NSG233/NSG 233 Final Exam V2 | Medical-
Surgical Nursing III Q&A with Rationale |
Herzing University
1. A nurse is caring for a patient who has developed Torsades de Pointes. Which of the
following medications should the nurse anticipate administering first?
A. Amiodarone
B. Epinephrine
C. Lidocaine
D. Magnesium Sulfate
Correct Answer: D
Rationale: Magnesium Sulfate is the first-line pharmacologic treatment for Torsades de
Pointes, a specific form of polymorphic ventricular tachycardia. This medication helps
stabilize the cardiac membrane and shorten the QT interval which is often prolonged in
these patients. The nurse must monitor for signs of magnesium toxicity such as decreased
deep tendon reflexes and respiratory depression.
2. Which of the following findings is considered a hallmark sign of Acute Respiratory Distress
Syndrome (ARDS)?
A. Hypoxemia that is responsive to high-flow oxygen
B. Decreased pulmonary artery wedge pressure (PAWP)
,C. Refractory hypoxemia despite increasing FiO2 levels
D. Respiratory acidosis caused by hyperventilation
Correct Answer: C
Rationale: Refractory hypoxemia is a definitive characteristic of ARDS where the patient’s
arterial oxygen levels do not improve even with aggressive supplemental oxygen delivery.
This occurs because the alveoli are filled with fluid or have collapsed, preventing effective
gas exchange. Nursing interventions often include the use of Positive End-Expiratory
Pressure (PEEP) to keep the alveoli open.
3. A patient with a traumatic brain injury (TBI) is showing signs of Cushing’s Triad. Which
clinical manifestations should the nurse expect to observe?
A. Tachycardia, hypotension, and tachypnea
B. Tachycardia, hypertension, and Kussmaul respirations
C. Bradycardia, hypotension, and Cheyne-Stokes respirations
D. Bradycardia, hypertension with a widening pulse pressure, and irregular respirations
Correct Answer: D
Rationale: Cushing’s Triad consists of bradycardia, hypertension with a widening pulse
pressure, and irregular or slowed respirations. These symptoms indicate a late stage of
increased intracranial pressure (ICP) and impending brain herniation. Immediate
intervention is required to reduce ICP and prevent further neurological damage.
,4. A patient in the oliguric phase of acute kidney injury (AKI) is at highest risk for which of the
following electrolyte imbalances?
A. Hypokalemia
B. Hypomagnesemia
C. Hyperkalemia
D. Hypercalcemia
Correct Answer: C
Rationale: Hyperkalemia is the most common and life-threatening electrolyte imbalance
during the oliguric phase of AKI due to the kidneys’ inability to excrete potassium. High
potassium levels can lead to lethal cardiac arrhythmias such as ventricular fibrillation or
asystole. The nurse should monitor the ECG for peaked T waves and widened QRS
complexes.
5. The nurse is assessing a patient with Diabetic Ketoacidosis (DKA). Which of the following
findings would help differentiate DKA from Hyperosmolar Hyperglycemic State (HHS)?
A. Blood glucose level of 450 mg/dL
B. Manifestations of severe dehydration
C. Presence of ketones in the urine and blood
D. Altered mental status and confusion
Correct Answer: C
, Rationale: The presence of ketones and metabolic acidosis are the primary clinical
features that differentiate DKA from HHS. While both conditions involve hyperglycemia
and dehydration, HHS typically presents with much higher glucose levels and a lack of
significant ketosis. Patients with DKA often exhibit Kussmaul respirations as a
compensatory mechanism to blow off excess CO2.
6. A patient’s cardiac monitor shows Supraventricular Tachycardia (SVT) with a heart rate of
190 bpm. The patient is symptomatic but stable. What is the initial nursing action?
A. Instruct the patient to perform a Valsalva maneuver
B. Administer a bolus of Amiodarone
C. Prepare for synchronized cardioversion
D. Administer IV Atropine
Correct Answer: A
Rationale: For a stable patient in SVT, vagal maneuvers such as the Valsalva maneuver or
coughing are often attempted first to slow the heart rate. If these maneuvers fail, the
pharmacological treatment of choice is typically Adenosine administered rapidly via IV
push. Synchronized cardioversion is reserved for patients who are hemodynamically
unstable.
7. Using the Parkland Formula, calculate the total fluid volume needed in the first 24 hours
for a 70 kg patient with 40% total body surface area (TBSA) burns.
