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

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INSTANT PDF DOWNLOAD — This comprehensive test bank for NUR 209 Exam 1 Medical Surgical Nursing II at Fortis College covers all content for the 2026/2027 academic year first examination. It contains 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) PNEUMONIA Definition – Inflammation of the lung parenchyma (alveoli, interstitial spaces, bronchioles) caused by infectious agents (bacteria, viruses, fungi, parasites) or non-infectious causes (aspiration, chemical, radiation). Leading cause of death from infectious disease worldwide. Classification (by location of acquisition) – Community-acquired pneumonia (CAP): acquired outside healthcare facilities. Most common: Streptococcus pneumoniae (most common overall, 30-50% of cases), Haemophilus influenzae, Mycoplasma pneumoniae (atypical pneumonia – younger adults, gradual onset, dry cough, extrapulmonary symptoms, normal WBC, cold agglutinins positive), Chlamydia pneumoniae, Legionella pneumophila (Legionnaires' disease – contaminated water sources, high fever, GI symptoms, hyponatremia, CXR multilobar). Hospital-acquired pneumonia (HAP): acquired 48+ hours after hospital admission, not incubating at admission. Most common: Gram-negative bacilli (Pseudomonas aeruginosa, Klebsiella pneumoniae, E. coli, Acinetobacter), S. aureus (including MRSA). Multidrug-resistant organisms (MDRO) common. Ventilator-associated pneumonia (VAP): HAP occurring 48+ hours after endotracheal intubation; highest mortality rate. Healthcare-associated pneumonia (HCAP) : acquired in healthcare settings (nursing homes, hemodialysis, outpatient clinics, recent hospitalization within 90 days) – similar organisms to HAP. Risk Factors – Age 65, chronic lung disease (COPD, asthma, bronchiectasis, cystic fibrosis), smoking, immunosuppression (HIV, corticosteroids, chemotherapy, transplant recipients), dysphagia (aspiration risk), decreased level of consciousness (alcohol, drugs, sedation, neurologic disorders), malnutrition, recent hospitalization or institutionalization, mechanical ventilation. Assessment Findings – Fever (may be absent or low-grade in elderly, immunocompromised), chills, rigors, cough (productive or dry/dry), sputum production (purulent, green, yellow, rust-colored – pneumococcal, blood-tinged), pleuritic chest pain (worse with deep breathing, coughing – inflammation of parietal pleura), dyspnea, tachypnea, increased work of breathing, crackles (rales) on auscultation (over affected area), bronchial breath sounds (consolidation), egophony ("E-to-A" change – patient says "E", sounds like "A" over consolidated lung), whispered pectoriloquy (whispered words transmitted clearly), tactile fremitus increased (consolidation), dullness to percussion (consolidation or effusion). Atypical pneumonia (Mycoplasma, viruses): gradual onset, dry cough, extrapulmonary symptoms (headache, myalgias, malaise, sore throat, nausea, diarrhea), normal or low WBC, CXR interstitial pattern. Elderly/Immunocompromised Atypical Presentation – Confusion (altered mental status) may be primary or only manifestation (no fever, no cough, normal WBC). Increased falls, decreased appetite, generalized weakness, functional decline, tachypnea (often first sign – increased respiratory rate, subtle). Diagnostic Tests – Chest X-ray (confirms diagnosis, determines extent/location/pattern – lobar consolidation (typical – pneumococcus), interstitial/bilateral (atypical, viral). Not always necessary for mild outpatient CAP but recommended for all hospitalized patients. Sputum culture and Gram stain (before antibiotics), blood cultures (2 sets, before antibiotics), CBC (leukocytosis – elevated WBC, left shift; leukopenia in severe infection, immunocompromised), serum electrolytes, BUN/creatinine, liver function tests, CRP, procalcitonin (elevated in bacterial infection; low in viral; guides antibiotic duration), pulse oximetry/ABGs (hypoxia, hypercapnia in severe disease), urinary antigen tests (Legionella, pneumococcus), mycoplasma PCR, COVID-19, influenza PCR. Bronchoscopy with BAL (ventilator-associated pneumonia, non-resolving pneumonia, immunocompromised host). Severity Scores – CURB-65 (used to determine inpatient vs outpatient, ICU need): Confusion (new onset), Uremia (BUN 19 mg/dL), Respiratory rate ≥30 breaths/min, low Blood pressure (SBP 90 mmHg or DBP ≤60 mmHg), Age ≥65 years. Score 0-1: outpatient (low mortality); Score 2: inpatient (moderate mortality); Score 3-5: ICU admission (high mortality). Treatment (Antibiotic Selection) – Outpatient CAP (no comorbidities) : amoxicillin (first-line), doxycycline, macrolide (azithromycin, clarithromycin – but increasing resistance among S. pneumoniae, use only in low resistance areas). **Outpatient CAP (with comorbidities – COPD, DM, CKD, CHF, malignancy, asplenia, immunosuppression,

