Saudi Prometric Nursing Medical-Surgical Nursing 1 — Questions and Answers
Question 1: A patient with type 2 diabetes is prescribed metformin. Which condition is a contraindication to metformin therapy?
- Chronic kidney disease (eGFR <30 mL/min) (Correct answer)
- Hypertension
- Obesity
- Hypercholesterolemia
Correct answer: Chronic kidney disease (eGFR <30 mL/min)
Metformin is contraindicated in patients with significant renal impairment (eGFR <30 mL/min) because it is renally excreted and accumulation increases the risk of lactic acidosis, a rare but potentially fatal complication.
Question 2: A nurse is caring for a patient following a myocardial infarction. The patient develops new ST elevation in leads II, III, and aVF. Which area of the heart is most likely affected?
- Inferior wall (Correct answer)
- Anterior wall
- Lateral wall
- Posterior wall
Correct answer: Inferior wall
Leads II, III, and aVF view the inferior wall of the heart, which is supplied by the right coronary artery (RCA). ST elevation in these leads indicates an inferior MI, most commonly due to RCA occlusion.
Question 3: A patient with chronic obstructive pulmonary disease (COPD) is admitted with acute exacerbation. Which oxygen delivery method and target saturation is most appropriate?
- Controlled oxygen via Venturi mask, target SpO2 88–92% (Correct answer)
- High-flow oxygen via non-rebreather mask, target SpO2 95–100%
- Nasal cannula at 6 L/min
- Bilevel positive airway pressure (BiPAP) immediately
Correct answer: Controlled oxygen via Venturi mask, target SpO2 88–92%
COPD patients with hypercapnia rely on hypoxic drive for breathing. Controlled oxygen via Venturi mask targeting SpO2 88–92% avoids both hypoxia and excessive oxygen that could suppress respiratory drive and worsen hypercapnia.
Question 4: The nurse is caring for a patient post-thyroidectomy. Which finding should the nurse assess for as the most serious immediate complication?
- Stridor and respiratory distress (Correct answer)
- Mild hoarseness
- Hypokalemia
- Facial flushing
Correct answer: Stridor and respiratory distress
Post-thyroidectomy, the most immediate life-threatening complication is hematoma formation causing airway compression, presenting as stridor and respiratory distress. Hypocalcemia (from parathyroid removal) and hoarseness are also concerns but are less immediately fatal.
Question 5: A patient is prescribed digoxin. Which assessment finding requires the nurse to withhold the medication and notify the physician?
- Apical pulse of 52 beats per minute (Correct answer)
- Blood pressure of 130/82 mmHg
- Serum potassium of 3.8 mEq/L
- Serum sodium of 138 mEq/L
Correct answer: Apical pulse of 52 beats per minute
Digoxin should be withheld if the apical pulse is below 60 beats per minute. Bradycardia is a sign of digoxin toxicity. Hypokalemia also increases digoxin toxicity risk, but the potassium level here is normal.
Question 6: The nurse assesses a patient and finds pitting edema in both ankles rated 3+. What does this finding indicate?
- The indentation persists for more than 1 minute and is 5–6 mm deep (Correct answer)
- The indentation disappears immediately
- The indentation is 1–2 mm deep and rebounds quickly
- The indentation is >8 mm and does not rebound
Correct answer: The indentation persists for more than 1 minute and is 5–6 mm deep
Pitting edema is graded 1+ to 4+. 3+ edema produces a 5–6 mm pit that persists for more than 1 minute. 4+ edema produces an indentation >8 mm that does not rebound. This grading system helps track fluid overload.
Saudi Prometric Nursing Medical-Surgical Nursing 1
A patient with type 2 diabetes is prescribed metformin.
Which condition is a contraindication to metformin therapy?