NURS 211L | NURS211L Exam 1: Med Surg 2 - WCU
Updated and Latest Questions and Correct
Answers with Rationale
1. A patient’s arterial blood gas (ABG) results are pH 7.28, PaCO2 52 mmHg, and HCO3 24
mEq/L. Which acid-base imbalance does the nurse identify?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: A
Rationale: The pH level is below 7.35, indicating a state of acidosis in the patient. The
PaCO2 is elevated above 45 mmHg, which reflects a respiratory cause for the pH shift. Since
the bicarbonate level remains within the normal range, the imbalance is not metabolic in
origin. This specific pattern is commonly observed in patients experiencing hypoventilation
or chronic obstructive pulmonary disease. The nurse should focus on improving the
patient’s ventilation to restore normal gas exchange.
2. A nurse is assessing a patient with a serum potassium level of 6.2 mEq/L. Which EKG
change is most indicative of this condition?
A. Prominent U waves
B. Shortened PR interval
C. Tall, peaked T waves
D. ST-segment depression
Correct Answer: C
Rationale: Hyperkalemia is defined by serum potassium levels exceeding the normal range
of 3.5 to 5.0 mEq/L. Peaked T waves are the earliest and most common electrocardiogram
sign associated with high potassium levels. As the level continues to rise, the patient may
progress to QRS widening and cardiac arrest. The nurse must immediately notify the
healthcare provider to initiate potassium-lowering therapies such as insulin or sodium
polystyrene sulfonate. Monitoring the patient’s cardiac rhythm continuously is a priority
nursing action to ensure safety.
3. Which clinical finding should the nurse expect in a patient diagnosed with hypocalcemia?
A. Positive Trousseau’s sign
B. Absent deep tendon reflexes
,C. Polyuria and polydipsia
D. Constipation and lethargy
Correct Answer: A
Rationale: Hypocalcemia increases neuromuscular irritability, leading to specific physical
signs during assessment. A positive Trousseau’s sign is identified by carpal spasms induced
by inflating a blood pressure cuff. Chvostek’s sign is another indicator characterized by
facial twitching when the facial nerve is tapped. The nurse must also monitor for serious
complications like laryngeal spasms or seizures. Early recognition of these signs allows for
prompt administration of calcium gluconate to prevent further neurological decline.
4. A patient with SIADH has a serum sodium level of 122 mEq/L. Which nursing intervention is
the highest priority?
A. Initiate seizure precautions
B. Encourage increased oral fluid intake
C. Administer a rapid IV bolus of normal saline
D. Measure abdominal girth every shift
Correct Answer: A
Rationale: Severe hyponatremia places the patient at a significant risk for cerebral edema
and seizure activity. SIADH involves excessive water retention, which dilutes the serum
sodium and requires strict fluid restriction. Rapid correction of sodium must be avoided to
prevent osmotic demyelination syndrome in the brain. The nurse should ensure suction
and oxygen are available at the bedside for safety. Monitoring neurological status
frequently is essential to detect any worsening of the patient’s condition.
5. The nurse is caring for a patient with Diabetes Insipidus (DI). Which assessment finding is
most characteristic of this disorder?
A. High urine specific gravity
B. Low serum osmolality
C. Weight gain and edema
D. Excessive urine output
Correct Answer: D
Rationale: Diabetes Insipidus is characterized by a deficiency of antidiuretic hormone,
leading to massive diuresis. Patients typically produce large volumes of dilute urine with a
very low specific gravity. Because of the excessive fluid loss, the patient will experience
intense thirst and high serum osmolality. The primary goal of treatment is to replace fluids
and administer synthetic vasopressin as ordered. Nurses must monitor for signs of
dehydration and hypovolemic shock in these acute situations.
, 6. A patient is admitted with Diabetic Ketoacidosis (DKA). Which of the following is the
priority initial treatment?
A. Intravenous fluid resuscitation
B. Subcutaneous long-acting insulin
C. Oral potassium supplements
D. Bicarbonate infusion for pH 7.3
Correct Answer: A
Rationale: The initial priority in treating DKA is to restore circulatory volume and stabilize
the patient’s blood pressure. Profound dehydration occurs due to osmotic diuresis caused
by high blood glucose levels. Once fluid resuscitation has begun, an intravenous insulin drip
is typically started to lower glucose. Potassium must be monitored closely because insulin
causes potassium to shift into the cells. Managing the underlying cause and monitoring
electrolytes are critical steps in the recovery process.
7. Which symptom is uniquely associated with Hyperosmolar Hyperglycemic State (HHS)
rather than DKA?
A. Severe dehydration and very high blood glucose
B. Fruity breath odor
C. Presence of Kussmaul respirations
D. Positive ketones in the urine
Correct Answer: A
Rationale: HHS typically occurs in Type 2 diabetics who have enough insulin to prevent
ketosis but not enough to control hyperglycemia. Blood glucose levels in HHS are often
significantly higher than those seen in DKA. Because there is no metabolic acidosis,
Kussmaul respirations and fruity breath are usually absent. The extreme hyperglycemia
leads to severe osmotic diuresis and profound total body water depletion. Treatment
focuses on aggressive fluid replacement and careful blood sugar management to avoid
cerebral edema.
