NUR 209 MEDICAL-SURGICAL NURSING
II ADVANCED COMPREHENSIVE
EXAMINATION QUESTIONS AND
ANSWERS
1. A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 22 mmHg.
Which of the following nursing interventions is prioritized to maintain cerebral perfusion
pressure (CPP)?
A. Flex the patient’s hips to decrease intra-abdominal pressure.
B. Perform frequent endotracheal suctioning to ensure airway patency.
C. Administer hypotonic saline IV to reduce cerebral edema.
D. Maintain the head of the bed at 30 degrees and head in a neutral position.
Answer: D
Conceptual Explanation: Normal ICP is 5-15 mmHg; 22 is elevated. Elevating the HOB to
30 degrees and keeping the neck neutral promotes venous drainage from the brain,
reducing ICP. Hip flexion and frequent suctioning increase ICP. Hypotonic solutions
increase cerebral edema; hypertonic solutions are used instead.
,2. A patient is admitted in Diabetic Ketoacidosis (DKA) with a blood glucose of 550 mg/dL and
a serum potassium of 3.3 mEq/L. What is the nurse’s priority action?
A. Administer potassium replacement prior to initiating insulin therapy.
B. Initiate a high-dose intravenous insulin bolus immediately.
C. Administer intravenous sodium bicarbonate to correct acidosis.
D. Start a rapid infusion of 0.45% normal saline.
Answer: A
Conceptual Explanation: Insulin causes potassium to shift into the cells, which can lead to
life-threatening hypokalemia. If the baseline potassium is already low (normal 3.5-5.0), it
must be replaced before insulin is started to prevent cardiac arrest.
3. Which clinical finding most strongly suggests the development of Cardiac Tamponade in a
patient following a pericardiectomy?
A. Systolic hypertension and bounding pulses.
B. ST-segment elevation in all leads.
C. Flattened neck veins and bradycardia.
D. Muffled heart sounds and Pulsus Paradoxus.
Answer: D
, Conceptual Explanation: Beck’s Triad for cardiac tamponade includes muffled heart
sounds, JVD, and hypotension. Pulsus Paradoxus (a drop in systolic BP > 10 mmHg during
inspiration) is a hallmark sign of the heart being compressed.
4. A patient with Acute Respiratory Distress Syndrome (ARDS) is being mechanically
ventilated. The nurse notes the PEEP is set to 15 cm H2O. Which complication should the
nurse monitor for most closely?
A. Respiratory alkalosis.
B. Increased cardiac output.
C. Decreased intracranial pressure.
D. Pneumothorax due to barotrauma.
Answer: D
Conceptual Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase
the risk of barotrauma, which can lead to a pneumothorax. High PEEP also increases
intrathoracic pressure, which decreases venous return and cardiac output, and may
increase ICP.
5. A patient with Chronic Kidney Disease (CKD) presents with a serum phosphorus level of 6.2
mg/dL. Which medication order does the nurse anticipate?
A. Calcitriol (Rocaltrol) taken at bedtime.
B. Calcium carbonate (Tums) taken with meals.
C. Aluminum hydroxide taken between meals.
II ADVANCED COMPREHENSIVE
EXAMINATION QUESTIONS AND
ANSWERS
1. A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 22 mmHg.
Which of the following nursing interventions is prioritized to maintain cerebral perfusion
pressure (CPP)?
A. Flex the patient’s hips to decrease intra-abdominal pressure.
B. Perform frequent endotracheal suctioning to ensure airway patency.
C. Administer hypotonic saline IV to reduce cerebral edema.
D. Maintain the head of the bed at 30 degrees and head in a neutral position.
Answer: D
Conceptual Explanation: Normal ICP is 5-15 mmHg; 22 is elevated. Elevating the HOB to
30 degrees and keeping the neck neutral promotes venous drainage from the brain,
reducing ICP. Hip flexion and frequent suctioning increase ICP. Hypotonic solutions
increase cerebral edema; hypertonic solutions are used instead.
,2. A patient is admitted in Diabetic Ketoacidosis (DKA) with a blood glucose of 550 mg/dL and
a serum potassium of 3.3 mEq/L. What is the nurse’s priority action?
A. Administer potassium replacement prior to initiating insulin therapy.
B. Initiate a high-dose intravenous insulin bolus immediately.
C. Administer intravenous sodium bicarbonate to correct acidosis.
D. Start a rapid infusion of 0.45% normal saline.
Answer: A
Conceptual Explanation: Insulin causes potassium to shift into the cells, which can lead to
life-threatening hypokalemia. If the baseline potassium is already low (normal 3.5-5.0), it
must be replaced before insulin is started to prevent cardiac arrest.
3. Which clinical finding most strongly suggests the development of Cardiac Tamponade in a
patient following a pericardiectomy?
A. Systolic hypertension and bounding pulses.
B. ST-segment elevation in all leads.
C. Flattened neck veins and bradycardia.
D. Muffled heart sounds and Pulsus Paradoxus.
Answer: D
, Conceptual Explanation: Beck’s Triad for cardiac tamponade includes muffled heart
sounds, JVD, and hypotension. Pulsus Paradoxus (a drop in systolic BP > 10 mmHg during
inspiration) is a hallmark sign of the heart being compressed.
4. A patient with Acute Respiratory Distress Syndrome (ARDS) is being mechanically
ventilated. The nurse notes the PEEP is set to 15 cm H2O. Which complication should the
nurse monitor for most closely?
A. Respiratory alkalosis.
B. Increased cardiac output.
C. Decreased intracranial pressure.
D. Pneumothorax due to barotrauma.
Answer: D
Conceptual Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase
the risk of barotrauma, which can lead to a pneumothorax. High PEEP also increases
intrathoracic pressure, which decreases venous return and cardiac output, and may
increase ICP.
5. A patient with Chronic Kidney Disease (CKD) presents with a serum phosphorus level of 6.2
mg/dL. Which medication order does the nurse anticipate?
A. Calcitriol (Rocaltrol) taken at bedtime.
B. Calcium carbonate (Tums) taken with meals.
C. Aluminum hydroxide taken between meals.
