NUR 170- NUR 171 EXAM 2 A
QUESTIONS AND CORRECT ANSWERS
2026/2027
1. A client is admitted with a serum sodium level of 152 mEq/L. Which clinical manifestation
should the nurse prioritize in the assessment?
A. Muscle weakness and bradycardia
B. Abdominal cramping and diarrhea
C. Agitation and restlessness
D. Trousseau’s sign
Answer: C
Conceptual Explanation: Hypernatremia (Sodium > 145 mEq/L) primarily affects the
central nervous system due to cellular dehydration, leading to agitation, restlessness, and
potential seizures.
2. Which arterial blood gas (ABG) result is most consistent with a patient experiencing a
severe panic attack?
A. pH 7.32, PaCO2 50, HCO3 24
B. pH 7.50, PaCO2 45, HCO3 32
C. pH 7.25, PaCO2 40, HCO3 18
,D. pH 7.48, PaCO2 30, HCO3 23
Answer: D
Conceptual Explanation: Hyperventilation during a panic attack causes excessive loss of
CO2, leading to Respiratory Alkalosis (high pH, low PaCO2).
3. A nurse is caring for a postoperative patient who has not voided for 8 hours. What is the
priority nursing action?
A. Insert an indwelling urinary catheter immediately
B. Increase IV fluid flow rate
C. Perform a bladder scan
D. Encourage the patient to use a bedpan
Answer: C
Conceptual Explanation: A bladder scan is a non-invasive assessment tool to determine
the volume of urine in the bladder before proceeding to more invasive interventions like
catheterization.
4. Which electrolyte imbalance is most likely to cause a positive Chvostek’s sign?
A. Hyperkalemia
B. Hypocalcemia
C. Hyponatremia
D. Hypermagnesemia
, Answer: B
Conceptual Explanation: Hypocalcemia increases neuromuscular excitability; Chvostek’s
sign is a twitching of the facial muscles in response to tapping over the facial nerve.
5. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via a
Venturi mask at 24%. Why is this delivery system preferred for this patient?
A. It provides the highest concentration of oxygen possible
B. It delivers a precise and consistent concentration of oxygen
C. It allows the patient to talk and eat comfortably
D. It humidifies the air automatically
Answer: B
Conceptual Explanation: The Venturi mask is the most accurate device for delivering a
fixed, precise oxygen concentration, which is critical for COPD patients to avoid
suppressing their hypoxic drive.
6. During the intraoperative phase, which member of the surgical team is responsible for
maintaining the sterile field and passing instruments?
A. Circulating nurse
B. Surgeon’s assistant
C. Anesthesiologist
D. Scrub nurse
QUESTIONS AND CORRECT ANSWERS
2026/2027
1. A client is admitted with a serum sodium level of 152 mEq/L. Which clinical manifestation
should the nurse prioritize in the assessment?
A. Muscle weakness and bradycardia
B. Abdominal cramping and diarrhea
C. Agitation and restlessness
D. Trousseau’s sign
Answer: C
Conceptual Explanation: Hypernatremia (Sodium > 145 mEq/L) primarily affects the
central nervous system due to cellular dehydration, leading to agitation, restlessness, and
potential seizures.
2. Which arterial blood gas (ABG) result is most consistent with a patient experiencing a
severe panic attack?
A. pH 7.32, PaCO2 50, HCO3 24
B. pH 7.50, PaCO2 45, HCO3 32
C. pH 7.25, PaCO2 40, HCO3 18
,D. pH 7.48, PaCO2 30, HCO3 23
Answer: D
Conceptual Explanation: Hyperventilation during a panic attack causes excessive loss of
CO2, leading to Respiratory Alkalosis (high pH, low PaCO2).
3. A nurse is caring for a postoperative patient who has not voided for 8 hours. What is the
priority nursing action?
A. Insert an indwelling urinary catheter immediately
B. Increase IV fluid flow rate
C. Perform a bladder scan
D. Encourage the patient to use a bedpan
Answer: C
Conceptual Explanation: A bladder scan is a non-invasive assessment tool to determine
the volume of urine in the bladder before proceeding to more invasive interventions like
catheterization.
4. Which electrolyte imbalance is most likely to cause a positive Chvostek’s sign?
A. Hyperkalemia
B. Hypocalcemia
C. Hyponatremia
D. Hypermagnesemia
, Answer: B
Conceptual Explanation: Hypocalcemia increases neuromuscular excitability; Chvostek’s
sign is a twitching of the facial muscles in response to tapping over the facial nerve.
5. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via a
Venturi mask at 24%. Why is this delivery system preferred for this patient?
A. It provides the highest concentration of oxygen possible
B. It delivers a precise and consistent concentration of oxygen
C. It allows the patient to talk and eat comfortably
D. It humidifies the air automatically
Answer: B
Conceptual Explanation: The Venturi mask is the most accurate device for delivering a
fixed, precise oxygen concentration, which is critical for COPD patients to avoid
suppressing their hypoxic drive.
6. During the intraoperative phase, which member of the surgical team is responsible for
maintaining the sterile field and passing instruments?
A. Circulating nurse
B. Surgeon’s assistant
C. Anesthesiologist
D. Scrub nurse
