NURS 201 INTERMEDIATE MED SURG MIDTERM EXAM
2026/2027 WEST COAST UNIVERSITY ACCURATE TEST
APPROVED QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES (VERIFIED SOLUTIONS) LATEST
UPDATED VERSION 2026 EDITION |ALREADY GRADED A+
|BRAND NEW! |WCU
1. A patient with chronic heart failure is prescribed furosemide. Which
assessment finding requires immediate action by the nurse?
A. Serum potassium 3.8 mEq/L
B. Weight loss of 1 kg in 24 hours
C. Blood pressure 100/70 mm Hg
D. Serum potassium 3.0 mEq/L
CORRECT ANSWER: D – A potassium level of 3.0 mEq/L is
hypokalemia, a critical risk for cardiac dysrhythmias, especially with
digoxin use. Furosemide is a loop diuretic that causes potassium
wasting; this level requires immediate replacement and monitoring.
2. A patient with diabetes mellitus type 2 is admitted with
hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which
finding is most consistent with this condition?
A. Kussmaul respirations and fruity breath
B. Serum glucose 800 mg/dL and osmolality 320 mOsm/kg
C. Positive urine ketones and pH 7.28
D. Rapid onset with abdominal pain
,CORRECT ANSWER: B – HHNS is characterized by extreme
hyperglycemia (>600 mg/dL), high osmolality, and absence of
significant ketosis. Option A indicates DKA; option C suggests DKA;
option D is more typical of DKA.
3. The nurse is caring for a patient post-myocardial infarction. Which
laboratory value is most indicative of myocardial necrosis?
A. Creatine kinase-MB (CK-MB) 5% of total CK
B. Troponin I 4.5 ng/mL
C. Myoglobin 70 mcg/L
D. C-reactive protein 2.5 mg/L
CORRECT ANSWER: B – Troponin I is highly specific and sensitive
for myocardial necrosis; normal is <0.04 ng/mL. Elevated troponin
indicates cardiac injury even with minor elevations. CK-MB is less
specific; myoglobin is early but non-specific.
4. A patient with chronic obstructive pulmonary disease (COPD) has a
pulse oximetry reading of 88% on room air. Which action should the
nurse take first?
A. Administer bronchodilator
B. Apply oxygen at 2 L/min via nasal cannula
C. Obtain an arterial blood gas (ABG)
D. Encourage pursed-lip breathing
CORRECT ANSWER: B – Hypoxemia (SpO2 <90%) requires
immediate oxygen therapy to prevent tissue hypoxia. In COPD, titrate
oxygen to maintain 88-92% to avoid suppressing respiratory drive.
Pursed-lip breathing helps but is not the first action.
,5. A patient with acute pancreatitis reports severe abdominal pain
radiating to the back, nausea, and vomiting. Which laboratory finding
supports this diagnosis?
A. Elevated alanine aminotransferase (ALT)
B. Serum lipase 450 U/L
C. Elevated blood urea nitrogen (BUN)
D. Serum amylase 100 U/L
CORRECT ANSWER: B – Lipase is highly specific for pancreatitis;
normal is 0-160 U/L. Amylase also rises but is less specific. ALT
suggests hepatobiliary cause but not diagnostic. Lipase remains elevated
longer.
6. The nurse assesses a patient with cirrhosis who has asterixis. What is
the pathophysiological cause of this finding?
A. Hypokalemia from diuretic use
B. Accumulation of ammonia affecting the basal ganglia
C. Metabolic acidosis from renal failure
D. Cerebral edema from hyponatremia
CORRECT ANSWER: B – Asterixis (liver flap) indicates hepatic
encephalopathy due to ammonia crossing blood-brain barrier, altering
neurotransmission. It is a metabolic tremor. Other options do not cause
asterixis.
7. A patient with heart failure is receiving digoxin. Which finding
indicates digoxin toxicity?
, A. Heart rate 72 bpm and regular
B. Serum digoxin level 2.5 ng/mL and visual halos
C. Blood pressure 130/80 mm Hg
D. Serum potassium 4.2 mEq/L
CORRECT ANSWER: B – Therapeutic digoxin level is 0.5-2.0 ng/mL;
>2.0 is toxic. Visual halos are classic signs of toxicity, along with
nausea, bradycardia, and dysrhythmias.
8. A patient with chronic kidney disease stage 4 has a hemoglobin of 8.2
g/dL. What is the most likely cause?
A. Iron deficiency from poor intake
B. Erythropoietin deficiency
C. Hemolysis from uremia
D. Vitamin B12 malabsorption
CORRECT ANSWER: B – Kidneys produce erythropoietin; in CKD,
decreased erythropoietin leads to normocytic, normochromic anemia.
Iron deficiency may coexist but is not primary.
9. The nurse is teaching a patient with peripheral arterial disease (PAD).
Which instruction is most important?
