College Exams & Notes

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QUESTION #1
Medical-Surgical Exam 1 Med-Surg
During assessment of a postoperative patient, the nurse notes the patient’s respirations are shallow. Which intervention is the nurse’s priority to prevent respiratory acidosis?
A Administer oxygen via nasal cannula.
B Auscultate lung sounds.
C Encourage use of the incentive spirometer.
D Administer pain medication as ordered.

Explanations

A
Oxygen improves oxygenation but does not correct hypoventilation or prevent CO₂ retention, which leads to respiratory acidosis.
B
Assessment alone does not address the underlying problem of shallow respirations.
C
Incentive spirometry promotes deep breathing, improves alveolar ventilation, and prevents CO₂ retention and respiratory acidosis.
D
Pain control is important, but the direct intervention to prevent respiratory acidosis is improving ventilation.
QUESTION #2
Medical-Surgical Exam 1 Med-Surg
A nurse is caring for a client who has the following arterial blood gas (ABG) values: pH 7.12, PaO₂ 56 mm Hg, PaCO₂ 65 mm Hg, HCO₃⁻ 22 mEq/L. Which clinical situation should the nurse correlate with these values?
A Diabetic ketoacidosis in a person with emphysema
B Bronchial obstruction related to aspiration of a hot dog
C Anxiety-induced hyperventilation in an adolescent
D Diarrhea for 36 hours in an older, frail woman

Explanations

A
DKA causes metabolic acidosis with low bicarbonate, not the primary respiratory acidosis seen here.
B
Airway obstruction leads to hypoventilation, CO₂ retention, hypoxemia, and acute respiratory acidosis.
C
Hyperventilation causes respiratory alkalosis with low PaCO₂, not acidosis.
D
Prolonged diarrhea causes metabolic acidosis from bicarbonate loss, not elevated PaCO₂.
QUESTION #3
Medical-Surgical Exam 1 Med-Surg
A nurse is caring for a client who is experiencing moderate metabolic alkalosis. Which action should the nurse take?
A Monitor daily hemoglobin and hematocrit values.
B Administer furosemide (Lasix) intravenously
C Encourage the client to take deep breaths.
D Teach the client fall prevention measures.

Explanations

A
These labs assess blood volume or anemia and are not directly related to managing metabolic alkalosis.
B
Loop diuretics can worsen metabolic alkalosis by increasing hydrogen and potassium loss.
C
Deep breathing affects respiratory acid–base balance and may worsen alkalosis rather than correct it.
D
Metabolic alkalosis causes neuromuscular excitability, dizziness, and weakness, increasing the risk for falls and injury.
QUESTION #4
Medical-Surgical Exam 1 Med-Surg
A client who had abdominal surgery 18 hours ago is reporting incisional pain. Recent ABG results are pH 7.49, PaO₂ 89 mm Hg, PaCO₂ 31 mm Hg, HCO₃⁻ 22 mEq/L. Which action should the nurse take first?
A Teach the client how to use a splinting pillow when coughing.
B Give the client the PRN IV morphine sulfate 4 mg as ordered.
C Notify the health care provider about the ABG results.
D Teach the client to take slow, deep breaths.

Explanations

A
Splinting is helpful, but the client’s immediate problem is uncontrolled pain, which must be addressed first.
B
Pain is likely causing hyperventilation and respiratory alkalosis, so treating the pain will correct both the discomfort and the abnormal ABGs.
C
The ABGs show mild respiratory alkalosis related to pain and anxiety, which can be managed with nursing interventions.
D
Breathing techniques may help, but pain control is the priority to prevent ongoing hyperventilation.
QUESTION #5
Medical-Surgical Exam 1 Med-Surg
A patient who is taking a loop diuretic for fluid volume overload reports generalized weakness. Which action is most appropriate for the nurse to take?
A Assess the patient’s hemoglobin level.
B Ask the patient about loose stools.
C Advise the patient to avoid drinking orange juice with meals.
D Request that the health care provider order a basic metabolic panel.

