NSG 233 Med Surg 3 Exam 1
Herzing Questions and Ansẉers with
Rationales 2026\2027 update
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Questions and Ansẉers
format set of multiple-choice
Expert-Verified rationales
Verified ẉith trusted textbooks
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1. Which of the following is the earliest sign of hypovolemic shock?
A) Hypotension
B) Tachycardia
C) Oliguria
D) Altered mental status
Answer: B. Rationale: Tachycardia is an early compensatory
response to decreased intravascular volume. Hypotension, oliguria,
and altered mental status are late signs indicating decompensation.
2. A patient is in septic shock. Which vasopressor is the first-line
agent to maintain perfusion pressure?
A) Epinephrine
B) Vasopressin
C) Norepinephrine
D) Phenylephrine
Answer: C. Rationale: Norepinephrine is the first-line vasopressor for
septic shock because it provides potent alpha-adrenergic
vasoconstriction to improve blood pressure, with mild beta-1 effects
to maintain cardiac output.
3. The nurse is caring for a patient with cardiogenic shock. Which
hemodynamic parameter would the nurse expect to find?
A) Decreased cardiac output, increased pulmonary artery wedge
pressure (PAWP)
B) Increased cardiac output, decreased PAWP
C) Decreased cardiac output, decreased PAWP
D) Increased cardiac output, increased PAWP
Answer: A. Rationale: In cardiogenic shock, the heart fails as a
pump, leading to decreased cardiac output. Blood backs up into the
pulmonary vasculature, causing an increased PAWP.
,4. Which clinical finding differentiates distributive shock from
hypovolemic shock?
A) Tachycardia
B) Oliguria
C) Warm, flushed skin
D) Altered mental status
Answer: C. Rationale: Distributive shock (like septic or neurogenic)
features massive vasodilation, leading to warm, flushed skin early
on. Hypovolemic and cardiogenic shock present with cool, pale,
clammy skin due to vasoconstriction.
5. A patient in the ICU is diagnosed with acute respiratory distress
syndrome (ARDS). Which assessment finding is most characteristic?
A) Decreased PaCO2
B) Refractory hypoxemia
C) Metabolic alkalosis
D) Clear, watery sputum
Answer: B. Rationale: Refractory hypoxemia (hypoxemia that does
not improve with oxygen administration) is the hallmark of ARDS
due to severe alveolar collapse and intrapulmonary shunting.
6. What is the most appropriate ventilator mode for a patient with
ARDS to improve oxygenation and prevent barotrauma?
A) Synchronized intermittent mandatory ventilation (SIMV)
B) High-frequency oscillatory ventilation (HFOV) or low tidal volume
ventilation
C) Assist-control (AC) with high tidal volumes
D) Pressure support ventilation (PSV)
Answer: B. Rationale: Low tidal volume ventilation (6 mL/kg) is the
gold standard for ARDS to prevent ventilator-induced lung injury.
HFOV is also used in severe cases to maintain open alveoli with low
pressures.
, 7. A patient with a pulmonary artery catheter has a central venous
pressure (CVP) of 2 mmHg. What does this indicate?
A) Right ventricular failure
B) Fluid overload
C) Hypovolemia
D) Pulmonary hypertension
Answer: C. Rationale: Normal CVP is 2-8 mmHg. A CVP of 2 mmHg is
at the very low end, indicating decreased right atrial pressure, which
is typically seen in hypovolemia.
8. The nurse is assessing a patient with a chest tube. Which finding
requires immediate intervention?
A) Continuous bubbling in the water seal chamber
B) Intermittent bubbling in the suction control chamber
C) Tidaling in the water seal chamber
D) Drainage of 50 mL in the first hour
Answer: A. Rationale: Continuous bubbling in the water seal
chamber indicates an air leak in the system or the patient.
Intermittent bubbling in the suction chamber is normal, and tidaling
is normal.
9. Which medication is the priority for a patient experiencing an
acute myocardial infarction (MI)?
A) Morphine
B) Aspirin
C) Nitroglycerin
D) Metoprolol
Answer: B. Rationale: Aspirin is the priority because it prevents
platelet aggregation, limiting the size of the thrombus. The other
medications are also given, but aspirin is the immediate first action.
10. A patient presents with ST elevation in leads II, III, and aVF.
Which area of the heart is affected?
