ADVANCED MEDICAL-SURGICAL
NURSING EXAM (NUR242) QUESTIONS
AND ANSWERS
1. A patient with a history of chronic heart failure is prescribed Furosemide and Digoxin. The
nurse notes the patient’s potassium level is 3.1 mEq/L. Which action is the priority?
A. Administer the Digoxin as scheduled
B. Encourage the patient to eat a banana
C. Notify the healthcare provider and hold the Digoxin
D. Document the finding as expected for diuretic use
Answer: C
Conceptual Explanation: Hypokalemia (potassium < 3.5 mEq/L) significantly increases
the risk of Digoxin toxicity. The nurse must hold the medication and notify the provider to
address the electrolyte imbalance before administration.
2. A client is admitted with Hyperosmolar Hyperglycemic State (HHS). Which clinical
manifestation should the nurse expect to find?
A. Kussmaul respirations
,B. Severe dehydration and blood glucose >600 mg/dL
C. Positive urine ketones
D. Metabolic acidosis with a low pH
Answer: B
Conceptual Explanation: HHS is characterized by extreme hyperglycemia and
dehydration without significant ketosis or acidosis, unlike Diabetic Ketoacidosis (DKA)
which features Kussmaul respirations and ketones.
3. Which arterial blood gas (ABG) result indicates compensated respiratory acidosis?
A. pH 7.32, PaCO2 50, HCO3 24
B. pH 7.25, PaCO2 35, HCO3 18
C. pH 7.48, PaCO2 30, HCO3 22
D. pH 7.36, PaCO2 55, HCO3 30
Answer: D
Conceptual Explanation: In compensated respiratory acidosis, the pH is within normal
range (7.35-7.45) but on the acidic side, while the PaCO2 is elevated and the HCO3 is also
elevated as the kidneys retain bicarbonate to compensate.
4. A patient is 24 hours post-thyroidectomy. The nurse notes the patient has a positive
Chvostek’s sign. What is the most likely cause?
A. Hyperkalemia
, B. Hyponatremia
C. Hypermagnesemia
D. Hypocalcemia
Answer: D
Conceptual Explanation: Accidental removal or damage to the parathyroid glands during
thyroidectomy can cause hypocalcemia. A positive Chvostek’s sign (facial twitching) is a
classic sign of neuromuscular irritability due to low calcium.
5. When caring for a patient with a chest tube, the nurse notes continuous bubbling in the
water-seal chamber. What does this indicate?
A. The system is functioning normally
B. There is an air leak in the system
C. The patient has a resolving pneumothorax
D. The suction is set too high
Answer: B
Conceptual Explanation: Intermittent bubbling is expected in a patient with a
pneumothorax, but continuous bubbling in the water-seal chamber indicates an air leak in
the drainage system or the patient’s pleural space.
NURSING EXAM (NUR242) QUESTIONS
AND ANSWERS
1. A patient with a history of chronic heart failure is prescribed Furosemide and Digoxin. The
nurse notes the patient’s potassium level is 3.1 mEq/L. Which action is the priority?
A. Administer the Digoxin as scheduled
B. Encourage the patient to eat a banana
C. Notify the healthcare provider and hold the Digoxin
D. Document the finding as expected for diuretic use
Answer: C
Conceptual Explanation: Hypokalemia (potassium < 3.5 mEq/L) significantly increases
the risk of Digoxin toxicity. The nurse must hold the medication and notify the provider to
address the electrolyte imbalance before administration.
2. A client is admitted with Hyperosmolar Hyperglycemic State (HHS). Which clinical
manifestation should the nurse expect to find?
A. Kussmaul respirations
,B. Severe dehydration and blood glucose >600 mg/dL
C. Positive urine ketones
D. Metabolic acidosis with a low pH
Answer: B
Conceptual Explanation: HHS is characterized by extreme hyperglycemia and
dehydration without significant ketosis or acidosis, unlike Diabetic Ketoacidosis (DKA)
which features Kussmaul respirations and ketones.
3. Which arterial blood gas (ABG) result indicates compensated respiratory acidosis?
A. pH 7.32, PaCO2 50, HCO3 24
B. pH 7.25, PaCO2 35, HCO3 18
C. pH 7.48, PaCO2 30, HCO3 22
D. pH 7.36, PaCO2 55, HCO3 30
Answer: D
Conceptual Explanation: In compensated respiratory acidosis, the pH is within normal
range (7.35-7.45) but on the acidic side, while the PaCO2 is elevated and the HCO3 is also
elevated as the kidneys retain bicarbonate to compensate.
4. A patient is 24 hours post-thyroidectomy. The nurse notes the patient has a positive
Chvostek’s sign. What is the most likely cause?
A. Hyperkalemia
, B. Hyponatremia
C. Hypermagnesemia
D. Hypocalcemia
Answer: D
Conceptual Explanation: Accidental removal or damage to the parathyroid glands during
thyroidectomy can cause hypocalcemia. A positive Chvostek’s sign (facial twitching) is a
classic sign of neuromuscular irritability due to low calcium.
5. When caring for a patient with a chest tube, the nurse notes continuous bubbling in the
water-seal chamber. What does this indicate?
A. The system is functioning normally
B. There is an air leak in the system
C. The patient has a resolving pneumothorax
D. The suction is set too high
Answer: B
Conceptual Explanation: Intermittent bubbling is expected in a patient with a
pneumothorax, but continuous bubbling in the water-seal chamber indicates an air leak in
the drainage system or the patient’s pleural space.
