,NUR 221 Midterm Exam Nursing II Questions And Answers
2026/2027 Jersey College
Q1. A postoperative patient reports increasing abdominal pain
despite receiving analgesia. The nurse notes tachycardia, cool skin,
and blood pressure trending downward. Which action is the priority?
A) Assess immediately for a developing postoperative complication and
impaired perfusion
B) Reassure the patient that pain commonly increases after surgery
C) Wait until the next scheduled vital-sign assessment
D) Encourage ambulation before completing further assessment
Correct Answer: A) Assess immediately for a developing postoperative
complication and impaired perfusion
Rationale: Increasing pain accompanied by tachycardia, hypotension, and
cool skin may indicate hemorrhage or another complication causing
inadequate tissue perfusion and requires immediate evaluation.
Q2. Which characteristic best distinguishes acute pain from chronic
pain?
A) Acute pain never produces physiologic responses
B) Chronic pain always has an identifiable tissue injury
C) Acute pain commonly has a recent onset related to injury or illness and
generally improves as healing occurs
D) Chronic pain cannot affect functional ability
Correct Answer: C) Acute pain commonly has a recent onset related to injury
or illness and generally improves as healing occurs
Rationale: Acute pain typically accompanies recent tissue injury or illness
and decreases as the underlying condition resolves, whereas chronic pain
persists beyond the expected healing period.
Q3. A patient receiving opioid analgesia becomes increasingly
difficult to awaken. Which finding most strongly indicates clinically
important respiratory depression?
A) Pain rating decreases from 8/10 to 5/10
B) Mild nausea develops
C) The patient sleeps between assessments
D) Respiratory rate decreases to 7/min with shallow respirations
,Correct Answer: D) Respiratory rate decreases to 7/min with shallow
respirations
Rationale: Marked bradypnea with shallow ventilation and increasing
sedation suggests opioid-induced respiratory depression and requires
immediate intervention.
Q4. A patient with chronic painful neuropathy reports burning and
electric-shock sensations. Which medication category may be used
as an adjuvant specifically for this type of pain?
A) Antacids
B) Loop diuretics
C) Antitussives
D) Certain anticonvulsant medications
Correct Answer: D) Certain anticonvulsant medications
Rationale: Some anticonvulsants reduce abnormal neuronal signaling and
are commonly used as adjuvant therapy for neuropathic pain.
Q5. Which assessment finding most strongly supports early
hypovolemic shock?
A) Tachycardia with narrowing pulse pressure and cool skin
B) Bradycardia with bounding peripheral pulses
C) Hypertension with pulmonary crackles
D) Warm flushed skin with slow pulse
Correct Answer: A) Tachycardia with narrowing pulse pressure and cool skin
Rationale: Compensatory sympathetic activation during hypovolemia
increases heart rate and causes peripheral vasoconstriction, producing cool
skin and often a narrowing pulse pressure.
Q6. Why does urine output decrease during significant
hypovolemia?
A) The kidneys intentionally increase water excretion
B) Reduced renal perfusion activates mechanisms that conserve sodium and
water
C) Glomerular filtration increases dramatically
D) Antidiuretic hormone secretion stops
Correct Answer: B) Reduced renal perfusion activates mechanisms that
conserve sodium and water
, Rationale: Falling circulating volume reduces renal blood flow and triggers
sympathetic, renin-angiotensin-aldosterone, and antidiuretic responses that
conserve fluid.
Q7. Which finding best indicates that fluid resuscitation for
hypovolemic shock is improving end-organ perfusion?
A) Urine output rises and mental status improves
B) Heart rate continues increasing
C) Skin becomes progressively cooler
D) Blood pressure continues falling
Correct Answer: A) Urine output rises and mental status improves
Rationale: Improved renal output and neurologic function indicate better
blood flow to vital organs and are useful signs of successful resuscitation.
Q8. A patient scheduled for surgery reports a severe latex allergy.
What is the most appropriate nursing action?
A) Document it after surgery
B) Give an antihistamine and take no further action
C) Communicate the allergy clearly so a latex-safe perioperative
environment can be prepared
D) Assume surgical gloves are automatically latex-free
Correct Answer: C) Communicate the allergy clearly so a latex-safe
perioperative environment can be prepared
Rationale: Significant latex allergy can cause severe perioperative
reactions. Avoidance requires advance communication and preparation of
latex-safe equipment and supplies.
Q9. Which preoperative laboratory finding most directly increases
concern for impaired hemostasis?
A) Mildly elevated fasting glucose
B) Markedly prolonged INR
C) Normal sodium concentration
D) Normal white blood cell count
Correct Answer: B) Markedly prolonged INR
Rationale: A prolonged INR indicates delayed clot formation and may
substantially increase perioperative bleeding risk.
