College Exams & Notes

Master your nursing exams with comprehensive practice questions and detailed explanations

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QUESTION #1
Medical-Surgical Exam 2 Med-Surg
A client was just admitted to the emergency department with a diagnosis of new-onset acute ischemic stroke. What drug would the nurse anticipate to treat the client at this time?
A Heparin
B Nimodipine
C Alteplase
D Aspirin

Explanations

A
Anticoagulants are not used in the acute phase of ischemic stroke due to bleeding risk and lack of immediate benefit.
B
This medication is used to prevent cerebral vasospasm in subarachnoid hemorrhage, not ischemic stroke.
C
Alteplase is a fibrinolytic (tPA) used to dissolve clots in acute ischemic stroke when given within the approved time window.
D
Aspirin is used for secondary prevention and is started after hemorrhage is ruled out or if the client is not eligible for tPA.
QUESTION #2
Medical-Surgical Exam 2 Med-Surg
It’s highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which of the following reasons?
A All clients are recommended to have these vaccines.
B These vaccines produce bronchodilation and improve oxygenation.
C These vaccines help reduce the tachypnea these clients experience.
D Respiratory infections can cause severe hypoxia and possibly death in these clients.

Explanations

A
While many people are advised to receive them, this does not explain the increased priority for clients with chronic lung disease.
B
Vaccines prevent infection; they do not have direct bronchodilator effects.
C
Tachypnea is a symptom, not the primary reason for vaccination.
D
Chronic lung disease clients have limited respiratory reserve, so infections can quickly lead to life-threatening hypoxemia.
QUESTION #3
Medical-Surgical Exam 2 Med-Surg
The term “pink puffer” refers to the client with which of the following conditions?
A ARDS
B Asthma
C Chronic obstructive bronchitis
D Emphysema

Explanations

A
ARDS is an acute, severe inflammatory lung condition and is not associated with the “pink puffer” description.
B
Asthma involves episodic, reversible airway obstruction and does not fit the chronic presentation of a “pink puffer.”
C
This condition is classically referred to as the “blue bloater.”
D
Emphysema causes alveolar destruction and air trapping, leading to dyspnea, weight loss, and relatively maintained oxygenation—hence “pink puffer.”
QUESTION #4
Medical-Surgical Exam 2 Med-Surg
The term “blue bloater” refers to which of the following conditions?
A Adult respiratory distress syndrome (ARDS)
B Asthma
C Chronic obstructive bronchitis
D Emphysema

Explanations

A
ARDS is an acute inflammatory lung injury and is not associated with the classic “blue bloater” description.
B
Asthma involves reversible airway obstruction and does not cause chronic cyanosis with fluid retention.
C
Chronic bronchitis causes chronic hypoxemia and hypercapnia, leading to cyanosis (“blue”) and fluid retention or edema (“bloater”).
D
Emphysema is classically associated with the “pink puffer” phenotype rather than cyanosis and edema.
QUESTION #5
Medical-Surgical Exam 2 Med-Surg
A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first?
A Take a full medication history.
B Give a bronchodilator by nebulizer.
C Apply a cardiac monitor to the client.
D Provide emotional support to the client.

Explanations

A
History is important but must not delay immediate treatment of life-threatening bronchospasm.
B
Acute asthma with severe tachypnea requires rapid bronchodilation to relieve airway obstruction.
C
Monitoring is useful but secondary to opening the airway.
D
Supportive care is helpful but does not address the urgent respiratory compromise.
QUESTION #6
Medical-Surgical Exam 2 Med-Surg
A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away?
A Beta-adrenergic blockers
B Bronchodilators
C Inhaled steroids
D Oral steroids

Explanations

A
These medications can worsen bronchoconstriction and are contraindicated in acute asthma.
B
Short-acting beta-agonist bronchodilators rapidly relax bronchial smooth muscle, improving airflow and expiratory volume in an acute attack.
C
These reduce airway inflammation but do not provide immediate relief during acute bronchospasm.
D
Systemic steroids are important for reducing inflammation but take hours to work and are not first-line for immediate symptom relief.
QUESTION #7
Medical-Surgical Exam 2 Med-Surg
An elderly client with pneumonia may appear with which of the following symptoms first?
A Altered mental status and dehydration
B Fever and chills
C Hemoptysis and dyspnea
D Pleuritic chest pain and cough

Explanations

A
Older adults often present atypically, with confusion, lethargy, and dehydration appearing before classic respiratory symptoms.
B
Elderly clients may have a blunted febrile response, so fever may be absent or mild early on.
C
These are later or more severe findings and are not usually the earliest symptoms in older adults.
D
Classic pneumonia symptoms may be subtle or delayed in the elderly.
QUESTION #8
Medical-Surgical Exam 2 Med-Surg
If a client continues to hypoventilate, the nurse will continually assess for a complication of:
A Respiratory acidosis
B Respiratory alkalosis
C Metabolic acidosis
D Metabolic alkalosis

Explanations

A
Hypoventilation causes CO₂ retention, leading to increased PaCO₂ and decreased pH.
B
This occurs with hyperventilation, not hypoventilation.
C
This results from excess acid production or bicarbonate loss, not inadequate ventilation.
D
This is associated with excessive bicarbonate or acid loss, not respiratory failure.
QUESTION #9
Medical-Surgical Exam 2 Med-Surg
Immediately following a thoracentesis, which clinical manifestations indicate that a complication has occurred and the physician should be notified?
A Serosanguineous drainage from the puncture site.
B Increased temperature and blood pressure.
C Increased pulse and pallor.
D Hypotension and hypothermia.

Explanations

A
A small amount of drainage can be expected and is not necessarily a complication.
B
Fever would not occur immediately, and blood pressure typically does not rise with post-procedure complications.
C
Tachycardia and pallor suggest acute bleeding or pneumothorax, both serious complications requiring immediate provider notification.
D
Hypotension may occur with bleeding, but hypothermia is not a typical acute post-thoracentesis complication.
QUESTION #10
Medical-Surgical Exam 2 Med-Surg
A cyanotic client with an unknown diagnosis is admitted to the emergency room. In relation to oxygen, the first nursing action would be to:
A Wait until the client’s lab work is done.
B Not administer oxygen unless ordered by the physician.
C Administer oxygen at 2 L flow per minute.
D Administer oxygen at 10 L flow per minute and check the client’s nail beds.

Explanations

A
Delaying oxygen therapy in a cyanotic client places the client at risk for worsening hypoxia.
B
Oxygen may be initiated by the nurse in an emergency without waiting for a prescription.
C
In a client with an unknown diagnosis, oxygen should be started at a low flow rate to improve oxygenation while avoiding potential oxygen-induced complications (e.g., in COPD).
D
High-flow oxygen may be harmful in clients who rely on hypoxic drive and is not the safest initial action when the diagnosis is unknown.
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