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NUR 265 EXAM 1 ADVANCED CONCEPT IN
MEDICAL SURGICAL NURSING Exam Preparation
With Complete Questions And Correct Answers With
Rationales Already Graded A+ Brand New Version!!
QUESTION 1
A patient with acute respiratory distress syndrome (ARDS) is receiving
mechanical ventilation with positive end-expiratory pressure (PEEP).
Which assessment finding indicates a complication of this therapy?
A. Decreased cardiac output
B. Increased urine output
C. Respiratory rate of 16 breaths per minute
D. PaO2 of 88 mmHg
Answer: A
Rationale: Positive end-expiratory pressure (PEEP) increases
intrathoracic pressure, which can impede venous return to the heart,
leading to decreased cardiac output. This is a significant complication
that requires careful hemodynamic monitoring. Increased urine output
is not associated with PEEP therapy; rather, decreased renal perfusion
may occur. A respiratory rate of 16 is within normal range and does not
indicate a complication. A PaO2 of 88 mmHg indicates adequate
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oxygenation and is a desired outcome of PEEP therapy, not a
complication.
QUESTION 2
The nurse is caring for a patient with a chest tube connected to a three-
chamber drainage system. The water seal chamber shows continuous
bubbling. What is the priority nursing action?
A. Increase the suction pressure
B. Clamp the chest tube
C. Assess the system for an air leak
D. Document the finding as normal
Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an
air leak in the system. The priority action is to assess the system to
locate the source of the leak, which could be at the insertion site,
connection points, or within the drainage unit. Increasing suction
pressure would not resolve an air leak and could cause tissue damage.
Clamping the chest tube is contraindicated as it could lead to tension
pneumothorax. Continuous bubbling is not a normal finding; tidaling is
the expected pattern in the water seal chamber.
QUESTION 3
A patient with heart failure is receiving intravenous furosemide. Which
laboratory value requires the most immediate intervention?
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A. Serum potassium of 3.1 mEq/L
B. Serum sodium of 135 mEq/L
C. Serum magnesium of 1.8 mg/dL
D. Serum calcium of 9.2 mg/dL
Answer: A
Rationale: Furosemide is a loop diuretic that can cause significant
potassium depletion. A serum potassium of 3.1 mEq/L represents
moderate hypokalemia, which can precipitate life-threatening cardiac
dysrhythmias in patients with heart failure who are already at risk for
rhythm disturbances. The other values are within normal limits: sodium
135-145 mEq/L, magnesium 1.5-2.5 mg/dL, and calcium 8.5-10.5
mg/dL.
QUESTION 4
The nurse is preparing to administer digoxin to a patient with atrial
fibrillation. Which finding would indicate the need to withhold the
medication?
A. Apical pulse of 68 beats per minute
B. Serum digoxin level of 2.1 ng/mL
C. Blood pressure of 140/88 mmHg
D. Respiratory rate of 18 breaths per minute
Answer: B
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Rationale: The therapeutic range for digoxin is 0.5-2.0 ng/mL. A level of
2.1 ng/mL is above the therapeutic range and indicates digoxin toxicity.
The nurse should withhold the medication and notify the healthcare
provider. An apical pulse of 68 is within the acceptable range for digoxin
administration (typically >60 bpm). The blood pressure and respiratory
rate are within normal limits and do not contraindicate digoxin
administration.
QUESTION 5
A patient with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Which assessment
finding indicates the oxygen therapy is effective?
A. Respiratory rate increases from 22 to 28 breaths per minute
B. Patient reports decreased shortness of breath
C. Pulse oximetry reading of 88%
D. Patient becomes more lethargic
Answer: B
Rationale: The primary goal of oxygen therapy in COPD patients is to
improve oxygenation and relieve symptoms of hypoxemia. A patient
reporting decreased shortness of breath indicates that the oxygen
therapy is effective in improving comfort and gas exchange. An
increasing respiratory rate suggests worsening respiratory distress. A
pulse oximetry reading of 88% indicates inadequate oxygenation; the
goal is typically 88-92% for COPD patients but 88% is on the lower end.
Lethargy could indicate carbon dioxide retention, a complication of
excessive oxygen administration in COPD patients.
