A patient with ARDS is on mechanical ventilation with high PEEP. The nurse notes a sudden
drop in SpO2 and absent breath sounds on the right side. What is the priority action?
A. Prepare for immediate needle decompression
B. Perform endotracheal suctioning
C. Increase the FiO2 to 100%
D. Obtain a portable chest X-ray
Answer: A
Conceptual Explanation: High PEEP in ARDS increases the risk of barotrauma and
pneumothorax. Absent breath sounds and desaturation suggest a tension pneumothorax
requiring immediate decompression.
2. Which clinical finding is most indicative of the compensatory stage of shock?
A. Cold, clammy skin and metabolic acidosis
B. Anuria and lethargy
C. Narrowed pulse pressure and tachycardia
,D. Petechiae and mottled skin
Answer: C
Conceptual Explanation: In the compensatory stage, the body maintains BP via
tachycardia and vasoconstriction, leading to a narrowed pulse pressure. Cold skin and
acidosis occur in the progressive stage.
3. A patient with a T4 spinal cord injury reports a severe headache and has a BP of 190/110.
What is the nurse’s first intervention?
A. Administer IV hydralazine
B. Elevate the head of the bed to 90 degrees
C. Place the patient in a supine position
D. Check the patient’s bladder for distension
Answer: B
Conceptual Explanation: Autonomic dysreflexia is a medical emergency. The immediate
priority is to sit the patient up to induce orthostatic pressure reduction before checking for
the noxious stimulus (like a full bladder).
4. During the emergent phase of a 40% TBSA burn, which lab value does the nurse anticipate?
A. Hypernatremia
B. Hypokalemia
C. Increased Hematocrit
, D. Decreased BUN
Answer: C
Conceptual Explanation: In the emergent phase, fluid shifts out of the vascular space
(hemo-concentration), leading to an elevated hematocrit. Potassium increases due to cell
lysis.
5. A patient with cirrhosis and esophageal varices is prescribed Propranolol. What is the
primary purpose of this medication?
A. To treat systemic hypertension
B. To reduce portal venous pressure
C. To increase cardiac output
D. To prevent bacterial peritonitis
Answer: B
Conceptual Explanation: Non-selective beta-blockers like Propranolol reduce portal
pressure, thereby decreasing the risk of variceal bleeding.
6. Which EKG change is most characteristic of hyperkalemia in a patient with Acute Kidney
Injury?
A. Prominent U waves
B. ST-segment depression
C. Prolonged QT interval
2 ADVANCED CONCEPTS. EXAM
QUESTIONS AND ANSWERS
1. A patient with ARDS is on mechanical ventilation with high PEEP. The nurse notes a sudden
drop in SpO2 and absent breath sounds on the right side. What is the priority action?
A. Prepare for immediate needle decompression
B. Perform endotracheal suctioning
C. Increase the FiO2 to 100%
D. Obtain a portable chest X-ray
Answer: A
Conceptual Explanation: High PEEP in ARDS increases the risk of barotrauma and
pneumothorax. Absent breath sounds and desaturation suggest a tension pneumothorax
requiring immediate decompression.
2. Which clinical finding is most indicative of the compensatory stage of shock?
A. Cold, clammy skin and metabolic acidosis
B. Anuria and lethargy
C. Narrowed pulse pressure and tachycardia
,D. Petechiae and mottled skin
Answer: C
Conceptual Explanation: In the compensatory stage, the body maintains BP via
tachycardia and vasoconstriction, leading to a narrowed pulse pressure. Cold skin and
acidosis occur in the progressive stage.
3. A patient with a T4 spinal cord injury reports a severe headache and has a BP of 190/110.
What is the nurse’s first intervention?
A. Administer IV hydralazine
B. Elevate the head of the bed to 90 degrees
C. Place the patient in a supine position
D. Check the patient’s bladder for distension
Answer: B
Conceptual Explanation: Autonomic dysreflexia is a medical emergency. The immediate
priority is to sit the patient up to induce orthostatic pressure reduction before checking for
the noxious stimulus (like a full bladder).
4. During the emergent phase of a 40% TBSA burn, which lab value does the nurse anticipate?
A. Hypernatremia
B. Hypokalemia
C. Increased Hematocrit
, D. Decreased BUN
Answer: C
Conceptual Explanation: In the emergent phase, fluid shifts out of the vascular space
(hemo-concentration), leading to an elevated hematocrit. Potassium increases due to cell
lysis.
5. A patient with cirrhosis and esophageal varices is prescribed Propranolol. What is the
primary purpose of this medication?
A. To treat systemic hypertension
B. To reduce portal venous pressure
C. To increase cardiac output
D. To prevent bacterial peritonitis
Answer: B
Conceptual Explanation: Non-selective beta-blockers like Propranolol reduce portal
pressure, thereby decreasing the risk of variceal bleeding.
6. Which EKG change is most characteristic of hyperkalemia in a patient with Acute Kidney
Injury?
A. Prominent U waves
B. ST-segment depression
C. Prolonged QT interval
