MED-SURG FINAL EXAM
COMPREHENSIVE PRACTICE
QUESTIONS AND VERIFIED ANSWERS
|GRADE A+| JUST RELEASED
1. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation
with high PEEP. The nurse notes a sudden drop in blood pressure and absent breath sounds
on the right side. What is the priority action?
A. Prepare for immediate needle decompression
B. Increase the FiO2 to 100%
C. Suction the endotracheal tube
D. Obtain a STAT portable chest X-ray
Answer: A
Conceptual Explanation: High PEEP levels increase the risk of barotrauma, leading to a
tension pneumothorax. Symptoms like hypotension and absent breath sounds indicate this
life-threatening complication requiring immediate decompression.
2. Which assessment finding is most indicative of a cardiac tamponade in a patient following
cardiac surgery?
A. Widening pulse pressure and bradycardia
,B. Inspiratory crackles and S3 gallop
C. Muffled heart sounds and jugular venous distention
D. ST-segment elevation in all leads
Answer: C
Conceptual Explanation: Beck’s Triad for cardiac tamponade includes hypotension with
narrowed pulse pressure, muffled heart sounds, and JVD due to increased intrapericardial
pressure.
3. A patient is admitted with a suspected pheochromocytoma. Which nursing action is
contraindicated?
A. Monitoring blood pressure every 15 minutes
B. Palpating the abdomen to check for masses
C. Collecting a 24-hour urine for catecholamines
D. Administering alpha-adrenergic blockers as ordered
Answer: B
Conceptual Explanation: Palpating the abdomen can trigger the release of catecholamines
from the tumor, potentially causing a hypertensive crisis.
4. In the early stages of hypovolemic shock, which physiological compensatory mechanism
occurs?
A. Decreased peripheral vascular resistance
, B. Increased parasympathetic nervous system activity
C. Decreased heart rate to conserve oxygen
D. Activation of the renin-angiotensin-aldosterone system
Answer: D
Conceptual Explanation: The RAAS is activated to retain sodium and water, increasing
blood volume and pressure in response to decreased renal perfusion.
5. A patient with Chronic Kidney Disease (CKD) has a serum potassium of 6.8 mEq/L. Which
medication should the nurse prioritize?
A. Calcium Gluconate
B. Furosemide (Lasix)
C. Sodium Polystyrene Sulfonate (Kayexalate)
D. Spironolactone (Aldactone)
Answer: A
Conceptual Explanation: Calcium gluconate does not lower potassium but stabilizes the
myocardial membrane to prevent lethal arrhythmias caused by hyperkalemia.
6. Which arterial blood gas (ABG) result is expected in a patient with severe, prolonged
vomiting?
A. pH 7.30, PaCO2 50, HCO3 28
B. pH 7.32, PaCO2 30, HCO3 18
COMPREHENSIVE PRACTICE
QUESTIONS AND VERIFIED ANSWERS
|GRADE A+| JUST RELEASED
1. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation
with high PEEP. The nurse notes a sudden drop in blood pressure and absent breath sounds
on the right side. What is the priority action?
A. Prepare for immediate needle decompression
B. Increase the FiO2 to 100%
C. Suction the endotracheal tube
D. Obtain a STAT portable chest X-ray
Answer: A
Conceptual Explanation: High PEEP levels increase the risk of barotrauma, leading to a
tension pneumothorax. Symptoms like hypotension and absent breath sounds indicate this
life-threatening complication requiring immediate decompression.
2. Which assessment finding is most indicative of a cardiac tamponade in a patient following
cardiac surgery?
A. Widening pulse pressure and bradycardia
,B. Inspiratory crackles and S3 gallop
C. Muffled heart sounds and jugular venous distention
D. ST-segment elevation in all leads
Answer: C
Conceptual Explanation: Beck’s Triad for cardiac tamponade includes hypotension with
narrowed pulse pressure, muffled heart sounds, and JVD due to increased intrapericardial
pressure.
3. A patient is admitted with a suspected pheochromocytoma. Which nursing action is
contraindicated?
A. Monitoring blood pressure every 15 minutes
B. Palpating the abdomen to check for masses
C. Collecting a 24-hour urine for catecholamines
D. Administering alpha-adrenergic blockers as ordered
Answer: B
Conceptual Explanation: Palpating the abdomen can trigger the release of catecholamines
from the tumor, potentially causing a hypertensive crisis.
4. In the early stages of hypovolemic shock, which physiological compensatory mechanism
occurs?
A. Decreased peripheral vascular resistance
, B. Increased parasympathetic nervous system activity
C. Decreased heart rate to conserve oxygen
D. Activation of the renin-angiotensin-aldosterone system
Answer: D
Conceptual Explanation: The RAAS is activated to retain sodium and water, increasing
blood volume and pressure in response to decreased renal perfusion.
5. A patient with Chronic Kidney Disease (CKD) has a serum potassium of 6.8 mEq/L. Which
medication should the nurse prioritize?
A. Calcium Gluconate
B. Furosemide (Lasix)
C. Sodium Polystyrene Sulfonate (Kayexalate)
D. Spironolactone (Aldactone)
Answer: A
Conceptual Explanation: Calcium gluconate does not lower potassium but stabilizes the
myocardial membrane to prevent lethal arrhythmias caused by hyperkalemia.
6. Which arterial blood gas (ABG) result is expected in a patient with severe, prolonged
vomiting?
A. pH 7.30, PaCO2 50, HCO3 28
B. pH 7.32, PaCO2 30, HCO3 18
