NUR 1211
MEDICAL SURGICAL
FINAL EXAM
CONTAINS:
• NUR 1211 course-related exam and study material
• Nursing Fundamentals content
• NCLEX-style multiple-choice questions
• Correct answers clearly identified
• Rationales/explanations for answers
• Basic nursing concepts and terminology
• Patient safety and standard precautions
• Vital signs and basic nursing assessments
• Infection control principles
• Patient care and comfort measures
• Nursing roles, responsibilities, and scope of practice
• Communication and documentation basics
• Introduction to clinical judgment and prioritization
• Exam preparation material aligned with NUR 1211 objectives
,A 68-year-old male patient is admitted to the telemetry unit with a diagnosis of heart failure (HF). The
nurse notes the patient has bilateral pitting edema in the lower extremities, jugular venous
distention, and crackles auscultated in the bilateral lung bases. Which pathophysiological mechanism
is the primary cause of these symptoms?
A) Decreased cardiac output leading to fluid retention
B) Increased preload leading to vasodilation
C) Hypermetabolic state causing increased fluid demand
D) Increased contractility leading to emptying of the ventricles
Correct Answer: A) Decreased cardiac output leading to fluid retention
Explanation / Rationale:
In heart failure, the heart is unable to pump sufficient blood to meet the body's metabolic needs. This
reduced cardiac output triggers compensatory mechanisms, such as the renin-angiotensin-aldosterone
system (RAAS) and sympathetic nervous system activation. These mechanisms cause the kidneys to
retain sodium and water to increase blood volume and preload. However, because the failing heart
cannot effectively pump this increased volume, fluid backs up into the pulmonary circulation (causing
crackles) and systemic venous circulation (causing jugular venous distention and peripheral edema).
Options B and D describe hemodynamic changes that are not consistent with the backup of fluid seen
in HF. Option C is unrelated to the fluid overload mechanics of heart failure.
A nurse is caring for a patient who is 2 days post-operative following a total hip replacement. The
patient suddenly complains of chest pain and dyspnea. Upon assessment, the nurse notes
tachycardia, tachypnea, and hypoxia. Which diagnostic test is the gold standard for confirming the
nurse's suspected diagnosis of pulmonary embolism (PE)?
A) D-dimer assay
B) Computed Tomography Pulmonary Angiography (CTPA)
C) Ventilation-Perfusion (V/Q) scan
D) Chest X-ray
Correct Answer: B) Computed Tomography Pulmonary Angiography (CTPA)
,Explanation / Rationale:
CTPA is currently considered the gold standard for diagnosing pulmonary embolism because it
provides direct visualization of thrombi within the pulmonary arteries. While a D-dimer assay (Option
A) is sensitive for clot presence, it is not specific; elevated levels can occur in pregnancy, cancer,
trauma, or post-surgical states, leading to false positives. A V/Q scan (Option C) is typically used for
patients who cannot tolerate contrast dye or have renal insufficiency, but CTPA is generally preferred
for its accuracy and speed. A Chest X-ray (Option D) is often performed to rule out other pathologies
(like pneumothorax or pneumonia) but cannot diagnose a PE directly.
A patient with type 2 diabetes mellitus is admitted with a foot ulcer that extends down to the bone.
The nurse educates the patient on the importance of foot care. Which statement by the patient
indicates a need for further teaching?
A) "I will wash my feet daily with warm water and mild soap."
B) "I will apply heating pads to my feet to keep them warm at night."
C) "I will inspect my feet every day for any cuts or blisters."
D) "I will wear white socks so I can see if there is any drainage."
Correct Answer: B) "I will apply heating pads to my feet to keep them warm at night."
Explanation / Rationale:
Patients with diabetes often have diabetic neuropathy, which results in a loss of sensation,
particularly in the lower extremities. Because they cannot feel temperature changes accurately, the
use of heating pads, hot water bottles, or soaking feet in very hot water poses a significant risk for
thermal injury and burns. The patient should rely on socks for warmth. Options A, C, and D
demonstrate correct self-care practices for preventing infection and injury in diabetic patients.
Select-All-That-Apply: A nurse is preparing to administer a blood transfusion to a patient with a
hemoglobin level of 6.8 g/dL. Which of the following actions are essential before initiating the
transfusion? (Select all that apply.)
A) Verify the patient’s identity using two identifiers.
B) Ensure the patient has a patent IV site, preferably an 18-gauge or larger.
C) Prime the tubing with 0.9% Sodium Chloride (Normal Saline).
