NUR242 MEDICAL-SURGICAL NURSING
ADVANCED EXAM PREP QUESTIONS
AND ANSWERS
1. A client with heart failure is receiving digoxin. Which of the following findings should the
nurse recognize as an early sign of digoxin toxicity?
A. Anorexia and nausea
B. Visual disturbances, such as seeing yellow-green halos
C. Increase in urinary output
D. Sudden onset of hypertension
Answer: A
Conceptual Explanation: Gastrointestinal symptoms like anorexia, nausea, and vomiting
are typically the earliest signs of digoxin toxicity. Visual changes like halos usually occur
later.
2. A patient is admitted with a suspected Myocardial Infarction (MI). Which cardiac
biomarker is most specific for myocardial injury and remains elevated for up to two weeks?
A. Myoglobin
,B. CK-MB
C. Troponin T
D. C-reactive protein
Answer: C
Conceptual Explanation: Troponin T and Troponin I are highly specific to cardiac muscle
and can remain elevated for 10 to 14 days, making them excellent markers for both acute
and recent injury.
3. A client in the ICU has developed Cushing’s triad. The nurse recognizes this as a sign of
which condition?
A. Severe dehydration
B. Increased intracranial pressure
C. Imminent liver failure
D. Cardiogenic shock
Answer: B
Conceptual Explanation: Cushing’s triad (widening pulse pressure/hypertension,
bradycardia, and irregular respirations) is a late sign of significantly increased intracranial
pressure (ICP).
, 4. Which arterial blood gas (ABG) result would the nurse expect to see in a patient with a
massive pulmonary embolism?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.35, PaCO2 40, HCO3 24
C. pH 7.50, PaCO2 30, HCO3 22
D. pH 7.48, PaCO2 45, HCO3 32
Answer: C
Conceptual Explanation: Patients with pulmonary embolism often hyperventilate due to
hypoxia and pain, leading to respiratory alkalosis (high pH, low PaCO2).
5. A client with Chronic Kidney Disease (CKD) is prescribed Sevelamer. What is the primary
purpose of this medication?
A. To increase serum calcium levels
B. To lower serum potassium
C. To stimulate erythropoietin production
D. To bind dietary phosphorus
Answer: D
Conceptual Explanation: Sevelamer is a phosphate binder used in CKD to prevent
hyperphosphatemia by binding phosphorus in the GI tract from food.
ADVANCED EXAM PREP QUESTIONS
AND ANSWERS
1. A client with heart failure is receiving digoxin. Which of the following findings should the
nurse recognize as an early sign of digoxin toxicity?
A. Anorexia and nausea
B. Visual disturbances, such as seeing yellow-green halos
C. Increase in urinary output
D. Sudden onset of hypertension
Answer: A
Conceptual Explanation: Gastrointestinal symptoms like anorexia, nausea, and vomiting
are typically the earliest signs of digoxin toxicity. Visual changes like halos usually occur
later.
2. A patient is admitted with a suspected Myocardial Infarction (MI). Which cardiac
biomarker is most specific for myocardial injury and remains elevated for up to two weeks?
A. Myoglobin
,B. CK-MB
C. Troponin T
D. C-reactive protein
Answer: C
Conceptual Explanation: Troponin T and Troponin I are highly specific to cardiac muscle
and can remain elevated for 10 to 14 days, making them excellent markers for both acute
and recent injury.
3. A client in the ICU has developed Cushing’s triad. The nurse recognizes this as a sign of
which condition?
A. Severe dehydration
B. Increased intracranial pressure
C. Imminent liver failure
D. Cardiogenic shock
Answer: B
Conceptual Explanation: Cushing’s triad (widening pulse pressure/hypertension,
bradycardia, and irregular respirations) is a late sign of significantly increased intracranial
pressure (ICP).
, 4. Which arterial blood gas (ABG) result would the nurse expect to see in a patient with a
massive pulmonary embolism?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.35, PaCO2 40, HCO3 24
C. pH 7.50, PaCO2 30, HCO3 22
D. pH 7.48, PaCO2 45, HCO3 32
Answer: C
Conceptual Explanation: Patients with pulmonary embolism often hyperventilate due to
hypoxia and pain, leading to respiratory alkalosis (high pH, low PaCO2).
5. A client with Chronic Kidney Disease (CKD) is prescribed Sevelamer. What is the primary
purpose of this medication?
A. To increase serum calcium levels
B. To lower serum potassium
C. To stimulate erythropoietin production
D. To bind dietary phosphorus
Answer: D
Conceptual Explanation: Sevelamer is a phosphate binder used in CKD to prevent
hyperphosphatemia by binding phosphorus in the GI tract from food.
