NU158 | NU 158 Medical-Surgical Nursing I
Midterm v3 | Questions with Correct Answers and
Expert Explanation for Each Question | Galen
1. A patient’s arterial blood gas (ABG) results are pH 7.25, PaCO2 50 mm Hg, and HCO3
24 mEq/L. How should the nurse interpret these results?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
Correct Answer: C
Expert Explanation: The pH of 7.25 indicates acidosis since it is below the normal
range of 7.35 to 7.45. The PaCO2 is elevated at 50 mm Hg, which is the primary
cause of the low pH in respiratory conditions. Because the bicarbonate level is
within the normal range, this is uncompensated respiratory acidosis.
2. A nurse is assessing a patient with a serum potassium level of 6.2 mEq/L. Which
finding is the priority for the nurse to monitor?
A. Increased bowel sounds
B. Hyperactive deep tendon reflexes
C. Muscle weakness
,D. Cardiac dysrhythmias
Correct Answer: D
Expert Explanation: Hyperkalemia, defined as a potassium level above 5.0 mEq/L,
significantly affects cardiac conduction and can lead to life-threatening arrhythmias.
The nurse must prioritize continuous ECG monitoring to detect changes such as
peaked T waves or widened QRS complexes. While muscle weakness and GI changes
occur, cardiac arrest is the most immediate risk to the patient’s life.
3. Which intravenous solution is considered isotonic and commonly used for fluid
volume replacement?
A. 0.45% Sodium Chloride
B. 0.9% Sodium Chloride
C. 3% Sodium Chloride
D. Dextrose 10% in water
Correct Answer: B
Expert Explanation: 0.9% Sodium Chloride, also known as normal saline, has an
osmolality similar to that of blood plasma. It stays within the intravascular
compartment, making it ideal for treating hypovolemia and hypotension. Other
solutions like 0.45% saline are hypotonic, while 3% saline is hypertonic.
,4. A patient scheduled for surgery is confused about the procedure. What is the most
appropriate action for the nurse to take regarding informed consent?
A. Notify the surgeon that the patient has questions
B. Ask the patient’s spouse to sign the form
C. Explain the risks and benefits to the patient
D. Proceed with the surgery as the form was already signed
Correct Answer: A
Expert Explanation: The nurse’s role in informed consent is to witness the
signature and ensure the patient is competent. It is the surgeon’s legal responsibility
to explain the procedure, risks, and alternatives to the patient. If the patient
expresses confusion or has questions, the nurse must call the surgeon back to
provide further clarification before the procedure begins.
5. What is the primary goal of the ‘Time Out’ procedure in the operating room?
A. To ensure the surgical equipment is sterile
B. To verify the correct patient, site, and procedure
C. To allow the anesthesia provider to prepare
D. To document the start time of the surgery
Correct Answer: B
, Expert Explanation: The ‘Time Out’ is a critical safety step performed immediately
before starting a surgical procedure. All members of the surgical team participate to
verify the identity of the patient and the correct surgical site. This process is
essential for preventing wrong-site, wrong-procedure, and wrong-person surgeries.
6. A nurse is caring for a patient with hypocalcemia. Which clinical manifestation
should the nurse expect to find?
A. Constipation
B. Negative Trousseau’s sign
C. Lethargy
D. Positive Chvostek’s sign
Correct Answer: D
Expert Explanation: Hypocalcemia increases neuromuscular excitability, which can
be assessed via Chvostek’s sign (facial twitching when the facial nerve is tapped).
Trousseau’s sign, a carpal spasm induced by inflating a blood pressure cuff, would
also be positive in these patients. Symptoms like constipation and lethargy are more
commonly associated with hypercalcemia, not hypocalcemia.
7. A patient with a history of COPD is at risk for which acid-base imbalance?
A. Metabolic acidosis
B. Respiratory alkalosis
Midterm v3 | Questions with Correct Answers and
Expert Explanation for Each Question | Galen
1. A patient’s arterial blood gas (ABG) results are pH 7.25, PaCO2 50 mm Hg, and HCO3
24 mEq/L. How should the nurse interpret these results?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
Correct Answer: C
Expert Explanation: The pH of 7.25 indicates acidosis since it is below the normal
range of 7.35 to 7.45. The PaCO2 is elevated at 50 mm Hg, which is the primary
cause of the low pH in respiratory conditions. Because the bicarbonate level is
within the normal range, this is uncompensated respiratory acidosis.
2. A nurse is assessing a patient with a serum potassium level of 6.2 mEq/L. Which
finding is the priority for the nurse to monitor?
A. Increased bowel sounds
B. Hyperactive deep tendon reflexes
C. Muscle weakness
,D. Cardiac dysrhythmias
Correct Answer: D
Expert Explanation: Hyperkalemia, defined as a potassium level above 5.0 mEq/L,
significantly affects cardiac conduction and can lead to life-threatening arrhythmias.
The nurse must prioritize continuous ECG monitoring to detect changes such as
peaked T waves or widened QRS complexes. While muscle weakness and GI changes
occur, cardiac arrest is the most immediate risk to the patient’s life.
3. Which intravenous solution is considered isotonic and commonly used for fluid
volume replacement?
A. 0.45% Sodium Chloride
B. 0.9% Sodium Chloride
C. 3% Sodium Chloride
D. Dextrose 10% in water
Correct Answer: B
Expert Explanation: 0.9% Sodium Chloride, also known as normal saline, has an
osmolality similar to that of blood plasma. It stays within the intravascular
compartment, making it ideal for treating hypovolemia and hypotension. Other
solutions like 0.45% saline are hypotonic, while 3% saline is hypertonic.
,4. A patient scheduled for surgery is confused about the procedure. What is the most
appropriate action for the nurse to take regarding informed consent?
A. Notify the surgeon that the patient has questions
B. Ask the patient’s spouse to sign the form
C. Explain the risks and benefits to the patient
D. Proceed with the surgery as the form was already signed
Correct Answer: A
Expert Explanation: The nurse’s role in informed consent is to witness the
signature and ensure the patient is competent. It is the surgeon’s legal responsibility
to explain the procedure, risks, and alternatives to the patient. If the patient
expresses confusion or has questions, the nurse must call the surgeon back to
provide further clarification before the procedure begins.
5. What is the primary goal of the ‘Time Out’ procedure in the operating room?
A. To ensure the surgical equipment is sterile
B. To verify the correct patient, site, and procedure
C. To allow the anesthesia provider to prepare
D. To document the start time of the surgery
Correct Answer: B
, Expert Explanation: The ‘Time Out’ is a critical safety step performed immediately
before starting a surgical procedure. All members of the surgical team participate to
verify the identity of the patient and the correct surgical site. This process is
essential for preventing wrong-site, wrong-procedure, and wrong-person surgeries.
6. A nurse is caring for a patient with hypocalcemia. Which clinical manifestation
should the nurse expect to find?
A. Constipation
B. Negative Trousseau’s sign
C. Lethargy
D. Positive Chvostek’s sign
Correct Answer: D
Expert Explanation: Hypocalcemia increases neuromuscular excitability, which can
be assessed via Chvostek’s sign (facial twitching when the facial nerve is tapped).
Trousseau’s sign, a carpal spasm induced by inflating a blood pressure cuff, would
also be positive in these patients. Symptoms like constipation and lethargy are more
commonly associated with hypercalcemia, not hypocalcemia.
7. A patient with a history of COPD is at risk for which acid-base imbalance?
A. Metabolic acidosis
B. Respiratory alkalosis
