NUR242 MEDICAL-SURGICAL NURSING
ADVANCED CONCEPTS EXAM
QUESTIONS AND ANSWERS
1. A patient with a history of heart failure presents with a potassium level of 6.4 mEq/L and
tall, peaked T waves on the EKG. Which intervention is the highest priority?
A. Administering sodium polystyrene sulfonate orally
B. Initiating a continuous infusion of regular insulin with dextrose
C. Administering intravenous calcium gluconate
D. Preparing the patient for emergent hemodialysis
Answer: C
Conceptual Explanation: Intravenous calcium gluconate is the priority because it
stabilizes the myocardial cell membrane to prevent lethal arrhythmias, even though it does
not lower the potassium level itself.
,2. A client is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS). The
nurse notes a PO2 of 52 mmHg despite being on 100% oxygen via a non-rebreather mask.
Which pathophysiological mechanism explains this?
A. Right-to-left shunting
B. Alveolar hypoventilation
C. Diffusion limitation
D. Ventilation-perfusion mismatching
Answer: A
Conceptual Explanation: In ARDS, alveoli fill with fluid or collapse, causing blood to pass
through the lungs without being oxygenated, known as a right-to-left shunt, which is
refractory to supplemental oxygen.
3. A patient who underwent a thyroidectomy 12 hours ago develops muscle tremors and a
positive Chvostek’s sign. Which medication should the nurse prepare to administer?
A. Potassium chloride
B. Calcium gluconate
C. Magnesium sulfate
D. Sodium bicarbonate
Answer: B
, Conceptual Explanation: A positive Chvostek’s sign indicates hypocalcemia, a common
complication of thyroidectomy if the parathyroid glands are accidentally damaged or
removed.
4. The nurse is caring for a patient in the compensatory stage of shock. Which clinical finding
is expected?
A. Metabolic acidosis and cold, clammy skin
B. Narrowing pulse pressure and tachycardia
C. Mottled extremities and decreased consciousness
D. Anuria and respiratory failure
Answer: B
Conceptual Explanation: In the compensatory stage, the body attempts to maintain
homeostasis through sympathetic nervous system activation, leading to tachycardia and
vasoconstriction (narrowing pulse pressure).
5. A client with a C6 spinal cord injury reports a sudden, severe headache and has a blood
pressure of 210/110 mmHg. What is the nurse’s first action?
A. Administer an antihypertensive medication
B. Assess the client for bladder distention
C. Lower the head of the bed to a flat position
D. Notify the healthcare provider immediately
ADVANCED CONCEPTS EXAM
QUESTIONS AND ANSWERS
1. A patient with a history of heart failure presents with a potassium level of 6.4 mEq/L and
tall, peaked T waves on the EKG. Which intervention is the highest priority?
A. Administering sodium polystyrene sulfonate orally
B. Initiating a continuous infusion of regular insulin with dextrose
C. Administering intravenous calcium gluconate
D. Preparing the patient for emergent hemodialysis
Answer: C
Conceptual Explanation: Intravenous calcium gluconate is the priority because it
stabilizes the myocardial cell membrane to prevent lethal arrhythmias, even though it does
not lower the potassium level itself.
,2. A client is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS). The
nurse notes a PO2 of 52 mmHg despite being on 100% oxygen via a non-rebreather mask.
Which pathophysiological mechanism explains this?
A. Right-to-left shunting
B. Alveolar hypoventilation
C. Diffusion limitation
D. Ventilation-perfusion mismatching
Answer: A
Conceptual Explanation: In ARDS, alveoli fill with fluid or collapse, causing blood to pass
through the lungs without being oxygenated, known as a right-to-left shunt, which is
refractory to supplemental oxygen.
3. A patient who underwent a thyroidectomy 12 hours ago develops muscle tremors and a
positive Chvostek’s sign. Which medication should the nurse prepare to administer?
A. Potassium chloride
B. Calcium gluconate
C. Magnesium sulfate
D. Sodium bicarbonate
Answer: B
, Conceptual Explanation: A positive Chvostek’s sign indicates hypocalcemia, a common
complication of thyroidectomy if the parathyroid glands are accidentally damaged or
removed.
4. The nurse is caring for a patient in the compensatory stage of shock. Which clinical finding
is expected?
A. Metabolic acidosis and cold, clammy skin
B. Narrowing pulse pressure and tachycardia
C. Mottled extremities and decreased consciousness
D. Anuria and respiratory failure
Answer: B
Conceptual Explanation: In the compensatory stage, the body attempts to maintain
homeostasis through sympathetic nervous system activation, leading to tachycardia and
vasoconstriction (narrowing pulse pressure).
5. A client with a C6 spinal cord injury reports a sudden, severe headache and has a blood
pressure of 210/110 mmHg. What is the nurse’s first action?
A. Administer an antihypertensive medication
B. Assess the client for bladder distention
C. Lower the head of the bed to a flat position
D. Notify the healthcare provider immediately
