NURS 211L | NURS211L Final Exam: Med Surg 2 -
WCU Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with left-sided heart failure is admitted to the medical-surgical unit. Which
clinical manifestation should the nurse prioritize during the assessment?
A. Peripheral edema and weight gain
B. Jugular venous distention
C. Auscultation of crackles in the lungs
D. Hepatic tenderness and ascites
Correct Answer: C
Rationale: Left-sided heart failure leads to a backflow of blood into the pulmonary
circulation, causing pulmonary congestion. The presence of crackles indicates fluid in the
alveolar spaces, which can compromise gas exchange. The nurse must monitor respiratory
status closely to prevent acute pulmonary edema. Peripheral edema and jugular distention
are more characteristic of right-sided heart failure. Early intervention often involves the
administration of diuretics and supplemental oxygen.
2. A nurse is caring for a patient with Chronic Kidney Disease (CKD) who has a potassium level
of 6.2 mEq/L. Which medication should the nurse anticipate administering first?
A. Sodium polystyrene sulfonate
B. Epoetin alfa
C. Calcium carbonate
D. Furosemide
Correct Answer: A
Rationale: Hyperkalemia is a life-threatening complication in patients with chronic kidney
disease due to decreased renal excretion. Sodium polystyrene sulfonate works by
exchanging sodium ions for potassium ions in the intestinal tract to reduce serum levels.
The nurse must assess bowel sounds before administration to ensure the gastrointestinal
tract is functioning. Epoetin alfa is used for anemia, while calcium carbonate is used as a
phosphate binder. While furosemide can lower potassium, it is often less effective in
advanced stages of CKD.
3. Which arterial blood gas (ABG) result would the nurse expect to see in a patient
experiencing an acute exacerbation of COPD?
A. pH 7.50, PaCO2 30, HCO3 24
B. pH 7.30, PaCO2 55, HCO3 26
,C. pH 7.32, PaCO2 38, HCO3 18
D. pH 7.48, PaCO2 42, HCO3 30
Correct Answer: B
Rationale: Patients with COPD often suffer from chronic air trapping, leading to carbon
dioxide retention. This results in respiratory acidosis, characterized by a low pH and an
elevated PaCO2. In an acute exacerbation, the body may not have enough time to fully
compensate using the kidneys. The nurse should monitor for signs of respiratory distress
and mental status changes. Oxygen therapy should be titrated carefully to maintain target
saturations without suppressing the hypoxic drive.
4. A patient is prescribed Warfarin for the treatment of Atrial Fibrillation. Which lab value
should the nurse monitor to evaluate the effectiveness of the therapy?
A. International Normalized Ratio (INR)
B. Platelet count
C. Activated partial thromboplastin time (aPTT)
D. Bleeding time
Correct Answer: A
Rationale: The INR is the standard laboratory test used to monitor the therapeutic effect of
Warfarin. A target range of 2.0 to 3.0 is typically desired for patients with atrial fibrillation
to prevent stroke. The nurse must educate the patient on consistent intake of Vitamin K-
rich foods to avoid fluctuations in levels. Monitoring for signs of bleeding, such as
hematuria or bruising, is a critical nursing responsibility. Heparin, not Warfarin, is
monitored using the aPTT value.
5. A patient with Type 1 Diabetes is found sweaty, shaky, and confused. The bedside glucose
monitor reads 45 mg/dL. What is the priority nursing action?
A. Call the healthcare provider immediately
B. Administer 15g of rapid-acting carbohydrate
C. Administer 10 units of regular insulin
D. Provide a complex carbohydrate like a sandwich
Correct Answer: B
Rationale: The patient is demonstrating clinical signs of hypoglycemia, which requires
immediate treatment according to the ‘Rule of 15’. Administering 15 grams of simple
carbohydrates will quickly raise the blood glucose level. If the patient is unconscious, the
nurse would instead administer glucagon or dextrose intravenously. Retesting the glucose
level after 15 minutes is essential to ensure the treatment was effective. Providing a
complex carbohydrate follows the initial stabilization to prevent another drop in glucose.
, 6. A patient presents to the ER with sudden onset of right-sided weakness and facial
drooping. The symptoms began 1 hour ago. Which diagnostic test is the priority?
A. Magnetic Resonance Imaging (MRI)
B. Non-contrast Computed Tomography (CT) scan
C. Electrocardiogram (ECG)
D. Carotid Doppler ultrasound
Correct Answer: B
Rationale: A non-contrast CT scan is the gold standard for initially evaluating a suspected
stroke to rule out hemorrhage. This determination is critical because thrombolytic therapy
can only be given for ischemic strokes. The procedure must be performed rapidly within
the ‘golden window’ of symptom onset. If a bleed is ruled out, the patient may be eligible
for tissue plasminogen activator (tPA). While other tests are valuable, they do not take
precedence over identifying the type of stroke.
7. Which medication is typically administered to a patient with liver cirrhosis to reduce serum
ammonia levels and prevent encephalopathy?
A. Spironolactone
B. Propranolol
C. Lactulose
D. Vitamin K
E. Rifaximin
Correct Answer: C
Rationale: Lactulose is an osmotic laxative that promotes the excretion of ammonia
through the stool. In cirrhosis, the liver cannot convert ammonia to urea, leading to
neurological changes. The goal of therapy is to achieve two to three soft bowel movements
per day. The nurse should monitor the patient’s mental status and skin integrity due to
increased stooling. If the patient develops diarrhea that is too frequent, the dose may need
adjustment by the provider.
8. A nurse is assessing a patient for systemic inflammatory response syndrome (SIRS). Which
finding meets the criteria for SIRS?
