,NUR 265 Exam 2 – Adv Med-Surg Concepts –
Actual Q&A (GCN) (Updated PDF)
1. A client arrives in the emergency department with sudden dyspnea, pleuritic
chest pain, and tachycardia. The nurse suspects a pulmonary embolism. Which
arterial blood gas finding would the nurse anticipate initially?
A) pH 7.31, PaCO₂ 50, HCO₃⁻ 24
B) pH 7.48, PaCO₂ 32, HCO₃⁻ 23
C) pH 7.35, PaCO₂ 42, HCO₃⁻ 26
D) pH 7.40, PaCO₂ 38, HCO₃⁻ 24
Correct Answer: B) pH 7.48, PaCO₂ 32, HCO₃⁻ 23
Rationale: PE initially causes hyperventilation, leading to respiratory alkalosis
with elevated pH and decreased PaCO₂. Option A shows respiratory acidosis,
Option C is compensated normal, Option D is normal. Early alkalosis is the
hallmark.
2. A patient with ARDS is mechanically ventilated. Despite 100% FiO₂, the SpO₂
remains 82%. This finding indicates:
A) Refractory hypoxemia
B) Ventilator-associated pneumonia
C) Pulmonary fibrosis
D) Oxygen toxicity
Correct Answer: A) Refractory hypoxemia
,Rationale: Refractory hypoxemia, persistent hypoxemia despite high oxygen
concentration, is a defining feature of ARDS due to severe shunting and V/Q
mismatch. It requires interventions like PEEP and prone positioning.
3. The nurse is caring for a client with a chest tube to water seal drainage.
Continuous bubbling is observed in the water seal chamber. This finding
indicates:
A) Normal fluctuation with respiration
B) An air leak in the system
C) The lung has fully re-expanded
D) The suction control is working properly
Correct Answer: B) An air leak in the system
Rationale: Continuous bubbling in the water seal chamber signifies an air leak,
either from the patient or the system. Intermittent tidaling is normal. Suction
control chamber bubbling is expected; water seal continuous bubbling is
abnormal.
4. A patient with a pulmonary embolism suddenly develops hypotension,
jugular vein distention, and cyanosis. The nurse interprets these signs as:
A) Left-sided heart failure
B) Cardiac tamponade
C) Right-sided heart failure from increased pulmonary pressure
D) Anaphylactic reaction
Correct Answer: C) Right-sided heart failure from increased pulmonary pressure
, Rationale: PE obstructs pulmonary blood flow, increasing right ventricular
afterload leading to acute right heart failure. Signs include JVD, hypotension,
and cyanosis. Left heart failure would cause pulmonary congestion.
5. A client with SIADH has a serum sodium level of 118 mEq/L. Which nursing
intervention is the priority?
A) Administer hypertonic saline as prescribed
B) Encourage increased oral fluid intake
C) Restrict fluids to 800-1000 mL/day
D) Administer furosemide
Correct Answer: C) Restrict fluids to 800-1000 mL/day
Rationale: SIADH causes water retention and dilutional hyponatremia. Fluid
restriction is the primary treatment to reduce water overload. Hypertonic saline
is used for severe symptoms; diuretics may be adjunct.
6. A nurse is assessing a client with diabetes insipidus. Which finding is
expected?
A) Concentrated urine with high specific gravity
B) Polyuria of dilute urine and hypernatremia
C) Fluid retention and crackles
D) Hyponatremia and weight gain
Correct Answer: B) Polyuria of dilute urine and hypernatremia
Actual Q&A (GCN) (Updated PDF)
1. A client arrives in the emergency department with sudden dyspnea, pleuritic
chest pain, and tachycardia. The nurse suspects a pulmonary embolism. Which
arterial blood gas finding would the nurse anticipate initially?
A) pH 7.31, PaCO₂ 50, HCO₃⁻ 24
B) pH 7.48, PaCO₂ 32, HCO₃⁻ 23
C) pH 7.35, PaCO₂ 42, HCO₃⁻ 26
D) pH 7.40, PaCO₂ 38, HCO₃⁻ 24
Correct Answer: B) pH 7.48, PaCO₂ 32, HCO₃⁻ 23
Rationale: PE initially causes hyperventilation, leading to respiratory alkalosis
with elevated pH and decreased PaCO₂. Option A shows respiratory acidosis,
Option C is compensated normal, Option D is normal. Early alkalosis is the
hallmark.
2. A patient with ARDS is mechanically ventilated. Despite 100% FiO₂, the SpO₂
remains 82%. This finding indicates:
A) Refractory hypoxemia
B) Ventilator-associated pneumonia
C) Pulmonary fibrosis
D) Oxygen toxicity
Correct Answer: A) Refractory hypoxemia
,Rationale: Refractory hypoxemia, persistent hypoxemia despite high oxygen
concentration, is a defining feature of ARDS due to severe shunting and V/Q
mismatch. It requires interventions like PEEP and prone positioning.
3. The nurse is caring for a client with a chest tube to water seal drainage.
Continuous bubbling is observed in the water seal chamber. This finding
indicates:
A) Normal fluctuation with respiration
B) An air leak in the system
C) The lung has fully re-expanded
D) The suction control is working properly
Correct Answer: B) An air leak in the system
Rationale: Continuous bubbling in the water seal chamber signifies an air leak,
either from the patient or the system. Intermittent tidaling is normal. Suction
control chamber bubbling is expected; water seal continuous bubbling is
abnormal.
4. A patient with a pulmonary embolism suddenly develops hypotension,
jugular vein distention, and cyanosis. The nurse interprets these signs as:
A) Left-sided heart failure
B) Cardiac tamponade
C) Right-sided heart failure from increased pulmonary pressure
D) Anaphylactic reaction
Correct Answer: C) Right-sided heart failure from increased pulmonary pressure
, Rationale: PE obstructs pulmonary blood flow, increasing right ventricular
afterload leading to acute right heart failure. Signs include JVD, hypotension,
and cyanosis. Left heart failure would cause pulmonary congestion.
5. A client with SIADH has a serum sodium level of 118 mEq/L. Which nursing
intervention is the priority?
A) Administer hypertonic saline as prescribed
B) Encourage increased oral fluid intake
C) Restrict fluids to 800-1000 mL/day
D) Administer furosemide
Correct Answer: C) Restrict fluids to 800-1000 mL/day
Rationale: SIADH causes water retention and dilutional hyponatremia. Fluid
restriction is the primary treatment to reduce water overload. Hypertonic saline
is used for severe symptoms; diuretics may be adjunct.
6. A nurse is assessing a client with diabetes insipidus. Which finding is
expected?
A) Concentrated urine with high specific gravity
B) Polyuria of dilute urine and hypernatremia
C) Fluid retention and crackles
D) Hyponatremia and weight gain
Correct Answer: B) Polyuria of dilute urine and hypernatremia