2026/2027 Jersey College
Q1. A postoperative patient reports increasing abdominal pain
despite receiving analgesia. The nurse notes tachycardia, cool skin,
and blood pressure trending downward. Which action is the priority?
A) Assess immediately for a developing postoperative complication and
impaired perfusion
B) Reassure the patient that pain commonly increases after surgery
C) Wait until the next scheduled vital-sign assessment
D) Encourage ambulation before completing further assessment
Correct Answer: A) Assess immediately for a developing postoperative
complication and impaired perfusion
Rationale: Increasing pain accompanied by tachycardia, hypotension, and
cool skin may indicate hemorrhage or another complication causing
inadequate tissue perfusion and requires immediate evaluation.
Q2. Which characteristic best distinguishes acute pain from chronic
pain?
A) Acute pain never produces physiologic responses
B) Chronic pain always has an identifiable tissue injury
C) Acute pain commonly has a recent onset related to injury or illness and
generally improves as healing occurs
D) Chronic pain cannot affect functional ability
Correct Answer: C) Acute pain commonly has a recent onset related to injury
or illness and generally improves as healing occurs
Rationale: Acute pain typically accompanies recent tissue injury or illness
and decreases as the underlying condition resolves, whereas chronic pain
persists beyond the expected healing period.
Q3. A patient receiving opioid analgesia becomes increasingly
difficult to awaken. Which finding most strongly indicates clinically
important respiratory depression?
A) Pain rating decreases from 8/10 to 5/10
B) Mild nausea develops
C) The patient sleeps between assessments
D) Respiratory rate decreases to 7/min with shallow respirations
,Correct Answer: D) Respiratory rate decreases to 7/min with shallow
respirations
Rationale: Marked bradypnea with shallow ventilation and increasing
sedation suggests opioid-induced respiratory depression and requires
immediate intervention.
Q4. A patient with chronic painful neuropathy reports burning and
electric-shock sensations. Which medication category may be used
as an adjuvant specifically for this type of pain?
A) Antacids
B) Loop diuretics
C) Antitussives
D) Certain anticonvulsant medications
Correct Answer: D) Certain anticonvulsant medications
Rationale: Some anticonvulsants reduce abnormal neuronal signaling and
are commonly used as adjuvant therapy for neuropathic pain.
Q5. Which assessment finding most strongly supports early
hypovolemic shock?
A) Tachycardia with narrowing pulse pressure and cool skin
B) Bradycardia with bounding peripheral pulses
C) Hypertension with pulmonary crackles
D) Warm flushed skin with slow pulse
Correct Answer: A) Tachycardia with narrowing pulse pressure and cool skin
Rationale: Compensatory sympathetic activation during hypovolemia
increases heart rate and causes peripheral vasoconstriction, producing cool
skin and often a narrowing pulse pressure.
Q6. Why does urine output decrease during significant
hypovolemia?
A) The kidneys intentionally increase water excretion
B) Reduced renal perfusion activates mechanisms that conserve sodium and
water
C) Glomerular filtration increases dramatically
D) Antidiuretic hormone secretion stops
Correct Answer: B) Reduced renal perfusion activates mechanisms that
conserve sodium and water
, Rationale: Falling circulating volume reduces renal blood flow and triggers
sympathetic, renin-angiotensin-aldosterone, and antidiuretic responses that
conserve fluid.
Q7. Which finding best indicates that fluid resuscitation for
hypovolemic shock is improving end-organ perfusion?
A) Urine output rises and mental status improves
B) Heart rate continues increasing
C) Skin becomes progressively cooler
D) Blood pressure continues falling
Correct Answer: A) Urine output rises and mental status improves
Rationale: Improved renal output and neurologic function indicate better
blood flow to vital organs and are useful signs of successful resuscitation.
Q8. A patient scheduled for surgery reports a severe latex allergy.
What is the most appropriate nursing action?
A) Document it after surgery
B) Give an antihistamine and take no further action
C) Communicate the allergy clearly so a latex-safe perioperative
environment can be prepared
D) Assume surgical gloves are automatically latex-free
Correct Answer: C) Communicate the allergy clearly so a latex-safe
perioperative environment can be prepared
Rationale: Significant latex allergy can cause severe perioperative
reactions. Avoidance requires advance communication and preparation of
latex-safe equipment and supplies.
Q9. Which preoperative laboratory finding most directly increases
concern for impaired hemostasis?
A) Mildly elevated fasting glucose
B) Markedly prolonged INR
C) Normal sodium concentration
D) Normal white blood cell count
Correct Answer: B) Markedly prolonged INR
Rationale: A prolonged INR indicates delayed clot formation and may
substantially increase perioperative bleeding risk.
