Detailed Answer Key For Medical Surgical Exam, A+ Solutions
Updated 2025
Detailed Answer Key
Medical Surgical, A+
• A nurse is caring for a client who has acute kidney injury (AKI). Which of the following arterial blood gas values
would the nurse expect this client to have?
A. pH 7.49, HCO3 24, PaCO2 30
Rationale: These values suggest uncompensated respiratory alkalosis, which is unlikely to result solely
from AKI.
B. pH 7.49, HCO3 30, PaCO2 40
Rationale: These values suggest uncompensated metabolic alkalosis, which is unlikely to result solely
from AKI.
C. pH 7.26, HCO3 24, PaCO2 46
Rationale:
These values suggest uncompensated respiratory acidosis, which is unlikely to result solely
from AKI.
D. pH 7.26, HCO3 14, PaCO2 30
Rationale: AKI causes metabolic acidosis because the kidneys cannot adequately process and excrete
the acidic substances the usual bodily functions produce every day. With metabolic acidosis,
the pH is low, the bicarbonate is low, and the PaCO2 is low or in the expected range, as in
these results.
• AA nurse is reviewing a client's laboratory values. Which of the following values should the nurse report to the
provider?
A. Hct 45%
Rationale: An Hct of 45% is within the expected reference range.
B. WBC 1,700/mm3
Rationale: A WBC count of 1,700/mm3 is a critical value that indicates the client is susceptible to infection.
The nurse should report this value to the provider.
C. Hgb 14.7 g/dL
Rationale: An Hgb level of 14.7 g/dL is within the expected reference range.
D. Platelets 160,000/mm3
Rationale: A platelet count of 160,000/mm3 is within the expected reference range.
• A nurse is caring for a client who is experiencing hypovolemic shock. Which of the following blood products
, should the nurse anticipate administering to this client?
A. Cryoprecipitates
Rationale: Cryoprecipitates are administered to clients who have hemophilia or von Willebrand disease.
B. Platelets
Rationale: Platelets are administered to clients who have thrombocytopenia.
C. Albumin
Rationale: Albumin is administered to clients who have hypoproteinemia and burns.
D. Packed RBCs
Rationale: Packed RBCs are given to restore blood volume and replace hematocrit and hemoglobin
levels in clients who have hypovolemic shock.
1. A nurse is reviewing the cause of gout with a group of nurses. Which of the following statements should the nurse
make?
A. "Uric acid levels drop and calcium forms precipitate."
Rationale: With gout, clients have hyperuricemia, rather than a reduction in uric acid.
B. "Tophi form in the kidneys and they impair the excretion of uric acid."
Rationale: Tophi, or deposits in tissues near a joint, develop in chronic, late-stage gout. They are not part of
the primary disease process.
C. "The intra-articular deposition of urate crystals causes inflammation."
Rationale: Gout, or gouty arthritis, develops when urate crystals deposit in joints and tissues and cause
inflammation and pain.
D. "Articular cartilage thins, leading to splitting and fragmentation."
Rationale: Gout does not thin and fragment cartilage.
2. A nurse is teaching a group of clients about osteoarthritis. Which of the following recommendations should the
nurse include in the teaching?
A. Use Echinacea to manage joint pain.
Rationale: The nurse may include the use of complementary and alternative therapies in the teaching.
However, Echinacea is used for the treatment of the common cold, not osteoarthritis. Alternative
therapies that are used for osteoarthritis include glucosamine, chondroitin, and topical capsaicin.
B. Apply ice to the joint before exercising.
Rationale: The nurse should recommend that the clients begin exercising immediately following the
application of heat. This reduces pain and improves mobility, allowing for increased
range-of-motion during exercises. Cold application may be applied following exercise to
decrease discomfort and inflammation.
Page 2
, C. Maintain a recommended body weight.
Rationale: Obesity is a risk factor for the development of osteoarthritis. Maintenance of an ideal weight is
one way a client can prevent added wear and tear on joints and promote overall joint health.
D. Reduce the amount of purine in the diet.
Rationale: The nurse should recognize that limiting purine in the diet, which is often found in organ meats,
is recommended for clients who have gout.
