NUR 209/NUR209 Exam 3 V3 | Medical-
Surgical Nursing II Q&A with Rationale |
Fortis College
1. A patient is admitted with a pH of 7.28, PaCO2 of 50 mmHg, and HCO3 of 24 mEq/L. Which
acid-base imbalance is the patient experiencing?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Correct Answer: A
Expert Explanation: Respiratory acidosis is characterized by a pH below 7.35 and a PaCO2
above 45 mmHg. In this case, the normal bicarbonate level suggests that the body has not
yet compensated for the respiratory failure. The nurse must focus on improving the
patient’s ventilation to blow off excess carbon dioxide.
2. The nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is on
mechanical ventilation. Which setting helps prevent the collapse of alveoli during expiration?
A. Tidal Volume
B. Fraction of Inspired Oxygen (FiO2)
C. Respiratory Rate
,D. Positive End-Expiratory Pressure (PEEP)
Correct Answer: D
Expert Explanation: PEEP maintains pressure in the lungs at the end of expiration to keep
the alveoli open and improve gas exchange. It is a critical setting for patients with ARDS
who suffer from widespread alveolar collapse. However, the nurse must monitor for
complications such as barotrauma or decreased cardiac output.
3. A patient with cirrhosis has developed hepatic encephalopathy. The nurse expects to
administer which medication to reduce ammonia levels?
A. Spironolactone
B. Lactulose
C. Propranolol
D. Furosemide
Correct Answer: B
Expert Explanation: Lactulose works by promoting the excretion of ammonia through the
stool by creating an acidic environment in the bowel. The goal of therapy is to achieve two
to three soft stools per day to effectively lower systemic ammonia. The nurse must monitor
the patient’s potassium levels as frequent diarrhea can lead to electrolyte imbalances.
4. Which clinical manifestation would the nurse expect to find in a patient with a suspected
tension pneumothorax?
A. Hypertension
, B. Bradycardia
C. Tracheal deviation to the affected side
D. Tracheal deviation to the unaffected side
Correct Answer: D
Expert Explanation: A tension pneumothorax causes air to become trapped in the pleural
space, leading to a shift of the mediastinum. This shift results in the trachea being pushed
toward the opposite, unaffected side of the chest. It is a medical emergency that requires
immediate needle decompression followed by chest tube insertion.
5. A patient with chronic kidney disease (CKD) has a potassium level of 6.4 mEq/L. Which
medication is most effective for rapid intracellular shifting of potassium?
A. Sodium Polystyrene Sulfonate
B. Calcium Gluconate
C. Regular Insulin and IV Dextrose
D. Furosemide
Correct Answer: C
Expert Explanation: IV regular insulin helps move potassium from the extracellular fluid
into the intracellular space, and dextrose is given simultaneously to prevent hypoglycemia.
While this provides a rapid temporary fix for hyperkalemia, it does not remove potassium
Surgical Nursing II Q&A with Rationale |
Fortis College
1. A patient is admitted with a pH of 7.28, PaCO2 of 50 mmHg, and HCO3 of 24 mEq/L. Which
acid-base imbalance is the patient experiencing?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Correct Answer: A
Expert Explanation: Respiratory acidosis is characterized by a pH below 7.35 and a PaCO2
above 45 mmHg. In this case, the normal bicarbonate level suggests that the body has not
yet compensated for the respiratory failure. The nurse must focus on improving the
patient’s ventilation to blow off excess carbon dioxide.
2. The nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is on
mechanical ventilation. Which setting helps prevent the collapse of alveoli during expiration?
A. Tidal Volume
B. Fraction of Inspired Oxygen (FiO2)
C. Respiratory Rate
,D. Positive End-Expiratory Pressure (PEEP)
Correct Answer: D
Expert Explanation: PEEP maintains pressure in the lungs at the end of expiration to keep
the alveoli open and improve gas exchange. It is a critical setting for patients with ARDS
who suffer from widespread alveolar collapse. However, the nurse must monitor for
complications such as barotrauma or decreased cardiac output.
3. A patient with cirrhosis has developed hepatic encephalopathy. The nurse expects to
administer which medication to reduce ammonia levels?
A. Spironolactone
B. Lactulose
C. Propranolol
D. Furosemide
Correct Answer: B
Expert Explanation: Lactulose works by promoting the excretion of ammonia through the
stool by creating an acidic environment in the bowel. The goal of therapy is to achieve two
to three soft stools per day to effectively lower systemic ammonia. The nurse must monitor
the patient’s potassium levels as frequent diarrhea can lead to electrolyte imbalances.
4. Which clinical manifestation would the nurse expect to find in a patient with a suspected
tension pneumothorax?
A. Hypertension
, B. Bradycardia
C. Tracheal deviation to the affected side
D. Tracheal deviation to the unaffected side
Correct Answer: D
Expert Explanation: A tension pneumothorax causes air to become trapped in the pleural
space, leading to a shift of the mediastinum. This shift results in the trachea being pushed
toward the opposite, unaffected side of the chest. It is a medical emergency that requires
immediate needle decompression followed by chest tube insertion.
5. A patient with chronic kidney disease (CKD) has a potassium level of 6.4 mEq/L. Which
medication is most effective for rapid intracellular shifting of potassium?
A. Sodium Polystyrene Sulfonate
B. Calcium Gluconate
C. Regular Insulin and IV Dextrose
D. Furosemide
Correct Answer: C
Expert Explanation: IV regular insulin helps move potassium from the extracellular fluid
into the intracellular space, and dextrose is given simultaneously to prevent hypoglycemia.
While this provides a rapid temporary fix for hyperkalemia, it does not remove potassium
