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NUR 2291 NUR2291 Advanced Concepts of
Medical-Surgical Nursing Exam Prep| Questions
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- A patient with chronic kidney disease is scheduled for hemodialysis. Which finding indicates the need to hold dialysis treatment? A) Blood pressure 140/90 mmHg B) Weight gain of 1 kg since last session C) Active infection at the vascular access site D) Mild fatigue before dialysis Active infection at the access site increases risk for sepsis during dialysis, so treatment should be held until infection is treated.
- Which electrolyte imbalance is most commonly associated with diabetic ketoacidosis (DKA)? A) Hypercalcemia B) Hypernatremia C) Hyperkalemia D) Hypomagnesemia
DKA leads to potassium shifts from intracellular to extracellular space, causing hyperkalemia despite total body potassium depletion.
- A nurse is caring for a patient with acute respiratory distress syndrome (ARDS). Which is the priority intervention? A) Administering diuretics B) Encouraging deep breathing exercises C) Maintaining adequate oxygenation and ventilation D) Monitoring urine output The priority in ARDS is to maintain oxygenation and ventilation to prevent hypoxia and organ failure.
- A patient with heart failure is prescribed furosemide. What should the nurse monitor closely? A) Blood glucose B) Serum sodium C) Serum potassium D) Liver function Furosemide is a loop diuretic that causes potassium loss, increasing risk of hypokalemia, which can cause cardiac arrhythmias.
- Which sign is an early indicator of increased intracranial pressure (ICP)? A) Bradycardia
- What is the most important teaching point for a patient with asthma about their inhaled corticosteroid? A) Use only when having symptoms B) Take with food C) Use daily for prevention even when asymptomatic D) Rinse mouth before use Inhaled corticosteroids must be used regularly to control inflammation and prevent asthma attacks, not just for acute relief.
- A patient presents with signs of hypovolemic shock. Which intervention should the nurse implement first? A) Administer vasopressors B) Initiate IV fluid resuscitation C) Obtain arterial blood gas D) Prepare for intubation The first priority in hypovolemic shock is restoring circulating volume with IV fluids. 10.Which acid-base imbalance is expected in a patient with chronic obstructive pulmonary disease (COPD)? A) Respiratory alkalosis B) Metabolic alkalosis
C) Respiratory acidosis D) Metabolic acidosis COPD causes CO2 retention leading to respiratory acidosis due to impaired ventilation. 11.What is the primary goal of treatment for a patient with sepsis? A) Reduce fever B) Early identification and aggressive antibiotic therapy C) Maintain strict bed rest D) Restrict fluid intake Early recognition and rapid administration of antibiotics reduces mortality in sepsis. 12.A patient with pancreatitis complains of severe abdominal pain radiating to the back. What is the best nursing action? A) Administer opioid analgesics as prescribed B) Apply heat to the abdomen C) Encourage oral intake D) Place patient in supine position Pain from pancreatitis is severe and opioid analgesics are necessary; heat and oral intake may worsen symptoms.
Cor pulmonale is right-sided heart failure due to lung disease, presenting with jugular venous distention and edema. 16.What is the most common cause of acute pancreatitis? A) Viral infection B) Hyperlipidemia C) Gallstones and alcohol abuse D) Trauma Gallstones blocking the pancreatic duct and alcohol abuse are the leading causes of acute pancreatitis. 17.A patient with ulcerative colitis is experiencing a severe exacerbation. What is the priority nursing intervention? A) Encourage high fiber diet B) Monitor for dehydration and electrolyte imbalance C) Administer laxatives D) Provide bowel rest and initiate IV fluids Severe UC exacerbations require bowel rest and fluid replacement to prevent complications. 18.Which electrolyte imbalance is a concern in patients with Addison’s disease? A) Hypernatremia
B) Hypokalemia C) Hyponatremia and hyperkalemia D) Hypercalcemia Addison’s disease causes aldosterone deficiency, resulting in sodium loss and potassium retention. 19.A patient with chronic liver failure develops hepatic encephalopathy. Which nursing action is appropriate? A) Restrict protein intake B) Administer lactulose as prescribed C) Monitor for hypoglycemia D) All of the above Managing encephalopathy includes protein restriction, lactulose to reduce ammonia, and monitoring blood sugar. 20.Which medication is used to treat hyperthyroidism? A) Levothyroxine B) Methimazole C) Prednisone D) Radioactive iodine Methimazole inhibits thyroid hormone synthesis and is a primary treatment for hyperthyroidism.
IV benzodiazepines are the first-line treatment for rapid seizure control in status epilepticus. 24.Which clinical manifestation is consistent with a diagnosis of hypothyroidism? A) Weight loss B) Heat intolerance C) Bradycardia and cold intolerance D) Diarrhea Hypothyroidism slows metabolism causing cold intolerance, bradycardia, and weight gain. 25.What is the priority nursing intervention for a patient with a chest tube following thoracic surgery? A) Encourage coughing and deep breathing B) Maintain suction and monitor for air leaks C) Ensure chest tube drainage system is below chest level D) Change the dressing daily Keeping the drainage system below chest level prevents backflow of fluid into the pleural space. 26.Which lab value indicates effective treatment in a patient with chronic anemia?
