NSG 233 Med Surge 3 Final Exam 2026|2027
Questions with Detailed Verified Answers (100%
Correct Answers) | Already Graded A+
SCI- intermediate intervention - Answer -The immediate management at the scene of the injury
is critical because improper handling of the patient can cause further damage and loss of
neurologic function. Any patient who is involved in a motor vehicle crash, a diving or contact
sports injury, a fall, or any direct trauma to the head and neck must be considered to have SCI
until such an injury is ruled out. Initial care must include a rapid assessment, immobilization,
extrication, and stabilization or control of life-threatening injuries, and transportation to the
most appropriate medical facility. Immediate transportation to a trauma center with the
capacity to manage major neurologic trauma is then necessary.
At the scene of the injury, the patient must be immobilized on a spinal (back) board, with the
head and neck maintained in a neutral position, to prevent an incomplete injury from becoming
complete. One member of the team must assume control of the patient's head to prevent
flexion, rotation, or extension; this is done by placing the hands on both sides of the patient's
head at about ear level to limit movement and maintain alignment while a spinal board and
cervical immobilizing device is applied. If possible, at least four people should slide the patient
carefully onto a board for transfer to the hospital. Head blocks should also be considered, as
they will further limit any neck movement. Any twisting movement may irreversibly damage the
spinal cord by causing bony fragment or disc movement or exacerbating ligamentous injury,
causing further instability. The patient is referred to a regional spinal injury or trauma center
because of the multidisciplinary personnel and support services required to counteract the
destructive changes that occur in the first 24 hours after injury.
Traumatic Brain Injury- ICP - Answer -There is ongoing controversy about the use of
hyperventilation therapy in traumatic brain injury. This therapy is used in some circumstances to
reduce ICP by causing cerebral vasoconstriction and a decrease in cerebral blood volume. The
nurse collaborates with the respiratory therapist in monitoring the PaCO2, which is usually
maintained at less than 30 mm Hg. Employing hyperventilation should follow guidelines for
management of TBI as it involves risk of cerebral vasoconstriction and ischemia. Patients
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,undergoing hyperventilation therapy also benefit from multimodality monitoring to determine
the overall effect of this therapy on brain perfusion.
Automatic Dysreflexia S&S - Answer -This syndrome is characterized by a severe, pounding
headache with paroxysmal hypertension, profuse diaphoresis above the spinal level of the
lesion (most often of the forehead), nausea, nasal congestion, and bradycardia. It occurs among
patients with cord lesions above T6 (the sympathetic visceral outflow level) after spinal shock
has subsided.
SCI Assess - Answer -The patient's breathing pattern and the strength of the cough are assessed
and the lungs are auscultated, because paralysis of the diaphragm, in addition to abdominal and
respiratory muscles, diminishes coughing and makes clearing of bronchial and pharyngeal
secretions difficult. Reduced excursion of the chest also results.
The patient is monitored closely for any changes in motor or sensory function and for symptoms
of progressive neurologic damage. In the early stages of SCI, determining whether the cord has
been severed may not be possible, because signs and symptoms of cord edema are
indistinguishable from those of cord transection. Edema of the spinal cord may occur with any
severe cord injury and may further compromise spinal cord function.
Motor and sensory functions are assessed through careful neurologic examination. These
findings are recorded on a flow sheet so that changes in the baseline neurologic status can be
monitored closely and accurately. The ASIA classification is commonly used to describe the level
of function for patients with SCI. The patient is also assessed for spinal shock, which is a
complete loss of all reflex, motor, sensory, and autonomic activity below the level of the lesion
that causes bladder paralysis and distention. The lower abdomen is palpated for signs of urinary
retention and overdistention of the bladder. Further assessment is made for gastric dilation and
paralytic ileus caused by an atonic bowel, a result of autonomic disruption.
Temperature is monitored because the patient may have periods of hyperthermia as a result of
altered temperature control, which is due to the inability to perspire related to autonomic
disruption.
