NUR 206 MEDICAL-SURGICAL NURSING II EXAM
PREDICTOR Q&A 2026
1. A patient with chronic obstructive pulmonary disease (COPD) is
admitted with acute exacerbation. The arterial blood gas (ABG)
results show: pH 7.28, PaCO₂ 58 mmHg, PaO₂ 60 mmHg, HCO₃⁻ 26
mEq/L. Which interpretation is correct?
A. Uncompensated respiratory alkalosis
B. Uncompensated respiratory acidosis
C. Partially compensated metabolic acidosis
D. Fully compensated metabolic alkalosis
Correct Answer: B
Explanation: The low pH (<7.35) and elevated PaCO₂ (>45 mmHg)
indicate respiratory acidosis. The normal HCO₃⁻ (22–26 mEq/L)
shows no metabolic compensation, making it uncompensated.
This is classic in COPD exacerbations due to CO₂ retention.
2. A patient with heart failure is prescribed furosemide 40 mg PO
daily. Which laboratory value requires immediate notification of
the provider?
A. Sodium 138 mEq/L
B. Potassium 3.1 mEq/L
C. Magnesium 1.8 mEq/L
D. Creatinine 0.9 mg/dL
Correct Answer: B
Explanation: Furosemide is a loop diuretic that causes potassium
loss. Potassium <3.5 mEq/L indicates hypokalemia, which
, increases risk for life-threatening dysrhythmias. The other values
are within normal limits.
3. Which assessment finding in a patient with a newly placed chest
tube requires immediate intervention?
A. Tidaling in the water seal chamber
B. Drainage of 50 mL/hr of serosanguinous fluid
C. Subcutaneous emphysema around the insertion site
D. Continuous bubbling in the water seal chamber
Correct Answer: D
Explanation: Continuous bubbling in the water seal chamber
indicates an air leak, which is abnormal and requires immediate
assessment. Tidaling is normal, 50 mL/hr is acceptable drainage,
and mild subcutaneous emphysema may resolve.
4. A patient with type 1 diabetes presents with nausea, vomiting,
abdominal pain, Kussmaul respirations, and blood glucose 420
mg/dL. Which order should the nurse implement first?
A. Administer IV regular insulin
B. Start IV normal saline bolus
C. Administer IV potassium
D. Obtain arterial blood gases
Correct Answer: B
Explanation: This patient has diabetic ketoacidosis (DKA). Fluid
resuscitation with normal saline is the priority to restore
intravascular volume and improve perfusion. Insulin is started
after fluids, and potassium is given once levels are known.
,5. Which ECG finding indicates ventricular fibrillation?
A. Regular P waves with narrow QRS complexes
B. Irregularly irregular rhythm with no discernible P waves
C. Chaotic, irregular waveforms with no identifiable QRS
complexes
D. Wide QRS complexes at a rate of 180 bpm with visible P waves
Correct Answer: C
Explanation: Ventricular fibrillation shows chaotic, irregular
waveforms with no identifiable QRS complexes and is a cardiac
arrest rhythm requiring immediate defibrillation. Option B
describes atrial fibrillation.
6. A patient post-thyroidectomy reports tingling around the mouth
and muscle cramps. Which laboratory value is most concerning?
A. TSH 2.5 mIU/L
B. Calcium 7.2 mg/dL
C. Sodium 140 mEq/L
D. Potassium 4.0 mEq/L
Correct Answer: B
Explanation: Tingling (paresthesia) and muscle cramps after
thyroidectomy suggest hypocalcemia from accidental parathyroid
removal. Calcium <8.5 mg/dL is hypocalcemia and can cause
tetany and laryngospasm.
7. Which medication is contraindicated in a patient with suspected
acute myocardial infarction and history of asthma?
, A. Aspirin
B. Nitroglycerin
C. Metoprolol
D. Morphine
Correct Answer: C
Explanation: Beta-blockers like metoprolol can cause
bronchoconstriction and are relatively contraindicated in asthma.
Aspirin, nitroglycerin, and morphine are standard ACS treatments.
8. A patient with pneumonia has the following ABG: pH 7.50, PaCO₂
29 mmHg, PaO₂ 75 mmHg, HCO₃⁻ 24 mEq/L. What is the acid-base
imbalance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: B
Explanation: pH >7.45 and PaCO₂ <35 mmHg indicate respiratory
alkalosis, commonly from hyperventilation due to hypoxia in
pneumonia. HCO₃⁻ is normal, showing no compensation.
9. Which assessment finding is most indicative of compartment
syndrome in a patient with a tibial fracture?
