GALEN NUR 242 COMPREHENSIVE
MED SURG EXAM QUESTIONS AND
ANSWERS
1. A patient with chronic kidney disease presents with a serum potassium level of 6.8 mEq/L.
Which ECG change should the nurse expect to see first?
A. Tall, peaked T waves
B. Prominent U waves
C. ST-segment depression
D. Shortened PR interval
Answer: A
Conceptual Explanation: Hyperkalemia (K+ > 5.0) causes tall, peaked T waves. As levels
rise, the QRS widens and the P wave may disappear, eventually leading to ventricular
fibrillation.
2. A patient is admitted with suspected Diabetic Ketoacidosis (DKA). Which arterial blood gas
(ABG) result is most consistent with this diagnosis?
A. pH 7.30, PaCO2 30, HCO3 16
,B. pH 7.48, PaCO2 32, HCO3 22
C. pH 7.32, PaCO2 50, HCO3 28
D. pH 7.50, PaCO2 45, HCO3 34
Answer: A
Conceptual Explanation: DKA results in metabolic acidosis with respiratory
compensation. A low pH (< 7.35) and low HCO3 (< 22) signify metabolic acidosis, while the
low PaCO2 shows the lungs are trying to blow off CO2 (Kussmaul respirations).
3. A nurse is caring for a patient who is 24 hours post-thyroidectomy. The patient reports
tingling in the fingers and around the mouth. Which action should the nurse take first?
A. Assess for Chvostek’s sign
B. Administer a dose of levothyroxine
C. Check the blood pressure for hypertension
D. Assess the surgical dressing for bleeding
Answer: A
Conceptual Explanation: Tingling around the mouth (circumoral paresthesia) and fingers
are early signs of hypocalcemia, often caused by accidental removal of the parathyroid
glands during surgery. Chvostek’s sign (facial twitching) confirms neuromuscular
irritability.
, 4. Which clinical manifestation is a hallmark sign of Left-Sided Heart Failure?
A. Jugular Venous Distention (JVD)
B. Dependent peripheral edema
C. Crackles in the lung bases
D. Hepatosplenomegaly
Answer: C
Conceptual Explanation: Left-sided heart failure leads to pulmonary congestion because
the left ventricle cannot pump blood forward, causing it to back up into the lungs. JVD,
edema, and hepatosplenomegaly are signs of Right-sided heart failure.
5. An elderly patient is being treated for a Hip Fracture. Which assessment finding should the
nurse prioritize as a potential complication of fat embolism syndrome?
A. Paresthesia and cool skin distal to the injury
B. Decreased bowel sounds and abdominal distention
C. Localized pain and swelling at the fracture site
D. Sudden onset of confusion and petechiae on the chest
Answer: D
Conceptual Explanation: Fat embolism syndrome typically occurs 24-48 hours after a
long bone or hip fracture. Classic signs include respiratory distress, confusion (due to
cerebral emboli), and a petechial rash on the chest or neck.
MED SURG EXAM QUESTIONS AND
ANSWERS
1. A patient with chronic kidney disease presents with a serum potassium level of 6.8 mEq/L.
Which ECG change should the nurse expect to see first?
A. Tall, peaked T waves
B. Prominent U waves
C. ST-segment depression
D. Shortened PR interval
Answer: A
Conceptual Explanation: Hyperkalemia (K+ > 5.0) causes tall, peaked T waves. As levels
rise, the QRS widens and the P wave may disappear, eventually leading to ventricular
fibrillation.
2. A patient is admitted with suspected Diabetic Ketoacidosis (DKA). Which arterial blood gas
(ABG) result is most consistent with this diagnosis?
A. pH 7.30, PaCO2 30, HCO3 16
,B. pH 7.48, PaCO2 32, HCO3 22
C. pH 7.32, PaCO2 50, HCO3 28
D. pH 7.50, PaCO2 45, HCO3 34
Answer: A
Conceptual Explanation: DKA results in metabolic acidosis with respiratory
compensation. A low pH (< 7.35) and low HCO3 (< 22) signify metabolic acidosis, while the
low PaCO2 shows the lungs are trying to blow off CO2 (Kussmaul respirations).
3. A nurse is caring for a patient who is 24 hours post-thyroidectomy. The patient reports
tingling in the fingers and around the mouth. Which action should the nurse take first?
A. Assess for Chvostek’s sign
B. Administer a dose of levothyroxine
C. Check the blood pressure for hypertension
D. Assess the surgical dressing for bleeding
Answer: A
Conceptual Explanation: Tingling around the mouth (circumoral paresthesia) and fingers
are early signs of hypocalcemia, often caused by accidental removal of the parathyroid
glands during surgery. Chvostek’s sign (facial twitching) confirms neuromuscular
irritability.
, 4. Which clinical manifestation is a hallmark sign of Left-Sided Heart Failure?
A. Jugular Venous Distention (JVD)
B. Dependent peripheral edema
C. Crackles in the lung bases
D. Hepatosplenomegaly
Answer: C
Conceptual Explanation: Left-sided heart failure leads to pulmonary congestion because
the left ventricle cannot pump blood forward, causing it to back up into the lungs. JVD,
edema, and hepatosplenomegaly are signs of Right-sided heart failure.
5. An elderly patient is being treated for a Hip Fracture. Which assessment finding should the
nurse prioritize as a potential complication of fat embolism syndrome?
A. Paresthesia and cool skin distal to the injury
B. Decreased bowel sounds and abdominal distention
C. Localized pain and swelling at the fracture site
D. Sudden onset of confusion and petechiae on the chest
Answer: D
Conceptual Explanation: Fat embolism syndrome typically occurs 24-48 hours after a
long bone or hip fracture. Classic signs include respiratory distress, confusion (due to
cerebral emboli), and a petechial rash on the chest or neck.
