NU 185 Medical Surgical Nursing II Advanced
Comprehensive Ex 1 Exam 1 Practice Questions,
Exams of Nursing
1. A patient with acute decompensated heart failure is receiving IV furosemide. Which
assessment finding best indicates the medication is achieving its intended therapeutic
effect?
A. Serum potassium increase from 3.2 to 4.0 mEq/L
B. Urine output of 120 mL/hr with decreased bilateral crackles
C. Blood pressure decrease from 148/92 to 118/76 mm Hg
D. Weight gain of 0.5 kg since admission
Answer: B
Rationale: Loop diuretics reduce preload by promoting diuresis; effective response is
demonstrated by increased urine output and clearing of pulmonary congestion (crackles).
Potassium rising reflects correction of hypokalemia, not diuresis; BP reduction is a side effect,
not the primary therapeutic endpoint; weight gain indicates fluid retention.
2. A patient with COPD has an order for oxygen therapy. Which delivery method and
target saturation range is most appropriate to prevent hypercapnia?
A. High-flow nasal cannula titrated to SpO2 98-100%
B. Venturi mask titrated to SpO2 88-92%
C. Non-rebreather mask at 15 L/min targeting SpO2 95%
D. Simple face mask at 10 L/min targeting SpO2 94-98%
Answer: B
Rationale: In COPD, target SpO2 is 88–92% to avoid oxygen-induced hypercapnia; a Venturi
mask allows precise FiO2 control. High-flow or non-rebreather targeting near-100% risks CO2
retention; simple mask at 10 L/min is less precise and may exceed safe saturation.
3. A patient with type 1 diabetes is admitted with DKA. Which laboratory finding is most
consistent with this diagnosis?
A. Blood glucose 210 mg/dL, pH 7.48, HCO3 28 mEq/L
B. Blood glucose 480 mg/dL, pH 7.22, HCO3 12 mEq/L, positive serum ketones
C. Blood glucose 320 mg/dL, pH 7.36, HCO3 24 mEq/L, negative ketones
D. Blood glucose 90 mg/dL, pH 7.30, HCO3 18 mEq/L, positive ketones
Answer: B
Rationale: DKA is defined by hyperglycemia (>250 mg/dL), metabolic acidosis (pH <7.30,
HCO3 <18), and ketonemia. Option A shows alkalosis; C lacks acidosis and ketones (suggests
Page 1
,HHS); D shows hypoglycemia, not consistent with classic DKA.
4. A patient with chronic kidney disease has a serum potassium of 6.4 mEq/L. Which
intervention should the nurse anticipate implementing first?
A. Administer sodium polystyrene sulfonate orally
B. Initiate a continuous insulin infusion with dextrose
C. Prepare for emergency hemodialysis
D. Restrict dietary potassium and recheck in 4 hours
Answer: B
Rationale: Severe hyperkalemia (>6.0 mEq/L) with cardiac risk requires immediate stabilization;
IV insulin with dextrose shifts potassium intracellularly within minutes. Polystyrene and dietary
restriction act too slowly; dialysis is definitive but not the first immediate stabilizing measure.
5. A patient is admitted with an acute ischemic stroke and is within the 4.5-hour
thrombolytic window. Which assessment is the priority before administering IV alteplase?
A. National Institutes of Health Stroke Scale (NIHSS) score
B. Blood glucose level
C. Non-contrast CT scan of the head
D. Blood pressure measurement
Answer: C
Rationale: Alteplase is contraindicated in hemorrhagic stroke; a non-contrast CT must be
performed first to rule out bleeding. NIHSS quantifies severity, glucose rules out hypoglycemia
mimic, and BP must be <185/110, but CT is the essential gatekeeper before thrombolysis.
6. A patient with neutropenia from chemotherapy has a temperature of 38.3°C (101°F).
Which action should the nurse take first?
A. Administer acetaminophen as ordered and reassess in 1 hour
B. Obtain blood cultures from two sites and initiate broad-spectrum antibiotics
C. Place the patient in a negative-pressure isolation room
D. Encourage oral fluids and apply cooling measures
Answer: B
Rationale: Febrile neutropenia is an oncologic emergency; cultures must be drawn and empiric
broad-spectrum antibiotics started within 1 hour. Antipyretics may mask infection; isolation is
protective but not the immediate priority; cooling and fluids do not address the underlying
sepsis risk.
7. A patient is scheduled for a colon resection. Which preoperative instruction is most
important to include in the teaching plan?
