HERZING UNIVERSITY | NSG 233 | LATEST UPDATE
NSG233 / NSG 233 EXAM 1
Medical-Surgical Nursing III
Guide with Questions and Verified Answers
150 Questions | 10 Sections | 100% Correct
Cognitive Distribution: 20% Recall | 50% Application | 30% Analysis
75% Scenario-Based | 25% Direct Knowledge
Aligned with: NCLEX-RN Test Plan | QSEN Competencies
Medical-Surgical Nursing III Competencies | NSG 233 Syllabus
Section 1: Complex Cardiovascular Disorders (20 Questions)
Section 2: Complex Respiratory Disorders (18 Questions)
Section 3: Neurological & Neurosurgical Disorders (18 Questions)
Section 4: Renal & Genitourinary Disorders (15 Questions)
Section 5: Endocrine & Metabolic Disorders (15 Questions)
Section 6: Gastrointestinal & Hepatic Disorders (15 Questions)
Section 7: Hematological & Oncological Disorders (15 Questions)
Section 8: Musculoskeletal & Integumentary Disorders (12 Questions)
Section 9: Multisystem & Critical Care Concepts (12 Questions)
Section 10: Pharmacology & Medication Management (10 Questions)
100% VERIFIED CORRECT ANSWERS | DETAILED RATIONALES PROVIDED
,NSG 233 Exam 1 | Medical-Surgical Nursing III | Herzing University
NSG233 / NSG 233 EXAM 1 (Latest Update)
Medical-Surgical Nursing III | Guide with Questions and Verified Answers |
100% Correct - Herzing
This comprehensive examination guide contains 150 multiple-choice questions organized into ten clinical specialty
sections aligned with the Herzing University NSG 233 Medical-Surgical Nursing III syllabus, the NCLEX-RN Test
Plan, QSEN Competencies, and current Medical-Surgical Nursing III Competencies. Each question is presented with
four options, the verified correct answer, and a detailed rationale grounded in evidence-based nursing practice. The
cognitive distribution targets 20% recall, 50% application, and 30% analysis, with 75% of items scenario-based to
mirror real clinical decision-making. Twenty priority-setting questions, fifteen pharmacology questions, and ten
laboratory-value interpretation items are distributed throughout the guide.
Section 1: Complex Cardiovascular Disorders
Acute coronary syndromes, myocardial infarction, heart failure, cardiogenic shock, dysrhythmias, valvular
disorders, cardiac surgery (CABG, valve replacement), pacemakers, ICDs, hemodynamic monitoring,
cardiovascular medications, peripheral vascular disease, aneurysms, DVT, and anticoagulant therapy.
Q1. A 62-year-old male presents to the ED with crushing chest pain radiating to the left jaw,
diaphoresis, and dyspnea for the past 45 minutes. Vital signs: BP 148/92, HR 102, RR 24, SpO2 92%
on room air. The 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF. Which action
should the nurse implement FIRST?
A. Administer sublingual nitroglycerin 0.4 mg and reassess pain in 5 minutes.
B. Establish IV access, draw cardiac biomarkers and troponin, and administer aspirin 325 mg chewed.
C. Obtain a STAT bedside echocardiogram to confirm wall-motion abnormalities.
D. Place the patient on continuous telemetry and begin supplemental oxygen via nasal cannula at 4
L/min. *[CORRECT]*
Correct Answer: D
Rationale: Per the NSG 233 curriculum and AHA/ACC STEMI guidelines, the priority nursing action in a suspected
inferior STEMI is the MONA-B pathway (Morphine, Oxygen, Nitroglycerin, Aspirin, Beta-blocker) initiated only
AFTER oxygenation, IV access, and aspirin administration. The first action is to oxygenate, place on continuous
cardiac monitoring, and establish IV access so definitive therapy (PCI or fibrinolytics) can proceed. Nitroglycerin is
contraindicated prior to IV access and may worsen hypotension in inferior MI (RV involvement). Echocardiogram is
diagnostic but not prioritized over stabilization. Aspirin alone delays oxygenation.
Latest Update | 100% Verified Answers Page 2
,NSG 233 Exam 1 | Medical-Surgical Nursing III | Herzing University
Q2. A patient who is 6 hours post-primary PCI for an anterior STEMI suddenly develops coarse
ventricular fibrillation. The patient is unresponsive, apneic, and pulseless. Which intervention is
MOST appropriate per ACLS algorithms?
