NUR 209/NUR209 Final Exam V2 | Medical-
Surgical Nursing II Q&A with Rationale |
Fortis College
1. A nurse is caring for a patient who is 24 hours post-thyroidectomy. The patient reports
tingling in the fingers and around the mouth. Which action should the nurse take first?
A. Assess for Chvostek’s sign.
B. Check the patient’s blood pressure.
C. Administer a dose of levothyroxine.
D. Notify the surgeon immediately.
Correct Answer: A
Expert Explanation: Tingling in the extremities and circumoral area are classic signs of
hypocalcemia, which can occur if the parathyroid glands are accidentally damaged or
removed during a thyroidectomy. Assessing for Chvostek’s sign involves tapping the facial
nerve to look for twitching, which confirms neuromuscular irritability. This assessment is
the priority to determine the severity of the electrolyte imbalance before notifying the
provider for calcium replacement.
2. A patient with chronic kidney disease (CKD) is prescribed epoetin alfa. What is the primary
purpose of this medication in this population?
A. To lower serum potassium levels.
,B. To increase calcium absorption.
C. To stimulate red blood cell production.
D. To reduce nitrogenous waste products.
Correct Answer: C
Expert Explanation: In CKD, the kidneys fail to produce enough erythropoietin, the
hormone responsible for stimulating the bone marrow to create red blood cells. Epoetin
alfa is a synthetic form of this hormone used to treat the resulting anemia. This medication
helps improve oxygenation and reduces the need for blood transfusions in patients with
renal failure.
3. The nurse is assessing a patient with a history of cirrhosis who has developed hepatic
encephalopathy. Which laboratory finding is most consistent with this diagnosis?
A. Elevated serum ammonia levels.
B. Decreased serum creatinine.
C. Elevated serum glucose.
D. Decreased prothrombin time.
Correct Answer: A
Expert Explanation: Hepatic encephalopathy is caused by the liver’s inability to detoxify
metabolic byproducts, primarily ammonia. When ammonia levels rise, the toxin crosses the
,blood-brain barrier, leading to cognitive impairment and altered consciousness. Monitoring
ammonia levels is crucial for evaluating the effectiveness of treatments like lactulose.
4. A patient is admitted with suspected Acute Pancreatitis. Which diagnostic test is the most
specific indicator for this condition?
A. Serum Amylase
B. Serum Lipase
C. White Blood Cell Count
D. Serum Bilirubin
Correct Answer: B
Expert Explanation: While both amylase and lipase rise during acute pancreatitis, lipase is
considered more specific because it remains elevated for a longer period and is less
influenced by other factors. Amylase can rise due to other conditions like mumps or
salivary gland issues. Diagnosing pancreatitis usually relies on the elevation of these
enzymes alongside clinical symptoms like severe epigastric pain.
5. A patient with Type 1 Diabetes Mellitus presents to the ER with a blood glucose of 550
mg/dL, fruity breath, and Kussmaul respirations. What is the priority nursing intervention?
A. Administering subcutaneous glargine insulin.
B. Providing a carbohydrate-rich snack.
C. Initiating intravenous fluid resuscitation with Normal Saline.
, D. Ordering a stat arterial blood gas (ABG).
Correct Answer: C
Expert Explanation: This patient is exhibiting signs of Diabetic Ketoacidosis (DKA), which
causes severe dehydration due to osmotic diuresis. The immediate priority is to restore
circulatory volume with isotonic fluids before starting insulin therapy. While insulin is
necessary to stop ketone production, fluid resuscitation prevents hypovolemic shock and
stabilizes the patient.
6. Which assessment finding should the nurse expect in a patient diagnosed with Cushing’s
Syndrome?
A. Weight loss and hypotension.
B. Trunk obesity and a ‘buffalo hump.’
C. Hyperpigmentation of the skin.
D. Increased muscle mass in the extremities.
Correct Answer: B
Expert Explanation: Cushing’s Syndrome is characterized by an excess of glucocorticoids,
leading to a redistribution of fat to the abdomen and cervical spine area. Patients often
present with thin extremities due to muscle wasting alongside a rounded face and
abdominal striae. This condition contrasts with Addison’s disease, which involves cortisol
deficiency and weight loss.