3. A nurse is caring for a client who has had a myocardial infarction. Upon his first visit to cardiac rehabilitation, he
tells the nurse that he doesn't understand why he needs to be there because there is nothing more to do, as the
Page 3
, damage is done. Which of the following is the correct nursing response?
A. "Cardiac rehabilitation cannot undo the damage to your heart but it can help you get back to your previous
level of activity safely."
Rationale: With this response, the nurse uses the therapeutic communication technique of presenting
reality by indicating her perception of the situation for the client.
B. "It’s not unusual to feel that way at first, but once you learn the routine, you’ll enjoy it."
Rationale: With this response, the nurse illustrates the nontherapeutic communication technique of giving
reassurance, thus discouraging the client from further communication.
C. "Exercise is good for you and good for your heart."
Rationale: With this response, the nurse illustrates the nontherapeutic communication techniques of
disagreeing and giving advice.
D. "Your doctor is the expert here, and I’m sure he would only recommend what is best for you."
Rationale: With this response, the nurse illustrates the nontherapeutic communication technique of
defending.
4. A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The nurse should identify
which of the following medications as the cause of the client’s low potassium level?
A. Furosemide
Rationale: Furosemide is a loop (high-ceiling) diuretic that inhibits the reabsorption of sodium and chloride
and results in diuresis, which decreases potassium through excretion in the distal nephrons.
Hypokalemia is an adverse effect of furosemide.
B. Nitroglycerin
Rationale: A potassium level of 2.4 mEq/L is not an adverse effect of nitroglycerin. Nitroglycerin is a
vasodilator medication to treat angina.
C. Metoprolol
Rationale: A potassium level of 2.4 mEq/L is not an adverse effect of metoprolol. Metoprolol is a
beta-blocker that slows the heart rate and improves contractility of the heart muscle.
D. Spironolactone
Rationale: Spironolactone is a potassium-sparing diuretic medication; therefore, hyperkalemia is an
adverse effect of this medication.
5. A nurse is caring for a client who is postoperative following an open reduction internal fixation (ORIF) of a femur
fracture. Which of the following parameters should the nurse include in the evaluation of the neurovascular status of
the client's affected extremity? (Select all that apply.)
Page 4
Updated 2025
Detailed Answer Key
Medical Surgical, A+
• A nurse is caring for a client who has acute kidney injury (AKI). Which of the following arterial blood gas values
would the nurse expect this client to have?
A. pH 7.49, HCO3 24, PaCO2 30
Rationale: These values suggest uncompensated respiratory alkalosis, which is unlikely to result solely
from AKI.
B. pH 7.49, HCO3 30, PaCO2 40
Rationale: These values suggest uncompensated metabolic alkalosis, which is unlikely to result solely
from AKI.
C. pH 7.26, HCO3 24, PaCO2 46
Rationale:
These values suggest uncompensated respiratory acidosis, which is unlikely to result solely
from AKI.
D. pH 7.26, HCO3 14, PaCO2 30
Rationale: AKI causes metabolic acidosis because the kidneys cannot adequately process and excrete
the acidic substances the usual bodily functions produce every day. With metabolic acidosis,
the pH is low, the bicarbonate is low, and the PaCO2 is low or in the expected range, as in
these results.
• AA nurse is reviewing a client's laboratory values. Which of the following values should the nurse report to the
provider?
A. Hct 45%
Rationale: An Hct of 45% is within the expected reference range.
B. WBC 1,700/mm3
Rationale: A WBC count of 1,700/mm3 is a critical value that indicates the client is susceptible to infection.
The nurse should report this value to the provider.
C. Hgb 14.7 g/dL
Rationale: An Hgb level of 14.7 g/dL is within the expected reference range.
D. Platelets 160,000/mm3
Rationale: A platelet count of 160,000/mm3 is within the expected reference range.
• A nurse is caring for a client who is experiencing hypovolemic shock. Which of the following blood products
, should the nurse anticipate administering to this client?
A. Cryoprecipitates
Rationale: Cryoprecipitates are administered to clients who have hemophilia or von Willebrand disease.
B. Platelets
Rationale: Platelets are administered to clients who have thrombocytopenia.
C. Albumin
Rationale: Albumin is administered to clients who have hypoproteinemia and burns.
