ADVANCED MEDICAL-SURGICAL
NURSING PRACTICE EXAM QUESTIONS
AND ANSWERS
1. A patient with chronic kidney disease (CKD) presents with a serum potassium level of 7.2
mEq/L and electrocardiogram (ECG) changes including peaked T-waves. Which medication
should the nurse prioritize to protect the heart from arrhythmias?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Regular insulin with Dextrose
D. Furosemide
Answer: B
Conceptual Explanation: Calcium gluconate does not lower potassium but is administered
to stabilize the myocardium and prevent life-threatening arrhythmias in the presence of
severe hyperkalemia.
,2. A client is admitted with suspected Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which laboratory finding is most consistent with this diagnosis?
A. Serum osmolality of 310 mOsm/kg
B. Serum sodium of 128 mEq/L
C. Urine specific gravity of 1.002
D. Hypernatremia
Answer: B
Conceptual Explanation: SIADH involves excessive ADH release, leading to water
retention and dilutional hyponatremia. Serum sodium levels below 135 mEq/L are classic
indicators.
3. The nurse is caring for a patient post-thyroidectomy. The patient reports tingling in the
fingertips and around the mouth. Which assessment should the nurse perform next?
A. Check for Homan’s sign
B. Check for Babinski reflex
C. Monitor for rebound tenderness
D. Assess for Chvostek’s sign
Answer: D
Conceptual Explanation: Hypocalcemia can occur if the parathyroid glands are
accidentally damaged or removed during a thyroidectomy. Chvostek’s sign (facial
, twitching) and Trousseau’s sign are indicators of neuromuscular irritability due to low
calcium.
4. A client with a history of heart failure reports a sudden weight gain of 4 lbs in 2 days and
increased shortness of breath. The nurse notes jugular venous distention (JVD) and peripheral
edema. These findings primarily indicate which condition?
A. Left-sided heart failure
B. Pulmonary embolism
C. Right-sided heart failure
D. Cardiac tamponade
Answer: C
Conceptual Explanation: Right-sided heart failure causes systemic venous congestion,
manifesting as JVD, peripheral edema, and hepatomegaly.
5. Which arterial blood gas (ABG) result is most indicative of a patient in uncompensated
respiratory acidosis?
A. pH 7.30, PaCO2 35, HCO3 18
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.32, PaCO2 50, HCO3 24
D. pH 7.35, PaCO2 48, HCO3 28
Answer: C
NURSING PRACTICE EXAM QUESTIONS
AND ANSWERS
1. A patient with chronic kidney disease (CKD) presents with a serum potassium level of 7.2
mEq/L and electrocardiogram (ECG) changes including peaked T-waves. Which medication
should the nurse prioritize to protect the heart from arrhythmias?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Regular insulin with Dextrose
D. Furosemide
Answer: B
Conceptual Explanation: Calcium gluconate does not lower potassium but is administered
to stabilize the myocardium and prevent life-threatening arrhythmias in the presence of
severe hyperkalemia.
,2. A client is admitted with suspected Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which laboratory finding is most consistent with this diagnosis?
A. Serum osmolality of 310 mOsm/kg
B. Serum sodium of 128 mEq/L
C. Urine specific gravity of 1.002
D. Hypernatremia
Answer: B
Conceptual Explanation: SIADH involves excessive ADH release, leading to water
retention and dilutional hyponatremia. Serum sodium levels below 135 mEq/L are classic
indicators.
3. The nurse is caring for a patient post-thyroidectomy. The patient reports tingling in the
fingertips and around the mouth. Which assessment should the nurse perform next?
A. Check for Homan’s sign
B. Check for Babinski reflex
C. Monitor for rebound tenderness
D. Assess for Chvostek’s sign
Answer: D
Conceptual Explanation: Hypocalcemia can occur if the parathyroid glands are
accidentally damaged or removed during a thyroidectomy. Chvostek’s sign (facial
, twitching) and Trousseau’s sign are indicators of neuromuscular irritability due to low
calcium.
4. A client with a history of heart failure reports a sudden weight gain of 4 lbs in 2 days and
increased shortness of breath. The nurse notes jugular venous distention (JVD) and peripheral
edema. These findings primarily indicate which condition?
A. Left-sided heart failure
B. Pulmonary embolism
C. Right-sided heart failure
D. Cardiac tamponade
Answer: C
Conceptual Explanation: Right-sided heart failure causes systemic venous congestion,
manifesting as JVD, peripheral edema, and hepatomegaly.
5. Which arterial blood gas (ABG) result is most indicative of a patient in uncompensated
respiratory acidosis?
A. pH 7.30, PaCO2 35, HCO3 18
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.32, PaCO2 50, HCO3 24
D. pH 7.35, PaCO2 48, HCO3 28
Answer: C
