NUR242 Final Exam V3 | NUR 242 Med-Surg
Exam Q&A | Galen College of Nursing
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This comprehensive final exam preparation material is designed to strengthen understanding of
advanced medical-surgical nursing concepts, critical care management, and complex adult
patient interventions. The content focuses on integrating nursing knowledge into real-world
clinical scenarios and healthcare decision-making.
The questions are structured to closely mirror actual nursing final exams while reinforcing
analytical reasoning, prioritization, and nursing intervention strategies. Detailed expert
explanations are included to support concept mastery and academic success.
════════════════════════════════════
The Exam Covers:
• Multisystem adult disorders
• Advanced nursing assessment
• Adult emergency and trauma care
• Critical care pharmacology
• Complex patient management
• Comprehensive nursing interventions
• Patient-centered nursing care
• Final medical-surgical review
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1. A patient with a major burn injury is in the emergent phase of care. Which of the following
laboratory results should the nurse expect to find?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
,D. Decreased hematocrit
Correct Answer: B
Expert Explanation: During the emergent phase of a burn injury, massive cell destruction
occurs, leading to the release of potassium into the extracellular fluid. This result is
hyperkalemia, which requires close cardiac monitoring. Additionally, the nurse would
typically see hyponatremia due to sodium moving into the interstitial space and an
increased hematocrit due to hemoconcentration.
2. The nurse is caring for a patient with Acute Respiratory Distress Syndrome (ARDS) on a
ventilator. The provider increases the Positive End-Expiratory Pressure (PEEP) setting. What is
the primary purpose of this intervention?
A. To decrease the risk of barotrauma
B. To treat respiratory alkalosis
C. To increase the fraction of inspired oxygen (FiO2)
D. To prevent alveolar collapse at the end of expiration
Correct Answer: D
Expert Explanation: PEEP is used in ARDS to keep the alveoli open at the end of
expiration, which improves gas exchange and oxygenation. By preventing alveolar collapse,
it allows for a lower FiO2 to be used, reducing oxygen toxicity risks. However, high levels of
PEEP can increase the risk of barotrauma and decreased cardiac output.
,3. A patient arrives in the emergency department with a Glasgow Coma Scale (GCS) score of
7. Which action should the nurse prioritize?
A. Prepare for immediate endotracheal intubation
B. Assess the patient’s pupil response
C. Obtain a full set of vital signs
D. Check the patient’s blood glucose level
Correct Answer: A
Expert Explanation: A GCS score of 8 or less typically indicates that the patient is in a
coma and cannot protect their own airway. Endotracheal intubation is a priority to ensure
adequate ventilation and prevent aspiration. While other assessments are important,
securing the airway is the first step in the ABC stabilization process.
4. A patient in septic shock is receiving aggressive fluid resuscitation but remains
hypotensive. The nurse anticipates the administration of which medication?
A. Nitroglycerin
B. Furosemide
C. Norepinephrine
D. Atropine
Correct Answer: C
, Expert Explanation: Norepinephrine is the first-line vasopressor used in septic shock
when fluid resuscitation fails to maintain an adequate mean arterial pressure (MAP). It
works by causing vasoconstriction to increase systemic vascular resistance and blood
pressure. The goal is to ensure adequate perfusion to vital organs.
5. Which of the following clinical manifestations is most characteristic of a patient in the
compensatory stage of shock?
A. Multiple organ dysfunction syndrome (MODS)
B. Lethargy and metabolic acidosis
C. Refractory hypotension and anuria
D. Cool, clammy skin and tachycardia
Correct Answer: D
Expert Explanation: In the compensatory stage of shock, the body activates the
sympathetic nervous system to maintain cardiac output and blood pressure. This results in
tachycardia and vasoconstriction, which causes the skin to feel cool and clammy. As shock
progresses to the progressive stage, metabolic acidosis and altered mental status become
more prominent.
6. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which medication should the nurse be prepared to administer first to protect the heart?
