NUR242/ NUR 242 (New 2025/2026) Medical-Surgical Nursing Exam1 Questions
and Verified Answers| 100% Correct
Question 1
A nurse is caring for a patient who is 24 hours postoperative following a subtotal thyroidectomy.
The patient reports numbness and tingling in the fingers and around the mouth. Which action
should the nurse take first?
A) Check the patient’s blood pressure and heart rate.
B) Administer the prescribed PRN opioid analgesic.
C) Assess for Chvostek’s and Trousseau’s signs.
D) Encourage the patient to use an incentive spirometer.
E) Notify the surgeon to request a STAT serum potassium level.
Correct Answer: C) Assess for Chvostek’s and Trousseau’s signs.
Rationale: During a thyroidectomy, the parathyroid glands can be accidentally damaged or
removed, leading to hypocalcemia. Numbness and tingling (paresthesia) are early signs of
low serum calcium. Assessing for Chvostek's sign (facial twitching when the facial nerve is
tapped) and Trousseau's sign (carpal spasm induced by inflating a blood pressure cuff) are
standard physical assessments to confirm clinical hypocalcemia. While vital signs are
important, the specific neurological symptoms point directly to calcium imbalance, which
can lead to laryngospasm and seizures if not addressed with calcium gluconate.
Question 2
A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is admitted with an
acute exacerbation. The nurse notes the patient is confused and has a respiratory rate of 8
breaths/minute. The most recent Arterial Blood Gas (ABG) shows: pH 7.25, PaCO2 80 mmHg,
and HCO3 26 mEq/L. How should the nurse interpret these findings?
A) Compensated Metabolic Acidosis
B) Uncompensated Respiratory Acidosis
C) Partially Compensated Respiratory Alkalosis
D) Uncompensated Metabolic Alkalosis
E) Compensated Respiratory Acidosis
Correct Answer: B) Uncompensated Respiratory Acidosis
Rationale: The pH is 7.25, which is below the normal range (7.35–7.45), indicating acidosis.
The PaCO2 is 80 mmHg, which is significantly elevated (normal 35–45), indicating a
respiratory cause for the acidosis (the lungs are retaining CO2). The HCO3 (bicarbonate) is
26 mEq/L, which is within the normal range (22–26). Because the bicarbonate has not yet
increased significantly to move the pH back toward normal, the condition is
"uncompensated." This is a medical emergency often seen in end-stage COPD or acute
respiratory failure where the patient's drive to breathe is diminished.
, 2
Question 3
A patient is admitted to the emergency department with a suspected myocardial infarction (MI).
The nurse knows that which cardiac enzyme is the most sensitive and specific indicator of
myocardial injury?
A) Creatine Kinase-MB (CK-MB)
B) Myoglobin
C) Lactate Dehydrogenase (LDH)
D) Troponin I
E) Brain Natriuretic Peptide (BNP)
Correct Answer: D) Troponin I
Rationale: Troponin I is a myocardial muscle protein released into the bloodstream when
there is injury to myocardial cells. It is highly specific to cardiac tissue and remains
elevated for 1 to 2 weeks after an MI, making it the "gold standard" for diagnosis. CK-MB
is also useful but can be elevated by skeletal muscle damage. Myoglobin rises early but
lacks specificity. BNP is used to diagnose heart failure, not acute myocardial infarction.
LDH is an older marker no longer commonly used for acute MI diagnosis due to its lack of
specificity.
Question 4
A nurse is providing discharge teaching to a patient newly diagnosed with Heart Failure (HF)
who will be taking Furosemide and Digoxin. Which instruction is most important to include?
A) "Take your pulse for one full minute and call the provider if it is less than 60."
B) "Increase your intake of leafy green vegetables and high-calcium foods."
C) "You should expect to have a persistent, dry cough while taking these medications."
D) "Decrease your fluid intake to no more than 500 mL per day."
E) "Only take your Furosemide if you notice swelling in your ankles."
Correct Answer: A) "Take your pulse for one full minute and call the provider if it is less
than 60."
Rationale: Digoxin is a cardiac glycoside that increases the force of contraction but slows
the heart rate. A heart rate below 60 bpm can indicate Digoxin toxicity. Furthermore,
Furosemide is a loop diuretic that can cause hypokalemia (low potassium). Low potassium
levels significantly increase the risk of Digoxin toxicity. Patients must be taught to monitor
their heart rate before every dose. Option C refers to ACE inhibitors, not Digoxin. Option
E is incorrect because Furosemide for heart failure must be taken as scheduled to prevent
fluid overload, not just when symptoms appear.
