NU189 | NU 189 Medical-Surgical Nursing II Final
Exam v3 | Questions with Correct Answers and
Expert Explanation for Each Question | Galen
1. A patient arrives at the emergency department with suspected myocardial
infarction (MI). Which intervention should the nurse perform first?
A. Administer morphine for pain relief.
B. Apply supplemental oxygen via nasal cannula.
C. Administer 325 mg of aspirin.
D. Obtain a 12-lead electrocardiogram (ECG).
Correct Answer: D
Expert Explanation: A 12-lead ECG is the gold standard for diagnosing a
myocardial infarction and should be completed within 10 minutes of arrival. Early
identification of ST-segment elevation allows for rapid initiation of reperfusion
therapy. Other treatments like aspirin and morphine are important but follow the
diagnostic confirmation and assessment of cardiac rhythm.
2. A patient with Chronic Obstructive Pulmonary Disease (COPD) has the following
ABG results: pH 7.32, PaCO2 55, HCO3 28. How should the nurse interpret these
findings?
A. Respiratory Alkalosis, fully compensated
,B. Metabolic Alkalosis, uncompensated
C. Respiratory Acidosis, partially compensated
D. Metabolic Acidosis, partially compensated
Correct Answer: C
Expert Explanation: The pH is below 7.35, indicating acidosis, while the PaCO2 is
elevated above 45, indicating a respiratory cause. The HCO3 is elevated above 26,
which shows the kidneys are attempting to compensate for the acidic environment.
Because the pH is not yet within the normal range, it is considered partially
compensated respiratory acidosis.
3. Which clinical manifestation is most indicative of right-sided heart failure?
A. Crackles in the lungs
B. Orthopnea and paroxysmal nocturnal dyspnea
C. Jugular venous distention (JVD)
D. Pink, frothy sputum
Correct Answer: C
Expert Explanation: Right-sided heart failure causes blood to back up into the
systemic venous circulation. This leads to symptoms such as JVD, peripheral edema,
,and hepatomegaly. Lung-related symptoms like crackles and orthopnea are
characteristic of left-sided heart failure due to pulmonary congestion.
4. A nurse is caring for a patient in the ICU who is developing Septic Shock. Which
hemodynamic change is expected during the early (hyperdynamic) phase?
A. Increased systemic vascular resistance (SVR)
B. Increased cardiac output
C. Decreased cardiac output
D. Bradycardia
Correct Answer: B
Expert Explanation: In the early phase of septic shock, also known as the ‘warm’
phase, the body compensates for vasodilation by increasing heart rate and stroke
volume. This results in an increased cardiac output and a bounding pulse. As the
shock progresses to the cold phase, the cardiac output will eventually drop as the
heart fails.
5. A patient is admitted with Diabetic Ketoacidosis (DKA). Which IV fluid should the
nurse anticipate hanging first?
A. D5W with 20 mEq KCl
B. 0.45% Normal Saline
, C. 0.9% Normal Saline
D. Dextrose 5% in 0.9% Normal Saline
Correct Answer: C
Expert Explanation: The initial priority in DKA is to restore extracellular fluid
volume and maintain perfusion to vital organs. Isotonic saline (0.9% NaCl) is used to
correct dehydration and hypotension. Once blood glucose levels drop to
approximately 250 mg/dL, dextrose-containing fluids are added to prevent
hypoglycemia and cerebral edema.
6. Which of the following is the priority assessment for a patient immediately
following a thyroidectomy?
A. Assessing for airway patency and respiratory distress
B. Assessing the patient’s voice for hoarseness
C. Checking the back of the neck for bleeding
D. Monitoring for Chvostek’s sign
Correct Answer: A
Expert Explanation: Post-thyroidectomy patients are at risk for airway obstruction
due to edema or hematoma formation. Maintaining a patent airway is always the
Exam v3 | Questions with Correct Answers and
Expert Explanation for Each Question | Galen
1. A patient arrives at the emergency department with suspected myocardial
infarction (MI). Which intervention should the nurse perform first?
A. Administer morphine for pain relief.
B. Apply supplemental oxygen via nasal cannula.
C. Administer 325 mg of aspirin.
D. Obtain a 12-lead electrocardiogram (ECG).
Correct Answer: D
Expert Explanation: A 12-lead ECG is the gold standard for diagnosing a
myocardial infarction and should be completed within 10 minutes of arrival. Early
identification of ST-segment elevation allows for rapid initiation of reperfusion
therapy. Other treatments like aspirin and morphine are important but follow the
diagnostic confirmation and assessment of cardiac rhythm.
2. A patient with Chronic Obstructive Pulmonary Disease (COPD) has the following
ABG results: pH 7.32, PaCO2 55, HCO3 28. How should the nurse interpret these
findings?
A. Respiratory Alkalosis, fully compensated
,B. Metabolic Alkalosis, uncompensated
C. Respiratory Acidosis, partially compensated
D. Metabolic Acidosis, partially compensated
Correct Answer: C
Expert Explanation: The pH is below 7.35, indicating acidosis, while the PaCO2 is
elevated above 45, indicating a respiratory cause. The HCO3 is elevated above 26,
which shows the kidneys are attempting to compensate for the acidic environment.
Because the pH is not yet within the normal range, it is considered partially
compensated respiratory acidosis.
3. Which clinical manifestation is most indicative of right-sided heart failure?
A. Crackles in the lungs
B. Orthopnea and paroxysmal nocturnal dyspnea
C. Jugular venous distention (JVD)
D. Pink, frothy sputum
Correct Answer: C
Expert Explanation: Right-sided heart failure causes blood to back up into the
systemic venous circulation. This leads to symptoms such as JVD, peripheral edema,
,and hepatomegaly. Lung-related symptoms like crackles and orthopnea are
characteristic of left-sided heart failure due to pulmonary congestion.
4. A nurse is caring for a patient in the ICU who is developing Septic Shock. Which
hemodynamic change is expected during the early (hyperdynamic) phase?
A. Increased systemic vascular resistance (SVR)
B. Increased cardiac output
C. Decreased cardiac output
D. Bradycardia
Correct Answer: B
Expert Explanation: In the early phase of septic shock, also known as the ‘warm’
phase, the body compensates for vasodilation by increasing heart rate and stroke
volume. This results in an increased cardiac output and a bounding pulse. As the
shock progresses to the cold phase, the cardiac output will eventually drop as the
heart fails.
5. A patient is admitted with Diabetic Ketoacidosis (DKA). Which IV fluid should the
nurse anticipate hanging first?
A. D5W with 20 mEq KCl
B. 0.45% Normal Saline
, C. 0.9% Normal Saline
D. Dextrose 5% in 0.9% Normal Saline
Correct Answer: C
Expert Explanation: The initial priority in DKA is to restore extracellular fluid
volume and maintain perfusion to vital organs. Isotonic saline (0.9% NaCl) is used to
correct dehydration and hypotension. Once blood glucose levels drop to
approximately 250 mg/dL, dextrose-containing fluids are added to prevent
hypoglycemia and cerebral edema.
6. Which of the following is the priority assessment for a patient immediately
following a thyroidectomy?
A. Assessing for airway patency and respiratory distress
B. Assessing the patient’s voice for hoarseness
C. Checking the back of the neck for bleeding
D. Monitoring for Chvostek’s sign
Correct Answer: A
Expert Explanation: Post-thyroidectomy patients are at risk for airway obstruction
due to edema or hematoma formation. Maintaining a patent airway is always the
