1|Page
NUR209 Exam 4 Medical Surgical Nursing 2
2026/2027 Comprehensive Questions with
Verified Answers and Rationales Grade A
1. What is a collection of purulent fluid within the pleural space?
Correct Answer: Empyema
Rationale:
1. Empyema is pus in the pleural space, usually from bacterial pneumonia or
lung abscess.
2. Symptoms include fever, chills, chest pain, and nonproductive cough.
3. Chest tube drainage may be turbid or purulent.
4. Treatment requires antibiotics and chest tube drainage.
2. The nurse is caring for a client with an endotracheal tube who is
receiving mechanical ventilation. When assessing the client, the nurse
knows to maintain what cuff pressure to maintain appropriate pressure
on the tracheal wall?
Correct Answer: 20-25 mm Hg
,2|Page
Rationale:
1. Endotracheal tube cuff pressure should be maintained at 20-25 mm Hg.
2. This pressure seals the airway for positive pressure ventilation without
causing tracheal injury.
3. High pressure causes tracheal ischemia, necrosis, and stenosis.
4. Low pressure allows air leak and aspiration of secretions.
3. Which vitamin is usually administered with isoniazid (INH) to prevent
INH-associated peripheral neuropathy?
Correct Answer: Vitamin B6 (pyridoxine)
Rationale:
1. Isoniazid (INH) causes peripheral neuropathy by interfering with vitamin B6
metabolism.
2. Vitamin B6 supplementation prevents and treats INH-induced neuropathy.
3. Patients at highest risk include malnourished individuals, alcoholics, and
pregnant women.
4. What technique is used for tracheostomy care (clean or sterile)?
Correct Answer: Sterile
, 3|Page
Rationale:
1. Tracheostomy care requires sterile technique to prevent infection.
2. The trachea is a sterile environment; introducing pathogens causes
pneumonia.
3. Use sterile gloves, sterile supplies, and sterile water for cleaning the inner
cannula.
5. The nurse is caring for a client undergoing treatment for active
tuberculosis (TB) with isoniazid and rifampin. Which laboratory test is
most important for the nurse to monitor to detect potential adverse
effects of these medications?
Correct Answer: Liver function tests (LFTs)
Rationale:
1. Both isoniazid and rifampin are hepatotoxic medications.
2. Monitor AST, ALT, and bilirubin for signs of liver injury.
3. Patients should be taught signs of hepatitis (dark urine, jaundice, fatigue,
nausea).
6. A client with unresolved hemothorax is febrile, with chills and
sweating. The client has a nonproductive cough and chest pain. The
NUR209 Exam 4 Medical Surgical Nursing 2
2026/2027 Comprehensive Questions with
Verified Answers and Rationales Grade A
1. What is a collection of purulent fluid within the pleural space?
Correct Answer: Empyema
Rationale:
1. Empyema is pus in the pleural space, usually from bacterial pneumonia or
lung abscess.
2. Symptoms include fever, chills, chest pain, and nonproductive cough.
3. Chest tube drainage may be turbid or purulent.
4. Treatment requires antibiotics and chest tube drainage.
2. The nurse is caring for a client with an endotracheal tube who is
receiving mechanical ventilation. When assessing the client, the nurse
knows to maintain what cuff pressure to maintain appropriate pressure
on the tracheal wall?
Correct Answer: 20-25 mm Hg
,2|Page
Rationale:
1. Endotracheal tube cuff pressure should be maintained at 20-25 mm Hg.
2. This pressure seals the airway for positive pressure ventilation without
causing tracheal injury.
3. High pressure causes tracheal ischemia, necrosis, and stenosis.
4. Low pressure allows air leak and aspiration of secretions.
3. Which vitamin is usually administered with isoniazid (INH) to prevent
INH-associated peripheral neuropathy?
Correct Answer: Vitamin B6 (pyridoxine)
Rationale:
1. Isoniazid (INH) causes peripheral neuropathy by interfering with vitamin B6
metabolism.
2. Vitamin B6 supplementation prevents and treats INH-induced neuropathy.
3. Patients at highest risk include malnourished individuals, alcoholics, and
pregnant women.
4. What technique is used for tracheostomy care (clean or sterile)?
Correct Answer: Sterile
, 3|Page
Rationale:
1. Tracheostomy care requires sterile technique to prevent infection.
2. The trachea is a sterile environment; introducing pathogens causes
pneumonia.
3. Use sterile gloves, sterile supplies, and sterile water for cleaning the inner
cannula.
5. The nurse is caring for a client undergoing treatment for active
tuberculosis (TB) with isoniazid and rifampin. Which laboratory test is
most important for the nurse to monitor to detect potential adverse
effects of these medications?
Correct Answer: Liver function tests (LFTs)
Rationale:
1. Both isoniazid and rifampin are hepatotoxic medications.
2. Monitor AST, ALT, and bilirubin for signs of liver injury.
3. Patients should be taught signs of hepatitis (dark urine, jaundice, fatigue,
nausea).
6. A client with unresolved hemothorax is febrile, with chills and
sweating. The client has a nonproductive cough and chest pain. The
