HERZING UNIVERSITY
NSG 223 MED-SURG II EXAM 1 (2025–2026) COMPLETE
STUDY GUIDE WITH UPDATED PRACTICE
QUESTIONS, THOROUGH VERIFIED ANSWERS, AND
HIGH-YIELD EXAM PREPARATION MATERIAL –
LATEST EDITION, A+ GRADED VERSION
PRACTICE EXAM: 25 VERIFIED QUESTIONS &
RATIONALES
QUESTION 1 (Scenario-Based – Perioperative)
A 68-year-old male patient is 4 hours post-operative following a right total
hip arthroplasty. He suddenly reports "not being able to catch my breath"
and has sharp chest pain that worsens with inspiration. VS: HR 118, RR 32,
BP 158/90, SpO2 88% on 2L NC. What is the nurse's priority action?
A) Administer morphine sulfate 4mg IV push.
B) Apply sequential compression devices (SCDs).
C) Position the patient in high-Fowler's and prepare for oxygen
titration/possible intubation.
D) Encourage deep breathing and coughing exercises.
Correct Answer: C
Rationale: The scenario describes a pulmonary embolism (PE) – sudden
dyspnea, pleuritic chest pain, tachypnea, hypoxia. The priority is airway and
breathing: sit the patient up (high-Fowler's) to maximize lung expansion,
increase O2, and prepare for advanced respiratory support. Morphine (A) may
P a g e 1 | 48
,be given later for pain/anxiety but is not first. SCDs (B) are for prevention, not
treatment. Deep breathing (D) is insufficient for an acute PE.
Nursing Takeaway: Post-op day 0-5 is highest risk for DVT/PE. Hypoxia +
pleuritic pain = PE until proven otherwise.
QUESTION 2 (Fluids & Electrolytes – SIADH)
A patient with small cell lung cancer develops SIADH. Which assessment
finding requires immediate intervention?
A) Serum sodium 128 mEq/L.
B) Weight gain of 2 kg in 24 hours.
C) Urine specific gravity 1.030.
D) Patient reports a new onset headache and nausea.
Correct Answer: D
Rationale: In SIADH, hyponatremia causes cerebral edema. New headache +
nausea are early signs of worsening cerebral edema, which can progress to
seizures, coma, and herniation. This requires immediate intervention
(hypertonic saline, fluid restriction). Sodium 128 (A) is low but not critical (<125
is severe). Weight gain (B) indicates fluid retention but is expected. High urine
specific gravity (C) >1.020 is expected in SIADH.
Nursing Takeaway: In SIADH, neuro symptoms (headache, confusion,
vomiting) are the red flags for impending crisis. Never correct sodium faster
than 8-10 mEq/L in 24 hours to avoid central pontine myelinolysis.
QUESTION 3 (Endocrine – DKA vs. HHNS)
A 23-year-old type 1 diabetic is brought to the ED with polyuria, vomiting,
and confusion. ABG: pH 7.25, HCO3 14. Glucose 650. Which intervention
does the nurse anticipate FIRST?
A) IV regular insulin bolus.
B) IV 0.9% normal saline at 1L/hour.
C) IV sodium bicarbonate infusion.
D) Oral potassium supplements.
Correct Answer: B
Rationale: The patient is in DKA (metabolic acidosis, type 1). The priority
is fluid resuscitation with isotonic saline (0.9% NS) to restore circulating
P a g e 2 | 48
,volume, improve tissue perfusion, and reduce glucose via dilution. Insulin (A) is
given after fluids and potassium are established (except in hyperkalemia). Bicarb
(C) is rarely used (only if pH <6.9). Potassium (D) is replaced once urine output is
confirmed but not first.
Nursing Takeaway: DKA management order: 1) Fluids (NS), 2) Insulin drip, 3)
Replace K+, 4) Monitor for cerebral edema.
QUESTION 4 (Select All That Apply – Thyroid Storm)
A patient with Graves' disease presents with fever (104°F), HR 160,
vomiting, and agitation. Which interventions should the nurse initiate
immediately? (Select All That Apply)
A) Administer propylthiouracil (PTU) orally.
B) Place a cooling blanket and administer acetaminophen.
C) Prepare for IV propranolol.
D) Provide warmed blankets to prevent shivering.
E) Administer IV levothyroxine.
Correct Answers: A, B, C
Rationale: Thyroid storm is a hypermetabolic crisis.
• A (PTU) – blocks new thyroid hormone synthesis.
• B (Cooling) – fever worsens tachycardia and metabolism.
• C (Propranolol) – controls severe tachycardia, palpitations, and anxiety.
• D (Warmed blankets) – wrong; would increase temperature and
metabolic rate.
• E (Levothyroxine) – would worsen storm; never give thyroid hormone in
hyperthyroidism.
