NUR 265 ADVANCED MED-SURG
NURSING - EXAM 2 PRACTICE
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE. JUST RELEASED
1. A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation with high levels of Positive End-Expiratory Pressure (PEEP). The nurse should
monitor for which significant complication?
A. Reduced dead space ventilation leading to hypercapnia
B. Improved alveolar recruitment leading to metabolic alkalosis
C. Increased pulmonary capillary wedge pressure (PCWP)
D. Decreased cardiac output due to increased intrathoracic pressure
Answer: D
Conceptual Explanation: High PEEP increases intrathoracic pressure, which can compress
the heart and great vessels, thereby reducing venous return and cardiac output.
2. A patient is admitted in Diabetic Ketoacidosis (DKA). The initial laboratory results show a
serum potassium of 3.2 mEq/L. Which action should the nurse take first?
A. Administer the prescribed intravenous insulin bolus
,B. Wait for the repeat potassium level results
C. Start a bicarbonate infusion to correct the metabolic acidosis
D. Notify the provider and ensure potassium replacement is started
Answer: D
Conceptual Explanation: Insulin will shift potassium into the cells, further dropping
serum potassium. Potassium must be at least 3.3 mEq/L before starting insulin to prevent
life-threatening dysrhythmias.
3. A nurse is caring for a patient with Chronic Kidney Disease (CKD) who has a serum
potassium of 6.8 mEq/L and ECG changes including peaked T waves. What is the priority
intervention?
A. Administer Sodium Polystyrene Sulfonate (Kayexalate) orally
B. Start the patient on a low-potassium diet
C. Administer intravenous Calcium Gluconate
D. Prepare the patient for emergency hemodialysis
Answer: C
Conceptual Explanation: While other treatments lower potassium, Calcium Gluconate is
the priority to stabilize the cardiac membrane and prevent arrest in the presence of ECG
changes.
, 4. Which clinical finding is most characteristic of Hyperosmolar Hyperglycemic State (HHS)
rather than Diabetic Ketoacidosis (DKA)?
A. Kussmaul respirations and fruity breath odor
B. Presence of significant ketonuria
C. A rapid onset of symptoms within 24 hours
D. Serum glucose levels often exceeding 600 mg/dL
Answer: D
Conceptual Explanation: HHS is characterized by extreme hyperglycemia (often >600
mg/dL) and profound dehydration without the significant ketoacidosis seen in DKA.
5. A patient’s ECG shows a rapid, irregular rhythm with no discernible P waves and a narrow
QRS complex. The patient is symptomatic with a blood pressure of 88/50 mmHg. What is the
appropriate management?
A. Vagal maneuvers and carotid massage
B. Defibrillation at 200 Joules
C. Administration of Amiodarone 150 mg IV push
D. Synchronized cardioversion
Answer: D
NURSING - EXAM 2 PRACTICE
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE. JUST RELEASED
1. A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation with high levels of Positive End-Expiratory Pressure (PEEP). The nurse should
monitor for which significant complication?
A. Reduced dead space ventilation leading to hypercapnia
B. Improved alveolar recruitment leading to metabolic alkalosis
C. Increased pulmonary capillary wedge pressure (PCWP)
D. Decreased cardiac output due to increased intrathoracic pressure
Answer: D
Conceptual Explanation: High PEEP increases intrathoracic pressure, which can compress
the heart and great vessels, thereby reducing venous return and cardiac output.
2. A patient is admitted in Diabetic Ketoacidosis (DKA). The initial laboratory results show a
serum potassium of 3.2 mEq/L. Which action should the nurse take first?
A. Administer the prescribed intravenous insulin bolus
,B. Wait for the repeat potassium level results
C. Start a bicarbonate infusion to correct the metabolic acidosis
D. Notify the provider and ensure potassium replacement is started
Answer: D
Conceptual Explanation: Insulin will shift potassium into the cells, further dropping
serum potassium. Potassium must be at least 3.3 mEq/L before starting insulin to prevent
life-threatening dysrhythmias.
3. A nurse is caring for a patient with Chronic Kidney Disease (CKD) who has a serum
potassium of 6.8 mEq/L and ECG changes including peaked T waves. What is the priority
intervention?
A. Administer Sodium Polystyrene Sulfonate (Kayexalate) orally
B. Start the patient on a low-potassium diet
C. Administer intravenous Calcium Gluconate
D. Prepare the patient for emergency hemodialysis
Answer: C
Conceptual Explanation: While other treatments lower potassium, Calcium Gluconate is
the priority to stabilize the cardiac membrane and prevent arrest in the presence of ECG
changes.
, 4. Which clinical finding is most characteristic of Hyperosmolar Hyperglycemic State (HHS)
rather than Diabetic Ketoacidosis (DKA)?
A. Kussmaul respirations and fruity breath odor
B. Presence of significant ketonuria
C. A rapid onset of symptoms within 24 hours
D. Serum glucose levels often exceeding 600 mg/dL
Answer: D
Conceptual Explanation: HHS is characterized by extreme hyperglycemia (often >600
mg/dL) and profound dehydration without the significant ketoacidosis seen in DKA.
5. A patient’s ECG shows a rapid, irregular rhythm with no discernible P waves and a narrow
QRS complex. The patient is symptomatic with a blood pressure of 88/50 mmHg. What is the
appropriate management?
A. Vagal maneuvers and carotid massage
B. Defibrillation at 200 Joules
C. Administration of Amiodarone 150 mg IV push
D. Synchronized cardioversion
Answer: D