A. 5,600 mL
Surgical Nursing III Q&A with Rationale |
Herzing University
1. A nurse is caring for a patient who has developed Torsades de Pointes. Which of the
following medications should the nurse anticipate administering first?
A. Amiodarone
B. Epinephrine
C. Lidocaine
D. Magnesium Sulfate
Correct Answer: D
Rationale: Magnesium Sulfate is the first-line pharmacologic treatment for Torsades de
Pointes, a specific form of polymorphic ventricular tachycardia. This medication helps
stabilize the cardiac membrane and shorten the QT interval which is often prolonged in
these patients. The nurse must monitor for signs of magnesium toxicity such as decreased
deep tendon reflexes and respiratory depression.
2. Which of the following findings is considered a hallmark sign of Acute Respiratory Distress
Syndrome (ARDS)?
A. Hypoxemia that is responsive to high-flow oxygen
B. Decreased pulmonary artery wedge pressure (PAWP)
,C. Refractory hypoxemia despite increasing FiO2 levels
D. Respiratory acidosis caused by hyperventilation
Correct Answer: C
Rationale: Refractory hypoxemia is a definitive characteristic of ARDS where the patient’s
arterial oxygen levels do not improve even with aggressive supplemental oxygen delivery.
This occurs because the alveoli are filled with fluid or have collapsed, preventing effective
gas exchange. Nursing interventions often include the use of Positive End-Expiratory
Pressure (PEEP) to keep the alveoli open.
3. A patient with a traumatic brain injury (TBI) is showing signs of Cushing’s Triad. Which
clinical manifestations should the nurse expect to observe?
A. Tachycardia, hypotension, and tachypnea
B. Tachycardia, hypertension, and Kussmaul respirations
C. Bradycardia, hypotension, and Cheyne-Stokes respirations
D. Bradycardia, hypertension with a widening pulse pressure, and irregular respirations
Correct Answer: D
Rationale: Cushing’s Triad consists of bradycardia, hypertension with a widening pulse
pressure, and irregular or slowed respirations. These symptoms indicate a late stage of
increased intracranial pressure (ICP) and impending brain herniation. Immediate
intervention is required to reduce ICP and prevent further neurological damage.
,4. A patient in the oliguric phase of acute kidney injury (AKI) is at highest risk for which of the
following electrolyte imbalances?
A. Hypokalemia
B. Hypomagnesemia
C. Hyperkalemia
D. Hypercalcemia
Correct Answer: C
Rationale: Hyperkalemia is the most common and life-threatening electrolyte imbalance
during the oliguric phase of AKI due to the kidneys’ inability to excrete potassium. High
potassium levels can lead to lethal cardiac arrhythmias such as ventricular fibrillation or
asystole. The nurse should monitor the ECG for peaked T waves and widened QRS
complexes.
5. The nurse is assessing a patient with Diabetic Ketoacidosis (DKA). Which of the following
findings would help differentiate DKA from Hyperosmolar Hyperglycemic State (HHS)?
A. Blood glucose level of 450 mg/dL
B. Manifestations of severe dehydration
C. Presence of ketones in the urine and blood
D. Altered mental status and confusion
Correct Answer: C
, Rationale: The presence of ketones and metabolic acidosis are the primary clinical
features that differentiate DKA from HHS. While both conditions involve hyperglycemia
and dehydration, HHS typically presents with much higher glucose levels and a lack of
significant ketosis. Patients with DKA often exhibit Kussmaul respirations as a
compensatory mechanism to blow off excess CO2.
6. A patient’s cardiac monitor shows Supraventricular Tachycardia (SVT) with a heart rate of
190 bpm. The patient is symptomatic but stable. What is the initial nursing action?
A. Instruct the patient to perform a Valsalva maneuver
B. Administer a bolus of Amiodarone
C. Prepare for synchronized cardioversion
D. Administer IV Atropine
Correct Answer: A
Rationale: For a stable patient in SVT, vagal maneuvers such as the Valsalva maneuver or
coughing are often attempted first to slow the heart rate. If these maneuvers fail, the
pharmacological treatment of choice is typically Adenosine administered rapidly via IV
push. Synchronized cardioversion is reserved for patients who are hemodynamically
unstable.
7. Using the Parkland Formula, calculate the total fluid volume needed in the first 24 hours
for a 70 kg patient with 40% total body surface area (TBSA) burns.
A. 5,600 mL
