MEDICAL-SURGICAL NURSING EXAM 2
(NUR242) QUESTIONS AND ANSWERS
1. A patient presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 28 mEq/L. Which
acid-base imbalance is occurring?
A. Fully compensated respiratory acidosis
B. Partially compensated metabolic alkalosis
C. Uncompensated respiratory alkalosis
D. Partially compensated respiratory acidosis
Answer: D
Conceptual Explanation: The pH is acidic (<7.35), the PaCO2 is high (>45) indicating a
respiratory cause, and the HCO3 is elevated (>26) indicating the kidneys are attempting to
compensate, but the pH has not yet returned to normal range.
2. Which clinical manifestation is a hallmark sign of Autonomic Dysreflexia in a patient with a
T6 spinal cord injury?
A. Sudden hypotension and tachycardia
B. Extreme hypertension and a pounding headache
C. Flaccid paralysis and loss of reflexes below the injury
,D. Hyperthermia and dry skin throughout the body
Answer: B
Conceptual Explanation: Autonomic dysreflexia is a medical emergency characterized by
severe hypertension, pounding headache, and bradycardia, often triggered by a full bladder
or fecal impaction.
3. When caring for a patient in the oliguric phase of Acute Kidney Injury (AKI), which
electrolyte abnormality is the nurse most likely to observe?
A. Hypokalemia
B. Hyperkalemia
C. Hypercalcemia
D. Hypophosphatemia
Answer: B
Conceptual Explanation: In the oliguric phase of AKI, the kidneys’ inability to excrete
potassium leads to hyperkalemia, which is potentially life-threatening due to cardiac
arrhythmias.
4. A patient with SIADH is experiencing severe hyponatremia. Which IV fluid should the nurse
anticipate administering?
A. 0.45% Sodium Chloride
B. 3% Sodium Chloride
, C. Lactated Ringer’s
D. Dextrose 5% in Water
Answer: B
Conceptual Explanation: Hypertonic saline (3% NaCl) is used in severe symptomatic
hyponatremia associated with SIADH to slowly raise serum sodium levels while monitoring
for osmotic demyelination.
5. In a patient with Graves’ disease, the nurse notes a sudden increase in temperature, heart
rate, and extreme agitation. What is the priority intervention?
A. Administering a bolus of IV insulin
B. Maintaining a patent airway and providing oxygen
C. Providing a warm blanket to prevent shivering
D. Encouraging the patient to walk to burn off energy
Answer: B
Conceptual Explanation: These symptoms suggest a thyroid storm, a life-threatening
emergency. Airway and oxygenation are the highest priorities followed by reducing heart
rate and body temperature.
6. Which medication is considered the ‘gold standard’ for treating a patient experiencing an
acute episode of ventricular tachycardia with a pulse?
A. Amiodarone
(NUR242) QUESTIONS AND ANSWERS
1. A patient presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 28 mEq/L. Which
acid-base imbalance is occurring?
A. Fully compensated respiratory acidosis
B. Partially compensated metabolic alkalosis
C. Uncompensated respiratory alkalosis
D. Partially compensated respiratory acidosis
Answer: D
Conceptual Explanation: The pH is acidic (<7.35), the PaCO2 is high (>45) indicating a
respiratory cause, and the HCO3 is elevated (>26) indicating the kidneys are attempting to
compensate, but the pH has not yet returned to normal range.
2. Which clinical manifestation is a hallmark sign of Autonomic Dysreflexia in a patient with a
T6 spinal cord injury?
A. Sudden hypotension and tachycardia
B. Extreme hypertension and a pounding headache
C. Flaccid paralysis and loss of reflexes below the injury
,D. Hyperthermia and dry skin throughout the body
Answer: B
Conceptual Explanation: Autonomic dysreflexia is a medical emergency characterized by
severe hypertension, pounding headache, and bradycardia, often triggered by a full bladder
or fecal impaction.
3. When caring for a patient in the oliguric phase of Acute Kidney Injury (AKI), which
electrolyte abnormality is the nurse most likely to observe?
A. Hypokalemia
B. Hyperkalemia
C. Hypercalcemia
D. Hypophosphatemia
Answer: B
Conceptual Explanation: In the oliguric phase of AKI, the kidneys’ inability to excrete
potassium leads to hyperkalemia, which is potentially life-threatening due to cardiac
arrhythmias.
4. A patient with SIADH is experiencing severe hyponatremia. Which IV fluid should the nurse
anticipate administering?
A. 0.45% Sodium Chloride
B. 3% Sodium Chloride
, C. Lactated Ringer’s
D. Dextrose 5% in Water
Answer: B
Conceptual Explanation: Hypertonic saline (3% NaCl) is used in severe symptomatic
hyponatremia associated with SIADH to slowly raise serum sodium levels while monitoring
for osmotic demyelination.
5. In a patient with Graves’ disease, the nurse notes a sudden increase in temperature, heart
rate, and extreme agitation. What is the priority intervention?
A. Administering a bolus of IV insulin
B. Maintaining a patent airway and providing oxygen
C. Providing a warm blanket to prevent shivering
D. Encouraging the patient to walk to burn off energy
Answer: B
Conceptual Explanation: These symptoms suggest a thyroid storm, a life-threatening
emergency. Airway and oxygenation are the highest priorities followed by reducing heart
rate and body temperature.
6. Which medication is considered the ‘gold standard’ for treating a patient experiencing an
acute episode of ventricular tachycardia with a pulse?
A. Amiodarone
