NUR 242 MED-SURG NURSING EXAM 1
COMPREHENSIVE QUESTIONS AND
ANSWERS
1. A patient with a history of chronic kidney disease presents with a potassium level of 6.2
mEq/L. Which ECG change should the nurse prioritize as an immediate threat?
A. Prominent U waves
B. Peaked T waves
C. Shortened QT interval
D. ST-segment depression
Answer: B
Conceptual Explanation: Hyperkalemia (K+ > 5.0) causes peaked T waves, widened QRS,
and can progress to ventricular fibrillation or asystole. U waves are associated with
hypokalemia.
2. When assessing a patient in the compensatory stage of shock, which finding is most
characteristic?
A. Cold, clammy skin and metabolic acidosis
,B. Normal blood pressure with increased heart rate
C. Mean arterial pressure (MAP) decrease of 20 mmHg from baseline
D. Anuria and lethargy
Answer: B
Conceptual Explanation: In the compensatory stage of shock, the body maintains blood
pressure within normal limits through vasoconstriction and increased heart rate, even
though tissue perfusion is starting to decrease.
3. An elderly patient is 12 hours post-abdominal surgery. The nurse notes the patient is
confused and has an oxygen saturation of 88% on room air. What is the nurse’s first priority?
A. Apply oxygen and perform a respiratory assessment
B. Increase the IV fluid rate
C. Encourage the use of an incentive spirometer
D. Administer prescribed PRN pain medication
Answer: A
Conceptual Explanation: Postoperative confusion and hypoxia in the elderly are red flags
for respiratory complications or pulmonary embolism. The nurse should immediately
apply oxygen and assess breath sounds.
, 4. A patient is diagnosed with Respiratory Acidosis. Which arterial blood gas (ABG) result
matches this diagnosis?
A. pH 7.30, PaCO2 52, HCO3 24
B. pH 7.32, PaCO2 35, HCO3 18
C. pH 7.50, PaCO2 30, HCO3 22
D. pH 7.48, PaCO2 45, HCO3 30
Answer: A
Conceptual Explanation: Respiratory acidosis is characterized by a low pH (<7.35) and an
elevated PaCO2 (>45 mmHg) with a normal or compensating bicarbonate level.
5. During a surgical procedure, the patient develops a heart rate of 130 bpm, muscle rigidity,
and a rapidly rising temperature of 104°F. Which medication must the nurse prepare?
A. Dantrolene sodium
B. Epinephrine
C. Atropine sulfate
D. Sodium nitroprusside
Answer: A
Conceptual Explanation: These are classic signs of Malignant Hyperthermia, a life-
threatening reaction to general anesthesia. Dantrolene is the specific skeletal muscle
relaxant used to treat it.
COMPREHENSIVE QUESTIONS AND
ANSWERS
1. A patient with a history of chronic kidney disease presents with a potassium level of 6.2
mEq/L. Which ECG change should the nurse prioritize as an immediate threat?
A. Prominent U waves
B. Peaked T waves
C. Shortened QT interval
D. ST-segment depression
Answer: B
Conceptual Explanation: Hyperkalemia (K+ > 5.0) causes peaked T waves, widened QRS,
and can progress to ventricular fibrillation or asystole. U waves are associated with
hypokalemia.
2. When assessing a patient in the compensatory stage of shock, which finding is most
characteristic?
A. Cold, clammy skin and metabolic acidosis
,B. Normal blood pressure with increased heart rate
C. Mean arterial pressure (MAP) decrease of 20 mmHg from baseline
D. Anuria and lethargy
Answer: B
Conceptual Explanation: In the compensatory stage of shock, the body maintains blood
pressure within normal limits through vasoconstriction and increased heart rate, even
though tissue perfusion is starting to decrease.
3. An elderly patient is 12 hours post-abdominal surgery. The nurse notes the patient is
confused and has an oxygen saturation of 88% on room air. What is the nurse’s first priority?
A. Apply oxygen and perform a respiratory assessment
B. Increase the IV fluid rate
C. Encourage the use of an incentive spirometer
D. Administer prescribed PRN pain medication
Answer: A
Conceptual Explanation: Postoperative confusion and hypoxia in the elderly are red flags
for respiratory complications or pulmonary embolism. The nurse should immediately
apply oxygen and assess breath sounds.
, 4. A patient is diagnosed with Respiratory Acidosis. Which arterial blood gas (ABG) result
matches this diagnosis?
A. pH 7.30, PaCO2 52, HCO3 24
B. pH 7.32, PaCO2 35, HCO3 18
C. pH 7.50, PaCO2 30, HCO3 22
D. pH 7.48, PaCO2 45, HCO3 30
Answer: A
Conceptual Explanation: Respiratory acidosis is characterized by a low pH (<7.35) and an
elevated PaCO2 (>45 mmHg) with a normal or compensating bicarbonate level.
5. During a surgical procedure, the patient develops a heart rate of 130 bpm, muscle rigidity,
and a rapidly rising temperature of 104°F. Which medication must the nurse prepare?
A. Dantrolene sodium
B. Epinephrine
C. Atropine sulfate
D. Sodium nitroprusside
Answer: A
Conceptual Explanation: These are classic signs of Malignant Hyperthermia, a life-
threatening reaction to general anesthesia. Dantrolene is the specific skeletal muscle
relaxant used to treat it.
