NURS 201 Intermediate Med Surg Midterm Exam | Questions
and Answers | 2026 Update | 100% Correct - WCU
1. A patient with heart failure is prescribed furosemide. Which laboratory value requires the most
immediate intervention?
- A) Serum sodium 135 mEq/L
- B) Serum potassium 2.8 mEq/L
- C) Serum chloride 100 mEq/L
- D) Serum magnesium 2.0 mg/dL
Answer: B
Explanation: Furosemide is a loop diuretic that can cause hypokalemia. A potassium of 2.8 mEq/L is
critically low and increases risk for cardiac dysrhythmias.
2. In a patient with chronic obstructive pulmonary disease (COPD), which arterial blood gas (ABG)
finding is expected?
- A) pH 7.38, PaCO2 40, HCO3 24
- B) pH 7.32, PaCO2 58, HCO3 30
- C) pH 7.48, PaCO2 30, HCO3 22
- D) pH 7.36, PaCO2 45, HCO3 26
Answer: B
Explanation: COPD often leads to chronic respiratory acidosis with compensatory metabolic alkalosis. pH
is low (acidosis), PaCO2 is elevated, and HCO3 is increased as compensation.
3. A nurse is caring for a patient after a right total knee arthroplasty. Which intervention is most
important to prevent venous thromboembolism?
- A) Applying sequential compression devices
,- B) Elevating the right leg on two pillows
- C) Administering oral acetaminophen
- D) Restricting fluids to reduce edema
Answer: A
Explanation: Sequential compression devices promote venous return and reduce stasis, preventing deep
vein thrombosis. Elevation helps edema but is not primary for VTE prevention.
4. A diabetic patient with a foot ulcer has redness, warmth, and purulent drainage. What is the priority
action?
- A) Obtain a wound culture before starting antibiotics
- B) Apply dry sterile dressing immediately
- C) Debride the ulcer with a scalpel
- D) Instruct patient to perform foot soaks twice daily
Answer: A
Explanation: Signs of infection require culture to guide antibiotic therapy. Debridement may be needed
but not before culture; soaks are avoided in infected wounds.
5. A patient with pneumonia has increased work of breathing, SpO2 88% on room air. Which oxygen
delivery device provides the most reliable FiO2?
- A) Nasal cannula at 2 L/min
- B) Simple face mask at 6 L/min
- C) Non-rebreather mask at 15 L/min
- D) Venturi mask at 40%
Answer: D
Explanation: Venturi mask delivers precise FiO2 regardless of patient’s respiratory pattern. Non-
rebreather gives high FiO2 but not fixed.
,6. After a stroke, a patient has left-sided neglect. Which nursing intervention is appropriate?
- A) Place all personal items on the right side
- B) Approach the patient from the left side frequently
- C) Encourage the patient to scan the left visual field using cues
- D) Restrain the left arm to prevent injury
Answer: C
Explanation: Scanning training helps compensate for neglect. Placing items on right ignores the deficit;
approaching from left may startle.
7. A patient with cirrhosis develops asterixis. What condition does this indicate?
- A) Portal hypertension
- B) Hepatic encephalopathy
- C) Esophageal varices
- D) Hepatorenal syndrome
Answer: B
Explanation: Asterixis (liver flap) is a sign of hepatic encephalopathy due to ammonia accumulation.
8. Which finding in a patient with a chest tube to water seal indicates an air leak?
- A) Continuous bubbling in the water seal chamber
- B) Tidaling with inspiration and expiration
- C) Serosanguinous drainage 50 mL in 4 hours
- D) Fluctuation of fluid in the tubing
, Answer: A
Explanation: Continuous bubbling suggests an air leak; tidaling is normal. Intermittent bubbling may
occur initially.
9. A patient with pancreatitis reports severe abdominal pain radiating to the back. Which laboratory
finding is most specific?
- A) Elevated white blood cell count
- B) Elevated serum lipase
- C) Elevated blood urea nitrogen
- D) Elevated alanine aminotransferase
Answer: B
Explanation: Lipase is highly specific for pancreatitis; it rises within 4–8 hours and remains elevated
longer than amylase.
10. The nurse assesses a patient with hyperthyroidism. Which finding requires immediate provider
notification?
- A) Heart rate 110 bpm and blood pressure 130/80
- B) Temperature 102.5°F, confusion, and atrial fibrillation
- C) Fine tremor of the hands and weight loss
- D) Exophthalmos and lid lag
Answer: B
Explanation: Fever, confusion, and atrial fibrillation suggest thyroid storm, a life-threatening emergency.
and Answers | 2026 Update | 100% Correct - WCU
1. A patient with heart failure is prescribed furosemide. Which laboratory value requires the most
immediate intervention?
