NSG233 Medical Surgical Nursing III Exam 3 Study
Guide & Practice Questions - Herzing University |
2026/2027 Mastery Update
Exam Profile
Questions: 65 | Time: 90 min
Focus: Advanced Clinical Judgment, Multi-System Failure, High-Acuity Prioritization
Formats: Unfolding Case Studies, SATA, Complex Multiple Choice, Calculations
CLUSTER 1 – Cardio-Respiratory-Renal Integration (15 Questions)
Case Study 1 – Questions 1-4
A 68-year-old with ischemic cardiomyopathy (EF 25 %) is admitted with acute dyspnea,
bilateral crackles, +3 pitting edema. ABG on 4 L NC: pH 7.28, PaCO₂ 55 mmHg, PaO₂ 68
mmHg, HCO₃ 24 mEq/L.
Q1 The nurse’s primary interpretation is:
A. Acute pulmonary embolism
B. Acute respiratory acidosis due to COPD exacerbation
C. Cardiogenic pulmonary edema leading to hypoxemia and respiratory acidosis
D. Metabolic acidosis with respiratory compensation
Verified Answer: C
,Rationale: Low EF + crackles/edema + acute ↑PaCO₂/low pO₂ = flash pulmonary edema;
normal HCO₃ rules out chronic process.
Q2 (Follow-up) Provider orders: furosemide 80 mg IV STAT, nitroglycerin 10 mcg/min IV.
Most critical assessment within 1 hour?
A. Monitor for hypokalemia
B. Frequent BP & respiratory rate assessment
C. Check for ototoxicity
D. Assess urine output q4 h
Verified Answer: B
Rationale: High-dose diuretic + vasodilator in hypotension-prone patient mandates
continuous hemodynamic monitoring; prevents cardiogenic shock.
Q3 (SATA) After 2 h on BiPAP (IPAP 12, EPAP 5) ABG: pH 7.22, PaCO₂ 75, PaO₂ 70.
Which actions are immediately appropriate? (Select ALL)
A. Call anesthesia for urgent intubation
B. Increase IPAP to 16 cm H₂O
C. Obtain ABG in 30 min
D. Start norepinephrine for MAP <65 mmHg
E. Give bicarbonate 1 amp IV
Verified Answers: A, B, C, D
,Rationale: Worsening hypercapnic acidosis = NIV failure; prepare for intubation (A),
optimize settings (B), monitor (C), support perfusion (D). Bicarb (E) not indicated.
Q4 (Calc) Loading dose aminophylline 6 mg/kg IV over 30 min; concentration 500
mg/250 mL. Client weight 65 kg.
a) Volume = ______ mL b) Pump rate = ______ mL/hr
Answers: a) 19.5 mL b) 39 mL/hr
Rationale: 6 × 65 = 390 mg; 500 mg/250 mL = 2 mg/mL → 390 ÷ 2 = 19.5 mL. Over 30
min → 19.5 × 2 = 39 mL/hr.
Q5 Stroke client NIHSS 14, last known normal 90 min ago, CT negative. Next priority?
A. Start heparin drip
B. Administer tPA 0.9 mg/kg IV per protocol
C. Obtain MRI
D. Lower BP to <140/90
Verified Answer: B
Rationale: <4.5 h window + eligible NIHSS → tPA is time-sensitive priority (AHA 2025).
Heparin (A) not acute therapy.
Q6 (SATA) Client with STEMI on tPA; sudden headache, NIHSS ↑ by 4, BP 190/100.
Immediate actions? (Select ALL)
A. Stop tPA infusion immediately
, B. Obtain non-contrast CT within 1 h
C. Prepare blood products (6 U PRBC, FFP, platelets)
D. Lower BP with labetalol to <185/110
E. Give mannitol 1 g/kg IV
Verified Answers: A, B, C, D
Rationale: Suspected ICH: stop thrombolytic (A), urgent imaging (B), blood products
ready (C), control HTT (D). Mannitol (E) after neurosurgical consult.
Q7 Client on mechanical ventilation (VC-AC) has peak airway pressure ↑ from 25 to 45
cm H₂O; plateau unchanged. Problem?
A. Airway obstruction or secretions
B. Tension pneumothorax
C. ARDS development
D. Abdominal distension
Verified Answer: A
Rationale: ↑ peak with normal plateau = increased airway resistance (secretions, kink,
bronchospasm). Plateau ↑ = compliance issue (B, C, D).
Q8 (Prioritization) Four post-MI clients on telemetry. Who needs immediate
assessment?
