NUR_242: Med-Surg Nursing Prep with Detailed
Rationales
Course Code: NUR_242
Course Name: Medical-Surgical Nursing (Exam 3)
Academic Year: 2026/2027
Question 1
A nurse is assessing a patient admitted with an acute exacerbation of chronic
obstructive pulmonary disease (COPD). The patient is anxious, using accessory
muscles to breathe, and has a respiratory rate of 28 breaths per minute. Which
initial oxygen delivery method is most appropriate to ensure a precise, controlled
fraction of inspired oxygen (FiO₂)?
A. Simple face mask running at 5 L/min.
B. Venturi mask titrated to the prescribed percentage.
C. Non-rebreather mask running at 15 L/min.
D. Nasal cannula running at 6 L/min.
, CORRECT ANSWER: B
RATIONALE: For patients with COPD experiencing an acute exacerbation, a
Venturi mask is the premier oxygen delivery device because it delivers a highly
precise, controlled concentration of oxygen (FiO₂). This avoids delivering
excessive oxygen, which can suppress the hypoxic drive to breathe in patients with
chronic hypercapnia. Simple masks, nasal cannulas, and non-rebreather masks do
not provide the exact, predictable FiO₂ required for delicate titration in this specific
patient population.
Question 2
The medical-surgical nurse is evaluating a 65-year-old male tracking severe
peripheral arterial disease (PAD). The patient reports a deep, boring pain in his calf
muscles that occurs consistently when walking a distance of half a block, which
resolves completely within 5 minutes of sitting down.
Based on the clinical presentation and the vascular perfusion mechanics illustrated
in the diagram, which clinical term matches this musculoskeletal manifestation?
A. Raynaud's phenomenon
B. Thromboangiitis obliterans
C. Intermittent claudication
D. Deep vein thrombosis
, CORRECT ANSWER: C
RATIONALE: Intermittent claudication is the hallmark manifestation of
chronic peripheral arterial disease (PAD). As illustrated in the perfusion
mechanics flowchart, a significant narrowing of the arterial lumen due to
atherosclerotic plaque restricts blood flow. During exercise (walking), the oxygen
demand of the calf muscles outstrips the restricted arterial supply, causing
ischemia and producing pain. Resting decreases the tissue's metabolic demand,
balancing the curve and relieving the pain. Raynaud's involves cold-induced
vasospasm. DVT presents with constant, unilateral swelling and warmth.
Question 3
A nurse is caring for a patient who returned from a total hip arthroplasty 4 hours
ago. The patient has an autologous blood transfusion collection system in place.
Which laboratory parameters should the nurse prioritize checking to determine the
patient's immediate baseline status and tracking for postoperative blood loss?
A. Blood urea nitrogen (BUN) and serum creatinine.
B. Hemoglobin and Hematocrit (H&H).
C. Prothrombin time (PT) and International Normalized Ratio (INR).
D. White blood cell count (WBC) and platelets.
CORRECT ANSWER: B
RATIONALE: Following large-joint orthopedic surgeries like a total hip
arthroplasty, monitoring Hemoglobin and Hematocrit (H&H) is the priority to
evaluate the extent of intraoperative and postoperative blood loss and guide
decisions regarding fluid resuscitation or blood transfusions. While PT/INR are
important for checking clotting and baseline anticoagulant safety, H&H directly
reflects red blood cell volume status.
Question 4
A patient with a history of deep vein thrombosis (DVT) is prescribed a continuous
intravenous Heparin infusion. The nurse checks the morning laboratory profile.
Which lab test must guide the titration of the Heparin infusion pump settings?
A. Prothrombin time (PT).
B. Activated Partial Thromboplastin Time (aPTT).
Rationales
Course Code: NUR_242
Course Name: Medical-Surgical Nursing (Exam 3)
Academic Year: 2026/2027
Question 1
A nurse is assessing a patient admitted with an acute exacerbation of chronic
obstructive pulmonary disease (COPD). The patient is anxious, using accessory
muscles to breathe, and has a respiratory rate of 28 breaths per minute. Which
initial oxygen delivery method is most appropriate to ensure a precise, controlled
fraction of inspired oxygen (FiO₂)?
A. Simple face mask running at 5 L/min.
B. Venturi mask titrated to the prescribed percentage.
C. Non-rebreather mask running at 15 L/min.
D. Nasal cannula running at 6 L/min.
, CORRECT ANSWER: B
RATIONALE: For patients with COPD experiencing an acute exacerbation, a
Venturi mask is the premier oxygen delivery device because it delivers a highly
precise, controlled concentration of oxygen (FiO₂). This avoids delivering
excessive oxygen, which can suppress the hypoxic drive to breathe in patients with
chronic hypercapnia. Simple masks, nasal cannulas, and non-rebreather masks do
not provide the exact, predictable FiO₂ required for delicate titration in this specific
patient population.
Question 2
The medical-surgical nurse is evaluating a 65-year-old male tracking severe
peripheral arterial disease (PAD). The patient reports a deep, boring pain in his calf
muscles that occurs consistently when walking a distance of half a block, which
resolves completely within 5 minutes of sitting down.
Based on the clinical presentation and the vascular perfusion mechanics illustrated
in the diagram, which clinical term matches this musculoskeletal manifestation?
A. Raynaud's phenomenon
B. Thromboangiitis obliterans
C. Intermittent claudication
D. Deep vein thrombosis
, CORRECT ANSWER: C
RATIONALE: Intermittent claudication is the hallmark manifestation of
chronic peripheral arterial disease (PAD). As illustrated in the perfusion
mechanics flowchart, a significant narrowing of the arterial lumen due to
atherosclerotic plaque restricts blood flow. During exercise (walking), the oxygen
demand of the calf muscles outstrips the restricted arterial supply, causing
ischemia and producing pain. Resting decreases the tissue's metabolic demand,
balancing the curve and relieving the pain. Raynaud's involves cold-induced
vasospasm. DVT presents with constant, unilateral swelling and warmth.
Question 3
A nurse is caring for a patient who returned from a total hip arthroplasty 4 hours
ago. The patient has an autologous blood transfusion collection system in place.
Which laboratory parameters should the nurse prioritize checking to determine the
patient's immediate baseline status and tracking for postoperative blood loss?
A. Blood urea nitrogen (BUN) and serum creatinine.
B. Hemoglobin and Hematocrit (H&H).
C. Prothrombin time (PT) and International Normalized Ratio (INR).
D. White blood cell count (WBC) and platelets.
CORRECT ANSWER: B
RATIONALE: Following large-joint orthopedic surgeries like a total hip
arthroplasty, monitoring Hemoglobin and Hematocrit (H&H) is the priority to
evaluate the extent of intraoperative and postoperative blood loss and guide
decisions regarding fluid resuscitation or blood transfusions. While PT/INR are
important for checking clotting and baseline anticoagulant safety, H&H directly
reflects red blood cell volume status.
Question 4
A patient with a history of deep vein thrombosis (DVT) is prescribed a continuous
intravenous Heparin infusion. The nurse checks the morning laboratory profile.
Which lab test must guide the titration of the Heparin infusion pump settings?
A. Prothrombin time (PT).
B. Activated Partial Thromboplastin Time (aPTT).
