HERZING UNIVERSITY
EXA M 4 A SSESSM ENT
NSG223 / NSG 223 (Latest 2026/2027
Update) Medical-Surgical Nursing II |
Guide Questions and Verified Answers |
100% Correct | Grade A
Course: NSG 223 - Medical-Surgical
Nursing II
Exam: Exam 4 - Comprehensive
Assessment
Questions: 75 Multiple Choice Questions
Format: Scenario-Based, Clinical
Judgment
Academic Year: 2026/2027
LATEST UPDATE 2 02 6/2 02 7
,NSG 223 Exam 4: Medical-Surgical Nursing II | Herzing University | 2026/2027
NSG223 / NSG 223 Exam 4 (Latest 2026/2027 Update)
Medical-Surgical Nursing II
Guide Questions and Verified Answers | 100% Correct | Grade A
Herzing University
Section 1: Hematologic and Immunologic Disorders (Q1-Q10)
Q1: A 45-year-old female patient presents with fatigue, pallor, and dyspnea on exertion. Laboratory results
reveal hemoglobin 8.2 g/dL, hematocrit 24.8%, and MCV 78 fL. Which type of anemia is most consistent with
these findings?
A. A. Iron deficiency anemia [CORRECT]
B. B. Pernicious anemia
C. C. Aplastic anemia
D. D. Hemolytic anemia
Correct Answer: A
Rationale: The patient presents with microcytic (MCV 78 fL, normal 80-100 fL) and hypochromic anemia, which is the classic
presentation of iron deficiency anemia. The low hemoglobin and hematocrit confirm significant anemia. Pernicious anemia typically
presents with macrocytic (elevated MCV) anemia due to vitamin B12 deficiency. Aplastic anemia involves pancytopenia from bone
marrow failure. Hemolytic anemia often presents with elevated reticulocyte count and indirect bilirubin as the body tries to compensate
for red blood cell destruction.
Q2: A nurse is caring for a patient with sickle cell disease who is experiencing an acute vaso-occlusive crisis.
Which intervention should the nurse prioritize?
A. A. Administer prophylactic antibiotics
B. B. Initiate aggressive intravenous hydration [CORRECT]
C. C. Apply cold compresses to affected joints
D. D. Restrict fluid intake to prevent fluid overload
Correct Answer: B
Rationale: The priority intervention for an acute vaso-occlusive (pain) crisis in sickle cell disease is aggressive intravenous hydration.
Adequate hydration reduces blood viscosity and helps prevent further sickling of red blood cells. Hydration dilutes the concentration of
hemoglobin S and improves microvascular circulation. Opioid analgesics for pain control are also essential, but hydration is the
foundational intervention. Cold compresses should be avoided because cold triggers vasoconstriction and can worsen sickling. Fluid
restriction is contraindicated as dehydration is a known precipitating factor for sickle cell crises.
Q3: A patient with hemophilia A is scheduled for a dental extraction. The nurse anticipates that the healthcare
provider will order which replacement therapy prior to the procedure?
A. A. Fresh frozen plasma (FFP)
B. B. Factor VIII concentrate [CORRECT]
C. C. Vitamin K injection
D. D. Platelet transfusion
Correct Answer: B
Page 1
, NSG 223 Exam 4: Medical-Surgical Nursing II | Herzing University | 2026/2027
Rationale: Hemophilia A is caused by a deficiency of clotting Factor VIII. Prior to invasive procedures such as dental extractions, the
patient requires replacement with Factor VIII concentrate to prevent excessive bleeding. The dose and timing are calculated based on the
patient's weight and the desired factor level. Fresh frozen plasma contains all coagulation factors but is less specific and carries a larger
volume load. Vitamin K is used for vitamin K deficiency or warfarin reversal, not hemophilia. Platelet transfusions are indicated for
thrombocytopenia, not factor deficiencies.
Q4: A 62-year-old patient with acute myeloid leukemia (AML) is receiving induction chemotherapy. The nurse
assesses the patient and finds a temperature of 38.6 degrees Celsius (101.5 degrees Fahrenheit), heart rate 110
bpm, and blood pressure 90/58 mmHg. What is the nurse's priority action?
A. A. Administer the next scheduled dose of chemotherapy
B. B. Obtain blood cultures and initiate broad-spectrum antibiotics [CORRECT]
C. C. Apply a cooling blanket and reassess in 30 minutes
D. D. Encourage increased oral fluid intake
Correct Answer: B
Rationale: Fever in a neutropenic patient (which is expected during induction chemotherapy for AML) is a medical emergency known as
febrile neutropenia. The priority action is to obtain blood cultures from two separate sites and immediately initiate broad-spectrum
empiric antibiotics, as delay in treatment significantly increases mortality. The combination of fever, tachycardia, and hypotension
suggests possible sepsis. Chemotherapy should be held during active infection. Cooling measures are secondary to treating the
underlying infection. Oral fluids are insufficient for a patient showing signs of hemodynamic instability.
