**The Pinnacle Proctored Prep: NGN Medical-
Surgical Mastery**
1. Post-op day 2, client reports sudden dyspnea, pleuritic chest pain. SpO2 88% on 2L NC. Priority
action?
💫RATIONALE✔️✔️: Suspect pulmonary embolism (PE). High-flow O2 first to correct hypoxemia before
diagnostics.
💫ANSWER✔️✔️: C. Apply high-flow oxygen via non-rebreather mask
---
2. Chronic kidney disease stage 4. Meds: calcitriol. Primary goal?
💫RATIONALE✔️✔️: Calcitriol (active Vit D) increases calcium absorption. Prevents renal osteodystrophy
from low active Vit D.
💫ANSWER✔️✔️: B. Prevent bone demineralization
---
3. Heart failure pt with furosemide. Monitor most closely for?
💫RATIONALE✔️✔️: Furosemide causes kaliuresis. Hypokalemia increases digoxin toxicity and arrhythmia
risk.
💫ANSWER✔️✔️: D. Serum potassium 3.1 mEq/L
---
4. Cirrhosis with ascites. Abdominal paracentesis removes 5L. Post-procedure priority?
💫RATIONALE✔️✔️: Large-volume removal shifts fluid to abdomen, risking hypotension. Monitor BP and
pulse.
💫ANSWER✔️✔️: A. Assess for hypovolemia
---
, 5. Pt on warfarin, INR 1.2. Holding warfarin. Next action?
💫RATIONALE✔️✔️: INR 1.2 is subtherapeutic (goal 2-3). No reversal needed; may require increased dose.
💫ANSWER✔️✔️: C. Notify provider for dose adjustment
---
6. COPD exacerbation, ABG: pH 7.31, PaCO2 68, HCO3 26. Interpretation?
💫RATIONALE✔️✔️: Acute respiratory acidosis (low pH, high PaCO2, normal HCO3). No renal
compensation yet.
💫ANSWER✔️✔️: B. Acute respiratory acidosis
---
7. Post-thyroidectomy, client reports tingling lips and fingers. Next action?
💫RATIONALE✔️✔️: Tingling indicates hypocalcemia from accidental parathyroid injury. Check
Chvostek/Trousseau.
💫ANSWER✔️✔️: D. Assess for muscle twitching and laryngospasm
---
8. Diabetic ketoacidosis: IV insulin drip. Which lab requires immediate intervention?
💫RATIONALE✔️✔️: Potassium 2.8 risks cardiac arrest. Insulin drives K+ intracellularly, worsening
hypokalemia.
💫ANSWER✔️✔️: A. Serum potassium 2.8 mEq/L
---
9. MI day 1, auscultate new harsh holosystolic murmur at apex. Suspect?
💫RATIONALE✔️✔️: Papillary muscle rupture causes mitral regurgitation. Holosystolic murmur,
cardiogenic shock risk.
💫ANSWER✔️✔️: C. Mitral regurgitation
---
Surgical Mastery**
1. Post-op day 2, client reports sudden dyspnea, pleuritic chest pain. SpO2 88% on 2L NC. Priority
action?
💫RATIONALE✔️✔️: Suspect pulmonary embolism (PE). High-flow O2 first to correct hypoxemia before
diagnostics.
💫ANSWER✔️✔️: C. Apply high-flow oxygen via non-rebreather mask
---
2. Chronic kidney disease stage 4. Meds: calcitriol. Primary goal?
💫RATIONALE✔️✔️: Calcitriol (active Vit D) increases calcium absorption. Prevents renal osteodystrophy
from low active Vit D.
💫ANSWER✔️✔️: B. Prevent bone demineralization
---
3. Heart failure pt with furosemide. Monitor most closely for?
💫RATIONALE✔️✔️: Furosemide causes kaliuresis. Hypokalemia increases digoxin toxicity and arrhythmia
risk.
💫ANSWER✔️✔️: D. Serum potassium 3.1 mEq/L
---
4. Cirrhosis with ascites. Abdominal paracentesis removes 5L. Post-procedure priority?
💫RATIONALE✔️✔️: Large-volume removal shifts fluid to abdomen, risking hypotension. Monitor BP and
pulse.
💫ANSWER✔️✔️: A. Assess for hypovolemia
---
, 5. Pt on warfarin, INR 1.2. Holding warfarin. Next action?
💫RATIONALE✔️✔️: INR 1.2 is subtherapeutic (goal 2-3). No reversal needed; may require increased dose.
💫ANSWER✔️✔️: C. Notify provider for dose adjustment
---
6. COPD exacerbation, ABG: pH 7.31, PaCO2 68, HCO3 26. Interpretation?
💫RATIONALE✔️✔️: Acute respiratory acidosis (low pH, high PaCO2, normal HCO3). No renal
compensation yet.
💫ANSWER✔️✔️: B. Acute respiratory acidosis
---
7. Post-thyroidectomy, client reports tingling lips and fingers. Next action?
💫RATIONALE✔️✔️: Tingling indicates hypocalcemia from accidental parathyroid injury. Check
Chvostek/Trousseau.
💫ANSWER✔️✔️: D. Assess for muscle twitching and laryngospasm
---
8. Diabetic ketoacidosis: IV insulin drip. Which lab requires immediate intervention?
💫RATIONALE✔️✔️: Potassium 2.8 risks cardiac arrest. Insulin drives K+ intracellularly, worsening
hypokalemia.
💫ANSWER✔️✔️: A. Serum potassium 2.8 mEq/L
---
9. MI day 1, auscultate new harsh holosystolic murmur at apex. Suspect?
💫RATIONALE✔️✔️: Papillary muscle rupture causes mitral regurgitation. Holosystolic murmur,
cardiogenic shock risk.
💫ANSWER✔️✔️: C. Mitral regurgitation
---
