NSG 233 MED SURGE 3 FINAL EXAM
QUESTIONS AND ANSWERS GRADED A+
2026
Chest Trauma- Complications - ANS Flail chest is frequently a complication of blunt chest
trauma, which may occur from a steering wheel injury, motor vehicle crash involving a
pedestrian or cyclist, a significant fall onto the chest, or an assault with a blunt weapon. As with
rib fracture, treatment of flail chest is usually supportive. Management includes providing
ventilatory support, clearing secretions from the lungs, and controlling pain. For mild-to-
moderate flail chest injuries, the underlying pulmonary contusion is treated by monitoring fluid
intake and appropriate fluid replacement while relieving chest pain. Pulmonary physiotherapy
focusing on lung volume expansion and secretion management techniques is performed. The
patient is closely monitored for further respiratory compromise.
For severe flail chest injuries, ET intubation and mechanical ventilation are required to provide
internal pneumatic stabilization of the flail chest and to correct abnormalities in gas exchange.
Shock Fluid - ANS At least two large-gauge IV lines are inserted to establish access for fluid
administration. Because the goal of the fluid replacement is to restore intravascular volume, it is
necessary to administer fluids that will remain in the intravascular compartment to avoid fluid
shifts from the intravascular compartment into the intracellular compartment. As discussed
earlier, crystalloid solutions such as lactated Ringer's solution or 0.9% sodium chloride solution
are commonly used to treat hypovolemic shock, as large amounts of fluid must be given to
restore intravascular volume.
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 1
,Hypovolemic Shock - ANS Hypovolemic shock, the most common type of shock, is
characterized by decreased intravascular volume. Body fluid is contained in the intracellular and
extracellular compartments. Intracellular fluid accounts for about two thirds of the total body
water. The extracellular body fluid is found in one of two compartments: intravascular (inside
blood vessels) or interstitial (surrounding tissues). The volume of interstitial fluid is about three
to four times that of intravascular fluid. Hypovolemic shock occurs when there is a reduction in
intravascular volume by 15% to 30%, which represents an approximate loss of 750 to 1500 mL
of blood in a 70-kg (154-lb) person
Cardiogenic Shock S&S - ANS Cardiogenic shock occurs when the heart's ability to contract
and to pump blood is impaired and the supply of oxygen is inadequate for the heart and the
tissues. In cardiogenic shock, cardiac output, which is a function of both stroke volume and
heart rate, is compromised. Patients in cardiogenic shock may experience the pain of angina,
develop arrhythmias, complain of fatigue, express feelings of doom, and show signs of
hemodynamic instability.
Hemorrhage- Shock - ANS If the patient is hemorrhaging, efforts are made to stop the
bleeding. This may involve applying pressure to the bleeding site or surgical interventions to
stop internal bleeding. If the cause of the hypovolemia is diarrhea or vomiting, medications to
treat diarrhea and vomiting are given while efforts are made to identify and treat the cause. In
older adult patients, dehydration may be the cause of hypovolemic shock.
Shock Septic- Dopamine - ANS Dopamine, a naturally occurring precursor of norepinephrine
and epinephrine, functions as a neurotransmitter. Dopamine is useful in hypovolemic and
cardiogenic shock. Adequate fluid therapy is necessary for maximal pressor (increased blood
pressure) effect. Acidosis decreases the effectiveness of the drug. If fluid therapy alone does not
effectively improve tissue perfusion, vasopressor agents, specifically norepinephrine or
dopamine, may be initiated to achieve a MAP of 65 mm Hg or higher
AAA- Tests - ANS The most important diagnostic indication of an abdominal aortic aneurysm
is a pulsatile mass in the middle and upper abdomen. Most clinically significant aortic
aneurysms are palpable during routine physical examination; however, the sensitivity depends
upon the size of the aneurysm, abdominal girth of the patient (i.e., more difficult to find in the
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 2
, patient with obesity), and the skill of the examiner. A systolic bruit may be heard over the mass.
Duplex ultrasonography or CTA is used to determine the size, length, and location of the
aneurysm. When the aneurysm is small, ultrasonography is conducted at 6-month intervals until
the aneurysm reaches a size so that surgery to prevent rupture is of more benefit than the
possible complications of a surgical procedure. Some aneurysms remain stable over many years
of monitoring.