A. Administer amiodarone 300 mg IV push followed by synchronized cardioversion at 200 joules.
B. Defibrillate immediately at 200 joules biphasic, then begin high-quality CPR starting with chest
compressions. *[CORRECT]*
C. Administer epinephrine 1 mg IV push every 3 to 5 minutes before the first defibrillation attempt.
D. Insert an advanced airway and deliver 10 breaths per minute via bag-valve-mask before defibrillation.
Correct Answer: B
Rationale: Per the ACLS algorithm and NSG 233 critical care content, ventricular fibrillation in an unresponsive,
pulseless post-MI patient is a shockable rhythm requiring IMMEDIATE defibrillation (biphasic 120-200 J, or
monophasic 360 J), followed immediately by 2 minutes of high-quality CPR and rhythm reassessment. Amiodarone is
given after the second shock, not as first-line. Epinephrine is given after the second shock, not before defibrillation.
Airway management occurs simultaneously but does not precede defibrillation in a shockable rhythm.
Q3. A 72-year-old female with a history of hypertension and chronic kidney disease is admitted with
decompensated heart failure. She has crackles bilaterally in lung bases, JVD at 12 cm, and 3+
pitting edema to the knees. Which hemodynamic parameter obtained from a pulmonary artery
catheter would the nurse MOST expect to find?
A. Decreased pulmonary capillary wedge pressure (PCWP) less than 8 mm Hg with elevated systemic
vascular resistance (SVR).
B. Elevated PCWP greater than 18 mm Hg with elevated SVR and decreased cardiac index.
*[CORRECT]*
C. Elevated PCWP greater than 18 mm Hg with decreased SVR and elevated cardiac index.
D. Normal PCWP between 8 and 12 mm Hg with decreased SVR and decreased cardiac index.
Correct Answer: B
Rationale: In decompensated heart failure with volume overload, the pulmonary capillary wedge pressure (PCWP)
rises above 18 mm Hg (normal 6-12 mm Hg) because the failing left ventricle cannot accommodate venous return,
causing back-pressure into the pulmonary vasculature. SVR is typically elevated due to compensatory sympathetic
activation and RAAS stimulation, and the cardiac index falls below 2.5 L/min/m². Choice A describes hypovolemic
shock. Choice C describes distributive shock such as early sepsis. Choice D does not align with the clinical presentation
of fluid overload.
Latest Update | 100% Verified Answers Page 3
, NSG 233 Exam 1 | Medical-Surgical Nursing III | Herzing University
Q4. The nurse is caring for four patients on a telemetry unit. Which patient should the nurse assess
FIRST?
A. A 55-year-old post-CABG day 2 with a mediastinal chest tube output of 75 mL in the last hour.
B. A 68-year-old with new-onset atrial fibrillation with a ventricular rate of 132 and chest
discomfort. *[CORRECT]*
C. A 74-year-old on a heparin drip for DVT with an aPTT of 78 seconds (control 35).
D. A 60-year-old post-pacemaker insertion reporting mild incisional pain at the insertion site.
Correct Answer: B
Rationale: Using the ABC and acute-vs-chronic prioritization framework taught in NSG 233, the patient with
new-onset rapid atrial fibrillation (RVR) and chest discomfort is hemodynamically unstable and at risk for
myocardial ischemia, stroke, and hemodynamic collapse — this patient requires immediate assessment and possible
synchronized cardioversion. The CABG patient's chest tube output of 75 mL/hr is below the 200 mL/hr threshold for
notification. A heparin aPTT of 78 sec is at the upper end of therapeutic (1.5-2.5× control) but not acutely critical.
Mild incisional pain post-pacemaker is expected.
Q5. A patient 4 hours post-CABG surgery has a mediastinal chest tube with sudden drainage of 250
mL of bright red blood in 30 minutes. The patient's BP drops from 118/70 to 88/52, HR rises from
92 to 124, and CVP falls from 10 to 5 cm H2O. Which action by the nurse is PRIORITY?
A. Titrate the patient-controlled analgesia pump to control postoperative pain and reassess in 15 minutes.
B. Increase the IV fluid infusion rate, notify the surgeon STAT, and prepare for possible
re-exploration. *[CORRECT]*
C. Milk the chest tube to dislodge clots and reposition the patient to facilitate drainage.
D. Administer protamine sulfate to reverse residual heparin effects from cardiopulmonary bypass.
Correct Answer: B
Rationale: Sudden excessive mediastinal drainage (>200 mL/hr) combined with hypotension, tachycardia, and
dropping CVP indicates active postoperative hemorrhage — a life-threatening complication of CABG. The NSG 233
post-cardiac surgery protocol mandates immediate volume resuscitation, STAT surgeon notification, type and
crossmatch, and preparation for re-exploration. Milking chest tubes is generally contraindicated due to risk of
dislodging clots and provoking more bleeding. Protamine is given in the OR for heparin reversal, not on the floor. Pain
management is secondary to hemorrhage control.
