NSG 223 MED SURG II
HERZING UNIVERSITY- MEDICAL-SURGICAL NURSING II
170 QUESTIONS AND CORRECT ANSWERS
NSG 223 MED SURG II -2027/2027 FINAL EXAM
This comprehensive 170-question final exam guide for NSG 223 Med Surg II
reflects the latest evidence-based practices in advanced medical-surgical
nursing for the 2026/2027 academic cycle. The content emphasizes complex
patient management, critical thinking in high-acuity settings, interdisciplinary
collaboration, and application of advanced pathophysiology and pharmacology
principles to adult health disorders. Each question includes four answer choices
(1-4) with the correct answer highlighted and detailed rationales incorporating
priority-setting frameworks, pharmacological management, and evidence-based
protocols for complex medical-surgical conditions. This resource is designed
for nursing students preparing for comprehensive final examinations, NCLEX-RN
preparation, and clinical practice integration.
1. A patient with acute myocardial infarction (STEMI) is receiving thrombolytic therapy.
Which finding requires immediate intervention?
1) Mild headache
2) Facial droop and slurred speech
3) Nausea
4) Sinus tachycardia at 102 bpm
Correct Answer: 2) Facial droop and slurred speech
Explanation: Thrombolytics (e.g., alteplase) increase the risk of intracranial hemorrhage
(ICH). Facial droop and slurred speech are signs of stroke, a life-threatening complication.
Immediate neurologic assessment and CT scan are required. Mild headache may be
benign, but new focal neurologic deficits are red flags per AHA/ACC STEMI guidelines.
2. The nurse is caring for a patient with acute decompensated heart failure (ADHF) and
crackles in all lung fields. Which medication should the nurse anticipate administering first?
1) Metoprolol
2) Furosemide
3) Lisinopril
4) Spironolactone
Correct Answer: 2) Furosemide
, Explanation: Furosemide (loop diuretic) is first-line for acute pulmonary edema in ADHF
to reduce preload and fluid overload. Beta-blockers (metoprolol) and ACE inhibitors
(lisinopril) are contraindicated in acute decompensation due to negative inotropy and
hypotension risk. Spironolactone is a potassium-sparing diuretic used for chronic
management, not acute rescue.
3. A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2
mEq/L. Which intervention is the priority?
1) Administer sodium polystyrene sulfonate (Kayexalate)
2) Give IV calcium gluconate
3) Initiate dialysis
4) Restrict dietary potassium
Correct Answer: 2) Give IV calcium gluconate
Explanation: Hyperkalemia >6.0 mEq/L with ECG changes (e.g., peaked T-waves) is a
medical emergency. IV calcium gluconate stabilizes the myocardium within minutes to
prevent lethal arrhythmias. Kayexalate lowers K+ over hours; dialysis is definitive but not
immediate. Cardiac protection takes precedence over K+ reduction per KDIGO
guidelines.
4. A patient with traumatic brain injury (TBI) has an intracranial pressure (ICP) of 28 mm
Hg. Which action should the nurse take first?
1) Elevate the head of the bed to 30 degrees
2) Administer mannitol 1 g/kg IV
3) Hyperventilate to PaCO₂ of 25 mmHg
4) Notify the provider immediately
Correct Answer: 1) Elevate the head of the bed to 30 degrees
Explanation: Elevating the head of the bed promotes venous drainage and reduces
ICP—a non-invasive, immediate intervention per the Brain Trauma Foundation guidelines.
Mannitol is second-line; hyperventilation is reserved for acute herniation due to rebound
ischemia risk. The nurse can implement HOB elevation without a provider order.
5. A patient with septic shock has a mean arterial pressure (MAP) of 58 mm Hg despite
fluid resuscitation. Which vasopressor should the nurse anticipate?
1) Dopamine
2) Epinephrine
3) Norepinephrine
4) Phenylephrine
Correct Answer: 3) Norepinephrine
Explanation: Norepinephrine is first-line vasopressor in septic shock per Surviving Sepsis
Campaign guidelines due to its potent alpha-agonist effects (vasoconstriction) with minimal
beta-effects (tachycardia). Dopamine is second-line; epinephrine is added if
norepinephrine fails; phenylephrine lacks inotropic support.
,6. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation
with PEEP of 12 cm H₂O. Which assessment finding indicates PEEP is effective?
