NU 185 Medical Surgical Nursing II Exam 3
Comprehensive Study Guide Exam 3 Practice Quest,
Exams of Nursing
1. A patient with heart failure is prescribed furosemide and digoxin. Which assessment
finding most urgently requires the nurse to hold the digoxin and notify the provider?
A. Heart rate of 52 beats per minute with new-onset nausea and visual halos
B. Serum potassium of 3.8 mEq/L and mild ankle edema
C. Blood pressure of 118/72 mm Hg and urinary output of 40 mL/hr
D. Complaint of dry mouth and a 0.5 kg weight loss since yesterday
Answer: A
Rationale: Bradycardia accompanied by nausea and visual disturbances (halos) are classic signs
of digoxin toxicity, often precipitated by furosemide-induced hypokalemia; the drug must be held
and the provider notified. The other findings are either within normal limits or expected
therapeutic effects.
2. A patient with COPD has an oxygen saturation of 88% on room air. Which oxygen
delivery method best balances adequate oxygenation with avoidance of hypercapnia?
A. Non-rebreather mask at 10 L/min
B. Venturi mask titrated to maintain SpO2 88-92%
C. Simple face mask at 8 L/min
D. Nasal cannula at 6 L/min continuously
Answer: B
Rationale: For COPD patients at risk for CO2 retention, a Venturi mask allows precise FiO2
control to target SpO2 88-92%, minimizing hypercapnia risk. High-flow masks or high cannula
rates can overshoot the target and suppress hypoxic drive.
3. A patient with type 1 diabetes presents with blood glucose 412 mg/dL, pH 7.22, and
positive serum ketones. Which prescription should the nurse anticipate as the priority?
A. Subcutaneous insulin glargine 20 units now
B. IV regular insulin infusion with 0.9% NaCl
C. IV sodium bicarbonate 50 mEq bolus
D. Oral metformin 500 mg immediately
Answer: B
Rationale: Diabetic ketoacidosis requires rapid IV regular insulin infusion plus fluid
resuscitation with isotonic saline to correct hyperglycemia and ketosis. Subcutaneous
long-acting insulin alone is too slow, bicarbonate is reserved for severe acidosis (pH <6.9), and
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,metformin is not indicated for type 1 diabetes.
4. A patient with acute kidney injury has a serum potassium of 6.8 mEq/L. Which
intervention should the nurse implement first?
A. Administer oral sodium polystyrene sulfonate
B. Prepare for emergency hemodialysis
C. Give IV calcium gluconate as prescribed
D. Restrict dietary potassium and recheck in 4 hours
Answer: C
Rationale: IV calcium gluconate is the immediate treatment for hyperkalemia to stabilize cardiac
membranes and prevent lethal arrhythmias. Potassium binders and dietary restriction act too
slowly, and dialysis is definitive but not the first stabilizing action.
5. A patient who had a total thyroidectomy develops tingling in the fingertips and around
the mouth. Which complication should the nurse suspect?
A. Thyroid storm
B. Hypocalcemia from parathyroid injury
C. Recurrent laryngeal nerve damage
D. Hemorrhage at the surgical site
Answer: B
Rationale: Accidental parathyroid removal or injury during thyroidectomy causes hypocalcemia,
manifesting as perioral and digital paresthesias (Chvostek and Trousseau signs). Thyroid storm
is a hypermetabolic crisis, nerve damage causes hoarseness, and hemorrhage presents with neck
swelling and respiratory distress.
6. A patient recovering from an acute ischemic stroke has dysphagia. Which nursing action
is most appropriate before oral intake?
A. Offer thin liquids to assess swallowing reflex
B. Perform a bedside swallow screening and maintain NPO until cleared
C. Place the patient supine during meals
D. Encourage straw use for easier liquid intake
Answer: B
Rationale: Patients with stroke-related dysphagia are at high risk for aspiration; a bedside
swallow screen must be completed and the patient kept NPO until cleared by a speech-language
pathologist. Thin liquids, supine positioning, and straws all increase aspiration risk.
7. A patient with cirrhosis has ascites and is prescribed spironolactone and furosemide.
Which laboratory value indicates a therapeutic response?
