NU 185 Medical Surgical Nursing II Exam 1
Comprehensive Quiz Exam 1 Practice Questions &,
Exams of Nursing
1. A patient with chronic heart failure is prescribed sacubitril/valsartan. Which assessment
finding most urgently requires withholding the drug and notifying the provider?
A. Potassium 5.6 mEq/L
B. Blood pressure 88/54 mm Hg
C. Heart rate 92 beats/min
D. Serum creatinine 1.3 mg/dL
Answer: B
Rationale: Sacubitril/valsartan is an ARNI that causes vasodilation and can produce
symptomatic hypotension; a systolic BP <90 mm Hg warrants holding the dose. Hyperkalemia is
more characteristic of ARBs/ACE inhibitors alone, but the most immediate safety concern with
this agent is hypotension. Heart rate and mild creatinine elevation are not absolute
contraindications.
2. Which arterial blood gas value is most consistent with an acute exacerbation of COPD
with CO2 retention?
A. pH 7.48, PaCO2 30 mm Hg, HCO3 24 mEq/L
B. pH 7.30, PaCO2 58 mm Hg, HCO3 26 mEq/L
C. pH 7.50, PaCO2 40 mm Hg, HCO3 30 mEq/L
D. pH 7.36, PaCO2 40 mm Hg, HCO3 24 mEq/L
Answer: B
Rationale: Acute CO2 retention produces respiratory acidosis: low pH with elevated PaCO2 and
near-normal bicarbonate before renal compensation. Option A reflects respiratory alkalosis.
Option C suggests metabolic alkalosis with compensation. Option D is a normal ABG.
3. A patient with type 1 diabetes has a blood glucose of 310 mg/dL, pH 7.22, and positive
serum ketones. Which prescription should the nurse question?
A. 0.9% sodium chloride IV bolus
B. Regular insulin IV infusion
C. Sodium bicarbonate IV push
D. Potassium chloride 20 mEq IV in the infusion
Answer: C
Rationale: Sodium bicarbonate is not routinely indicated in DKA unless pH is severely low
(<6.9) and is typically reserved for extreme acidosis; routine use can worsen hypokalemia and
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,cerebral edema. IV fluids, insulin infusion, and potassium replacement (once K+ is not
dangerously high) are standard DKA management.
4. Which finding in a patient receiving continuous bladder irrigation after transurethral
resection of the prostate requires immediate intervention?
A. Urine output is clear and light pink
B. Patient reports bladder spasms
C. Returned irrigant is dark red with clots and output is less than irrigant infused
D. Serum sodium is 138 mEq/L
Answer: C
Rationale: Dark red return with clots and output less than irrigant infused suggests clot retention
or hemorrhage and possible bladder distention; the nurse must stop irrigation, assess for clots,
and notify the provider. Light pink output is expected. Bladder spasms may occur but are not the
priority over possible hemorrhage. Normal sodium is reassuring.
5. A patient with cirrhosis has ascites and is prescribed spironolactone. Which laboratory
value is most important to monitor for a therapeutic complication?
A. Serum potassium
B. Serum calcium
C. Serum amylase
D. Serum magnesium
Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic; hyperkalemia is a major risk,
especially in cirrhosis with renal impairment. Calcium, amylase, and magnesium are not the
primary monitoring parameters for spironolactone therapy.
6. A patient is admitted with an acute ischemic stroke and is being evaluated for
thrombolytic therapy. Which finding would contraindicate alteplase administration?
A. Blood pressure 178/98 mm Hg
B. Platelet count 210,000/mm3
C. INR 1.1
D. Blood glucose 140 mg/dL
Answer: A
Rationale: Alteplase is contraindicated when blood pressure is >185/110 mm Hg because of the
risk of intracranial hemorrhage; it must be lowered and stabilized before thrombolysis. Normal
platelet count, normal INR, and mild hyperglycemia are not contraindications.
7. Which assessment finding is an early sign of compartment syndrome in a patient with a
tibial fracture?