A. Expect to resume a regular diet within 24 hours after surgery
B. Perform incentive spirometry every 2 hours while awake after surgery
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, C. Discontinue all medications the morning of surgery
D. Limit ambulation to prevent wound dehiscence
Answer: B
Rationale: Incentive spirometry prevents atelectasis and pneumonia, a major postoperative risk
after abdominal surgery. Diet is advanced gradually; not all medications are discontinued (e.g.,
beta-blockers); early ambulation is encouraged, not limited.
8. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mm Hg.
Which nursing intervention is most appropriate to help lower ICP?
A. Elevate the head of the bed to 30 degrees and keep the neck midline
B. Cluster nursing care to allow uninterrupted rest periods
C. Administer hypotonic IV fluids to maintain hydration
D. Perform vigorous endotracheal suctioning every hour
Answer: A
Rationale: Elevating the head of bed to 30° with neutral neck alignment promotes venous
drainage and reduces ICP. Clustering care can increase ICP; hypotonic fluids worsen cerebral
edema; frequent vigorous suctioning raises ICP.
9. A patient with a new diagnosis of atrial fibrillation is started on apixaban. Which
instruction is essential for the nurse to include in discharge teaching?
A. Take the medication with a full glass of grapefruit juice
B. Report any unusual bleeding, bruising, or black tarry stools
C. Double the dose if a dose is missed
D. Stop the medication 1 day before any dental procedure without consulting the provider
Answer: B
Rationale: Apixaban is a direct oral anticoagulant; bleeding is the major adverse effect and must
be reported. Grapefruit juice does not interact with apixaban; missed doses should not be
doubled; stopping before procedures requires provider guidance.
10. A patient with a new colostomy is learning to care for the stoma. Which statement by
the patient indicates correct understanding?
A. I should clean the stoma with alcohol and apply a new pouch every day.
B. I should expect the stoma to be pale and dry.
C. I should measure the stoma and cut the wafer to fit before applying the pouch.
D. I should avoid eating any foods that produce gas.
Answer: C
Rationale: A properly fitted wafer protects peristomal skin and prevents leakage. Alcohol is too
drying; a healthy stoma is red and moist; gas-producing foods need not be eliminated but can be
limited as tolerated.
Page 3
Comprehensive Ex 1 Exam 1 Practice Questions,
Exams of Nursing
1. A patient with acute decompensated heart failure is receiving IV furosemide. Which
assessment finding best indicates the medication is achieving its intended therapeutic
effect?
A. Serum potassium increase from 3.2 to 4.0 mEq/L
B. Urine output of 120 mL/hr with decreased bilateral crackles
C. Blood pressure decrease from 148/92 to 118/76 mm Hg
D. Weight gain of 0.5 kg since admission
Answer: B
Rationale: Loop diuretics reduce preload by promoting diuresis; effective response is
demonstrated by increased urine output and clearing of pulmonary congestion (crackles).
Potassium rising reflects correction of hypokalemia, not diuresis; BP reduction is a side effect,
not the primary therapeutic endpoint; weight gain indicates fluid retention.
2. A patient with COPD has an order for oxygen therapy. Which delivery method and
target saturation range is most appropriate to prevent hypercapnia?
A. High-flow nasal cannula titrated to SpO2 98-100%
B. Venturi mask titrated to SpO2 88-92%
C. Non-rebreather mask at 15 L/min targeting SpO2 95%
D. Simple face mask at 10 L/min targeting SpO2 94-98%
Answer: B
Rationale: In COPD, target SpO2 is 88–92% to avoid oxygen-induced hypercapnia; a Venturi
mask allows precise FiO2 control. High-flow or non-rebreather targeting near-100% risks CO2
retention; simple mask at 10 L/min is less precise and may exceed safe saturation.
3. A patient with type 1 diabetes is admitted with DKA. Which laboratory finding is most
consistent with this diagnosis?
A. Blood glucose 210 mg/dL, pH 7.48, HCO3 28 mEq/L
B. Blood glucose 480 mg/dL, pH 7.22, HCO3 12 mEq/L, positive serum ketones
C. Blood glucose 320 mg/dL, pH 7.36, HCO3 24 mEq/L, negative ketones
D. Blood glucose 90 mg/dL, pH 7.30, HCO3 18 mEq/L, positive ketones
Answer: B
Rationale: DKA is defined by hyperglycemia (>250 mg/dL), metabolic acidosis (pH <7.30,
HCO3 <18), and ketonemia. Option A shows alkalosis; C lacks acidosis and ketones (suggests
Page 1
,HHS); D shows hypoglycemia, not consistent with classic DKA.