Latest Update | 100% Verified Answers Page 4
NSG233 / NSG 233 EXAM 1
Medical-Surgical Nursing III
Guide with Questions and Verified Answers
150 Questions | 10 Sections | 100% Correct
Cognitive Distribution: 20% Recall | 50% Application | 30% Analysis
75% Scenario-Based | 25% Direct Knowledge
Aligned with: NCLEX-RN Test Plan | QSEN Competencies
Medical-Surgical Nursing III Competencies | NSG 233 Syllabus
Section 1: Complex Cardiovascular Disorders (20 Questions)
Section 2: Complex Respiratory Disorders (18 Questions)
Section 3: Neurological & Neurosurgical Disorders (18 Questions)
Section 4: Renal & Genitourinary Disorders (15 Questions)
Section 5: Endocrine & Metabolic Disorders (15 Questions)
Section 6: Gastrointestinal & Hepatic Disorders (15 Questions)
Section 7: Hematological & Oncological Disorders (15 Questions)
Section 8: Musculoskeletal & Integumentary Disorders (12 Questions)
Section 9: Multisystem & Critical Care Concepts (12 Questions)
Section 10: Pharmacology & Medication Management (10 Questions)
100% VERIFIED CORRECT ANSWERS | DETAILED RATIONALES PROVIDED
,NSG 233 Exam 1 | Medical-Surgical Nursing III | Herzing University
NSG233 / NSG 233 EXAM 1 (Latest Update)
Medical-Surgical Nursing III | Guide with Questions and Verified Answers |
100% Correct - Herzing
This comprehensive examination guide contains 150 multiple-choice questions organized into ten clinical specialty
sections aligned with the Herzing University NSG 233 Medical-Surgical Nursing III syllabus, the NCLEX-RN Test
Plan, QSEN Competencies, and current Medical-Surgical Nursing III Competencies. Each question is presented with
four options, the verified correct answer, and a detailed rationale grounded in evidence-based nursing practice. The
cognitive distribution targets 20% recall, 50% application, and 30% analysis, with 75% of items scenario-based to
mirror real clinical decision-making. Twenty priority-setting questions, fifteen pharmacology questions, and ten
laboratory-value interpretation items are distributed throughout the guide.
Section 1: Complex Cardiovascular Disorders
Acute coronary syndromes, myocardial infarction, heart failure, cardiogenic shock, dysrhythmias, valvular
disorders, cardiac surgery (CABG, valve replacement), pacemakers, ICDs, hemodynamic monitoring,
cardiovascular medications, peripheral vascular disease, aneurysms, DVT, and anticoagulant therapy.
Q1. A 62-year-old male presents to the ED with crushing chest pain radiating to the left jaw,
diaphoresis, and dyspnea for the past 45 minutes. Vital signs: BP 148/92, HR 102, RR 24, SpO2 92%
on room air. The 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF. Which action
should the nurse implement FIRST?
A. Administer sublingual nitroglycerin 0.4 mg and reassess pain in 5 minutes.
B. Establish IV access, draw cardiac biomarkers and troponin, and administer aspirin 325 mg chewed.
C. Obtain a STAT bedside echocardiogram to confirm wall-motion abnormalities.
D. Place the patient on continuous telemetry and begin supplemental oxygen via nasal cannula at 4
L/min. *[CORRECT]*
Correct Answer: D
Rationale: Per the NSG 233 curriculum and AHA/ACC STEMI guidelines, the priority nursing action in a suspected
inferior STEMI is the MONA-B pathway (Morphine, Oxygen, Nitroglycerin, Aspirin, Beta-blocker) initiated only
AFTER oxygenation, IV access, and aspirin administration. The first action is to oxygenate, place on continuous
cardiac monitoring, and establish IV access so definitive therapy (PCI or fibrinolytics) can proceed. Nitroglycerin is
contraindicated prior to IV access and may worsen hypotension in inferior MI (RV involvement). Echocardiogram is
diagnostic but not prioritized over stabilization. Aspirin alone delays oxygenation.
Latest Update | 100% Verified Answers Page 2
,NSG 233 Exam 1 | Medical-Surgical Nursing III | Herzing University
Q2. A patient who is 6 hours post-primary PCI for an anterior STEMI suddenly develops coarse
ventricular fibrillation. The patient is unresponsive, apneic, and pulseless. Which intervention is
MOST appropriate per ACLS algorithms?