NUR 265 EXAM 1 ADVANCED CONCEPT IN
MEDICAL SURGICAL NURSING Exam Preparation
With Complete Questions And Correct Answers With
Rationales Already Graded A+ Brand New Version!!
QUESTION 1
A patient with acute respiratory distress syndrome (ARDS) is receiving
mechanical ventilation with positive end-expiratory pressure (PEEP).
Which assessment finding indicates a complication of this therapy?
A. Decreased cardiac output
B. Increased urine output
C. Respiratory rate of 16 breaths per minute
D. PaO2 of 88 mmHg
Answer: A
Rationale: Positive end-expiratory pressure (PEEP) increases
intrathoracic pressure, which can impede venous return to the heart,
leading to decreased cardiac output. This is a significant complication
that requires careful hemodynamic monitoring. Increased urine output
is not associated with PEEP therapy; rather, decreased renal perfusion
may occur. A respiratory rate of 16 is within normal range and does not
indicate a complication. A PaO2 of 88 mmHg indicates adequate
,2|Page
oxygenation and is a desired outcome of PEEP therapy, not a
complication.
QUESTION 2
The nurse is caring for a patient with a chest tube connected to a three-
chamber drainage system. The water seal chamber shows continuous
bubbling. What is the priority nursing action?
A. Increase the suction pressure
B. Clamp the chest tube
C. Assess the system for an air leak
D. Document the finding as normal
Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an
air leak in the system. The priority action is to assess the system to
locate the source of the leak, which could be at the insertion site,
connection points, or within the drainage unit. Increasing suction
pressure would not resolve an air leak and could cause tissue damage.
Clamping the chest tube is contraindicated as it could lead to tension
pneumothorax. Continuous bubbling is not a normal finding; tidaling is
the expected pattern in the water seal chamber.
QUESTION 3
A patient with heart failure is receiving intravenous furosemide. Which
laboratory value requires the most immediate intervention?
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A. Serum potassium of 3.1 mEq/L
B. Serum sodium of 135 mEq/L
C. Serum magnesium of 1.8 mg/dL
D. Serum calcium of 9.2 mg/dL
Answer: A
Rationale: Furosemide is a loop diuretic that can cause significant
potassium depletion. A serum potassium of 3.1 mEq/L represents
moderate hypokalemia, which can precipitate life-threatening cardiac
dysrhythmias in patients with heart failure who are already at risk for
rhythm disturbances. The other values are within normal limits: sodium
135-145 mEq/L, magnesium 1.5-2.5 mg/dL, and calcium 8.5-10.5
mg/dL.
QUESTION 4
The nurse is preparing to administer digoxin to a patient with atrial
fibrillation. Which finding would indicate the need to withhold the
medication?
A. Apical pulse of 68 beats per minute
B. Serum digoxin level of 2.1 ng/mL
C. Blood pressure of 140/88 mmHg
D. Respiratory rate of 18 breaths per minute
Answer: B
, 4|Page
Rationale: The therapeutic range for digoxin is 0.5-2.0 ng/mL. A level of
2.1 ng/mL is above the therapeutic range and indicates digoxin toxicity.
The nurse should withhold the medication and notify the healthcare
provider. An apical pulse of 68 is within the acceptable range for digoxin
administration (typically >60 bpm). The blood pressure and respiratory
rate are within normal limits and do not contraindicate digoxin
administration.
QUESTION 5
A patient with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Which assessment
finding indicates the oxygen therapy is effective?
A. Respiratory rate increases from 22 to 28 breaths per minute
B. Patient reports decreased shortness of breath
C. Pulse oximetry reading of 88%
D. Patient becomes more lethargic
Answer: B
Rationale: The primary goal of oxygen therapy in COPD patients is to
improve oxygenation and relieve symptoms of hypoxemia. A patient
reporting decreased shortness of breath indicates that the oxygen
therapy is effective in improving comfort and gas exchange. An
increasing respiratory rate suggests worsening respiratory distress. A
pulse oximetry reading of 88% indicates inadequate oxygenation; the
goal is typically 88-92% for COPD patients but 88% is on the lower end.
Lethargy could indicate carbon dioxide retention, a complication of
excessive oxygen administration in COPD patients.
