Med surge 2 exam 2 Herzing university test bank
EXAM QUESTIONS AND ANSWERS WITH
RATIONALE
HERZING UNIVERSITY 2025
A client with Clostridioides difficile is receiving evaluation following several days of frequent
loose stools. Which of the following assessments will be most important in determining the
need for further IV hydration?
Postural vital sign measurement
Rationale :Postural vital sign measurements include the pulse and blood pressure readings
before and after position changes. When fluid levels are insufficient, the pulse increases and
the blood pressure will decrease when moving from a laying to sitting or sitting to standing
position. This information is often used to determine hydration status. Stool analysis,
pupillary response, and medication reconciliation would not provide information needed to
determine the need for IV hydration.
A patient who has taken pantoprazole for several years reports six or more incidents of foul-
smelling watery diarrhea over the last 3 days. Which of the following statements best
describes the likely cause of the patient's symptoms?
Normal stomach acidity has been altered, which changed the environment of normal flora
bacteria.
Rationale: Signs and symptoms indicate Clostridioides difficile (C. difficile) diarrhea. Changes
in acidity in the stomach change the environment of normal flora bacteria, which can lead to
opportunistic infections such as C. difficile. Proton pump inhibitors do not change the
gastrointestinal lining or immune system or cause bacterial mutations.
,A patient is placed on pantoprazole for the treatment of PUD. Which of the following
information should be included when providing patient education on this drug? (Select all that
apply.)
Eat several small meals during the day rather than three large meals.,
This medication should not be taken long-term without consulting with the provider.
Rationale: Eating several small meals will help prevent gastrointestinal adverse effects.
Proton pump inhibitors are indicated for short-term treatment and may cause significant
adverse effects if used long-term. The medication should be swallowed whole without
chewing. Ginkgo biloba reduces the effect of pantoprazole. Magnesium and calcium levels
should be monitored while taking the drug.
A client has been diagnosed with peptic ulcer disease (PUD). Which of the following factors
place(s) this client at a higher risk for developing this condition? (Select all that apply.)
Cigarette smoking,
High levels of stress, Family history
Rationale:Peptic ulcer disease is genetic. Risk factors include cigarette smoking, age, high
stress, use of certain medications, exposure to irritants, and family history. Type A blood is a
risk factor for gastric ulcers, and type O blood is a risk factor for duodenal ulcers. There is no
known link between type B blood and peptic ulcer disease. Gastric or duodenal mucosal
defects, not esophageal defects, will increase the risk of PUD.
A patient with PUD wants to know if taking probiotics will improve the condition. Which of the
following statements is correct regarding probiotics?
Probiotics are helpful in replacing healthy bacteria in the digestive tract.
Rationale:Probiotics are considered 'good bacteria.' Probiotics may be helpful in replacing
healthy bacteria in the gut and decreasing negative side effects of antibiotics or the
symptoms associated with PUD. Probiotics are available over the counter as dietary
supplements, so they are not regulated by the Food and Drug Administration (FDA).
Probiotics are found naturally in the gastrointestinal tract.
A patient reports severe epigastric pain after eating. Test results show the presence of
Helicobacter pylori (H. pylori). Which of the following data are most important for the nurse to
obtain based on this information? (Select all that apply.)
Comprehensive pain assessment,
,Abdominal assessment
Rationale:Presence of epigastric pain and positive H. pylori are indicators of PUD.
Assessment for PUD will include a comprehensive pain assessment and abdominal
assessment. The location, duration, and type of pain will help differentiate duodenal from
gastric ulcers. The abdominal assessment will provide further information regarding location
of pain, presence of guarding or rebound tenderness, and frequency/quality of bowel
sounds. The cardiopulmonary assessment and recent travel data will not provide additional
assessment information related to PUD.
Which of the following complications of peptic ulcers is associated with the presence of H.
pylori?
Carcinoma
Rationale:Increased risk of gastric adenocarcinoma in patients with peptic ulcer disease is
associated with the presence of H. pylori. The other answer choices are not typical
complications associated with the presence of H. pylori.
Which of the following drugs may be included in triple (combination) therapy for patients with
peptic ulcers caused by H. pylori? (Select all that apply.)
Amoxicillin,
Clarithromycin
Rationale:Triple therapy to treat H. pylori consists of a proton pump inhibitor with two
antibiotics. A proton pump inhibitor, such as omeprazole, esomeprazole, lansoprazole,
dexlansoprazole, or rabeprazole, is used with the combination of clarithromycin and
amoxicillin or clarithromycin and metronidazole hydrochloride. Indomethacin is a
nonsteroidal anti-inflammatory medication. It is not used in triple therapy for patients with
peptic ulcers caused by H. pylori. Bismuth subsalicylate and tetracycline are options included
when quadruple therapy is initiated.