2|Page
, DIC - Answer -Disseminated intravascular coagulation (DIC) is not an actual disease but a sign of
an underlying condition. DIC may be triggered by sepsis, trauma, cancer, shock, abruptio
placentae, toxins, allergic reactions, and other conditions; the vast majority (two-thirds) of cases
of DIC are initiated by an infection or a malignancy. Patients with frank DIC may bleed from
mucous membranes, venipuncture sites, and the GI and urinary tracts. The bleeding can range
from minimal occult internal bleeding to profuse hemorrhage from all orifices. Patients typically
develop MODS, and they may exhibit acute kidney injury as well as pulmonary and multifocal
central nervous system infarctions as a result of microthromboses, macrothromboses, or
hemorrhages. Clinically, the diagnosis of DIC is often established by laboratory tests that reflect
consumption of platelets and clotting factors (i.e., drop in platelet count, an elevation in fibrin
degradation products and D-dimer, an increase in PT and aPTT, and a low fibrinogen level)
Cardiac Tamponade PEA - Answer -Pulseless electrical activity (PEA) refers to cardiac arrest in
which the electrocardiogram shows a heart rhythm that should produce a pulse, but does not.
Pulseless electrical activity is found initially in about 55% of people in cardiac arrest. Common
causes of PEA are cardiac tamponade, dynamic lung hyperinflation, tension pneumothorax, and
coronary artery graft occlusion or dehiscence. Severe hypovolemia due to blood loss (e.g., into
the chest) may also manifest as PEA
Pneumothorax Action - Answer -Pneumothorax may occur after thoracic surgery if there is an
air leak from the surgical site to the pleural cavity or from the pleural cavity to the environment.
Failure of the chest drainage system prevents return of negative pressure in the pleural cavity
and results in pneumothorax. In the postoperative patient, pneumothorax is often accompanied
by hemothorax. The nurse maintains the chest drainage system and monitors the patient for
signs and symptoms of pneumothorax: increasing shortness of breath, tachycardia, increased
respiratory rate, and increasing respiratory distress
Pneumonectomy Chest Tube - Answer -After a pneumonectomy, the operated side should be
dependent so that fluid in the pleural space remains below the level of the bronchial stump and
the other lung can fully expand
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Questions with Detailed Verified Answers (100%
Correct Answers) | Already Graded A+
SCI- intermediate intervention - Answer -The immediate management at the scene of the injury
is critical because improper handling of the patient can cause further damage and loss of
neurologic function. Any patient who is involved in a motor vehicle crash, a diving or contact
sports injury, a fall, or any direct trauma to the head and neck must be considered to have SCI
until such an injury is ruled out. Initial care must include a rapid assessment, immobilization,
extrication, and stabilization or control of life-threatening injuries, and transportation to the
most appropriate medical facility. Immediate transportation to a trauma center with the
capacity to manage major neurologic trauma is then necessary.
At the scene of the injury, the patient must be immobilized on a spinal (back) board, with the
head and neck maintained in a neutral position, to prevent an incomplete injury from becoming
complete. One member of the team must assume control of the patient's head to prevent
flexion, rotation, or extension; this is done by placing the hands on both sides of the patient's
head at about ear level to limit movement and maintain alignment while a spinal board and
cervical immobilizing device is applied. If possible, at least four people should slide the patient
carefully onto a board for transfer to the hospital. Head blocks should also be considered, as
they will further limit any neck movement. Any twisting movement may irreversibly damage the
spinal cord by causing bony fragment or disc movement or exacerbating ligamentous injury,
causing further instability. The patient is referred to a regional spinal injury or trauma center
because of the multidisciplinary personnel and support services required to counteract the
destructive changes that occur in the first 24 hours after injury.
Traumatic Brain Injury- ICP - Answer -There is ongoing controversy about the use of
hyperventilation therapy in traumatic brain injury. This therapy is used in some circumstances to
reduce ICP by causing cerebral vasoconstriction and a decrease in cerebral blood volume. The
nurse collaborates with the respiratory therapist in monitoring the PaCO2, which is usually
maintained at less than 30 mm Hg. Employing hyperventilation should follow guidelines for
management of TBI as it involves risk of cerebral vasoconstriction and ischemia. Patients
1|Page
,undergoing hyperventilation therapy also benefit from multimodality monitoring to determine
the overall effect of this therapy on brain perfusion.
