Advanced Medical-Surgical Nursing | Final Exam Questions With
Answers and detailed Rationales
Question 1.
A patient’s arterial blood gas results are pH 7.30, PaCO2 55 mm Hg, and HCO3 24 mEq/L.
Which condition does the nurse suspect?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Correct Answer: A. Respiratory Acidosis
Explanation: The pH is low (acidosis) and the PaCO2 is high, indicating the primary cause
is respiratory. The bicarbonate is normal, suggesting no compensation yet.
Question 2.
Which assessment finding is most indicative of a patient developing Autonomic
Dysreflexia?
A. Hypotension and tachycardia
B. Hyperglycemia and fruity breath
C. Sudden hypertension and bradycardia
D. Flaccid paralysis and loss of reflexes
Correct Answer: C. Sudden hypertension and bradycardia
Explanation: Autonomic Dysreflexia is a medical emergency in spinal cord injury patients
characterized by sudden, severe hypertension, a pounding headache, and bradycardia.
Question 3.
The nurse is caring for a patient on a mechanical ventilator. The high-pressure alarm
sounds. What is the most likely cause?
A. Disconnection of the ventilator tubing
B. The patient needs suctioning due to secretions
C. A leak in the endotracheal tube cuff
D. The patient has stopped breathing spontaneously
Correct Answer: B. The patient needs suctioning due to secretions
Explanation: High-pressure alarms are triggered by increased resistance, such as
secretions, biting the tube, or kinking. Low-pressure alarms indicate disconnections or
leaks.
, Question 4.
In the emergent phase of a burn injury, what is the primary goal of nursing care?
A. Infection prevention
B. Emotional counseling
C. Nutritional support
D. Fluid resuscitation
Correct Answer: D. Fluid resuscitation
Explanation: During the first 24-48 hours (emergent phase), preventing hypovolemic
shock through aggressive fluid resuscitation is the highest priority.
Question 5.
A patient with a head injury has a Glasgow Coma Scale score of 7. How should the nurse
interpret this result?
A. The patient is fully alert and oriented
B. The patient has a minor head injury
C. The patient has moderate neurological impairment
D. The patient is in a coma and requires airway protection
Correct Answer: D. The patient is in a coma and requires airway protection
Explanation: A GCS score of 8 or less is generally accepted as the definition of a coma
and often necessitates intubation to protect the airway.
Question 6.
Which medication is the priority for a patient experiencing a hypertensive crisis with
evidence of target organ damage?
A. Oral Lisinopril
B. Intravenous Sodium Nitroprusside
C. Sublingual Nitroglycerin
D. Oral Amlodipine
Correct Answer: B. Intravenous Sodium Nitroprusside
Explanation: Hypertensive emergencies require immediate, controlled reduction of blood
pressure using intravenous vasodilators like Sodium Nitroprusside.
Question 7.
The nurse is monitoring a patient with Acute Respiratory Distress Syndrome (ARDS). Which
positioning strategy is often used to improve oxygenation?
A. High-Fowler’s position
B. Trendelenburg position
C. Supine positioning
D. Prone positioning
Correct Answer: D. Prone positioning
Answers and detailed Rationales
Question 1.
A patient’s arterial blood gas results are pH 7.30, PaCO2 55 mm Hg, and HCO3 24 mEq/L.
Which condition does the nurse suspect?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Correct Answer: A. Respiratory Acidosis
Explanation: The pH is low (acidosis) and the PaCO2 is high, indicating the primary cause
is respiratory. The bicarbonate is normal, suggesting no compensation yet.
Question 2.
Which assessment finding is most indicative of a patient developing Autonomic
Dysreflexia?
A. Hypotension and tachycardia
B. Hyperglycemia and fruity breath
C. Sudden hypertension and bradycardia
D. Flaccid paralysis and loss of reflexes
Correct Answer: C. Sudden hypertension and bradycardia
Explanation: Autonomic Dysreflexia is a medical emergency in spinal cord injury patients
characterized by sudden, severe hypertension, a pounding headache, and bradycardia.
Question 3.
The nurse is caring for a patient on a mechanical ventilator. The high-pressure alarm
sounds. What is the most likely cause?
A. Disconnection of the ventilator tubing
B. The patient needs suctioning due to secretions
C. A leak in the endotracheal tube cuff
D. The patient has stopped breathing spontaneously
Correct Answer: B. The patient needs suctioning due to secretions
Explanation: High-pressure alarms are triggered by increased resistance, such as
secretions, biting the tube, or kinking. Low-pressure alarms indicate disconnections or
leaks.
, Question 4.
In the emergent phase of a burn injury, what is the primary goal of nursing care?
A. Infection prevention
B. Emotional counseling
C. Nutritional support
D. Fluid resuscitation
Correct Answer: D. Fluid resuscitation
Explanation: During the first 24-48 hours (emergent phase), preventing hypovolemic
shock through aggressive fluid resuscitation is the highest priority.
Question 5.
A patient with a head injury has a Glasgow Coma Scale score of 7. How should the nurse
interpret this result?
A. The patient is fully alert and oriented
B. The patient has a minor head injury
C. The patient has moderate neurological impairment
D. The patient is in a coma and requires airway protection
Correct Answer: D. The patient is in a coma and requires airway protection
Explanation: A GCS score of 8 or less is generally accepted as the definition of a coma
and often necessitates intubation to protect the airway.
Question 6.
Which medication is the priority for a patient experiencing a hypertensive crisis with
evidence of target organ damage?
A. Oral Lisinopril
B. Intravenous Sodium Nitroprusside
C. Sublingual Nitroglycerin
D. Oral Amlodipine
Correct Answer: B. Intravenous Sodium Nitroprusside
Explanation: Hypertensive emergencies require immediate, controlled reduction of blood
pressure using intravenous vasodilators like Sodium Nitroprusside.
Question 7.
The nurse is monitoring a patient with Acute Respiratory Distress Syndrome (ARDS). Which
positioning strategy is often used to improve oxygenation?
A. High-Fowler’s position
B. Trendelenburg position
C. Supine positioning
D. Prone positioning
Correct Answer: D. Prone positioning