- A) Serum sodium 135 mEq/L
- B) Serum potassium 2.8 mEq/L
- C) Serum chloride 100 mEq/L
- D) Serum magnesium 2.0 mg/dL
Answer: B
Explanation: Furosemide is a loop diuretic that can cause hypokalemia. A potassium of 2.8 mEq/L is
critically low and increases risk for cardiac dysrhythmias.
2. In a patient with chronic obstructive pulmonary disease (COPD), which arterial blood gas (ABG)
finding is expected?
- A) pH 7.38, PaCO2 40, HCO3 24
- B) pH 7.32, PaCO2 58, HCO3 30
- C) pH 7.48, PaCO2 30, HCO3 22
- D) pH 7.36, PaCO2 45, HCO3 26
Answer: B
Explanation: COPD often leads to chronic respiratory acidosis with compensatory metabolic alkalosis. pH
is low (acidosis), PaCO2 is elevated, and HCO3 is increased as compensation.
3. A nurse is caring for a patient after a right total knee arthroplasty. Which intervention is most
important to prevent venous thromboembolism?
- A) Applying sequential compression devices
,- B) Elevating the right leg on two pillows
- C) Administering oral acetaminophen
- D) Restricting fluids to reduce edema
Answer: A
Explanation: Sequential compression devices promote venous return and reduce stasis, preventing deep
vein thrombosis. Elevation helps edema but is not primary for VTE prevention.
4. A diabetic patient with a foot ulcer has redness, warmth, and purulent drainage. What is the priority
action?
- A) Obtain a wound culture before starting antibiotics
- B) Apply dry sterile dressing immediately
- C) Debride the ulcer with a scalpel
- D) Instruct patient to perform foot soaks twice daily
Answer: A
Explanation: Signs of infection require culture to guide antibiotic therapy. Debridement may be needed
but not before culture; soaks are avoided in infected wounds.
5. A patient with pneumonia has increased work of breathing, SpO2 88% on room air. Which oxygen
delivery device provides the most reliable FiO2?
- A) Nasal cannula at 2 L/min
- B) Simple face mask at 6 L/min
- C) Non-rebreather mask at 15 L/min
- D) Venturi mask at 40%
Answer: D
Explanation: Venturi mask delivers precise FiO2 regardless of patient’s respiratory pattern. Non-
rebreather gives high FiO2 but not fixed.
,6. After a stroke, a patient has left-sided neglect. Which nursing intervention is appropriate?
- A) Place all personal items on the right side
- B) Approach the patient from the left side frequently
- C) Encourage the patient to scan the left visual field using cues
- D) Restrain the left arm to prevent injury
Answer: C
Explanation: Scanning training helps compensate for neglect. Placing items on right ignores the deficit;
approaching from left may startle.
7. A patient with cirrhosis develops asterixis. What condition does this indicate?
- A) Portal hypertension
- B) Hepatic encephalopathy
- C) Esophageal varices
- D) Hepatorenal syndrome
Answer: B
Explanation: Asterixis (liver flap) is a sign of hepatic encephalopathy due to ammonia accumulation.
8. Which finding in a patient with a chest tube to water seal indicates an air leak?
- A) Continuous bubbling in the water seal chamber
- B) Tidaling with inspiration and expiration
- C) Serosanguinous drainage 50 mL in 4 hours
- D) Fluctuation of fluid in the tubing
, Answer: A
Explanation: Continuous bubbling suggests an air leak; tidaling is normal. Intermittent bubbling may
occur initially.
9. A patient with pancreatitis reports severe abdominal pain radiating to the back. Which laboratory
finding is most specific?
- A) Elevated white blood cell count
- B) Elevated serum lipase
- C) Elevated blood urea nitrogen
- D) Elevated alanine aminotransferase
Answer: B
Explanation: Lipase is highly specific for pancreatitis; it rises within 4–8 hours and remains elevated
longer than amylase.
10. The nurse assesses a patient with hyperthyroidism. Which finding requires immediate provider
notification?
- A) Heart rate 110 bpm and blood pressure 130/80
- B) Temperature 102.5°F, confusion, and atrial fibrillation
- C) Fine tremor of the hands and weight loss
- D) Exophthalmos and lid lag
Answer: B
Explanation: Fever, confusion, and atrial fibrillation suggest thyroid storm, a life-threatening emergency.
