NUR 242 MEDICAL-SURGICAL NURSING
EXAM QUESTIONS AND ANSWERS
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. The nurse notes the patient’s SpO2 is 89% and the patient appears slightly
short of breath. Which action should the nurse take first?
A. Increase the oxygen flow rate to 4 L/min immediately.
B. Place the patient in a high-Fowler’s position.
C. Notify the healthcare provider of the low saturation.
D. Assess the patient’s respiratory rate and effort.
Answer: D
Conceptual Explanation: In stable COPD patients, an SpO2 of 88-92% is often acceptable.
The nurse should first assess the clinical status (respiratory rate/effort) before changing
oxygen levels, as high levels of O2 can suppress the hypoxic drive in some COPD patients.
2. A client is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS). Which
clinical finding is most characteristic of this condition?
A. Hypercapnia that resolves with oxygen therapy.
,B. Hypoxemia that does not improve with supplemental oxygen.
C. Increased lung compliance on mechanical ventilation.
D. Pulmonary edema caused by left-sided heart failure.
Answer: B
Conceptual Explanation: Refractory hypoxemia, which is hypoxemia that remains
unresponsive to increasing levels of supplemental oxygen, is a hallmark sign of ARDS due
to significant shunting.
3. Following a thyroidectomy, a patient reports numbness and tingling around the mouth and
in the fingertips. The nurse should prioritize assessing for which sign?
A. Chvostek’s sign
B. Babinski’s sign
C. Brudzinski’s sign
D. Kernig’s sign
Answer: A
Conceptual Explanation: Numbness and tingling are signs of hypocalcemia, a potential
complication of thyroidectomy if the parathyroid glands are damaged. Chvostek’s sign
(facial twitching) is used to assess for hypocalcemia.
, 4. Which laboratory value is the most sensitive indicator of renal function in a client with
chronic kidney disease?
A. Serum Creatinine
B. Blood Urea Nitrogen (BUN)
C. Urine Specific Gravity
D. Glomerular Filtration Rate (GFR)
Answer: D
Conceptual Explanation: While creatinine is useful, GFR is considered the most accurate
measure of overall kidney function and is used to stage chronic kidney disease.
5. A nurse is caring for a patient who had a permanent pacemaker implanted 6 hours ago.
Which finding is the most significant concern?
A. Redness at the incision site.
B. Heart rate of 72 bpm when the pacemaker is set at 70.
C. Frequent hiccups.
D. Patient reporting mild soreness at the site.
Answer: C
Conceptual Explanation: Frequent hiccups in a patient with a new pacemaker can
indicate that the lead wire has perforated the ventricle and is stimulating the diaphragm.
EXAM QUESTIONS AND ANSWERS
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. The nurse notes the patient’s SpO2 is 89% and the patient appears slightly
short of breath. Which action should the nurse take first?
A. Increase the oxygen flow rate to 4 L/min immediately.
B. Place the patient in a high-Fowler’s position.
C. Notify the healthcare provider of the low saturation.
D. Assess the patient’s respiratory rate and effort.
Answer: D
Conceptual Explanation: In stable COPD patients, an SpO2 of 88-92% is often acceptable.
The nurse should first assess the clinical status (respiratory rate/effort) before changing
oxygen levels, as high levels of O2 can suppress the hypoxic drive in some COPD patients.
2. A client is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS). Which
clinical finding is most characteristic of this condition?
A. Hypercapnia that resolves with oxygen therapy.
,B. Hypoxemia that does not improve with supplemental oxygen.
C. Increased lung compliance on mechanical ventilation.
D. Pulmonary edema caused by left-sided heart failure.
Answer: B
Conceptual Explanation: Refractory hypoxemia, which is hypoxemia that remains
unresponsive to increasing levels of supplemental oxygen, is a hallmark sign of ARDS due
to significant shunting.
3. Following a thyroidectomy, a patient reports numbness and tingling around the mouth and
in the fingertips. The nurse should prioritize assessing for which sign?
A. Chvostek’s sign
B. Babinski’s sign
C. Brudzinski’s sign
D. Kernig’s sign
Answer: A
Conceptual Explanation: Numbness and tingling are signs of hypocalcemia, a potential
complication of thyroidectomy if the parathyroid glands are damaged. Chvostek’s sign
(facial twitching) is used to assess for hypocalcemia.
, 4. Which laboratory value is the most sensitive indicator of renal function in a client with
chronic kidney disease?
A. Serum Creatinine
B. Blood Urea Nitrogen (BUN)
C. Urine Specific Gravity
D. Glomerular Filtration Rate (GFR)
Answer: D
Conceptual Explanation: While creatinine is useful, GFR is considered the most accurate
measure of overall kidney function and is used to stage chronic kidney disease.
5. A nurse is caring for a patient who had a permanent pacemaker implanted 6 hours ago.
Which finding is the most significant concern?
A. Redness at the incision site.
B. Heart rate of 72 bpm when the pacemaker is set at 70.
C. Frequent hiccups.
D. Patient reporting mild soreness at the site.
Answer: C
Conceptual Explanation: Frequent hiccups in a patient with a new pacemaker can
indicate that the lead wire has perforated the ventricle and is stimulating the diaphragm.
