NUR 209 MEDICAL-SURGICAL NURSING
II ADVANCED COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated
with PEEP. Which finding should the nurse prioritize as a potential complication of high PEEP
settings?
A. Subcutaneous emphysema and pneumothorax
B. Increased cardiac output
C. Improved renal perfusion
D. Decreased intracranial pressure
Answer: A
Conceptual Explanation: High Positive End-Expiratory Pressure (PEEP) increases
intrathoracic pressure, which can lead to barotrauma, such as pneumothorax or
subcutaneous emphysema, and can also decrease venous return, reducing cardiac output.
,2. Which arterial blood gas (ABG) result is most indicative of a patient in the early stages of a
massive pulmonary embolism?
A. pH 7.30, PaCO2 55, HCO3 26
B. pH 7.25, PaCO2 35, HCO3 18
C. pH 7.35, PaCO2 45, HCO3 28
D. pH 7.48, PaCO2 30, HCO3 22
Answer: D
Conceptual Explanation: Early in a pulmonary embolism, patients typically
hyperventilate due to hypoxia and anxiety, leading to respiratory alkalosis (high pH and
low PaCO2).
3. A patient is admitted with a diagnosis of pheochromocytoma. Which clinical manifestation
should the nurse monitor for most closely during the pre-operative period?
A. Severe orthostatic hypotension
B. Bradycardia and bradypnea
C. Hypoglycemic episodes
D. Profuse diaphoresis and tachycardia
Answer: D
, Conceptual Explanation: Pheochromocytoma is a catecholamine-secreting tumor of the
adrenal medulla. The hallmark symptoms include the triad of headache, tachycardia, and
profuse diaphoresis, along with severe hypertension.
4. A patient with Chronic Kidney Disease (CKD) presents with a potassium level of 6.8 mEq/L.
Which EKG change is the nurse most likely to observe?
A. Prominent U waves
B. Prolonged QT interval
C. Tall, peaked T waves
D. ST-segment depression
Answer: C
Conceptual Explanation: Hyperkalemia (K+ > 5.0 mEq/L) typically manifests on an EKG
as tall, peaked T waves. As it worsens, the QRS widens and the P wave may disappear,
eventually leading to sine wave patterns or cardiac arrest.
5. A patient is in the compensatory stage of shock. Which physiological finding should the
nurse expect?
A. Increased urine output
B. Vasodilation in the skin
C. Respiratory acidosis
D. Narrowing pulse pressure
II ADVANCED COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated
with PEEP. Which finding should the nurse prioritize as a potential complication of high PEEP
settings?
A. Subcutaneous emphysema and pneumothorax
B. Increased cardiac output
C. Improved renal perfusion
D. Decreased intracranial pressure
Answer: A
Conceptual Explanation: High Positive End-Expiratory Pressure (PEEP) increases
intrathoracic pressure, which can lead to barotrauma, such as pneumothorax or
subcutaneous emphysema, and can also decrease venous return, reducing cardiac output.
,2. Which arterial blood gas (ABG) result is most indicative of a patient in the early stages of a
massive pulmonary embolism?
A. pH 7.30, PaCO2 55, HCO3 26
B. pH 7.25, PaCO2 35, HCO3 18
C. pH 7.35, PaCO2 45, HCO3 28
D. pH 7.48, PaCO2 30, HCO3 22
Answer: D
Conceptual Explanation: Early in a pulmonary embolism, patients typically
hyperventilate due to hypoxia and anxiety, leading to respiratory alkalosis (high pH and
low PaCO2).
3. A patient is admitted with a diagnosis of pheochromocytoma. Which clinical manifestation
should the nurse monitor for most closely during the pre-operative period?
A. Severe orthostatic hypotension
B. Bradycardia and bradypnea
C. Hypoglycemic episodes
D. Profuse diaphoresis and tachycardia
Answer: D
, Conceptual Explanation: Pheochromocytoma is a catecholamine-secreting tumor of the
adrenal medulla. The hallmark symptoms include the triad of headache, tachycardia, and
profuse diaphoresis, along with severe hypertension.
4. A patient with Chronic Kidney Disease (CKD) presents with a potassium level of 6.8 mEq/L.
Which EKG change is the nurse most likely to observe?
A. Prominent U waves
B. Prolonged QT interval
C. Tall, peaked T waves
D. ST-segment depression
Answer: C
Conceptual Explanation: Hyperkalemia (K+ > 5.0 mEq/L) typically manifests on an EKG
as tall, peaked T waves. As it worsens, the QRS widens and the P wave may disappear,
eventually leading to sine wave patterns or cardiac arrest.
5. A patient is in the compensatory stage of shock. Which physiological finding should the
nurse expect?
A. Increased urine output
B. Vasodilation in the skin
C. Respiratory acidosis
D. Narrowing pulse pressure
