NU 185 Medical Surgical Nursing II Exam 4
Comprehensive Study Guide Exam 4 Practice Quest,
Exams of Nursing
1. A patient with heart failure is prescribed furosemide. Which laboratory result requires
immediate notification of the provider?
A. Potassium 3.1 mEq/L
B. Sodium 138 mEq/L
C. Creatinine 1.0 mg/dL
D. Hemoglobin 13.5 g/dL
Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium loss, and a level below 3.5 mEq/L
indicates hypokalemia, increasing the risk for dysrhythmias. Sodium, creatinine, and
hemoglobin values are within normal limits and do not require immediate action.
2. Which assessment finding is most concerning in a patient recovering from a
thyroidectomy?
A. Hoarse voice
B. Serum calcium 8.0 mg/dL
C. Incisional pain rated 4/10
D. Heart rate 88 beats/min
Answer: B
Rationale: Hypocalcemia after thyroidectomy may indicate parathyroid injury and can progress
to tetany and laryngospasm. Hoarseness and incisional pain are expected; a heart rate of 88 is
normal.
3. The nurse is reviewing prescriptions for a patient with an acute exacerbation of COPD.
Which order should the nurse question?
A. Oxygen at 2 L/min via nasal cannula
B. Albuterol nebulizer every 4 hours
C. Methylprednisolone IV every 6 hours
D. Promethazine 25 mg IV every 6 hours
Answer: D
Rationale: Promethazine is contraindicated in COPD because it can cause respiratory
depression and thicken secretions. Low-flow oxygen, bronchodilators, and corticosteroids are
standard therapies for COPD exacerbation.
Page 1
,4. A patient with chronic kidney disease has a hemoglobin of 9.0 g/dL. Which medication
does the nurse anticipate administering?
A. Ferrous sulfate
B. Epoetin alfa
C. Folic acid
D. Vitamin B12
Answer: B
Rationale: Anemia in CKD is primarily due to decreased erythropoietin production, so epoetin
alfa is the treatment of choice. Iron, folate, and B12 may be supplemented but do not address the
primary cause.
5. Which finding in a patient with acute pancreatitis indicates a potential complication
requiring immediate intervention?
A. Blood glucose 180 mg/dL
B. Serum amylase 200 U/L
C. Heart rate 120 beats/min and blood pressure 88/50 mm Hg
D. Pain relieved by fetal positioning
Answer: C
Rationale: Tachycardia and hypotension suggest hypovolemic shock from pancreatic hemorrhage
or third-spacing, a life-threatening complication. Elevated glucose and amylase are expected;
pain relief with positioning is typical.
6. A patient is admitted with a fractured femur and is placed in skeletal traction. Which
nursing action is priority?
A. Ensure weights hang freely and are not touching the floor
B. Perform passive range-of-motion exercises on the affected leg
C. Remove the traction weights during repositioning
D. Apply lotion to the skin around the pin sites
Answer: A
Rationale: Traction weights must hang freely to maintain proper alignment and prevent
complications. Range-of-motion and removing weights are contraindicated; lotion should not be
applied near pin sites due to infection risk.
7. The nurse is caring for a patient with increased intracranial pressure. Which position is
most appropriate?
A. Flat supine
B. Trendelenburg
C. Head of bed elevated 30 degrees
D. Prone
Answer: C
Page 2
, Rationale: Elevating the head of the bed 30 degrees promotes venous drainage from the head and helps reduce intracranial
pressure. Flat, Trendelenburg, and prone positions can increase ICP.
8. A patient receiving chemotherapy has a platelet count of 20,000/mm³. Which precaution
is most important for the nurse to implement?
A. Use a soft-bristled toothbrush
B. Encourage a high-fiber diet
C. Administer enemas as needed
D. Use rectal thermometers for temperature checks
Answer: A
Rationale: Severe thrombocytopenia increases bleeding risk, so using a soft-bristled toothbrush
prevents gum trauma. High-fiber diets, enemas, and rectal thermometers can cause mucosal
injury and bleeding.
9. Which assessment finding in a patient with a new colostomy requires immediate
follow-up?
A. Stoma is pink and moist
B. Stoma is dusky and cyanotic
C. Small amount of serosanguineous drainage
D. Mild abdominal cramping
Answer: B
Rationale: A dusky or cyanotic stoma indicates compromised blood supply and possible necrosis,
requiring immediate intervention. A pink, moist stoma is normal; serosanguineous drainage and
cramping are expected postoperatively.
10. The nurse is teaching a patient about warfarin therapy. Which statement by the patient
indicates a need for further teaching?
A. I will use a soft toothbrush and electric razor.
B. I will increase my intake of green leafy vegetables.
C. I will report any unusual bleeding or bruising.
D. I will keep my follow-up appointments for blood tests.
Answer: B
Rationale: Green leafy vegetables are high in vitamin K, which antagonizes warfarin and can
decrease its effectiveness. The other statements reflect correct understanding of bleeding
precautions and monitoring.
11. A patient with acute decompensated heart failure is started on IV furosemide. Which
assessment finding best indicates the therapy is producing the desired hemodynamic effect?
