MSNC 505 MEDICAL-SURGICAL
NURSING PRACTICE EXAM QUESTIONS
AND DETAILED SOLUTIONS JUST
RELEASED
1. A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) presents with an
arterial blood gas (ABG) showing pH 7.31, PaCO2 58 mmHg, and HCO3 30 mEq/L. Which acid-
base imbalance is occurring?
A. Partially compensated respiratory acidosis
B. Uncompensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Partially compensated metabolic acidosis
Answer: A
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory origin),
and the HCO3 is high (indicating the kidneys are attempting to compensate, but the pH is
not yet normal).
2. A patient is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
Which laboratory result should the nurse prioritize for immediate reporting?
A. Blood urea nitrogen (BUN) of 10 mg/dL
,B. Urine specific gravity of 1.030
C. Serum potassium of 3.6 mEq/L
D. Serum sodium of 118 mEq/L
Answer: D
Conceptual Explanation: Severe hyponatremia (below 120 mEq/L) puts the patient at
high risk for cerebral edema and seizures, requiring urgent intervention.
3. When managing a patient with acute pancreatitis, which intervention is the highest priority
during the first 24 hours?
A. Administering pancreatic enzymes with meals
B. Starting enteral nutrition via a nasojejunal tube
C. Maintaining strict bed rest to decrease metabolic rate
D. Aggressive fluid resuscitation with isotonic crystalloids
Answer: D
Conceptual Explanation: Fluid resuscitation is critical in acute pancreatitis to prevent
hypovolemia and organ failure due to third-spacing of fluids.
4. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg.
Which position is most appropriate for this patient?
A. Flat with the head in a neutral position
B. Head of bed elevated 30 to 45 degrees, head neutral
, C. Trendelenburg to increase cerebral perfusion
D. Left side-lying with knees flexed to reduce abdominal pressure
Answer: B
Conceptual Explanation: Elevating the head of the bed promotes venous drainage from
the brain, and keeping the head neutral avoids jugular vein compression.
5. A patient is receiving a continuous heparin infusion for a deep vein thrombosis. The
activated partial thromboplastin time (aPTT) is 110 seconds (control: 30 seconds). What is the
nurse’s first action?
A. Stop the infusion and notify the provider
B. Prepare to administer Vitamin K
C. Increase the infusion rate per protocol
D. Continue the infusion and recheck aPTT in 1 hour
Answer: A
Conceptual Explanation: The aPTT is significantly above the therapeutic range (usually
1.5 to 2.5 times the control). The infusion must be stopped to prevent hemorrhage.
6. During the acute phase of a myocardial infarction, which cardiac biomarker is most specific
for myocardial damage?
A. Myoglobin
B. CK-MB
NURSING PRACTICE EXAM QUESTIONS
AND DETAILED SOLUTIONS JUST
RELEASED
1. A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) presents with an
arterial blood gas (ABG) showing pH 7.31, PaCO2 58 mmHg, and HCO3 30 mEq/L. Which acid-
base imbalance is occurring?
A. Partially compensated respiratory acidosis
B. Uncompensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Partially compensated metabolic acidosis
Answer: A
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory origin),
and the HCO3 is high (indicating the kidneys are attempting to compensate, but the pH is
not yet normal).
2. A patient is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
Which laboratory result should the nurse prioritize for immediate reporting?
A. Blood urea nitrogen (BUN) of 10 mg/dL
,B. Urine specific gravity of 1.030
C. Serum potassium of 3.6 mEq/L
D. Serum sodium of 118 mEq/L
Answer: D
Conceptual Explanation: Severe hyponatremia (below 120 mEq/L) puts the patient at
high risk for cerebral edema and seizures, requiring urgent intervention.
3. When managing a patient with acute pancreatitis, which intervention is the highest priority
during the first 24 hours?
A. Administering pancreatic enzymes with meals
B. Starting enteral nutrition via a nasojejunal tube
C. Maintaining strict bed rest to decrease metabolic rate
D. Aggressive fluid resuscitation with isotonic crystalloids
Answer: D
Conceptual Explanation: Fluid resuscitation is critical in acute pancreatitis to prevent
hypovolemia and organ failure due to third-spacing of fluids.
4. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg.
Which position is most appropriate for this patient?
A. Flat with the head in a neutral position
B. Head of bed elevated 30 to 45 degrees, head neutral
, C. Trendelenburg to increase cerebral perfusion
D. Left side-lying with knees flexed to reduce abdominal pressure
Answer: B
Conceptual Explanation: Elevating the head of the bed promotes venous drainage from
the brain, and keeping the head neutral avoids jugular vein compression.
5. A patient is receiving a continuous heparin infusion for a deep vein thrombosis. The
activated partial thromboplastin time (aPTT) is 110 seconds (control: 30 seconds). What is the
nurse’s first action?
A. Stop the infusion and notify the provider
B. Prepare to administer Vitamin K
C. Increase the infusion rate per protocol
D. Continue the infusion and recheck aPTT in 1 hour
Answer: A
Conceptual Explanation: The aPTT is significantly above the therapeutic range (usually
1.5 to 2.5 times the control). The infusion must be stopped to prevent hemorrhage.
6. During the acute phase of a myocardial infarction, which cardiac biomarker is most specific
for myocardial damage?
A. Myoglobin
B. CK-MB