A. Decreased pulse in the affected limb
B. Pain out of proportion to injury
C. Pallor of the foot
D. Paralysis of the toes
PREDICTOR Q&A 2026
1. A patient with chronic obstructive pulmonary disease (COPD) is
admitted with acute exacerbation. The arterial blood gas (ABG)
results show: pH 7.28, PaCO₂ 58 mmHg, PaO₂ 60 mmHg, HCO₃⁻ 26
mEq/L. Which interpretation is correct?
A. Uncompensated respiratory alkalosis
B. Uncompensated respiratory acidosis
C. Partially compensated metabolic acidosis
D. Fully compensated metabolic alkalosis
Correct Answer: B
Explanation: The low pH (<7.35) and elevated PaCO₂ (>45 mmHg)
indicate respiratory acidosis. The normal HCO₃⁻ (22–26 mEq/L)
shows no metabolic compensation, making it uncompensated.
This is classic in COPD exacerbations due to CO₂ retention.
2. A patient with heart failure is prescribed furosemide 40 mg PO
daily. Which laboratory value requires immediate notification of
the provider?
A. Sodium 138 mEq/L
B. Potassium 3.1 mEq/L
C. Magnesium 1.8 mEq/L
D. Creatinine 0.9 mg/dL
Correct Answer: B
Explanation: Furosemide is a loop diuretic that causes potassium
loss. Potassium <3.5 mEq/L indicates hypokalemia, which
, increases risk for life-threatening dysrhythmias. The other values
are within normal limits.
3. Which assessment finding in a patient with a newly placed chest
tube requires immediate intervention?
A. Tidaling in the water seal chamber
B. Drainage of 50 mL/hr of serosanguinous fluid
C. Subcutaneous emphysema around the insertion site
D. Continuous bubbling in the water seal chamber
Correct Answer: D
Explanation: Continuous bubbling in the water seal chamber
indicates an air leak, which is abnormal and requires immediate
assessment. Tidaling is normal, 50 mL/hr is acceptable drainage,
and mild subcutaneous emphysema may resolve.
4. A patient with type 1 diabetes presents with nausea, vomiting,
abdominal pain, Kussmaul respirations, and blood glucose 420
mg/dL. Which order should the nurse implement first?
A. Administer IV regular insulin
B. Start IV normal saline bolus
C. Administer IV potassium
D. Obtain arterial blood gases
Correct Answer: B
Explanation: This patient has diabetic ketoacidosis (DKA). Fluid
resuscitation with normal saline is the priority to restore
intravascular volume and improve perfusion. Insulin is started
after fluids, and potassium is given once levels are known.
,5. Which ECG finding indicates ventricular fibrillation?
A. Regular P waves with narrow QRS complexes
B. Irregularly irregular rhythm with no discernible P waves
C. Chaotic, irregular waveforms with no identifiable QRS
complexes
D. Wide QRS complexes at a rate of 180 bpm with visible P waves
Correct Answer: C
Explanation: Ventricular fibrillation shows chaotic, irregular
waveforms with no identifiable QRS complexes and is a cardiac
arrest rhythm requiring immediate defibrillation. Option B
describes atrial fibrillation.
6. A patient post-thyroidectomy reports tingling around the mouth
and muscle cramps. Which laboratory value is most concerning?
A. TSH 2.5 mIU/L
B. Calcium 7.2 mg/dL
C. Sodium 140 mEq/L
D. Potassium 4.0 mEq/L
Correct Answer: B
Explanation: Tingling (paresthesia) and muscle cramps after
thyroidectomy suggest hypocalcemia from accidental parathyroid
removal. Calcium <8.5 mg/dL is hypocalcemia and can cause
tetany and laryngospasm.
7. Which medication is contraindicated in a patient with suspected
acute myocardial infarction and history of asthma?
, A. Aspirin
B. Nitroglycerin
C. Metoprolol
D. Morphine
Correct Answer: C
Explanation: Beta-blockers like metoprolol can cause
bronchoconstriction and are relatively contraindicated in asthma.
Aspirin, nitroglycerin, and morphine are standard ACS treatments.
8. A patient with pneumonia has the following ABG: pH 7.50, PaCO₂
29 mmHg, PaO₂ 75 mmHg, HCO₃⁻ 24 mEq/L. What is the acid-base
imbalance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: B
Explanation: pH >7.45 and PaCO₂ <35 mmHg indicate respiratory
alkalosis, commonly from hyperventilation due to hypoxia in
pneumonia. HCO₃⁻ is normal, showing no compensation.
9. Which assessment finding is most indicative of compartment
syndrome in a patient with a tibial fracture?
A. Decreased pulse in the affected limb
B. Pain out of proportion to injury
C. Pallor of the foot
D. Paralysis of the toes