Question 5
A patient with Type 1 Diabetes Mellitus is brought to the ED with a blood glucose of 612 mg/dL,
Kussmaul respirations, and a fruity breath odor. Which IV fluid order should the nurse expect to
, 3
implement first?
A) 5% Dextrose in 0.45% Sodium Chloride
B) 0.9% Sodium Chloride (Normal Saline)
C) 3% Hypertonic Saline
D) Lactated Ringer’s solution
E) 10% Dextrose in Water
Correct Answer: B) 0.9% Sodium Chloride (Normal Saline)
Rationale: The patient is manifesting classic signs of Diabetic Ketoacidosis (DKA). The
priority in DKA management is fluid resuscitation to restore extracellular fluid volume and
improve perfusion to the kidneys. Normal Saline (0.9% NaCl) is the initial fluid of choice.
Once blood glucose levels drop to approximately 250–300 mg/dL, the provider will typically
switch to a dextrose-containing fluid (like D5 1/2 NS) to prevent hypoglycemia and cerebral
edema during the insulin infusion. Hypertonic saline is contraindicated as it would worsen
cellular dehydration.
Question 6
A nurse is caring for a patient with a chest tube placed for a pneumothorax. While assessing the
water-seal chamber, the nurse notes constant, vigorous bubbling. What does this finding most
likely indicate?
A) The pneumothorax is resolving as expected.
B) The suction is turned up too high.
C) There is an air leak in the system.
D) This is a normal finding during the first 24 hours.
E) The chest tube is obstructed by a blood clot.
Correct Answer: C) There is an air leak in the system.
Rationale: In a water-seal drainage system, intermittent bubbling is normal when the
patient coughs or exhales (if the pneumothorax is still present). However, continuous,
vigorous bubbling in the water-seal chamber indicates an air leak between the patient and
the drainage unit. The nurse should check the connections and the insertion site. If the
bubbling was in the suction control chamber, it would be a normal finding indicating the
suction is active. Resolving pneumothorax would show decreased or no bubbling.
Question 7
A patient is diagnosed with Chronic Kidney Disease (CKD) and has a serum potassium level of
6.8 mEq/L. Which cardiac rhythm change is the nurse most likely to observe on the EKG?
A) Prominent U-waves
B) Prolonged QT interval
C) Tall, peaked T-waves
, 4
D) ST-segment depression
E) Shortened PR interval
Correct Answer: C) Tall, peaked T-waves
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) causes specific EKG changes due to its
effect on myocardial repolarization. Tall, peaked T-waves are the earliest sign. As levels rise
further, the nurse may see a widened QRS complex, prolonged PR interval, and eventually
a "sine wave" pattern leading to asystole or ventricular fibrillation. U-waves and ST
depression are associated with hypokalemia (low potassium), not hyperkalemia.
Question 8
A nurse is preparing to administer a tube feeding to a patient via a nasogastric (NG) tube. What is
the most reliable bedside method for confirming the placement of the tube before starting the
feeding?
A) Auscultating a "whoosh" sound over the epigastric area while injecting air.
B) Checking the pH of the aspirated gastric contents.
C) Observing the color of the aspirated fluid.
D) Asking the patient to speak or cough.
E) Placing the end of the tube in a cup of water to check for bubbles.
Correct Answer: B) Checking the pH of the aspirated gastric contents.
Rationale: While a chest X-ray is the "gold standard" for initial placement, checking the
pH of aspirate is the most reliable bedside method. Gastric pH is typically acidic (1 to 5),
whereas respiratory or intestinal pH is usually higher (above 6). Auscultating for air (the
"whoosh" test) is outdated and proven to be unreliable because air in the esophagus or
bronchus can sound remarkably similar to air in the stomach. Bubbles in water can occur
if the tube is in the lungs, but this is also not a definitive or safe primary method.
Question 9
Which of the following clinical manifestations should a nurse expect to find in a patient
diagnosed with Cushing’s Syndrome?
A) Weight loss, hypotension, and hyperkalemia.
B) Extreme fatigue, bronze skin pigmentation, and salt craving.
C) Truncal obesity, "buffalo hump," and thin skin with striae.
D) Exophthalmos, tachycardia, and heat intolerance.
E) Polydipsia, polyuria, and low urine specific gravity.
Correct Answer: C) Truncal obesity, "buffalo hump," and thin skin with striae.
Rationale: Cushing’s Syndrome results from an excess of corticosteroids (particularly
cortisol). Classic signs include a redistribution of fat to the abdomen (truncal obesity), the
cervical spine (buffalo hump), and the face (moon face). High cortisol also leads to protein
wasting, which results in thin, fragile skin, easy bruising, and purple striae (stretch marks)
and Verified Answers| 100% Correct
Question 1
A nurse is caring for a patient who is 24 hours postoperative following a subtotal thyroidectomy.