Explanations

A
Anemia can cause weakness, but loop diuretics more commonly affect electrolyte balance rather than hemoglobin.
B
Diarrhea can cause electrolyte loss, but there is no indication this is occurring.
C
Orange juice contains potassium, which is often needed—not avoided—in clients taking loop diuretics.
D
Loop diuretics can cause electrolyte imbalances, especially hypokalemia, which commonly presents as generalized weakness.
QUESTION #6
Medical-Surgical Exam 1 Med-Surg
Which effect on respiratory effort does the nurse expect to find in a client with severe hypokalemia?
A Shallow respirations and low oxygen saturation
B Deep, rapid respirations with high oxygen saturation
C Deep, slow respirations with high oxygen saturation
D No specific change in respiratory rate or effectiveness

Explanations

A
Severe hypokalemia causes skeletal muscle weakness, including respiratory muscles, leading to shallow breathing and impaired ventilation.
B
This pattern is more consistent with metabolic acidosis (e.g., Kussmaul respirations), not hypokalemia.
C
Hypokalemia weakens muscles rather than increasing respiratory depth.
D
Severe hypokalemia can significantly impair respiratory muscle function and is not benign.
QUESTION #7
Medical-Surgical Exam 1 Med-Surg
Which sign or symptom does the nurse expect to see in a client who has mild hypernatremia?
A Muscle twitching and irregular muscle contractions
B Inability of muscles and nerves to respond to a stimulus
C Muscle weakness occurring bilaterally with no specific pattern
D Reduced or absent bilateral deep tendon reflexes

Explanations

A
Mild hypernatremia increases neuromuscular excitability, leading to twitching and muscle irritability.
B
This finding is more consistent with severe hypernatremia or electrolyte imbalances such as hypercalcemia.
C
Generalized weakness is more commonly associated with potassium imbalances rather than sodium excess.
D
Decreased reflexes are more typical of hypermagnesemia or severe hypokalemia.
QUESTION #8
Medical-Surgical Exam 1 Med-Surg
A nurse is assessing a client with hypokalemia and notes that the client’s handgrip strength has diminished since the previous assessment 1 hour ago. Which action should the nurse take first?
A Assess the client’s respiratory rate, rhythm, and depth.
B Measure the client’s pulse and blood pressure.
C Document findings and monitor the client.
D Call the health care provider.

Explanations

A
Hypokalemia causes skeletal muscle weakness, which can progress to respiratory muscle involvement and respiratory failure, making breathing the immediate priority.
B
Cardiac assessment is important in hypokalemia, but airway and breathing take priority when muscle weakness is worsening.
C
Documentation without further assessment delays intervention and is unsafe given the change in neuromuscular status.
D
The nurse must first complete focused assessment data before notifying the provider.
QUESTION #9
Medical-Surgical Exam 1 Med-Surg
A patient is receiving a 3% saline continuous IV infusion for hyponatremia. Which assessment data will require the most rapid response by the nurse?
A The patient’s radial pulse is 105 beats/min
B There are crackles throughout both lung fields
C There is sediment and blood in the patient’s urine
D The patient’s blood pressure increases to 142/94 mm Hg

Explanations

A
Mild tachycardia can occur with stress or illness and is not the most urgent finding.
B
Crackles indicate fluid overload and possible pulmonary edema, a life-threatening complication of hypertonic saline therapy.
C
This finding suggests a urinary issue but does not pose an immediate airway or breathing threat.
D
A moderate increase in blood pressure can occur with sodium administration but is less urgent than respiratory compromise.
QUESTION #10
Medical-Surgical Exam 1 Med-Surg
A nurse is assessing clients on a medical-surgical unit. Which client is at risk for hypokalemia?
A Client with pancreatitis who has continuous nasogastric suctioning
B Client who is prescribed an angiotensin-converting enzyme (ACE) inhibitor
C Client in a motor vehicle crash who is receiving 6 units of packed red blood cells
D Client with uncontrolled diabetes and a serum pH level of 7.33

Explanations

A
Gastric suction removes potassium-rich gastric fluids, placing the client at high risk for hypokalemia.
B
ACE inhibitors decrease potassium excretion and are more commonly associated with hyperkalemia.
C
Massive transfusions can increase potassium levels due to potassium leakage from stored red blood cells.
D
Acidosis causes potassium to shift out of cells, increasing serum potassium rather than decreasing it.
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