NUR 3345 (Adult Health I/Medical-Surgical)-
Examination With A+ Graded Solution(2026/2027)
1. A 72-year-old client is 48 hours postoperative following an abdominal aortic aneurysm
(AAA) repair. The nurse notes the urine output has dropped to 15 mL/hour for the past
three hours, and the serum creatinine has risen from 1.0 mg/dL to 2.1 mg/dL. Based on the
surgical procedure performed, explain the most likely physiological cause for this decline in
renal function and identify the priority nursing intervention.
Answer: The surgical repair of an AAA involves cross-clamping the aorta to control bleeding
while the graft is placed. If the clamp is positioned above the renal arteries, or if there is
significant hypotension during the procedure, the kidneys suffer from acute hypoperfusion.
This results in Prerenal Acute Kidney Injury (AKI). The drop in urine output (oliguria) and rise
in creatinine are hallmark signs. The nurse must immediately notify the surgeon and the
Rapid Response Team, as the client may require a fluid challenge or vasopressors to restore
renal perfusion and prevent permanent tubular necrosis.
Correct Answer: Prerenal Acute Kidney Injury due to decreased renal perfusion during
aortic cross-clamping.
2. A client with a history of Chronic Obstructive Pulmonary Disease (COPD) is admitted with
an exacerbation. The client is receiving oxygen at 4 L/min via nasal cannula. The nurse
notes the client is becoming increasingly lethargic and difficult to arouse. An Arterial Blood
Gas (ABG) reveals: pH 7.25, PaCO2 68 mmHg, PaO2 58 mmHg, and HCO3 31 mEq/L.
Interpret this ABG and explain the physiological danger of high-flow oxygen therapy in this
specific client.
Answer: The ABG shows Partially Compensated Respiratory Acidosis. In chronic COPD, the
body becomes accustomed to high carbon dioxide levels, and the "hypoxic drive" becomes
the primary stimulus for breathing (breathing because oxygen is low, rather than because
CO2 is high). By providing 4 L/min of oxygen, the nurse may have raised the PaO2 enough to
signal the brain that the drive to breathe is no longer necessary. This leads to
hypoventilation, further CO2 retention (CO2 narcosis), and decreased consciousness. The
nurse should decrease the oxygen to the lowest level needed to maintain a saturation of 88–
92% and notify the provider.
Correct Answer: Partially Compensated Respiratory Acidosis; high-flow oxygen suppresses
the hypoxic drive.
3. A nurse is assessing a client who is 4 hours postoperative from a total thyroidectomy. The
client complains of muscle cramps and a "pins and needles" sensation around the mouth
and in the hands. The nurse observes a carpal spasm when taking the client's blood
pressure. Which electrolyte imbalance is occurring, and which anatomical structure was
likely affected during surgery?
Answer: The client is experiencing Hypocalcemia. The numbness (paresthesia) and the
carpal spasm (Trousseau’s sign) indicate neuromuscular irritability. During a thyroidectomy,
the small parathyroid glands—which regulate calcium via Parathyroid Hormone (PTH)—can
be accidentally damaged or removed. When PTH drops, serum calcium levels plummet. This
is a medical emergency because it can lead to laryngospasm and seizures. The nurse must
have Calcium Gluconate available for immediate IV administration.
Correct Answer: Hypocalcemia caused by accidental damage to the parathyroid glands.
, 4. A client is admitted with a diagnosis of Decompensated Right-Sided Heart Failure. During
the physical assessment, the nurse notes significant jugular vein distention (JVD), a
palpable liver border (hepatomegaly), and 3+ pitting edema in the lower extremities.
Explain the backward-failure pathophysiology that leads to these specific systemic
findings.
Answer: In right-sided heart failure, the right ventricle fails to pump blood effectively into
the pulmonary artery. This causes blood to "back up" into the right atrium and subsequently
into the superior and inferior vena cava. The increased pressure in the venous system forces
fluid into the systemic tissues, causing peripheral edema. The backup into the superior vena
cava causes JVD, while the backup into the inferior vena cava leads to venous congestion in
the liver (hepatomegaly) and the abdominal organs (ascites).
Correct Answer: Backward failure of the right ventricle leading to systemic venous
congestion.
5. A 55-year-old client is being prepared for an elective surgery. During the preoperative
interview, the client mentions that their sibling died unexpectedly from a "fever" during a
previous surgery. What rare but life-threatening intraoperative complication is the client at
risk for, and what is the pathophysiology of this condition?
