NSG 223 Med Surg Exam 2: (Latest 2026/2027 Update) Pulmonary, Renal,
Hepatic & GI Emergencies | Q&A | Grade A | 100% Correct (Verified Answers)
– Nursing Program
Subject: NSG 223 – Medical-Surgical Nursing / Advanced Concepts
Source: NSG 223 Med Surg Exam 2 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is the best position for a patient with a pulmonary embolism (PE)?
Correct Answer: Upright with legs dangling (sitting position, HOB 45-90°) — this is the best position
for a patient with PE. If patient has difficulty breathing, this is the priority action.
1. Upright position improves lung expansion, reduces preload, and increases oxygenation.
2. Semi-Fowler's or high-Fowler's position decreases venous return (preload) and pulmonary
congestion.
2. What is the difference between a DVT and VTE?
Correct Answer: A DVT is a stationary clot (deep vein thrombosis). VTE (venous thromboembolism)
is an umbrella term that includes both DVT and pulmonary embolism (PE).
1. DVT: clot in deep veins (legs, pelvis, arms).
2. PE occurs when part of DVT breaks off and travels to pulmonary arteries.
3. VTE prophylaxis: anticoagulants, sequential compression devices (SCDs), early ambulation.
3. What is positive end-expiratory pressure (PEEP) and its purpose?
Correct Answer: Positive pressure applied at the end of ventilation which opens collapsed alveoli,
decreasing V/Q mismatch. Helps prevent alveolar collapse.
1. PEEP improves oxygenation by recruiting alveoli, reducing intrapulmonary shunt.
2. Used in ARDS, pulmonary edema, atelectasis.
3. High PEEP may cause barotrauma (pneumothorax) and decreased cardiac output (impaired
venous return).
4. What are the symptoms of acute pancreatitis that are most concerning?
Correct Answer: Rigid board-like abdomen (necrotizing pancreatitis) — notify provider immediately.
Severe persistent end-organ damage >48 hours. Increased pain requires reporting to provider.
1. Rigid abdomen indicates peritonitis or hemorrhagic pancreatitis.
3. Monitor for organ failure (respiratory, renal, cardiovascular).
, 5. What is the goal of dialysis and what does it do?
Correct Answer: Balance electrolytes. Dialysis removes waste products and extra fluid from blood by
filtering through a membrane/filter (hemodialysis or peritoneal dialysis).
1. Indications: fluid overload, uremia, hyperkalemia, severe metabolic acidosis.
3. Peritoneal dialysis: catheter in abdomen; continuous or nightly exchanges.
6. How do you understand compensation in acid-base disorders?
Correct Answer: Fully Compensated = pH always normal (both CO2 and HCO3 abnormal). Partial
compensated = all 3 buffers abnormal (pH, CO2, HCO3 all abnormal). Uncompensated = 1 buffer
normal (pH abnormal, one value normal, the other abnormal).
1. Determine primary disorder from pH and which value matches (CO2 for respiratory, HCO3 for
metabolic).
2. Look at opposite value to see if compensation present.
3. Compensation never returns pH to normal if acute (chronic conditions can fully compensate).
7. What is Vecuronium and when is it used?
Correct Answer: Class: Neuromuscular blocking agent (paralytic). Therapeutic use: used prior to
intubating a patient. Side effect: relaxes vocal cords and jaw muscles (facilitates intubation). Give
before intubating.
1. Vecuronium is a nondepolarizing neuromuscular blocker (no sedation, no analgesia).
2. MUST use with sedation (benzodiazepine, propofol) to prevent awareness during paralysis.
3. Train-of-Four monitoring to assess blockade level.
8. What is the difference between a DVT and VTE? (repeated - maintain original)
Correct Answer: A DVT is a stationary clot. A VTE can be two things: a deep vein thrombus or a
pulmonary embolus.
1. DVT most common in lower extremities; risk increases with immobility, surgery, cancer,
pregnancy.
2. Symptoms: unilateral leg swelling, pain, warmth, erythema, Homan sign (not reliable).
9. What is the most common cause of chronic pancreatitis?
Correct Answer: Alcohol (chronic alcohol use accounts for 70-80% of cases; also smoking, genetic,
autoimmune).
1. Alcohol-induced oxidative stress and toxic metabolites cause pancreatic injury.
2. Chronic pancreatitis leads to exocrine insufficiency (malabsorption, steatorrhea) and endocrine
insufficiency (diabetes).
