HERZING UNIVERSITY NSG 223 MEDICAL-SURGICAL NURSING II COMPREHENSIVE
FINAL EXAMINATION 2026/2027 ACADEMIC YEAR | BRAND NEW VERSION WITH
VERIFIED ANSWERS AND RATIONALES | INTERMEDIATE TO ADVANCED LEVEL
SECTION A: PERIOPERATIVE AND CRITICAL CARE NURSING
1. The nurse is completing a preoperative assessment on a male client who states, "I
am allergic to codeine." Which intervention should the nurse implement first?
A. Apply an allergy bracelet on the client's wrist.
B. Label the client's allergies on the front of the chart.
C. Ask the client what happens when he takes the codeine.
D. Document the allergy on the medication administration record.
Answer: C
Rationale: The nurse must first assess the specific reaction to the medication, as
clients often mistake side effects like nausea for a true allergic reaction. This
assessment determines whether an actual allergy exists and guides subsequent
interventions.
2. Which laboratory result would require immediate intervention by the nurse for a
client scheduled for surgery?
A. Calcium 9.2 mg/dL.
B. Bleeding time 2 minutes.
C. Hemoglobin 15 g/dL.
D. Potassium 2.4 mEq/L.
Answer: D
Rationale: A potassium level of 2.4 mEq/L indicates severe hypokalemia, which is
critical because potassium is essential for muscle function, including cardiac
muscle. This abnormality requires immediate reporting to the healthcare provider
and intervention.
3. The circulating nurse observes the surgical scrub technician remove a sponge from
the edge of the sterile field with a clamp and place the sponge and clamp in a
designated area. What is the appropriate action?
A. Place the sponge back where it was.
, B. Tell the technician not to waste supplies.
C. Do nothing because this is the correct procedure.
D. Take the sponge out of the room immediately.
Answer: C
Rationale: The technician followed the correct procedure. Sponges are counted
meticulously to maintain client safety and must be kept together to verify the count
before the incision is closed. Removing sponges and placing them in a designated
area ensures they are available for the final count.
4. The circulating nurse and the scrub technician find a discrepancy in the sponge
count. Which action should the circulating nurse take first?
A. Notify the client's surgeon.
B. Complete an occurrence report.
C. Contact the surgical manager.
D. Continue searching for the missing sponge.
Answer: A
Rationale: A discrepancy in the sponge count is a critical safety issue that must be
immediately communicated to the surgeon. The surgeon needs to be aware of this
situation before closing the incision to take appropriate action.
5. A client has a decrease in T cells and B cells. What nursing action is a priority?
A. Monitor for altered kidney function.
B. Monitor regularly for blood loss.
C. Monitor for joint swelling and tenderness.
D. Monitor regularly for signs of infection.
Answer: D
Rationale: Decreased T cells and B cells compromise the immune system and
increase the risk of infection. Monitoring for signs of infection allows for early
intervention and prevention of complications.
6. A client arrives in the emergency department after being bitten by a raccoon. What
nursing action does the nurse anticipate preparing for?
A. Administering a rabies vaccine to provide naturally acquired active immunity.
B. Administering a rabies vaccine to provide artificially acquired passive immunity.
C. Administering a rabies vaccine to create antibody-mediated immunity.
D. Administering a rabies vaccine to provide naturally acquired passive immunity.
Answer: B
Rationale: Rabies immunization provides artificially acquired passive immunity by
, injecting ready-made antibodies. These antibodies were produced by another
individual's immune system to provide immediate protection.
7. The nurse is discussing the benefits of breast-feeding to a pregnant mother. What
statement made by the client demonstrates understanding of the benefits?
A. "The infant will receive artificially acquired active immunity to provide protection
from viruses."
B. "The infant will receive artificially acquired passive immunity to provide protection
from bacteria."
C. "The infant will receive naturally acquired active immunity to provide protection
from diseases."
D. "The infant will receive naturally acquired passive immunity to provide protection
from infections."
Answer: D
Rationale: Breastfeeding provides naturally acquired passive immunity through the
transfer of maternal antibodies. The infant receives ready-made antibodies, not
active immunity, because the infant does not produce them independently.
8. A 75-year-old patient is scheduled for surgery. Which age-related change increases
this patient's risk for hypothermia in the perioperative period?
A. Decreased muscle mass.
B. Decreased basal body temperature.
C. Thinning of subcutaneous fat.
D. Increased metabolic rate.
Answer: C
Rationale: Older adults have thinning of subcutaneous fat, which reduces
insulation and increases susceptibility to hypothermia. Monitoring and maintaining
body temperature is crucial in this population.