1) SaO₂ 88%
2) PaO₂ 65 mm Hg
3) PaO₂/FiO₂ ratio of 180
4) PaO₂/FiO₂ ratio of 320
Correct Answer: 4) PaO₂/FiO₂ ratio of 320
Explanation: ARDS is defined by PaO₂/FiO₂ ≤300 (mild), ≤200 (moderate), ≤100
(severe). A ratio of 320 indicates improved oxygenation and effective PEEP. SaO₂ 88%
and PaO₂ 65 mm Hg reflect hypoxemia; a ratio of 180 indicates moderate ARDS.
7. A patient with type 1 diabetes has blood glucose of 420 mg/dL, arterial pH of 7.18,
and serum bicarbonate of 12 mEq/L. Which condition does the nurse anticipate?
1) Hyperosmolar hyperglycemic state (HHS)
2) Diabetic ketoacidosis (DKA)
3) Hypoglycemia
4) Lactic acidosis
Correct Answer: 2) Diabetic ketoacidosis (DKA)
Explanation: DKA is characterized by hyperglycemia (>250 mg/dL), metabolic acidosis
(pH <7.3, HCO₃⁻ <18), and ketonemia. HHS presents with extreme hyperglycemia (>600
mg/dL) but minimal acidosis. Lactic acidosis has elevated lactate; hypoglycemia has low
glucose. DKA requires insulin, fluids, and electrolyte replacement per ADA protocol.
8. A patient with multiple myeloma reports severe bone pain. Which medication is the
priority?
1) Ibuprofen
2) Acetaminophen
3) Morphine
4) Aspirin
Correct Answer: 3) Morphine
Explanation: Multiple myeloma causes lytic bone lesions and severe pain requiring
opioid analgesia. NSAIDs (ibuprofen, aspirin) are contraindicated due to nephrotoxicity
risk in myeloma (light chain cast nephropathy). Acetaminophen is insufficient for severe
pain. Morphine provides effective analgesia with renal dose adjustment.
9. A patient with cirrhosis develops asterixis and confusion. Which condition should the
nurse suspect?
1) Hypoglycemia
2) Hepatic encephalopathy
3) Hyponatremia
, 4) Hyperkalemia
Correct Answer: 2) Hepatic encephalopathy
Explanation: Asterixis (liver flap) and confusion are classic signs of hepatic
encephalopathy caused by ammonia accumulation due to liver failure. Hypoglycemia may
occur but doesn't cause asterixis. Hyponatremia and hyperkalemia are electrolyte
imbalances seen in cirrhosis but don't directly cause asterixis. Treatment includes lactulose
and rifaximin.
10. A patient with acute pancreatitis has severe abdominal pain radiating to the back.
Which laboratory finding is most specific for this diagnosis?
1) Elevated amylase
2) Elevated lipase
3) Elevated ALT
4) Elevated bilirubin
Correct Answer: 2) Elevated lipase
Explanation: Lipase is more specific and sensitive for acute pancreatitis than amylase.
Amylase can be elevated in other conditions (e.g., salivary gland disorders). ALT and
bilirubin indicate hepatic/biliary pathology, which may be a cause but not diagnostic of
pancreatitis. Lipase remains elevated longer than amylase.
11. A patient with COPD has an arterial blood gas (ABG) showing: pH 7.30, PaCO₂ 58
mm Hg, HCO₃⁻ 30 mEq/L. Which condition does this indicate?
1) Acute respiratory acidosis
2) Chronic respiratory acidosis with metabolic compensation
3) Metabolic alkalosis
4) Acute respiratory alkalosis
Correct Answer: 2) Chronic respiratory acidosis with metabolic compensation
Explanation: Low pH (<7.35) and high PaCO₂ (>45) indicate respiratory acidosis.
Elevated HCO₃⁻ (>26) indicates metabolic compensation, suggesting chronicity (renal
retention of bicarbonate). Acute respiratory acidosis would have normal HCO₃⁻.
Metabolic alkalosis has high pH; respiratory alkalosis has low PaCO₂.
12. A patient receiving chemotherapy develops tumor lysis syndrome. Which electrolyte
abnormality should the nurse monitor most closely?
1) Hypokalemia
2) Hypophosphatemia
3) Hyperkalemia
4) Hypocalcemia
Correct Answer: 3) Hyperkalemia
Explanation: Tumor lysis syndrome causes rapid release of intracellular contents,
leading to hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia.
