Herzing University NSG 223 Med Surg II Final Exam
(2026/2027 Edition)
Comprehensive Practice Examination
1. A 68-year-old client with chronic heart failure is admitted with acute decompensated heart
failure. Which assessment finding is most indicative of worsening heart failure?
A) Blood pressure 138/86 mmHg
B) Jugular venous distension
C) Heart rate 88 beats/min
D) Respiratory rate 18 breaths/min
Answer: B) Jugular venous distension
Rationale: Jugular venous distension (JVD) is a classic sign of increased central venous pressure,
indicating right-sided heart failure and fluid overload. It is a direct indicator of worsening heart
failure. The vital signs listed are within normal limits and do not specifically indicate
decompensation.
2. A client with acute pancreatitis has a serum amylase of 450 U/L and lipase of 600 U/L.
Which nursing intervention is the priority?
A) Administer IV fluids
B) Encourage oral intake
C) Place the client on NPO status
D) Apply warm compresses to the abdomen
Answer: A) Administer IV fluids
Rationale: The priority intervention for acute pancreatitis is to maintain fluid and electrolyte
balance. IV fluids are essential because clients are at risk for hypovolemia due to third-spacing
and vomiting. NPO status is important but fluid replacement takes precedence. Oral intake
should be withheld, not encouraged.
3. A client with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of
88% on room air. The client is receiving oxygen at 2 L/min via nasal cannula. Which finding
indicates the client is experiencing oxygen toxicity?
A) Headache
B) Cough
,C) Substernal chest pain
D) Confusion
Answer: C) Substernal chest pain
Rationale: Substernal chest pain is a sign of oxygen toxicity, which can occur with high oxygen
concentrations over extended periods. Headache, cough, and confusion can occur with both
hypoxia and hyperoxia, but substernal chest pain is more specific to oxygen toxicity. Oxygen
should be administered cautiously in clients with COPD due to the hypoxic drive.
4. A client who is 3 days post-operative after a bowel resection develops abdominal
distension, nausea, and vomiting. The nurse notes the client's bowel sounds are absent.
Which complication should the nurse suspect?
A) Wound infection
B) Paralytic ileus
C) Intra-abdominal bleeding
D) Adhesive small bowel obstruction
Answer: B) Paralytic ileus
Rationale: Paralytic ileus is common after abdominal surgery due to manipulation of the bowel
and the effects of anesthesia. The classic signs include abdominal distension, nausea, vomiting,
and absent bowel sounds. Wound infection typically presents with fever and wound erythema.
Intra-abdominal bleeding would present with hypotension and tachycardia. Obstruction often
presents with hyperactive bowel sounds.
5. A client with a diagnosis of pulmonary embolism (PE) is receiving IV heparin therapy.
Which laboratory value should the nurse monitor to evaluate the effectiveness of therapy?
A) Activated partial thromboplastin time (aPTT)
B) Prothrombin time (PT)
C) International normalized ratio (INR)
D) Platelet count
Answer: A) Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored using aPTT, with a therapeutic goal of 1.5-2.5 times the
normal control value. PT and INR are used to monitor warfarin therapy. Platelet count is
monitored for heparin-induced thrombocytopenia (HIT), but it is not used to evaluate
therapeutic effectiveness.
6. A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which serum
electrolyte value should the nurse report to the healthcare provider before dialysis?
,A) Potassium 5.8 mEq/L
B) Sodium 138 mEq/L
C) Calcium 9.2 mg/dL
D) Magnesium 2.0 mEq/L
Answer: A) Potassium 5.8 mEq/L
Rationale: A potassium level of 5.8 mEq/L is elevated (normal: 3.5-5.0 mEq/L). Hyperkalemia is a
life-threatening complication of ESRD. While dialysis will remove potassium, the elevated level
should be reported and may require additional interventions before or during dialysis. The other
values are within normal limits.
7. A client is prescribed furosemide (Lasix) 40 mg IV push. The nurse notes the client's blood
pressure is 90/60 mmHg. Which action should the nurse take?
A) Administer the medication as prescribed
B) Hold the medication and notify the healthcare provider
C) Administer the medication at half the dose
D) Administer the medication over 5 minutes
Answer: B) Hold the medication and notify the healthcare provider
Rationale: Furosemide is a potent diuretic that can further lower blood pressure. A blood
pressure of 90/60 mmHg is hypotensive and the medication should be held until the provider is
notified. The hypotension may be due to hypovolemia, and administering the diuretic could lead
to further compromise.
