Advanced Medical-Surgical Nursing | Final Exam Prep Questions
With Answers and detailed Rationales
Question 1.
A patient with a major burn injury is in the emergent phase. Which laboratory value should
the nurse expect to find?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Decreased Hematocrit
Correct Answer: B. Hyperkalemia
Explanation: In the emergent phase of a burn, massive cell destruction releases
potassium into the extracellular fluid, leading to hyperkalemia.
Question 2.
Which assessment finding is most characteristic of the compensatory stage of shock?
A. Cold, clammy skin
B. Anuria
C. Lethargy and confusion
D. Heart rate of 115 bpm
Correct Answer: D. Heart rate of 115 bpm
Explanation: In the compensatory stage, the body activates the sympathetic nervous
system, leading to tachycardia and increased respiratory rate to maintain cardiac output.
Question 3.
A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). Which ventilator
setting is specifically designed to keep the alveoli open at the end of expiration?
A. Tidal Volume
B. Fraction of Inspired Oxygen (FiO2)
C. Inspiratory Rate
D. Positive End-Expiratory Pressure (PEEP)
Correct Answer: D. Positive End-Expiratory Pressure (PEEP)
Explanation: PEEP provides positive pressure at the end of expiration to prevent alveolar
collapse and improve oxygenation in ARDS.
,Question 4.
A nurse is caring for a patient with a Mean Arterial Pressure (MAP) of 55 mmHg. What is
the priority intervention?
A. Decrease the IV fluid rate
B. Notify the provider and prepare for vasopressors
C. Check the patient’s temperature
D. Assess for bowel sounds
Correct Answer: B. Notify the provider and prepare for vasopressors
Explanation: A MAP below 60-65 mmHg indicates inadequate organ perfusion.
Interventions like fluid resuscitation or vasopressors are required immediately.
Question 5.
Which rhythm is characterized by a ‘sawtooth’ pattern on an ECG?
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. Sinus Bradycardia
D. Atrial Flutter
Correct Answer: D. Atrial Flutter
Explanation: Atrial flutter is recognized by rapid, regular sawtooth-shaped waves
(F-waves).
Question 6.
A patient with chronic kidney disease (CKD) has a potassium level of 6.8 mEq/L. Which
medication should the nurse expect to administer first to protect the heart?
A. Calcium Gluconate
B. Sodium Polystyrene Sulfonate
C. Insulin and D50W
D. Furosemide
Correct Answer: A. Calcium Gluconate
Explanation: While other meds lower potassium, Calcium Gluconate is administered first
to stabilize the myocardial cell membrane and prevent lethal dysrhythmias.
Question 7.
A patient is experiencing Autonomic Dysreflexia. Which is the first action the nurse should
take?
A. Raise the head of the bed to a high-Fowler’s position
B. Check for a full bladder or fecal impaction
C. Administer antihypertensive medication
D. Call a Rapid Response Team
Correct Answer: A. Raise the head of the bed to a high-Fowler’s position
,Explanation: The first action is to sit the patient up to utilize orthostatic pressure to help
lower the blood pressure before looking for the cause.
Question 8.
What is a classic sign of Neurogenic Shock following a spinal cord injury?
A. Tachycardia and Hypertension
B. Bradycardia and Hypotension
C. Fever and Chills
D. Tachypnea and Diaphoresis
Correct Answer: B. Bradycardia and Hypotension
Explanation: Neurogenic shock results in the loss of sympathetic tone, leading to the
unique combination of bradycardia and hypotension.
Question 9.
A patient with Acute Pancreatitis has a positive Cullen’s sign. This indicates:
A. Intra-abdominal hemorrhage
B. Hypocalcemia
C. Biliary obstruction
D. Pancreatic pseudocyst
Correct Answer: A. Intra-abdominal hemorrhage
Explanation: Cullen’s sign is bluish discoloration around the umbilicus, signifying
retroperitoneal or intra-abdominal bleeding.
Question 10.
When assessing a patient with a chest tube, the nurse notes continuous bubbling in the
water-seal chamber. This indicates:
A. Normal functioning
B. The lung has fully re-expanded
C. Suction is set too high
D. An air leak in the system
Correct Answer: D. An air leak in the system
Explanation: Intermittent bubbling is normal in a patient with a pneumothorax, but
continuous bubbling indicates a leak in the drainage system.
, Question 11.
Which Glasgow Coma Scale (GCS) score would indicate a patient is in a coma and requires
intubation?
A. 15
B. 8
C. 12
D. 10
Correct Answer: B. 8
Explanation: A GCS score of 8 or less is generally the threshold for indicating a coma and
the need for airway protection.
Question 12.
In the management of Disseminated Intravascular Coagulation (DIC), which lab result is
most specific to the breakdown of clots?
A. Elevated D-dimer
B. Decreased Platelets
C. Prolonged PT/PTT
D. Low Hemoglobin
Correct Answer: A. Elevated D-dimer
Explanation: D-dimer measures fibrin degradation products, which are elevated in DIC
due to excessive clot breakdown.
Question 13.
A patient is in the ‘Cold Phase’ (Late) of Septic Shock. What physical finding would the
nurse expect?
A. Flushed, warm skin
B. Cool, clammy, and pale skin
C. High cardiac output
D. Bounding pulses
Correct Answer: B. Cool, clammy, and pale skin
Explanation: In late septic shock (hypodynamic phase), cardiac output drops, and
peripheral vasoconstriction makes the skin cool and clammy.
Question 14.
Which treatment is most appropriate for a patient in Ventricular Fibrillation?
A. Defibrillation
B. Synchronized Cardioversion
C. Adenosine IV Push
D. Atropine
Correct Answer: A. Defibrillation
With Answers and detailed Rationales
Question 1.
