Medical surgical NCLEX UWORLD 2 Questions &
Definitive Solutions / Updated 2025/2026
peripheral artery disease Sx - Answer--Coolness of the skin and shiny, hairless legs,
feet, and toes
--**Dry, scaly skin
--"burning pain" that is worsened by elevating the legs and improved when the legs are
dependent
--Ulcers and gangrene occur usually at the most distal part of the body, where
circulation is poorest.
--Clients should be advised that a progressive walking program will aid the development
of collateral circulation.
--**apply moisturizing lotions on legs daily
--**Keep legs below heart level
Angina pectoris - AnswerAny factor that increases oxygen demand or decreases
oxygen supply to cardiac muscle may cause angina, including the following:
--Physical exertion (eg, exercise, sexual activity):
--Intense emotion (eg, anxiety, fear):
--Temperature extremes: Usually cold exposure and hypothermia (vasoconstriction);
occasionally hyperthermia (vasodilation and blood pooling)
--Tobacco use and second-hand smoke inhalation: Replaces oxygen with carbon
monoxide; nicotine causes vasoconstriction and catecholamine release
--Stimulants (eg, cocaine, amphetamines): Increase heart rate and cause
vasoconstriction
--Coronary artery narrowing (eg, atherosclerosis, coronary artery spasm): Decreases
blood flow to myocardium
considered a surgical emergency - Answeran expected manifestation of
poststreptococcal glomerulonephritis. It is usually mild and does not require urgent
attention.
septic arthritis. - AnswerThis client is exhibiting localized (eg, pain, limited range of
motion) and systemic infection symptoms (eg, fever)
considered a surgical emergency
2 hours after surgery, - AnswerSerosanguineous (pink) drainage would be expected
Asthma exacerbations - Answermay require repeat nebulization every 20 minutes, or
continuous nebulization for 1 hour, to relieve severe bronchoconstriction until the
administered corticosteroids take effect and start to reduce the inflammation
,target serum glucose range for clients receiving nutritional support - Answer140-180
mg/dL (7.8-10.0 mmol/L)
Monitor a client receiving TPN for hyperglycemia (serum glucose >180 mg/dL [10.0
mmol/L]) and hypoglycemia (serum glucose <70 mg/dL [3.9 mmol/L])
hemicolectomy - Answerexcision of half of the colon
deep venous thrombosis (DVT)--Interventions to prevent DVT reoccurrence i -
Answer--Obtain adequate fluid intake and limit caffeine and alcohol intake (Option 2).
--Elevate the legs when sitting and dorsiflex the feet often to reduce edema and
promote venous return (Option 3).
--Resume an exercise program (eg, walking, swimming) and change positions
frequently to promote venous return (Option 4).
--Stop smoking to prevent endothelial damage and vasoconstriction.
--Avoid restrictive clothing (eg, tight jeans), which interferes with circulation and
promotes clotting.
--Consult with a dietitian if overweight; excess weight increases venous insufficiency by
compressing large pelvic vessels.
Notes: Clients do not need to avoid traveling in a car or airplane. However, during
extended travel (>4 hours), clients must use preventive measures (eg, wear
compression stockings, exercise calf and foot muscles frequently, walk every hour)
DVT --Sx - Answer--Unilateral leg edema
--Redness
---warmth
--Calf pain
--**occasionally low-grade fever
Notes: blue, cyanotic toes indicate artery problem (arterial occlusion (eg, arterial
embolism))f
, not a sign of DVT
Atrial fibrillation (Treatment goal) - Answer--decrease in ventricular rate to <100/min
--adequate anticoagulation to prevent thromboembolic complications
Notes: risk for stroke
Receive prophylactic antibiotics prior to dental procedures to prevent infective
endocarditis (IE). - Answer--Prosthetic heart valve or prosthetic material used to
repair heart valve
--Previous history of IE
Some forms of congenital heart disease:
--Unrepaired cyanotic congenital defect
--Repaired congenital defect with prosthetic (mechanical) material or device for 6
months after procedure
,--Repaired congenital defect with residual defects at the site or adjacent to the site of a
prosthetic patch or device
--Cardiac transplantation recipients who develop heart valve disease
Supraventricular tachycardia (SVT) - AnswerDysrhythmia that originates from an
ectopic focus above the bifurcation of the bundle of His.
