Advanced Medical-Surgical Nursing Exam 2 Practice 2026
UPDATED ACTUAL Questions and CORRECT Answers
1. A patient is admitted with suspected Acute Respiratory Distress Syndrome
(ARDS). Which of the following is considered the hallmark clinical manifestation
of ARDS?
A. Respiratory alkalosis with hypocapnia
B. Increased lung compliance and decreased work of breathing
C. Refractory hypoxemia despite high FiO2
D. Bradycardia and hypertension
Answer: C
Rationale: The hallmark of ARDS is refractory hypoxemia, which is hypoxemia that does
not improve even when high concentrations of oxygen are administered.
2. A patient with a head injury exhibits Cushing’s triad. Which set of vital signs
does the nurse expect to find?
A. Tachycardia, hypotension, and tachypnea
B. Bradycardia, hypertension with a widening pulse pressure, and irregular respirations
C. Tachycardia, hypertension, and Cheyne-Stokes respirations
D. Bradycardia, hypotension, and shallow breathing
Answer: B
Rationale: Cushing’s triad is a late sign of increased intracranial pressure (ICP) consisting
of bradycardia, hypertension (with widening pulse pressure), and irregular respirations.
,3. Which electrolyte imbalance is the most common cause of tall, peaked T-
waves on an ECG?
A. Hypocalcemia
B. Hypernatremia
C. Hypomagnesemia
D. Hyperkalemia
Answer: D
Rationale: Hyperkalemia (high potassium) typically causes tall, peaked T-waves on an
electrocardiogram (ECG).
4. A patient is in the oliguric phase of Acute Kidney Injury (AKI). Which of the
following findings is the nurse most likely to observe?
A. Fluid volume excess and edema
B. Metabolic alkalosis
C. Urine output greater than 400 mL/day
D. Decreased serum creatinine levels
Answer: A
Rationale: In the oliguric phase of AKI, urine output drops significantly, leading to fluid
retention, edema, and hypertension.
5. The nurse is caring for a patient with Diabetic Ketoacidosis (DKA). What is the
priority initial nursing intervention?
A. Initiating IV fluid resuscitation with 0.9% Normal Saline
B. Assessing for Kussmaul respirations
C. Administering IV insulin bolus
D. Monitoring hourly blood glucose levels
Answer: A
Rationale: Dehydration is severe in DKA. Rehydration with isotonic saline is the priority to
restore circulatory volume before starting insulin.
, 6. Which cardiac rhythm is characterized by a ‘sawtooth’ pattern and a rapid
atrial rate?
A. Ventricular Fibrillation
B. Atrial Fibrillation
C. Atrial Flutter
D. Third-degree Heart Block
Answer: C
Rationale: Atrial Flutter is distinguished by a sawtooth-like wave pattern (F-waves) on the
ECG.
7. A nurse is monitoring a patient on a mechanical ventilator. The ‘High
Pressure’ alarm sounds. Which of the following could be the cause?
A. A leak in the ventilator circuit
B. The endotracheal tube cuff has deflated
C. The patient is biting the endotracheal tube
D. The patient has become disconnected from the ventilator
Answer: C
Rationale: High pressure alarms are triggered by resistance, such as the patient biting the
tube, secretions in the airway, or a kink in the tubing.
8. When assessing a patient with a Spinal Cord Injury at the T6 level, the nurse
notes a severe headache, flushing above the level of injury, and a BP of
190/100. What is the priority action?
A. Administer PRN antihypertensive medication
B. Lower the head of the bed to the supine position
C. Check for bladder distention or fecal impaction
D. Notify the physician immediately without further assessment
Answer: C
UPDATED ACTUAL Questions and CORRECT Answers
1. A patient is admitted with suspected Acute Respiratory Distress Syndrome
(ARDS). Which of the following is considered the hallmark clinical manifestation
of ARDS?
A. Respiratory alkalosis with hypocapnia
B. Increased lung compliance and decreased work of breathing
C. Refractory hypoxemia despite high FiO2
D. Bradycardia and hypertension
Answer: C
Rationale: The hallmark of ARDS is refractory hypoxemia, which is hypoxemia that does
not improve even when high concentrations of oxygen are administered.
2. A patient with a head injury exhibits Cushing’s triad. Which set of vital signs
does the nurse expect to find?
A. Tachycardia, hypotension, and tachypnea
B. Bradycardia, hypertension with a widening pulse pressure, and irregular respirations
C. Tachycardia, hypertension, and Cheyne-Stokes respirations
D. Bradycardia, hypotension, and shallow breathing
Answer: B
Rationale: Cushing’s triad is a late sign of increased intracranial pressure (ICP) consisting
of bradycardia, hypertension (with widening pulse pressure), and irregular respirations.
,3. Which electrolyte imbalance is the most common cause of tall, peaked T-
waves on an ECG?
A. Hypocalcemia
B. Hypernatremia
C. Hypomagnesemia
D. Hyperkalemia
Answer: D
Rationale: Hyperkalemia (high potassium) typically causes tall, peaked T-waves on an
electrocardiogram (ECG).
4. A patient is in the oliguric phase of Acute Kidney Injury (AKI). Which of the
following findings is the nurse most likely to observe?
A. Fluid volume excess and edema
B. Metabolic alkalosis
C. Urine output greater than 400 mL/day
D. Decreased serum creatinine levels
Answer: A
Rationale: In the oliguric phase of AKI, urine output drops significantly, leading to fluid
retention, edema, and hypertension.
5. The nurse is caring for a patient with Diabetic Ketoacidosis (DKA). What is the
priority initial nursing intervention?
A. Initiating IV fluid resuscitation with 0.9% Normal Saline
B. Assessing for Kussmaul respirations
C. Administering IV insulin bolus
D. Monitoring hourly blood glucose levels
Answer: A
Rationale: Dehydration is severe in DKA. Rehydration with isotonic saline is the priority to
restore circulatory volume before starting insulin.
, 6. Which cardiac rhythm is characterized by a ‘sawtooth’ pattern and a rapid
atrial rate?
A. Ventricular Fibrillation
B. Atrial Fibrillation
C. Atrial Flutter
D. Third-degree Heart Block
Answer: C
Rationale: Atrial Flutter is distinguished by a sawtooth-like wave pattern (F-waves) on the
ECG.
7. A nurse is monitoring a patient on a mechanical ventilator. The ‘High
Pressure’ alarm sounds. Which of the following could be the cause?
A. A leak in the ventilator circuit
B. The endotracheal tube cuff has deflated
C. The patient is biting the endotracheal tube
D. The patient has become disconnected from the ventilator
Answer: C
Rationale: High pressure alarms are triggered by resistance, such as the patient biting the
tube, secretions in the airway, or a kink in the tubing.
8. When assessing a patient with a Spinal Cord Injury at the T6 level, the nurse
notes a severe headache, flushing above the level of injury, and a BP of
190/100. What is the priority action?
A. Administer PRN antihypertensive medication
B. Lower the head of the bed to the supine position
C. Check for bladder distention or fecal impaction
D. Notify the physician immediately without further assessment
Answer: C