HERZING UNIVERSITY- MEDICAL-SURGICAL NURSING II
170 QUESTIONS AND CORRECT ANSWERS
NSG 223 MED SURG II -2027/2027 FINAL EXAM
This comprehensive 170-question final exam guide for NSG 223 Med Surg II
reflects the latest evidence-based practices in advanced medical-surgical
nursing for the 2026/2027 academic cycle. The content emphasizes complex
patient management, critical thinking in high-acuity settings, interdisciplinary
collaboration, and application of advanced pathophysiology and pharmacology
principles to adult health disorders. Each question includes four answer choices
(1-4) with the correct answer highlighted and detailed rationales incorporating
priority-setting frameworks, pharmacological management, and evidence-based
protocols for complex medical-surgical conditions. This resource is designed
for nursing students preparing for comprehensive final examinations, NCLEX-RN
preparation, and clinical practice integration.
1. A patient with acute myocardial infarction (STEMI) is receiving thrombolytic therapy.
Which finding requires immediate intervention?
1) Mild headache
2) Facial droop and slurred speech
3) Nausea
4) Sinus tachycardia at 102 bpm
Correct Answer: 2) Facial droop and slurred speech
Explanation: Thrombolytics (e.g., alteplase) increase the risk of intracranial hemorrhage
(ICH). Facial droop and slurred speech are signs of stroke, a life-threatening complication.
Immediate neurologic assessment and CT scan are required. Mild headache may be
benign, but new focal neurologic deficits are red flags per AHA/ACC STEMI guidelines.
2. The nurse is caring for a patient with acute decompensated heart failure (ADHF) and
crackles in all lung fields. Which medication should the nurse anticipate administering first?
1) Metoprolol
2) Furosemide
3) Lisinopril
4) Spironolactone
Correct Answer: 2) Furosemide
, Explanation: Furosemide (loop diuretic) is first-line for acute pulmonary edema in ADHF
to reduce preload and fluid overload. Beta-blockers (metoprolol) and ACE inhibitors
(lisinopril) are contraindicated in acute decompensation due to negative inotropy and
hypotension risk. Spironolactone is a potassium-sparing diuretic used for chronic
management, not acute rescue.
3. A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2
mEq/L. Which intervention is the priority?
1) Administer sodium polystyrene sulfonate (Kayexalate)
2) Give IV calcium gluconate
3) Initiate dialysis
4) Restrict dietary potassium
Correct Answer: 2) Give IV calcium gluconate
Explanation: Hyperkalemia >6.0 mEq/L with ECG changes (e.g., peaked T-waves) is a
medical emergency. IV calcium gluconate stabilizes the myocardium within minutes to
prevent lethal arrhythmias. Kayexalate lowers K+ over hours; dialysis is definitive but not
immediate. Cardiac protection takes precedence over K+ reduction per KDIGO
guidelines.
4. A patient with traumatic brain injury (TBI) has an intracranial pressure (ICP) of 28 mm
Hg. Which action should the nurse take first?
1) Elevate the head of the bed to 30 degrees
2) Administer mannitol 1 g/kg IV
3) Hyperventilate to PaCO₂ of 25 mmHg
4) Notify the provider immediately
Correct Answer: 1) Elevate the head of the bed to 30 degrees
Explanation: Elevating the head of the bed promotes venous drainage and reduces
ICP—a non-invasive, immediate intervention per the Brain Trauma Foundation guidelines.
Mannitol is second-line; hyperventilation is reserved for acute herniation due to rebound
ischemia risk. The nurse can implement HOB elevation without a provider order.
5. A patient with septic shock has a mean arterial pressure (MAP) of 58 mm Hg despite
fluid resuscitation. Which vasopressor should the nurse anticipate?
1) Dopamine
2) Epinephrine
3) Norepinephrine
4) Phenylephrine
Correct Answer: 3) Norepinephrine
Explanation: Norepinephrine is first-line vasopressor in septic shock per Surviving Sepsis
Campaign guidelines due to its potent alpha-agonist effects (vasoconstriction) with minimal
beta-effects (tachycardia). Dopamine is second-line; epinephrine is added if
norepinephrine fails; phenylephrine lacks inotropic support.
,6. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation
with PEEP of 12 cm H₂O. Which assessment finding indicates PEEP is effective?
