NSG 223 Med Surg Exam 3: (Latest 2026/2027 Update) Endocrine,
Neuromuscular, Orthopedic & Critical Care | Q&A | Grade A | 100% Correct
(Verified Answers) – Nursing Program
Subject: NSG 223 – Medical-Surgical Nursing / Advanced Concepts
Source: NSG 223 Med Surg Exam 3 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is the first sign of compartment syndrome?
Correct Answer: Pain unrelieved by medication (pain out of proportion to injury is earliest sign).
Always assess pain in a patient with a cast. They can lose the leg or arm.
1. Pain that worsens with passive stretch of the involved muscle is hallmark.
2. Paresthesia (numbness/tingling) is early sign; pulselessness is a late sign (irreversible damage).
3. Do NOT elevate extremity above heart level (decreases arterial pressure).
2. What is the difference between gigantism and acromegaly?
Correct Answer: Gigantism: occurs when excessive growth hormone (GH) occurs before the growth
plates in the bones fuse (during childhood). Acromegaly: occurs when excess GH occurs during
adulthood.
1. Gigantism results in excessive linear growth (tall stature) with normal proportions.
2. Acromegaly causes enlargement of hands, feet, facial features (prognathism, coarse features),
organomegaly.
3. Both caused by pituitary adenoma; treatment: surgery, octreotide, pegvisomant.
3. What is Guillain-Barré Syndrome (GBS)?
Correct Answer: Rapid ascending paralysis starting in the legs and eventually reaching the respiratory
system, which can kill the client within a few hours to few days. Most concerning complication:
impaired gas exchange.
1. GBS is autoimmune demyelinating neuropathy, often post-infectious (Campylobacter jejuni,
CMV, EBV, Zika).
2. Ascending weakness; areflexia; progresses over days to weeks.
3. Treatment: IV immunoglobulin (IVIG) or plasmapheresis; monitor vital capacity for
respiratory failure.
4. What is the first thing the nurse would do with a patient with a fracture in the leg or arm?
Correct Answer: Immobilize the area. Ask the patient to remain as still as possible. Place padding
around the injury for extra support. Immobilization prevents further soft tissue damage and bleeding.
1. Splint the fracture in the position found; do not attempt to realign bones.
2. Assess neurovascular status (6 Ps: pain, pallor, paresthesia, paralysis, pulselessness, pressure).
3. Apply ice and elevate if not suspected compartment syndrome.
, 5. What is a fluid deprivation test?
Correct Answer: A water deprivation test (fluid deprivation test) measures how well the kidneys work
and helps diagnose diabetes insipidus. This would cause unchanged urine osmolality.
1. After water deprivation, normal persons concentrate urine (osmolality >800); DI patients
cannot concentrate urine.
2. Desmopressin (DDAVP) administration after test distinguishes central DI (responds to
DDAVP) from nephrogenic DI (no response).
3. Monitor weight, vital signs, urine output; stop if weight loss >5%.
6. What is the medication for acromegaly?
Correct Answer: Octreotide (somatostatin analog). This medication helps to reduce or block release of
GH. Administer intramuscular (IM) such as intragluteal; avoid deltoid.
1. Octreotide reduces GH and IGF-1 levels in 50-70% of patients.
2. Side effects: gallstones (biliary sludge), bradycardia, hyper/hypoglycemia, GI upset.
3. Long-acting release (LAR) injection monthly; also used for carcinoid syndrome, variceal
bleeding.
7. What are signs and symptoms of compartment syndrome? (Select all that apply)
Correct Answer: Tingling, numbness, pressure, pain, muscle weakness, "foot falling asleep"
(paresthesia). Pain or burning is a sign of compartment syndrome — notify provider immediately. Pain
is first sign; they can lose the limb.
1. 6 Ps: Pain (out of proportion), Paresthesia, Pallor, Paralysis, Pulselessness (late),
Poikilothermia (cold).
2. Pain with passive stretch of involved muscle (e.g., dorsiflexion of toes with anterior
compartment syndrome).
3. Compartment pressure >30 mmHg requires emergency fasciotomy within 6 hours.
8. What is the high risk of a crushed pelvis due to a motor vehicle accident?
Correct Answer: Shock. Shock due to a crushed pelvis refers to a life-threatening condition where a
severely fractured pelvis causes significant internal bleeding, leading to a rapid drop in blood pressure
and systemic shock due to damage to major blood vessels within the pelvic region.
1. Pelvis is highly vascular; fracture can cause retroperitoneal hemorrhage (2-4 L blood loss).
2. Signs: hypotension, tachycardia, abdominal distension, pelvic instability on exam.
3. Treatment: pelvic binder, massive transfusion protocol, angiography with embolization or
surgical fixation.