A. Serum potassium 5.8 mEq/L
B. Serum sodium 128 mEq/L
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, C. Serum creatinine 1.0 mg/dL with increased urine output
D. Serum albumin 2.1 g/dL
Answer: C
Rationale: Improved urine output with stable renal function indicates effective diuresis in ascites
management. Hyperkalemia suggests excessive spironolactone effect, hyponatremia may worsen
with over-diuresis, and low albumin is a manifestation of liver disease, not a therapeutic
response.
8. A patient with a below-the-knee amputation reports phantom limb pain. Which
intervention is most appropriate?
A. Apply a heating pad to the residual limb
B. Administer prescribed gabapentin and use mirror therapy
C. Elevate the residual limb on a pillow continuously
D. Tightly wrap the limb with an elastic bandage
Answer: B
Rationale: Phantom limb pain is neuropathic and responds to medications like gabapentin and
therapies such as mirror therapy. Heat, elevation, and tight wrapping address stump edema or
circulation, not neuropathic pain, and may cause harm.
9. A patient receiving chemotherapy has a neutrophil count of 450/mm³. Which instruction
is most important for the nurse to include in discharge teaching?
A. Avoid crowded places and report any fever immediately
B. Increase intake of fresh fruits and vegetables
C. Use a soft toothbrush and avoid flossing
D. Take acetaminophen at the first sign of infection
Answer: A
Rationale: Severe neutropenia increases infection risk; avoiding crowds and promptly reporting
fever are critical. Fresh produce may harbor pathogens, soft toothbrush use is appropriate but
not the priority, and acetaminophen can mask fever without treating infection.
10. A patient is scheduled for a colonoscopy. Which bowel preparation instruction is
essential for the nurse to reinforce?
A. Eat a low-fiber diet the day before the procedure
B. Stop all medications including antihypertensives 24 hours prior
C. Complete the prescribed bowel prep and maintain clear liquids as directed
D. Take iron supplements to prevent anemia during prep
Answer: C
Rationale: Adequate bowel cleansing with the prescribed prep and clear liquids is essential for
visualization and safety during colonoscopy. A low-fiber diet alone is insufficient,
antihypertensives are typically continued, and iron supplements are held because they obscure
visualization.
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Comprehensive Study Guide Exam 3 Practice Quest,
Exams of Nursing
1. A patient with heart failure is prescribed furosemide and digoxin. Which assessment
finding most urgently requires the nurse to hold the digoxin and notify the provider?
A. Heart rate of 52 beats per minute with new-onset nausea and visual halos
B. Serum potassium of 3.8 mEq/L and mild ankle edema
C. Blood pressure of 118/72 mm Hg and urinary output of 40 mL/hr
D. Complaint of dry mouth and a 0.5 kg weight loss since yesterday
Answer: A
Rationale: Bradycardia accompanied by nausea and visual disturbances (halos) are classic signs
of digoxin toxicity, often precipitated by furosemide-induced hypokalemia; the drug must be held
and the provider notified. The other findings are either within normal limits or expected
therapeutic effects.
2. A patient with COPD has an oxygen saturation of 88% on room air. Which oxygen
delivery method best balances adequate oxygenation with avoidance of hypercapnia?
A. Non-rebreather mask at 10 L/min
B. Venturi mask titrated to maintain SpO2 88-92%
C. Simple face mask at 8 L/min
D. Nasal cannula at 6 L/min continuously
Answer: B
Rationale: For COPD patients at risk for CO2 retention, a Venturi mask allows precise FiO2
control to target SpO2 88-92%, minimizing hypercapnia risk. High-flow masks or high cannula
rates can overshoot the target and suppress hypoxic drive.
3. A patient with type 1 diabetes presents with blood glucose 412 mg/dL, pH 7.22, and
positive serum ketones. Which prescription should the nurse anticipate as the priority?
A. Subcutaneous insulin glargine 20 units now
B. IV regular insulin infusion with 0.9% NaCl
C. IV sodium bicarbonate 50 mEq bolus
D. Oral metformin 500 mg immediately
Answer: B
Rationale: Diabetic ketoacidosis requires rapid IV regular insulin infusion plus fluid
resuscitation with isotonic saline to correct hyperglycemia and ketosis. Subcutaneous
long-acting insulin alone is too slow, bicarbonate is reserved for severe acidosis (pH <6.9), and
Page 1
,metformin is not indicated for type 1 diabetes.
