HERZING UNIVERSITY NSG 223 MED SURG II
EXAM 1 NEWEST 2025 2026 COMPLETE
QUESTIONS AND CORRECT ANSWERS
NSG 223 MED SURG II – EXAM 1
100 QUESTIONS WITH RATIONALES & NURSING TAKEAWAYS
QUESTION 1 (Scenario – Perioperative Nausea)
A patient in PACU reports nausea and vomits 200 mL of greenish fluid after
laparoscopic cholecystectomy. The patient has a history of PONV. Which
medication does the nurse anticipate administering first?
A) Metoclopramide 10 mg IV
B) Ondansetron 4 mg IV
C) Promethazine 12.5 mg IM
D) Scopolamine patch
Correct Answer: B
Rationale: Ondansetron (Zofran) is first-line for PONV due to efficacy and
minimal side effects. Metoclopramide can cause extrapyramidal symptoms.
Promethazine is more sedating. Scopolamine patch is used for prophylaxis, not
acute treatment.
P a g e 1 | 47
,Nursing Takeaway: For active PONV, give IV ondansetron; for prevention,
consider multimodal (dexamethasone, scopolamine, propofol anesthesia).
QUESTION 2 (Fluids & Electrolytes – Hypertonic
Hyponatremia)
A patient with hyperglycemia (glucose 600 mg/dL) has a serum sodium of
128 mEq/L. After correcting for glucose, what is the true sodium level?
(Formula: add 1.6 mEq/L for every 100 mg/dL glucose above 100)
A) 128 mEq/L
B) 132 mEq/L
C) 136 mEq/L
D) 140 mEq/L
Correct Answer: C
Rationale: Correction: glucose above 100 = 500. 500/100 = 5. 5 × 1.6 = 8. 128
+ 8 = 136 mEq/L. This indicates pseudohyponatremia from hyperglycemia
drawing water into the vascular space. True sodium is normal.
Nursing Takeaway: Always correct sodium for glucose in hyperglycemic
patients. Treatment is insulin and fluids, not hypertonic saline.
QUESTION 3 (Endocrine – DKA Fluid Management)
A patient with DKA has received 2L of 0.9% NS over 2 hours. Current
glucose is 450 mg/dL (down from 800). The nurse notes crackles in lung
bases. What is the priority action?
A) Decrease the IV fluid rate.
B) Switch to 0.45% NS.
C) Administer furosemide.
D) Continue same rate.
Correct Answer: A
Rationale: Crackles indicate possible fluid overload, especially in elderly or
those with heart failure. Reduce the infusion rate. Switching to hypotonic fluid
(B) may worsen overload. Furosemide (C) may be ordered but not first without
provider order.
Nursing Takeaway: Monitor for fluid overload in DKA, especially with high-
volume resuscitation. Adjust rate based on hemodynamics and lung sounds.
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,QUESTION 4 (Perioperative – DVT Risk Factor)
Which patient has the highest risk for postoperative deep vein thrombosis?
A) 25-year-old marathon runner undergoing ACL repair.
B) 45-year-old with BMI 32, undergoing bariatric surgery.
C) 60-year-old with atrial fibrillation on warfarin, undergoing cataract surgery.
D) 70-year-old with history of PE, undergoing hip fracture repair.
Correct Answer: D
Rationale: Highest risk: prior VTE + major orthopedic surgery + age >60. Hip
fracture repair is high-risk. Bariatric surgery (B) is moderate risk but no prior VTE.
Cataract surgery (C) is low risk.
Nursing Takeaway: Caprini score >5 = high risk. Prophylaxis: anticoagulation +
mechanical devices unless contraindicated.
QUESTION 5 (Immunology – SLE Flare Trigger)
A patient with SLE reports increased fatigue, joint pain, and a new rash.
Which question by the nurse is most relevant to identify a trigger?
A) "Have you been exposed to anyone with a cold?"
B) "Have you spent time in the sun without sunscreen?"
C) "Have you eaten any shellfish recently?"
D) "Have you changed your birth control pill?"
Correct Answer: B
Rationale: UV light (sun exposure) is a major trigger for SLE flares, especially
cutaneous and systemic. Infection (A) is another trigger but less direct. Shellfish
(C) not typical. Estrogen (D) can affect SLE but change in OCP is less common as
acute trigger.
