1
NURS 201 Intermediate Med Surg Midterm Exam |
Questions and Answers | 2026 Update | 100% Correct -
WCU.
A radioactive implant falls out of a patient receiving brachytherapy. What should the nurse do first?
• A. Call the radiation safety officer
• B. Pick it up with forceps and place it in a lead container
• C. Leave it on the floor and evacuate the room
• D. Pick it up with bare hands and place it in the trash
<details><summary><b>Answer & Rationale</b></summary> **Correct: B.** Never touch a radioactive
implant with bare hands. Use long-handled forceps to pick it up and immediately place it in a lead-lined
container to contain radiation exposure. </details>
The earliest sign of deterioration in a patient with hemorrhagic stroke is:
• A. Widening pulse pressure
• B. Cushing's triad
• C. Change in level of consciousness (LOC)
• D. Fixed, dilated pupils
<details><summary><b>Answer & Rationale</b></summary> **Correct: C.** A change in LOC
(confusion, restlessness, drowsiness) is the earliest and most sensitive indicator of increasing
intracranial pressure following hemorrhagic stroke. Pupillary changes and Cushing's triad are late signs
of herniation. </details>
5. HEART FAILURE & FUROSEMIDE
): A nurse is caring for a client receiving furosemide to treat heart failure. Which laboratory value should
the nurse monitor closely?
• A. Serum sodium
• B. Serum potassium
• C. Blood glucose
• D. Serum calcium
pg. 1
,2
<details><summary><b>Answer & Rationale</b></summary> **Correct: B.** Furosemide is a loop
diuretic that causes significant potassium loss, increasing the risk of hypokalemia. Serum potassium
should be closely monitored, and the client should be encouraged to consume potassium-rich foods
(bananas, oranges, potatoes). </details>
6. CAST CARE (Musculoskeletal)
A nurse is assessing a client who had a plaster cast applied to their left leg 2 hours ago. Which of the
following findings requires immediate intervention?
• A. The client reports mild itching under the cast
• B. The client's toes are pale, cool, and capillary refill is 5 seconds
• C. The cast is slightly damp from the application process
• D. The client reports pain rated 4 on a 0-10 scale
<details><summary><b>Answer & Rationale</b></summary> **Correct: B.** Pale, cool toes with
delayed capillary refill indicate compromised circulation, a potential sign of compartment syndrome.
This is a medical emergency requiring immediate provider notification. Itching and mild pain are
expected. A new plaster cast may be slightly damp initially. </details>
Q7. A patient with asthma has symptoms >2 days per week (not daily), nighttime awakenings 3-4
times per month, and uses SABA >2 days per week. According to the stepwise approach, this patient
has:
• A. Intermittent asthma
• B. Mild persistent asthma
• C. Moderate persistent asthma
• D. Severe persistent asthma
<details> <summary><b>Answer & Rationale</b></summary>
Correct: B. Symptoms >2 days/week but not daily, with nighttime awakenings 3-4x/month and minor
limitations, meet criteria for mild persistent asthma. Step 2 treatment is indicated.
</details>
Topic: Status Asthmaticus
A life-threatening medical emergency characterized by hypoxia (SpO₂ <50%), hypercapnia, and acute
respiratory failure. First-line treatment is intubation and mechanical ventilation—bronchodilators and
corticosteroids are NOT effective at this stage.
Q8. A patient in status asthmaticus arrives in the ED unresponsive with SpO₂ of 48%. What is the
priority intervention?
• A. Administer IV corticosteroids
pg. 2
,3
• B. Administer nebulized albuterol
• C. Prepare for intubation and mechanical ventilation
• D. Administer subcutaneous epinephrine
<details> <summary><b>Answer & Rationale</b></summary>
Correct: C. Status asthmaticus is refractory to bronchodilators and corticosteroids. The patient requires
immediate intubation and mechanical ventilation to secure the airway and provide oxygenation.
</details>
2. CARDIAC (Ventricular Tachycardia & Heart Failure)
Q9. A patient with a pulse has ventricular tachycardia. What is the appropriate treatment?
• A. IV amiodarone or lidocaine, then cardioversion
• B. Immediate defibrillation
• C. Vagal maneuvers only
• D. Adenosine IV push
<details> <summary><b>Answer & Rationale</b></summary>
Correct: A. When the patient has a pulse with VT, administer IV amiodarone or lidocaine and perform
synchronized cardioversion. If the patient is pulseless, immediate defibrillation (SHOCK) is indicated.
