NU 185: Med-Surge II EXAM 1 - 4 Questions And
Answers (Verified And Updated)
Question 1
A patient with heart failure is prescribed metoprolol succinate. Which
assessment finding requires the nurse to hold the medication and notify
the provider?
A) Heart rate of 72 bpm
B) Heart rate of 52 bpm
C) Blood pressure of 118/76 mmHg
D) Respiratory rate of 18 breaths/min
Answer: B) Heart rate of 52 bpm
Explanation: Beta-blockers such as metoprolol should be withheld if
the heart rate is below 60 bpm. A heart rate of 52 bpm indicates
bradycardia and requires provider notification before
administration.
Question 2
A patient with an abdominal aortic aneurysm reports sudden severe back
pain and has a blood pressure of 80/50 mmHg. Which action should the
nurse take first?
,A) Administer IV morphine for pain
B) Notify the provider and prepare for emergent surgery
C) Obtain a stat abdominal ultrasound
D) Increase IV fluid rate to 200 mL/hr
Answer: B) Notify the provider and prepare for emergent surgery
Explanation: Sudden severe back pain with hypotension in a patient
with AAA suggests rupture, a life-threatening emergency requiring
immediate surgical intervention.
Question 3
A patient with peripheral arterial disease (PAD) reports pain in the calf
that occurs with walking and resolves with rest. The nurse documents this
finding as:
A) Intermittent claudication
B) Rest pain
C) Paresthesia
D) Phantom pain
Answer: A) Intermittent claudication
Explanation: Intermittent claudication is the classic symptom of PAD,
characterized by muscle pain with exercise that resolves with rest
due to inadequate arterial blood flow.
,Question 4
A patient with a new below-the-knee amputation asks about phantom limb
pain. Which response by the nurse is most appropriate?
A) "Phantom pain is not real and will go away on its own."
B) "Phantom pain is a real sensation caused by nerve signals from the
amputated limb."
C) "You should ignore the pain and it will resolve."
D) "Phantom pain means the surgery was not successful."
Answer: B) "Phantom pain is a real sensation caused by nerve
signals from the amputated limb."
Explanation: Phantom limb pain is a real phenomenon caused by
nerve signals from the severed nerves. It should be acknowledged
and treated with medications such as gabapentin.
Question 5
A patient with an open fracture of the tibia is admitted. Which intervention
is the priority?
A) Administer IV antibiotics and prepare for surgical debridement
B) Apply a sterile dressing and splint
C) Administer tetanus prophylaxis
D) Obtain an X-ray of the affected leg
Answer: A) Administer IV antibiotics and prepare for surgical
debridement
, Explanation: Open fractures carry a high risk of infection. IV
antibiotics and surgical debridement are the priority to prevent
osteomyelitis.
Question 6
A patient with a new spinal cord injury at T4 has a heart rate of 48 bpm
and blood pressure of 82/50 mmHg. Which intervention should the nurse
anticipate?
A) Administer atropine and IV fluids
B) Administer antihypertensives
C) Apply a cooling blanket
D) Restrict fluids to 1 L/day
Answer: A) Administer atropine and IV fluids
Explanation: Neurogenic shock causes bradycardia and hypotension
due to loss of sympathetic tone. Treatment includes IV fluids,
vasopressors, and atropine for bradycardia.
Question 7
A patient with increased intracranial pressure has a prescription for
mannitol. Which assessment finding indicates the medication is effective?
A) Increased urine output
B) Decreased urine output
Answers (Verified And Updated)
Question 1
A patient with heart failure is prescribed metoprolol succinate. Which
assessment finding requires the nurse to hold the medication and notify
the provider?
A) Heart rate of 72 bpm
B) Heart rate of 52 bpm
C) Blood pressure of 118/76 mmHg
D) Respiratory rate of 18 breaths/min
Answer: B) Heart rate of 52 bpm
Explanation: Beta-blockers such as metoprolol should be withheld if
the heart rate is below 60 bpm. A heart rate of 52 bpm indicates
bradycardia and requires provider notification before
administration.
Question 2
A patient with an abdominal aortic aneurysm reports sudden severe back
pain and has a blood pressure of 80/50 mmHg. Which action should the
nurse take first?
,A) Administer IV morphine for pain
B) Notify the provider and prepare for emergent surgery
C) Obtain a stat abdominal ultrasound
D) Increase IV fluid rate to 200 mL/hr
Answer: B) Notify the provider and prepare for emergent surgery
Explanation: Sudden severe back pain with hypotension in a patient
with AAA suggests rupture, a life-threatening emergency requiring
immediate surgical intervention.
Question 3
A patient with peripheral arterial disease (PAD) reports pain in the calf
that occurs with walking and resolves with rest. The nurse documents this
finding as:
A) Intermittent claudication
B) Rest pain
C) Paresthesia
D) Phantom pain
Answer: A) Intermittent claudication
Explanation: Intermittent claudication is the classic symptom of PAD,
characterized by muscle pain with exercise that resolves with rest
due to inadequate arterial blood flow.
,Question 4
A patient with a new below-the-knee amputation asks about phantom limb
pain. Which response by the nurse is most appropriate?
A) "Phantom pain is not real and will go away on its own."
B) "Phantom pain is a real sensation caused by nerve signals from the
amputated limb."
C) "You should ignore the pain and it will resolve."
D) "Phantom pain means the surgery was not successful."
Answer: B) "Phantom pain is a real sensation caused by nerve
signals from the amputated limb."
Explanation: Phantom limb pain is a real phenomenon caused by
nerve signals from the severed nerves. It should be acknowledged
and treated with medications such as gabapentin.
Question 5
A patient with an open fracture of the tibia is admitted. Which intervention
is the priority?
A) Administer IV antibiotics and prepare for surgical debridement
B) Apply a sterile dressing and splint
C) Administer tetanus prophylaxis
D) Obtain an X-ray of the affected leg
Answer: A) Administer IV antibiotics and prepare for surgical
debridement
, Explanation: Open fractures carry a high risk of infection. IV
antibiotics and surgical debridement are the priority to prevent
osteomyelitis.
Question 6
A patient with a new spinal cord injury at T4 has a heart rate of 48 bpm
and blood pressure of 82/50 mmHg. Which intervention should the nurse
anticipate?
A) Administer atropine and IV fluids
B) Administer antihypertensives
C) Apply a cooling blanket
D) Restrict fluids to 1 L/day
Answer: A) Administer atropine and IV fluids
Explanation: Neurogenic shock causes bradycardia and hypotension
due to loss of sympathetic tone. Treatment includes IV fluids,
vasopressors, and atropine for bradycardia.
Question 7
A patient with increased intracranial pressure has a prescription for
mannitol. Which assessment finding indicates the medication is effective?
A) Increased urine output
B) Decreased urine output
