NSG 223 Exam 2 Study Guide | Nursing
Practice Questions & Answers
NSG 223 Exam 2 Study Guide | Nursing Practice Questions & Answers
Examination Overview
This comprehensive examination consists of 200 multiple-choice questions covering the core
content areas for NSG 223 Medical-Surgical Nursing II, Exam 2. The examination assesses knowledge,
clinical application, and critical thinking across respiratory disorders (pulmonary embolism, acute
respiratory distress syndrome, mechanical ventilation, arterial blood gas interpretation, respiratory
failure), renal and urinary disorders (acute kidney injury, chronic kidney disease, dialysis),
gastrointestinal and hepatic disorders (hepatitis, pancreatitis, cirrhosis), and fluid, electrolyte, and
acid-base imbalances. Questions range from foundational knowledge to advanced clinical judgment,
prioritizing nursing safety and evidence-based practice.
Table of Contents
Section Topic Questions
I Pulmonary Embolism 1–25
II Acute Respiratory Distress Syndrome (ARDS) 26–50
III Mechanical Ventilation 51–75
IV Arterial Blood Gas Interpretation & Acid-Base Imbalances 76–100
V Acute Kidney Injury & Chronic Kidney Disease 101–130
VI Dialysis 131–150
VII Hepatitis 151–165
VIII Pancreatitis 166–180
IX Cirrhosis & Hepatic Encephalopathy 181–200
pg. 1
,Section I: Pulmonary Embolism (Questions 1–25)
Q1. A client is admitted with a suspected pulmonary embolism. Which assessment finding is most
consistent with this diagnosis?
A. Bradycardia and hypertension
B. Sudden onset of dyspnea and pleuritic chest pain
C. Productive cough with yellow sputum
D. Gradual onset of peripheral edema
Correct Answer: B. Sudden onset of dyspnea and pleuritic chest pain
Rationale: Pulmonary embolism classically presents with sudden onset of dyspnea, pleuritic chest
pain, and tachypnea due to obstruction of pulmonary blood flow. Bradycardia and hypertension are
not typical; productive cough suggests infection; peripheral edema is more consistent with heart
failure.
Q2. A postoperative client suddenly develops shortness of breath and tachycardia. The nurse
suspects pulmonary embolism. Which action should the nurse take first?
A. Administer prescribed anticoagulant
B. Apply supplemental oxygen
C. Obtain a chest x-ray
D. Position the client supine
Correct Answer: B. Apply supplemental oxygen
Rationale: Airway and breathing take priority. Oxygenation should be addressed immediately while
preparing for diagnostic confirmation. Anticoagulants are administered after diagnosis is confirmed
(unless high clinical suspicion with provider order). Chest x-ray helps rule out other causes but is not
the immediate priority. Supine positioning may worsen respiratory distress; semi-Fowler's is
preferred.
Q3. Which laboratory test is most specific for diagnosing pulmonary embolism?
A. D-dimer
B. Troponin
C. BNP
D. Complete blood count
Correct Answer: A. D-dimer
Rationale: D-dimer is a degradation product of cross-linked fibrin and is elevated in the presence of
thrombosis. A negative D-dimer in low-risk patients effectively rules out PE. Troponin and BNP are
cardiac markers; CBC is nonspecific.
Q4. A client with pulmonary embolism is started on a heparin infusion. Which laboratory value
should the nurse monitor to evaluate therapeutic effectiveness?
pg. 2
,A. INR
B. aPTT
C. Platelet count
D. Hemoglobin
Correct Answer: B. aPTT
Rationale: Unfractionated heparin therapy is monitored using the activated partial thromboplastin
time (aPTT), with a therapeutic goal typically 1.5–2.5 times the control value. INR is used for
warfarin. Platelet count is monitored for heparin-induced thrombocytopenia but does not measure
therapeutic anticoagulation.
Q5. A client receiving heparin for pulmonary embolism develops a sudden drop in platelet count
from 250,000 to 80,000/mm³. What is the nurse's priority action?
A. Continue heparin as prescribed
B. Hold heparin and notify the provider
C. Administer vitamin K
D. Increase heparin infusion rate
Correct Answer: B. Hold heparin and notify the provider
Rationale: A sudden drop in platelets suggests heparin-induced thrombocytopenia (HIT), a serious
immune-mediated complication. Heparin must be stopped immediately and the provider notified.
Vitamin K reverses warfarin, not heparin. Increasing the rate would worsen HIT.
Q6. Which client is at highest risk for developing a pulmonary embolism?
A. A client with asthma
B. A client 48 hours post–total hip arthroplasty
C. A client with peptic ulcer disease
D. A client with chronic bronchitis
Correct Answer: B. A client 48 hours post–total hip arthroplasty
Rationale: Major orthopedic surgery, especially hip and knee arthroplasty, is a significant risk factor
for venous thromboembolism due to immobility, surgical trauma, and venous stasis. Asthma, peptic
ulcer disease, and chronic bronchitis are not primary PE risk factors.
Q7. A client with pulmonary embolism is prescribed warfarin. Which instruction should the nurse
include in teaching?