Stimulants (eg, nicotine, caffeine, cocaine) and organic heart disease can cause SVT.
Supraventricular tachycardia (SVT)--Sx - AnswerA prolonged episode of SVT with a
heart rate >180/min will cause decreased cardiac output and hypotension. The client
may also experience palpitations, dyspnea, and angina
Supraventricular tachycardia (SVT)--treatment - Answervagal stimulation and drug
therapy.
--IV adenosine
Notes: If vagal stimulation and drug therapy are ineffective and the client becomes
hemodynamically unstable, synchronized cardioversion is used.
vagal maneuvers - AnswerValsalva, coughing, and carotid massage.
signs of hypovolemia. - Answerdecreased BP
increased capillary refill
decreased urine output
increased urine specific gravity
poor skin turgor (tent)
Notes: Narrowing pulse pressure (the difference between systolic and diastolic) is a sign
of hypovolemic shock
Hypovolemic shock - AnswerClinical manifestations of hypovolemic shock are
associated with inadequate tissue perfusion and include:
--Change in mental status
--Tachycardia with thready pulse 丝状脉
--Cool, clammy skin (Warm, flushed skin can be an early sign of septic or neurogenic
shock)
--**Oliguria (<0.5 mL/kg/hr)
--Tachypnea
Ventricular fibrillation (V-fib)--treatments - Answer--rapid initiation of CPR
--defibrillation
--the use of drug therapy (eg, epinephrine, vasopressin, amiodarone)
Asystole - AnswerCPR, CANNOT defibrillate
drug therapy
, Sinus bradycardia (with Sx) - Answerfirst treated with atropine.
If atropine is ineffective, transcutaneous pacing or an infusion of dopamine or
epinephrine is considered
CPR - Answer--Chest compressions are performed at a rate of 100-120/min and a
depth of 2.0-2.4 inches (5-6 cm), allowing complete chest recoil between compressions
--Defibrillator pads are placed on the right upper chest, just below the clavicle, and on
the left lateral chest, near the anterior axillary line below the nipple line
https://www.ambulance.qld.gov.au/docs/clinical/cpp/CPP_Defibrillation.pdf
--During CPR, compressions are paused every 2 minutes to assess the client's pulse.
This pause should be no longer than 10 seconds to minimize delays between
compression cycles
--Manual breaths are administered at a rate of 2 breaths per 30 chest compressions in
clients without advanced airways
--Correct hand placement is in the center of the chest, on the lower half of the sternum
(breastbone).
Allen's test - AnswerThe modified Allen's test includes the following steps:
--Instruct the client to make a tight fist (if possible)
--Occlude the radial and ulnar arteries using firm pressure
--Instruct the client to open the fist; the palm will be white if both arteries are sufficiently
occluded
--Release the pressure on the ulnar artery; the palm should turn pink within 15 seconds
as circulation is restored to the hand, indicating patency of the ulnar artery (positive
Allen's test)
If the Allen's test is positive, the arterial blood gas can be drawn;
Steps to perform defibrillation - Answer--Turn on the defibrillator
--Place defibrillator pads on the client's chest (Option 1)
--Charge defibrillator. Chest compressions should continue until defibrillator has
charged and is ready to deliver the shock.
--Before delivering the shock, ensure that the area is "all clear." Confirm that no
personnel are touching the client, bed, or any equipment attached to the client (Option
2).