The patient reports numbness and tingling in the fingers and around the mouth. Which action
should the nurse take first?
A) Check the patient’s blood pressure and heart rate.
B) Administer the prescribed PRN opioid analgesic.
C) Assess for Chvostek’s and Trousseau’s signs.
D) Encourage the patient to use an incentive spirometer.
E) Notify the surgeon to request a STAT serum potassium level.
Correct Answer: C) Assess for Chvostek’s and Trousseau’s signs.
Rationale: During a thyroidectomy, the parathyroid glands can be accidentally damaged or
removed, leading to hypocalcemia. Numbness and tingling (paresthesia) are early signs of
low serum calcium. Assessing for Chvostek's sign (facial twitching when the facial nerve is
tapped) and Trousseau's sign (carpal spasm induced by inflating a blood pressure cuff) are
standard physical assessments to confirm clinical hypocalcemia. While vital signs are
important, the specific neurological symptoms point directly to calcium imbalance, which
can lead to laryngospasm and seizures if not addressed with calcium gluconate.
Question 2
A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is admitted with an
acute exacerbation. The nurse notes the patient is confused and has a respiratory rate of 8
breaths/minute. The most recent Arterial Blood Gas (ABG) shows: pH 7.25, PaCO2 80 mmHg,
and HCO3 26 mEq/L. How should the nurse interpret these findings?
A) Compensated Metabolic Acidosis
B) Uncompensated Respiratory Acidosis
C) Partially Compensated Respiratory Alkalosis
D) Uncompensated Metabolic Alkalosis
E) Compensated Respiratory Acidosis
Correct Answer: B) Uncompensated Respiratory Acidosis
Rationale: The pH is 7.25, which is below the normal range (7.35–7.45), indicating acidosis.
The PaCO2 is 80 mmHg, which is significantly elevated (normal 35–45), indicating a
respiratory cause for the acidosis (the lungs are retaining CO2). The HCO3 (bicarbonate) is
26 mEq/L, which is within the normal range (22–26). Because the bicarbonate has not yet
increased significantly to move the pH back toward normal, the condition is
"uncompensated." This is a medical emergency often seen in end-stage COPD or acute
respiratory failure where the patient's drive to breathe is diminished.
, 2
Question 3
A patient is admitted to the emergency department with a suspected myocardial infarction (MI).
The nurse knows that which cardiac enzyme is the most sensitive and specific indicator of
myocardial injury?
A) Creatine Kinase-MB (CK-MB)
B) Myoglobin
C) Lactate Dehydrogenase (LDH)
D) Troponin I
E) Brain Natriuretic Peptide (BNP)
Correct Answer: D) Troponin I
Rationale: Troponin I is a myocardial muscle protein released into the bloodstream when
there is injury to myocardial cells. It is highly specific to cardiac tissue and remains
elevated for 1 to 2 weeks after an MI, making it the "gold standard" for diagnosis. CK-MB
is also useful but can be elevated by skeletal muscle damage. Myoglobin rises early but
lacks specificity. BNP is used to diagnose heart failure, not acute myocardial infarction.
LDH is an older marker no longer commonly used for acute MI diagnosis due to its lack of
specificity.
Question 4
A nurse is providing discharge teaching to a patient newly diagnosed with Heart Failure (HF)
who will be taking Furosemide and Digoxin. Which instruction is most important to include?
A) "Take your pulse for one full minute and call the provider if it is less than 60."
B) "Increase your intake of leafy green vegetables and high-calcium foods."
C) "You should expect to have a persistent, dry cough while taking these medications."
D) "Decrease your fluid intake to no more than 500 mL per day."
E) "Only take your Furosemide if you notice swelling in your ankles."
Correct Answer: A) "Take your pulse for one full minute and call the provider if it is less
than 60."
Rationale: Digoxin is a cardiac glycoside that increases the force of contraction but slows
the heart rate. A heart rate below 60 bpm can indicate Digoxin toxicity. Furthermore,
Furosemide is a loop diuretic that can cause hypokalemia (low potassium). Low potassium
levels significantly increase the risk of Digoxin toxicity. Patients must be taught to monitor
their heart rate before every dose. Option C refers to ACE inhibitors, not Digoxin. Option
E is incorrect because Furosemide for heart failure must be taken as scheduled to prevent
fluid overload, not just when symptoms appear.