1) SaO₂ 88%
2) PaO₂ 65 mm Hg
3) PaO₂/FiO₂ ratio of 180
4) PaO₂/FiO₂ ratio of 320
Correct Answer: 4) PaO₂/FiO₂ ratio of 320
Explanation: ARDS is defined by PaO₂/FiO₂ ≤300 (mild), ≤200 (moderate), ≤100
(severe). A ratio of 320 indicates improved oxygenation and effective PEEP. SaO₂ 88%
and PaO₂ 65 mm Hg reflect hypoxemia; a ratio of 180 indicates moderate ARDS.
7. A patient with type 1 diabetes has blood glucose of 420 mg/dL, arterial pH of 7.18,
and serum bicarbonate of 12 mEq/L. Which condition does the nurse anticipate?
1) Hyperosmolar hyperglycemic state (HHS)
2) Diabetic ketoacidosis (DKA)
3) Hypoglycemia
4) Lactic acidosis
Correct Answer: 2) Diabetic ketoacidosis (DKA)
Explanation: DKA is characterized by hyperglycemia (>250 mg/dL), metabolic acidosis
(pH <7.3, HCO₃⁻ <18), and ketonemia. HHS presents with extreme hyperglycemia (>600
mg/dL) but minimal acidosis. Lactic acidosis has elevated lactate; hypoglycemia has low
glucose. DKA requires insulin, fluids, and electrolyte replacement per ADA protocol.
8. A patient with multiple myeloma reports severe bone pain. Which medication is the
priority?
1) Ibuprofen
2) Acetaminophen
3) Morphine
4) Aspirin
Correct Answer: 3) Morphine
Explanation: Multiple myeloma causes lytic bone lesions and severe pain requiring
opioid analgesia. NSAIDs (ibuprofen, aspirin) are contraindicated due to nephrotoxicity
risk in myeloma (light chain cast nephropathy). Acetaminophen is insufficient for severe
pain. Morphine provides effective analgesia with renal dose adjustment.
9. A patient with cirrhosis develops asterixis and confusion. Which condition should the
nurse suspect?
1) Hypoglycemia
2) Hepatic encephalopathy
3) Hyponatremia
, 4) Hyperkalemia
Correct Answer: 2) Hepatic encephalopathy
Explanation: Asterixis (liver flap) and confusion are classic signs of hepatic
encephalopathy caused by ammonia accumulation due to liver failure. Hypoglycemia may
occur but doesn't cause asterixis. Hyponatremia and hyperkalemia are electrolyte
imbalances seen in cirrhosis but don't directly cause asterixis. Treatment includes lactulose
and rifaximin.
10. A patient with acute pancreatitis has severe abdominal pain radiating to the back.
Which laboratory finding is most specific for this diagnosis?
1) Elevated amylase
2) Elevated lipase
3) Elevated ALT
4) Elevated bilirubin
Correct Answer: 2) Elevated lipase
Explanation: Lipase is more specific and sensitive for acute pancreatitis than amylase.
Amylase can be elevated in other conditions (e.g., salivary gland disorders). ALT and
bilirubin indicate hepatic/biliary pathology, which may be a cause but not diagnostic of
pancreatitis. Lipase remains elevated longer than amylase.
11. A patient with COPD has an arterial blood gas (ABG) showing: pH 7.30, PaCO₂ 58
mm Hg, HCO₃⁻ 30 mEq/L. Which condition does this indicate?
1) Acute respiratory acidosis
2) Chronic respiratory acidosis with metabolic compensation
3) Metabolic alkalosis
4) Acute respiratory alkalosis
Correct Answer: 2) Chronic respiratory acidosis with metabolic compensation
Explanation: Low pH (<7.35) and high PaCO₂ (>45) indicate respiratory acidosis.
Elevated HCO₃⁻ (>26) indicates metabolic compensation, suggesting chronicity (renal
retention of bicarbonate). Acute respiratory acidosis would have normal HCO₃⁻.
Metabolic alkalosis has high pH; respiratory alkalosis has low PaCO₂.
12. A patient receiving chemotherapy develops tumor lysis syndrome. Which electrolyte
abnormality should the nurse monitor most closely?
1) Hypokalemia
2) Hypophosphatemia
3) Hyperkalemia
4) Hypocalcemia
Correct Answer: 3) Hyperkalemia
Explanation: Tumor lysis syndrome causes rapid release of intracellular contents,
leading to hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia.
