ADVANCED MEDICAL-SURGICAL
NURSING COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A client diagnosed with left-sided heart failure is experiencing increasing dyspnea and
agitation. Which clinical finding should the nurse prioritize during the physical assessment?
A. Pitting edema in the lower extremities
B. Auscultation of crackles in the lung bases
C. Jugular venous distention when sitting upright
D. Hepatomegaly and abdominal tenderness
Answer: B
Conceptual Explanation: Left-sided heart failure causes blood to back up into the
pulmonary circulation, leading to pulmonary congestion and crackles. The other options
are primarily signs of right-sided heart failure.
2. A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is receiving
oxygen via a nasal cannula at 2 L/min. Which arterial blood gas (ABG) result would most likely
indicate the development of respiratory failure?
A. pH 7.36, PaCO2 45, HCO3 26
,B. pH 7.32, PaCO2 58, HCO3 30
C. pH 7.48, PaCO2 30, HCO3 22
D. pH 7.25, PaCO2 70, HCO3 28
Answer: D
Conceptual Explanation: Respiratory failure in COPD is characterized by severe
hypercapnia (high PaCO2) and respiratory acidosis (low pH). Option D shows a significant
drop in pH and a dangerously high CO2 level.
3. The nurse is caring for a client who underwent a total thyroidectomy. The client reports a
tingling sensation around the mouth and fingertips. Which action is most appropriate?
A. Check the client’s serum potassium level
B. Administer an ordered opioid analgesic
C. Place the client in a high-Fowler’s position
D. Assess for Chvostek’s sign
Answer: D
Conceptual Explanation: Tingling around the mouth (circumoral paresthesia) and
fingertips are early signs of hypocalcemia, which can occur if the parathyroid glands are
accidentally damaged during thyroid surgery. Chvostek’s sign is a clinical indicator of
hypocalcemia.
, 4. A client with Type 1 Diabetes Mellitus presents to the emergency department with fruity-
smelling breath, Kussmaul respirations, and a blood glucose of 450 mg/dL. Which intravenous
fluid should the nurse anticipate first?
A. 0.9% Normal Saline
B. 5% Dextrose in 0.45% Saline
C. 3% Hypertonic Saline
D. Lactated Ringer’s solution
Answer: A
Conceptual Explanation: In Diabetic Ketoacidosis (DKA), the priority is volume
resuscitation to treat dehydration. Isotonic saline (0.9% NS) is the initial fluid of choice.
5. When assessing a client with Cushing’s Syndrome, which clinical manifestation should the
nurse expect to observe?
A. Increased muscle mass in the extremities
B. Truncal obesity and a buffalo hump
C. Hyperpigmentation of the skin
D. Hypotension and weight loss
Answer: B
Conceptual Explanation: Cushing’s Syndrome, caused by excess cortisol, results in fat
redistribution leading to truncal obesity, a buffalo hump, and a moon face.
NURSING COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A client diagnosed with left-sided heart failure is experiencing increasing dyspnea and
agitation. Which clinical finding should the nurse prioritize during the physical assessment?
A. Pitting edema in the lower extremities
B. Auscultation of crackles in the lung bases
C. Jugular venous distention when sitting upright
D. Hepatomegaly and abdominal tenderness
Answer: B
Conceptual Explanation: Left-sided heart failure causes blood to back up into the
pulmonary circulation, leading to pulmonary congestion and crackles. The other options
are primarily signs of right-sided heart failure.
2. A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is receiving
oxygen via a nasal cannula at 2 L/min. Which arterial blood gas (ABG) result would most likely
indicate the development of respiratory failure?
A. pH 7.36, PaCO2 45, HCO3 26
,B. pH 7.32, PaCO2 58, HCO3 30
C. pH 7.48, PaCO2 30, HCO3 22
D. pH 7.25, PaCO2 70, HCO3 28
Answer: D
Conceptual Explanation: Respiratory failure in COPD is characterized by severe
hypercapnia (high PaCO2) and respiratory acidosis (low pH). Option D shows a significant
drop in pH and a dangerously high CO2 level.
3. The nurse is caring for a client who underwent a total thyroidectomy. The client reports a
tingling sensation around the mouth and fingertips. Which action is most appropriate?
A. Check the client’s serum potassium level
B. Administer an ordered opioid analgesic
C. Place the client in a high-Fowler’s position
D. Assess for Chvostek’s sign
Answer: D
Conceptual Explanation: Tingling around the mouth (circumoral paresthesia) and
fingertips are early signs of hypocalcemia, which can occur if the parathyroid glands are
accidentally damaged during thyroid surgery. Chvostek’s sign is a clinical indicator of
hypocalcemia.
, 4. A client with Type 1 Diabetes Mellitus presents to the emergency department with fruity-
smelling breath, Kussmaul respirations, and a blood glucose of 450 mg/dL. Which intravenous
fluid should the nurse anticipate first?
A. 0.9% Normal Saline
B. 5% Dextrose in 0.45% Saline
C. 3% Hypertonic Saline
D. Lactated Ringer’s solution
Answer: A
Conceptual Explanation: In Diabetic Ketoacidosis (DKA), the priority is volume
resuscitation to treat dehydration. Isotonic saline (0.9% NS) is the initial fluid of choice.
5. When assessing a client with Cushing’s Syndrome, which clinical manifestation should the
nurse expect to observe?
A. Increased muscle mass in the extremities
B. Truncal obesity and a buffalo hump
C. Hyperpigmentation of the skin
D. Hypotension and weight loss
Answer: B
Conceptual Explanation: Cushing’s Syndrome, caused by excess cortisol, results in fat
redistribution leading to truncal obesity, a buffalo hump, and a moon face.