Nursing Takeaway: Thyroid storm triggers: infection, surgery, or stopping
antithyroid meds. Treat aggressively: PTU + beta-blocker + steroids + cooling.
QUESTION 5 (Scenario – Addisonian Crisis)
A patient with Addison's disease is admitted with hypotension (70/40),
weakness, and hyperpigmentation of the skin. The nurse notes a serum
potassium of 6.2 mEq/L and sodium of 120 mEq/L. Which prescribed
medication should be given FIRST?
A) Fludrocortisone acetate (Florinef).
P a g e 3 | 48
, B) IV hydrocortisone sodium succinate (Solu-Cortef).
C) Oral potassium supplements.
D) IV furosemide (Lasix).
Correct Answer: B
Rationale: This is Addisonian crisis (adrenal insufficiency) – hypotension,
hyponatremia, hyperkalemia. IV hydrocortisone is life-saving and must be
given first to replace cortisol, restore vascular tone, and lower potassium.
Florinef (A) is for long-term mineralocorticoid replacement. Potassium
supplements (C) would worsen hyperkalemia. Furosemide (D) may drop BP
further and is not indicated.
Nursing Takeaway: Addisonian crisis = give IV hydrocortisone immediately;
then normal saline fluids. Monitor for hypoglycemia.
QUESTION 6 (Immunology – Anaphylaxis)
A patient receives IV ceftriaxone and within 5 minutes reports throat
tightness, difficulty breathing, and has diffuse hives. BP 80/50. What is the
priority action?
A) Stop the infusion and administer epinephrine 0.3 mg IM.
B) Slow the infusion and administer diphenhydramine IV.
C) Stop the infusion and prepare for intubation.
D) Continue the infusion and call a rapid response.
Correct Answer: A
Rationale: This is anaphylaxis (airway compromise +
hypotension). Epinephrine IM is the only first-line treatment – it causes
vasoconstriction and bronchodilation. Stop the antibiotic immediately.
Diphenhydramine (B) treats hives but not hypotension or bronchospasm.
Intubation (C) may be needed but after epinephrine. Continuing the infusion (D)
is dangerous.
Nursing Takeaway: Epinephrine is the only drug that can reverse anaphylaxis.
Give in the lateral thigh (vastus lateralis) for fastest absorption.
QUESTION 7 (Fluids & Electrolytes – Hyperkalemia)
A patient with chronic kidney disease has a potassium level of 6.8 mEq/L.
The ECG shows peaked T waves. Which nursing intervention is priority?
P a g e 4 | 48
NSG 223 MED-SURG II EXAM 1 (2025–2026) COMPLETE
STUDY GUIDE WITH UPDATED PRACTICE
QUESTIONS, THOROUGH VERIFIED ANSWERS, AND
HIGH-YIELD EXAM PREPARATION MATERIAL –
LATEST EDITION, A+ GRADED VERSION
PRACTICE EXAM: 25 VERIFIED QUESTIONS &
RATIONALES
QUESTION 1 (Scenario-Based – Perioperative)
A 68-year-old male patient is 4 hours post-operative following a right total
hip arthroplasty. He suddenly reports "not being able to catch my breath"
and has sharp chest pain that worsens with inspiration. VS: HR 118, RR 32,
BP 158/90, SpO2 88% on 2L NC. What is the nurse's priority action?
A) Administer morphine sulfate 4mg IV push.
B) Apply sequential compression devices (SCDs).
C) Position the patient in high-Fowler's and prepare for oxygen
titration/possible intubation.
D) Encourage deep breathing and coughing exercises.
Correct Answer: C
Rationale: The scenario describes a pulmonary embolism (PE) – sudden
dyspnea, pleuritic chest pain, tachypnea, hypoxia. The priority is airway and
breathing: sit the patient up (high-Fowler's) to maximize lung expansion,
increase O2, and prepare for advanced respiratory support. Morphine (A) may
P a g e 1 | 48
,be given later for pain/anxiety but is not first. SCDs (B) are for prevention, not
treatment. Deep breathing (D) is insufficient for an acute PE.
Nursing Takeaway: Post-op day 0-5 is highest risk for DVT/PE. Hypoxia +
pleuritic pain = PE until proven otherwise.
QUESTION 2 (Fluids & Electrolytes – SIADH)
A patient with small cell lung cancer develops SIADH. Which assessment
finding requires immediate intervention?
A) Serum sodium 128 mEq/L.
B) Weight gain of 2 kg in 24 hours.
C) Urine specific gravity 1.030.
D) Patient reports a new onset headache and nausea.
Correct Answer: D
Rationale: In SIADH, hyponatremia causes cerebral edema. New headache +
nausea are early signs of worsening cerebral edema, which can progress to
seizures, coma, and herniation. This requires immediate intervention
(hypertonic saline, fluid restriction). Sodium 128 (A) is low but not critical (<125
is severe). Weight gain (B) indicates fluid retention but is expected. High urine
specific gravity (C) >1.020 is expected in SIADH.