A patient with a history of vomiting and diarrhea is admitted to the hospital and is exhibiting
signs of weakness and confusion. Assessment reveals hypotension, tachycardia, and poor skin
turgor. Which of the following equipment should the nurse gather first based on the patient's
signs and symptoms?
Intravenous tubing
Rationale:The patient is exhibiting signs and symptoms of dehydration. Treatment may
include administration of intravenous fluids. The patient is vomiting and there is no
, indication of malnutrition, so insertion of tube feeding is not a priority. Signs and symptoms
do not indicate the need for tracheostomy tube or skin traction setup.
A client has a history of diabetes mellitus. After assessing the client, the primary healthcare
provider confirms damage to the sensory limb of the bladder spinal reflex arc. Which clinical
manifestations could confirm this condition?
1. Incomplete voiding
2. Overdistention of bladder
3. Lack of control on micturition
4. Infrequent voiding of large residual volumes
4. Infrequent voiding of large residual volumes
Damage to the sensory limb of the bladder spinal reflex arc is a type of sensory neurogenic
bladder where the client lacks the sensation of needing to urinate. This is usually seen in
clients with multiple sclerosis and diabetes mellitus. Its clinical manifestation is infrequent
voiding of large residual volumes. Incomplete voiding is a symptom of reflexic neurogenic
bladder. Overdistention of the bladder and lack of control on micturition are the symptoms
of areflexic neurogenic bladder.
What are the reasons for performing a lumbar puncture on a client? Select all that apply.
1.Confirming spinal cord injuries
2. Assessing sensory nerve problems
3. Measuring blood flow in many areas
4. Reading cerebrospinal fluid pressure
5. Injecting contrast medium for diagnostic study
4. Reading cerebrospinal fluid pressure
5. Injecting contrast medium for diagnostic study
A lumbar puncture is the insertion of a spinal needle into the subarachnoid space between
the third and fourth lumbar vertebrae; it can be used to obtain cerebrospinal fluid readings
with a manometer. Using a lumbar puncture, contrast medium or air is injected for
diagnostic study. Evoked potentials measure the electrical signals to the brain generated by
sound, light, or touch, and are used to confirm neurologic conditions like spinal cord injuries
and multiple sclerosis. Evoked potentials are also used to assess sensory nerve problems.
Cerebral blood flow evaluation is used to measure blood flow in many areas using
radioactive substances.
EXAM QUESTIONS AND ANSWERS WITH
RATIONALE
HERZING UNIVERSITY 2025
A client with Clostridioides difficile is receiving evaluation following several days of frequent
loose stools. Which of the following assessments will be most important in determining the
need for further IV hydration?
Postural vital sign measurement
Rationale :Postural vital sign measurements include the pulse and blood pressure readings
before and after position changes. When fluid levels are insufficient, the pulse increases and
the blood pressure will decrease when moving from a laying to sitting or sitting to standing
position. This information is often used to determine hydration status. Stool analysis,
pupillary response, and medication reconciliation would not provide information needed to
determine the need for IV hydration.
A patient who has taken pantoprazole for several years reports six or more incidents of foul-
smelling watery diarrhea over the last 3 days. Which of the following statements best
describes the likely cause of the patient's symptoms?
Normal stomach acidity has been altered, which changed the environment of normal flora
bacteria.
Rationale: Signs and symptoms indicate Clostridioides difficile (C. difficile) diarrhea. Changes
in acidity in the stomach change the environment of normal flora bacteria, which can lead to
opportunistic infections such as C. difficile. Proton pump inhibitors do not change the
gastrointestinal lining or immune system or cause bacterial mutations.
,A patient is placed on pantoprazole for the treatment of PUD. Which of the following
information should be included when providing patient education on this drug? (Select all that
apply.)
Eat several small meals during the day rather than three large meals.,
This medication should not be taken long-term without consulting with the provider.
Rationale: Eating several small meals will help prevent gastrointestinal adverse effects.
Proton pump inhibitors are indicated for short-term treatment and may cause significant
adverse effects if used long-term. The medication should be swallowed whole without
chewing. Ginkgo biloba reduces the effect of pantoprazole. Magnesium and calcium levels
should be monitored while taking the drug.
A client has been diagnosed with peptic ulcer disease (PUD). Which of the following factors
place(s) this client at a higher risk for developing this condition? (Select all that apply.)
Cigarette smoking,
High levels of stress, Family history
Rationale:Peptic ulcer disease is genetic. Risk factors include cigarette smoking, age, high
stress, use of certain medications, exposure to irritants, and family history. Type A blood is a
risk factor for gastric ulcers, and type O blood is a risk factor for duodenal ulcers. There is no
known link between type B blood and peptic ulcer disease. Gastric or duodenal mucosal
defects, not esophageal defects, will increase the risk of PUD.