Nursing Takeaway: Teach SLE patients to avoid sun, use SPF 50+, wear
protective clothing.
QUESTION 6 (Fluids & Electrolytes – Hypocalcemia Post-
Thyroidectomy)
P a g e 3 | 47
, A patient post-thyroidectomy develops paresthesias and muscle twitching.
The nurse taps the facial nerve and observes twitching of the corner of the
mouth. Which action is most appropriate?
A) Administer IV calcium gluconate as ordered.
B) Reassure the patient that this is expected.
C) Apply a warm compress to the face.
D) Check a blood glucose level.
Correct Answer: A
Rationale: Chvostek’s sign indicates hypocalcemia from accidental parathyroid
injury. IV calcium gluconate is the treatment. Do not reassure – this is a
complication. Warm compress (C) is useless. Glucose (D) is not indicated.
Nursing Takeaway: Post-thyroidectomy: monitor for hypocalcemia (tingling,
Chvostek’s, Trousseau’s). Keep IV calcium at bedside.
QUESTION 7 (Endocrine – Thyroid Storm vs. Sepsis)
A patient with Graves’ disease has fever, tachycardia, and confusion. Lab:
WBC 12,000, free T4 5.0 (high), TSH <0.01. The nurse suspects thyroid
storm. Which additional finding supports thyroid storm over sepsis?
A) Hypotension
B) Elevated procalcitonin
C) Absence of an infectious source
D) Hyperglycemia
Correct Answer: C
Rationale: Thyroid storm is a diagnosis of exclusion after ruling out infection.
Absence of an infectious source supports storm. Procalcitonin (B) is elevated in
bacterial infection. Hypotension (A) and hyperglycemia (D) can occur in both.
Nursing Takeaway: Treat both empirically (antithyroid drugs + antibiotics) until
cultures rule out infection.
QUESTION 8 (Perioperative – Malignant Hyperthermia
Prevention)
Which preoperative assessment is most critical to identify a patient at risk
for malignant hyperthermia?
A) History of previous anesthesia with no complications.
B) Family history of unexplained death during anesthesia or high fever post-op.
P a g e 4 | 47
EXAM 1 NEWEST 2025 2026 COMPLETE
QUESTIONS AND CORRECT ANSWERS
NSG 223 MED SURG II – EXAM 1
100 QUESTIONS WITH RATIONALES & NURSING TAKEAWAYS
QUESTION 1 (Scenario – Perioperative Nausea)
A patient in PACU reports nausea and vomits 200 mL of greenish fluid after
laparoscopic cholecystectomy. The patient has a history of PONV. Which
medication does the nurse anticipate administering first?
A) Metoclopramide 10 mg IV
B) Ondansetron 4 mg IV
C) Promethazine 12.5 mg IM
D) Scopolamine patch
Correct Answer: B
Rationale: Ondansetron (Zofran) is first-line for PONV due to efficacy and
minimal side effects. Metoclopramide can cause extrapyramidal symptoms.
Promethazine is more sedating. Scopolamine patch is used for prophylaxis, not
acute treatment.
P a g e 1 | 47
,Nursing Takeaway: For active PONV, give IV ondansetron; for prevention,
consider multimodal (dexamethasone, scopolamine, propofol anesthesia).
QUESTION 2 (Fluids & Electrolytes – Hypertonic
Hyponatremia)
A patient with hyperglycemia (glucose 600 mg/dL) has a serum sodium of
128 mEq/L. After correcting for glucose, what is the true sodium level?
(Formula: add 1.6 mEq/L for every 100 mg/dL glucose above 100)
A) 128 mEq/L
B) 132 mEq/L
C) 136 mEq/L
D) 140 mEq/L
Correct Answer: C
Rationale: Correction: glucose above 100 = 500. 500/100 = 5. 5 × 1.6 = 8. 128
+ 8 = 136 mEq/L. This indicates pseudohyponatremia from hyperglycemia
drawing water into the vascular space. True sodium is normal.
Nursing Takeaway: Always correct sodium for glucose in hyperglycemic
patients. Treatment is insulin and fluids, not hypertonic saline.
QUESTION 3 (Endocrine – DKA Fluid Management)
A patient with DKA has received 2L of 0.9% NS over 2 hours. Current
glucose is 450 mg/dL (down from 800). The nurse notes crackles in lung
bases. What is the priority action?
