,Herzing NSG 233 Exam 1 | Medical-Surgical Nursing III
(2026) Q&A
1. A triage nurse in the Emergency Department is sorting incoming patients using the
Emergency Severity Index (ESI). Which patient should be assigned the highest priority (ESI
Level 1)?
A) A patient with a closed forearm fracture and moderate pain
B) A patient with a fever of 101°F and a productive cough
C) A patient who is unresponsive with a weak, thready pulse
D) A patient with a laceration requiring sutures
Correct Answer: A patient who is unresponsive with a weak, thready pulse
Rationale: ESI Level 1 is reserved for patients who are actively dying or in immediate life-
threatening conditions. An unresponsive patient with a weak, thready pulse is in critical
condition requiring immediate lifesaving intervention. The other patients are stable and
would be triaged at lower ESI levels.
2. A patient with hemorrhagic shock is being managed in the emergency department. What
is the nurse's priority intervention to treat the underlying cause?
A) Administer broad-spectrum antibiotics
B) Apply direct pressure to the bleeding site
C) Administer intravenous fluids rapidly
D) Place the patient in the Trendelenburg position
Correct Answer: Apply direct pressure to the bleeding site
Rationale: In hemorrhagic shock, the priority is to stop the bleeding. Direct pressure should
be applied to the bleeding site immediately. While fluid resuscitation and positioning are
important, they are secondary to controlling the source of hemorrhage.
,3. A patient is in hypovolemic shock secondary to severe nausea, vomiting, and diarrhea
(NVD). What intervention should the nurse anticipate to address the underlying cause?
A) Administer antiemetic and antidiarrheal medications
B) Administer packed red blood cells
C) Place the patient in modified Trendelenburg position
D) Apply direct pressure
Correct Answer: Administer antiemetic and antidiarrheal medications
Rationale: When hypovolemic shock is caused by severe NVD, the underlying cause must be
treated by administering medications to stop the vomiting and diarrhea. Fluid losses must be
replaced simultaneously, but addressing the source is critical.
4. The nurse is preparing to administer intravenous fluids to a patient in hypovolemic shock.
Which type of fluid is most appropriate for initial resuscitation?
A) Dextrose 5% in water (D5W)
B) 0.9% normal saline (NS) or Lactated Ringer's (LR)
C) 3% normal saline
D) Albumin
Correct Answer: 0.9% normal saline (NS) or Lactated Ringer's (LR)
Rationale: Isotonic crystalloids such as 0.9% normal saline (NS) and Lactated Ringer's (LR)
are the preferred fluids for initial resuscitation in hypovolemic shock. They expand
intravascular volume effectively. D5W is hypotonic and distributes into cells, and hypertonic
saline is used for specific conditions.
5. A patient is receiving a massive blood transfusion for hypovolemic shock. Which nursing
intervention is essential to prevent a serious complication?
A) Warm the blood products before administration
, B) Administer the blood through a small-bore IV catheter
C) Administer the blood rapidly without monitoring
D) Mix the blood with dextrose solutions
Correct Answer: Warm the blood products before administration
Rationale: Massive transfusions of cold blood products can lead to hypothermia. It is
essential to warm blood products before administration to prevent this serious complication.
Large-bore IV catheters should be used, and blood should not be mixed with dextrose
solutions.
6. A patient in hypovolemic shock is placed in the modified Trendelenburg position. What is
the primary goal of this intervention?
A) To improve venous return and restore intravascular volume
B) To prevent aspiration
C) To improve cerebral perfusion
D) To reduce cardiac workload
Correct Answer: To improve venous return and restore intravascular volume
Rationale: The modified Trendelenburg position (legs elevated) helps to improve venous
return to the heart, thereby restoring intravascular volume and improving cardiac output. It
is a temporary measure while fluid resuscitation is being initiated.
7. A patient with a 20% total body surface area (TBSA) burn weighing 98 lbs (44.5 kg) is being
resuscitated using the Parkland formula. The nurse calculates the total fluid requirement for
the first 24 hours. How much Lactated Ringer's should be administered in the first 8 hours?