A. "Increase intake of leafy green vegetables."
B. "Use a soft toothbrush and electric razor."
C. "Take aspirin for headaches."
D. "Expect your INR to be monitored weekly only."
Correct Answer: B. "Use a soft toothbrush and electric razor."
pg. 3
, Rationale: Warfarin increases bleeding risk. Clients should use soft toothbrushes and electric razors
to minimize trauma-induced bleeding. Leafy greens contain vitamin K and should be maintained at
consistent intake, not increased. Aspirin increases bleeding risk. INR monitoring frequency varies;
weekly is not always sufficient.
Q8. Which finding indicates that a client with pulmonary embolism is deteriorating?
A. Oxygen saturation of 94% on 2 L nasal cannula
B. Heart rate of 100 beats/min
C. Respiratory rate of 28 breaths/min and increasing confusion
D. Blood pressure of 118/72 mm Hg
Correct Answer: C. Respiratory rate of 28 breaths/min and increasing confusion
Rationale: Increasing respiratory rate and altered mental status indicate worsening oxygenation and
possible hemodynamic compromise. These are signs of clinical deterioration requiring immediate
intervention. The other findings, while abnormal, do not indicate acute deterioration.
Q9. A client with a history of deep vein thrombosis asks how to prevent future pulmonary embolism.
Which response by the nurse is most accurate?
A. "You should avoid all physical activity."
B. "Take your prescribed anticoagulant exactly as directed and keep follow-up appointments."
C. "You only need to worry if you have leg pain."
D. "Compression stockings are not helpful."
Correct Answer: B. "Take your prescribed anticoagulant exactly as directed and keep follow-up
appointments."
Rationale: Consistent anticoagulation and regular monitoring are essential for preventing recurrent
VTE. Activity should be encouraged, not avoided. Leg pain is not the only indicator of DVT.
Compression stockings reduce stasis and are beneficial.
Q10. A client with pulmonary embolism has a new order for enoxaparin. Which statement by the
client indicates understanding of teaching?
A. "I will take this medication with food."
B. "I will need regular blood tests to check my INR."
C. "I should report any unusual bruising or bleeding."
D. "I can stop this medication once I feel better."
Correct Answer: C. "I should report any unusual bruising or bleeding."
Rationale: Enoxaparin (low molecular weight heparin) increases bleeding risk; clients should report
signs of bleeding. It is not monitored with INR (aPTT or anti-Xa may be used). Food does not
significantly affect absorption. Anticoagulants must not be stopped abruptly without provider
direction.
pg. 4
Practice Questions & Answers
NSG 223 Exam 2 Study Guide | Nursing Practice Questions & Answers
Examination Overview
This comprehensive examination consists of 200 multiple-choice questions covering the core
content areas for NSG 223 Medical-Surgical Nursing II, Exam 2. The examination assesses knowledge,
clinical application, and critical thinking across respiratory disorders (pulmonary embolism, acute
respiratory distress syndrome, mechanical ventilation, arterial blood gas interpretation, respiratory
failure), renal and urinary disorders (acute kidney injury, chronic kidney disease, dialysis),
gastrointestinal and hepatic disorders (hepatitis, pancreatitis, cirrhosis), and fluid, electrolyte, and
acid-base imbalances. Questions range from foundational knowledge to advanced clinical judgment,
prioritizing nursing safety and evidence-based practice.
Table of Contents
Section Topic Questions
I Pulmonary Embolism 1–25
II Acute Respiratory Distress Syndrome (ARDS) 26–50
III Mechanical Ventilation 51–75
IV Arterial Blood Gas Interpretation & Acid-Base Imbalances 76–100
V Acute Kidney Injury & Chronic Kidney Disease 101–130
VI Dialysis 131–150
VII Hepatitis 151–165
VIII Pancreatitis 166–180
IX Cirrhosis & Hepatic Encephalopathy 181–200
pg. 1
,Section I: Pulmonary Embolism (Questions 1–25)
Q1. A client is admitted with a suspected pulmonary embolism. Which assessment finding is most
consistent with this diagnosis?
A. Bradycardia and hypertension
B. Sudden onset of dyspnea and pleuritic chest pain
C. Productive cough with yellow sputum
D. Gradual onset of peripheral edema
Correct Answer: B. Sudden onset of dyspnea and pleuritic chest pain
Rationale: Pulmonary embolism classically presents with sudden onset of dyspnea, pleuritic chest
pain, and tachypnea due to obstruction of pulmonary blood flow. Bradycardia and hypertension are
not typical; productive cough suggests infection; peripheral edema is more consistent with heart
failure.
Q2. A postoperative client suddenly develops shortness of breath and tachycardia. The nurse
suspects pulmonary embolism. Which action should the nurse take first?
A. Administer prescribed anticoagulant
B. Apply supplemental oxygen
C. Obtain a chest x-ray
D. Position the client supine
Correct Answer: B. Apply supplemental oxygen
Rationale: Airway and breathing take priority. Oxygenation should be addressed immediately while
preparing for diagnostic confirmation. Anticoagulants are administered after diagnosis is confirmed
(unless high clinical suspicion with provider order). Chest x-ray helps rule out other causes but is not
the immediate priority. Supine positioning may worsen respiratory distress; semi-Fowler's is
preferred.