8. A client with diabetes mellitus type 2 is admitted with a blood glucose level of 680 mg/dL.
The client is lethargic, has Kussmaul respirations, and serum ketones are positive. Which acid-
base imbalance should the nurse expect?
A) Respiratory acidosis
B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis
Answer: B) Metabolic acidosis
Rationale: Diabetic ketoacidosis (DKA) causes metabolic acidosis due to the accumulation of
ketone bodies from fatty acid metabolism. Kussmaul respirations are a compensatory
mechanism. Respiratory acidosis would show elevated CO2; respiratory alkalosis would show
decreased CO2; metabolic alkalosis would show elevated bicarbonate and pH.
, 9. A client who is receiving IV fluids at 125 mL/hour develops crackles in the lung bases,
dyspnea, and an increase in blood pressure. Which action should the nurse take first?
A) Slow the IV infusion rate
B) Notify the healthcare provider
C) Place the client in a high Fowler's position
D) Administer supplemental oxygen
Answer: A) Slow the IV infusion rate
Rationale: The client is exhibiting signs of fluid overload (crackles, dyspnea, hypertension). The
first action is to slow the IV infusion rate to prevent further fluid accumulation. After slowing the
rate, the nurse should notify the provider and then position the client and administer oxygen as
needed.
10. A client with liver cirrhosis has ascites and is prescribed spironolactone (Aldactone).
Which laboratory value should the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Answer: B) Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic. Hyperkalemia is a potential
complication that must be monitored. While sodium, calcium, and magnesium are important,
potassium is the priority due to the risk of life-threatening cardiac dysrhythmias.
11. A client who is post-operative from a hip replacement surgery has a sudden onset of
dyspnea, chest pain, and oxygen saturation of 88%. Which condition should the nurse
suspect?
A) Atelectasis
B) Pulmonary embolism
C) Pneumonia
D) Pulmonary edema
Answer: B) Pulmonary embolism
Rationale: Sudden dyspnea, chest pain, and hypoxia in a post-operative client are classic signs of
pulmonary embolism (PE). This is especially concerning after orthopedic surgery due to the risk
of venous thromboembolism from immobility and surgical trauma. Atelectasis develops more
gradually; pneumonia would have infectious symptoms; pulmonary edema would have crackles
and potential fluid overload signs.
(2026/2027 Edition)
Comprehensive Practice Examination
1. A 68-year-old client with chronic heart failure is admitted with acute decompensated heart
failure. Which assessment finding is most indicative of worsening heart failure?
A) Blood pressure 138/86 mmHg
B) Jugular venous distension
C) Heart rate 88 beats/min
D) Respiratory rate 18 breaths/min
Answer: B) Jugular venous distension
Rationale: Jugular venous distension (JVD) is a classic sign of increased central venous pressure,
indicating right-sided heart failure and fluid overload. It is a direct indicator of worsening heart
failure. The vital signs listed are within normal limits and do not specifically indicate
decompensation.
2. A client with acute pancreatitis has a serum amylase of 450 U/L and lipase of 600 U/L.
Which nursing intervention is the priority?
A) Administer IV fluids
B) Encourage oral intake
C) Place the client on NPO status
D) Apply warm compresses to the abdomen
Answer: A) Administer IV fluids
Rationale: The priority intervention for acute pancreatitis is to maintain fluid and electrolyte
balance. IV fluids are essential because clients are at risk for hypovolemia due to third-spacing
and vomiting. NPO status is important but fluid replacement takes precedence. Oral intake
should be withheld, not encouraged.
3. A client with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of
88% on room air. The client is receiving oxygen at 2 L/min via nasal cannula. Which finding
indicates the client is experiencing oxygen toxicity?
A) Headache
B) Cough
,C) Substernal chest pain
D) Confusion
Answer: C) Substernal chest pain
Rationale: Substernal chest pain is a sign of oxygen toxicity, which can occur with high oxygen
concentrations over extended periods. Headache, cough, and confusion can occur with both
hypoxia and hyperoxia, but substernal chest pain is more specific to oxygen toxicity. Oxygen
should be administered cautiously in clients with COPD due to the hypoxic drive.
4. A client who is 3 days post-operative after a bowel resection develops abdominal
distension, nausea, and vomiting. The nurse notes the client's bowel sounds are absent.
Which complication should the nurse suspect?
