NU189 | NU 189 Medical-Surgical Nursing II Final
Exam v1 | Questions with Correct Answers and
Expert Explanation for Each Question | Galen
1. A nurse is assessing a patient with suspected left-sided heart failure. Which finding
should the nurse prioritize?
A. Jugular venous distention
B. Dependent edema
C. Crackles in the lung bases
D. Hepatomegaly
Correct Answer: C
Expert Explanation: Left-sided heart failure causes blood to back up into the
pulmonary circulation, leading to pulmonary congestion. Crackles in the lungs are a
classic sign of fluid accumulation in the alveoli. The other options are symptoms
typically associated with right-sided heart failure.
2. Which arterial blood gas (ABG) result is consistent with a patient experiencing a
severe asthma attack?
A. pH 7.48, PaCO2 30, HCO3 24
B. pH 7.32, PaCO2 52, HCO3 26
C. pH 7.35, PaCO2 40, HCO3 24
,D. pH 7.50, PaCO2 40, HCO3 32
Correct Answer: B
Expert Explanation: A severe asthma attack can lead to respiratory acidosis due to
air trapping and hypoventilation. In this state, the pH drops below 7.35 and the
PaCO2 rises above 45 mmHg. This indicates that the patient is unable to effectively
exhale carbon dioxide.
3. A patient is prescribed Digoxin for heart failure. Which laboratory value should the
nurse monitor most closely to prevent toxicity?
A. Serum sodium
B. Serum glucose
C. Serum calcium
D. Serum potassium
Correct Answer: D
Expert Explanation: Hypokalemia, or low potassium levels, significantly increases
the risk of Digoxin toxicity. Potassium and Digoxin compete for the same binding
sites on the sodium-potassium ATPase pump. The nurse must ensure potassium
levels remain within the normal range of 3.5 to 5.0 mEq/L.
,4. A patient presents with a sudden onset of chest pain and shortness of breath.
Which diagnostic test is most specific for identifying a pulmonary embolism (PE)?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. Complete Blood Count (CBC)
D. Computed Tomography Angiography (CTA)
Correct Answer: D
Expert Explanation: Computed Tomography Angiography (CTA) is considered the
gold standard for diagnosing a pulmonary embolism because it provides a detailed
view of the pulmonary vasculature. A chest X-ray is often normal in patients with PE
and is used primarily to rule out other conditions. An ECG may show signs of right
heart strain but is not definitive for a PE.
5. The nurse is caring for a patient with Chronic Kidney Disease (CKD). What is the
primary reason this patient develops anemia?
A. Increased destruction of red blood cells
B. Chronic blood loss during dialysis
C. Decreased production of erythropoietin
D. Iron deficiency due to poor diet
, Correct Answer: C
Expert Explanation: The kidneys are responsible for producing erythropoietin, a
hormone that stimulates the bone marrow to produce red blood cells. In CKD, the
damaged kidneys produce insufficient amounts of this hormone, leading to
decreased red blood cell production. While other factors may contribute,
erythropoietin deficiency is the primary cause of anemia in these patients.
6. A patient with Type 1 Diabetes arrives at the ER with Kussmaul respirations and a
fruity breath odor. What is the priority nursing intervention?
A. Administering oral glucose
B. Administering rapid-acting insulin intravenously
C. Encouraging the patient to breathe into a paper bag
D. Administering a dose of long-acting glargine insulin
Correct Answer: B
Expert Explanation: The patient is exhibiting signs of Diabetic Ketoacidosis (DKA),
a life-threatening complication characterized by hyperglycemia and acidosis.
Intravenous regular insulin is required to drive glucose into the cells and halt the
production of ketones. Rehydration with IV fluids is also a critical component of
initial DKA management.
Exam v1 | Questions with Correct Answers and
Expert Explanation for Each Question | Galen
1. A nurse is assessing a patient with suspected left-sided heart failure. Which finding
should the nurse prioritize?
A. Jugular venous distention
B. Dependent edema
C. Crackles in the lung bases
D. Hepatomegaly
Correct Answer: C
Expert Explanation: Left-sided heart failure causes blood to back up into the
pulmonary circulation, leading to pulmonary congestion. Crackles in the lungs are a
classic sign of fluid accumulation in the alveoli. The other options are symptoms
typically associated with right-sided heart failure.
2. Which arterial blood gas (ABG) result is consistent with a patient experiencing a
severe asthma attack?
A. pH 7.48, PaCO2 30, HCO3 24
B. pH 7.32, PaCO2 52, HCO3 26
C. pH 7.35, PaCO2 40, HCO3 24
,D. pH 7.50, PaCO2 40, HCO3 32
Correct Answer: B
Expert Explanation: A severe asthma attack can lead to respiratory acidosis due to
air trapping and hypoventilation. In this state, the pH drops below 7.35 and the
PaCO2 rises above 45 mmHg. This indicates that the patient is unable to effectively
exhale carbon dioxide.
3. A patient is prescribed Digoxin for heart failure. Which laboratory value should the
nurse monitor most closely to prevent toxicity?
A. Serum sodium
B. Serum glucose
C. Serum calcium
D. Serum potassium
Correct Answer: D
Expert Explanation: Hypokalemia, or low potassium levels, significantly increases
the risk of Digoxin toxicity. Potassium and Digoxin compete for the same binding
sites on the sodium-potassium ATPase pump. The nurse must ensure potassium
levels remain within the normal range of 3.5 to 5.0 mEq/L.
,4. A patient presents with a sudden onset of chest pain and shortness of breath.
Which diagnostic test is most specific for identifying a pulmonary embolism (PE)?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. Complete Blood Count (CBC)
D. Computed Tomography Angiography (CTA)
Correct Answer: D
Expert Explanation: Computed Tomography Angiography (CTA) is considered the
gold standard for diagnosing a pulmonary embolism because it provides a detailed
view of the pulmonary vasculature. A chest X-ray is often normal in patients with PE
and is used primarily to rule out other conditions. An ECG may show signs of right
heart strain but is not definitive for a PE.
5. The nurse is caring for a patient with Chronic Kidney Disease (CKD). What is the
primary reason this patient develops anemia?
A. Increased destruction of red blood cells
B. Chronic blood loss during dialysis
C. Decreased production of erythropoietin
D. Iron deficiency due to poor diet
, Correct Answer: C
Expert Explanation: The kidneys are responsible for producing erythropoietin, a
hormone that stimulates the bone marrow to produce red blood cells. In CKD, the
damaged kidneys produce insufficient amounts of this hormone, leading to
decreased red blood cell production. While other factors may contribute,
erythropoietin deficiency is the primary cause of anemia in these patients.
6. A patient with Type 1 Diabetes arrives at the ER with Kussmaul respirations and a
fruity breath odor. What is the priority nursing intervention?
A. Administering oral glucose
B. Administering rapid-acting insulin intravenously
C. Encouraging the patient to breathe into a paper bag
D. Administering a dose of long-acting glargine insulin
Correct Answer: B
Expert Explanation: The patient is exhibiting signs of Diabetic Ketoacidosis (DKA),
a life-threatening complication characterized by hyperglycemia and acidosis.
Intravenous regular insulin is required to drive glucose into the cells and halt the
production of ketones. Rehydration with IV fluids is also a critical component of
initial DKA management.
