NUR 445 – Exam 1 (Newest 2025) Advanced Med-Surg Practice Questions (100) with Answers & Rationales.

NUR 445 – Exam 1 (Newest 2025) Advanced Med-Surg Practice Questions (100) with Answers & Rationales. 1. A 68-year-old with COPD presents with increased dyspnea and purulent sputum. ABG: pH 7.32, PaCO2 58 mmHg, HCO3- 28 mEq/L. Which interpretation is correct? a. Metabolic acidosis with respiratory compensation b. Acute respiratory alkalosis c. Acute on chronic respiratory acidosis with metabolic compensation d. Normal ABG for COPD Answer: c Rationale: Elevated PaCO2 with low pH and elevated HCO3- suggests respiratory acidosis; since HCO3- is increased (compensation), this fits acute on chronic. 2. A post-op patient has shallow respirations, pinpoint pupils, and decreased responsiveness after opioid PCA. Best immediate action? a. Give naloxone and call rapid response b. Increase oxygen and observe c. Give flumazenil d. Decrease opioid dose and discharge Answer: a Rationale: Signs of opioid overdose require naloxone and urgent intervention. 3. In acute MI, which lab rises first and is most specific for myocardial necrosis? a. CK-MB rises first and is most specific b. Troponin I/T (troponin) — rises early and is most specific c. Myoglobin is specific for MI d. LDH isoenzymes rise first and are specific Answer: b Rationale: Troponin is the most specific and sensitive marker for myocardial injury, rising early. 4. A patient with hyperkalemia (K+ 6.8 mEq/L) and peaked T waves on ECG — immediate priority? a. Administer IV calcium gluconate, insulin with glucose, and stabilize cardiac membrane b. Give oral potassium binder only c. Start IV potassium chloride d. Observe and repeat labs in 6 hours Answer: a Rationale: Severe hyperkalemia with ECG changes is life-threatening; calcium stabilizes myocardium and insulin drives K+ intracellularly. 1 | P a g e 5. Which symptom best differentiates restrictive cardiomyopathy from dilated cardiomyopathy? a. Systolic dysfunction with large ventricular volumes b. Predominant diastolic dysfunction with decreased ventricular compliance and preserved ejection fraction c. Volume overload with low EF only d. Valvular cusp prolapse Answer: b Rationale: Restrictive cardiomyopathy causes diastolic dysfunction due to stiff ventricles, often preserved EF. 6. A patient receives IV gentamicin. Which lab should be monitored closely? a. Serum transaminases weekly b. Peak and trough levels; renal function (creatinine) for nephrotoxicity c. INR daily d. Serum magnesium only Answer: b Rationale: Aminoglycosides are nephrotoxic and ototoxic; monitor renal function and drug levels. 7. A 55-year-old with DKA has K+ 3.2 mEq/L on admission. How does this affect management? a. Start insulin infusion immediately without K+ replacement b. Hold potassium replacement as insulin will cause hyperkalemia c. Replace potassium before starting insulin because insulin shifts K+ intracellularly d. Give sodium bicarbonate first only Answer: c Rationale: Low K+ must be corrected before insulin to avoid severe hypokalemia from intracellular shift. 8. Which finding indicates early increased intracranial pressure (ICP)? a. Bradycardia and hypertension only (Cushing triad is late) b. Subtle changes in level of consciousness and restlessness c. Fixed, dilated pupils immediately d. Decerebrate posturing only (late sign) Answer: b Rationale: Early ICP increase often presents with altered mental status and restlessness before late signs. 9. A patient with acute coronary syndrome is given tPA (alteplase). Contraindication? a. History of controlled hypertension b. Ischemic stroke 3 months ago but no hemorrhage 2 | P a g e c. Active internal bleeding or recent intracranial hemorrhage d. Diabetes mellitus Answer: c Rationale: Active bleeding and recent intracranial hemorrhage are absolute contraindications to thrombolysis. 10. For septic shock, after adequate fluid resuscitation, first-line vasopressor is: a. Norepinephrine b. Dopamine c. Epinephrine first-line always d. Vasopressin only Answer: a Rationale: Norepinephrine is first-line vasopressor for septic shock after fluids. 11. A patient on warfarin presents with INR 9.0 and minor bleeding. Best management? a. Stop warfarin; give oral vitamin K (phytonadione) and consider low-dose IV if needed b. Continue warfarin and repeat INR in a week c. Immediate transfusion of platelets d. Give protamine sulfate Answer: a Rationale: High INR with bleeding — vitamin K reverses warfarin; protamine reverses heparin, not warfarin. 12. A 24-hour urine collection shows creatinine clearance markedly reduced — best bedside interpretation? a. GFR estimate decreased — consider acute kidney injury and review medications and fluid status b. Lab error always c. Only indicates chronic kidney disease d. Always normal in elderly only Answer: a Rationale: Decreased creatinine clearance indicates reduced GFR; assess for AKI causes and medications. 13. An elderly postoperative patient becomes acutely confused with fluctuating consciousness — most likely diagnosis? a. Delirium; identify precipitants (infection, meds, electrolyte imbalance) b. Dementia progression only c. Major depressive disorder d. Normal aging Answer: a Rationale: Acute fluctuating confusion is delirium; reversible causes should be sought.