A) Wound infection
B) Paralytic ileus
C) Intra-abdominal bleeding
D) Adhesive small bowel obstruction
Answer: B) Paralytic ileus
Rationale: Paralytic ileus is common after abdominal surgery due to manipulation of the bowel
and the effects of anesthesia. The classic signs include abdominal distension, nausea, vomiting,
and absent bowel sounds. Wound infection typically presents with fever and wound erythema.
Intra-abdominal bleeding would present with hypotension and tachycardia. Obstruction often
presents with hyperactive bowel sounds.
5. A client with a diagnosis of pulmonary embolism (PE) is receiving IV heparin therapy.
Which laboratory value should the nurse monitor to evaluate the effectiveness of therapy?
A) Activated partial thromboplastin time (aPTT)
B) Prothrombin time (PT)
C) International normalized ratio (INR)
D) Platelet count
Answer: A) Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored using aPTT, with a therapeutic goal of 1.5-2.5 times the
normal control value. PT and INR are used to monitor warfarin therapy. Platelet count is
monitored for heparin-induced thrombocytopenia (HIT), but it is not used to evaluate
therapeutic effectiveness.
6. A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which serum
electrolyte value should the nurse report to the healthcare provider before dialysis?
,A) Potassium 5.8 mEq/L
B) Sodium 138 mEq/L
C) Calcium 9.2 mg/dL
D) Magnesium 2.0 mEq/L
Answer: A) Potassium 5.8 mEq/L
Rationale: A potassium level of 5.8 mEq/L is elevated (normal: 3.5-5.0 mEq/L). Hyperkalemia is a
life-threatening complication of ESRD. While dialysis will remove potassium, the elevated level
should be reported and may require additional interventions before or during dialysis. The other
values are within normal limits.
7. A client is prescribed furosemide (Lasix) 40 mg IV push. The nurse notes the client's blood
pressure is 90/60 mmHg. Which action should the nurse take?
A) Administer the medication as prescribed
B) Hold the medication and notify the healthcare provider
C) Administer the medication at half the dose
D) Administer the medication over 5 minutes
Answer: B) Hold the medication and notify the healthcare provider
Rationale: Furosemide is a potent diuretic that can further lower blood pressure. A blood
pressure of 90/60 mmHg is hypotensive and the medication should be held until the provider is
notified. The hypotension may be due to hypovolemia, and administering the diuretic could lead
to further compromise.
8. A client with diabetes mellitus type 2 is admitted with a blood glucose level of 680 mg/dL.
The client is lethargic, has Kussmaul respirations, and serum ketones are positive. Which acid-
base imbalance should the nurse expect?
A) Respiratory acidosis
B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis
Answer: B) Metabolic acidosis
Rationale: Diabetic ketoacidosis (DKA) causes metabolic acidosis due to the accumulation of
ketone bodies from fatty acid metabolism. Kussmaul respirations are a compensatory
mechanism. Respiratory acidosis would show elevated CO2; respiratory alkalosis would show
decreased CO2; metabolic alkalosis would show elevated bicarbonate and pH.
, 9. A client who is receiving IV fluids at 125 mL/hour develops crackles in the lung bases,
dyspnea, and an increase in blood pressure. Which action should the nurse take first?
A) Slow the IV infusion rate
B) Notify the healthcare provider
C) Place the client in a high Fowler's position
D) Administer supplemental oxygen
Answer: A) Slow the IV infusion rate
Rationale: The client is exhibiting signs of fluid overload (crackles, dyspnea, hypertension). The
first action is to slow the IV infusion rate to prevent further fluid accumulation. After slowing the
rate, the nurse should notify the provider and then position the client and administer oxygen as
needed.
10. A client with liver cirrhosis has ascites and is prescribed spironolactone (Aldactone).
Which laboratory value should the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Answer: B) Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic. Hyperkalemia is a potential
complication that must be monitored. While sodium, calcium, and magnesium are important,
potassium is the priority due to the risk of life-threatening cardiac dysrhythmias.
11. A client who is post-operative from a hip replacement surgery has a sudden onset of
dyspnea, chest pain, and oxygen saturation of 88%. Which condition should the nurse
suspect?
A) Atelectasis
B) Pulmonary embolism
C) Pneumonia
D) Pulmonary edema
Answer: B) Pulmonary embolism
Rationale: Sudden dyspnea, chest pain, and hypoxia in a post-operative client are classic signs of
pulmonary embolism (PE). This is especially concerning after orthopedic surgery due to the risk
of venous thromboembolism from immobility and surgical trauma. Atelectasis develops more
gradually; pneumonia would have infectious symptoms; pulmonary edema would have crackles
and potential fluid overload signs.