Q5: A nurse is teaching a patient with idiopathic thrombocytopenic purpura (ITP) about self-care. Which
statement by the patient indicates the need for further teaching?
A. A. 'I should use a soft-bristled toothbrush for oral care.'
B. B. 'I will avoid taking aspirin and ibuprofen for pain relief.'
C. C. 'I can continue participating in my contact karate class.' [CORRECT]
D. D. 'I should report any unexplained bruising or bleeding to my provider.'
Correct Answer: C
Rationale: Patients with ITP have low platelet counts (thrombocytopenia) that put them at significant risk for bleeding. Contact sports
such as karate should be strictly avoided due to the risk of traumatic bleeding, including life-threatening intracranial hemorrhage. The
other statements demonstrate appropriate understanding: soft-bristled toothbrushes minimize gum bleeding, NSAIDs like aspirin and
ibuprofen impair platelet function and should be avoided, and unexplained bruising or bleeding warrants immediate medical evaluation.
Q6: A patient with disseminated intravascular coagulation (DIC) has the following laboratory results: platelet
count 60,000/mm3, fibrinogen 80 mg/dL, PT 18 seconds, aPTT 55 seconds, and D-dimer elevated. The nurse
understands that which pathophysiological process is occurring?
A. A. Primary fibrinolysis
B. B. Simultaneous clotting and bleeding [CORRECT]
C. C. Isolated platelet destruction
D. D. Vitamin K deficiency
Correct Answer: B
Rationale: DIC is characterized by widespread activation of the coagulation cascade, leading to simultaneous formation of microthrombi
throughout the vasculature (consumption coagulopathy) and consumption of clotting factors and platelets, which results in bleeding. The
lab findings reflect this dual process: low platelets and fibrinogen from consumption, prolonged PT and aPTT from factor depletion, and
elevated D-dimer from fibrin degradation. Primary fibrinolysis does not involve microthrombi formation. Isolated platelet destruction
would not cause prolonged PT/aPTT. Vitamin K deficiency would prolong PT/aPTT but would not cause thrombocytopenia or elevated
D-dimer.
Q7: A nurse is caring for a patient who received a bone marrow transplant 10 days ago. The patient's white
blood cell count is 1,200/mm3. Which nursing diagnosis should be the priority?
A. A. Risk for impaired skin integrity
B. B. Risk for infection [CORRECT]
C. C. Risk for fluid volume deficit
Page 2
EXA M 4 A SSESSM ENT
NSG223 / NSG 223 (Latest 2026/2027
Update) Medical-Surgical Nursing II |
Guide Questions and Verified Answers |
100% Correct | Grade A
Course: NSG 223 - Medical-Surgical
Nursing II
Exam: Exam 4 - Comprehensive
Assessment
Questions: 75 Multiple Choice Questions
Format: Scenario-Based, Clinical
Judgment
Academic Year: 2026/2027
LATEST UPDATE 2 02 6/2 02 7
,NSG 223 Exam 4: Medical-Surgical Nursing II | Herzing University | 2026/2027
NSG223 / NSG 223 Exam 4 (Latest 2026/2027 Update)
Medical-Surgical Nursing II
Guide Questions and Verified Answers | 100% Correct | Grade A
Herzing University
Section 1: Hematologic and Immunologic Disorders (Q1-Q10)
Q1: A 45-year-old female patient presents with fatigue, pallor, and dyspnea on exertion. Laboratory results
reveal hemoglobin 8.2 g/dL, hematocrit 24.8%, and MCV 78 fL. Which type of anemia is most consistent with
these findings?
A. A. Iron deficiency anemia [CORRECT]
B. B. Pernicious anemia
C. C. Aplastic anemia
D. D. Hemolytic anemia
Correct Answer: A
Rationale: The patient presents with microcytic (MCV 78 fL, normal 80-100 fL) and hypochromic anemia, which is the classic
presentation of iron deficiency anemia. The low hemoglobin and hematocrit confirm significant anemia. Pernicious anemia typically
presents with macrocytic (elevated MCV) anemia due to vitamin B12 deficiency. Aplastic anemia involves pancytopenia from bone
marrow failure. Hemolytic anemia often presents with elevated reticulocyte count and indirect bilirubin as the body tries to compensate
for red blood cell destruction.
Q2: A nurse is caring for a patient with sickle cell disease who is experiencing an acute vaso-occlusive crisis.
Which intervention should the nurse prioritize?
A. A. Administer prophylactic antibiotics
B. B. Initiate aggressive intravenous hydration [CORRECT]
C. C. Apply cold compresses to affected joints
D. D. Restrict fluid intake to prevent fluid overload
Correct Answer: B
Rationale: The priority intervention for an acute vaso-occlusive (pain) crisis in sickle cell disease is aggressive intravenous hydration.
