NUR 242 MEDICAL-SURGICAL NURSING
ADVANCED PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A patient presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 24 mEq/L. Which
acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
with a normal HCO3 indicates that the lungs are retaining CO2, causing respiratory
acidosis.
2. A client with heart failure is prescribed Digoxin. Which assessment finding should the nurse
prioritize as a sign of toxicity?
A. Increased urine output
,B. Heart rate of 82 bpm
C. Visual disturbances such as yellow-green halos
D. Hypertension
Answer: C
Conceptual Explanation: Visual changes (halos, blurred vision) and gastrointestinal upset
are classic signs of digoxin toxicity. Bradycardia is also a sign, not tachycardia or
hypertension.
3. Which clinical manifestation is most indicative of a tension pneumothorax?
A. Tracheal deviation to the unaffected side
B. Increased breath sounds on the affected side
C. Bradypnea
D. Flattened neck veins
Answer: A
Conceptual Explanation: Tension pneumothorax causes air to trap in the pleural space,
shifting mediastinal structures and pushing the trachea toward the opposite (unaffected)
side.
4. A patient is 24 hours post-thyroidectomy. The nurse notes muscle twitching and a positive
Chvostek’s sign. What is the priority intervention?
A. Prepare for administration of calcium gluconate
, B. Administer potassium chloride IV
C. Encourage the patient to cough and deep breathe
D. Notify the provider of impending thyroid storm
Answer: A
Conceptual Explanation: Positive Chvostek’s and Trousseau’s signs indicate
hypocalcemia, often due to accidental parathyroid gland removal during thyroidectomy.
Calcium gluconate is the emergency treatment.
5. When assessing a patient with Cushing’s Syndrome, which finding is most expected?
A. Hypotension and weight loss
B. Hyperkalemia and hyponatremia
C. Decreased blood glucose levels
D. Thinning extremities and a ‘buffalo hump’
Answer: D
Conceptual Explanation: Cushing’s Syndrome involves excess cortisol, leading to fat
redistribution (buffalo hump, moon face, truncal obesity) and protein wasting in the
extremities.
6. A patient with a history of deep vein thrombosis (DVT) suddenly reports dyspnea and chest
pain. What is the nurse’s first action?
A. Auscultate lung sounds
ADVANCED PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A patient presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 24 mEq/L. Which
acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
with a normal HCO3 indicates that the lungs are retaining CO2, causing respiratory
acidosis.
2. A client with heart failure is prescribed Digoxin. Which assessment finding should the nurse
prioritize as a sign of toxicity?
A. Increased urine output
,B. Heart rate of 82 bpm
C. Visual disturbances such as yellow-green halos
D. Hypertension
Answer: C
Conceptual Explanation: Visual changes (halos, blurred vision) and gastrointestinal upset
are classic signs of digoxin toxicity. Bradycardia is also a sign, not tachycardia or
hypertension.
3. Which clinical manifestation is most indicative of a tension pneumothorax?
A. Tracheal deviation to the unaffected side
B. Increased breath sounds on the affected side
C. Bradypnea
D. Flattened neck veins
Answer: A
Conceptual Explanation: Tension pneumothorax causes air to trap in the pleural space,
shifting mediastinal structures and pushing the trachea toward the opposite (unaffected)
side.
4. A patient is 24 hours post-thyroidectomy. The nurse notes muscle twitching and a positive
Chvostek’s sign. What is the priority intervention?
A. Prepare for administration of calcium gluconate
, B. Administer potassium chloride IV
C. Encourage the patient to cough and deep breathe
D. Notify the provider of impending thyroid storm
Answer: A
Conceptual Explanation: Positive Chvostek’s and Trousseau’s signs indicate
hypocalcemia, often due to accidental parathyroid gland removal during thyroidectomy.
Calcium gluconate is the emergency treatment.
5. When assessing a patient with Cushing’s Syndrome, which finding is most expected?
A. Hypotension and weight loss
B. Hyperkalemia and hyponatremia
C. Decreased blood glucose levels
D. Thinning extremities and a ‘buffalo hump’
Answer: D
Conceptual Explanation: Cushing’s Syndrome involves excess cortisol, leading to fat
redistribution (buffalo hump, moon face, truncal obesity) and protein wasting in the
extremities.
6. A patient with a history of deep vein thrombosis (DVT) suddenly reports dyspnea and chest
pain. What is the nurse’s first action?
A. Auscultate lung sounds
