NUR 3270 ADVANCED MEDICAL-
SURGICAL NURSING EXAM 3
QUESTIONS WITH VERIFIED ANSWERS
AND DETAILED EXPLANATIONS
1. A patient with chronic kidney disease (CKD) presents with a serum potassium level of 6.8
mEq/L and tall, peaked T-waves on the EKG. Which medication should the nurse expect to
administer first to stabilize the cardiac membrane?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Regular Insulin and 50% Dextrose
C. Calcium Gluconate
D. Sodium Bicarbonate
Answer: C
Conceptual Explanation: Calcium gluconate is administered to stabilize the myocardium
and prevent lethal arrhythmias in severe hyperkalemia. While insulin/dextrose and
Kayexalate lower potassium, they do not stabilize the cardiac membrane directly.
2. A nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). Which
clinical finding should the nurse prioritize?
A. Urine output of 300 mL/day
,B. Crackle sounds in the lung bases
C. Metabolic alkalosis
D. Serum creatinine of 2.0 mg/dL
Answer: B
Conceptual Explanation: Fluid volume overload is a major risk during the oliguric phase.
Lung crackles indicate pulmonary edema, which is a life-threatening complication
requiring immediate intervention.
3. A patient with Type 1 Diabetes is admitted with Diabetic Ketoacidosis (DKA). The nurse
notes Kussmaul respirations. What is the physiological purpose of this breathing pattern?
A. To increase oxygen saturation
B. To retain carbon dioxide to counteract alkalosis
C. To decrease the work of breathing
D. To blow off carbon dioxide to compensate for metabolic acidosis
Answer: D
Conceptual Explanation: Kussmaul respirations are deep, rapid breaths that represent
the body’s attempt to compensate for metabolic acidosis by exhaling excess carbon dioxide
(an acid).
, 4. Which assessment finding in a patient with Hyperosmolar Hyperglycemic Syndrome (HHS)
distinguishes it from Diabetic Ketoacidosis (DKA)?
A. Blood glucose level of 450 mg/dL
B. Absence of significant metabolic acidosis
C. Severe dehydration
D. Presence of ketones in the urine
Answer: B
Conceptual Explanation: HHS is characterized by extreme hyperglycemia and
dehydration but lacks the significant ketosis and metabolic acidosis found in DKA because
there is enough insulin to prevent fat breakdown.
5. A patient with Cushing’s Syndrome is being monitored post-adrenalectomy. Which finding
would most likely indicate an acute adrenal insufficiency?
A. Hypertension and bradycardia
B. Hyperglycemia and weight gain
C. Hypotension and tachycardia
D. Hypernatremia and hypokalemia
Answer: C
Conceptual Explanation: Following adrenalectomy, a sudden drop in cortisol can lead to
Addisonian crisis, characterized by vascular collapse (hypotension and tachycardia).
SURGICAL NURSING EXAM 3
QUESTIONS WITH VERIFIED ANSWERS
AND DETAILED EXPLANATIONS
1. A patient with chronic kidney disease (CKD) presents with a serum potassium level of 6.8
mEq/L and tall, peaked T-waves on the EKG. Which medication should the nurse expect to
administer first to stabilize the cardiac membrane?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Regular Insulin and 50% Dextrose
C. Calcium Gluconate
D. Sodium Bicarbonate
Answer: C
Conceptual Explanation: Calcium gluconate is administered to stabilize the myocardium
and prevent lethal arrhythmias in severe hyperkalemia. While insulin/dextrose and
Kayexalate lower potassium, they do not stabilize the cardiac membrane directly.
2. A nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). Which
clinical finding should the nurse prioritize?
A. Urine output of 300 mL/day
,B. Crackle sounds in the lung bases
C. Metabolic alkalosis
D. Serum creatinine of 2.0 mg/dL
Answer: B
Conceptual Explanation: Fluid volume overload is a major risk during the oliguric phase.
Lung crackles indicate pulmonary edema, which is a life-threatening complication
requiring immediate intervention.
3. A patient with Type 1 Diabetes is admitted with Diabetic Ketoacidosis (DKA). The nurse
notes Kussmaul respirations. What is the physiological purpose of this breathing pattern?
A. To increase oxygen saturation
B. To retain carbon dioxide to counteract alkalosis
C. To decrease the work of breathing
D. To blow off carbon dioxide to compensate for metabolic acidosis
Answer: D
Conceptual Explanation: Kussmaul respirations are deep, rapid breaths that represent
the body’s attempt to compensate for metabolic acidosis by exhaling excess carbon dioxide
(an acid).
, 4. Which assessment finding in a patient with Hyperosmolar Hyperglycemic Syndrome (HHS)
distinguishes it from Diabetic Ketoacidosis (DKA)?
A. Blood glucose level of 450 mg/dL
B. Absence of significant metabolic acidosis
C. Severe dehydration
D. Presence of ketones in the urine
Answer: B
Conceptual Explanation: HHS is characterized by extreme hyperglycemia and
dehydration but lacks the significant ketosis and metabolic acidosis found in DKA because
there is enough insulin to prevent fat breakdown.
5. A patient with Cushing’s Syndrome is being monitored post-adrenalectomy. Which finding
would most likely indicate an acute adrenal insufficiency?
A. Hypertension and bradycardia
B. Hyperglycemia and weight gain
C. Hypotension and tachycardia
D. Hypernatremia and hypokalemia
Answer: C
Conceptual Explanation: Following adrenalectomy, a sudden drop in cortisol can lead to
Addisonian crisis, characterized by vascular collapse (hypotension and tachycardia).
