NU 185 Exam 3 Medical Surgical Nursing II
Advanced Critical Care and Complex Systems Exam,
Exams of Nursing
1. A client is brought to the Emergency Department after fainting in a local department
store. The client has been fasting and has ketones in the urine. Which acid-base imbalance
should the nurse expect to assess in this client?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Respiratory acidosis
Answer: A
Rationale: A client who is fasting is at risk for development of metabolic acidosis. The body
recognizes fasting as starvation and begins to metabolize its own proteins into ketones, which
are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in
metabolic alkalosis.
2. The nurse manager at a long-term care facility is planning care for a client who is
receiving radiation therapy for laryngeal cancer. Which of these tasks is best to delegate to
a nursing assistant?
A. Teaching the client about the side effects of radiation therapy
B. Assessing the client's skin for signs of radiation dermatitis
C. Washing the skin with soap and water
D. Administering prescribed pain medication before radiation treatment
Answer: C
Rationale: Personal hygiene is within the scope of practice of the nursing assistant.
3. During installation, does the configuration wizard generate a trusted SSL certificate?
A. Yes
B. No, SSL certificates must be manually installed after the wizard completes.
C. Only if a valid certificate authority is configured beforehand.
D. No, it generates a self-signed certificate that is not trusted by default.
Answer: A
Rationale: The configuration wizard is designed to generate a trusted SSL certificate as part of
the installation process, ensuring secure communications out of the box. This eliminates the
need for manual certificate creation or pre-configuration of a certificate authority.
Page 1
,4. What occurs when the soot loading on a diesel particulate filter (DPF) exceeds 80%?
A. Automatic active regeneration initiates and continues until the filter is fully cleaned.
B. Engine de-rate and shutdown.
C. The DPF warning lamp illuminates only, with no change in engine power or operation.
D. The exhaust gas recirculation (EGR) valve opens fully to reduce particulate formation.
Answer: B
Rationale: When soot loading in a DPF exceeds approximately 80%, the engine control module
triggers a protective engine de-rate and eventual shutdown to prevent excessive backpressure,
overheating, and irreversible filter damage. Regeneration or warning-only responses are
inadequate at this threshold and would not prevent damage.
5. What is Mr. Jones's reported pain score on a 0-to-10 numeric rating scale?
A. 6/10
B. 8/10
C. 2/10
D. 4/10
Answer: D
Rationale: The correct pain score for Mr. Jones is 4/10, indicating moderate pain on a 0-to-10
numeric rating scale. The other values represent either milder or more severe pain and do not
match the documented assessment.
6. A client has just undergone insertion of a central venous catheter at the bedside. Before
initiating the flow rate of the client's IV solution at 100 mL/hr, the nurse should be sure to
check the results of which of the following?
A. Coagulation studies (PT/INR)
B. Serum electrolyte panel
C. Complete blood count (CBC)
D. Portable chest x-ray film
Answer: D
Rationale: After central venous catheter insertion, a portable chest x-ray is essential to confirm
proper catheter tip placement and rule out complications such as pneumothorax or hemothorax
before infusing IV fluids. Electrolyte, coagulation, and blood count tests are important for
overall assessment but do not directly verify catheter position or safety for immediate use.
7. Where is the patient's pain located?
A. Down the front of my left leg
B. In the right upper quadrant of my abdomen
C. Behind my breastbone, radiating to my jaw
D. Across my lower back
Answer: D
Page 2
, Rationale: The patient reports pain across the lower back, which localizes the discomfort to the lumbar region. The other
options describe different anatomic areas, so they do not match the patient's statement. The correct answer preserves the
patient's own description of the pain's location.
8. A client with lung cancer undergoes removal of the left lower lobe of the lung. Which
postoperative measure is typically included in the plan of care?
A. Early ambulation and leg exercises
B. Chest physiotherapy with incentive spirometry
C. Administration of prophylactic antibiotics
D. Closed chest drainage
Answer: D
Rationale: The client with a lung resection will have chest tubes and a drainage-collection
device. He probably will not have a tracheoostomy or me- diastinal tube, and he will not have an
order for percussion, vibration, or drainage.
9. The nurse on the 3-11 shift is reviewing the chart of a client with an abdominal aneurysm
scheduled for surgery in the morning. The nurse notes that the consent form has been
signed, but the client is unclear about the surgery and possible complications. Which is the
most appropriate action?
A. Call the surgeon and ask him or her to see the client to clarify the information
B. Notify the nursing supervisor that the consent form is invalid because the client does not understand
the surgery
C. Explain the procedure and possible complications to the client, and then have the client sign a new
consent form
D. Document the client's lack of understanding in the chart and proceed with the surgery as scheduled
Answer: A
Rationale: It is the responsibility of the physician to explain and clarify the procedure to the
client.
10. Which client requires immediate attention by the registered nurse (RN)?
A. A 62-year-old client who is mechanically ventilated and has an oxygen saturation of 90% on 40%
FiO2
B. A 45-year-old client who is mechanically ventilated and has bilateral crackles with a temperature of
38.3°C (101°F)
C. A 58-year-old client who is mechanically ventilated and has a peak inspiratory pressure increase
from 20 to 28 cm H2O
D. A 54-year-old client who is mechanically ventilated and has tracheal deviation
Answer: D
Rationale: This client is showing signs of a tension pneumothorax that could lead to decreased
cardiac output and shock if not addressed promptly.