AAA- Post Op - ANS The patient who has had an endovascular repair must lie supine for 6
hours; the head of the bed may be elevated up to 45 degrees after two hours. The patient needs
to use a bedpan or urinal while on bed rest. Vital signs and Doppler assessment of peripheral
pulses are performed initially every 15 minutes and then at progressively longer intervals if the
patient's status remains stable. The access site (usually the femoral artery) is assessed when
vital signs and pulses are monitored. The nurse assesses for bleeding, pulsation, swelling, pain,
and hematoma formation. Skin changes of the lower extremity, lumbar area, or buttocks that
might indicate signs of embolization, such as extremely tender, irregularly shaped, cyanotic
areas, as well as any changes in vital signs, pulse quality, bleeding, swelling, pain, or hematoma,
are immediately reported to the primary provider.
The patient's temperature should be monitored every four hours, and any signs of
postimplantation syndrome should be reported. Postimplantation syndrome typically begins
within 24 hours of stent-graft placement and consists of a spontaneously occurring fever,
leukocytosis, and occasionally, transient thrombocytopenia. This condition has been attributed
to complex immunologic changes that occur because of manipulations with sheaths and
catheters with the aortic lumen, although the exact etiology is unknown. The symptoms are
thought to be related to the activation of cytokines. They can be managed with a mild analgesic
(e.g., acetaminophen [Tylenol]) or an anti-inflammatory agent (e.g., ibuprofen [Motrin]) and
usually subside within a week.
Because of the increased risk of hemorrhage, the primary provider is also notified of persistent
coughing, sneezing, vomiting, or systolic blood pressure greater than 180 mm Hg. Most patients
can resume their pre-proce
Asystole Drug Choice - ANS In such cases, the treatment is the same as for asystole and
pulseless electrical activity (PEA) if the patient is in cardiac arrest or for bradycardia if the
patient is not in cardiac arrest. Interventions include identifying the underlying cause;
administering IV epinephrine, atropine, and vasopressor medications; and initiating emergency
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 3
QUESTIONS AND ANSWERS GRADED A+
2026
Chest Trauma- Complications - ANS Flail chest is frequently a complication of blunt chest
trauma, which may occur from a steering wheel injury, motor vehicle crash involving a
pedestrian or cyclist, a significant fall onto the chest, or an assault with a blunt weapon. As with
rib fracture, treatment of flail chest is usually supportive. Management includes providing
ventilatory support, clearing secretions from the lungs, and controlling pain. For mild-to-
moderate flail chest injuries, the underlying pulmonary contusion is treated by monitoring fluid
intake and appropriate fluid replacement while relieving chest pain. Pulmonary physiotherapy
focusing on lung volume expansion and secretion management techniques is performed. The
patient is closely monitored for further respiratory compromise.
For severe flail chest injuries, ET intubation and mechanical ventilation are required to provide
internal pneumatic stabilization of the flail chest and to correct abnormalities in gas exchange.
Shock Fluid - ANS At least two large-gauge IV lines are inserted to establish access for fluid
administration. Because the goal of the fluid replacement is to restore intravascular volume, it is
necessary to administer fluids that will remain in the intravascular compartment to avoid fluid
shifts from the intravascular compartment into the intracellular compartment. As discussed
earlier, crystalloid solutions such as lactated Ringer's solution or 0.9% sodium chloride solution
are commonly used to treat hypovolemic shock, as large amounts of fluid must be given to
restore intravascular volume.
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 1
,Hypovolemic Shock - ANS Hypovolemic shock, the most common type of shock, is
characterized by decreased intravascular volume. Body fluid is contained in the intracellular and
extracellular compartments. Intracellular fluid accounts for about two thirds of the total body
water. The extracellular body fluid is found in one of two compartments: intravascular (inside
blood vessels) or interstitial (surrounding tissues). The volume of interstitial fluid is about three
to four times that of intravascular fluid. Hypovolemic shock occurs when there is a reduction in
intravascular volume by 15% to 30%, which represents an approximate loss of 750 to 1500 mL
of blood in a 70-kg (154-lb) person
Cardiogenic Shock S&S - ANS Cardiogenic shock occurs when the heart's ability to contract
and to pump blood is impaired and the supply of oxygen is inadequate for the heart and the
tissues. In cardiogenic shock, cardiac output, which is a function of both stroke volume and
heart rate, is compromised. Patients in cardiogenic shock may experience the pain of angina,
develop arrhythmias, complain of fatigue, express feelings of doom, and show signs of
hemodynamic instability.
