ADVANCED MEDICAL-SURGICAL
NURSING COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A client with a history of chronic heart failure presents with increased dyspnea and crackles
in the lung bases. Which physiological mechanism most likely explains these symptoms?
A. Decreased peripheral vascular resistance
B. Decreased left ventricular contractility leading to pulmonary venous congestion
C. Increased right ventricular afterload
D. Increased systemic venous pressure
Answer: B
Conceptual Explanation: Left-sided heart failure leads to decreased cardiac output and
blood backing up into the pulmonary circulation, causing pulmonary edema and
respiratory symptoms.
2. An arterial blood gas (ABG) result shows pH 7.30, PaCO2 52 mmHg, and HCO3 24 mEq/L.
How should the nurse interpret these findings?
A. Respiratory Acidosis
,B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: A
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
with a normal bicarbonate level confirms the origin is respiratory.
3. A patient is admitted with suspected Cushing’s Triad due to increased intracranial pressure
(ICP). Which set of vital signs is most consistent with this condition?
A. Tachycardia, Hypotension, Tachypnea
B. Tachycardia, Hypertension, Bradypnea
C. Bradycardia, Hypotension, Bradypnea
D. Bradycardia, Hypertension with widening pulse pressure, Irregular respirations
Answer: D
Conceptual Explanation: Cushing’s Triad is a late sign of increased ICP characterized by a
slow heart rate, rising systolic blood pressure with a wide pulse pressure, and abnormal
breathing patterns.
4. A client is diagnosed with Diabetic Ketoacidosis (DKA). Which clinical manifestation should
the nurse expect to observe?
A. Bradycardia and hypertension
, B. Moist skin and tremors
C. Kussmaul respirations and fruity breath odor
D. Peripheral edema and weight gain
Answer: C
Conceptual Explanation: DKA results in metabolic acidosis, which the body tries to
compensate for via deep, rapid Kussmaul respirations. The breakdown of ketones produces
a characteristic fruity breath.
5. A nurse is caring for a client post-thyroidectomy. The client reports numbness and tingling
around the mouth. Which action should the nurse take first?
A. Encourage the client to use an incentive spirometer
B. Increase the intravenous infusion rate
C. Administer a prescribed sedative
D. Check for a positive Trousseau’s sign
Answer: D
Conceptual Explanation: Numbness and tingling (paresthesia) after thyroid surgery
suggest hypocalcemia due to accidental parathyroid damage. Trousseau’s sign assesses for
neuromuscular irritability associated with low calcium.
NURSING COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A client with a history of chronic heart failure presents with increased dyspnea and crackles
in the lung bases. Which physiological mechanism most likely explains these symptoms?
A. Decreased peripheral vascular resistance
B. Decreased left ventricular contractility leading to pulmonary venous congestion
C. Increased right ventricular afterload
D. Increased systemic venous pressure
Answer: B
Conceptual Explanation: Left-sided heart failure leads to decreased cardiac output and
blood backing up into the pulmonary circulation, causing pulmonary edema and
respiratory symptoms.
2. An arterial blood gas (ABG) result shows pH 7.30, PaCO2 52 mmHg, and HCO3 24 mEq/L.
How should the nurse interpret these findings?
A. Respiratory Acidosis
,B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: A
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
with a normal bicarbonate level confirms the origin is respiratory.
3. A patient is admitted with suspected Cushing’s Triad due to increased intracranial pressure
(ICP). Which set of vital signs is most consistent with this condition?
A. Tachycardia, Hypotension, Tachypnea
B. Tachycardia, Hypertension, Bradypnea
C. Bradycardia, Hypotension, Bradypnea
D. Bradycardia, Hypertension with widening pulse pressure, Irregular respirations
Answer: D
Conceptual Explanation: Cushing’s Triad is a late sign of increased ICP characterized by a
slow heart rate, rising systolic blood pressure with a wide pulse pressure, and abnormal
breathing patterns.
4. A client is diagnosed with Diabetic Ketoacidosis (DKA). Which clinical manifestation should
the nurse expect to observe?
A. Bradycardia and hypertension
, B. Moist skin and tremors
C. Kussmaul respirations and fruity breath odor
D. Peripheral edema and weight gain
Answer: C
Conceptual Explanation: DKA results in metabolic acidosis, which the body tries to
compensate for via deep, rapid Kussmaul respirations. The breakdown of ketones produces
a characteristic fruity breath.
5. A nurse is caring for a client post-thyroidectomy. The client reports numbness and tingling
around the mouth. Which action should the nurse take first?
A. Encourage the client to use an incentive spirometer
B. Increase the intravenous infusion rate
C. Administer a prescribed sedative
D. Check for a positive Trousseau’s sign
Answer: D
Conceptual Explanation: Numbness and tingling (paresthesia) after thyroid surgery
suggest hypocalcemia due to accidental parathyroid damage. Trousseau’s sign assesses for
neuromuscular irritability associated with low calcium.
