NU189 | NU 189 Medical-Surgical Nursing II
Midterm v3 | Questions with Correct Answers and
Expert Explanation for Each Question | Galen
1. A patient is admitted with a diagnosis of Acute Respiratory Distress Syndrome
(ARDS). Which clinical manifestation should the nurse expect to find during the early
stages?
A. Severe metabolic acidosis
B. Rapid onset of dyspnea and tachypnea
C. Rapid onset of hypercapnia
D. Intercostal retractions and crackles
Correct Answer: B
Expert Explanation: Early ARDS is characterized by rapid onset of dyspnea and
tachypnea due to initial lung injury. Although oxygen levels are dropping, the
patient often maintains a normal or low CO2 initially. Crackles and severe acidosis
are typically seen as the condition progresses into later stages.
2. The nurse is caring for a patient with a chest tube following a thoracotomy. What
should the nurse do if the chest tube becomes disconnected from the drainage
system?
A. Immediately clamp the chest tube with a hemostat
,B. Submerge the end of the tube in sterile water
C. Cover the site with an occlusive dressing
D. Instruct the patient to perform the Valsalva maneuver
Correct Answer: B
Expert Explanation: Placing the end of the disconnected tube in sterile water
creates an emergency water seal to prevent air from entering the pleural space.
Clamping is generally avoided as it can cause a tension pneumothorax. The nurse
should then prepare a new drainage system for connection.
3. A patient is scheduled for a coronary artery bypass graft (CABG). Which medication
should the nurse expect to hold several days before the surgery?
A. Metoprolol
B. Lisinopril
C. Clopidogrel
D. Atorvastatin
Correct Answer: C
Expert Explanation: Clopidogrel is an antiplatelet agent that significantly increases
the risk of postoperative bleeding. It is typically held 5 to 7 days before elective
,major surgeries like a CABG. Beta-blockers and statins are often continued to
maintain cardiac stability.
4. Which assessment finding in a patient with a diagnosis of SIADH (Syndrome of
Inappropriate Antidiuretic Hormone) requires immediate intervention?
A. Weight gain of 1 kg in 24 hours
B. Urine specific gravity of 1.030
C. Complaints of thirst
D. Serum sodium level of 120 mEq/L
Correct Answer: D
Expert Explanation: A serum sodium level of 120 mEq/L indicates severe
hyponatremia, which puts the patient at high risk for seizures and cerebral edema.
The nurse must prioritize safety measures and notify the physician for hypertonic
saline administration. Other findings like high specific gravity and weight gain are
expected with SIADH but are not as acutely life-threatening.
5. The nurse is monitoring a patient receiving a blood transfusion. Within 15 minutes,
the patient develops fever, chills, and low back pain. What is the priority nursing
action?
A. Slow the infusion rate and notify the doctor
, B. Administer diphenhydramine as ordered
C. Obtain a urine specimen to check for hemoglobinuria
D. Stop the transfusion and disconnect the tubing
Correct Answer: D
Expert Explanation: These symptoms suggest an acute hemolytic reaction, which is
a medical emergency. The nurse must stop the transfusion immediately and
disconnect the tubing at the hub to prevent any more donor blood from entering the
patient. After stopping the blood, the nurse should maintain the IV line with normal
saline and notify the provider.
6. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8
mEq/L. Which medication should the nurse prepare to administer to protect the heart
from dysrhythmias?
A. Sodium polystyrene sulfonate
B. Regular insulin and glucose
C. Calcium gluconate
D. Furosemide
Correct Answer: C
Midterm v3 | Questions with Correct Answers and
Expert Explanation for Each Question | Galen
1. A patient is admitted with a diagnosis of Acute Respiratory Distress Syndrome
(ARDS). Which clinical manifestation should the nurse expect to find during the early
stages?
A. Severe metabolic acidosis
B. Rapid onset of dyspnea and tachypnea
C. Rapid onset of hypercapnia
D. Intercostal retractions and crackles
Correct Answer: B
Expert Explanation: Early ARDS is characterized by rapid onset of dyspnea and
tachypnea due to initial lung injury. Although oxygen levels are dropping, the
patient often maintains a normal or low CO2 initially. Crackles and severe acidosis
are typically seen as the condition progresses into later stages.
2. The nurse is caring for a patient with a chest tube following a thoracotomy. What
should the nurse do if the chest tube becomes disconnected from the drainage
system?
A. Immediately clamp the chest tube with a hemostat
,B. Submerge the end of the tube in sterile water
C. Cover the site with an occlusive dressing
D. Instruct the patient to perform the Valsalva maneuver
Correct Answer: B
Expert Explanation: Placing the end of the disconnected tube in sterile water
creates an emergency water seal to prevent air from entering the pleural space.
Clamping is generally avoided as it can cause a tension pneumothorax. The nurse
should then prepare a new drainage system for connection.
3. A patient is scheduled for a coronary artery bypass graft (CABG). Which medication
should the nurse expect to hold several days before the surgery?
A. Metoprolol
B. Lisinopril
C. Clopidogrel
D. Atorvastatin
Correct Answer: C
Expert Explanation: Clopidogrel is an antiplatelet agent that significantly increases
the risk of postoperative bleeding. It is typically held 5 to 7 days before elective
,major surgeries like a CABG. Beta-blockers and statins are often continued to
maintain cardiac stability.
4. Which assessment finding in a patient with a diagnosis of SIADH (Syndrome of
Inappropriate Antidiuretic Hormone) requires immediate intervention?
A. Weight gain of 1 kg in 24 hours
B. Urine specific gravity of 1.030
C. Complaints of thirst
D. Serum sodium level of 120 mEq/L
Correct Answer: D
Expert Explanation: A serum sodium level of 120 mEq/L indicates severe
hyponatremia, which puts the patient at high risk for seizures and cerebral edema.
The nurse must prioritize safety measures and notify the physician for hypertonic
saline administration. Other findings like high specific gravity and weight gain are
expected with SIADH but are not as acutely life-threatening.
5. The nurse is monitoring a patient receiving a blood transfusion. Within 15 minutes,
the patient develops fever, chills, and low back pain. What is the priority nursing
action?
A. Slow the infusion rate and notify the doctor
, B. Administer diphenhydramine as ordered
C. Obtain a urine specimen to check for hemoglobinuria
D. Stop the transfusion and disconnect the tubing
Correct Answer: D
Expert Explanation: These symptoms suggest an acute hemolytic reaction, which is
a medical emergency. The nurse must stop the transfusion immediately and
disconnect the tubing at the hub to prevent any more donor blood from entering the
patient. After stopping the blood, the nurse should maintain the IV line with normal
saline and notify the provider.
6. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8
mEq/L. Which medication should the nurse prepare to administer to protect the heart
from dysrhythmias?
A. Sodium polystyrene sulfonate
B. Regular insulin and glucose
C. Calcium gluconate
D. Furosemide
Correct Answer: C