A. Elevate legs above heart when resting
B. Inspect feet daily for breaks in skin
C. Apply heating pads for pain relief
D. Wear tight compression stockings
2026/2027 WEST COAST UNIVERSITY ACCURATE TEST
APPROVED QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES (VERIFIED SOLUTIONS) LATEST
UPDATED VERSION 2026 EDITION |ALREADY GRADED A+
|BRAND NEW! |WCU
1. A patient with chronic heart failure is prescribed furosemide. Which
assessment finding requires immediate action by the nurse?
A. Serum potassium 3.8 mEq/L
B. Weight loss of 1 kg in 24 hours
C. Blood pressure 100/70 mm Hg
D. Serum potassium 3.0 mEq/L
CORRECT ANSWER: D – A potassium level of 3.0 mEq/L is
hypokalemia, a critical risk for cardiac dysrhythmias, especially with
digoxin use. Furosemide is a loop diuretic that causes potassium
wasting; this level requires immediate replacement and monitoring.
2. A patient with diabetes mellitus type 2 is admitted with
hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which
finding is most consistent with this condition?
A. Kussmaul respirations and fruity breath
B. Serum glucose 800 mg/dL and osmolality 320 mOsm/kg
C. Positive urine ketones and pH 7.28
D. Rapid onset with abdominal pain
,CORRECT ANSWER: B – HHNS is characterized by extreme
hyperglycemia (>600 mg/dL), high osmolality, and absence of
significant ketosis. Option A indicates DKA; option C suggests DKA;
option D is more typical of DKA.
3. The nurse is caring for a patient post-myocardial infarction. Which
laboratory value is most indicative of myocardial necrosis?
A. Creatine kinase-MB (CK-MB) 5% of total CK
B. Troponin I 4.5 ng/mL
C. Myoglobin 70 mcg/L
D. C-reactive protein 2.5 mg/L
CORRECT ANSWER: B – Troponin I is highly specific and sensitive
for myocardial necrosis; normal is <0.04 ng/mL. Elevated troponin
indicates cardiac injury even with minor elevations. CK-MB is less
specific; myoglobin is early but non-specific.
4. A patient with chronic obstructive pulmonary disease (COPD) has a
pulse oximetry reading of 88% on room air. Which action should the
nurse take first?
A. Administer bronchodilator
B. Apply oxygen at 2 L/min via nasal cannula
C. Obtain an arterial blood gas (ABG)
D. Encourage pursed-lip breathing
CORRECT ANSWER: B – Hypoxemia (SpO2 <90%) requires
immediate oxygen therapy to prevent tissue hypoxia. In COPD, titrate
oxygen to maintain 88-92% to avoid suppressing respiratory drive.
Pursed-lip breathing helps but is not the first action.
,5. A patient with acute pancreatitis reports severe abdominal pain
radiating to the back, nausea, and vomiting. Which laboratory finding
supports this diagnosis?
A. Elevated alanine aminotransferase (ALT)
B. Serum lipase 450 U/L
C. Elevated blood urea nitrogen (BUN)
D. Serum amylase 100 U/L
CORRECT ANSWER: B – Lipase is highly specific for pancreatitis;
normal is 0-160 U/L. Amylase also rises but is less specific. ALT
suggests hepatobiliary cause but not diagnostic. Lipase remains elevated
longer.
6. The nurse assesses a patient with cirrhosis who has asterixis. What is
the pathophysiological cause of this finding?
A. Hypokalemia from diuretic use
B. Accumulation of ammonia affecting the basal ganglia
C. Metabolic acidosis from renal failure
D. Cerebral edema from hyponatremia
CORRECT ANSWER: B – Asterixis (liver flap) indicates hepatic
encephalopathy due to ammonia crossing blood-brain barrier, altering
neurotransmission. It is a metabolic tremor. Other options do not cause
asterixis.
7. A patient with heart failure is receiving digoxin. Which finding
indicates digoxin toxicity?
, A. Heart rate 72 bpm and regular
B. Serum digoxin level 2.5 ng/mL and visual halos
C. Blood pressure 130/80 mm Hg
D. Serum potassium 4.2 mEq/L
CORRECT ANSWER: B – Therapeutic digoxin level is 0.5-2.0 ng/mL;
>2.0 is toxic. Visual halos are classic signs of toxicity, along with
nausea, bradycardia, and dysrhythmias.
8. A patient with chronic kidney disease stage 4 has a hemoglobin of 8.2
g/dL. What is the most likely cause?
A. Iron deficiency from poor intake
B. Erythropoietin deficiency
C. Hemolysis from uremia
D. Vitamin B12 malabsorption
CORRECT ANSWER: B – Kidneys produce erythropoietin; in CKD,
decreased erythropoietin leads to normocytic, normochromic anemia.
Iron deficiency may coexist but is not primary.
9. The nurse is teaching a patient with peripheral arterial disease (PAD).
Which instruction is most important?
A. Elevate legs above heart when resting
B. Inspect feet daily for breaks in skin
C. Apply heating pads for pain relief
D. Wear tight compression stockings