</details>
Q10. A nurse is caring for a client receiving furosemide to treat heart failure. Which laboratory value
should the nurse monitor closely?
• A. Serum sodium
• B. Serum potassium
• C. Blood glucose
• D. Serum calcium
<details> <summary><b>Answer & Rationale</b></summary>
Correct: B. Furosemide is a loop diuretic that causes significant potassium loss, increasing the risk of
hypokalemia. Serum potassium should be closely monitored, and the client should be encouraged to
consume potassium-rich foods (bananas, oranges, potatoes).
</details>
3. COPD (Chronic Obstructive Pulmonary Disease)
Key points from NURS 201 course materials:
pg. 3
, 4
• Preventable and treatable disease with persistent airflow obstruction
• Primary cause: cigarette smoking
• Early signs: chronic cough, unproductive cough, fatigue, dyspnea with exertion
• Late signs: dyspnea at rest, accessory muscle use, barrel chest, tripod positioning
• Six-minute walk test: SaO₂ <88% at rest qualifies for supplemental O₂
• Nutritional requirements: High-calorie, high-protein diet
4. OLDER ADULTS & CANCER
Signs of Malignancy: Skin lesion larger than 6mm is a red flag.
Brachytherapy Precautions:
• Private room with door closed
• Radiation warning sign on door
• Wear dosimeter badge
• Limit visitors to 30-minute visits, maintain 6ft distance
• No pregnant visitors or children under 18
Pancytopenia Teaching:
• Low WBC, low platelets, low RBC
• High risk for infection, bleeding, and bruising
• Take temperature daily and report >100°F
• Maintain hygienic environment
Q11. Which of the following nursing actions is a priority when caring for a patient with a sealed
internal radiation implant?
• A. Wear a dosimeter badge at all times when in the patient's room
• B. Limit the time spent in the patient's room to 30 minutes per shift
• C. Ensure the patient's room is shared with another patient for support
• D. Allow pregnant visitors as long as they wear protective gear
<details> <summary><b>Answer & Rationale</b></summary>
Correct: B. For a patient with a sealed internal radiation implant, the nurse must limit the time spent in
the patient's room to 30 minutes per 8-hour shift. Other key precautions include wearing a dosimeter
badge, having the patient in a private room, and prohibiting pregnant visitors and children.
</details>
pg. 4
NURS 201 Intermediate Med Surg Midterm Exam |
Questions and Answers | 2026 Update | 100% Correct -
WCU.
A radioactive implant falls out of a patient receiving brachytherapy. What should the nurse do first?
• A. Call the radiation safety officer
• B. Pick it up with forceps and place it in a lead container
• C. Leave it on the floor and evacuate the room
• D. Pick it up with bare hands and place it in the trash
<details><summary><b>Answer & Rationale</b></summary> **Correct: B.** Never touch a radioactive
implant with bare hands. Use long-handled forceps to pick it up and immediately place it in a lead-lined
container to contain radiation exposure. </details>
The earliest sign of deterioration in a patient with hemorrhagic stroke is:
• A. Widening pulse pressure
• B. Cushing's triad
• C. Change in level of consciousness (LOC)
• D. Fixed, dilated pupils
<details><summary><b>Answer & Rationale</b></summary> **Correct: C.** A change in LOC
(confusion, restlessness, drowsiness) is the earliest and most sensitive indicator of increasing
intracranial pressure following hemorrhagic stroke. Pupillary changes and Cushing's triad are late signs
of herniation. </details>
5. HEART FAILURE & FUROSEMIDE
): A nurse is caring for a client receiving furosemide to treat heart failure. Which laboratory value should
the nurse monitor closely?
• A. Serum sodium
• B. Serum potassium
• C. Blood glucose
• D. Serum calcium
pg. 1
,2
<details><summary><b>Answer & Rationale</b></summary> **Correct: B.** Furosemide is a loop
diuretic that causes significant potassium loss, increasing the risk of hypokalemia. Serum potassium
should be closely monitored, and the client should be encouraged to consume potassium-rich foods
(bananas, oranges, potatoes). </details>
6. CAST CARE (Musculoskeletal)
A nurse is assessing a client who had a plaster cast applied to their left leg 2 hours ago. Which of the
following findings requires immediate intervention?
• A. The client reports mild itching under the cast
• B. The client's toes are pale, cool, and capillary refill is 5 seconds
• C. The cast is slightly damp from the application process
• D. The client reports pain rated 4 on a 0-10 scale
<details><summary><b>Answer & Rationale</b></summary> **Correct: B.** Pale, cool toes with
delayed capillary refill indicate compromised circulation, a potential sign of compartment syndrome.