Question 5
A patient with Type 1 Diabetes Mellitus is brought to the ED with a blood glucose of 612 mg/dL,
Kussmaul respirations, and a fruity breath odor. Which IV fluid order should the nurse expect to
, 3
implement first?
A) 5% Dextrose in 0.45% Sodium Chloride
B) 0.9% Sodium Chloride (Normal Saline)
C) 3% Hypertonic Saline
D) Lactated Ringer’s solution
E) 10% Dextrose in Water
Correct Answer: B) 0.9% Sodium Chloride (Normal Saline)
Rationale: The patient is manifesting classic signs of Diabetic Ketoacidosis (DKA). The
priority in DKA management is fluid resuscitation to restore extracellular fluid volume and
improve perfusion to the kidneys. Normal Saline (0.9% NaCl) is the initial fluid of choice.
Once blood glucose levels drop to approximately 250–300 mg/dL, the provider will typically
switch to a dextrose-containing fluid (like D5 1/2 NS) to prevent hypoglycemia and cerebral
edema during the insulin infusion. Hypertonic saline is contraindicated as it would worsen
cellular dehydration.
Question 6
A nurse is caring for a patient with a chest tube placed for a pneumothorax. While assessing the
water-seal chamber, the nurse notes constant, vigorous bubbling. What does this finding most
likely indicate?
A) The pneumothorax is resolving as expected.
B) The suction is turned up too high.
C) There is an air leak in the system.
D) This is a normal finding during the first 24 hours.
E) The chest tube is obstructed by a blood clot.
Correct Answer: C) There is an air leak in the system.
Rationale: In a water-seal drainage system, intermittent bubbling is normal when the
patient coughs or exhales (if the pneumothorax is still present). However, continuous,
vigorous bubbling in the water-seal chamber indicates an air leak between the patient and
the drainage unit. The nurse should check the connections and the insertion site. If the
bubbling was in the suction control chamber, it would be a normal finding indicating the
suction is active. Resolving pneumothorax would show decreased or no bubbling.
Question 7
A patient is diagnosed with Chronic Kidney Disease (CKD) and has a serum potassium level of
6.8 mEq/L. Which cardiac rhythm change is the nurse most likely to observe on the EKG?
A) Prominent U-waves
B) Prolonged QT interval
C) Tall, peaked T-waves
, 4
D) ST-segment depression
E) Shortened PR interval
Correct Answer: C) Tall, peaked T-waves
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) causes specific EKG changes due to its
effect on myocardial repolarization. Tall, peaked T-waves are the earliest sign. As levels rise
further, the nurse may see a widened QRS complex, prolonged PR interval, and eventually
a "sine wave" pattern leading to asystole or ventricular fibrillation. U-waves and ST
depression are associated with hypokalemia (low potassium), not hyperkalemia.
Question 8
A nurse is preparing to administer a tube feeding to a patient via a nasogastric (NG) tube. What is
the most reliable bedside method for confirming the placement of the tube before starting the
feeding?
A) Auscultating a "whoosh" sound over the epigastric area while injecting air.
B) Checking the pH of the aspirated gastric contents.
C) Observing the color of the aspirated fluid.
D) Asking the patient to speak or cough.
E) Placing the end of the tube in a cup of water to check for bubbles.
Correct Answer: B) Checking the pH of the aspirated gastric contents.
Rationale: While a chest X-ray is the "gold standard" for initial placement, checking the
pH of aspirate is the most reliable bedside method. Gastric pH is typically acidic (1 to 5),
whereas respiratory or intestinal pH is usually higher (above 6). Auscultating for air (the
"whoosh" test) is outdated and proven to be unreliable because air in the esophagus or
bronchus can sound remarkably similar to air in the stomach. Bubbles in water can occur
if the tube is in the lungs, but this is also not a definitive or safe primary method.
Question 9
Which of the following clinical manifestations should a nurse expect to find in a patient
diagnosed with Cushing’s Syndrome?
A) Weight loss, hypotension, and hyperkalemia.
B) Extreme fatigue, bronze skin pigmentation, and salt craving.
C) Truncal obesity, "buffalo hump," and thin skin with striae.
D) Exophthalmos, tachycardia, and heat intolerance.
E) Polydipsia, polyuria, and low urine specific gravity.
Correct Answer: C) Truncal obesity, "buffalo hump," and thin skin with striae.
Rationale: Cushing’s Syndrome results from an excess of corticosteroids (particularly
cortisol). Classic signs include a redistribution of fat to the abdomen (truncal obesity), the
cervical spine (buffalo hump), and the face (moon face). High cortisol also leads to protein
wasting, which results in thin, fragile skin, easy bruising, and purple striae (stretch marks)