Automatic Dysreflexia S&S - Answer -This syndrome is characterized by a severe, pounding
headache with paroxysmal hypertension, profuse diaphoresis above the spinal level of the
lesion (most often of the forehead), nausea, nasal congestion, and bradycardia. It occurs among
patients with cord lesions above T6 (the sympathetic visceral outflow level) after spinal shock
has subsided.
SCI Assess - Answer -The patient's breathing pattern and the strength of the cough are assessed
and the lungs are auscultated, because paralysis of the diaphragm, in addition to abdominal and
respiratory muscles, diminishes coughing and makes clearing of bronchial and pharyngeal
secretions difficult. Reduced excursion of the chest also results.
The patient is monitored closely for any changes in motor or sensory function and for symptoms
of progressive neurologic damage. In the early stages of SCI, determining whether the cord has
been severed may not be possible, because signs and symptoms of cord edema are
indistinguishable from those of cord transection. Edema of the spinal cord may occur with any
severe cord injury and may further compromise spinal cord function.
Motor and sensory functions are assessed through careful neurologic examination. These
findings are recorded on a flow sheet so that changes in the baseline neurologic status can be
monitored closely and accurately. The ASIA classification is commonly used to describe the level
of function for patients with SCI. The patient is also assessed for spinal shock, which is a
complete loss of all reflex, motor, sensory, and autonomic activity below the level of the lesion
that causes bladder paralysis and distention. The lower abdomen is palpated for signs of urinary
retention and overdistention of the bladder. Further assessment is made for gastric dilation and
paralytic ileus caused by an atonic bowel, a result of autonomic disruption.
Temperature is monitored because the patient may have periods of hyperthermia as a result of
altered temperature control, which is due to the inability to perspire related to autonomic
disruption.
2|Page
, DIC - Answer -Disseminated intravascular coagulation (DIC) is not an actual disease but a sign of
an underlying condition. DIC may be triggered by sepsis, trauma, cancer, shock, abruptio
placentae, toxins, allergic reactions, and other conditions; the vast majority (two-thirds) of cases
of DIC are initiated by an infection or a malignancy. Patients with frank DIC may bleed from
mucous membranes, venipuncture sites, and the GI and urinary tracts. The bleeding can range
from minimal occult internal bleeding to profuse hemorrhage from all orifices. Patients typically
develop MODS, and they may exhibit acute kidney injury as well as pulmonary and multifocal
central nervous system infarctions as a result of microthromboses, macrothromboses, or
hemorrhages. Clinically, the diagnosis of DIC is often established by laboratory tests that reflect
consumption of platelets and clotting factors (i.e., drop in platelet count, an elevation in fibrin
degradation products and D-dimer, an increase in PT and aPTT, and a low fibrinogen level)
Cardiac Tamponade PEA - Answer -Pulseless electrical activity (PEA) refers to cardiac arrest in
which the electrocardiogram shows a heart rhythm that should produce a pulse, but does not.
Pulseless electrical activity is found initially in about 55% of people in cardiac arrest. Common
causes of PEA are cardiac tamponade, dynamic lung hyperinflation, tension pneumothorax, and
coronary artery graft occlusion or dehiscence. Severe hypovolemia due to blood loss (e.g., into
the chest) may also manifest as PEA
Pneumothorax Action - Answer -Pneumothorax may occur after thoracic surgery if there is an
air leak from the surgical site to the pleural cavity or from the pleural cavity to the environment.
Failure of the chest drainage system prevents return of negative pressure in the pleural cavity
and results in pneumothorax. In the postoperative patient, pneumothorax is often accompanied
by hemothorax. The nurse maintains the chest drainage system and monitors the patient for
signs and symptoms of pneumothorax: increasing shortness of breath, tachycardia, increased
respiratory rate, and increasing respiratory distress
Pneumonectomy Chest Tube - Answer -After a pneumonectomy, the operated side should be
dependent so that fluid in the pleural space remains below the level of the bronchial stump and
the other lung can fully expand
3|Page