This is a medical emergency requiring immediate provider notification. Itching and mild pain are
expected. A new plaster cast may be slightly damp initially. </details>
Q7. A patient with asthma has symptoms >2 days per week (not daily), nighttime awakenings 3-4
times per month, and uses SABA >2 days per week. According to the stepwise approach, this patient
has:
• A. Intermittent asthma
• B. Mild persistent asthma
• C. Moderate persistent asthma
• D. Severe persistent asthma
<details> <summary><b>Answer & Rationale</b></summary>
Correct: B. Symptoms >2 days/week but not daily, with nighttime awakenings 3-4x/month and minor
limitations, meet criteria for mild persistent asthma. Step 2 treatment is indicated.
</details>
Topic: Status Asthmaticus
A life-threatening medical emergency characterized by hypoxia (SpO₂ <50%), hypercapnia, and acute
respiratory failure. First-line treatment is intubation and mechanical ventilation—bronchodilators and
corticosteroids are NOT effective at this stage.
Q8. A patient in status asthmaticus arrives in the ED unresponsive with SpO₂ of 48%. What is the
priority intervention?
• A. Administer IV corticosteroids
pg. 2
,3
• B. Administer nebulized albuterol
• C. Prepare for intubation and mechanical ventilation
• D. Administer subcutaneous epinephrine
<details> <summary><b>Answer & Rationale</b></summary>
Correct: C. Status asthmaticus is refractory to bronchodilators and corticosteroids. The patient requires
immediate intubation and mechanical ventilation to secure the airway and provide oxygenation.
</details>
2. CARDIAC (Ventricular Tachycardia & Heart Failure)
Q9. A patient with a pulse has ventricular tachycardia. What is the appropriate treatment?
• A. IV amiodarone or lidocaine, then cardioversion
• B. Immediate defibrillation
• C. Vagal maneuvers only
• D. Adenosine IV push
<details> <summary><b>Answer & Rationale</b></summary>
Correct: A. When the patient has a pulse with VT, administer IV amiodarone or lidocaine and perform
synchronized cardioversion. If the patient is pulseless, immediate defibrillation (SHOCK) is indicated.
</details>
Q10. A nurse is caring for a client receiving furosemide to treat heart failure. Which laboratory value
should the nurse monitor closely?
• A. Serum sodium
• B. Serum potassium
• C. Blood glucose
• D. Serum calcium
<details> <summary><b>Answer & Rationale</b></summary>
Correct: B. Furosemide is a loop diuretic that causes significant potassium loss, increasing the risk of
hypokalemia. Serum potassium should be closely monitored, and the client should be encouraged to
consume potassium-rich foods (bananas, oranges, potatoes).
</details>
3. COPD (Chronic Obstructive Pulmonary Disease)
Key points from NURS 201 course materials:
pg. 3
, 4
• Preventable and treatable disease with persistent airflow obstruction
• Primary cause: cigarette smoking
• Early signs: chronic cough, unproductive cough, fatigue, dyspnea with exertion
• Late signs: dyspnea at rest, accessory muscle use, barrel chest, tripod positioning
• Six-minute walk test: SaO₂ <88% at rest qualifies for supplemental O₂
• Nutritional requirements: High-calorie, high-protein diet
4. OLDER ADULTS & CANCER
Signs of Malignancy: Skin lesion larger than 6mm is a red flag.
Brachytherapy Precautions:
• Private room with door closed
• Radiation warning sign on door
• Wear dosimeter badge
• Limit visitors to 30-minute visits, maintain 6ft distance
• No pregnant visitors or children under 18
Pancytopenia Teaching:
• Low WBC, low platelets, low RBC
• High risk for infection, bleeding, and bruising
• Take temperature daily and report >100°F
• Maintain hygienic environment
Q11. Which of the following nursing actions is a priority when caring for a patient with a sealed
internal radiation implant?
• A. Wear a dosimeter badge at all times when in the patient's room
• B. Limit the time spent in the patient's room to 30 minutes per shift
• C. Ensure the patient's room is shared with another patient for support
• D. Allow pregnant visitors as long as they wear protective gear
<details> <summary><b>Answer & Rationale</b></summary>
Correct: B. For a patient with a sealed internal radiation implant, the nurse must limit the time spent in
the patient's room to 30 minutes per 8-hour shift. Other key precautions include wearing a dosimeter
badge, having the patient in a private room, and prohibiting pregnant visitors and children.
</details>
pg. 4
