NUR 209 MEDICAL-SURGICAL NURSING
II ADVANCED PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A client is admitted with Acute Respiratory Distress Syndrome (ARDS). Which clinical
finding should the nurse anticipate during the early stages of this condition?
A. Significant metabolic alkalosis
B. Generalized wheezing and stridor
C. Tachypnea and restlessness
D. Severe hypercapnia and lethargy
Answer: C
Conceptual Explanation: Early ARDS is characterized by rapid breathing (tachypnea) and
restlessness due to hypoxemia. Hypercapnia and lethargy occur later as respiratory failure
progresses.
2. A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is receiving
oxygen at 2L/min via nasal cannula. The nurse notes the patient’s PaO2 is 60 mmHg and
PaCO2 is 52 mmHg. What is the most appropriate nursing action?
A. Continue to monitor the patient
,B. Increase oxygen flow to 6L/min
C. Prepare for immediate intubation
D. Administer a rapid bolus of IV fluids
Answer: A
Conceptual Explanation: In COPD patients, a PaO2 of 60 mmHg and a slightly elevated
PaCO2 are often baseline findings. Over-oxygenation can suppress the hypoxic drive to
breathe.
3. A nurse is caring for a patient who had a subtotal thyroidectomy 24 hours ago. The patient
reports numbness and tingling in the fingers and around the mouth. Which action is the
priority?
A. Assess for Chvostek’s sign
B. Check the patient’s serum potassium level
C. Administer a prescribed analgesic
D. Encourage the patient to cough and deep breathe
Answer: A
Conceptual Explanation: Paresthesia after thyroid surgery suggests hypocalcemia due to
accidental parathyroid damage. Assessing Chvostek’s sign identifies neuromuscular
irritability.
, 4. Which cardiac rhythm is characterized by a lack of discernible P waves and an irregularly
irregular R-R interval?
A. Atrial Flutter
B. Ventricular Tachycardia
C. Atrial Fibrillation
D. Third-degree Heart Block
Answer: C
Conceptual Explanation: Atrial fibrillation is defined by the absence of P waves and an
irregular ventricular response (irregularly irregular rhythm).
5. A patient is experiencing Cushing’s Triad after a head injury. Which set of vital signs aligns
with this condition?
A. BP 90/60, Pulse 120, RR 24
B. BP 180/60, Pulse 50, RR 10 and irregular
C. BP 120/80, Pulse 80, RR 16
D. BP 200/110, Pulse 110, RR 28
Answer: B
Conceptual Explanation: Cushing’s Triad indicates increased intracranial pressure and
consists of bradycardia, widening pulse pressure (systolic HTN), and irregular respirations.
II ADVANCED PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A client is admitted with Acute Respiratory Distress Syndrome (ARDS). Which clinical
finding should the nurse anticipate during the early stages of this condition?
A. Significant metabolic alkalosis
B. Generalized wheezing and stridor
C. Tachypnea and restlessness
D. Severe hypercapnia and lethargy
Answer: C
Conceptual Explanation: Early ARDS is characterized by rapid breathing (tachypnea) and
restlessness due to hypoxemia. Hypercapnia and lethargy occur later as respiratory failure
progresses.
2. A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is receiving
oxygen at 2L/min via nasal cannula. The nurse notes the patient’s PaO2 is 60 mmHg and
PaCO2 is 52 mmHg. What is the most appropriate nursing action?
A. Continue to monitor the patient
,B. Increase oxygen flow to 6L/min
C. Prepare for immediate intubation
D. Administer a rapid bolus of IV fluids
Answer: A
Conceptual Explanation: In COPD patients, a PaO2 of 60 mmHg and a slightly elevated
PaCO2 are often baseline findings. Over-oxygenation can suppress the hypoxic drive to
breathe.
3. A nurse is caring for a patient who had a subtotal thyroidectomy 24 hours ago. The patient
reports numbness and tingling in the fingers and around the mouth. Which action is the
priority?
A. Assess for Chvostek’s sign
B. Check the patient’s serum potassium level
C. Administer a prescribed analgesic
D. Encourage the patient to cough and deep breathe
Answer: A
Conceptual Explanation: Paresthesia after thyroid surgery suggests hypocalcemia due to
accidental parathyroid damage. Assessing Chvostek’s sign identifies neuromuscular
irritability.
, 4. Which cardiac rhythm is characterized by a lack of discernible P waves and an irregularly
irregular R-R interval?
A. Atrial Flutter
B. Ventricular Tachycardia
C. Atrial Fibrillation
D. Third-degree Heart Block
Answer: C
Conceptual Explanation: Atrial fibrillation is defined by the absence of P waves and an
irregular ventricular response (irregularly irregular rhythm).
5. A patient is experiencing Cushing’s Triad after a head injury. Which set of vital signs aligns
with this condition?
A. BP 90/60, Pulse 120, RR 24
B. BP 180/60, Pulse 50, RR 10 and irregular
C. BP 120/80, Pulse 80, RR 16
D. BP 200/110, Pulse 110, RR 28
Answer: B
Conceptual Explanation: Cushing’s Triad indicates increased intracranial pressure and
consists of bradycardia, widening pulse pressure (systolic HTN), and irregular respirations.