Hepatic & GI Emergencies | Q&A | Grade A | 100% Correct (Verified Answers)
– Nursing Program
Subject: NSG 223 – Medical-Surgical Nursing / Advanced Concepts
Source: NSG 223 Med Surg Exam 2 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is the best position for a patient with a pulmonary embolism (PE)?
Correct Answer: Upright with legs dangling (sitting position, HOB 45-90°) — this is the best position
for a patient with PE. If patient has difficulty breathing, this is the priority action.
1. Upright position improves lung expansion, reduces preload, and increases oxygenation.
2. Semi-Fowler's or high-Fowler's position decreases venous return (preload) and pulmonary
congestion.
2. What is the difference between a DVT and VTE?
Correct Answer: A DVT is a stationary clot (deep vein thrombosis). VTE (venous thromboembolism)
is an umbrella term that includes both DVT and pulmonary embolism (PE).
1. DVT: clot in deep veins (legs, pelvis, arms).
2. PE occurs when part of DVT breaks off and travels to pulmonary arteries.
3. VTE prophylaxis: anticoagulants, sequential compression devices (SCDs), early ambulation.
3. What is positive end-expiratory pressure (PEEP) and its purpose?
Correct Answer: Positive pressure applied at the end of ventilation which opens collapsed alveoli,
decreasing V/Q mismatch. Helps prevent alveolar collapse.
1. PEEP improves oxygenation by recruiting alveoli, reducing intrapulmonary shunt.
2. Used in ARDS, pulmonary edema, atelectasis.
3. High PEEP may cause barotrauma (pneumothorax) and decreased cardiac output (impaired
venous return).
4. What are the symptoms of acute pancreatitis that are most concerning?
Correct Answer: Rigid board-like abdomen (necrotizing pancreatitis) — notify provider immediately.
Severe persistent end-organ damage >48 hours. Increased pain requires reporting to provider.
1. Rigid abdomen indicates peritonitis or hemorrhagic pancreatitis.
3. Monitor for organ failure (respiratory, renal, cardiovascular).
, 5. What is the goal of dialysis and what does it do?
Correct Answer: Balance electrolytes. Dialysis removes waste products and extra fluid from blood by
filtering through a membrane/filter (hemodialysis or peritoneal dialysis).
1. Indications: fluid overload, uremia, hyperkalemia, severe metabolic acidosis.
3. Peritoneal dialysis: catheter in abdomen; continuous or nightly exchanges.
6. How do you understand compensation in acid-base disorders?
Correct Answer: Fully Compensated = pH always normal (both CO2 and HCO3 abnormal). Partial
compensated = all 3 buffers abnormal (pH, CO2, HCO3 all abnormal). Uncompensated = 1 buffer
normal (pH abnormal, one value normal, the other abnormal).
1. Determine primary disorder from pH and which value matches (CO2 for respiratory, HCO3 for
metabolic).
2. Look at opposite value to see if compensation present.
3. Compensation never returns pH to normal if acute (chronic conditions can fully compensate).
7. What is Vecuronium and when is it used?
Correct Answer: Class: Neuromuscular blocking agent (paralytic). Therapeutic use: used prior to
intubating a patient. Side effect: relaxes vocal cords and jaw muscles (facilitates intubation). Give
before intubating.
1. Vecuronium is a nondepolarizing neuromuscular blocker (no sedation, no analgesia).
2. MUST use with sedation (benzodiazepine, propofol) to prevent awareness during paralysis.
3. Train-of-Four monitoring to assess blockade level.
8. What is the difference between a DVT and VTE? (repeated - maintain original)
Correct Answer: A DVT is a stationary clot. A VTE can be two things: a deep vein thrombus or a
pulmonary embolus.
1. DVT most common in lower extremities; risk increases with immobility, surgery, cancer,
pregnancy.
2. Symptoms: unilateral leg swelling, pain, warmth, erythema, Homan sign (not reliable).
9. What is the most common cause of chronic pancreatitis?
Correct Answer: Alcohol (chronic alcohol use accounts for 70-80% of cases; also smoking, genetic,
autoimmune).
1. Alcohol-induced oxidative stress and toxic metabolites cause pancreatic injury.
2. Chronic pancreatitis leads to exocrine insufficiency (malabsorption, steatorrhea) and endocrine
insufficiency (diabetes).