Adequate hydration reduces blood viscosity and helps prevent further sickling of red blood cells. Hydration dilutes the concentration of
hemoglobin S and improves microvascular circulation. Opioid analgesics for pain control are also essential, but hydration is the
foundational intervention. Cold compresses should be avoided because cold triggers vasoconstriction and can worsen sickling. Fluid
restriction is contraindicated as dehydration is a known precipitating factor for sickle cell crises.
Q3: A patient with hemophilia A is scheduled for a dental extraction. The nurse anticipates that the healthcare
provider will order which replacement therapy prior to the procedure?
A. A. Fresh frozen plasma (FFP)
B. B. Factor VIII concentrate [CORRECT]
C. C. Vitamin K injection
D. D. Platelet transfusion
Correct Answer: B
Page 1
, NSG 223 Exam 4: Medical-Surgical Nursing II | Herzing University | 2026/2027
Rationale: Hemophilia A is caused by a deficiency of clotting Factor VIII. Prior to invasive procedures such as dental extractions, the
patient requires replacement with Factor VIII concentrate to prevent excessive bleeding. The dose and timing are calculated based on the
patient's weight and the desired factor level. Fresh frozen plasma contains all coagulation factors but is less specific and carries a larger
volume load. Vitamin K is used for vitamin K deficiency or warfarin reversal, not hemophilia. Platelet transfusions are indicated for
thrombocytopenia, not factor deficiencies.
Q4: A 62-year-old patient with acute myeloid leukemia (AML) is receiving induction chemotherapy. The nurse
assesses the patient and finds a temperature of 38.6 degrees Celsius (101.5 degrees Fahrenheit), heart rate 110
bpm, and blood pressure 90/58 mmHg. What is the nurse's priority action?
A. A. Administer the next scheduled dose of chemotherapy
B. B. Obtain blood cultures and initiate broad-spectrum antibiotics [CORRECT]
C. C. Apply a cooling blanket and reassess in 30 minutes
D. D. Encourage increased oral fluid intake
Correct Answer: B
Rationale: Fever in a neutropenic patient (which is expected during induction chemotherapy for AML) is a medical emergency known as
febrile neutropenia. The priority action is to obtain blood cultures from two separate sites and immediately initiate broad-spectrum
empiric antibiotics, as delay in treatment significantly increases mortality. The combination of fever, tachycardia, and hypotension
suggests possible sepsis. Chemotherapy should be held during active infection. Cooling measures are secondary to treating the
underlying infection. Oral fluids are insufficient for a patient showing signs of hemodynamic instability.
Q5: A nurse is teaching a patient with idiopathic thrombocytopenic purpura (ITP) about self-care. Which
statement by the patient indicates the need for further teaching?
A. A. 'I should use a soft-bristled toothbrush for oral care.'
B. B. 'I will avoid taking aspirin and ibuprofen for pain relief.'
C. C. 'I can continue participating in my contact karate class.' [CORRECT]
D. D. 'I should report any unexplained bruising or bleeding to my provider.'
Correct Answer: C
Rationale: Patients with ITP have low platelet counts (thrombocytopenia) that put them at significant risk for bleeding. Contact sports
such as karate should be strictly avoided due to the risk of traumatic bleeding, including life-threatening intracranial hemorrhage. The
other statements demonstrate appropriate understanding: soft-bristled toothbrushes minimize gum bleeding, NSAIDs like aspirin and
ibuprofen impair platelet function and should be avoided, and unexplained bruising or bleeding warrants immediate medical evaluation.
Q6: A patient with disseminated intravascular coagulation (DIC) has the following laboratory results: platelet
count 60,000/mm3, fibrinogen 80 mg/dL, PT 18 seconds, aPTT 55 seconds, and D-dimer elevated. The nurse
understands that which pathophysiological process is occurring?
A. A. Primary fibrinolysis
B. B. Simultaneous clotting and bleeding [CORRECT]
C. C. Isolated platelet destruction
D. D. Vitamin K deficiency
Correct Answer: B
Rationale: DIC is characterized by widespread activation of the coagulation cascade, leading to simultaneous formation of microthrombi
throughout the vasculature (consumption coagulopathy) and consumption of clotting factors and platelets, which results in bleeding. The
lab findings reflect this dual process: low platelets and fibrinogen from consumption, prolonged PT and aPTT from factor depletion, and
elevated D-dimer from fibrin degradation. Primary fibrinolysis does not involve microthrombi formation. Isolated platelet destruction
would not cause prolonged PT/aPTT. Vitamin K deficiency would prolong PT/aPTT but would not cause thrombocytopenia or elevated
D-dimer.
Q7: A nurse is caring for a patient who received a bone marrow transplant 10 days ago. The patient's white
blood cell count is 1,200/mm3. Which nursing diagnosis should be the priority?
A. A. Risk for impaired skin integrity
B. B. Risk for infection [CORRECT]
C. C. Risk for fluid volume deficit
Page 2