9. What is the priority teaching point when the nurse is discussing narcotic analgesic
side effects with a patient who has had surgery?
A. Risk of hypotension.
B. Risk of constipation.
C. Risk of respiratory depression.
D. Risk of urinary retention.
Answer: C
Rationale: Respiratory depression is the most serious and potentially life-
threatening side effect of narcotic analgesics. While constipation, urinary retention,
, and hypotension are important, respiratory depression is the priority due to its
immediate danger.
10. A patient is receiving neuromuscular blocking agents for mechanical ventilation.
What nursing assessment is critical?
A. Monitoring for increased muscle strength.
B. Ensuring the patient can communicate verbally.
C. Providing eye care since the patient cannot blink.
D. Encouraging the patient to ambulate frequently.
Answer: C
Rationale: Neuromuscular blocking agents paralyze motor function, including the
blink reflex. This places the patient at risk for corneal abrasions. Eye care with
lubricating drops and protective patches is essential.
11. A patient with ARDS is being mechanically ventilated. Which acid-base imbalance is
associated with this condition?
A. Metabolic alkalosis.
B. Respiratory alkalosis.
C. Metabolic acidosis.
D. Respiratory acidosis.
Answer: D
Rationale: ARDS leads to impaired gas exchange and inadequate alveolar
ventilation, resulting in carbon dioxide retention. This causes respiratory acidosis,
requiring mechanical ventilation to correct.
12. A patient 12 hours post-burn injury with 30% TBSA burns requires fluid
resuscitation. Using the Parkland formula (4mL x kg x %TBSA), if the total 24-hour
fluid requirement is 8000 mL, how much should be infused in the first 8 hours total?
A. 2000 mL.
B. 8000 mL.
C. 4000 mL.
D. 1000 mL.
Answer: C
Rationale: The Parkland formula dictates that half of the total 24-hour fluid
requirement must be given in the first 8 hours post-injury. Therefore, 4000 mL should
be infused in the first 8 hours.
13. A patient in hypovolemic shock is being treated. Which parameter best indicates
that fluid resuscitation is successful?
A. Urine output of 40 mL/hr.
FINAL EXAMINATION 2026/2027 ACADEMIC YEAR | BRAND NEW VERSION WITH
VERIFIED ANSWERS AND RATIONALES | INTERMEDIATE TO ADVANCED LEVEL
SECTION A: PERIOPERATIVE AND CRITICAL CARE NURSING
1. The nurse is completing a preoperative assessment on a male client who states, "I
am allergic to codeine." Which intervention should the nurse implement first?
A. Apply an allergy bracelet on the client's wrist.
B. Label the client's allergies on the front of the chart.
C. Ask the client what happens when he takes the codeine.
D. Document the allergy on the medication administration record.
Answer: C
Rationale: The nurse must first assess the specific reaction to the medication, as
clients often mistake side effects like nausea for a true allergic reaction. This
assessment determines whether an actual allergy exists and guides subsequent
interventions.
2. Which laboratory result would require immediate intervention by the nurse for a
client scheduled for surgery?
A. Calcium 9.2 mg/dL.
B. Bleeding time 2 minutes.
C. Hemoglobin 15 g/dL.
D. Potassium 2.4 mEq/L.
Answer: D
Rationale: A potassium level of 2.4 mEq/L indicates severe hypokalemia, which is
critical because potassium is essential for muscle function, including cardiac
muscle. This abnormality requires immediate reporting to the healthcare provider
and intervention.
3. The circulating nurse observes the surgical scrub technician remove a sponge from
the edge of the sterile field with a clamp and place the sponge and clamp in a
designated area. What is the appropriate action?
A. Place the sponge back where it was.
, B. Tell the technician not to waste supplies.
C. Do nothing because this is the correct procedure.
D. Take the sponge out of the room immediately.
Answer: C
Rationale: The technician followed the correct procedure. Sponges are counted
meticulously to maintain client safety and must be kept together to verify the count
before the incision is closed. Removing sponges and placing them in a designated
area ensures they are available for the final count.
4. The circulating nurse and the scrub technician find a discrepancy in the sponge
count. Which action should the circulating nurse take first?