D. Packed RBCs
Rationale: Packed RBCs are given to restore blood volume and replace hematocrit and hemoglobin
levels in clients who have hypovolemic shock.
1. A nurse is reviewing the cause of gout with a group of nurses. Which of the following statements should the nurse
make?
A. "Uric acid levels drop and calcium forms precipitate."
Rationale: With gout, clients have hyperuricemia, rather than a reduction in uric acid.
B. "Tophi form in the kidneys and they impair the excretion of uric acid."
Rationale: Tophi, or deposits in tissues near a joint, develop in chronic, late-stage gout. They are not part of
the primary disease process.
C. "The intra-articular deposition of urate crystals causes inflammation."
Rationale: Gout, or gouty arthritis, develops when urate crystals deposit in joints and tissues and cause
inflammation and pain.
D. "Articular cartilage thins, leading to splitting and fragmentation."
Rationale: Gout does not thin and fragment cartilage.
2. A nurse is teaching a group of clients about osteoarthritis. Which of the following recommendations should the
nurse include in the teaching?
A. Use Echinacea to manage joint pain.
Rationale: The nurse may include the use of complementary and alternative therapies in the teaching.
However, Echinacea is used for the treatment of the common cold, not osteoarthritis. Alternative
therapies that are used for osteoarthritis include glucosamine, chondroitin, and topical capsaicin.
B. Apply ice to the joint before exercising.
Rationale: The nurse should recommend that the clients begin exercising immediately following the
application of heat. This reduces pain and improves mobility, allowing for increased
range-of-motion during exercises. Cold application may be applied following exercise to
decrease discomfort and inflammation.
Page 2
, C. Maintain a recommended body weight.
Rationale: Obesity is a risk factor for the development of osteoarthritis. Maintenance of an ideal weight is
one way a client can prevent added wear and tear on joints and promote overall joint health.
D. Reduce the amount of purine in the diet.
Rationale: The nurse should recognize that limiting purine in the diet, which is often found in organ meats,
is recommended for clients who have gout.
3. A nurse is caring for a client who has had a myocardial infarction. Upon his first visit to cardiac rehabilitation, he
tells the nurse that he doesn't understand why he needs to be there because there is nothing more to do, as the
Page 3
, damage is done. Which of the following is the correct nursing response?
A. "Cardiac rehabilitation cannot undo the damage to your heart but it can help you get back to your previous
level of activity safely."
Rationale: With this response, the nurse uses the therapeutic communication technique of presenting
reality by indicating her perception of the situation for the client.
B. "It’s not unusual to feel that way at first, but once you learn the routine, you’ll enjoy it."
Rationale: With this response, the nurse illustrates the nontherapeutic communication technique of giving
reassurance, thus discouraging the client from further communication.
C. "Exercise is good for you and good for your heart."
Rationale: With this response, the nurse illustrates the nontherapeutic communication techniques of
disagreeing and giving advice.
D. "Your doctor is the expert here, and I’m sure he would only recommend what is best for you."
Rationale: With this response, the nurse illustrates the nontherapeutic communication technique of
defending.
4. A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The nurse should identify
which of the following medications as the cause of the client’s low potassium level?
A. Furosemide
Rationale: Furosemide is a loop (high-ceiling) diuretic that inhibits the reabsorption of sodium and chloride
and results in diuresis, which decreases potassium through excretion in the distal nephrons.
Hypokalemia is an adverse effect of furosemide.
B. Nitroglycerin
Rationale: A potassium level of 2.4 mEq/L is not an adverse effect of nitroglycerin. Nitroglycerin is a
vasodilator medication to treat angina.
C. Metoprolol
Rationale: A potassium level of 2.4 mEq/L is not an adverse effect of metoprolol. Metoprolol is a
beta-blocker that slows the heart rate and improves contractility of the heart muscle.
D. Spironolactone
Rationale: Spironolactone is a potassium-sparing diuretic medication; therefore, hyperkalemia is an
adverse effect of this medication.
5. A nurse is caring for a client who is postoperative following an open reduction internal fixation (ORIF) of a femur
fracture. Which of the following parameters should the nurse include in the evaluation of the neurovascular status of
the client's affected extremity? (Select all that apply.)
Page 4
