DOH Nursing Adult Health Nursing 2 — Questions and Answers
Question 1: Which electrolyte imbalance is most commonly associated with prolonged nasogastric suction?
- Hypokalemia and metabolic alkalosis (Correct answer)
- Hyperkalemia and metabolic acidosis
- Hyponatremia and respiratory acidosis
- Hypernatremia and metabolic alkalosis
Correct answer: Hypokalemia and metabolic alkalosis
NG suction removes gastric acid (HCl) and fluids rich in potassium. Loss of hydrogen and chloride ions causes metabolic alkalosis. Continuous loss of gastric contents depletes potassium, causing hypokalemia.
Question 2: A patient post-thyroidectomy develops tetany and positive Chvostek's sign. Which electrolyte abnormality is most likely?
- Hypocalcemia (Correct answer)
- Hypomagnesemia
- Hypokalemia
- Hypophosphatemia
Correct answer: Hypocalcemia
The parathyroid glands lie adjacent to the thyroid and may be inadvertently removed or damaged during thyroidectomy. Loss of PTH causes hypocalcemia, manifesting as neuromuscular irritability, tetany, and positive Chvostek's/Trousseau's signs.
Question 3: Which finding should the nurse report immediately in a patient receiving heparin therapy?
- Sudden back pain and decreased blood pressure (Correct answer)
- aPTT of 60–80 seconds (therapeutic range met)
- Mild bruising at the injection site
- Urine output of 45 mL/hr
Correct answer: Sudden back pain and decreased blood pressure
Sudden back pain with hypotension in a heparinized patient suggests retroperitoneal hemorrhage or aortic dissection/hemorrhage — a life-threatening complication. This requires immediate physician notification and possible reversal with protamine sulfate.
Question 4: A patient's troponin I level is elevated 6 hours after chest pain onset. What does this finding indicate?
- Myocardial cell necrosis consistent with MI (Correct answer)
- Normal response to strenuous exercise
- Pulmonary embolism with right heart strain
- Pericarditis without myocardial damage
Correct answer: Myocardial cell necrosis consistent with MI
Troponin I is a highly specific cardiac biomarker released when cardiomyocytes die. Elevation 6 hours post-chest pain onset confirms myocardial necrosis (MI). Troponin begins rising 3–4 hours after MI and peaks at 24–48 hours.
Question 5: Which nursing assessment is most important after administering morphine for post-operative pain?
- Respiratory rate and oxygen saturation (Correct answer)
- Blood pressure alone
- Level of pain using a numeric scale
- Bowel sounds and last bowel movement
Correct answer: Respiratory rate and oxygen saturation
Opioids like morphine cause respiratory depression as their primary serious adverse effect. Monitoring respiratory rate and SpO2 is critical to detect early respiratory compromise. Naloxone (reversal agent) must be immediately available.
Question 6: A patient has a serum potassium of 6.8 mEq/L. Which ECG change is expected?
- Tall, peaked T waves (Correct answer)
- Flattened T waves and U waves
- ST elevation in inferior leads
- Widened QRS with left bundle branch block pattern
Correct answer: Tall, peaked T waves
Hyperkalemia (K+ >5.5 mEq/L) first causes tall, peaked (tented) T waves. As levels rise further, the PR interval widens, QRS broadens, and eventually a sine-wave pattern and ventricular fibrillation can occur.
DOH Nursing Adult Health Nursing 2
Which electrolyte imbalance is most commonly associated with prolonged nasogastric suction?