NUR 242 – MED-SURG EXAM 1 QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
GRADED A+ LATEST
Question 1
A patient with chronic obstructive pulmonary disease (COPD) reports increasing
dyspnea. Which finding would indicate respiratory acidosis?
A. pH 7.48, PaCO₂ 30 mmHg
B. pH 7.30, PaCO₂ 55 mmHg
C. pH 7.40, PaCO₂ 40 mmHg
D. pH 7.50, PaCO₂ 25 mmHg
Answer: B
Rationale: Respiratory acidosis occurs when CO₂ retention causes decreased pH.
A pH of 7.30 and PaCO₂ of 55 mmHg indicate hypoventilation and CO₂ retention,
typical in COPD exacerbations.
Question 2
A patient is admitted with acute pancreatitis. Which lab value is most indicative of
this condition?
A. Elevated amylase and lipase
B. Elevated AST and ALT
C. Decreased bilirubin
D. Decreased alkaline phosphatase
Answer: A
Rationale: Acute pancreatitis typically presents with elevated serum amylase and
lipase. AST and ALT are more liver-specific, and bilirubin/alkaline phosphatase
changes are more indicative of biliary obstruction.
,Question 3
A patient with heart failure is prescribed furosemide. Which electrolyte imbalance
requires immediate monitoring?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Answer: B
Rationale: Furosemide is a loop diuretic that can cause potassium loss, leading to
hypokalemia. This increases the risk of cardiac arrhythmias, so potassium levels
must be closely monitored.
Question 4
A patient with a nasogastric tube develops confusion and muscle twitching. Which
electrolyte imbalance is most likely?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hyponatremia
Answer: D
Rationale: NG suction can cause sodium and water loss, potentially leading to
hyponatremia, which manifests as confusion, weakness, and twitching.
Question 5
A patient with cirrhosis presents with ascites and peripheral edema. Which nursing
intervention is most appropriate?
A. Restricting fluid intake
B. Administering high-sodium diet
C. Encouraging ambulation
D. Providing high-protein diet
,Answer: A
Rationale: Fluid restriction is appropriate to manage ascites caused by fluid
retention. Sodium restriction is also necessary; high-sodium diets worsen edema.
High-protein diets are used cautiously in advanced liver disease due to risk of
hepatic encephalopathy.
Question 6
Which symptom is earliest in hypovolemic shock?
A. Decreased urine output
B. Hypotension
C. Tachycardia
D. Cool, clammy skin
Answer: C
Rationale: Tachycardia is the earliest compensatory response to hypovolemia.
Hypotension and decreased urine output occur later as shock progresses.
Question 7
A patient with pneumonia is receiving oxygen at 2 L/min via nasal cannula. Which
finding requires immediate intervention?
A. Respiratory rate 22/min
B. PaO₂ 55 mmHg
C. SpO₂ 94%
D. Heart rate 88 bpm
Answer: B
Rationale: A PaO₂ of 55 mmHg indicates hypoxemia requiring urgent oxygen
titration or further intervention. SpO₂ of 94% is generally acceptable.
, Question 8
A patient has chronic kidney disease (CKD) with hyperkalemia. Which EKG
change is most concerning?
A. ST depression
B. Peaked T waves
C. U waves
D. Flattened P waves
Answer: B
Rationale: Peaked T waves are classic early signs of hyperkalemia. Severe
hyperkalemia can progress to ventricular fibrillation or asystole, making it life-
threatening.
Question 9
Which assessment finding is most indicative of fluid overload?
A. Weight loss of 2 lb in 24 hours
B. Jugular vein distension
C. Dry mucous membranes
D. Decreased blood pressure
Answer: B
Rationale: Jugular vein distension indicates increased central venous pressure, a
hallmark of fluid overload. Weight gain, edema, and crackles are also common
findings.
Question 10
A patient with diabetes reports polyuria, polydipsia, and blurred vision. Lab results
show glucose 480 mg/dL, pH 7.32, serum bicarbonate 18 mEq/L. What is the most
likely diagnosis?