--Deliver the shock
--Immediately resume chest compressions
Chest drainage - Answer>100 mL/hr should be reported to the HCP
Hypomagnesemia - Answercauses a prolonged QT interval
Definitive Solutions / Updated 2025/2026
peripheral artery disease Sx - Answer--Coolness of the skin and shiny, hairless legs,
feet, and toes
--**Dry, scaly skin
--"burning pain" that is worsened by elevating the legs and improved when the legs are
dependent
--Ulcers and gangrene occur usually at the most distal part of the body, where
circulation is poorest.
--Clients should be advised that a progressive walking program will aid the development
of collateral circulation.
--**apply moisturizing lotions on legs daily
--**Keep legs below heart level
Angina pectoris - AnswerAny factor that increases oxygen demand or decreases
oxygen supply to cardiac muscle may cause angina, including the following:
--Physical exertion (eg, exercise, sexual activity):
--Intense emotion (eg, anxiety, fear):
--Temperature extremes: Usually cold exposure and hypothermia (vasoconstriction);
occasionally hyperthermia (vasodilation and blood pooling)
--Tobacco use and second-hand smoke inhalation: Replaces oxygen with carbon
monoxide; nicotine causes vasoconstriction and catecholamine release
--Stimulants (eg, cocaine, amphetamines): Increase heart rate and cause
vasoconstriction
--Coronary artery narrowing (eg, atherosclerosis, coronary artery spasm): Decreases
blood flow to myocardium
considered a surgical emergency - Answeran expected manifestation of
poststreptococcal glomerulonephritis. It is usually mild and does not require urgent
attention.
septic arthritis. - AnswerThis client is exhibiting localized (eg, pain, limited range of
motion) and systemic infection symptoms (eg, fever)
considered a surgical emergency
2 hours after surgery, - AnswerSerosanguineous (pink) drainage would be expected
Asthma exacerbations - Answermay require repeat nebulization every 20 minutes, or
continuous nebulization for 1 hour, to relieve severe bronchoconstriction until the
administered corticosteroids take effect and start to reduce the inflammation
,target serum glucose range for clients receiving nutritional support - Answer140-180
mg/dL (7.8-10.0 mmol/L)
Monitor a client receiving TPN for hyperglycemia (serum glucose >180 mg/dL [10.0
mmol/L]) and hypoglycemia (serum glucose <70 mg/dL [3.9 mmol/L])
hemicolectomy - Answerexcision of half of the colon
deep venous thrombosis (DVT)--Interventions to prevent DVT reoccurrence i -
Answer--Obtain adequate fluid intake and limit caffeine and alcohol intake (Option 2).
--Elevate the legs when sitting and dorsiflex the feet often to reduce edema and
promote venous return (Option 3).
--Resume an exercise program (eg, walking, swimming) and change positions
frequently to promote venous return (Option 4).
--Stop smoking to prevent endothelial damage and vasoconstriction.
--Avoid restrictive clothing (eg, tight jeans), which interferes with circulation and
promotes clotting.
--Consult with a dietitian if overweight; excess weight increases venous insufficiency by
compressing large pelvic vessels.
Notes: Clients do not need to avoid traveling in a car or airplane. However, during
extended travel (>4 hours), clients must use preventive measures (eg, wear
compression stockings, exercise calf and foot muscles frequently, walk every hour)
DVT --Sx - Answer--Unilateral leg edema
--Redness
---warmth
--Calf pain
--**occasionally low-grade fever
Notes: blue, cyanotic toes indicate artery problem (arterial occlusion (eg, arterial
embolism))f
, not a sign of DVT
Atrial fibrillation (Treatment goal) - Answer--decrease in ventricular rate to <100/min
--adequate anticoagulation to prevent thromboembolic complications
Notes: risk for stroke
Receive prophylactic antibiotics prior to dental procedures to prevent infective
endocarditis (IE). - Answer--Prosthetic heart valve or prosthetic material used to
repair heart valve
--Previous history of IE
Some forms of congenital heart disease:
--Unrepaired cyanotic congenital defect
--Repaired congenital defect with prosthetic (mechanical) material or device for 6
months after procedure
,--Repaired congenital defect with residual defects at the site or adjacent to the site of a
prosthetic patch or device
--Cardiac transplantation recipients who develop heart valve disease
Supraventricular tachycardia (SVT) - AnswerDysrhythmia that originates from an
ectopic focus above the bifurcation of the bundle of His.