4. A patient with chronic kidney disease has a serum potassium of 6.4 mEq/L. Which
intervention should the nurse anticipate implementing first?
A. Administer sodium polystyrene sulfonate orally
B. Initiate a continuous insulin infusion with dextrose
C. Prepare for emergency hemodialysis
D. Restrict dietary potassium and recheck in 4 hours
Answer: B
Rationale: Severe hyperkalemia (>6.0 mEq/L) with cardiac risk requires immediate stabilization;
IV insulin with dextrose shifts potassium intracellularly within minutes. Polystyrene and dietary
restriction act too slowly; dialysis is definitive but not the first immediate stabilizing measure.
5. A patient is admitted with an acute ischemic stroke and is within the 4.5-hour
thrombolytic window. Which assessment is the priority before administering IV alteplase?
A. National Institutes of Health Stroke Scale (NIHSS) score
B. Blood glucose level
C. Non-contrast CT scan of the head
D. Blood pressure measurement
Answer: C
Rationale: Alteplase is contraindicated in hemorrhagic stroke; a non-contrast CT must be
performed first to rule out bleeding. NIHSS quantifies severity, glucose rules out hypoglycemia
mimic, and BP must be <185/110, but CT is the essential gatekeeper before thrombolysis.
6. A patient with neutropenia from chemotherapy has a temperature of 38.3°C (101°F).
Which action should the nurse take first?
A. Administer acetaminophen as ordered and reassess in 1 hour
B. Obtain blood cultures from two sites and initiate broad-spectrum antibiotics
C. Place the patient in a negative-pressure isolation room
D. Encourage oral fluids and apply cooling measures
Answer: B
Rationale: Febrile neutropenia is an oncologic emergency; cultures must be drawn and empiric
broad-spectrum antibiotics started within 1 hour. Antipyretics may mask infection; isolation is
protective but not the immediate priority; cooling and fluids do not address the underlying
sepsis risk.
7. A patient is scheduled for a colon resection. Which preoperative instruction is most
important to include in the teaching plan?
A. Expect to resume a regular diet within 24 hours after surgery
B. Perform incentive spirometry every 2 hours while awake after surgery
Page 2
, C. Discontinue all medications the morning of surgery
D. Limit ambulation to prevent wound dehiscence
Answer: B
Rationale: Incentive spirometry prevents atelectasis and pneumonia, a major postoperative risk
after abdominal surgery. Diet is advanced gradually; not all medications are discontinued (e.g.,
beta-blockers); early ambulation is encouraged, not limited.
8. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mm Hg.
Which nursing intervention is most appropriate to help lower ICP?
A. Elevate the head of the bed to 30 degrees and keep the neck midline
B. Cluster nursing care to allow uninterrupted rest periods
C. Administer hypotonic IV fluids to maintain hydration
D. Perform vigorous endotracheal suctioning every hour
Answer: A
Rationale: Elevating the head of bed to 30° with neutral neck alignment promotes venous
drainage and reduces ICP. Clustering care can increase ICP; hypotonic fluids worsen cerebral
edema; frequent vigorous suctioning raises ICP.
9. A patient with a new diagnosis of atrial fibrillation is started on apixaban. Which
instruction is essential for the nurse to include in discharge teaching?
A. Take the medication with a full glass of grapefruit juice
B. Report any unusual bleeding, bruising, or black tarry stools
C. Double the dose if a dose is missed
D. Stop the medication 1 day before any dental procedure without consulting the provider
Answer: B
Rationale: Apixaban is a direct oral anticoagulant; bleeding is the major adverse effect and must
be reported. Grapefruit juice does not interact with apixaban; missed doses should not be
doubled; stopping before procedures requires provider guidance.
10. A patient with a new colostomy is learning to care for the stoma. Which statement by
the patient indicates correct understanding?
A. I should clean the stoma with alcohol and apply a new pouch every day.
B. I should expect the stoma to be pale and dry.
C. I should measure the stoma and cut the wafer to fit before applying the pouch.
D. I should avoid eating any foods that produce gas.
Answer: C
Rationale: A properly fitted wafer protects peristomal skin and prevents leakage. Alcohol is too
drying; a healthy stoma is red and moist; gas-producing foods need not be eliminated but can be
limited as tolerated.
Page 3