A patient with a major burn injury is in the emergent phase. Which laboratory value should
the nurse expect to find?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Decreased Hematocrit
Correct Answer: B. Hyperkalemia
Explanation: In the emergent phase of a burn, massive cell destruction releases
potassium into the extracellular fluid, leading to hyperkalemia.
Question 2.
Which assessment finding is most characteristic of the compensatory stage of shock?
A. Cold, clammy skin
B. Anuria
C. Lethargy and confusion
D. Heart rate of 115 bpm
Correct Answer: D. Heart rate of 115 bpm
Explanation: In the compensatory stage, the body activates the sympathetic nervous
system, leading to tachycardia and increased respiratory rate to maintain cardiac output.
Question 3.
A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). Which ventilator
setting is specifically designed to keep the alveoli open at the end of expiration?
A. Tidal Volume
B. Fraction of Inspired Oxygen (FiO2)
C. Inspiratory Rate
D. Positive End-Expiratory Pressure (PEEP)
Correct Answer: D. Positive End-Expiratory Pressure (PEEP)
Explanation: PEEP provides positive pressure at the end of expiration to prevent alveolar
collapse and improve oxygenation in ARDS.
,Question 4.
A nurse is caring for a patient with a Mean Arterial Pressure (MAP) of 55 mmHg. What is
the priority intervention?
A. Decrease the IV fluid rate
B. Notify the provider and prepare for vasopressors
C. Check the patient’s temperature
D. Assess for bowel sounds
Correct Answer: B. Notify the provider and prepare for vasopressors
Explanation: A MAP below 60-65 mmHg indicates inadequate organ perfusion.
Interventions like fluid resuscitation or vasopressors are required immediately.
Question 5.
Which rhythm is characterized by a ‘sawtooth’ pattern on an ECG?
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. Sinus Bradycardia
D. Atrial Flutter
Correct Answer: D. Atrial Flutter
Explanation: Atrial flutter is recognized by rapid, regular sawtooth-shaped waves
(F-waves).
Question 6.
A patient with chronic kidney disease (CKD) has a potassium level of 6.8 mEq/L. Which
medication should the nurse expect to administer first to protect the heart?
A. Calcium Gluconate
B. Sodium Polystyrene Sulfonate
C. Insulin and D50W
D. Furosemide
Correct Answer: A. Calcium Gluconate
Explanation: While other meds lower potassium, Calcium Gluconate is administered first
to stabilize the myocardial cell membrane and prevent lethal dysrhythmias.
Question 7.
A patient is experiencing Autonomic Dysreflexia. Which is the first action the nurse should
take?
A. Raise the head of the bed to a high-Fowler’s position
B. Check for a full bladder or fecal impaction
C. Administer antihypertensive medication
D. Call a Rapid Response Team
Correct Answer: A. Raise the head of the bed to a high-Fowler’s position
,Explanation: The first action is to sit the patient up to utilize orthostatic pressure to help
lower the blood pressure before looking for the cause.
Question 8.
What is a classic sign of Neurogenic Shock following a spinal cord injury?
A. Tachycardia and Hypertension
B. Bradycardia and Hypotension
C. Fever and Chills
D. Tachypnea and Diaphoresis
Correct Answer: B. Bradycardia and Hypotension
Explanation: Neurogenic shock results in the loss of sympathetic tone, leading to the
unique combination of bradycardia and hypotension.
Question 9.
A patient with Acute Pancreatitis has a positive Cullen’s sign. This indicates:
A. Intra-abdominal hemorrhage
B. Hypocalcemia
C. Biliary obstruction
D. Pancreatic pseudocyst
Correct Answer: A. Intra-abdominal hemorrhage
Explanation: Cullen’s sign is bluish discoloration around the umbilicus, signifying
retroperitoneal or intra-abdominal bleeding.
Question 10.
When assessing a patient with a chest tube, the nurse notes continuous bubbling in the
water-seal chamber. This indicates:
A. Normal functioning
B. The lung has fully re-expanded
C. Suction is set too high
D. An air leak in the system
Correct Answer: D. An air leak in the system
Explanation: Intermittent bubbling is normal in a patient with a pneumothorax, but
continuous bubbling indicates a leak in the drainage system.
, Question 11.
Which Glasgow Coma Scale (GCS) score would indicate a patient is in a coma and requires
intubation?
A. 15
B. 8
C. 12
D. 10
Correct Answer: B. 8
Explanation: A GCS score of 8 or less is generally the threshold for indicating a coma and
the need for airway protection.
Question 12.
In the management of Disseminated Intravascular Coagulation (DIC), which lab result is
most specific to the breakdown of clots?
A. Elevated D-dimer
B. Decreased Platelets
C. Prolonged PT/PTT
D. Low Hemoglobin
Correct Answer: A. Elevated D-dimer
Explanation: D-dimer measures fibrin degradation products, which are elevated in DIC
due to excessive clot breakdown.
Question 13.
A patient is in the ‘Cold Phase’ (Late) of Septic Shock. What physical finding would the
nurse expect?
A. Flushed, warm skin
B. Cool, clammy, and pale skin
C. High cardiac output
D. Bounding pulses
Correct Answer: B. Cool, clammy, and pale skin
Explanation: In late septic shock (hypodynamic phase), cardiac output drops, and
peripheral vasoconstriction makes the skin cool and clammy.
Question 14.
Which treatment is most appropriate for a patient in Ventricular Fibrillation?
A. Defibrillation
B. Synchronized Cardioversion
C. Adenosine IV Push
D. Atropine
Correct Answer: A. Defibrillation
