MSN DE HESI MEDICAL-SURGICAL EXAM 2 –
NSG 523 HERZING UNIVERSITY/ ACTUAL EXAM
QUESTIONS AND 100% VERIFIED ANSWERS
WITH RATIONALES GRADED A+ LATEST
1.
A patient with acute decompensated heart failure presents with dyspnea, crackles,
and frothy sputum. Oxygen saturation is 86% on room air. Which nursing action is
the priority?
A. Administer IV furosemide
B. Place the patient in high-Fowler’s position
C. Insert a urinary catheter
D. Restrict oral fluids
Correct Answer: B
Rationale: Positioning improves lung expansion and oxygenation immediately.
Airway and breathing take priority over pharmacologic and fluid interventions.
2.
A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse
notes increasing somnolence and a PaCO₂ of 68 mmHg. What is the most
appropriate nursing response?
A. Increase oxygen flow
B. Discontinue oxygen therapy
C. Notify the provider and prepare for ABG reassessment
D. Encourage pursed-lip breathing only
Correct Answer: C
Rationale: Excess oxygen can worsen CO₂ retention in COPD. Provider
notification and further evaluation are required to prevent respiratory acidosis.
,3.
A patient with chest pain has ST-segment elevation in leads II, III, and aVF. Which
complication should the nurse monitor for most closely?
A. Pulmonary embolism
B. Right ventricular failure
C. Aortic dissection
D. Pericarditis
Correct Answer: B
Rationale: Inferior wall myocardial infarctions often involve the right ventricle,
leading to preload sensitivity and hypotension.
4.
A patient with acute kidney injury has a potassium level of 6.4 mEq/L and peaked
T waves on ECG. Which provider order should the nurse implement first?
A. Sodium polystyrene sulfonate
B. Regular insulin with IV dextrose
C. Oral loop diuretic
D. Dietary potassium restriction
Correct Answer: B
Rationale: Insulin with glucose rapidly shifts potassium into cells, reducing
immediate cardiac risk.
,5.
A postoperative patient has absent bowel sounds, abdominal distention, and
nausea. Which action is most appropriate?
A. Encourage ambulation
B. Administer antiemetics
C. Notify the provider immediately
D. Offer clear liquids
Correct Answer: C
Rationale: These findings suggest paralytic ileus or bowel obstruction, which
requires prompt evaluation and intervention.
6.
A patient with diabetic ketoacidosis (DKA) is receiving IV insulin. Which lab
value indicates therapy is effective?
A. Blood glucose decreases from 520 to 280 mg/dL
B. Serum potassium increases from 3.2 to 4.0 mEq/L
C. Arterial pH improves from 7.12 to 7.32
D. Urine ketones remain positive
Correct Answer: C
Rationale: Resolution of metabolic acidosis best reflects effective DKA treatment.
7.
The nurse is caring for a patient with a chest tube following thoracic surgery.
Which finding requires immediate intervention?
A. Tidaling in the water-seal chamber
B. Continuous bubbling in the water-seal chamber
C. Drainage of 120 mL in the first hour
D. Pain at the insertion site
, Correct Answer: B
Rationale: Continuous bubbling indicates an air leak, which can impair lung re-
expansion.
8.
A patient receiving hemodialysis reports headache, nausea, and restlessness during
treatment. Which complication does the nurse suspect?
A. Fluid overload
B. Dialysis disequilibrium syndrome
C. Hypoglycemia
D. Hypercalcemia
Correct Answer: B
Rationale: Rapid solute shifts during dialysis can cause cerebral edema, leading to
neurologic symptoms.
9.
A patient with pneumonia becomes acutely confused without fever. Which
interpretation is most appropriate?
A. Normal aging response
B. Medication side effect
C. Atypical presentation of infection
D. Early dementia
Correct Answer: C
Rationale: Older adults often present with confusion as an early sign of infection.
NSG 523 HERZING UNIVERSITY/ ACTUAL EXAM
QUESTIONS AND 100% VERIFIED ANSWERS
WITH RATIONALES GRADED A+ LATEST
1.
A patient with acute decompensated heart failure presents with dyspnea, crackles,
and frothy sputum. Oxygen saturation is 86% on room air. Which nursing action is
the priority?
A. Administer IV furosemide
B. Place the patient in high-Fowler’s position
C. Insert a urinary catheter
D. Restrict oral fluids
Correct Answer: B
Rationale: Positioning improves lung expansion and oxygenation immediately.
Airway and breathing take priority over pharmacologic and fluid interventions.
2.
A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse
notes increasing somnolence and a PaCO₂ of 68 mmHg. What is the most
appropriate nursing response?
A. Increase oxygen flow
B. Discontinue oxygen therapy
C. Notify the provider and prepare for ABG reassessment
D. Encourage pursed-lip breathing only
Correct Answer: C
Rationale: Excess oxygen can worsen CO₂ retention in COPD. Provider
notification and further evaluation are required to prevent respiratory acidosis.
,3.
A patient with chest pain has ST-segment elevation in leads II, III, and aVF. Which
complication should the nurse monitor for most closely?
A. Pulmonary embolism
B. Right ventricular failure
C. Aortic dissection
D. Pericarditis
Correct Answer: B
Rationale: Inferior wall myocardial infarctions often involve the right ventricle,
leading to preload sensitivity and hypotension.
4.
A patient with acute kidney injury has a potassium level of 6.4 mEq/L and peaked
T waves on ECG. Which provider order should the nurse implement first?
A. Sodium polystyrene sulfonate
B. Regular insulin with IV dextrose
C. Oral loop diuretic
D. Dietary potassium restriction
Correct Answer: B
Rationale: Insulin with glucose rapidly shifts potassium into cells, reducing
immediate cardiac risk.
,5.
A postoperative patient has absent bowel sounds, abdominal distention, and
nausea. Which action is most appropriate?
A. Encourage ambulation
B. Administer antiemetics
C. Notify the provider immediately
D. Offer clear liquids
Correct Answer: C
Rationale: These findings suggest paralytic ileus or bowel obstruction, which
requires prompt evaluation and intervention.
6.
A patient with diabetic ketoacidosis (DKA) is receiving IV insulin. Which lab
value indicates therapy is effective?
A. Blood glucose decreases from 520 to 280 mg/dL
B. Serum potassium increases from 3.2 to 4.0 mEq/L
C. Arterial pH improves from 7.12 to 7.32
D. Urine ketones remain positive
Correct Answer: C
Rationale: Resolution of metabolic acidosis best reflects effective DKA treatment.
7.
The nurse is caring for a patient with a chest tube following thoracic surgery.
Which finding requires immediate intervention?
A. Tidaling in the water-seal chamber
B. Continuous bubbling in the water-seal chamber
C. Drainage of 120 mL in the first hour
D. Pain at the insertion site
, Correct Answer: B
Rationale: Continuous bubbling indicates an air leak, which can impair lung re-
expansion.
8.
A patient receiving hemodialysis reports headache, nausea, and restlessness during
treatment. Which complication does the nurse suspect?
A. Fluid overload
B. Dialysis disequilibrium syndrome
C. Hypoglycemia
D. Hypercalcemia
Correct Answer: B
Rationale: Rapid solute shifts during dialysis can cause cerebral edema, leading to
neurologic symptoms.
9.
A patient with pneumonia becomes acutely confused without fever. Which
interpretation is most appropriate?
A. Normal aging response
B. Medication side effect
C. Atypical presentation of infection
D. Early dementia
Correct Answer: C
Rationale: Older adults often present with confusion as an early sign of infection.