A. Sodium polystyrene sulfonate
B. Sodium bicarbonate
Exam Q&A | Galen College of Nursing
────────────────────────────────────
This comprehensive final exam preparation material is designed to strengthen understanding of
advanced medical-surgical nursing concepts, critical care management, and complex adult
patient interventions. The content focuses on integrating nursing knowledge into real-world
clinical scenarios and healthcare decision-making.
The questions are structured to closely mirror actual nursing final exams while reinforcing
analytical reasoning, prioritization, and nursing intervention strategies. Detailed expert
explanations are included to support concept mastery and academic success.
════════════════════════════════════
The Exam Covers:
• Multisystem adult disorders
• Advanced nursing assessment
• Adult emergency and trauma care
• Critical care pharmacology
• Complex patient management
• Comprehensive nursing interventions
• Patient-centered nursing care
• Final medical-surgical review
════════════════════════════════════
1. A patient with a major burn injury is in the emergent phase of care. Which of the following
laboratory results should the nurse expect to find?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
,D. Decreased hematocrit
Correct Answer: B
Expert Explanation: During the emergent phase of a burn injury, massive cell destruction
occurs, leading to the release of potassium into the extracellular fluid. This result is
hyperkalemia, which requires close cardiac monitoring. Additionally, the nurse would
typically see hyponatremia due to sodium moving into the interstitial space and an
increased hematocrit due to hemoconcentration.
2. The nurse is caring for a patient with Acute Respiratory Distress Syndrome (ARDS) on a
ventilator. The provider increases the Positive End-Expiratory Pressure (PEEP) setting. What is
the primary purpose of this intervention?
A. To decrease the risk of barotrauma
B. To treat respiratory alkalosis
C. To increase the fraction of inspired oxygen (FiO2)
D. To prevent alveolar collapse at the end of expiration
Correct Answer: D
Expert Explanation: PEEP is used in ARDS to keep the alveoli open at the end of
expiration, which improves gas exchange and oxygenation. By preventing alveolar collapse,
it allows for a lower FiO2 to be used, reducing oxygen toxicity risks. However, high levels of
PEEP can increase the risk of barotrauma and decreased cardiac output.
,3. A patient arrives in the emergency department with a Glasgow Coma Scale (GCS) score of
7. Which action should the nurse prioritize?
A. Prepare for immediate endotracheal intubation
B. Assess the patient’s pupil response
C. Obtain a full set of vital signs
D. Check the patient’s blood glucose level
Correct Answer: A
Expert Explanation: A GCS score of 8 or less typically indicates that the patient is in a
coma and cannot protect their own airway. Endotracheal intubation is a priority to ensure
adequate ventilation and prevent aspiration. While other assessments are important,
securing the airway is the first step in the ABC stabilization process.
4. A patient in septic shock is receiving aggressive fluid resuscitation but remains
hypotensive. The nurse anticipates the administration of which medication?
A. Nitroglycerin
B. Furosemide
C. Norepinephrine
D. Atropine
Correct Answer: C
, Expert Explanation: Norepinephrine is the first-line vasopressor used in septic shock
when fluid resuscitation fails to maintain an adequate mean arterial pressure (MAP). It
works by causing vasoconstriction to increase systemic vascular resistance and blood
pressure. The goal is to ensure adequate perfusion to vital organs.
5. Which of the following clinical manifestations is most characteristic of a patient in the
compensatory stage of shock?
A. Multiple organ dysfunction syndrome (MODS)
B. Lethargy and metabolic acidosis
C. Refractory hypotension and anuria
D. Cool, clammy skin and tachycardia
Correct Answer: D
Expert Explanation: In the compensatory stage of shock, the body activates the
sympathetic nervous system to maintain cardiac output and blood pressure. This results in
tachycardia and vasoconstriction, which causes the skin to feel cool and clammy. As shock
progresses to the progressive stage, metabolic acidosis and altered mental status become
more prominent.
6. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which medication should the nurse be prepared to administer first to protect the heart?
A. Sodium polystyrene sulfonate
B. Sodium bicarbonate
