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Exam 1: NUR 209/ NUR 209 (Latest 2026/ 2027 Update) Medical Surgical Nursing II: Med-Surg Review| Questions and Answers| Grade A| 100% Correct (Verified Solutions) – Fortis

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INSTANT PDF DOWNLOAD — This comprehensive exam preparation resource for NUR 209 Exam 1 Medical Surgical Nursing II at Fortis College covers all content for the 2026/2027 academic year first examination. It features verified questions and answers with detailed rationales in multiple-choice, select-all-that-apply (SATA), ordered response, and clinical scenario formats aligned with nursing program standards. RESPIRATORY DISORDERS (EXAM 1 FOCUS) CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Definition – Progressive airflow limitation that is not fully reversible due to chronic inflammation of airways and lung parenchyma. Two main types: chronic bronchitis (blue bloater) and emphysema (pink puffer). Many patients have features of both. Chronic Bronchitis – Defined clinically: productive cough for at least 3 months in 2 consecutive years. Pathophysiology: chronic inflammation → hypertrophy and hyperplasia of mucous glands (Reid index 0.4) → increased mucus production → impaired ciliary function → airway obstruction. Assessment findings: chronic productive cough (sputum often clear or purulent), cyanosis (hypoxia → "blue bloater"), peripheral edema (right heart failure → cor pulmonale), overweight, distended neck veins, prolonged expiratory phase, coarse crackles (rhonchi), wheezing. Emphysema – Pathophysiology: destruction of alveolar walls (loss of elastic recoil) and capillary beds → decreased surface area for gas exchange → air trapping (hyperinflation) → "pink puffer." Assessment findings: dyspnea (initially on exertion, progresses to at rest), minimal cough (dry, scant sputum), barrel chest (increased AP diameter from chronic hyperinflation), underweight (weight loss, muscle wasting), pursed-lip breathing (prolongs exhalation, prevents airway collapse), tripod position (leaning forward to use accessory muscles), decreased breath sounds, distant heart sounds, use of accessory muscles (sternocleidomastoid, scalenes), clubbing of fingers (chronic hypoxia). COPD Risk Factors – Cigarette smoking (#1 cause, includes secondhand smoke), occupational exposure (coal dust, cotton dust, grain dust, silica), air pollution (indoor/outdoor), alpha-1 antitrypsin deficiency (genetic – early-onset emphysema). COPD Diagnosis – Pulmonary function tests (PFTs) are gold standard: post-bronchodilator FEV1/FVC 0.70 confirms obstruction. Severity based on FEV1% predicted (GOLD grades 1-4). Chest X-ray: hyperinflation (flattened diaphragms, increased retrosternal air space, decreased vascular markings in emphysema). ABGs: PaO2 60 mmHg (hypoxemia), PaCO2 45 mmHg (hypercapnia/respiratory acidosis) in advanced disease, normal or slightly elevated HCO3 (metabolic compensation). GOLD Guidelines Treatment – Group A (low risk, fewer symptoms): short-acting bronchodilator (SABA: albuterol, or SAMA: ipratropium). Group B (low risk, more symptoms): LABA (salmeterol, formoterol) and/or LAMA (tiotropium Spiriva). Group E (high risk, exacerbations): LABA + LAMA (preferred); may add ICS (fluticasone, budesonide) if eosinophils 300. Oxygen therapy: target SpO2 88-92% (avoid 92% to prevent suppressing hypoxic drive and CO2 retention). Pulmonary rehabilitation: exercise training + education (improves symptoms, quality of life, reduces hospitalizations). Surgical options: lung volume reduction surgery (LVRS) for upper lobe emphysema with poor exercise tolerance, bullectomy for giant bullae, lung transplantation for select patients. Nursing Interventions – Breathing techniques: pursed-lip breathing (prolongs exhalation, prevents airway collapse), diaphragmatic (abdominal) breathing (strengthens diaphragm, improves ventilation). Secretion management: effective coughing techniques (huff cough), hydration (2-3 L/day unless fluid restriction), humidified oxygen, chest physiotherapy. Activity tolerance: pacing, energy conservation, rest periods between activities, assist with ADLs. Nutrition: small frequent meals (avoid large meals that increase dyspnea, gas-producing foods, carbonated beverages), high-calorie high-protein diet, supplements, maintain fluid intake. Smoking cessation: most important intervention (nicotine replacement therapy, varenicline, bupropion, counseling, support groups). Patient/family education: medication adherence (proper inhaler technique), signs of infection (increased sputum purulence/volume, fever, increased dyspnea), when to seek medical attention, advance directives. Complications – Respiratory infection (most common cause of exacerbation), acute respiratory failure, cor pulmonale (right heart failure due to pulmonary hypertension from chronic hypoxia – manifestations: JVD, peripheral edema