A. Pulselessness and paralysis
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, B. Severe pain out of proportion to injury, worsened by passive stretch
C. Warm, flushed extremity
D. Bounding pedal pulse
Answer: B
Rationale: The earliest and most sensitive sign of compartment syndrome is disproportionate
pain, especially with passive stretch of the affected muscles. Pulselessness and paralysis are late
findings. Warmth and bounding pulses are not typical early signs.
8. A patient receiving chemotherapy has a platelet count of 18,000/mm3. Which nursing
action is most appropriate?
A. Administer aspirin for mild headache
B. Use a soft-bristled toothbrush and electric razor
C. Encourage vigorous coughing and deep breathing
D. Apply heat to areas of bruising
Answer: B
Rationale: Severe thrombocytopenia increases bleeding risk; using soft oral care and electric
razors reduces trauma. Aspirin impairs platelet function and is contraindicated. Vigorous
coughing may precipitate bleeding. Heat can worsen bleeding and is not recommended.
9. Which statement by a patient scheduled for a colonoscopy with moderate sedation
indicates a need for further teaching?
A. I will drink only clear liquids the day before.
B. I will take my usual dose of insulin the morning of the procedure.
C. I will arrange for someone to drive me home.
D. I will stop my iron supplement several days before.
Answer: B
Rationale: Taking the usual insulin dose while NPO for a procedure increases the risk of
hypoglycemia; the dose should be adjusted per provider instructions. Clear liquids, a driver, and
stopping iron are all appropriate pre-procedure instructions.
10. A patient with a new tracheostomy is being taught about home care. Which statement
indicates correct understanding?
A. I will clean the stoma with hydrogen peroxide every day.
B. I will cover the tracheostomy with a loose cloth to keep out dust.
C. I will suction only when I feel short of breath.
D. I will change the tracheostomy ties only when they are soiled.
Answer: B
Rationale: A loose cloth or tracheostomy cover helps filter dust and humidify air while allowing
airflow; it is appropriate for home care. Hydrogen peroxide can irritate tissue and is not
recommended for routine stoma care. Suctioning should be based on assessment, not only
shortness of breath. Ties should be changed regularly and with two people when possible, not
Page 3
Comprehensive Quiz Exam 1 Practice Questions &,
Exams of Nursing
1. A patient with chronic heart failure is prescribed sacubitril/valsartan. Which assessment
finding most urgently requires withholding the drug and notifying the provider?
A. Potassium 5.6 mEq/L
B. Blood pressure 88/54 mm Hg
C. Heart rate 92 beats/min
D. Serum creatinine 1.3 mg/dL
Answer: B
Rationale: Sacubitril/valsartan is an ARNI that causes vasodilation and can produce
symptomatic hypotension; a systolic BP <90 mm Hg warrants holding the dose. Hyperkalemia is
more characteristic of ARBs/ACE inhibitors alone, but the most immediate safety concern with
this agent is hypotension. Heart rate and mild creatinine elevation are not absolute
contraindications.
2. Which arterial blood gas value is most consistent with an acute exacerbation of COPD
with CO2 retention?
A. pH 7.48, PaCO2 30 mm Hg, HCO3 24 mEq/L
B. pH 7.30, PaCO2 58 mm Hg, HCO3 26 mEq/L
C. pH 7.50, PaCO2 40 mm Hg, HCO3 30 mEq/L
D. pH 7.36, PaCO2 40 mm Hg, HCO3 24 mEq/L
Answer: B
Rationale: Acute CO2 retention produces respiratory acidosis: low pH with elevated PaCO2 and
near-normal bicarbonate before renal compensation. Option A reflects respiratory alkalosis.
Option C suggests metabolic alkalosis with compensation. Option D is a normal ABG.
3. A patient with type 1 diabetes has a blood glucose of 310 mg/dL, pH 7.22, and positive
serum ketones. Which prescription should the nurse question?
A. 0.9% sodium chloride IV bolus
B. Regular insulin IV infusion
C. Sodium bicarbonate IV push
D. Potassium chloride 20 mEq IV in the infusion
Answer: C
Rationale: Sodium bicarbonate is not routinely indicated in DKA unless pH is severely low
(<6.9) and is typically reserved for extreme acidosis; routine use can worsen hypokalemia and
Page 1
,cerebral edema. IV fluids, insulin infusion, and potassium replacement (once K+ is not
dangerously high) are standard DKA management.
