MED SURG III FINAL EXAM / NSG233
FINAL EXAM 2025/2026 COMPLETE
VERIFIED QUESTIONS AND CORRECT
DETAILED ANSWERS WITH
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MED SURG III FINAL EXAM
A client is admitted from the emergency department with a diagnosis of bowel
perforation. Which treatment strategies would the nurse anticipate based on this
admitting diagnosis? Select all that apply. - Answer ✓✓1. Electrocardiogram
monitoring
2. Broad-spectrum antibiotic therapy
3. Nasogastric tube for enteral feedings
4. Insertion of an indwelling urinary catheter
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5. Blood transfusion with fresh frozen plasma
6. Fluid replacement with lactated Ringer's solution
1,2,4,5
Anticipated treatment strategies for the client with bowel perforation include
electrocardiogram monitoring to assess for cardiac dysrhythmias; broad-spectrum
antibiotic therapy to treat bacterial peritonitis; nasogastric tube to stop the
spillage of gastric and duodenal contents into the peritoneal cavity and to provide
gastric decompression; insertion of an indwelling urinary catheter to monitor
hourly urine output to accurately assess renal function; and fluid replacement
with lactated Ringer's solution and blood transfusion with packed red blood cells
(not fresh frozen plasma) to restore circulating volume. The nasogastric tube is
not used for feedings; the client would be on NPO status.
The nurse is caring for a client with a history of peptic ulcer disease admitted to
the medical-surgical unit with abdominal pain that is worse towards the end of the
day. The client tells the nurse that he has had a bowel perforation in the past that
healed on its own. Given the client's history, which condition would the nurse
suspect? - Answer ✓✓1. Gastric ulcer
2. Duodenal ulcer
3. Gastric outlet obstruction
4. Gastrointestinal hemorrhage
3
Gastric outlet obstruction is characterized by epigastric abdominal pain and
postprandial vomiting due to mechanical obstruction. Acute and chronic peptic
ulcer disease, which includes both gastric and duodenal ulcers, can cause gastric
outlet obstruction. Particularly when small perforations caused by ulcers heal on
their own, strictures and obstruction of intestinal contents and the passage of
stool can occur from scar tissue formation. The client's history and clinical
presentation depict gastric outlet obstruction. Recall that gastric and duodenal
ulcers can cause gastrointestinal hemorrhage, and can eventually cause gastric
outlet obstruction as a result of the healing process.
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The nurse working on the medical-surgical unit admits a client with acute
appendicitis scheduled for an appendectomy the following morning. Which
interventions would the nurse implement in managing care for this client in the
pre-operative period? Select all that apply - Answer ✓✓1. Monitor vital signs
2. Administer antiemetics
3. Administer pain medications
4. Administer intravenous fluids
5. Nothing by mouth (NPO) status
6. Insert an indwelling urinary catheter
1,2,3,4,5
Ongoing assessment and vital signs would be conducted to determine change in
clinical status and detect deterioration. Antiemetics and pain medications are
administered as needed for comfort. Intravenous fluids are administered to
prevent fluid volume deficit. NPO status is instituted prior to surgery so the
stomach is empty and the risk for aspiration during surgery is decreased. An
indwelling urinary catheter is not usually required prior to this surgery.
The nurse working in an outpatient clinic is assisting with the admission intake on
a client. The nurse asks about the reason for the visit, and the client describes a
dull abdominal pain with diminished appetite and nausea. On further assessment,
the pain is described as right sided and low, persistent, and continuous; the
abdomen is tender, rigid with guarding and rebound tenderness. Based on the
assessment findings, the nurse anticipates which diagnostic tests to be prescribed?
- Answer ✓✓1. Amylase and lipase levels
2. Red blood cell count with indices
3. White blood cell count with differential
4. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
3
The client's clinical presentation is consistent with acute appendicitis. The
diagnostic tests used to confirm this diagnosis include the white blood cell count
with differential, which often shows a moderately high white blood cell count. A
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urinalysis is often also conducted as well as a computed tomography (CT) scan to
aid in confirmation. Amylase and lipase levels are used to diagnosis pancreatitis.
Red blood cell counts with indices test for anemia. AST and ALT levels are used to
confirm impairment in liver function.
The nurse is caring for a client with a diagnosis of acute appendicitis. Which
physical assessment finding consistent with this diagnosis would the nurse expect
to be documented in the client's medical record? - Answer ✓✓1. Positive Murphy's
sign
2. Positive Romberg's sign
3. Pain at McBurney's point
4. Positive anterior drawer test
3
Appendicitis usually starts with dull pain in the periumbilical area associated with
diminished appetite and sometimes nausea and vomiting. The pain is
characterized as persistent and continuous and then shifts later to the right lower
quadrant at McBurney's point, which is between the umbilicus and right iliac crest.
Murphy's sign is used to aid in diagnosing cholecystitis and is present when there is
tenderness on the inspiratory pause and is elicited during palpation of the right
upper quadrant. The Romberg's sign is used to test proprioception and is positive
when there is a loss of balance when the client closes their eyes. A positive
anterior drawer test is found when the shin bones move more on an injured leg
compared to an uninjured leg and is used to assess for anterior cruciate ligament
(ACL) stability.
The nurse is caring for a client with suspected esophageal stricture. Which
statement from the client supports this diagnosis? - Answer ✓✓1. "I feel dizzy and
sweaty after eating meals."
2 "I've been having trouble swallowing meat."
3. "I've been having episodes of shortness of breath."
4. "I need to be propped up on several pillows to sleep comfortably."
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