A) Elevated white blood cell count B) Increased hemoglobin and hematocrit levels C) Decreased platelet count D) Elevated blood glucose Hemoglobin and hematocrit are direct measures of anemia improvement. 27.A patient with COPD is receiving oxygen therapy. What is the safest oxygen delivery method? A) Non-rebreather mask at 15 L/min B) Nasal cannula at 2 L/min C) Venturi mask at 60% D) Face tent at 10 L/min Low flow oxygen ( 1 - 2 L/min) via nasal cannula is safer in COPD patients to avoid suppressing hypoxic drive. 28.Which clinical sign is indicative of a pulmonary embolism? A) Bradycardia B) Lower leg swelling C) Sudden onset dyspnea and pleuritic chest pain D) Abdominal distention Sudden shortness of breath with chest pain is classic for pulmonary embolism.
32.A patient with pneumonia is at risk for respiratory acidosis. Which arterial blood gas finding confirms this? A) pH 7.45, PaCO2 35 mmHg B) pH 7.50, PaCO2 30 mmHg C) pH 7.30, PaCO2 55 mmHg D) pH 7.50, PaCO2 20 mmHg Low pH with elevated PaCO2 indicates respiratory acidosis. 33.Which symptom is most characteristic of hyperglycemia? A) Diaphoresis B) Tremors C) Polyuria and polydipsia D) Confusion High blood glucose causes excessive urination and thirst as the body attempts to excrete glucose. 34.A patient with anemia is prescribed iron supplements. What is the best teaching point? A) Take with milk B) Take on an empty stomach with vitamin C C) Expect dark stools D) Avoid vitamin C intake
Iron can cause dark stools; taking it with vitamin C improves absorption, but milk inhibits it. 35.Which is the best indicator of nutritional status in a hospitalized patient? A) Serum glucose B) Serum sodium C) Serum albumin D) Blood urea nitrogen Serum albumin reflects protein status and is commonly used to assess nutrition. 36.Which assessment finding suggests worsening heart failure? A) Clear lung sounds B) Weight loss C) Increased peripheral edema and dyspnea D) Bradycardia Fluid retention causes edema and worsening shortness of breath in heart failure. 37.A patient with an ileostomy reports skin irritation around the stoma. What is the best nursing action? A) Apply steroid cream B) Change the pouch less frequently C) Ensure proper pouch fit and clean skin thoroughly D) Use alcohol to clean the area
B) Anxiety C) Myasthenic crisis due to insufficient medication D) Infection Myasthenic crisis results from inadequate anticholinesterase medication leading to muscle weakness. 41.Which clinical manifestation is common in patients with hypothyroidism? A) Diarrhea B) Constipation C) Heat intolerance D) Tachycardia Hypothyroidism slows metabolism causing constipation and cold intolerance. 42.What is the primary nursing focus for a patient with acute pancreatitis? A) Encouraging oral intake B) Administering laxatives C) Pain management and fluid balance D) Monitoring for hyperglycemia Pain control and fluid/electrolyte management are priorities in acute pancreatitis care. 43.A patient with a history of asthma develops sudden wheezing and respiratory distress. Which medication should be administered first?
A) Oral corticosteroids B) Leukotriene modifiers C) Short-acting beta-agonist inhaler (albuterol) D) Long-acting beta-agonist inhaler Short-acting beta-agonists provide rapid bronchodilation during acute asthma exacerbations. 44.Which of the following is a contraindication for MRI? A) Pacemaker B) Metal implants C) Both A and B D) History of claustrophobia MRI is contraindicated in patients with pacemakers or certain metal implants due to magnetic interference. 45.What is the most appropriate nursing action for a patient with a suspected stroke? A) Administer aspirin immediately B) Place patient in Trendelenburg position C) Perform a rapid neurological assessment and notify the provider D) Encourage oral fluids Rapid neuro assessment and prompt notification are critical to stroke management.
Hypokalemia increases digoxin toxicity risk, so both potassium and digoxin levels must be monitored. 49.Which is an early sign of hypoxia? A) Cyanosis B) Bradycardia C) Restlessness and agitation D) Hypotension Restlessness and agitation are early neurological signs of low oxygen levels. 50.What is the primary purpose of a pulmonary artery catheter? A) Measure blood glucose B) Assess cardiac output and hemodynamic status C) Deliver medications D) Monitor intracranial pressure Pulmonary artery catheters provide direct measurement of cardiac function and pressures. 51.Which of the following is a priority nursing action when caring for a patient with a chest tube? A) Clamp the chest tube frequently B) Strip the tubing to remove clots
C) Monitor for continuous bubbling in the water seal chamber D) Keep the drainage system above the chest level Continuous bubbling in the water seal chamber may indicate an air leak that requires immediate attention to prevent pneumothorax. 52.A patient with cirrhosis has ascites and is receiving spironolactone. What electrolyte imbalance is the nurse most concerned about? A) Hypokalemia B) Hypernatremia C) Hyperkalemia D) Hypocalcemia Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, especially in patients with impaired renal function. 53.Which clinical sign is typical of superior vena cava (SVC) syndrome? A) Lower extremity edema B) Facial swelling and distended neck veins C) Abdominal pain D) Bradycardia SVC syndrome results from obstruction of venous return causing swelling of the face, neck, and upper extremities.