Neuromuscular, Orthopedic & Critical Care | Q&A | Grade A | 100% Correct
(Verified Answers) – Nursing Program
Subject: NSG 223 – Medical-Surgical Nursing / Advanced Concepts
Source: NSG 223 Med Surg Exam 3 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is the first sign of compartment syndrome?
Correct Answer: Pain unrelieved by medication (pain out of proportion to injury is earliest sign).
Always assess pain in a patient with a cast. They can lose the leg or arm.
1. Pain that worsens with passive stretch of the involved muscle is hallmark.
2. Paresthesia (numbness/tingling) is early sign; pulselessness is a late sign (irreversible damage).
3. Do NOT elevate extremity above heart level (decreases arterial pressure).
2. What is the difference between gigantism and acromegaly?
Correct Answer: Gigantism: occurs when excessive growth hormone (GH) occurs before the growth
plates in the bones fuse (during childhood). Acromegaly: occurs when excess GH occurs during
adulthood.
1. Gigantism results in excessive linear growth (tall stature) with normal proportions.
2. Acromegaly causes enlargement of hands, feet, facial features (prognathism, coarse features),
organomegaly.
3. Both caused by pituitary adenoma; treatment: surgery, octreotide, pegvisomant.
3. What is Guillain-Barré Syndrome (GBS)?
Correct Answer: Rapid ascending paralysis starting in the legs and eventually reaching the respiratory
system, which can kill the client within a few hours to few days. Most concerning complication:
impaired gas exchange.
1. GBS is autoimmune demyelinating neuropathy, often post-infectious (Campylobacter jejuni,
CMV, EBV, Zika).
2. Ascending weakness; areflexia; progresses over days to weeks.
3. Treatment: IV immunoglobulin (IVIG) or plasmapheresis; monitor vital capacity for
respiratory failure.
4. What is the first thing the nurse would do with a patient with a fracture in the leg or arm?
Correct Answer: Immobilize the area. Ask the patient to remain as still as possible. Place padding
around the injury for extra support. Immobilization prevents further soft tissue damage and bleeding.
1. Splint the fracture in the position found; do not attempt to realign bones.
2. Assess neurovascular status (6 Ps: pain, pallor, paresthesia, paralysis, pulselessness, pressure).
3. Apply ice and elevate if not suspected compartment syndrome.
, 5. What is a fluid deprivation test?
Correct Answer: A water deprivation test (fluid deprivation test) measures how well the kidneys work
and helps diagnose diabetes insipidus. This would cause unchanged urine osmolality.
1. After water deprivation, normal persons concentrate urine (osmolality >800); DI patients
cannot concentrate urine.
2. Desmopressin (DDAVP) administration after test distinguishes central DI (responds to
DDAVP) from nephrogenic DI (no response).
3. Monitor weight, vital signs, urine output; stop if weight loss >5%.
6. What is the medication for acromegaly?
Correct Answer: Octreotide (somatostatin analog). This medication helps to reduce or block release of
GH. Administer intramuscular (IM) such as intragluteal; avoid deltoid.
1. Octreotide reduces GH and IGF-1 levels in 50-70% of patients.
2. Side effects: gallstones (biliary sludge), bradycardia, hyper/hypoglycemia, GI upset.
3. Long-acting release (LAR) injection monthly; also used for carcinoid syndrome, variceal
bleeding.
7. What are signs and symptoms of compartment syndrome? (Select all that apply)
Correct Answer: Tingling, numbness, pressure, pain, muscle weakness, "foot falling asleep"
(paresthesia). Pain or burning is a sign of compartment syndrome — notify provider immediately. Pain
is first sign; they can lose the limb.
1. 6 Ps: Pain (out of proportion), Paresthesia, Pallor, Paralysis, Pulselessness (late),
Poikilothermia (cold).
2. Pain with passive stretch of involved muscle (e.g., dorsiflexion of toes with anterior
compartment syndrome).
3. Compartment pressure >30 mmHg requires emergency fasciotomy within 6 hours.
8. What is the high risk of a crushed pelvis due to a motor vehicle accident?
Correct Answer: Shock. Shock due to a crushed pelvis refers to a life-threatening condition where a
severely fractured pelvis causes significant internal bleeding, leading to a rapid drop in blood pressure
and systemic shock due to damage to major blood vessels within the pelvic region.
1. Pelvis is highly vascular; fracture can cause retroperitoneal hemorrhage (2-4 L blood loss).
2. Signs: hypotension, tachycardia, abdominal distension, pelvic instability on exam.
3. Treatment: pelvic binder, massive transfusion protocol, angiography with embolization or
surgical fixation.