Answer: The client is at risk for Malignant Hyperthermia (MH), an autosomal dominant
genetic disorder. When exposed to certain anesthetic gases (succinylcholine or volatile
inhalants), the client’s skeletal muscles experience an uncontrolled release of calcium from
the sarcoplasmic reticulum. This leads to a massive hypermetabolic state, muscle rigidity,
rapid rise in body temperature, and metabolic acidosis. The priority is to stop the triggering
agent and administer Dantrolene, which inhibits the calcium release.
Correct Answer: Malignant Hyperthermia; treated with Dantrolene to stop calcium release.
6. A nurse is caring for a client with a Chest Tube that was recently inserted for a
hemothorax. The nurse notes that the drainage has suddenly increased to 250 mL over the
last hour and is bright red. Additionally, the client’s heart rate has increased to 118 bpm
and blood pressure has dropped to 92/54 mmHg. What does this signify, and what is the
nurse's priority action?
Answer: This signifies active hemorrhage and impending hypovolemic shock. Bright red
drainage (sanguineous) exceeding 100–200 mL/hr is a critical finding in postoperative chest
tube patients. The compensatory tachycardia and hypotension indicate that the client is
losing volume faster than the body can compensate. The nurse's priority is to notify the
surgeon immediately, stay with the client to monitor vitals every 15 minutes, and prepare for
fluid resuscitation or a return to the operating room.
Correct Answer: Active hemorrhage; notify the surgeon immediately for drainage >100
mL/hr.
7. A client with a history of Deep Vein Thrombosis (DVT) is receiving a continuous Heparin
infusion. The client’s most recent Activated Partial Thromboplastin Time (aPTT) is 120
seconds (baseline control: 30 seconds). Interpret this value and describe the clinical risks
and the specific pharmacological antagonist required.
Answer: The therapeutic goal for Heparin therapy is usually 1.5 to 2.5 times the control value
(approx. 45–75 seconds). An aPTT of 120 seconds is supratherapeutic, meaning the blood is
taking too long to clot. This puts the client at extreme risk for spontaneous internal bleeding,
such as a cerebral hemorrhage or GI bleed. The nurse should stop the infusion and notify the
provider. The antagonist for Heparin is Protamine Sulfate, which should be kept on hand to
Examination With A+ Graded Solution(2026/2027)
1. A 72-year-old client is 48 hours postoperative following an abdominal aortic aneurysm
(AAA) repair. The nurse notes the urine output has dropped to 15 mL/hour for the past
three hours, and the serum creatinine has risen from 1.0 mg/dL to 2.1 mg/dL. Based on the
surgical procedure performed, explain the most likely physiological cause for this decline in
renal function and identify the priority nursing intervention.
Answer: The surgical repair of an AAA involves cross-clamping the aorta to control bleeding
while the graft is placed. If the clamp is positioned above the renal arteries, or if there is
significant hypotension during the procedure, the kidneys suffer from acute hypoperfusion.
This results in Prerenal Acute Kidney Injury (AKI). The drop in urine output (oliguria) and rise
in creatinine are hallmark signs. The nurse must immediately notify the surgeon and the
Rapid Response Team, as the client may require a fluid challenge or vasopressors to restore
renal perfusion and prevent permanent tubular necrosis.
Correct Answer: Prerenal Acute Kidney Injury due to decreased renal perfusion during
aortic cross-clamping.
2. A client with a history of Chronic Obstructive Pulmonary Disease (COPD) is admitted with
an exacerbation. The client is receiving oxygen at 4 L/min via nasal cannula. The nurse
notes the client is becoming increasingly lethargic and difficult to arouse. An Arterial Blood
Gas (ABG) reveals: pH 7.25, PaCO2 68 mmHg, PaO2 58 mmHg, and HCO3 31 mEq/L.
Interpret this ABG and explain the physiological danger of high-flow oxygen therapy in this
specific client.
Answer: The ABG shows Partially Compensated Respiratory Acidosis. In chronic COPD, the
body becomes accustomed to high carbon dioxide levels, and the "hypoxic drive" becomes
the primary stimulus for breathing (breathing because oxygen is low, rather than because
CO2 is high). By providing 4 L/min of oxygen, the nurse may have raised the PaO2 enough to
signal the brain that the drive to breathe is no longer necessary. This leads to
hypoventilation, further CO2 retention (CO2 narcosis), and decreased consciousness. The
nurse should decrease the oxygen to the lowest level needed to maintain a saturation of 88–
92% and notify the provider.