Page 3
Advanced Critical Care and Complex Systems Exam,
Exams of Nursing
1. A client is brought to the Emergency Department after fainting in a local department
store. The client has been fasting and has ketones in the urine. Which acid-base imbalance
should the nurse expect to assess in this client?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Respiratory acidosis
Answer: A
Rationale: A client who is fasting is at risk for development of metabolic acidosis. The body
recognizes fasting as starvation and begins to metabolize its own proteins into ketones, which
are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in
metabolic alkalosis.
2. The nurse manager at a long-term care facility is planning care for a client who is
receiving radiation therapy for laryngeal cancer. Which of these tasks is best to delegate to
a nursing assistant?
A. Teaching the client about the side effects of radiation therapy
B. Assessing the client's skin for signs of radiation dermatitis
C. Washing the skin with soap and water
D. Administering prescribed pain medication before radiation treatment
Answer: C
Rationale: Personal hygiene is within the scope of practice of the nursing assistant.
3. During installation, does the configuration wizard generate a trusted SSL certificate?
A. Yes
B. No, SSL certificates must be manually installed after the wizard completes.
C. Only if a valid certificate authority is configured beforehand.
D. No, it generates a self-signed certificate that is not trusted by default.
Answer: A
Rationale: The configuration wizard is designed to generate a trusted SSL certificate as part of
the installation process, ensuring secure communications out of the box. This eliminates the
need for manual certificate creation or pre-configuration of a certificate authority.
Page 1
,4. What occurs when the soot loading on a diesel particulate filter (DPF) exceeds 80%?
A. Automatic active regeneration initiates and continues until the filter is fully cleaned.
B. Engine de-rate and shutdown.
C. The DPF warning lamp illuminates only, with no change in engine power or operation.
D. The exhaust gas recirculation (EGR) valve opens fully to reduce particulate formation.
Answer: B
Rationale: When soot loading in a DPF exceeds approximately 80%, the engine control module
triggers a protective engine de-rate and eventual shutdown to prevent excessive backpressure,
overheating, and irreversible filter damage. Regeneration or warning-only responses are
inadequate at this threshold and would not prevent damage.
5. What is Mr. Jones's reported pain score on a 0-to-10 numeric rating scale?
A. 6/10
B. 8/10
C. 2/10
D. 4/10
Answer: D
Rationale: The correct pain score for Mr. Jones is 4/10, indicating moderate pain on a 0-to-10
numeric rating scale. The other values represent either milder or more severe pain and do not
match the documented assessment.
6. A client has just undergone insertion of a central venous catheter at the bedside. Before
initiating the flow rate of the client's IV solution at 100 mL/hr, the nurse should be sure to
check the results of which of the following?
A. Coagulation studies (PT/INR)
B. Serum electrolyte panel
C. Complete blood count (CBC)
D. Portable chest x-ray film
Answer: D
Rationale: After central venous catheter insertion, a portable chest x-ray is essential to confirm
proper catheter tip placement and rule out complications such as pneumothorax or hemothorax
before infusing IV fluids. Electrolyte, coagulation, and blood count tests are important for
overall assessment but do not directly verify catheter position or safety for immediate use.
7. Where is the patient's pain located?
A. Down the front of my left leg
B. In the right upper quadrant of my abdomen
C. Behind my breastbone, radiating to my jaw
D. Across my lower back
Answer: D
Page 2
, Rationale: The patient reports pain across the lower back, which localizes the discomfort to the lumbar region. The other
options describe different anatomic areas, so they do not match the patient's statement. The correct answer preserves the
patient's own description of the pain's location.
8. A client with lung cancer undergoes removal of the left lower lobe of the lung. Which
postoperative measure is typically included in the plan of care?
A. Early ambulation and leg exercises
B. Chest physiotherapy with incentive spirometry
C. Administration of prophylactic antibiotics
D. Closed chest drainage
Answer: D
Rationale: The client with a lung resection will have chest tubes and a drainage-collection
device. He probably will not have a tracheoostomy or me- diastinal tube, and he will not have an
order for percussion, vibration, or drainage.
9. The nurse on the 3-11 shift is reviewing the chart of a client with an abdominal aneurysm
scheduled for surgery in the morning. The nurse notes that the consent form has been
signed, but the client is unclear about the surgery and possible complications. Which is the
most appropriate action?
A. Call the surgeon and ask him or her to see the client to clarify the information
B. Notify the nursing supervisor that the consent form is invalid because the client does not understand
the surgery
C. Explain the procedure and possible complications to the client, and then have the client sign a new
consent form
D. Document the client's lack of understanding in the chart and proceed with the surgery as scheduled
Answer: A
Rationale: It is the responsibility of the physician to explain and clarify the procedure to the
client.
10. Which client requires immediate attention by the registered nurse (RN)?
A. A 62-year-old client who is mechanically ventilated and has an oxygen saturation of 90% on 40%
FiO2
B. A 45-year-old client who is mechanically ventilated and has bilateral crackles with a temperature of
38.3°C (101°F)
C. A 58-year-old client who is mechanically ventilated and has a peak inspiratory pressure increase
from 20 to 28 cm H2O
D. A 54-year-old client who is mechanically ventilated and has tracheal deviation
Answer: D
Rationale: This client is showing signs of a tension pneumothorax that could lead to decreased
cardiac output and shock if not addressed promptly.
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