4. A patient with acute kidney injury has a serum potassium of 6.8 mEq/L. Which
intervention should the nurse implement first?
A. Administer oral sodium polystyrene sulfonate
B. Prepare for emergency hemodialysis
C. Give IV calcium gluconate as prescribed
D. Restrict dietary potassium and recheck in 4 hours
Answer: C
Rationale: IV calcium gluconate is the immediate treatment for hyperkalemia to stabilize cardiac
membranes and prevent lethal arrhythmias. Potassium binders and dietary restriction act too
slowly, and dialysis is definitive but not the first stabilizing action.
5. A patient who had a total thyroidectomy develops tingling in the fingertips and around
the mouth. Which complication should the nurse suspect?
A. Thyroid storm
B. Hypocalcemia from parathyroid injury
C. Recurrent laryngeal nerve damage
D. Hemorrhage at the surgical site
Answer: B
Rationale: Accidental parathyroid removal or injury during thyroidectomy causes hypocalcemia,
manifesting as perioral and digital paresthesias (Chvostek and Trousseau signs). Thyroid storm
is a hypermetabolic crisis, nerve damage causes hoarseness, and hemorrhage presents with neck
swelling and respiratory distress.
6. A patient recovering from an acute ischemic stroke has dysphagia. Which nursing action
is most appropriate before oral intake?
A. Offer thin liquids to assess swallowing reflex
B. Perform a bedside swallow screening and maintain NPO until cleared
C. Place the patient supine during meals
D. Encourage straw use for easier liquid intake
Answer: B
Rationale: Patients with stroke-related dysphagia are at high risk for aspiration; a bedside
swallow screen must be completed and the patient kept NPO until cleared by a speech-language
pathologist. Thin liquids, supine positioning, and straws all increase aspiration risk.
7. A patient with cirrhosis has ascites and is prescribed spironolactone and furosemide.
Which laboratory value indicates a therapeutic response?
A. Serum potassium 5.8 mEq/L
B. Serum sodium 128 mEq/L
Page 2
, C. Serum creatinine 1.0 mg/dL with increased urine output
D. Serum albumin 2.1 g/dL
Answer: C
Rationale: Improved urine output with stable renal function indicates effective diuresis in ascites
management. Hyperkalemia suggests excessive spironolactone effect, hyponatremia may worsen
with over-diuresis, and low albumin is a manifestation of liver disease, not a therapeutic
response.
8. A patient with a below-the-knee amputation reports phantom limb pain. Which
intervention is most appropriate?
A. Apply a heating pad to the residual limb
B. Administer prescribed gabapentin and use mirror therapy
C. Elevate the residual limb on a pillow continuously
D. Tightly wrap the limb with an elastic bandage
Answer: B
Rationale: Phantom limb pain is neuropathic and responds to medications like gabapentin and
therapies such as mirror therapy. Heat, elevation, and tight wrapping address stump edema or
circulation, not neuropathic pain, and may cause harm.
9. A patient receiving chemotherapy has a neutrophil count of 450/mm³. Which instruction
is most important for the nurse to include in discharge teaching?
A. Avoid crowded places and report any fever immediately
B. Increase intake of fresh fruits and vegetables
C. Use a soft toothbrush and avoid flossing
D. Take acetaminophen at the first sign of infection
Answer: A
Rationale: Severe neutropenia increases infection risk; avoiding crowds and promptly reporting
fever are critical. Fresh produce may harbor pathogens, soft toothbrush use is appropriate but
not the priority, and acetaminophen can mask fever without treating infection.
10. A patient is scheduled for a colonoscopy. Which bowel preparation instruction is
essential for the nurse to reinforce?
A. Eat a low-fiber diet the day before the procedure
B. Stop all medications including antihypertensives 24 hours prior
C. Complete the prescribed bowel prep and maintain clear liquids as directed
D. Take iron supplements to prevent anemia during prep
Answer: C
Rationale: Adequate bowel cleansing with the prescribed prep and clear liquids is essential for
visualization and safety during colonoscopy. A low-fiber diet alone is insufficient,
antihypertensives are typically continued, and iron supplements are held because they obscure
visualization.
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