NURS 307: MEDICAL-SURGICAL
NURSING ADVANCED REVIEW
QUESTIONS AND VERIFIED ANSWERS |
100% CORRECT | GRADE A+
1. A patient presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 24 mEq/L. Which
acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Conceptual Explanation: A pH below 7.35 indicates acidosis. An elevated PaCO2 (above
45) with a normal HCO3 indicates the cause is respiratory.
2. Which clinical manifestation is most indicative of left-sided heart failure rather than right-
sided heart failure?
A. Jugular venous distention
B. Crackles in the lung bases
C. Peripheral edema
,D. Hepatosplenomegaly
Answer: B
Conceptual Explanation: Left-sided heart failure causes blood to back up into the
pulmonary circulation, leading to pulmonary congestion and crackles.
3. A patient with Type 1 Diabetes is admitted with Kussmaul respirations and a fruity breath
odor. What is the priority intervention?
A. Administering IV regular insulin
B. Starting IV fluid resuscitation with normal saline
C. Administering oral glucose
D. Checking for ketones in the urine
Answer: B
Conceptual Explanation: In Diabetic Ketoacidosis (DKA), the initial priority is fluid
resuscitation to restore circulatory volume before insulin administration.
4. Which sign is a classic early indicator of increased intracranial pressure (ICP)?
A. Altered level of consciousness
B. Cushing’s triad
C. Fixed and dilated pupils
D. Posturing (Decerebrate)
, Answer: A
Conceptual Explanation: A change in the level of consciousness is the most sensitive and
earliest indicator of neurological decline and increased ICP.
5. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen via nasal
cannula. Why is it important to avoid high concentrations of oxygen?
A. Oxygen toxicity can cause blindness
B. It causes sudden metabolic alkalosis
C. It increases the risk of combustion in the hospital
D. High oxygen levels may eliminate the patient’s drive to breathe
Answer: D
Conceptual Explanation: Some COPD patients rely on a ‘hypoxic drive’ to breathe.
Excessive oxygen can suppress this stimulus, leading to respiratory arrest.
6. Which electrolyte imbalance is most likely to cause a positive Trousseau’s sign?
A. Hyperkalemia
B. Hypocalcemia
C. Hyponatremia
D. Hypermagnesemia
Answer: B
NURSING ADVANCED REVIEW
QUESTIONS AND VERIFIED ANSWERS |
100% CORRECT | GRADE A+
1. A patient presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 24 mEq/L. Which
acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Conceptual Explanation: A pH below 7.35 indicates acidosis. An elevated PaCO2 (above
45) with a normal HCO3 indicates the cause is respiratory.
2. Which clinical manifestation is most indicative of left-sided heart failure rather than right-
sided heart failure?
A. Jugular venous distention
B. Crackles in the lung bases
C. Peripheral edema
,D. Hepatosplenomegaly
Answer: B
Conceptual Explanation: Left-sided heart failure causes blood to back up into the
pulmonary circulation, leading to pulmonary congestion and crackles.
3. A patient with Type 1 Diabetes is admitted with Kussmaul respirations and a fruity breath
odor. What is the priority intervention?
A. Administering IV regular insulin
B. Starting IV fluid resuscitation with normal saline
C. Administering oral glucose
D. Checking for ketones in the urine
Answer: B
Conceptual Explanation: In Diabetic Ketoacidosis (DKA), the initial priority is fluid
resuscitation to restore circulatory volume before insulin administration.
4. Which sign is a classic early indicator of increased intracranial pressure (ICP)?
A. Altered level of consciousness
B. Cushing’s triad
C. Fixed and dilated pupils
D. Posturing (Decerebrate)
, Answer: A
Conceptual Explanation: A change in the level of consciousness is the most sensitive and
earliest indicator of neurological decline and increased ICP.
5. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen via nasal
cannula. Why is it important to avoid high concentrations of oxygen?
A. Oxygen toxicity can cause blindness
B. It causes sudden metabolic alkalosis
C. It increases the risk of combustion in the hospital
D. High oxygen levels may eliminate the patient’s drive to breathe
Answer: D
Conceptual Explanation: Some COPD patients rely on a ‘hypoxic drive’ to breathe.
Excessive oxygen can suppress this stimulus, leading to respiratory arrest.
6. Which electrolyte imbalance is most likely to cause a positive Trousseau’s sign?
A. Hyperkalemia
B. Hypocalcemia
C. Hyponatremia
D. Hypermagnesemia
Answer: B