Nursing Takeaway: In SIADH, neuro symptoms (headache, confusion,
vomiting) are the red flags for impending crisis. Never correct sodium faster
than 8-10 mEq/L in 24 hours to avoid central pontine myelinolysis.
QUESTION 3 (Endocrine – DKA vs. HHNS)
A 23-year-old type 1 diabetic is brought to the ED with polyuria, vomiting,
and confusion. ABG: pH 7.25, HCO3 14. Glucose 650. Which intervention
does the nurse anticipate FIRST?
A) IV regular insulin bolus.
B) IV 0.9% normal saline at 1L/hour.
C) IV sodium bicarbonate infusion.
D) Oral potassium supplements.
Correct Answer: B
Rationale: The patient is in DKA (metabolic acidosis, type 1). The priority
is fluid resuscitation with isotonic saline (0.9% NS) to restore circulating
P a g e 2 | 48
,volume, improve tissue perfusion, and reduce glucose via dilution. Insulin (A) is
given after fluids and potassium are established (except in hyperkalemia). Bicarb
(C) is rarely used (only if pH <6.9). Potassium (D) is replaced once urine output is
confirmed but not first.
Nursing Takeaway: DKA management order: 1) Fluids (NS), 2) Insulin drip, 3)
Replace K+, 4) Monitor for cerebral edema.
QUESTION 4 (Select All That Apply – Thyroid Storm)
A patient with Graves' disease presents with fever (104°F), HR 160,
vomiting, and agitation. Which interventions should the nurse initiate
immediately? (Select All That Apply)
A) Administer propylthiouracil (PTU) orally.
B) Place a cooling blanket and administer acetaminophen.
C) Prepare for IV propranolol.
D) Provide warmed blankets to prevent shivering.
E) Administer IV levothyroxine.
Correct Answers: A, B, C
Rationale: Thyroid storm is a hypermetabolic crisis.
• A (PTU) – blocks new thyroid hormone synthesis.
• B (Cooling) – fever worsens tachycardia and metabolism.
• C (Propranolol) – controls severe tachycardia, palpitations, and anxiety.
• D (Warmed blankets) – wrong; would increase temperature and
metabolic rate.
• E (Levothyroxine) – would worsen storm; never give thyroid hormone in
hyperthyroidism.
Nursing Takeaway: Thyroid storm triggers: infection, surgery, or stopping
antithyroid meds. Treat aggressively: PTU + beta-blocker + steroids + cooling.
QUESTION 5 (Scenario – Addisonian Crisis)
A patient with Addison's disease is admitted with hypotension (70/40),
weakness, and hyperpigmentation of the skin. The nurse notes a serum
potassium of 6.2 mEq/L and sodium of 120 mEq/L. Which prescribed
medication should be given FIRST?
A) Fludrocortisone acetate (Florinef).
P a g e 3 | 48
, B) IV hydrocortisone sodium succinate (Solu-Cortef).
C) Oral potassium supplements.
D) IV furosemide (Lasix).
Correct Answer: B
Rationale: This is Addisonian crisis (adrenal insufficiency) – hypotension,
hyponatremia, hyperkalemia. IV hydrocortisone is life-saving and must be
given first to replace cortisol, restore vascular tone, and lower potassium.
Florinef (A) is for long-term mineralocorticoid replacement. Potassium
supplements (C) would worsen hyperkalemia. Furosemide (D) may drop BP
further and is not indicated.
Nursing Takeaway: Addisonian crisis = give IV hydrocortisone immediately;
then normal saline fluids. Monitor for hypoglycemia.
QUESTION 6 (Immunology – Anaphylaxis)
A patient receives IV ceftriaxone and within 5 minutes reports throat
tightness, difficulty breathing, and has diffuse hives. BP 80/50. What is the
priority action?
A) Stop the infusion and administer epinephrine 0.3 mg IM.
B) Slow the infusion and administer diphenhydramine IV.
C) Stop the infusion and prepare for intubation.
D) Continue the infusion and call a rapid response.
Correct Answer: A
Rationale: This is anaphylaxis (airway compromise +
hypotension). Epinephrine IM is the only first-line treatment – it causes
vasoconstriction and bronchodilation. Stop the antibiotic immediately.
Diphenhydramine (B) treats hives but not hypotension or bronchospasm.
Intubation (C) may be needed but after epinephrine. Continuing the infusion (D)
is dangerous.
Nursing Takeaway: Epinephrine is the only drug that can reverse anaphylaxis.
Give in the lateral thigh (vastus lateralis) for fastest absorption.
QUESTION 7 (Fluids & Electrolytes – Hyperkalemia)
A patient with chronic kidney disease has a potassium level of 6.8 mEq/L.
The ECG shows peaked T waves. Which nursing intervention is priority?
P a g e 4 | 48