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Instelling
NUR 209/ NUR209
Vak
NUR 209/ NUR209

Voorbeeld van de inhoud

1|Page




NUR 209 Exam 1 Medical Surgical Nursing II

Fortis 2026/2027 Test Bank with Verified

Answers and Detailed Rationales Grade A


1. The occupational health nurse is planning a safety in service for a

group of clerical workers. Which of the following topics would be most

beneficial?

A) Principles of body alignment

B) The use of protective clothing

C) The use of ear plugs

D) Appropriate storage of combustible cleaning solutions

Correct Answer: A) Principles of body alignment

Rationale:

1. Rationales help students to understand the concept, not just the answer.

2. Clerical workers spend prolonged periods sitting at desks, making

musculoskeletal injuries from poor posture a primary risk.

3. Principles of body alignment directly address ergonomics and proper sitting

posture, which prevent back and neck strain.

,2|Page


4. Protective clothing, ear plugs, and combustible storage are less relevant to

typical clerical office environments.



2. A patient has presented to the Emergency Department after splashing

a chemical in the eyes. When managing the injury, which of the following

should be included in the plan of care?

A) Wash the eyes with a hypertonic solution for at least 30 minutes.

B) Advise the patient to avoid blinking until after the eyes are irrigated.

C) Flush the eyes with water for 10 minutes.

D) Flush the eyes with a cool saline solution for a 10-minute period.

Correct Answer: C) Flush the eyes with water for 10 minutes.

Rationale:

1. Immediate and copious irrigation with water is the standard first aid for

chemical eye injuries.

2. A 10-minute flush is sufficient for most non-penetrating chemical splashes,

though longer may be needed for alkalis.

3. Hypertonic solutions are not used for emergency eye irrigation.

4. Avoiding blinking is impractical and unnecessary; blinking helps tear flow.

5. Cool saline is acceptable but water is more readily available in emergency

settings.

,3|Page




3. The nurse is discussing car safety with the mother of a 6-year-old

child. The child's mother questions the need for the use of special car

seats for her child. What information can be provided to her?

A) "Car seats are only recommended until children are 3 years old."

B) "At the age of 6 your child should be using a booster seat."

C) "Car seats are recommended until children are at least 10 years old."

D) "Your child will be safe in the car using the provided shoulder harness and

lap belts."

Correct Answer: B) "At the age of 6 your child should be using a booster

seat."

Rationale:

1. Children aged 4 to 8 years who are under 4 feet 9 inches tall should use

booster seats.

2. Standard seat belts do not fit young children properly, increasing injury risk.

3. A 6-year-old typically is not tall enough for adult seat belts alone.

4. Option A is incorrect; car seats are recommended beyond age 3.

5. Option C is incorrect; age 10 is too broad and not standard.

6. Option D is incorrect because lap/shoulder belts alone are unsafe for a 6-

year-old without a booster.

, 4|Page




4. After identifying a medication error, the nurse completes an incident

report. The nurse correctly recognizes which of the following about the

use of these documents? Select all that apply.

A) The incident report should be placed with the patient's medical records.

B) Incident reports provide a clear, concise recording of the situation that can

be provided to the patient's legal representative in the event of a lawsuit.

C) The incident report should include factual information about the incident.

D) The nurse should include their own personal perception about the cause of

the incident in the report.

E) Completion of the incident report should be noted in the nurse's notes.

Correct Answer: B) Incident reports provide a clear, concise recording of

the situation that can be provided to the patient's legal representative in

the event of a lawsuit. and C) The incident report should include factual

information about the incident.

Rationale:

1. Incident reports are factual, objective documents not placed in the medical

record.

2. They are used for risk management and quality improvement.

3. Personal perceptions or opinions should not be included.

Geschreven voor

Instelling
NUR 209/ NUR209
Vak
NUR 209/ NUR209

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Aantal pagina's
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Geschreven in
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