4. Which finding in a patient receiving continuous bladder irrigation after transurethral
resection of the prostate requires immediate intervention?
A. Urine output is clear and light pink
B. Patient reports bladder spasms
C. Returned irrigant is dark red with clots and output is less than irrigant infused
D. Serum sodium is 138 mEq/L
Answer: C
Rationale: Dark red return with clots and output less than irrigant infused suggests clot retention
or hemorrhage and possible bladder distention; the nurse must stop irrigation, assess for clots,
and notify the provider. Light pink output is expected. Bladder spasms may occur but are not the
priority over possible hemorrhage. Normal sodium is reassuring.
5. A patient with cirrhosis has ascites and is prescribed spironolactone. Which laboratory
value is most important to monitor for a therapeutic complication?
A. Serum potassium
B. Serum calcium
C. Serum amylase
D. Serum magnesium
Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic; hyperkalemia is a major risk,
especially in cirrhosis with renal impairment. Calcium, amylase, and magnesium are not the
primary monitoring parameters for spironolactone therapy.
6. A patient is admitted with an acute ischemic stroke and is being evaluated for
thrombolytic therapy. Which finding would contraindicate alteplase administration?
A. Blood pressure 178/98 mm Hg
B. Platelet count 210,000/mm3
C. INR 1.1
D. Blood glucose 140 mg/dL
Answer: A
Rationale: Alteplase is contraindicated when blood pressure is >185/110 mm Hg because of the
risk of intracranial hemorrhage; it must be lowered and stabilized before thrombolysis. Normal
platelet count, normal INR, and mild hyperglycemia are not contraindications.
7. Which assessment finding is an early sign of compartment syndrome in a patient with a
tibial fracture?
A. Pulselessness and paralysis
Page 2
, B. Severe pain out of proportion to injury, worsened by passive stretch
C. Warm, flushed extremity
D. Bounding pedal pulse
Answer: B
Rationale: The earliest and most sensitive sign of compartment syndrome is disproportionate
pain, especially with passive stretch of the affected muscles. Pulselessness and paralysis are late
findings. Warmth and bounding pulses are not typical early signs.
8. A patient receiving chemotherapy has a platelet count of 18,000/mm3. Which nursing
action is most appropriate?
A. Administer aspirin for mild headache
B. Use a soft-bristled toothbrush and electric razor
C. Encourage vigorous coughing and deep breathing
D. Apply heat to areas of bruising
Answer: B
Rationale: Severe thrombocytopenia increases bleeding risk; using soft oral care and electric
razors reduces trauma. Aspirin impairs platelet function and is contraindicated. Vigorous
coughing may precipitate bleeding. Heat can worsen bleeding and is not recommended.
9. Which statement by a patient scheduled for a colonoscopy with moderate sedation
indicates a need for further teaching?
A. I will drink only clear liquids the day before.
B. I will take my usual dose of insulin the morning of the procedure.
C. I will arrange for someone to drive me home.
D. I will stop my iron supplement several days before.
Answer: B
Rationale: Taking the usual insulin dose while NPO for a procedure increases the risk of
hypoglycemia; the dose should be adjusted per provider instructions. Clear liquids, a driver, and
stopping iron are all appropriate pre-procedure instructions.
10. A patient with a new tracheostomy is being taught about home care. Which statement
indicates correct understanding?
A. I will clean the stoma with hydrogen peroxide every day.
B. I will cover the tracheostomy with a loose cloth to keep out dust.
C. I will suction only when I feel short of breath.
D. I will change the tracheostomy ties only when they are soiled.
Answer: B
Rationale: A loose cloth or tracheostomy cover helps filter dust and humidify air while allowing
airflow; it is appropriate for home care. Hydrogen peroxide can irritate tissue and is not
recommended for routine stoma care. Suctioning should be based on assessment, not only
shortness of breath. Ties should be changed regularly and with two people when possible, not
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