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemia
D. Metabolic alkalosis
CORRECT ANSWERS WITH RATIONALES
GRADED A+ LATEST
Question 1
A patient with chronic obstructive pulmonary disease (COPD) reports increasing
dyspnea. Which finding would indicate respiratory acidosis?
A. pH 7.48, PaCO₂ 30 mmHg
B. pH 7.30, PaCO₂ 55 mmHg
C. pH 7.40, PaCO₂ 40 mmHg
D. pH 7.50, PaCO₂ 25 mmHg
Answer: B
Rationale: Respiratory acidosis occurs when CO₂ retention causes decreased pH.
A pH of 7.30 and PaCO₂ of 55 mmHg indicate hypoventilation and CO₂ retention,
typical in COPD exacerbations.
Question 2
A patient is admitted with acute pancreatitis. Which lab value is most indicative of
this condition?
A. Elevated amylase and lipase
B. Elevated AST and ALT
C. Decreased bilirubin
D. Decreased alkaline phosphatase
Answer: A
Rationale: Acute pancreatitis typically presents with elevated serum amylase and
lipase. AST and ALT are more liver-specific, and bilirubin/alkaline phosphatase
changes are more indicative of biliary obstruction.
,Question 3
A patient with heart failure is prescribed furosemide. Which electrolyte imbalance
requires immediate monitoring?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Answer: B
Rationale: Furosemide is a loop diuretic that can cause potassium loss, leading to
hypokalemia. This increases the risk of cardiac arrhythmias, so potassium levels
must be closely monitored.
Question 4
A patient with a nasogastric tube develops confusion and muscle twitching. Which
electrolyte imbalance is most likely?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hyponatremia
Answer: D
Rationale: NG suction can cause sodium and water loss, potentially leading to
hyponatremia, which manifests as confusion, weakness, and twitching.
Question 5
A patient with cirrhosis presents with ascites and peripheral edema. Which nursing
intervention is most appropriate?
A. Restricting fluid intake
B. Administering high-sodium diet
C. Encouraging ambulation
D. Providing high-protein diet
,Answer: A
Rationale: Fluid restriction is appropriate to manage ascites caused by fluid
retention. Sodium restriction is also necessary; high-sodium diets worsen edema.
High-protein diets are used cautiously in advanced liver disease due to risk of
hepatic encephalopathy.
Question 6
Which symptom is earliest in hypovolemic shock?
A. Decreased urine output
B. Hypotension
C. Tachycardia
D. Cool, clammy skin
Answer: C
Rationale: Tachycardia is the earliest compensatory response to hypovolemia.
Hypotension and decreased urine output occur later as shock progresses.
Question 7
A patient with pneumonia is receiving oxygen at 2 L/min via nasal cannula. Which
finding requires immediate intervention?
A. Respiratory rate 22/min
B. PaO₂ 55 mmHg
C. SpO₂ 94%
D. Heart rate 88 bpm
Answer: B
Rationale: A PaO₂ of 55 mmHg indicates hypoxemia requiring urgent oxygen
titration or further intervention. SpO₂ of 94% is generally acceptable.
, Question 8
A patient has chronic kidney disease (CKD) with hyperkalemia. Which EKG
change is most concerning?
A. ST depression
B. Peaked T waves
C. U waves
D. Flattened P waves
Answer: B
Rationale: Peaked T waves are classic early signs of hyperkalemia. Severe
hyperkalemia can progress to ventricular fibrillation or asystole, making it life-
threatening.
Question 9
Which assessment finding is most indicative of fluid overload?
A. Weight loss of 2 lb in 24 hours
B. Jugular vein distension
C. Dry mucous membranes
D. Decreased blood pressure
Answer: B
Rationale: Jugular vein distension indicates increased central venous pressure, a
hallmark of fluid overload. Weight gain, edema, and crackles are also common
findings.
Question 10
A patient with diabetes reports polyuria, polydipsia, and blurred vision. Lab results
show glucose 480 mg/dL, pH 7.32, serum bicarbonate 18 mEq/L. What is the most
likely diagnosis?
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemia
D. Metabolic alkalosis
