NURS 201 | Medical-Surgical Nursing – Promoting Wellness | Module
Exam 4 (Week 12) 2026 |WCU
1. A nurse is caring for a client with left-sided heart failure. Which assessment
finding should the nurse prioritize as a sign of worsening pulmonary congestion?
A. Crackles auscultated in the lung bases
B. Peripheral edema in the lower extremities
C. Jugular venous distention (JVD)
D. Right upper quadrant tenderness
Answer: A
Rationale: Left-sided heart failure primarily affects the lungs due to backflow from the left
ventricle. Crackles indicate fluid in the alveoli. Options A, C, and D are signs of right-sided
heart failure.
2. A client is diagnosed with Atrial Fibrillation. The nurse understands that the
primary goal of pharmacological therapy with Warfarin is to prevent:
A. Ventricular tachycardia
B. Ventricular hypertrophy
C. Ischemic stroke
D. Myocardial infarction
Answer: C
Rationale: In Atrial Fibrillation, blood pools in the atria, increasing the risk of clot
formation, which can lead to an embolic stroke. Warfarin is an anticoagulant used to
prevent this.
,3. An arterial blood gas (ABG) result shows: pH 7.30, PaCO2 52 mmHg, and
HCO3 26 mEq/L. The nurse interprets this as:
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg indicates a
respiratory cause. Since the bicarbonate is normal, it is uncompensated respiratory
acidosis.
4. A client is 4 hours post-thyroidectomy. The nurse notes muscle twitching and
a positive Chvostek’s sign. Which medication should the nurse prepare to
administer?
A. Potassium Chloride
B. Calcium Gluconate
C. Magnesium Sulfate
D. Sodium Bicarbonate
Answer: B
Rationale: A positive Chvostek’s sign indicates hypocalcemia, a common complication if
the parathyroid glands are damaged during a thyroidectomy. Calcium Gluconate is the
treatment.
5. Which assessment finding is most indicative of a Tension Pneumothorax?
A. Presence of a pleural friction rub
B. Productive cough with rust-colored sputum
C. Decreased heart rate and hypertension
D. Tracheal deviation to the unaffected side
Answer: D
, Rationale: Tension pneumothorax causes increased intrapleural pressure, pushing the
mediastinum and trachea toward the opposite (unaffected) side. This is a medical
emergency.
6. A nurse is educating a client with Type 1 Diabetes about Diabetic Ketoacidosis
(DKA). Which symptom should the nurse include as a hallmark sign?
A. Bradypnea and moist skin
B. Severe peripheral edema and weight gain
C. Fruity breath odor and Kussmaul respirations
D. Hypoglycemia and tremors
Answer: C
Rationale: DKA results in metabolic acidosis; Kussmaul respirations are the body’s
attempt to blow off CO2. Ketones produce a characteristic fruity or acetone breath odor.
7. A client with Chronic Obstructive Pulmonary Disease (COPD) is receiving
oxygen. Why must the nurse exercise caution when increasing the FiO2?
A. Higher levels of oxygen cause metabolic alkalosis
B. High oxygen levels cause rapid pulmonary vasodilation
C. Oxygen is flammable and increases fire risk in hospitals
D. Excessive oxygen can abolish the hypoxic drive to breathe
Answer: D
Rationale: In some COPD patients with chronic CO2 retention, the stimulus to breathe is
low arterial oxygen levels (hypoxic drive). High oxygen delivery can suppress this drive,
leading to respiratory arrest.
Exam 4 (Week 12) 2026 |WCU
1. A nurse is caring for a client with left-sided heart failure. Which assessment
finding should the nurse prioritize as a sign of worsening pulmonary congestion?
A. Crackles auscultated in the lung bases
B. Peripheral edema in the lower extremities
C. Jugular venous distention (JVD)
D. Right upper quadrant tenderness
Answer: A
Rationale: Left-sided heart failure primarily affects the lungs due to backflow from the left
ventricle. Crackles indicate fluid in the alveoli. Options A, C, and D are signs of right-sided
heart failure.
2. A client is diagnosed with Atrial Fibrillation. The nurse understands that the
primary goal of pharmacological therapy with Warfarin is to prevent:
A. Ventricular tachycardia
B. Ventricular hypertrophy
C. Ischemic stroke
D. Myocardial infarction
Answer: C
Rationale: In Atrial Fibrillation, blood pools in the atria, increasing the risk of clot
formation, which can lead to an embolic stroke. Warfarin is an anticoagulant used to
prevent this.
,3. An arterial blood gas (ABG) result shows: pH 7.30, PaCO2 52 mmHg, and
HCO3 26 mEq/L. The nurse interprets this as:
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg indicates a
respiratory cause. Since the bicarbonate is normal, it is uncompensated respiratory
acidosis.
4. A client is 4 hours post-thyroidectomy. The nurse notes muscle twitching and
a positive Chvostek’s sign. Which medication should the nurse prepare to
administer?
A. Potassium Chloride
B. Calcium Gluconate
C. Magnesium Sulfate
D. Sodium Bicarbonate
Answer: B
Rationale: A positive Chvostek’s sign indicates hypocalcemia, a common complication if
the parathyroid glands are damaged during a thyroidectomy. Calcium Gluconate is the
treatment.
5. Which assessment finding is most indicative of a Tension Pneumothorax?
A. Presence of a pleural friction rub
B. Productive cough with rust-colored sputum
C. Decreased heart rate and hypertension
D. Tracheal deviation to the unaffected side
Answer: D
, Rationale: Tension pneumothorax causes increased intrapleural pressure, pushing the
mediastinum and trachea toward the opposite (unaffected) side. This is a medical
emergency.
6. A nurse is educating a client with Type 1 Diabetes about Diabetic Ketoacidosis
(DKA). Which symptom should the nurse include as a hallmark sign?
A. Bradypnea and moist skin
B. Severe peripheral edema and weight gain
C. Fruity breath odor and Kussmaul respirations
D. Hypoglycemia and tremors
Answer: C
Rationale: DKA results in metabolic acidosis; Kussmaul respirations are the body’s
attempt to blow off CO2. Ketones produce a characteristic fruity or acetone breath odor.
7. A client with Chronic Obstructive Pulmonary Disease (COPD) is receiving
oxygen. Why must the nurse exercise caution when increasing the FiO2?
A. Higher levels of oxygen cause metabolic alkalosis
B. High oxygen levels cause rapid pulmonary vasodilation
C. Oxygen is flammable and increases fire risk in hospitals
D. Excessive oxygen can abolish the hypoxic drive to breathe
Answer: D
Rationale: In some COPD patients with chronic CO2 retention, the stimulus to breathe is
low arterial oxygen levels (hypoxic drive). High oxygen delivery can suppress this drive,
leading to respiratory arrest.