A. Administer amiodarone 300 mg IV push followed by synchronized cardioversion at 200 joules.
B. Defibrillate immediately at 200 joules biphasic, then begin high-quality CPR starting with chest
compressions. *[CORRECT]*
C. Administer epinephrine 1 mg IV push every 3 to 5 minutes before the first defibrillation attempt.
D. Insert an advanced airway and deliver 10 breaths per minute via bag-valve-mask before defibrillation.
Correct Answer: B
Rationale: Per the ACLS algorithm and NSG 233 critical care content, ventricular fibrillation in an unresponsive,
pulseless post-MI patient is a shockable rhythm requiring IMMEDIATE defibrillation (biphasic 120-200 J, or
monophasic 360 J), followed immediately by 2 minutes of high-quality CPR and rhythm reassessment. Amiodarone is
given after the second shock, not as first-line. Epinephrine is given after the second shock, not before defibrillation.
Airway management occurs simultaneously but does not precede defibrillation in a shockable rhythm.
Q3. A 72-year-old female with a history of hypertension and chronic kidney disease is admitted with
decompensated heart failure. She has crackles bilaterally in lung bases, JVD at 12 cm, and 3+
pitting edema to the knees. Which hemodynamic parameter obtained from a pulmonary artery
catheter would the nurse MOST expect to find?
A. Decreased pulmonary capillary wedge pressure (PCWP) less than 8 mm Hg with elevated systemic
vascular resistance (SVR).
B. Elevated PCWP greater than 18 mm Hg with elevated SVR and decreased cardiac index.
*[CORRECT]*
C. Elevated PCWP greater than 18 mm Hg with decreased SVR and elevated cardiac index.
D. Normal PCWP between 8 and 12 mm Hg with decreased SVR and decreased cardiac index.
Correct Answer: B
Rationale: In decompensated heart failure with volume overload, the pulmonary capillary wedge pressure (PCWP)
rises above 18 mm Hg (normal 6-12 mm Hg) because the failing left ventricle cannot accommodate venous return,
causing back-pressure into the pulmonary vasculature. SVR is typically elevated due to compensatory sympathetic
activation and RAAS stimulation, and the cardiac index falls below 2.5 L/min/m². Choice A describes hypovolemic
shock. Choice C describes distributive shock such as early sepsis. Choice D does not align with the clinical presentation
of fluid overload.
Latest Update | 100% Verified Answers Page 3
, NSG 233 Exam 1 | Medical-Surgical Nursing III | Herzing University
Q4. The nurse is caring for four patients on a telemetry unit. Which patient should the nurse assess
FIRST?
A. A 55-year-old post-CABG day 2 with a mediastinal chest tube output of 75 mL in the last hour.
B. A 68-year-old with new-onset atrial fibrillation with a ventricular rate of 132 and chest
discomfort. *[CORRECT]*
C. A 74-year-old on a heparin drip for DVT with an aPTT of 78 seconds (control 35).
D. A 60-year-old post-pacemaker insertion reporting mild incisional pain at the insertion site.
Correct Answer: B
Rationale: Using the ABC and acute-vs-chronic prioritization framework taught in NSG 233, the patient with
new-onset rapid atrial fibrillation (RVR) and chest discomfort is hemodynamically unstable and at risk for
myocardial ischemia, stroke, and hemodynamic collapse — this patient requires immediate assessment and possible
synchronized cardioversion. The CABG patient's chest tube output of 75 mL/hr is below the 200 mL/hr threshold for
notification. A heparin aPTT of 78 sec is at the upper end of therapeutic (1.5-2.5× control) but not acutely critical.
Mild incisional pain post-pacemaker is expected.
Q5. A patient 4 hours post-CABG surgery has a mediastinal chest tube with sudden drainage of 250
mL of bright red blood in 30 minutes. The patient's BP drops from 118/70 to 88/52, HR rises from
92 to 124, and CVP falls from 10 to 5 cm H2O. Which action by the nurse is PRIORITY?
A. Titrate the patient-controlled analgesia pump to control postoperative pain and reassess in 15 minutes.
B. Increase the IV fluid infusion rate, notify the surgeon STAT, and prepare for possible
re-exploration. *[CORRECT]*
C. Milk the chest tube to dislodge clots and reposition the patient to facilitate drainage.
D. Administer protamine sulfate to reverse residual heparin effects from cardiopulmonary bypass.
Correct Answer: B
Rationale: Sudden excessive mediastinal drainage (>200 mL/hr) combined with hypotension, tachycardia, and
dropping CVP indicates active postoperative hemorrhage — a life-threatening complication of CABG. The NSG 233
post-cardiac surgery protocol mandates immediate volume resuscitation, STAT surgeon notification, type and
crossmatch, and preparation for re-exploration. Milking chest tubes is generally contraindicated due to risk of
dislodging clots and provoking more bleeding. Protamine is given in the OR for heparin reversal, not on the floor. Pain
management is secondary to hemorrhage control.
Latest Update | 100% Verified Answers Page 4