Q3. Which laboratory test is most specific for diagnosing pulmonary embolism?
A. D-dimer
B. Troponin
C. BNP
D. Complete blood count
Correct Answer: A. D-dimer
Rationale: D-dimer is a degradation product of cross-linked fibrin and is elevated in the presence of
thrombosis. A negative D-dimer in low-risk patients effectively rules out PE. Troponin and BNP are
cardiac markers; CBC is nonspecific.
Q4. A client with pulmonary embolism is started on a heparin infusion. Which laboratory value
should the nurse monitor to evaluate therapeutic effectiveness?
pg. 2
,A. INR
B. aPTT
C. Platelet count
D. Hemoglobin
Correct Answer: B. aPTT
Rationale: Unfractionated heparin therapy is monitored using the activated partial thromboplastin
time (aPTT), with a therapeutic goal typically 1.5–2.5 times the control value. INR is used for
warfarin. Platelet count is monitored for heparin-induced thrombocytopenia but does not measure
therapeutic anticoagulation.
Q5. A client receiving heparin for pulmonary embolism develops a sudden drop in platelet count
from 250,000 to 80,000/mm³. What is the nurse's priority action?
A. Continue heparin as prescribed
B. Hold heparin and notify the provider
C. Administer vitamin K
D. Increase heparin infusion rate
Correct Answer: B. Hold heparin and notify the provider
Rationale: A sudden drop in platelets suggests heparin-induced thrombocytopenia (HIT), a serious
immune-mediated complication. Heparin must be stopped immediately and the provider notified.
Vitamin K reverses warfarin, not heparin. Increasing the rate would worsen HIT.
Q6. Which client is at highest risk for developing a pulmonary embolism?
A. A client with asthma
B. A client 48 hours post–total hip arthroplasty
C. A client with peptic ulcer disease
D. A client with chronic bronchitis
Correct Answer: B. A client 48 hours post–total hip arthroplasty
Rationale: Major orthopedic surgery, especially hip and knee arthroplasty, is a significant risk factor
for venous thromboembolism due to immobility, surgical trauma, and venous stasis. Asthma, peptic
ulcer disease, and chronic bronchitis are not primary PE risk factors.
Q7. A client with pulmonary embolism is prescribed warfarin. Which instruction should the nurse
include in teaching?
A. "Increase intake of leafy green vegetables."
B. "Use a soft toothbrush and electric razor."
C. "Take aspirin for headaches."
D. "Expect your INR to be monitored weekly only."
Correct Answer: B. "Use a soft toothbrush and electric razor."
pg. 3
, Rationale: Warfarin increases bleeding risk. Clients should use soft toothbrushes and electric razors
to minimize trauma-induced bleeding. Leafy greens contain vitamin K and should be maintained at
consistent intake, not increased. Aspirin increases bleeding risk. INR monitoring frequency varies;
weekly is not always sufficient.
Q8. Which finding indicates that a client with pulmonary embolism is deteriorating?
A. Oxygen saturation of 94% on 2 L nasal cannula
B. Heart rate of 100 beats/min
C. Respiratory rate of 28 breaths/min and increasing confusion
D. Blood pressure of 118/72 mm Hg
Correct Answer: C. Respiratory rate of 28 breaths/min and increasing confusion
Rationale: Increasing respiratory rate and altered mental status indicate worsening oxygenation and
possible hemodynamic compromise. These are signs of clinical deterioration requiring immediate
intervention. The other findings, while abnormal, do not indicate acute deterioration.
Q9. A client with a history of deep vein thrombosis asks how to prevent future pulmonary embolism.
Which response by the nurse is most accurate?
A. "You should avoid all physical activity."
B. "Take your prescribed anticoagulant exactly as directed and keep follow-up appointments."
C. "You only need to worry if you have leg pain."
D. "Compression stockings are not helpful."
Correct Answer: B. "Take your prescribed anticoagulant exactly as directed and keep follow-up
appointments."
Rationale: Consistent anticoagulation and regular monitoring are essential for preventing recurrent
VTE. Activity should be encouraged, not avoided. Leg pain is not the only indicator of DVT.
Compression stockings reduce stasis and are beneficial.
Q10. A client with pulmonary embolism has a new order for enoxaparin. Which statement by the
client indicates understanding of teaching?
A. "I will take this medication with food."
B. "I will need regular blood tests to check my INR."
C. "I should report any unusual bruising or bleeding."
D. "I can stop this medication once I feel better."
Correct Answer: C. "I should report any unusual bruising or bleeding."
Rationale: Enoxaparin (low molecular weight heparin) increases bleeding risk; clients should report
signs of bleeding. It is not monitored with INR (aPTT or anti-Xa may be used). Food does not
significantly affect absorption. Anticoagulants must not be stopped abruptly without provider
direction.
pg. 4