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Voorbeeld van de inhoud

1|Page




NUR209 Exam 1 Medical Surgical Nursing 2

Fortis 2026/2027 Comprehensive Test Bank

with Verified Answers and Rationales Grade A


1. What are the safety measures that nurses take?

Correct Answer: Make sure you have the correct patient check

wristband, name and DOB, and correct medical record, comfortable, and

check head of the bed 30 degrees, NG tube nose to esophagus feeding

thru tube.

Rationale:

1. Patient identification using wristband, name, and date of birth prevents

medication and procedure errors.

2. Checking the medical record ensures correct orders and history.

3. Head of bed at 30 degrees reduces aspiration risk, especially with NG tube

feeding.

4. Comfort measures promote patient safety by reducing agitation and falls.



2. What is the nurse's role for safety measures?

,2|Page


Correct Answer: Accidents are preventable, water spilling, confusion in

patients who do not leave alone, and assisting patients that cannot walk.

Use critical thinking skills as the nurse. If we see something as the nurse

we must say something. Speak up in unsafe environments because it can

prevent injuries. Between 5 and 7 minutes sees the physician in a 24

hour period. The nurse is responsible for physical assessment, eating,

drinking, fever, blood pressure, using the bathroom. 11 hours and 53

minutes and at night the full 12 hours. You have your senses and

equipment and your responsibility to notice changes in the patient's

status and watch their safety. Our job is to make sure that the patient

assigned to us is provided safe, correct, and proper care. Safety is the

number one goal.

Rationale:

1. Accident prevention requires identifying hazards like water spills and

assisting immobile patients.

2. Critical thinking and speaking up prevent errors and injuries.

3. Nurses assess physical status, intake/output, vital signs, and elimination.

4. Continuous surveillance over 12-hour shifts detects changes in patient

condition.

5. Safety is the priority goal of nursing care.

,3|Page




3. What are the safety considerations for older adults?

Fall prevention, understand what we are telling them, steadiness, older adult

physical comp decreases. Are they cognitive - something to put something

together to create something else. Home safety - throw rugs biggest injury

factor or rug runners those rugs that are not taken down can cause older

people to fall and have a hip injury. The artery in the hip can break the hollow

organ to empty its displaced fracture, can cause sepsis and can lead to death.

50 percent of people with a hip injury die in the first year. If you fracture the

femur bone marrow gets exposed cause fat globules when going back to the

inferior vena cava heart will have fat in it. As it goes into the lungs and causes

a pulmonary clot (Embolism) a fat clot. 50 percent of patients die from

pneumonia. Cannot move blood will not be flowing correct, heart will lower,

blood will pool and clot can go to lungs and cause pulmonary blood clot. The

vessels will get smaller and will kill the heart muscle. go to coronary arteries.

Correct Answer: Fall prevention, understand what we are telling them,

steadiness, older adult physical comp decreases. Are they cognitive -

something to put something together to create something else. Home

safety - throw rugs biggest injury factor or rug runners those rugs that

are not taken down can cause older people to fall and have a hip injury.

, 4|Page


The artery in the hip can break the hollow organ to empty its displaced

fracture, can cause sepsis and can lead to death. 50 percent of people

with a hip injury die in the first year. If you fracture the femur bone

marrow gets exposed cause fat globules when going back to the inferior

vena cava heart will have fat in it. As it goes into the lungs and causes a

pulmonary clot (Embolism) a fat clot. 50 percent of patients die from

pneumonia. Cannot move blood will not be flowing correct, heart will

lower, blood will pool and clot can go to lungs and cause pulmonary

blood clot. The vessels will get smaller and will kill the heart muscle. go

to coronary arteries.

Rationale:

1. Fall prevention is critical due to decreased physical function and cognitive

changes.

2. Throw rugs are a major home hazard causing hip fractures.

3. Hip fracture leads to fat embolism, sepsis, and 50% first-year mortality.

4. Immobility after fracture causes venous stasis, DVT, and pulmonary embolism.

5. Pneumonia causes 50% of deaths in hip fracture patients due to immobility.



4. What are safety issues related to radiation exposure?

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