Stimulants (eg, nicotine, caffeine, cocaine) and organic heart disease can cause SVT.
Supraventricular tachycardia (SVT)--Sx - AnswerA prolonged episode of SVT with a
heart rate >180/min will cause decreased cardiac output and hypotension. The client
may also experience palpitations, dyspnea, and angina
Supraventricular tachycardia (SVT)--treatment - Answervagal stimulation and drug
therapy.
--IV adenosine
Notes: If vagal stimulation and drug therapy are ineffective and the client becomes
hemodynamically unstable, synchronized cardioversion is used.
vagal maneuvers - AnswerValsalva, coughing, and carotid massage.
signs of hypovolemia. - Answerdecreased BP
increased capillary refill
decreased urine output
increased urine specific gravity
poor skin turgor (tent)
Notes: Narrowing pulse pressure (the difference between systolic and diastolic) is a sign
of hypovolemic shock
Hypovolemic shock - AnswerClinical manifestations of hypovolemic shock are
associated with inadequate tissue perfusion and include:
--Change in mental status
--Tachycardia with thready pulse 丝状脉
--Cool, clammy skin (Warm, flushed skin can be an early sign of septic or neurogenic
shock)
--**Oliguria (<0.5 mL/kg/hr)
--Tachypnea
Ventricular fibrillation (V-fib)--treatments - Answer--rapid initiation of CPR
--defibrillation
--the use of drug therapy (eg, epinephrine, vasopressin, amiodarone)
Asystole - AnswerCPR, CANNOT defibrillate
drug therapy
, Sinus bradycardia (with Sx) - Answerfirst treated with atropine.
If atropine is ineffective, transcutaneous pacing or an infusion of dopamine or
epinephrine is considered
CPR - Answer--Chest compressions are performed at a rate of 100-120/min and a
depth of 2.0-2.4 inches (5-6 cm), allowing complete chest recoil between compressions
--Defibrillator pads are placed on the right upper chest, just below the clavicle, and on
the left lateral chest, near the anterior axillary line below the nipple line
https://www.ambulance.qld.gov.au/docs/clinical/cpp/CPP_Defibrillation.pdf
--During CPR, compressions are paused every 2 minutes to assess the client's pulse.
This pause should be no longer than 10 seconds to minimize delays between
compression cycles
--Manual breaths are administered at a rate of 2 breaths per 30 chest compressions in
clients without advanced airways
--Correct hand placement is in the center of the chest, on the lower half of the sternum
(breastbone).
Allen's test - AnswerThe modified Allen's test includes the following steps:
--Instruct the client to make a tight fist (if possible)
--Occlude the radial and ulnar arteries using firm pressure
--Instruct the client to open the fist; the palm will be white if both arteries are sufficiently
occluded
--Release the pressure on the ulnar artery; the palm should turn pink within 15 seconds
as circulation is restored to the hand, indicating patency of the ulnar artery (positive
Allen's test)
If the Allen's test is positive, the arterial blood gas can be drawn;
Steps to perform defibrillation - Answer--Turn on the defibrillator
--Place defibrillator pads on the client's chest (Option 1)
--Charge defibrillator. Chest compressions should continue until defibrillator has
charged and is ready to deliver the shock.
--Before delivering the shock, ensure that the area is "all clear." Confirm that no
personnel are touching the client, bed, or any equipment attached to the client (Option
2).
--Deliver the shock
--Immediately resume chest compressions
Chest drainage - Answer>100 mL/hr should be reported to the HCP
Hypomagnesemia - Answercauses a prolonged QT interval
