NUR 209 MED SURG 2 FINAL EXAM
QUESTIONS AND ANSWERS
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation
with a high PEEP setting. The nurse notes a sudden drop in blood pressure and decreased
breath sounds on the right side. What is the priority nursing action?
A. Increase the FiO2 to 100%
B. Suction the patient to clear secretions
C. Prepare for immediate needle decompression or chest tube insertion
D. Administer a bolus of IV fluids
Answer: C
Conceptual Explanation: High PEEP increases the risk of barotrauma, leading to a tension
pneumothorax. A sudden drop in BP and unilateral decreased breath sounds are classic
signs necessitating immediate decompression.
2. When managing a patient in the ‘cold shock’ phase of septic shock, which hemodynamic
finding should the nurse anticipate?
A. Decreased Central Venous Pressure (CVP)
B. Increased Cardiac Output
,C. Increased Systemic Vascular Resistance (SVR)
D. Vasodilation and flushed skin
Answer: C
Conceptual Explanation: In late or ‘cold’ septic shock, the body attempts to compensate
for low output via massive vasoconstriction, leading to an increased SVR and cool, clammy
skin.
3. A patient with a history of Chronic Kidney Disease (CKD) presents with a potassium level of
7.2 mEq/L and peaked T-waves. Which medication should the nurse administer first to
protect the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Insulin and Dextrose
D. Sodium Bicarbonate
Answer: B
Conceptual Explanation: Calcium Gluconate does not lower potassium, but it stabilizes
the myocardial membrane to prevent lethal arrhythmias while other therapies work to
shift or remove potassium.
, 4. A patient with a T6 spinal cord injury reports a sudden, throbbing headache and is found to
have a BP of 210/110 mmHg. What is the first action the nurse should take?
A. Administer PRN Nifedipine
B. Catheterize the patient immediately
C. Place the patient in a high-Fowler’s position
D. Notify the physician
Answer: C
Conceptual Explanation: The symptoms indicate Autonomic Dysreflexia. Elevating the
head of the bed to 45-90 degrees (high-Fowler’s) is the immediate priority to help lower
blood pressure via orthostatic effect.
5. A patient is admitted with Acute Pancreatitis. Which laboratory finding is the most specific
indicator of pancreatic cell injury?
A. Elevated Serum Lipase
B. Elevated Serum Amylase
C. Elevated White Blood Cell count
D. Decreased Serum Calcium
Answer: A
Conceptual Explanation: While both amylase and lipase rise, lipase is more specific to the
pancreas and remains elevated longer, making it a better diagnostic tool.
QUESTIONS AND ANSWERS
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation
with a high PEEP setting. The nurse notes a sudden drop in blood pressure and decreased
breath sounds on the right side. What is the priority nursing action?
A. Increase the FiO2 to 100%
B. Suction the patient to clear secretions
C. Prepare for immediate needle decompression or chest tube insertion
D. Administer a bolus of IV fluids
Answer: C
Conceptual Explanation: High PEEP increases the risk of barotrauma, leading to a tension
pneumothorax. A sudden drop in BP and unilateral decreased breath sounds are classic
signs necessitating immediate decompression.
2. When managing a patient in the ‘cold shock’ phase of septic shock, which hemodynamic
finding should the nurse anticipate?
A. Decreased Central Venous Pressure (CVP)
B. Increased Cardiac Output
,C. Increased Systemic Vascular Resistance (SVR)
D. Vasodilation and flushed skin
Answer: C
Conceptual Explanation: In late or ‘cold’ septic shock, the body attempts to compensate
for low output via massive vasoconstriction, leading to an increased SVR and cool, clammy
skin.
3. A patient with a history of Chronic Kidney Disease (CKD) presents with a potassium level of
7.2 mEq/L and peaked T-waves. Which medication should the nurse administer first to
protect the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Insulin and Dextrose
D. Sodium Bicarbonate
Answer: B
Conceptual Explanation: Calcium Gluconate does not lower potassium, but it stabilizes
the myocardial membrane to prevent lethal arrhythmias while other therapies work to
shift or remove potassium.
, 4. A patient with a T6 spinal cord injury reports a sudden, throbbing headache and is found to
have a BP of 210/110 mmHg. What is the first action the nurse should take?
A. Administer PRN Nifedipine
B. Catheterize the patient immediately
C. Place the patient in a high-Fowler’s position
D. Notify the physician
Answer: C
Conceptual Explanation: The symptoms indicate Autonomic Dysreflexia. Elevating the
head of the bed to 45-90 degrees (high-Fowler’s) is the immediate priority to help lower
blood pressure via orthostatic effect.
5. A patient is admitted with Acute Pancreatitis. Which laboratory finding is the most specific
indicator of pancreatic cell injury?
A. Elevated Serum Lipase
B. Elevated Serum Amylase
C. Elevated White Blood Cell count
D. Decreased Serum Calcium
Answer: A
Conceptual Explanation: While both amylase and lipase rise, lipase is more specific to the
pancreas and remains elevated longer, making it a better diagnostic tool.