D) Premedicate the patient with diphenhydramine (Benadryl) regardless of allergy history.
, E) Check the expiration date on the blood bag and cross-match compatibility.
Correct Answer: A) Verify the patient’s identity using two identifiers.
B) Ensure the patient has a patent IV site, preferably an 18-gauge or larger.
C) Prime the tubing with 0.9% Sodium Chlorine (Normal Saline).
E) Check the expiration date on the blood bag and cross-match compatibility.
Explanation / Rationale:
Strict protocols must be followed to prevent transfusion reactions. Verification of two identifiers
(Option A) and checking the blood compatibility and expiration (Option E) are critical safety steps. An
18-gauge or larger IV (Option B) is preferred to prevent hemolysis of red blood cells caused by the
shear force of passing through a smaller lumen, although a 20-gauge may be acceptable in adults if
necessary. Normal Saline (Option C) is the only solution compatible with blood products; IV tubing
must be primed with it. Dextrose solutions (like D5W) cause hemolysis. Premedication (Option D) is
not routine; it is only ordered if the patient has a history of previous transfusion reactions or specific
allergies.
A patient with chronic obstructive pulmonary disease (COPD) is receiving supplemental oxygen via
nasal cannula at 2 L/min. The patient’s current ABG results are pH 7.35, PaCO2 55 mm Hg, PaO2 58
mm Hg, and HCO3- 32 mEq/L. The nurse is concerned about the patient’s oxygenation status. Which
action should the nurse take regarding the oxygen flow rate?
A) Increase the oxygen to 4 L/min immediately to correct hypoxemia.
B) Maintain the current oxygen level and notify the physician.
C) Switch the patient to a non-rebreather mask at 15 L/min.
D) Decrease the oxygen to 1 L/min to prevent respiratory depression.
Correct Answer: B) Maintain the current oxygen level and notify the physician.
Explanation / Rationale:
Patients with chronic COPD often retain CO2 (as seen by the PaCO2 of 55 mm Hg) and rely on hypoxic
drive to stimulate breathing. Their chemoreceptors are less sensitive to CO2. While the "hypoxic drive"
theory is nuanced, providing high concentrations of oxygen can indeed suppress the respiratory drive
in some chronic retainers, leading to further CO2 retention and respiratory acidosis. However, the goal
MEDICAL SURGICAL
FINAL EXAM
CONTAINS:
• NUR 1211 course-related exam and study material
• Nursing Fundamentals content
• NCLEX-style multiple-choice questions
• Correct answers clearly identified
• Rationales/explanations for answers
• Basic nursing concepts and terminology
• Patient safety and standard precautions
• Vital signs and basic nursing assessments
• Infection control principles
• Patient care and comfort measures
• Nursing roles, responsibilities, and scope of practice
• Communication and documentation basics
• Introduction to clinical judgment and prioritization
• Exam preparation material aligned with NUR 1211 objectives
,A 68-year-old male patient is admitted to the telemetry unit with a diagnosis of heart failure (HF). The
nurse notes the patient has bilateral pitting edema in the lower extremities, jugular venous
distention, and crackles auscultated in the bilateral lung bases. Which pathophysiological mechanism
is the primary cause of these symptoms?
A) Decreased cardiac output leading to fluid retention
B) Increased preload leading to vasodilation
C) Hypermetabolic state causing increased fluid demand
D) Increased contractility leading to emptying of the ventricles
Correct Answer: A) Decreased cardiac output leading to fluid retention
Explanation / Rationale:
In heart failure, the heart is unable to pump sufficient blood to meet the body's metabolic needs. This
reduced cardiac output triggers compensatory mechanisms, such as the renin-angiotensin-aldosterone
system (RAAS) and sympathetic nervous system activation. These mechanisms cause the kidneys to
retain sodium and water to increase blood volume and preload. However, because the failing heart
cannot effectively pump this increased volume, fluid backs up into the pulmonary circulation (causing
crackles) and systemic venous circulation (causing jugular venous distention and peripheral edema).
Options B and D describe hemodynamic changes that are not consistent with the backup of fluid seen
in HF. Option C is unrelated to the fluid overload mechanics of heart failure.
A nurse is caring for a patient who is 2 days post-operative following a total hip replacement. The
patient suddenly complains of chest pain and dyspnea. Upon assessment, the nurse notes
tachycardia, tachypnea, and hypoxia. Which diagnostic test is the gold standard for confirming the
nurse's suspected diagnosis of pulmonary embolism (PE)?
