Herzing University NSG 223 Med Surg II Final Exam (2026/2027) | BRAND NEW VERSION
| QUESTIONS AND CORRECT ANSWERS
Herzing University NSG 223: Medical-Surgical Nursing II Final Examination | Core Domains:
Advanced Cardiovascular Disorders, Complex Respiratory Conditions, Neurological & Neurosurgical
Care, Renal & Urological Disorders, Endocrine & Metabolic Emergencies, Hematologic & Oncologic
Management, Multisystem Trauma, and Critical Care Nursing Principles | Nursing Program
Comprehensive Assessment Focus | Final Exam Format
Exam Structure
The Herzing University NSG 223 Med Surg II Final Exam for the 2026/2027 academic cycle is a
100-question, multiple-choice examination.
Introduction
This NSG 223 Med Surg II Final Exam guide for the 2026/2027 academic year reflects the latest
evidence-based practices in advanced medical-surgical nursing. The content emphasizes complex patient
management, critical thinking in high-acuity settings, interdisciplinary collaboration, and application of
advanced pathophysiology and pharmacology principles to adult health disorders.
Answer Format
All correct answers and nursing interventions must be presented in bold and green, followed by
detailed rationales incorporating advanced pathophysiology, priority-setting frameworks,
pharmacological management, and evidence-based protocols for complex medical-surgical conditions.
1. A patient with acute myocardial infarction (STEMI) is receiving thrombolytic therapy.
Which finding requires immediate intervention?
A. Mild headache
B. Facial droop and slurred speech
C. Nausea
D. Sinus tachycardia at 102 bpm
B. Facial droop and slurred speech
Thrombolytics (e.g., alteplase) increase the risk of intracranial hemorrhage (ICH). Facial droop and
slurred speech are signs of stroke, a life-threatening complication. Immediate neurologic assessment
and CT scan are required. Mild headache may be benign, but new focal neurologic deficits are red flags
per AHA/ACC STEMI guidelines.
,2. The nurse is caring for a patient with acute decompensated heart failure (ADHF) and
crackles in all lung fields. Which medication should the nurse anticipate administering
first?
A. Metoprolol
B. Furosemide
C. Lisinopril
D. Spironolactone
B. Furosemide
Furosemide (loop diuretic) is first-line for acute pulmonary edema in ADHF to reduce preload and fluid
overload. Beta-blockers (metoprolol) and ACE inhibitors (lisinopril) are contraindicated in acute
decompensation due to negative inotropy and hypotension risk. Spironolactone is a potassium-sparing
diuretic used for chronic management, not acute rescue.
3. A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2
mEq/L. Which intervention is the priority?
A. Administer sodium polystyrene sulfonate (Kayexalate)
B. Give IV calcium gluconate
C. Initiate dialysis
D. Restrict dietary potassium
B. Give IV calcium gluconate
Hyperkalemia >6.0 mEq/L with ECG changes (e.g., peaked T-waves) is a medical emergency. IV
calcium gluconate stabilizes the myocardium within minutes to prevent lethal arrhythmias. Kayexalate
lowers K⁺ over hours; dialysis is definitive but not immediate. Cardiac protection takes precedence over
K⁺ reduction per KDIGO guidelines.
4. A patient with traumatic brain injury (TBI) has an intracranial pressure (ICP) of 28 mm
Hg. Which action should the nurse take first?
A. Elevate the head of the bed to 30 degrees
B. Administer mannitol 1 g/kg IV
,C. Hyperventilate to PaCO₂ of 25 mm Hg
D. Notify the provider immediately
A. Elevate the head of the bed to 30 degrees
Elevating the head of the bed promotes venous drainage and reduces ICP—a non-invasive, immediate
intervention per the Brain Trauma Foundation guidelines. Mannitol is second-line; hyperventilation is
reserved for acute herniation due to rebound ischemia risk. The nurse can implement HOB elevation
without a provider order.
5. A patient with septic shock has a mean arterial pressure (MAP) of 58 mm Hg despite
fluid resuscitation. Which vasopressor should the nurse anticipate?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Phenylephrine
C. Norepinephrine
Norepinephrine is first-line vasopressor in septic shock per Surviving Sepsis Campaign guidelines due to
its potent alpha-agonist effects (vasoconstriction) with minimal beta-effects (tachycardia). Dopamine is
second-line; epinephrine is added if norepinephrine fails; phenylephrine lacks inotropic support.
6. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation
with PEEP of 12 cm H₂O. Which assessment finding indicates PEEP is effective?
A. SaO₂ 88%
B. PaO₂ 65 mm Hg
C. PaO₂/FiO₂ ratio of 180
D. PaO₂/FiO₂ ratio of 320
D. PaO₂/FiO₂ ratio of 320
ARDS is defined by PaO₂/FiO₂ ≤300 (mild), ≤200 (moderate), ≤100 (severe). A ratio of 320 indicates
improved oxygenation and effective PEEP. SaO₂ 88% and PaO₂ 65 mm Hg reflect hypoxemia; a ratio of
180 indicates moderate ARDS.
, 7. A patient with type 1 diabetes has blood glucose of 420 mg/dL, arterial pH of 7.18, and
serum bicarbonate of 12 mEq/L. Which condition does the nurse anticipate?
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemia
D. Lactic acidosis
B. Diabetic ketoacidosis (DKA)
DKA is characterized by hyperglycemia (>250 mg/dL), metabolic acidosis (pH <7.3, HCO₃⁻ <18), and
ketonemia. HHS presents with extreme hyperglycemia (>600 mg/dL) but minimal acidosis. Lactic
acidosis has elevated lactate; hypoglycemia has low glucose. DKA requires insulin, fluids, and
electrolyte replacement per ADA protocol.
8. A patient with multiple myeloma reports severe bone pain. Which medication is the
priority?
A. Ibuprofen
B. Acetaminophen
C. Morphine
D. Aspirin
C. Morphine
Multiple myeloma causes lytic bone lesions and severe pain requiring opioid analgesia. NSAIDs
(ibuprofen, aspirin) are contraindicated due to nephrotoxicity risk in myeloma (light chain cast
nephropathy). Acetaminophen is insufficient for severe pain. Morphine provides effective analgesia with
renal dose adjustment.
9. A patient with cirrhosis develops asterixis and confusion. Which condition should the
nurse suspect?
A. Hypoglycemia
B. Hepatic encephalopathy
C. Hyponatremia
| QUESTIONS AND CORRECT ANSWERS
Herzing University NSG 223: Medical-Surgical Nursing II Final Examination | Core Domains:
Advanced Cardiovascular Disorders, Complex Respiratory Conditions, Neurological & Neurosurgical
Care, Renal & Urological Disorders, Endocrine & Metabolic Emergencies, Hematologic & Oncologic
Management, Multisystem Trauma, and Critical Care Nursing Principles | Nursing Program
Comprehensive Assessment Focus | Final Exam Format
Exam Structure
The Herzing University NSG 223 Med Surg II Final Exam for the 2026/2027 academic cycle is a
100-question, multiple-choice examination.
Introduction
This NSG 223 Med Surg II Final Exam guide for the 2026/2027 academic year reflects the latest
evidence-based practices in advanced medical-surgical nursing. The content emphasizes complex patient
management, critical thinking in high-acuity settings, interdisciplinary collaboration, and application of
advanced pathophysiology and pharmacology principles to adult health disorders.
Answer Format
All correct answers and nursing interventions must be presented in bold and green, followed by
detailed rationales incorporating advanced pathophysiology, priority-setting frameworks,
pharmacological management, and evidence-based protocols for complex medical-surgical conditions.
1. A patient with acute myocardial infarction (STEMI) is receiving thrombolytic therapy.
Which finding requires immediate intervention?
A. Mild headache
B. Facial droop and slurred speech
C. Nausea
D. Sinus tachycardia at 102 bpm
B. Facial droop and slurred speech
Thrombolytics (e.g., alteplase) increase the risk of intracranial hemorrhage (ICH). Facial droop and
slurred speech are signs of stroke, a life-threatening complication. Immediate neurologic assessment
and CT scan are required. Mild headache may be benign, but new focal neurologic deficits are red flags
per AHA/ACC STEMI guidelines.
,2. The nurse is caring for a patient with acute decompensated heart failure (ADHF) and
crackles in all lung fields. Which medication should the nurse anticipate administering
first?