8. A patient with left-sided heart failure is likely to exhibit which of the following signs?
A. Jugular venous distention
B. Crackles in the lung bases
C. Peripheral edema
D. Hepatomegaly
Correct Answer: B
Updated and Latest Questions and Correct
Answers with Rationale
1. A patient’s arterial blood gas (ABG) results are pH 7.28, PaCO2 52 mmHg, and HCO3 24
mEq/L. Which acid-base imbalance does the nurse identify?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: A
Rationale: The pH level is below 7.35, indicating a state of acidosis in the patient. The
PaCO2 is elevated above 45 mmHg, which reflects a respiratory cause for the pH shift. Since
the bicarbonate level remains within the normal range, the imbalance is not metabolic in
origin. This specific pattern is commonly observed in patients experiencing hypoventilation
or chronic obstructive pulmonary disease. The nurse should focus on improving the
patient’s ventilation to restore normal gas exchange.
2. A nurse is assessing a patient with a serum potassium level of 6.2 mEq/L. Which EKG
change is most indicative of this condition?
A. Prominent U waves
B. Shortened PR interval
C. Tall, peaked T waves
D. ST-segment depression
Correct Answer: C
Rationale: Hyperkalemia is defined by serum potassium levels exceeding the normal range
of 3.5 to 5.0 mEq/L. Peaked T waves are the earliest and most common electrocardiogram
sign associated with high potassium levels. As the level continues to rise, the patient may
progress to QRS widening and cardiac arrest. The nurse must immediately notify the
healthcare provider to initiate potassium-lowering therapies such as insulin or sodium
polystyrene sulfonate. Monitoring the patient’s cardiac rhythm continuously is a priority
nursing action to ensure safety.
3. Which clinical finding should the nurse expect in a patient diagnosed with hypocalcemia?
A. Positive Trousseau’s sign
B. Absent deep tendon reflexes
,C. Polyuria and polydipsia
D. Constipation and lethargy
Correct Answer: A
Rationale: Hypocalcemia increases neuromuscular irritability, leading to specific physical
signs during assessment. A positive Trousseau’s sign is identified by carpal spasms induced
by inflating a blood pressure cuff. Chvostek’s sign is another indicator characterized by
facial twitching when the facial nerve is tapped. The nurse must also monitor for serious
complications like laryngeal spasms or seizures. Early recognition of these signs allows for
prompt administration of calcium gluconate to prevent further neurological decline.
4. A patient with SIADH has a serum sodium level of 122 mEq/L. Which nursing intervention is
the highest priority?
A. Initiate seizure precautions
B. Encourage increased oral fluid intake
C. Administer a rapid IV bolus of normal saline
D. Measure abdominal girth every shift
Correct Answer: A
Rationale: Severe hyponatremia places the patient at a significant risk for cerebral edema
and seizure activity. SIADH involves excessive water retention, which dilutes the serum
sodium and requires strict fluid restriction. Rapid correction of sodium must be avoided to
prevent osmotic demyelination syndrome in the brain. The nurse should ensure suction
and oxygen are available at the bedside for safety. Monitoring neurological status
frequently is essential to detect any worsening of the patient’s condition.
5. The nurse is caring for a patient with Diabetes Insipidus (DI). Which assessment finding is
most characteristic of this disorder?
A. High urine specific gravity
B. Low serum osmolality
C. Weight gain and edema
D. Excessive urine output
Correct Answer: D
Rationale: Diabetes Insipidus is characterized by a deficiency of antidiuretic hormone,
leading to massive diuresis. Patients typically produce large volumes of dilute urine with a
very low specific gravity. Because of the excessive fluid loss, the patient will experience
intense thirst and high serum osmolality. The primary goal of treatment is to replace fluids
and administer synthetic vasopressin as ordered. Nurses must monitor for signs of
dehydration and hypovolemic shock in these acute situations.
, 6. A patient is admitted with Diabetic Ketoacidosis (DKA). Which of the following is the
priority initial treatment?
A. Intravenous fluid resuscitation
B. Subcutaneous long-acting insulin
C. Oral potassium supplements
D. Bicarbonate infusion for pH 7.3
Correct Answer: A
Rationale: The initial priority in treating DKA is to restore circulatory volume and stabilize
the patient’s blood pressure. Profound dehydration occurs due to osmotic diuresis caused
by high blood glucose levels. Once fluid resuscitation has begun, an intravenous insulin drip
is typically started to lower glucose. Potassium must be monitored closely because insulin
causes potassium to shift into the cells. Managing the underlying cause and monitoring
electrolytes are critical steps in the recovery process.
7. Which symptom is uniquely associated with Hyperosmolar Hyperglycemic State (HHS)
rather than DKA?
A. Severe dehydration and very high blood glucose
B. Fruity breath odor
C. Presence of Kussmaul respirations
D. Positive ketones in the urine
Correct Answer: A
Rationale: HHS typically occurs in Type 2 diabetics who have enough insulin to prevent
ketosis but not enough to control hyperglycemia. Blood glucose levels in HHS are often
significantly higher than those seen in DKA. Because there is no metabolic acidosis,
Kussmaul respirations and fruity breath are usually absent. The extreme hyperglycemia
leads to severe osmotic diuresis and profound total body water depletion. Treatment
focuses on aggressive fluid replacement and careful blood sugar management to avoid
cerebral edema.
8. A patient with left-sided heart failure is likely to exhibit which of the following signs?
A. Jugular venous distention
B. Crackles in the lung bases
C. Peripheral edema
D. Hepatomegaly
Correct Answer: B