A) D-dimer assay
B) Computed Tomography Pulmonary Angiography (CTPA)
C) Ventilation-Perfusion (V/Q) scan
D) Chest X-ray
Correct Answer: B) Computed Tomography Pulmonary Angiography (CTPA)
,Explanation / Rationale:
CTPA is currently considered the gold standard for diagnosing pulmonary embolism because it
provides direct visualization of thrombi within the pulmonary arteries. While a D-dimer assay (Option
A) is sensitive for clot presence, it is not specific; elevated levels can occur in pregnancy, cancer,
trauma, or post-surgical states, leading to false positives. A V/Q scan (Option C) is typically used for
patients who cannot tolerate contrast dye or have renal insufficiency, but CTPA is generally preferred
for its accuracy and speed. A Chest X-ray (Option D) is often performed to rule out other pathologies
(like pneumothorax or pneumonia) but cannot diagnose a PE directly.
A patient with type 2 diabetes mellitus is admitted with a foot ulcer that extends down to the bone.
The nurse educates the patient on the importance of foot care. Which statement by the patient
indicates a need for further teaching?
A) "I will wash my feet daily with warm water and mild soap."
B) "I will apply heating pads to my feet to keep them warm at night."
C) "I will inspect my feet every day for any cuts or blisters."
D) "I will wear white socks so I can see if there is any drainage."
Correct Answer: B) "I will apply heating pads to my feet to keep them warm at night."
Explanation / Rationale:
Patients with diabetes often have diabetic neuropathy, which results in a loss of sensation,
particularly in the lower extremities. Because they cannot feel temperature changes accurately, the
use of heating pads, hot water bottles, or soaking feet in very hot water poses a significant risk for
thermal injury and burns. The patient should rely on socks for warmth. Options A, C, and D
demonstrate correct self-care practices for preventing infection and injury in diabetic patients.
Select-All-That-Apply: A nurse is preparing to administer a blood transfusion to a patient with a
hemoglobin level of 6.8 g/dL. Which of the following actions are essential before initiating the
transfusion? (Select all that apply.)
A) Verify the patient’s identity using two identifiers.
B) Ensure the patient has a patent IV site, preferably an 18-gauge or larger.
C) Prime the tubing with 0.9% Sodium Chloride (Normal Saline).
D) Premedicate the patient with diphenhydramine (Benadryl) regardless of allergy history.
, E) Check the expiration date on the blood bag and cross-match compatibility.
Correct Answer: A) Verify the patient’s identity using two identifiers.
B) Ensure the patient has a patent IV site, preferably an 18-gauge or larger.
C) Prime the tubing with 0.9% Sodium Chlorine (Normal Saline).
E) Check the expiration date on the blood bag and cross-match compatibility.
Explanation / Rationale:
Strict protocols must be followed to prevent transfusion reactions. Verification of two identifiers
(Option A) and checking the blood compatibility and expiration (Option E) are critical safety steps. An
18-gauge or larger IV (Option B) is preferred to prevent hemolysis of red blood cells caused by the
shear force of passing through a smaller lumen, although a 20-gauge may be acceptable in adults if
necessary. Normal Saline (Option C) is the only solution compatible with blood products; IV tubing
must be primed with it. Dextrose solutions (like D5W) cause hemolysis. Premedication (Option D) is
not routine; it is only ordered if the patient has a history of previous transfusion reactions or specific
allergies.
A patient with chronic obstructive pulmonary disease (COPD) is receiving supplemental oxygen via
nasal cannula at 2 L/min. The patient’s current ABG results are pH 7.35, PaCO2 55 mm Hg, PaO2 58
mm Hg, and HCO3- 32 mEq/L. The nurse is concerned about the patient’s oxygenation status. Which
action should the nurse take regarding the oxygen flow rate?
A) Increase the oxygen to 4 L/min immediately to correct hypoxemia.
B) Maintain the current oxygen level and notify the physician.
C) Switch the patient to a non-rebreather mask at 15 L/min.
D) Decrease the oxygen to 1 L/min to prevent respiratory depression.
Correct Answer: B) Maintain the current oxygen level and notify the physician.
Explanation / Rationale:
Patients with chronic COPD often retain CO2 (as seen by the PaCO2 of 55 mm Hg) and rely on hypoxic
drive to stimulate breathing. Their chemoreceptors are less sensitive to CO2. While the "hypoxic drive"
theory is nuanced, providing high concentrations of oxygen can indeed suppress the respiratory drive
in some chronic retainers, leading to further CO2 retention and respiratory acidosis. However, the goal
