CMSRN Medical-Surgical Nursing MCQ 4 — Questions and Answers
Question 1: A patient with acute respiratory distress syndrome (ARDS) is mechanically ventilated. Which ventilator strategy is consistent with lung-protective ventilation?
- Tidal volume of 10-12 mL/kg ideal body weight
- PEEP of 0-2 cmH2O
- Tidal volume of 4-6 mL/kg ideal body weight (Correct answer)
- FiO2 maintained at 1.0 continuously
Correct answer: Tidal volume of 4-6 mL/kg ideal body weight
Lung-protective ventilation in ARDS uses low tidal volumes (4-6 mL/kg IBW) to minimize ventilator-induced lung injury from barotrauma and volutrauma.
Question 2: A patient develops sudden-onset shortness of breath and hypotension 3 days after hip arthroplasty. Which complication is most likely?
- Hospital-acquired pneumonia
- Pulmonary embolism (Correct answer)
- Myocardial infarction
- Atelectasis
Correct answer: Pulmonary embolism
Pulmonary embolism classically presents with sudden dyspnea and hypotension in the post-operative period due to DVT embolizing to the pulmonary vasculature.
Question 3: A nurse is preparing to administer 40 mEq potassium chloride IV to a patient with hypokalemia. Which action is most important?
- Administer the dose via IV push over 5 minutes
- Dilute in at least 100 mL and infuse no faster than 10 mEq/hr (Correct answer)
- Mix with calcium gluconate before infusion
- Use a peripheral line and infuse at 40 mEq/hr
Correct answer: Dilute in at least 100 mL and infuse no faster than 10 mEq/hr
Potassium chloride must be diluted and infused slowly (≤10 mEq/hr peripheral) to prevent cardiac dysrhythmias and venous irritation.
Question 4: Which finding in a patient with a urinary catheter most strongly suggests catheter-associated urinary tract infection (CAUTI)?
- Urine output of 35 mL/hr
- Urine that appears cloudy with a foul odor and patient has fever (Correct answer)
- Mild hematuria noted on day 1 post-insertion
- Urine specific gravity of 1.020
Correct answer: Urine that appears cloudy with a foul odor and patient has fever
Cloudy, malodorous urine combined with fever in a catheterized patient meets clinical criteria for suspected CAUTI and warrants urine culture.
Question 5: A patient with Addison's disease is admitted for surgery. Which perioperative consideration is most critical?
- Restricting IV fluids to prevent fluid overload
- Administering stress-dose corticosteroids (Correct answer)
- Monitoring for hyperglycemia during recovery
- Avoiding opioid analgesics post-operatively
Correct answer: Administering stress-dose corticosteroids
Patients with Addison's disease cannot mount a cortisol stress response; stress-dose corticosteroids must be administered perioperatively to prevent adrenal crisis.
Question 6: A patient receiving chemotherapy for colon cancer has an absolute neutrophil count (ANC) of 400/mm³. Which visitor restriction is most appropriate?
- No restrictions are necessary
- Allow only family members who have received flu vaccination
- Restrict all visitors with signs of infection (Correct answer)
- Restrict all visitors until ANC exceeds 1,000/mm³
Correct answer: Restrict all visitors with signs of infection
Severe neutropenia (ANC <500) requires neutropenic precautions, including restricting visitors with any infection signs to prevent transmission of potentially fatal infections.
Question 7: A patient with a newly created colostomy appears tearful and states, 'I'll never be able to go out in public again.' Which nursing response is most therapeutic?
- Reassure the patient that the colostomy will not be noticeable to others
- Acknowledge the patient's feelings and discuss concerns about body image (Correct answer)
- Arrange a social work referral immediately
- Provide written materials about colostomy management
Correct answer: Acknowledge the patient's feelings and discuss concerns about body image
Acknowledging the patient's feelings validates their emotional response and opens therapeutic communication to address body image and psychosocial concerns.
CMSRN Medical-Surgical Nursing MCQ 4
A patient with acute respiratory distress syndrome (ARDS) is mechanically ventilated.
Which ventilator strategy is consistent with lung-protective ventilation?