CMSRN Medical-Surgical Nursing MCQ 2 — Questions and Answers
Question 1: A patient with chronic kidney disease has a serum potassium of 6.2 mEq/L. Which assessment finding requires the nurse's immediate attention?
- Dry, itchy skin
- Peaked T-waves on ECG (Correct answer)
- Periorbital edema
- Decreased urine output
Correct answer: Peaked T-waves on ECG
Peaked T-waves on ECG indicate cardiac toxicity from hyperkalemia and require immediate intervention to prevent life-threatening dysrhythmias.
Question 2: A nurse is caring for a post-operative patient who received general anesthesia 2 hours ago. Which respiratory assessment finding is most concerning?
- Respiratory rate of 14 breaths/min
- SpO2 of 94% on room air
- Productive cough with clear sputum
- Oxygen saturation of 88% on 2L nasal cannula (Correct answer)
Correct answer: Oxygen saturation of 88% on 2L nasal cannula
SpO2 of 88% despite supplemental oxygen indicates inadequate oxygenation and potential respiratory compromise requiring immediate intervention.
Question 3: A patient with type 2 diabetes is scheduled for a CT scan with contrast. Which pre-procedure action is most important?
- Administer sliding scale insulin
- Hold metformin 48 hours before the procedure (Correct answer)
- Encourage oral fluid intake
- Check blood glucose every 2 hours
Correct answer: Hold metformin 48 hours before the procedure
Metformin must be held before contrast administration because contrast-induced nephropathy can impair metformin excretion, leading to lactic acidosis.
Question 4: Which intervention is highest priority when a patient reports sudden-onset severe chest pain radiating to the left arm with diaphoresis?
- Obtain a 12-lead ECG (Correct answer)
- Administer aspirin 325 mg PO
- Establish IV access
- Notify the physician
Correct answer: Obtain a 12-lead ECG
Obtaining a 12-lead ECG is the first priority to identify ST changes and determine if the patient is experiencing an acute MI requiring emergent intervention.
Question 5: A patient receiving IV vancomycin develops flushing, erythema, and hypotension during the infusion. What is the most likely cause?
- Anaphylactic reaction
- Red man syndrome (Correct answer)
- Septic shock
- Phlebitis at the IV site
Correct answer: Red man syndrome
Red man syndrome is a rate-related reaction to rapid vancomycin infusion causing flushing, erythema, and hypotension due to histamine release.
Question 6: A patient with COPD is admitted with an acute exacerbation. Which oxygen delivery method is most appropriate?
- Non-rebreather mask at 15 L/min
- Venturi mask at 24-28% FiO2 (Correct answer)
- Simple face mask at 8 L/min
- Nasal cannula at 6 L/min
Correct answer: Venturi mask at 24-28% FiO2
A Venturi mask delivers precise, controlled FiO2 (24-28%) to avoid suppressing the hypoxic drive that COPD patients may rely on for respiratory stimulation.
Question 7: A nurse is caring for a patient with a thrombotic stroke who is receiving tPA. Which assessment finding requires immediate cessation of the infusion?
- Blood pressure of 148/90 mmHg
- New onset severe headache (Correct answer)
- Heart rate of 96 beats/min
- Mild facial droop unchanged from admission
Correct answer: New onset severe headache
New severe headache during tPA infusion may indicate intracranial hemorrhage, a life-threatening complication requiring immediate cessation of the drug.