A. Sinus bradycardia 48 bpm, BP 100/60, no symptoms
Guide & Practice Questions - Herzing University |
2026/2027 Mastery Update
Exam Profile
Questions: 65 | Time: 90 min
Focus: Advanced Clinical Judgment, Multi-System Failure, High-Acuity Prioritization
Formats: Unfolding Case Studies, SATA, Complex Multiple Choice, Calculations
CLUSTER 1 – Cardio-Respiratory-Renal Integration (15 Questions)
Case Study 1 – Questions 1-4
A 68-year-old with ischemic cardiomyopathy (EF 25 %) is admitted with acute dyspnea,
bilateral crackles, +3 pitting edema. ABG on 4 L NC: pH 7.28, PaCO₂ 55 mmHg, PaO₂ 68
mmHg, HCO₃ 24 mEq/L.
Q1 The nurse’s primary interpretation is:
A. Acute pulmonary embolism
B. Acute respiratory acidosis due to COPD exacerbation
C. Cardiogenic pulmonary edema leading to hypoxemia and respiratory acidosis
D. Metabolic acidosis with respiratory compensation
Verified Answer: C
,Rationale: Low EF + crackles/edema + acute ↑PaCO₂/low pO₂ = flash pulmonary edema;
normal HCO₃ rules out chronic process.
Q2 (Follow-up) Provider orders: furosemide 80 mg IV STAT, nitroglycerin 10 mcg/min IV.
Most critical assessment within 1 hour?
A. Monitor for hypokalemia
B. Frequent BP & respiratory rate assessment
C. Check for ototoxicity
D. Assess urine output q4 h
Verified Answer: B
Rationale: High-dose diuretic + vasodilator in hypotension-prone patient mandates
continuous hemodynamic monitoring; prevents cardiogenic shock.
Q3 (SATA) After 2 h on BiPAP (IPAP 12, EPAP 5) ABG: pH 7.22, PaCO₂ 75, PaO₂ 70.
Which actions are immediately appropriate? (Select ALL)
A. Call anesthesia for urgent intubation
B. Increase IPAP to 16 cm H₂O
C. Obtain ABG in 30 min
D. Start norepinephrine for MAP <65 mmHg
E. Give bicarbonate 1 amp IV
Verified Answers: A, B, C, D
,Rationale: Worsening hypercapnic acidosis = NIV failure; prepare for intubation (A),
optimize settings (B), monitor (C), support perfusion (D). Bicarb (E) not indicated.
Q4 (Calc) Loading dose aminophylline 6 mg/kg IV over 30 min; concentration 500
mg/250 mL. Client weight 65 kg.
a) Volume = ______ mL b) Pump rate = ______ mL/hr
Answers: a) 19.5 mL b) 39 mL/hr
Rationale: 6 × 65 = 390 mg; 500 mg/250 mL = 2 mg/mL → 390 ÷ 2 = 19.5 mL. Over 30
min → 19.5 × 2 = 39 mL/hr.
Q5 Stroke client NIHSS 14, last known normal 90 min ago, CT negative. Next priority?
A. Start heparin drip
B. Administer tPA 0.9 mg/kg IV per protocol
C. Obtain MRI
D. Lower BP to <140/90
Verified Answer: B
Rationale: <4.5 h window + eligible NIHSS → tPA is time-sensitive priority (AHA 2025).
Heparin (A) not acute therapy.
Q6 (SATA) Client with STEMI on tPA; sudden headache, NIHSS ↑ by 4, BP 190/100.
Immediate actions? (Select ALL)
A. Stop tPA infusion immediately
, B. Obtain non-contrast CT within 1 h
C. Prepare blood products (6 U PRBC, FFP, platelets)
D. Lower BP with labetalol to <185/110
E. Give mannitol 1 g/kg IV
Verified Answers: A, B, C, D
Rationale: Suspected ICH: stop thrombolytic (A), urgent imaging (B), blood products
ready (C), control HTT (D). Mannitol (E) after neurosurgical consult.
Q7 Client on mechanical ventilation (VC-AC) has peak airway pressure ↑ from 25 to 45
cm H₂O; plateau unchanged. Problem?
A. Airway obstruction or secretions
B. Tension pneumothorax
C. ARDS development
D. Abdominal distension
Verified Answer: A
Rationale: ↑ peak with normal plateau = increased airway resistance (secretions, kink,
bronchospasm). Plateau ↑ = compliance issue (B, C, D).
Q8 (Prioritization) Four post-MI clients on telemetry. Who needs immediate
assessment?
A. Sinus bradycardia 48 bpm, BP 100/60, no symptoms
