NSG233/NSG 233 Final Exam V1 | Medical-
Surgical Nursing III Q&A with Rationale |
Herzing University
1. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). Which clinical
finding should the nurse prioritize as an early sign of hypoxemia?
A. Central cyanosis
B. Restlessness and agitation
C. Bradypnea
D. Decreased heart rate
Correct Answer: B
Rationale: Restlessness and agitation are early neurological signs of hypoxia as the brain is
highly sensitive to oxygen deprivation. As hypoxemia progresses, the patient may develop
more severe symptoms like cyanosis or lethargy. The nurse must monitor mental status
closely in patients at risk for ARDS to intervene before permanent damage occurs.
2. A nurse is caring for a client with a high-pressure alarm sounding on the mechanical
ventilator. Which action should the nurse take first?
A. Manually ventilate the patient with a bag-valve mask
B. Increase the oxygen concentration to 100%
C. Check for kinks in the tubing or patient biting the tube
,D. Administer a sedative to the patient
Correct Answer: C
Rationale: High-pressure alarms indicate that the ventilator is meeting resistance when
delivering a breath, often caused by obstructions like kinks or secretions. Checking the
circuit for physical obstructions is the fastest and least invasive initial assessment step. If
the obstruction cannot be cleared and the patient is in distress, the nurse should then
proceed to manual ventilation.
3. A client with 40% total body surface area (TBSA) burns is in the emergent phase. Using the
Parkland formula (4mL/kg/%TBSA), how much fluid should the nurse administer in the first 8
hours for a client weighing 70 kg?
A. 8,400 mL
B. 11,200 mL
C. 2,800 mL
D. 5,600 mL
Correct Answer: D
Rationale: The total 24-hour fluid requirement is calculated as 4 mL × 70 kg × 40% =
11,200 mL. According to the Parkland formula, half of this total volume (5,600 mL) must be
administered within the first 8 hours after the burn injury. The remaining 5,600 mL is
administered over the subsequent 16 hours to ensure adequate tissue perfusion and
prevent burn shock.
, 4. Which hemodynamic parameter is the most indicative of Cardiogenic Shock in a patient
with a recent myocardial infarction?
A. Decreased Pulmonary Capillary Wedge Pressure (PCWP)
B. Increased Cardiac Index (CI)
C. Increased Pulmonary Capillary Wedge Pressure (PCWP)
D. Decreased Systemic Vascular Resistance (SVR)
Correct Answer: C
Rationale: In cardiogenic shock, the heart fails to pump effectively, leading to fluid backing
up into the pulmonary circulation. This results in an elevated PCWP, reflecting high left-
ventricular end-diastolic pressure. Contrastingly, hypovolemic shock would show a low
PCWP due to volume loss.
5. A nurse assesses a patient with a Glasgow Coma Scale (GCS) score of 7. Which intervention
is the highest priority?
A. Assess the patient’s pupillary response
B. Prepare the patient for endotracheal intubation
C. Obtain a Stat CT scan of the head
D. Monitor urine output hourly
Correct Answer: B
Surgical Nursing III Q&A with Rationale |
Herzing University
1. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). Which clinical
finding should the nurse prioritize as an early sign of hypoxemia?
A. Central cyanosis
B. Restlessness and agitation
C. Bradypnea
D. Decreased heart rate
Correct Answer: B
Rationale: Restlessness and agitation are early neurological signs of hypoxia as the brain is
highly sensitive to oxygen deprivation. As hypoxemia progresses, the patient may develop
more severe symptoms like cyanosis or lethargy. The nurse must monitor mental status
closely in patients at risk for ARDS to intervene before permanent damage occurs.
2. A nurse is caring for a client with a high-pressure alarm sounding on the mechanical
ventilator. Which action should the nurse take first?
A. Manually ventilate the patient with a bag-valve mask
B. Increase the oxygen concentration to 100%
C. Check for kinks in the tubing or patient biting the tube
,D. Administer a sedative to the patient
Correct Answer: C
Rationale: High-pressure alarms indicate that the ventilator is meeting resistance when
delivering a breath, often caused by obstructions like kinks or secretions. Checking the
circuit for physical obstructions is the fastest and least invasive initial assessment step. If
the obstruction cannot be cleared and the patient is in distress, the nurse should then
proceed to manual ventilation.
3. A client with 40% total body surface area (TBSA) burns is in the emergent phase. Using the
Parkland formula (4mL/kg/%TBSA), how much fluid should the nurse administer in the first 8
hours for a client weighing 70 kg?
A. 8,400 mL
B. 11,200 mL
C. 2,800 mL
D. 5,600 mL
Correct Answer: D
Rationale: The total 24-hour fluid requirement is calculated as 4 mL × 70 kg × 40% =
11,200 mL. According to the Parkland formula, half of this total volume (5,600 mL) must be
administered within the first 8 hours after the burn injury. The remaining 5,600 mL is
administered over the subsequent 16 hours to ensure adequate tissue perfusion and
prevent burn shock.
, 4. Which hemodynamic parameter is the most indicative of Cardiogenic Shock in a patient
with a recent myocardial infarction?
A. Decreased Pulmonary Capillary Wedge Pressure (PCWP)
B. Increased Cardiac Index (CI)
C. Increased Pulmonary Capillary Wedge Pressure (PCWP)
D. Decreased Systemic Vascular Resistance (SVR)
Correct Answer: C
Rationale: In cardiogenic shock, the heart fails to pump effectively, leading to fluid backing
up into the pulmonary circulation. This results in an elevated PCWP, reflecting high left-
ventricular end-diastolic pressure. Contrastingly, hypovolemic shock would show a low
PCWP due to volume loss.
5. A nurse assesses a patient with a Glasgow Coma Scale (GCS) score of 7. Which intervention
is the highest priority?
A. Assess the patient’s pupillary response
B. Prepare the patient for endotracheal intubation
C. Obtain a Stat CT scan of the head
D. Monitor urine output hourly
Correct Answer: B
