NUR 201/NUR201 Final Exam V1 | Medical-
Surgical Nursing I Q&A with Rationale |
Fortis College
1. A nurse is caring for a patient with a serum potassium level of 2.8 mEq/L. Which
assessment finding should the nurse prioritize?
A. Increased bowel sounds
B. Tachycardia
C. Hyperreflexia
D. Cardiac dysrhythmias
Correct Answer: D
Expert Explanation: Hypokalemia significantly affects cardiac electrical conduction,
potentially leading to life-threatening dysrhythmias such as ventricular fibrillation. The
nurse must prioritize cardiac monitoring to ensure early detection of these rhythm
changes. Other signs like muscle weakness and decreased bowel sounds are also common,
but cardiac instability is the most critical concern.
2. A patient is scheduled for elective surgery. Who is legally responsible for obtaining the
patient’s informed consent?
A. The surgeon
B. The surgical technician
,C. The registered nurse
D. The anesthesiologist
Correct Answer: A
Expert Explanation: The surgeon is legally responsible for explaining the procedure, risks,
benefits, and alternatives to the patient. The nurse’s role is primarily to witness the
patient’s signature on the form and ensure the patient understands what they are signing.
If the patient expresses confusion or has further questions, the nurse must notify the
surgeon to return and provide more information.
3. Which arterial blood gas (ABG) result is consistent with a patient experiencing metabolic
acidosis?
A. pH 7.48, PaCO2 35, HCO3 30
B. pH 7.50, PaCO2 28, HCO3 22
C. pH 7.30, PaCO2 50, HCO3 26
D. pH 7.32, PaCO2 40, HCO3 18
Correct Answer: D
Expert Explanation: Metabolic acidosis is characterized by a low pH (less than 7.35) and a
low bicarbonate (HCO3) level (less than 22 mEq/L). Option B shows both a low pH and a
low bicarbonate, which fits this clinical picture. In this state, the body may attempt to
compensate by lowering PaCO2 through hyperventilation, but the primary deficit remains
in the bicarbonate level.
, 4. A nurse is teaching a patient with COPD about pursed-lip breathing. What is the primary
purpose of this technique?
A. To strengthen the diaphragm muscle
B. To increase the intake of oxygen
C. To reduce the amount of mucus in the airways
D. To prevent airway collapse during expiration
Correct Answer: D
Expert Explanation: Pursed-lip breathing creates positive pressure in the airways, which
helps keep the bronchioles open during exhalation. This prevents air trapping and allows
the patient to exhale more completely, thereby reducing shortness of breath. It is a key
intervention for patients with obstructive lung diseases like emphysema to manage
dyspnea.
5. A patient with Type 1 Diabetes is found unconscious and clammy. What is the nurse’s first
action?
A. Administer 15g of oral glucose gel
B. Check the patient’s blood glucose level
C. Administer Glucagon IM or Subcutaneously
D. Call the healthcare provider for orders
Correct Answer: C
Surgical Nursing I Q&A with Rationale |
Fortis College
1. A nurse is caring for a patient with a serum potassium level of 2.8 mEq/L. Which
assessment finding should the nurse prioritize?
A. Increased bowel sounds
B. Tachycardia
C. Hyperreflexia
D. Cardiac dysrhythmias
Correct Answer: D
Expert Explanation: Hypokalemia significantly affects cardiac electrical conduction,
potentially leading to life-threatening dysrhythmias such as ventricular fibrillation. The
nurse must prioritize cardiac monitoring to ensure early detection of these rhythm
changes. Other signs like muscle weakness and decreased bowel sounds are also common,
but cardiac instability is the most critical concern.
2. A patient is scheduled for elective surgery. Who is legally responsible for obtaining the
patient’s informed consent?
A. The surgeon
B. The surgical technician
,C. The registered nurse
D. The anesthesiologist
Correct Answer: A
Expert Explanation: The surgeon is legally responsible for explaining the procedure, risks,
benefits, and alternatives to the patient. The nurse’s role is primarily to witness the
patient’s signature on the form and ensure the patient understands what they are signing.
If the patient expresses confusion or has further questions, the nurse must notify the
surgeon to return and provide more information.
3. Which arterial blood gas (ABG) result is consistent with a patient experiencing metabolic
acidosis?
A. pH 7.48, PaCO2 35, HCO3 30
B. pH 7.50, PaCO2 28, HCO3 22
C. pH 7.30, PaCO2 50, HCO3 26
D. pH 7.32, PaCO2 40, HCO3 18
Correct Answer: D
Expert Explanation: Metabolic acidosis is characterized by a low pH (less than 7.35) and a
low bicarbonate (HCO3) level (less than 22 mEq/L). Option B shows both a low pH and a
low bicarbonate, which fits this clinical picture. In this state, the body may attempt to
compensate by lowering PaCO2 through hyperventilation, but the primary deficit remains
in the bicarbonate level.
, 4. A nurse is teaching a patient with COPD about pursed-lip breathing. What is the primary
purpose of this technique?
A. To strengthen the diaphragm muscle
B. To increase the intake of oxygen
C. To reduce the amount of mucus in the airways
D. To prevent airway collapse during expiration
Correct Answer: D
Expert Explanation: Pursed-lip breathing creates positive pressure in the airways, which
helps keep the bronchioles open during exhalation. This prevents air trapping and allows
the patient to exhale more completely, thereby reducing shortness of breath. It is a key
intervention for patients with obstructive lung diseases like emphysema to manage
dyspnea.
5. A patient with Type 1 Diabetes is found unconscious and clammy. What is the nurse’s first
action?
A. Administer 15g of oral glucose gel
B. Check the patient’s blood glucose level
C. Administer Glucagon IM or Subcutaneously
D. Call the healthcare provider for orders
Correct Answer: C