A. Notify the client's surgeon.
B. Complete an occurrence report.
C. Contact the surgical manager.
D. Continue searching for the missing sponge.
Answer: A
Rationale: A discrepancy in the sponge count is a critical safety issue that must be
immediately communicated to the surgeon. The surgeon needs to be aware of this
situation before closing the incision to take appropriate action.
5. A client has a decrease in T cells and B cells. What nursing action is a priority?
A. Monitor for altered kidney function.
B. Monitor regularly for blood loss.
C. Monitor for joint swelling and tenderness.
D. Monitor regularly for signs of infection.
Answer: D
Rationale: Decreased T cells and B cells compromise the immune system and
increase the risk of infection. Monitoring for signs of infection allows for early
intervention and prevention of complications.
6. A client arrives in the emergency department after being bitten by a raccoon. What
nursing action does the nurse anticipate preparing for?
A. Administering a rabies vaccine to provide naturally acquired active immunity.
B. Administering a rabies vaccine to provide artificially acquired passive immunity.
C. Administering a rabies vaccine to create antibody-mediated immunity.
D. Administering a rabies vaccine to provide naturally acquired passive immunity.
Answer: B
Rationale: Rabies immunization provides artificially acquired passive immunity by
, injecting ready-made antibodies. These antibodies were produced by another
individual's immune system to provide immediate protection.
7. The nurse is discussing the benefits of breast-feeding to a pregnant mother. What
statement made by the client demonstrates understanding of the benefits?
A. "The infant will receive artificially acquired active immunity to provide protection
from viruses."
B. "The infant will receive artificially acquired passive immunity to provide protection
from bacteria."
C. "The infant will receive naturally acquired active immunity to provide protection
from diseases."
D. "The infant will receive naturally acquired passive immunity to provide protection
from infections."
Answer: D
Rationale: Breastfeeding provides naturally acquired passive immunity through the
transfer of maternal antibodies. The infant receives ready-made antibodies, not
active immunity, because the infant does not produce them independently.
8. A 75-year-old patient is scheduled for surgery. Which age-related change increases
this patient's risk for hypothermia in the perioperative period?
A. Decreased muscle mass.
B. Decreased basal body temperature.
C. Thinning of subcutaneous fat.
D. Increased metabolic rate.
Answer: C
Rationale: Older adults have thinning of subcutaneous fat, which reduces
insulation and increases susceptibility to hypothermia. Monitoring and maintaining
body temperature is crucial in this population.
9. What is the priority teaching point when the nurse is discussing narcotic analgesic
side effects with a patient who has had surgery?
A. Risk of hypotension.
B. Risk of constipation.
C. Risk of respiratory depression.
D. Risk of urinary retention.
Answer: C
Rationale: Respiratory depression is the most serious and potentially life-
threatening side effect of narcotic analgesics. While constipation, urinary retention,
, and hypotension are important, respiratory depression is the priority due to its
immediate danger.
10. A patient is receiving neuromuscular blocking agents for mechanical ventilation.
What nursing assessment is critical?
A. Monitoring for increased muscle strength.
B. Ensuring the patient can communicate verbally.
C. Providing eye care since the patient cannot blink.
D. Encouraging the patient to ambulate frequently.
Answer: C
Rationale: Neuromuscular blocking agents paralyze motor function, including the
blink reflex. This places the patient at risk for corneal abrasions. Eye care with
lubricating drops and protective patches is essential.
11. A patient with ARDS is being mechanically ventilated. Which acid-base imbalance is
associated with this condition?
A. Metabolic alkalosis.
B. Respiratory alkalosis.
C. Metabolic acidosis.
D. Respiratory acidosis.
Answer: D
Rationale: ARDS leads to impaired gas exchange and inadequate alveolar
ventilation, resulting in carbon dioxide retention. This causes respiratory acidosis,
requiring mechanical ventilation to correct.
12. A patient 12 hours post-burn injury with 30% TBSA burns requires fluid
resuscitation. Using the Parkland formula (4mL x kg x %TBSA), if the total 24-hour
fluid requirement is 8000 mL, how much should be infused in the first 8 hours total?
A. 2000 mL.
B. 8000 mL.
C. 4000 mL.
D. 1000 mL.
Answer: C
Rationale: The Parkland formula dictates that half of the total 24-hour fluid
requirement must be given in the first 8 hours post-injury. Therefore, 4000 mL should
be infused in the first 8 hours.
13. A patient in hypovolemic shock is being treated. Which parameter best indicates
that fluid resuscitation is successful?
A. Urine output of 40 mL/hr.
