NUR 170-171 EXAM 2 COMPREHENSIVE
QUESTIONS AND CORRECT ANSWERS
2026/2027
1. A patient’s ABG results are: pH 7.28, PaCO2 50 mm Hg, and HCO3 24 mEq/L. How should
the nurse interpret these findings?
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 mm Hg
with a normal HCO3 indicates that the respiratory system is the cause of the acidosis.
2. Which clinical manifestation should the nurse expect to find in a patient with a serum
potassium level of 6.2 mEq/L?
A. Inverted T waves on ECG
B. Hypoactive bowel sounds
C. Tall, peaked T waves on ECG
,D. Increased muscle strength
Answer: C
Conceptual Explanation: Hyperkalemia (K+ > 5.0) causes cardiac conductivity changes,
most notably tall, peaked T waves and widened QRS complexes.
3. A nurse is caring for a patient who is 1 day postoperative. Which intervention is most
effective in preventing atelectasis?
A. Administering prophylactic antibiotics
B. Restricting fluid intake to 1000 mL/day
C. Encouraging the use of an incentive spirometer 10 times per hour
D. Maintaining the patient in a supine position
Answer: C
Conceptual Explanation: Incentive spirometry promotes deep breathing and lung
expansion, which prevents alveolar collapse (atelectasis) in postoperative patients.
4. A patient with a serum sodium level of 128 mEq/L is at risk for which of the following
complications?
A. Hyporeflexia and muscle weakness
B. Cardiac dysrhythmias and cardiac arrest
C. Cerebral edema and seizures
D. Thirst and dry mucous membranes
, Answer: C
Conceptual Explanation: Hyponatremia (Na+ < 135) causes water to shift into cells. In the
brain, this results in cerebral edema, leading to neurological symptoms like confusion and
seizures.
5. When assessing a patient for Trousseau’s sign, the nurse should observe for which of the
following?
A. Twitching of the facial muscle when tapped
B. Carpal spasm after inflating a blood pressure cuff
C. Severe muscle cramps in the lower extremities
D. Circumoral tingling and numbness
Answer: B
Conceptual Explanation: Trousseau’s sign is an indication of hypocalcemia, characterized
by carpal spasms induced by ischemia from a blood pressure cuff.
6. A nurse is preparing to administer 0.45% Sodium Chloride (half-normal saline). Which type
of solution is this?
A. Isotonic
B. Hypotonic
C. Hypertonic
D. Colloid
QUESTIONS AND CORRECT ANSWERS
2026/2027
1. A patient’s ABG results are: pH 7.28, PaCO2 50 mm Hg, and HCO3 24 mEq/L. How should
the nurse interpret these findings?
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 mm Hg
with a normal HCO3 indicates that the respiratory system is the cause of the acidosis.
2. Which clinical manifestation should the nurse expect to find in a patient with a serum
potassium level of 6.2 mEq/L?
A. Inverted T waves on ECG
B. Hypoactive bowel sounds
C. Tall, peaked T waves on ECG
,D. Increased muscle strength
Answer: C
Conceptual Explanation: Hyperkalemia (K+ > 5.0) causes cardiac conductivity changes,
most notably tall, peaked T waves and widened QRS complexes.
3. A nurse is caring for a patient who is 1 day postoperative. Which intervention is most
effective in preventing atelectasis?
A. Administering prophylactic antibiotics
B. Restricting fluid intake to 1000 mL/day
C. Encouraging the use of an incentive spirometer 10 times per hour
D. Maintaining the patient in a supine position
Answer: C
Conceptual Explanation: Incentive spirometry promotes deep breathing and lung
expansion, which prevents alveolar collapse (atelectasis) in postoperative patients.
4. A patient with a serum sodium level of 128 mEq/L is at risk for which of the following
complications?
A. Hyporeflexia and muscle weakness
B. Cardiac dysrhythmias and cardiac arrest
C. Cerebral edema and seizures
D. Thirst and dry mucous membranes
, Answer: C
Conceptual Explanation: Hyponatremia (Na+ < 135) causes water to shift into cells. In the
brain, this results in cerebral edema, leading to neurological symptoms like confusion and
seizures.
5. When assessing a patient for Trousseau’s sign, the nurse should observe for which of the
following?
A. Twitching of the facial muscle when tapped
B. Carpal spasm after inflating a blood pressure cuff
C. Severe muscle cramps in the lower extremities
D. Circumoral tingling and numbness
Answer: B
Conceptual Explanation: Trousseau’s sign is an indication of hypocalcemia, characterized
by carpal spasms induced by ischemia from a blood pressure cuff.
6. A nurse is preparing to administer 0.45% Sodium Chloride (half-normal saline). Which type
of solution is this?
A. Isotonic
B. Hypotonic
C. Hypertonic
D. Colloid