A. Temperature 101.2°F (38.4°C)
B. Blood pressure 140/90 mmHg
C. Heart rate 55 beats per minute
D. White blood cell count 8,000/mm³
WCU Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with left-sided heart failure is admitted to the medical-surgical unit. Which
clinical manifestation should the nurse prioritize during the assessment?
A. Peripheral edema and weight gain
B. Jugular venous distention
C. Auscultation of crackles in the lungs
D. Hepatic tenderness and ascites
Correct Answer: C
Rationale: Left-sided heart failure leads to a backflow of blood into the pulmonary
circulation, causing pulmonary congestion. The presence of crackles indicates fluid in the
alveolar spaces, which can compromise gas exchange. The nurse must monitor respiratory
status closely to prevent acute pulmonary edema. Peripheral edema and jugular distention
are more characteristic of right-sided heart failure. Early intervention often involves the
administration of diuretics and supplemental oxygen.
2. A nurse is caring for a patient with Chronic Kidney Disease (CKD) who has a potassium level
of 6.2 mEq/L. Which medication should the nurse anticipate administering first?
A. Sodium polystyrene sulfonate
B. Epoetin alfa
C. Calcium carbonate
D. Furosemide
Correct Answer: A
Rationale: Hyperkalemia is a life-threatening complication in patients with chronic kidney
disease due to decreased renal excretion. Sodium polystyrene sulfonate works by
exchanging sodium ions for potassium ions in the intestinal tract to reduce serum levels.
The nurse must assess bowel sounds before administration to ensure the gastrointestinal
tract is functioning. Epoetin alfa is used for anemia, while calcium carbonate is used as a
phosphate binder. While furosemide can lower potassium, it is often less effective in
advanced stages of CKD.
3. Which arterial blood gas (ABG) result would the nurse expect to see in a patient
experiencing an acute exacerbation of COPD?
A. pH 7.50, PaCO2 30, HCO3 24
B. pH 7.30, PaCO2 55, HCO3 26
,C. pH 7.32, PaCO2 38, HCO3 18
D. pH 7.48, PaCO2 42, HCO3 30
Correct Answer: B
Rationale: Patients with COPD often suffer from chronic air trapping, leading to carbon
dioxide retention. This results in respiratory acidosis, characterized by a low pH and an
elevated PaCO2. In an acute exacerbation, the body may not have enough time to fully
compensate using the kidneys. The nurse should monitor for signs of respiratory distress
and mental status changes. Oxygen therapy should be titrated carefully to maintain target
saturations without suppressing the hypoxic drive.
4. A patient is prescribed Warfarin for the treatment of Atrial Fibrillation. Which lab value
should the nurse monitor to evaluate the effectiveness of the therapy?
A. International Normalized Ratio (INR)
B. Platelet count
C. Activated partial thromboplastin time (aPTT)
D. Bleeding time
Correct Answer: A
Rationale: The INR is the standard laboratory test used to monitor the therapeutic effect of
Warfarin. A target range of 2.0 to 3.0 is typically desired for patients with atrial fibrillation
to prevent stroke. The nurse must educate the patient on consistent intake of Vitamin K-
rich foods to avoid fluctuations in levels. Monitoring for signs of bleeding, such as
hematuria or bruising, is a critical nursing responsibility. Heparin, not Warfarin, is
monitored using the aPTT value.
5. A patient with Type 1 Diabetes is found sweaty, shaky, and confused. The bedside glucose
monitor reads 45 mg/dL. What is the priority nursing action?
A. Call the healthcare provider immediately
B. Administer 15g of rapid-acting carbohydrate
C. Administer 10 units of regular insulin
D. Provide a complex carbohydrate like a sandwich
Correct Answer: B
Rationale: The patient is demonstrating clinical signs of hypoglycemia, which requires
immediate treatment according to the ‘Rule of 15’. Administering 15 grams of simple
carbohydrates will quickly raise the blood glucose level. If the patient is unconscious, the
nurse would instead administer glucagon or dextrose intravenously. Retesting the glucose
level after 15 minutes is essential to ensure the treatment was effective. Providing a
complex carbohydrate follows the initial stabilization to prevent another drop in glucose.
, 6. A patient presents to the ER with sudden onset of right-sided weakness and facial
drooping. The symptoms began 1 hour ago. Which diagnostic test is the priority?
A. Magnetic Resonance Imaging (MRI)
B. Non-contrast Computed Tomography (CT) scan
C. Electrocardiogram (ECG)
D. Carotid Doppler ultrasound
Correct Answer: B
Rationale: A non-contrast CT scan is the gold standard for initially evaluating a suspected
stroke to rule out hemorrhage. This determination is critical because thrombolytic therapy
can only be given for ischemic strokes. The procedure must be performed rapidly within
the ‘golden window’ of symptom onset. If a bleed is ruled out, the patient may be eligible
for tissue plasminogen activator (tPA). While other tests are valuable, they do not take
precedence over identifying the type of stroke.
7. Which medication is typically administered to a patient with liver cirrhosis to reduce serum
ammonia levels and prevent encephalopathy?
A. Spironolactone
B. Propranolol
C. Lactulose
D. Vitamin K
E. Rifaximin
Correct Answer: C
Rationale: Lactulose is an osmotic laxative that promotes the excretion of ammonia
through the stool. In cirrhosis, the liver cannot convert ammonia to urea, leading to
neurological changes. The goal of therapy is to achieve two to three soft bowel movements
per day. The nurse should monitor the patient’s mental status and skin integrity due to
increased stooling. If the patient develops diarrhea that is too frequent, the dose may need
adjustment by the provider.
8. A nurse is assessing a patient for systemic inflammatory response syndrome (SIRS). Which
finding meets the criteria for SIRS?
A. Temperature 101.2°F (38.4°C)
B. Blood pressure 140/90 mmHg
C. Heart rate 55 beats per minute
D. White blood cell count 8,000/mm³