Hemorrhage- Shock - ANS If the patient is hemorrhaging, efforts are made to stop the
bleeding. This may involve applying pressure to the bleeding site or surgical interventions to
stop internal bleeding. If the cause of the hypovolemia is diarrhea or vomiting, medications to
treat diarrhea and vomiting are given while efforts are made to identify and treat the cause. In
older adult patients, dehydration may be the cause of hypovolemic shock.
Shock Septic- Dopamine - ANS Dopamine, a naturally occurring precursor of norepinephrine
and epinephrine, functions as a neurotransmitter. Dopamine is useful in hypovolemic and
cardiogenic shock. Adequate fluid therapy is necessary for maximal pressor (increased blood
pressure) effect. Acidosis decreases the effectiveness of the drug. If fluid therapy alone does not
effectively improve tissue perfusion, vasopressor agents, specifically norepinephrine or
dopamine, may be initiated to achieve a MAP of 65 mm Hg or higher
AAA- Tests - ANS The most important diagnostic indication of an abdominal aortic aneurysm
is a pulsatile mass in the middle and upper abdomen. Most clinically significant aortic
aneurysms are palpable during routine physical examination; however, the sensitivity depends
upon the size of the aneurysm, abdominal girth of the patient (i.e., more difficult to find in the
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 2
, patient with obesity), and the skill of the examiner. A systolic bruit may be heard over the mass.
Duplex ultrasonography or CTA is used to determine the size, length, and location of the
aneurysm. When the aneurysm is small, ultrasonography is conducted at 6-month intervals until
the aneurysm reaches a size so that surgery to prevent rupture is of more benefit than the
possible complications of a surgical procedure. Some aneurysms remain stable over many years
of monitoring.
AAA- Post Op - ANS The patient who has had an endovascular repair must lie supine for 6
hours; the head of the bed may be elevated up to 45 degrees after two hours. The patient needs
to use a bedpan or urinal while on bed rest. Vital signs and Doppler assessment of peripheral
pulses are performed initially every 15 minutes and then at progressively longer intervals if the
patient's status remains stable. The access site (usually the femoral artery) is assessed when
vital signs and pulses are monitored. The nurse assesses for bleeding, pulsation, swelling, pain,
and hematoma formation. Skin changes of the lower extremity, lumbar area, or buttocks that
might indicate signs of embolization, such as extremely tender, irregularly shaped, cyanotic
areas, as well as any changes in vital signs, pulse quality, bleeding, swelling, pain, or hematoma,
are immediately reported to the primary provider.
The patient's temperature should be monitored every four hours, and any signs of
postimplantation syndrome should be reported. Postimplantation syndrome typically begins
within 24 hours of stent-graft placement and consists of a spontaneously occurring fever,
leukocytosis, and occasionally, transient thrombocytopenia. This condition has been attributed
to complex immunologic changes that occur because of manipulations with sheaths and
catheters with the aortic lumen, although the exact etiology is unknown. The symptoms are
thought to be related to the activation of cytokines. They can be managed with a mild analgesic
(e.g., acetaminophen [Tylenol]) or an anti-inflammatory agent (e.g., ibuprofen [Motrin]) and
usually subside within a week.
Because of the increased risk of hemorrhage, the primary provider is also notified of persistent
coughing, sneezing, vomiting, or systolic blood pressure greater than 180 mm Hg. Most patients
can resume their pre-proce
Asystole Drug Choice - ANS In such cases, the treatment is the same as for asystole and
pulseless electrical activity (PEA) if the patient is in cardiac arrest or for bradycardia if the
patient is not in cardiac arrest. Interventions include identifying the underlying cause;
administering IV epinephrine, atropine, and vasopressor medications; and initiating emergency
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 3