Surgical Nursing II Q&A with Rationale |
Fortis College
1. A nurse is caring for a patient who is 24 hours post-thyroidectomy. The patient reports
tingling in the fingers and around the mouth. Which action should the nurse take first?
A. Assess for Chvostek’s sign.
B. Check the patient’s blood pressure.
C. Administer a dose of levothyroxine.
D. Notify the surgeon immediately.
Correct Answer: A
Expert Explanation: Tingling in the extremities and circumoral area are classic signs of
hypocalcemia, which can occur if the parathyroid glands are accidentally damaged or
removed during a thyroidectomy. Assessing for Chvostek’s sign involves tapping the facial
nerve to look for twitching, which confirms neuromuscular irritability. This assessment is
the priority to determine the severity of the electrolyte imbalance before notifying the
provider for calcium replacement.
2. A patient with chronic kidney disease (CKD) is prescribed epoetin alfa. What is the primary
purpose of this medication in this population?
A. To lower serum potassium levels.
,B. To increase calcium absorption.
C. To stimulate red blood cell production.
D. To reduce nitrogenous waste products.
Correct Answer: C
Expert Explanation: In CKD, the kidneys fail to produce enough erythropoietin, the
hormone responsible for stimulating the bone marrow to create red blood cells. Epoetin
alfa is a synthetic form of this hormone used to treat the resulting anemia. This medication
helps improve oxygenation and reduces the need for blood transfusions in patients with
renal failure.
3. The nurse is assessing a patient with a history of cirrhosis who has developed hepatic
encephalopathy. Which laboratory finding is most consistent with this diagnosis?
A. Elevated serum ammonia levels.
B. Decreased serum creatinine.
C. Elevated serum glucose.
D. Decreased prothrombin time.
Correct Answer: A
Expert Explanation: Hepatic encephalopathy is caused by the liver’s inability to detoxify
metabolic byproducts, primarily ammonia. When ammonia levels rise, the toxin crosses the
,blood-brain barrier, leading to cognitive impairment and altered consciousness. Monitoring
ammonia levels is crucial for evaluating the effectiveness of treatments like lactulose.
4. A patient is admitted with suspected Acute Pancreatitis. Which diagnostic test is the most
specific indicator for this condition?
A. Serum Amylase
B. Serum Lipase
C. White Blood Cell Count
D. Serum Bilirubin
Correct Answer: B
Expert Explanation: While both amylase and lipase rise during acute pancreatitis, lipase is
considered more specific because it remains elevated for a longer period and is less
influenced by other factors. Amylase can rise due to other conditions like mumps or
salivary gland issues. Diagnosing pancreatitis usually relies on the elevation of these
enzymes alongside clinical symptoms like severe epigastric pain.
5. A patient with Type 1 Diabetes Mellitus presents to the ER with a blood glucose of 550
mg/dL, fruity breath, and Kussmaul respirations. What is the priority nursing intervention?
A. Administering subcutaneous glargine insulin.
B. Providing a carbohydrate-rich snack.
C. Initiating intravenous fluid resuscitation with Normal Saline.
, D. Ordering a stat arterial blood gas (ABG).
Correct Answer: C
Expert Explanation: This patient is exhibiting signs of Diabetic Ketoacidosis (DKA), which
causes severe dehydration due to osmotic diuresis. The immediate priority is to restore
circulatory volume with isotonic fluids before starting insulin therapy. While insulin is
necessary to stop ketone production, fluid resuscitation prevents hypovolemic shock and
stabilizes the patient.
6. Which assessment finding should the nurse expect in a patient diagnosed with Cushing’s
Syndrome?
A. Weight loss and hypotension.
B. Trunk obesity and a ‘buffalo hump.’
C. Hyperpigmentation of the skin.
D. Increased muscle mass in the extremities.
Correct Answer: B
Expert Explanation: Cushing’s Syndrome is characterized by an excess of glucocorticoids,
leading to a redistribution of fat to the abdomen and cervical spine area. Patients often
present with thin extremities due to muscle wasting alongside a rounded face and
abdominal striae. This condition contrasts with Addison’s disease, which involves cortisol
deficiency and weight loss.
