Saudi Prometric Nursing Medical-Surgical Nursing 2 — Questions and Answers
Question 1: A patient is admitted with diabetic ketoacidosis (DKA). Which arterial blood gas result is expected?
- pH 7.28, PaCO2 28, HCO3 14 (metabolic acidosis with respiratory compensation) (Correct answer)
- pH 7.50, PaCO2 48, HCO3 36 (metabolic alkalosis)
- pH 7.35, PaCO2 40, HCO3 24 (normal)
- pH 7.48, PaCO2 32, HCO3 24 (respiratory alkalosis)
Correct answer: pH 7.28, PaCO2 28, HCO3 14 (metabolic acidosis with respiratory compensation)
DKA causes metabolic acidosis from ketone accumulation. Expected ABG findings are low pH (<7.35), low HCO3 (<18), and low PaCO2 due to compensatory hyperventilation (Kussmaul respirations), which attempts to blow off CO2 to raise pH.
Question 2: A nurse is caring for a patient with acute pancreatitis. Which position provides the most comfort?
- Fetal position (knees drawn to chest) (Correct answer)
- Supine with legs extended
- High Fowler's position
- Left lateral decubitus
Correct answer: Fetal position (knees drawn to chest)
The fetal position (knees drawn to chest, leaning forward) reduces tension on the retroperitoneal space and alleviates pain from pancreatic inflammation. This position is a characteristic finding in acute pancreatitis history.
Question 3: A post-operative patient reports sudden chest pain and shortness of breath on day 2 after hip replacement surgery. The nurse should first suspect:
- Pulmonary embolism (Correct answer)
- Pneumonia
- Myocardial infarction
- Pneumothorax
Correct answer: Pulmonary embolism
Sudden chest pain, dyspnea, tachycardia, and hypoxia in a post-orthopedic surgery patient are classic signs of pulmonary embolism (PE) due to deep vein thrombosis (DVT). Virchow's triad (stasis, hypercoagulability, vessel damage) is present post-surgery.
Question 4: The nurse is caring for a patient in acute liver failure. Which laboratory finding is of greatest concern?
- INR of 4.5 (Correct answer)
- ALT of 80 U/L
- Albumin of 3.2 g/dL
- Bilirubin of 2.5 mg/dL
Correct answer: INR of 4.5
An INR of 4.5 indicates severely impaired coagulation, as the liver produces clotting factors. This level significantly increases bleeding risk. While elevated ALT and bilirubin indicate liver damage, coagulopathy represents the most immediate life-threatening concern.
Question 5: A patient with chronic renal failure has a serum potassium of 6.2 mEq/L. Which ECG change should the nurse monitor for?
- Tall peaked T waves (Correct answer)
- ST depression
- Prolonged PR interval
- Widened QRS only
Correct answer: Tall peaked T waves
Hyperkalemia first manifests on ECG as tall, peaked (tent-shaped) T waves. As potassium rises further, PR interval prolongation, widened QRS, and eventually ventricular fibrillation can occur. Tall T waves are the earliest ECG sign.
Question 6: The nurse is caring for a patient after a right-sided stroke. Where should the nurse expect motor deficits?
- Left side of the body (Correct answer)
- Right side of the body
- Both sides equally
- Face only
Correct answer: Left side of the body
The brain controls the contralateral (opposite) side of the body due to decussation of motor fibers in the medulla. A right-sided stroke causes left-sided (contralateral) hemiplegia or hemiparesis.
Saudi Prometric Nursing Medical-Surgical Nursing 2
A patient is admitted with diabetic ketoacidosis (DKA).
Which arterial blood gas result is expected?