A) Decrease the IV fluid rate.
B) Switch to 0.45% NS.
C) Administer furosemide.
D) Continue same rate.
Correct Answer: A
Rationale: Crackles indicate possible fluid overload, especially in elderly or
those with heart failure. Reduce the infusion rate. Switching to hypotonic fluid
(B) may worsen overload. Furosemide (C) may be ordered but not first without
provider order.
Nursing Takeaway: Monitor for fluid overload in DKA, especially with high-
volume resuscitation. Adjust rate based on hemodynamics and lung sounds.
P a g e 2 | 47
,QUESTION 4 (Perioperative – DVT Risk Factor)
Which patient has the highest risk for postoperative deep vein thrombosis?
A) 25-year-old marathon runner undergoing ACL repair.
B) 45-year-old with BMI 32, undergoing bariatric surgery.
C) 60-year-old with atrial fibrillation on warfarin, undergoing cataract surgery.
D) 70-year-old with history of PE, undergoing hip fracture repair.
Correct Answer: D
Rationale: Highest risk: prior VTE + major orthopedic surgery + age >60. Hip
fracture repair is high-risk. Bariatric surgery (B) is moderate risk but no prior VTE.
Cataract surgery (C) is low risk.
Nursing Takeaway: Caprini score >5 = high risk. Prophylaxis: anticoagulation +
mechanical devices unless contraindicated.
QUESTION 5 (Immunology – SLE Flare Trigger)
A patient with SLE reports increased fatigue, joint pain, and a new rash.
Which question by the nurse is most relevant to identify a trigger?
A) "Have you been exposed to anyone with a cold?"
B) "Have you spent time in the sun without sunscreen?"
C) "Have you eaten any shellfish recently?"
D) "Have you changed your birth control pill?"
Correct Answer: B
Rationale: UV light (sun exposure) is a major trigger for SLE flares, especially
cutaneous and systemic. Infection (A) is another trigger but less direct. Shellfish
(C) not typical. Estrogen (D) can affect SLE but change in OCP is less common as
acute trigger.
Nursing Takeaway: Teach SLE patients to avoid sun, use SPF 50+, wear
protective clothing.
QUESTION 6 (Fluids & Electrolytes – Hypocalcemia Post-
Thyroidectomy)
P a g e 3 | 47
, A patient post-thyroidectomy develops paresthesias and muscle twitching.
The nurse taps the facial nerve and observes twitching of the corner of the
mouth. Which action is most appropriate?
A) Administer IV calcium gluconate as ordered.
B) Reassure the patient that this is expected.
C) Apply a warm compress to the face.
D) Check a blood glucose level.
Correct Answer: A
Rationale: Chvostek’s sign indicates hypocalcemia from accidental parathyroid
injury. IV calcium gluconate is the treatment. Do not reassure – this is a
complication. Warm compress (C) is useless. Glucose (D) is not indicated.
Nursing Takeaway: Post-thyroidectomy: monitor for hypocalcemia (tingling,
Chvostek’s, Trousseau’s). Keep IV calcium at bedside.
QUESTION 7 (Endocrine – Thyroid Storm vs. Sepsis)
A patient with Graves’ disease has fever, tachycardia, and confusion. Lab:
WBC 12,000, free T4 5.0 (high), TSH <0.01. The nurse suspects thyroid
storm. Which additional finding supports thyroid storm over sepsis?
A) Hypotension
B) Elevated procalcitonin
C) Absence of an infectious source
D) Hyperglycemia
Correct Answer: C
Rationale: Thyroid storm is a diagnosis of exclusion after ruling out infection.
Absence of an infectious source supports storm. Procalcitonin (B) is elevated in
bacterial infection. Hypotension (A) and hyperglycemia (D) can occur in both.
Nursing Takeaway: Treat both empirically (antithyroid drugs + antibiotics) until
cultures rule out infection.
QUESTION 8 (Perioperative – Malignant Hyperthermia
Prevention)
Which preoperative assessment is most critical to identify a patient at risk
for malignant hyperthermia?
A) History of previous anesthesia with no complications.
B) Family history of unexplained death during anesthesia or high fever post-op.
P a g e 4 | 47