A. Metoprolol
B. Furosemide
C. Lisinopril
D. Spironolactone
B. Furosemide
Furosemide (loop diuretic) is first-line for acute pulmonary edema in ADHF to reduce preload and fluid
overload. Beta-blockers (metoprolol) and ACE inhibitors (lisinopril) are contraindicated in acute
decompensation due to negative inotropy and hypotension risk. Spironolactone is a potassium-sparing
diuretic used for chronic management, not acute rescue.
3. A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2
mEq/L. Which intervention is the priority?
A. Administer sodium polystyrene sulfonate (Kayexalate)
B. Give IV calcium gluconate
C. Initiate dialysis
D. Restrict dietary potassium
B. Give IV calcium gluconate
Hyperkalemia >6.0 mEq/L with ECG changes (e.g., peaked T-waves) is a medical emergency. IV
calcium gluconate stabilizes the myocardium within minutes to prevent lethal arrhythmias. Kayexalate
lowers K⁺ over hours; dialysis is definitive but not immediate. Cardiac protection takes precedence over
K⁺ reduction per KDIGO guidelines.
4. A patient with traumatic brain injury (TBI) has an intracranial pressure (ICP) of 28 mm
Hg. Which action should the nurse take first?
A. Elevate the head of the bed to 30 degrees
B. Administer mannitol 1 g/kg IV
,C. Hyperventilate to PaCO₂ of 25 mm Hg
D. Notify the provider immediately
A. Elevate the head of the bed to 30 degrees
Elevating the head of the bed promotes venous drainage and reduces ICP—a non-invasive, immediate
intervention per the Brain Trauma Foundation guidelines. Mannitol is second-line; hyperventilation is
reserved for acute herniation due to rebound ischemia risk. The nurse can implement HOB elevation
without a provider order.
5. A patient with septic shock has a mean arterial pressure (MAP) of 58 mm Hg despite
fluid resuscitation. Which vasopressor should the nurse anticipate?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Phenylephrine
C. Norepinephrine
Norepinephrine is first-line vasopressor in septic shock per Surviving Sepsis Campaign guidelines due to
its potent alpha-agonist effects (vasoconstriction) with minimal beta-effects (tachycardia). Dopamine is
second-line; epinephrine is added if norepinephrine fails; phenylephrine lacks inotropic support.
6. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation
with PEEP of 12 cm H₂O. Which assessment finding indicates PEEP is effective?
A. SaO₂ 88%
B. PaO₂ 65 mm Hg
C. PaO₂/FiO₂ ratio of 180
D. PaO₂/FiO₂ ratio of 320
D. PaO₂/FiO₂ ratio of 320
ARDS is defined by PaO₂/FiO₂ ≤300 (mild), ≤200 (moderate), ≤100 (severe). A ratio of 320 indicates
improved oxygenation and effective PEEP. SaO₂ 88% and PaO₂ 65 mm Hg reflect hypoxemia; a ratio of
180 indicates moderate ARDS.
, 7. A patient with type 1 diabetes has blood glucose of 420 mg/dL, arterial pH of 7.18, and
serum bicarbonate of 12 mEq/L. Which condition does the nurse anticipate?
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemia
D. Lactic acidosis
B. Diabetic ketoacidosis (DKA)
DKA is characterized by hyperglycemia (>250 mg/dL), metabolic acidosis (pH <7.3, HCO₃⁻ <18), and
ketonemia. HHS presents with extreme hyperglycemia (>600 mg/dL) but minimal acidosis. Lactic
acidosis has elevated lactate; hypoglycemia has low glucose. DKA requires insulin, fluids, and
electrolyte replacement per ADA protocol.
8. A patient with multiple myeloma reports severe bone pain. Which medication is the
priority?
A. Ibuprofen
B. Acetaminophen
C. Morphine
D. Aspirin
C. Morphine
Multiple myeloma causes lytic bone lesions and severe pain requiring opioid analgesia. NSAIDs
(ibuprofen, aspirin) are contraindicated due to nephrotoxicity risk in myeloma (light chain cast
nephropathy). Acetaminophen is insufficient for severe pain. Morphine provides effective analgesia with
renal dose adjustment.
9. A patient with cirrhosis develops asterixis and confusion. Which condition should the
nurse suspect?
A. Hypoglycemia
B. Hepatic encephalopathy
C. Hyponatremia