A) Anterior
Herzing Questions and Ansẉers with
Rationales 2026\2027 update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
Expert-Verified rationales
Verified ẉith trusted textbooks
,───────────────────────────────────────────────────────
─
1. Which of the following is the earliest sign of hypovolemic shock?
A) Hypotension
B) Tachycardia
C) Oliguria
D) Altered mental status
Answer: B. Rationale: Tachycardia is an early compensatory
response to decreased intravascular volume. Hypotension, oliguria,
and altered mental status are late signs indicating decompensation.
2. A patient is in septic shock. Which vasopressor is the first-line
agent to maintain perfusion pressure?
A) Epinephrine
B) Vasopressin
C) Norepinephrine
D) Phenylephrine
Answer: C. Rationale: Norepinephrine is the first-line vasopressor for
septic shock because it provides potent alpha-adrenergic
vasoconstriction to improve blood pressure, with mild beta-1 effects
to maintain cardiac output.
3. The nurse is caring for a patient with cardiogenic shock. Which
hemodynamic parameter would the nurse expect to find?
A) Decreased cardiac output, increased pulmonary artery wedge
pressure (PAWP)
B) Increased cardiac output, decreased PAWP
C) Decreased cardiac output, decreased PAWP
D) Increased cardiac output, increased PAWP
Answer: A. Rationale: In cardiogenic shock, the heart fails as a
pump, leading to decreased cardiac output. Blood backs up into the
pulmonary vasculature, causing an increased PAWP.
,4. Which clinical finding differentiates distributive shock from
hypovolemic shock?
A) Tachycardia
B) Oliguria
C) Warm, flushed skin
D) Altered mental status
Answer: C. Rationale: Distributive shock (like septic or neurogenic)
features massive vasodilation, leading to warm, flushed skin early
on. Hypovolemic and cardiogenic shock present with cool, pale,
clammy skin due to vasoconstriction.
5. A patient in the ICU is diagnosed with acute respiratory distress
syndrome (ARDS). Which assessment finding is most characteristic?
A) Decreased PaCO2
B) Refractory hypoxemia
C) Metabolic alkalosis
D) Clear, watery sputum
Answer: B. Rationale: Refractory hypoxemia (hypoxemia that does
not improve with oxygen administration) is the hallmark of ARDS
due to severe alveolar collapse and intrapulmonary shunting.
6. What is the most appropriate ventilator mode for a patient with
ARDS to improve oxygenation and prevent barotrauma?
A) Synchronized intermittent mandatory ventilation (SIMV)
B) High-frequency oscillatory ventilation (HFOV) or low tidal volume
ventilation
C) Assist-control (AC) with high tidal volumes
D) Pressure support ventilation (PSV)
Answer: B. Rationale: Low tidal volume ventilation (6 mL/kg) is the
gold standard for ARDS to prevent ventilator-induced lung injury.
HFOV is also used in severe cases to maintain open alveoli with low
pressures.
, 7. A patient with a pulmonary artery catheter has a central venous
pressure (CVP) of 2 mmHg. What does this indicate?
A) Right ventricular failure
B) Fluid overload
C) Hypovolemia
D) Pulmonary hypertension
Answer: C. Rationale: Normal CVP is 2-8 mmHg. A CVP of 2 mmHg is
at the very low end, indicating decreased right atrial pressure, which
is typically seen in hypovolemia.
8. The nurse is assessing a patient with a chest tube. Which finding
requires immediate intervention?
A) Continuous bubbling in the water seal chamber
B) Intermittent bubbling in the suction control chamber
C) Tidaling in the water seal chamber
D) Drainage of 50 mL in the first hour
Answer: A. Rationale: Continuous bubbling in the water seal
chamber indicates an air leak in the system or the patient.
Intermittent bubbling in the suction chamber is normal, and tidaling
is normal.
9. Which medication is the priority for a patient experiencing an
acute myocardial infarction (MI)?
A) Morphine
B) Aspirin
C) Nitroglycerin
D) Metoprolol
Answer: B. Rationale: Aspirin is the priority because it prevents
platelet aggregation, limiting the size of the thrombus. The other
medications are also given, but aspirin is the immediate first action.
10. A patient presents with ST elevation in leads II, III, and aVF.
Which area of the heart is affected?
A) Anterior
