NUR242 MEDICAL-SURGICAL NURSING
FINAL EXAM COMPREHENSIVE STUDY
GUIDE
1. A patient presents with a pH of 7.28, PaCO2 of 55 mmHg, and HCO3 of 26 mEq/L. Which
acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Conceptual Explanation: A pH below 7.35 indicates acidosis. The elevated PaCO2 (>45)
indicates a respiratory origin, while the HCO3 is within normal range, suggesting
uncompensated respiratory acidosis.
2. Which electrolyte imbalance is most commonly associated with a positive Chvostek’s sign
and Trousseau’s sign?
A. Hyperkalemia
,B. Hyponatremia
C. Hypomagnesemia
D. Hypocalcemia
Answer: D
Conceptual Explanation: Hypocalcemia increases neuromuscular excitability. Chvostek’s
sign (facial twitching) and Trousseau’s sign (carpal spasm with BP cuff) are classic
indicators of low serum calcium.
3. A nurse is caring for a patient who is 12 hours post-thyroidectomy. The patient complains
of numbness around the mouth. What is the priority nursing action?
A. Check for airway patency and assess for hypocalcemia
B. Administer a prescribed analgesic
C. Encourage the patient to cough and deep breathe
D. Notify the surgeon that the patient is having a stroke
Answer: A
Conceptual Explanation: Tingling or numbness (paresthesia) after a thyroidectomy
suggests accidental removal or damage to the parathyroid glands, leading to hypocalcemia
and potential laryngospasm.
, 4. Which of the following is the earliest sign of malignant hyperthermia during general
anesthesia?
A. Tachycardia
B. Muscle rigidity
C. Hyperpyrexia (fever)
D. Respiratory acidosis
Answer: A
Conceptual Explanation: Tachycardia is often the earliest sign of malignant hyperthermia.
Fever is a late sign, often occurring after cellular metabolism has significantly increased.
5. A patient with COPD has a prescription for oxygen. The nurse knows that the oxygen flow
rate should be kept low primarily to avoid which complication?
A. Oxygen toxicity
B. Suppression of the respiratory drive
C. Drying of the nasal mucosa
D. Pulmonary edema
Answer: B
Conceptual Explanation: In chronic hypercapnia (like in COPD), the stimulus for
breathing becomes low oxygen levels (hypoxic drive). High oxygen delivery can suppress
this drive, leading to respiratory failure.
FINAL EXAM COMPREHENSIVE STUDY
GUIDE
1. A patient presents with a pH of 7.28, PaCO2 of 55 mmHg, and HCO3 of 26 mEq/L. Which
acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Conceptual Explanation: A pH below 7.35 indicates acidosis. The elevated PaCO2 (>45)
indicates a respiratory origin, while the HCO3 is within normal range, suggesting
uncompensated respiratory acidosis.
2. Which electrolyte imbalance is most commonly associated with a positive Chvostek’s sign
and Trousseau’s sign?
A. Hyperkalemia
,B. Hyponatremia
C. Hypomagnesemia
D. Hypocalcemia
Answer: D
Conceptual Explanation: Hypocalcemia increases neuromuscular excitability. Chvostek’s
sign (facial twitching) and Trousseau’s sign (carpal spasm with BP cuff) are classic
indicators of low serum calcium.
3. A nurse is caring for a patient who is 12 hours post-thyroidectomy. The patient complains
of numbness around the mouth. What is the priority nursing action?
A. Check for airway patency and assess for hypocalcemia
B. Administer a prescribed analgesic
C. Encourage the patient to cough and deep breathe
D. Notify the surgeon that the patient is having a stroke
Answer: A
Conceptual Explanation: Tingling or numbness (paresthesia) after a thyroidectomy
suggests accidental removal or damage to the parathyroid glands, leading to hypocalcemia
and potential laryngospasm.
, 4. Which of the following is the earliest sign of malignant hyperthermia during general
anesthesia?
A. Tachycardia
B. Muscle rigidity
C. Hyperpyrexia (fever)
D. Respiratory acidosis
Answer: A
Conceptual Explanation: Tachycardia is often the earliest sign of malignant hyperthermia.
Fever is a late sign, often occurring after cellular metabolism has significantly increased.
5. A patient with COPD has a prescription for oxygen. The nurse knows that the oxygen flow
rate should be kept low primarily to avoid which complication?
A. Oxygen toxicity
B. Suppression of the respiratory drive
C. Drying of the nasal mucosa
D. Pulmonary edema
Answer: B
Conceptual Explanation: In chronic hypercapnia (like in COPD), the stimulus for
breathing becomes low oxygen levels (hypoxic drive). High oxygen delivery can suppress
this drive, leading to respiratory failure.