A) 445 mL
B) 890 mL
C) 1780 mL
(2026) Q&A
1. A triage nurse in the Emergency Department is sorting incoming patients using the
Emergency Severity Index (ESI). Which patient should be assigned the highest priority (ESI
Level 1)?
A) A patient with a closed forearm fracture and moderate pain
B) A patient with a fever of 101°F and a productive cough
C) A patient who is unresponsive with a weak, thready pulse
D) A patient with a laceration requiring sutures
Correct Answer: A patient who is unresponsive with a weak, thready pulse
Rationale: ESI Level 1 is reserved for patients who are actively dying or in immediate life-
threatening conditions. An unresponsive patient with a weak, thready pulse is in critical
condition requiring immediate lifesaving intervention. The other patients are stable and
would be triaged at lower ESI levels.
2. A patient with hemorrhagic shock is being managed in the emergency department. What
is the nurse's priority intervention to treat the underlying cause?
A) Administer broad-spectrum antibiotics
B) Apply direct pressure to the bleeding site
C) Administer intravenous fluids rapidly
D) Place the patient in the Trendelenburg position
Correct Answer: Apply direct pressure to the bleeding site
Rationale: In hemorrhagic shock, the priority is to stop the bleeding. Direct pressure should
be applied to the bleeding site immediately. While fluid resuscitation and positioning are
important, they are secondary to controlling the source of hemorrhage.
,3. A patient is in hypovolemic shock secondary to severe nausea, vomiting, and diarrhea
(NVD). What intervention should the nurse anticipate to address the underlying cause?
A) Administer antiemetic and antidiarrheal medications
B) Administer packed red blood cells
C) Place the patient in modified Trendelenburg position
D) Apply direct pressure
Correct Answer: Administer antiemetic and antidiarrheal medications
Rationale: When hypovolemic shock is caused by severe NVD, the underlying cause must be
treated by administering medications to stop the vomiting and diarrhea. Fluid losses must be
replaced simultaneously, but addressing the source is critical.
4. The nurse is preparing to administer intravenous fluids to a patient in hypovolemic shock.
Which type of fluid is most appropriate for initial resuscitation?
A) Dextrose 5% in water (D5W)
B) 0.9% normal saline (NS) or Lactated Ringer's (LR)
C) 3% normal saline
D) Albumin
Correct Answer: 0.9% normal saline (NS) or Lactated Ringer's (LR)
Rationale: Isotonic crystalloids such as 0.9% normal saline (NS) and Lactated Ringer's (LR)
are the preferred fluids for initial resuscitation in hypovolemic shock. They expand
intravascular volume effectively. D5W is hypotonic and distributes into cells, and hypertonic
saline is used for specific conditions.
5. A patient is receiving a massive blood transfusion for hypovolemic shock. Which nursing
intervention is essential to prevent a serious complication?
A) Warm the blood products before administration
, B) Administer the blood through a small-bore IV catheter
C) Administer the blood rapidly without monitoring
D) Mix the blood with dextrose solutions
Correct Answer: Warm the blood products before administration
Rationale: Massive transfusions of cold blood products can lead to hypothermia. It is
essential to warm blood products before administration to prevent this serious complication.
Large-bore IV catheters should be used, and blood should not be mixed with dextrose
solutions.
6. A patient in hypovolemic shock is placed in the modified Trendelenburg position. What is
the primary goal of this intervention?
A) To improve venous return and restore intravascular volume
B) To prevent aspiration
C) To improve cerebral perfusion
D) To reduce cardiac workload
Correct Answer: To improve venous return and restore intravascular volume
Rationale: The modified Trendelenburg position (legs elevated) helps to improve venous
return to the heart, thereby restoring intravascular volume and improving cardiac output. It
is a temporary measure while fluid resuscitation is being initiated.
7. A patient with a 20% total body surface area (TBSA) burn weighing 98 lbs (44.5 kg) is being
resuscitated using the Parkland formula. The nurse calculates the total fluid requirement for
the first 24 hours. How much Lactated Ringer's should be administered in the first 8 hours?
A) 445 mL
B) 890 mL
C) 1780 mL