Correct Answer: Partially Compensated Respiratory Acidosis; high-flow oxygen suppresses
the hypoxic drive.
3. A nurse is assessing a client who is 4 hours postoperative from a total thyroidectomy. The
client complains of muscle cramps and a "pins and needles" sensation around the mouth
and in the hands. The nurse observes a carpal spasm when taking the client's blood
pressure. Which electrolyte imbalance is occurring, and which anatomical structure was
likely affected during surgery?
Answer: The client is experiencing Hypocalcemia. The numbness (paresthesia) and the
carpal spasm (Trousseau’s sign) indicate neuromuscular irritability. During a thyroidectomy,
the small parathyroid glands—which regulate calcium via Parathyroid Hormone (PTH)—can
be accidentally damaged or removed. When PTH drops, serum calcium levels plummet. This
is a medical emergency because it can lead to laryngospasm and seizures. The nurse must
have Calcium Gluconate available for immediate IV administration.
Correct Answer: Hypocalcemia caused by accidental damage to the parathyroid glands.
, 4. A client is admitted with a diagnosis of Decompensated Right-Sided Heart Failure. During
the physical assessment, the nurse notes significant jugular vein distention (JVD), a
palpable liver border (hepatomegaly), and 3+ pitting edema in the lower extremities.
Explain the backward-failure pathophysiology that leads to these specific systemic
findings.
Answer: In right-sided heart failure, the right ventricle fails to pump blood effectively into
the pulmonary artery. This causes blood to "back up" into the right atrium and subsequently
into the superior and inferior vena cava. The increased pressure in the venous system forces
fluid into the systemic tissues, causing peripheral edema. The backup into the superior vena
cava causes JVD, while the backup into the inferior vena cava leads to venous congestion in
the liver (hepatomegaly) and the abdominal organs (ascites).
Correct Answer: Backward failure of the right ventricle leading to systemic venous
congestion.
5. A 55-year-old client is being prepared for an elective surgery. During the preoperative
interview, the client mentions that their sibling died unexpectedly from a "fever" during a
previous surgery. What rare but life-threatening intraoperative complication is the client at
risk for, and what is the pathophysiology of this condition?
Answer: The client is at risk for Malignant Hyperthermia (MH), an autosomal dominant
genetic disorder. When exposed to certain anesthetic gases (succinylcholine or volatile
inhalants), the client’s skeletal muscles experience an uncontrolled release of calcium from
the sarcoplasmic reticulum. This leads to a massive hypermetabolic state, muscle rigidity,
rapid rise in body temperature, and metabolic acidosis. The priority is to stop the triggering
agent and administer Dantrolene, which inhibits the calcium release.
Correct Answer: Malignant Hyperthermia; treated with Dantrolene to stop calcium release.
6. A nurse is caring for a client with a Chest Tube that was recently inserted for a
hemothorax. The nurse notes that the drainage has suddenly increased to 250 mL over the
last hour and is bright red. Additionally, the client’s heart rate has increased to 118 bpm
and blood pressure has dropped to 92/54 mmHg. What does this signify, and what is the
nurse's priority action?
Answer: This signifies active hemorrhage and impending hypovolemic shock. Bright red
drainage (sanguineous) exceeding 100–200 mL/hr is a critical finding in postoperative chest
tube patients. The compensatory tachycardia and hypotension indicate that the client is
losing volume faster than the body can compensate. The nurse's priority is to notify the
surgeon immediately, stay with the client to monitor vitals every 15 minutes, and prepare for
fluid resuscitation or a return to the operating room.
Correct Answer: Active hemorrhage; notify the surgeon immediately for drainage >100
mL/hr.
7. A client with a history of Deep Vein Thrombosis (DVT) is receiving a continuous Heparin
infusion. The client’s most recent Activated Partial Thromboplastin Time (aPTT) is 120
seconds (baseline control: 30 seconds). Interpret this value and describe the clinical risks
and the specific pharmacological antagonist required.
Answer: The therapeutic goal for Heparin therapy is usually 1.5 to 2.5 times the control value
(approx. 45–75 seconds). An aPTT of 120 seconds is supratherapeutic, meaning the blood is
taking too long to clot. This puts the client at extreme risk for spontaneous internal bleeding,
such as a cerebral hemorrhage or GI bleed. The nurse should stop the infusion and notify the
provider. The antagonist for Heparin is Protamine Sulfate, which should be kept on hand to