A patient with PUD wants to know if taking probiotics will improve the condition. Which of the
following statements is correct regarding probiotics?
Probiotics are helpful in replacing healthy bacteria in the digestive tract.
Rationale:Probiotics are considered 'good bacteria.' Probiotics may be helpful in replacing
healthy bacteria in the gut and decreasing negative side effects of antibiotics or the
symptoms associated with PUD. Probiotics are available over the counter as dietary
supplements, so they are not regulated by the Food and Drug Administration (FDA).
Probiotics are found naturally in the gastrointestinal tract.
A patient reports severe epigastric pain after eating. Test results show the presence of
Helicobacter pylori (H. pylori). Which of the following data are most important for the nurse to
obtain based on this information? (Select all that apply.)
Comprehensive pain assessment,
,Abdominal assessment
Rationale:Presence of epigastric pain and positive H. pylori are indicators of PUD.
Assessment for PUD will include a comprehensive pain assessment and abdominal
assessment. The location, duration, and type of pain will help differentiate duodenal from
gastric ulcers. The abdominal assessment will provide further information regarding location
of pain, presence of guarding or rebound tenderness, and frequency/quality of bowel
sounds. The cardiopulmonary assessment and recent travel data will not provide additional
assessment information related to PUD.
Which of the following complications of peptic ulcers is associated with the presence of H.
pylori?
Carcinoma
Rationale:Increased risk of gastric adenocarcinoma in patients with peptic ulcer disease is
associated with the presence of H. pylori. The other answer choices are not typical
complications associated with the presence of H. pylori.
Which of the following drugs may be included in triple (combination) therapy for patients with
peptic ulcers caused by H. pylori? (Select all that apply.)
Amoxicillin,
Clarithromycin
Rationale:Triple therapy to treat H. pylori consists of a proton pump inhibitor with two
antibiotics. A proton pump inhibitor, such as omeprazole, esomeprazole, lansoprazole,
dexlansoprazole, or rabeprazole, is used with the combination of clarithromycin and
amoxicillin or clarithromycin and metronidazole hydrochloride. Indomethacin is a
nonsteroidal anti-inflammatory medication. It is not used in triple therapy for patients with
peptic ulcers caused by H. pylori. Bismuth subsalicylate and tetracycline are options included
when quadruple therapy is initiated.
A patient with a history of vomiting and diarrhea is admitted to the hospital and is exhibiting
signs of weakness and confusion. Assessment reveals hypotension, tachycardia, and poor skin
turgor. Which of the following equipment should the nurse gather first based on the patient's
signs and symptoms?
Intravenous tubing
Rationale:The patient is exhibiting signs and symptoms of dehydration. Treatment may
include administration of intravenous fluids. The patient is vomiting and there is no
, indication of malnutrition, so insertion of tube feeding is not a priority. Signs and symptoms
do not indicate the need for tracheostomy tube or skin traction setup.
A client has a history of diabetes mellitus. After assessing the client, the primary healthcare
provider confirms damage to the sensory limb of the bladder spinal reflex arc. Which clinical
manifestations could confirm this condition?
1. Incomplete voiding
2. Overdistention of bladder
3. Lack of control on micturition
4. Infrequent voiding of large residual volumes
4. Infrequent voiding of large residual volumes
Damage to the sensory limb of the bladder spinal reflex arc is a type of sensory neurogenic
bladder where the client lacks the sensation of needing to urinate. This is usually seen in
clients with multiple sclerosis and diabetes mellitus. Its clinical manifestation is infrequent
voiding of large residual volumes. Incomplete voiding is a symptom of reflexic neurogenic
bladder. Overdistention of the bladder and lack of control on micturition are the symptoms
of areflexic neurogenic bladder.
What are the reasons for performing a lumbar puncture on a client? Select all that apply.
1.Confirming spinal cord injuries
2. Assessing sensory nerve problems
3. Measuring blood flow in many areas
4. Reading cerebrospinal fluid pressure
5. Injecting contrast medium for diagnostic study
4. Reading cerebrospinal fluid pressure
5. Injecting contrast medium for diagnostic study
A lumbar puncture is the insertion of a spinal needle into the subarachnoid space between
the third and fourth lumbar vertebrae; it can be used to obtain cerebrospinal fluid readings
with a manometer. Using a lumbar puncture, contrast medium or air is injected for
diagnostic study. Evoked potentials measure the electrical signals to the brain generated by
sound, light, or touch, and are used to confirm neurologic conditions like spinal cord injuries
and multiple sclerosis. Evoked potentials are also used to assess sensory nerve problems.
Cerebral blood flow evaluation is used to measure blood flow in many areas using
radioactive substances.