A. Serum potassium has fallen from 4.2 to 3.4 mEq/L
B. Urine output has increased to 150 mL/hr with a 1.5 kg weight loss
Page 3
Comprehensive Study Guide Exam 4 Practice Quest,
Exams of Nursing
1. A patient with heart failure is prescribed furosemide. Which laboratory result requires
immediate notification of the provider?
A. Potassium 3.1 mEq/L
B. Sodium 138 mEq/L
C. Creatinine 1.0 mg/dL
D. Hemoglobin 13.5 g/dL
Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium loss, and a level below 3.5 mEq/L
indicates hypokalemia, increasing the risk for dysrhythmias. Sodium, creatinine, and
hemoglobin values are within normal limits and do not require immediate action.
2. Which assessment finding is most concerning in a patient recovering from a
thyroidectomy?
A. Hoarse voice
B. Serum calcium 8.0 mg/dL
C. Incisional pain rated 4/10
D. Heart rate 88 beats/min
Answer: B
Rationale: Hypocalcemia after thyroidectomy may indicate parathyroid injury and can progress
to tetany and laryngospasm. Hoarseness and incisional pain are expected; a heart rate of 88 is
normal.
3. The nurse is reviewing prescriptions for a patient with an acute exacerbation of COPD.
Which order should the nurse question?
A. Oxygen at 2 L/min via nasal cannula
B. Albuterol nebulizer every 4 hours
C. Methylprednisolone IV every 6 hours
D. Promethazine 25 mg IV every 6 hours
Answer: D
Rationale: Promethazine is contraindicated in COPD because it can cause respiratory
depression and thicken secretions. Low-flow oxygen, bronchodilators, and corticosteroids are
standard therapies for COPD exacerbation.
Page 1
,4. A patient with chronic kidney disease has a hemoglobin of 9.0 g/dL. Which medication
does the nurse anticipate administering?
A. Ferrous sulfate
B. Epoetin alfa
C. Folic acid
D. Vitamin B12
Answer: B
Rationale: Anemia in CKD is primarily due to decreased erythropoietin production, so epoetin
alfa is the treatment of choice. Iron, folate, and B12 may be supplemented but do not address the
primary cause.
5. Which finding in a patient with acute pancreatitis indicates a potential complication
requiring immediate intervention?
A. Blood glucose 180 mg/dL
B. Serum amylase 200 U/L
C. Heart rate 120 beats/min and blood pressure 88/50 mm Hg
D. Pain relieved by fetal positioning
Answer: C
Rationale: Tachycardia and hypotension suggest hypovolemic shock from pancreatic hemorrhage
or third-spacing, a life-threatening complication. Elevated glucose and amylase are expected;
pain relief with positioning is typical.
6. A patient is admitted with a fractured femur and is placed in skeletal traction. Which
nursing action is priority?
A. Ensure weights hang freely and are not touching the floor
B. Perform passive range-of-motion exercises on the affected leg
C. Remove the traction weights during repositioning
D. Apply lotion to the skin around the pin sites
Answer: A
Rationale: Traction weights must hang freely to maintain proper alignment and prevent
complications. Range-of-motion and removing weights are contraindicated; lotion should not be
applied near pin sites due to infection risk.
7. The nurse is caring for a patient with increased intracranial pressure. Which position is
most appropriate?
A. Flat supine
B. Trendelenburg
C. Head of bed elevated 30 degrees
D. Prone
Answer: C
Page 2
, Rationale: Elevating the head of the bed 30 degrees promotes venous drainage from the head and helps reduce intracranial
pressure. Flat, Trendelenburg, and prone positions can increase ICP.
8. A patient receiving chemotherapy has a platelet count of 20,000/mm³. Which precaution
is most important for the nurse to implement?
A. Use a soft-bristled toothbrush
B. Encourage a high-fiber diet
C. Administer enemas as needed
D. Use rectal thermometers for temperature checks
Answer: A
Rationale: Severe thrombocytopenia increases bleeding risk, so using a soft-bristled toothbrush
prevents gum trauma. High-fiber diets, enemas, and rectal thermometers can cause mucosal
injury and bleeding.
9. Which assessment finding in a patient with a new colostomy requires immediate
follow-up?
A. Stoma is pink and moist
B. Stoma is dusky and cyanotic
C. Small amount of serosanguineous drainage
D. Mild abdominal cramping
Answer: B
Rationale: A dusky or cyanotic stoma indicates compromised blood supply and possible necrosis,
requiring immediate intervention. A pink, moist stoma is normal; serosanguineous drainage and
cramping are expected postoperatively.
10. The nurse is teaching a patient about warfarin therapy. Which statement by the patient
indicates a need for further teaching?
A. I will use a soft toothbrush and electric razor.
B. I will increase my intake of green leafy vegetables.
C. I will report any unusual bleeding or bruising.
D. I will keep my follow-up appointments for blood tests.
Answer: B
Rationale: Green leafy vegetables are high in vitamin K, which antagonizes warfarin and can
decrease its effectiveness. The other statements reflect correct understanding of bleeding
precautions and monitoring.
11. A patient with acute decompensated heart failure is started on IV furosemide. Which
assessment finding best indicates the therapy is producing the desired hemodynamic effect?
A. Serum potassium has fallen from 4.2 to 3.4 mEq/L
B. Urine output has increased to 150 mL/hr with a 1.5 kg weight loss
Page 3
