CMSRN - Medical-Surgical Nursing Medical-Surgical Nursing 1

Question 1

A patient with a traumatic brain injury has a Glasgow Coma Scale score of 8 and begins exhibiting Cushing's triad. Which set of vital signs best represents this triad?

Accepted Answer

Hypertension, bradycardia, and irregular respirations

Answer

Cushing's triad is a late sign of increased intracranial pressure consisting of hypertension (widened pulse pressure), bradycardia, and irregular respirations (often Cheyne-Stokes). It signals impending brainstem herniation and requires immediate intervention.

Question 2

A patient is admitted with an acute exacerbation of COPD and an arterial blood gas showing pH 7.28, PaCO2 62 mmHg, HCO3 26 mEq/L, and PaO2 54 mmHg. How should the nurse interpret these results?

Accepted Answer

Respiratory acidosis, uncompensated

Answer

The low pH indicates acidosis; the elevated PaCO2 identifies the cause as respiratory (CO2 retention from hypoventilation). The HCO3 is normal, meaning the kidneys have not yet compensated, making this uncompensated respiratory acidosis.

Question 3

A nurse is caring for a postoperative patient who suddenly develops a PaO2 of 58 mmHg, dyspnea, pleuritic chest pain, and hemoptysis 3 days after a total hip replacement. What is the priority nursing action?

Accepted Answer

Administer supplemental oxygen and notify the physician immediately

Answer

The clinical picture — pleuritic chest pain, hemoptysis, hypoxemia, and dyspnea following orthopedic surgery — strongly suggests pulmonary embolism. The priority is to maintain oxygenation with supplemental oxygen while immediately notifying the physician for further management including imaging and anticoagulation.

Question 4

A patient with type 1 diabetes is found unresponsive with a blood glucose of 28 mg/dL. The patient has no IV access and is unable to swallow. Which intervention should the nurse perform first?

Accepted Answer

Administer 1 mg of glucagon intramuscularly

Answer

When a patient is unresponsive and has no IV access, intramuscular glucagon is the correct route of administration for severe hypoglycemia. Glucagon stimulates hepatic glycogenolysis to rapidly raise blood glucose. Oral glucose and buccal gel are contraindicated in an unresponsive patient due to aspiration risk.

Question 5

A patient with acute pancreatitis is prescribed morphine for pain management. The nurse understands that which laboratory value should be monitored most closely due to this drug's pharmacological effect?

Accepted Answer

Serum amylase and lipase levels

Answer

Opioids, including morphine, can cause spasm of the sphincter of Oddi, potentially worsening pancreatitis by impeding pancreatic enzyme drainage. Monitoring serum amylase and lipase tracks whether pancreatic inflammation is improving or worsening during treatment.

CMSRN - Medical-Surgical Nursing Practice Test

CMSRN - Medical-Surgical Nursing Practice Test

CMSRN - Medical-Surgical Nursing Medical-Surgical Nursing 1