NU216 Medical Surgical Nursing II Baton Rouge General School of Nursing
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Prescribed: Infuse 500 mL D5W over 3 hours
Drop factor: 15 gtt/mL
Calculate the flow rate in gtt/min. Round to the nearest whole number.
- 100 gtt/min
- 42 gtt/min
- 150 gtt/min
- 175 gtt/min
Explanation
Explanation
Formula:Flow rate (gtt/min) = (Total volume × Drop factor) ÷ Time (in minutes)
Step 1: Plug in the numbers
= (500 mL × 15 gtt/mL) ÷ (3 × 60 minutes)
= 7500 ÷ 180
Step 2: Solve
= 41.67 gtt/min
Step 3: Round to the nearest whole number
= 42 gtt/min
Correct Answer Is:
42 gtt/minWhy the other options are incorrect:
100 gtt/minToo high. This would deliver the infusion much faster than prescribed, finishing in less than 2 hours instead of 3, which could cause fluid overload.
150 gtt/min
Extremely high and unsafe, infusing 500 mL in roughly 40 minutes, which contradicts the 3-hour order and can lead to adverse effects.
175 gtt/min
This rate would be dangerously fast, infusing the entire bag in less than 30 minutes, which would cause serious harm.
When developing a teaching plan for a 61-year-old male patient with multiple risk factors for coronary artery disease (CAD), which modifiable risk factor would the nurse focus on?
- Increased risk associated with the patient’s gender
- Increased risk of cardiovascular disease as people age
- Elevated low-density lipoprotein (LDL) level
- Family history of coronary artery disease
Explanation
Explanation
Modifiable risk factors are those that can be controlled or changed through lifestyle or medical management. Elevated LDL cholesterol is a major modifiable risk factor for CAD because it can be lowered through diet, exercise, and medications such as statins. By focusing on this factor, the nurse can help reduce the patient’s overall cardiovascular risk.Correct Answer Is:
C. Elevated low-density lipoprotein (LDL) levelWhy the other options are incorrect:
A. Increased risk associated with the patient’s genderBeing male is a nonmodifiable risk factor; the nurse cannot change the patient’s gender.
B. Increased risk of cardiovascular disease as people age
Advancing age is another nonmodifiable risk factor; the risk naturally increases over time.
D. Family history of coronary artery disease
Genetics and family history are nonmodifiable risk factors; the patient cannot change their inherited predisposition.
Upon assessing a patient's central line IV site, the nurse notes moisture under the transparent dressing and that it has become loose. The next scheduled site care and dressing change is for the next day. The nurse would perform which action?
- A Reinforce with gauze dressing and change as scheduled.
- B Remove the dressing, perform site care and re-dress.
- C Notify the physician of leaking at the IV insertion site.
- D Chart findings and continue to observe.
Explanation
Explanation
A central line dressing must remain dry and occlusive to prevent infection. If the dressing is moist or loose, it no longer protects the insertion site and must be changed immediately, even if the next scheduled change is not due. The nurse should remove the compromised dressing, perform sterile site care, and apply a new sterile transparent dressing to protect the site.Correct Answer Is:
B. Remove the dressing, perform site care and re-dress.Why the other options are incorrect:
A. Reinforce with gauze dressing and change as scheduledReinforcing a moist or loose dressing is unsafe because it allows bacterial entry and increases the risk of central line-associated bloodstream infection (CLABSI).
C. Notify the physician of leaking at the IV insertion site
There is no evidence of leaking from the insertion site itself, only moisture under the dressing. This is a nursing action and does not require physician notification unless complications are observed.
D. Chart findings and continue to observe
Simply documenting without intervention leaves the site unprotected and increases the risk of infection, which is unsafe.
A patient arrives to the emergency department with complaints of a rash that "appeared about two days after doing yard work." The nurse knows that the patient is experiencing which type of hypersensitivity reaction?

- Type III Immune-Complex Reaction
- Type II Cytotoxic / Cytolytic Reaction
- Type I Immediate Hypersensitivity Reaction
- Type IV Delayed Hypersensitivity Reaction
Explanation
Explanation
Type IV hypersensitivity is cell-mediated, involving T lymphocytes rather than antibodies. It is characterized by a delayed onset, typically 24 to 72 hours after exposure to an allergen such as poison ivy, nickel, or latex. The patient’s presentation of a rash appearing two days after yard work matches this delayed mechanism. This is why it is often referred to as “delayed-type hypersensitivity.”Correct Answer Is:
Type IV Delayed Hypersensitivity ReactionWhy the other options are incorrect:
Type III Immune-Complex ReactionThis is incorrect because type III hypersensitivity involves immune complex deposition, leading to conditions like serum sickness, systemic lupus erythematosus, and some forms of vasculitis. It usually manifests with systemic symptoms such as fever, arthralgia, or nephritis, not a localized rash after contact exposure.
Type II Cytotoxic / Cytolytic Reaction
This is incorrect because type II hypersensitivity involves antibody-mediated destruction of specific cells, such as in hemolytic anemia, transfusion reactions, or Goodpasture’s syndrome. It does not present as a contact dermatitis rash days after exposure.
Type I Immediate Hypersensitivity Reaction
This is incorrect because type I hypersensitivity is mediated by IgE antibodies and occurs within minutes of exposure. Examples include anaphylaxis, asthma, or urticaria. The delayed rash occurring two days after exposure rules out type I hypersensitivity.
When the nurse assesses a patient who presents to the urgent care center with asthma exacerbation, what are the expected assessment findings? Select all that apply.
- Increased breath sounds on auscultation.
- Restlessness and agitation.
- Tachypnea and tachycardia.
- Oxygen saturation 99%.
- Audible wheezing on expiration.
Explanation
Explanation
Restlessness and agitationPatients with asthma exacerbations often develop restlessness and agitation due to hypoxemia and difficulty moving air. These are early signs of respiratory distress as the body attempts to compensate for decreased oxygenation. Recognizing this symptom helps in initiating prompt interventions before the condition worsens.
Tachypnea and tachycardia
An acute asthma attack typically results in increased respiratory rate (tachypnea) due to airway narrowing and the need to move more air. Tachycardia occurs as a compensatory mechanism to improve oxygen delivery to tissues. Both are classic findings in patients experiencing exacerbations.
Audible wheezing on expiration
Wheezing, especially on expiration, is a hallmark of asthma exacerbation caused by bronchospasm and narrowed airways. It may be audible without a stethoscope in severe cases. This clinical sign is one of the most reliable indicators of airway obstruction in asthma.
Correct Answer Is:
Restlessness and agitationTachypnea and tachycardia
Audible wheezing on expiration
Why the other options are incorrect:
Increased breath sounds on auscultationThis is incorrect because asthma is more likely to cause decreased or diminished breath sounds due to airflow limitation, not increased sounds. In severe cases, the absence of wheezing can be even more concerning, indicating minimal air movement.
Oxygen saturation 99%
This is incorrect because patients with asthma exacerbations usually have reduced oxygen saturation levels due to impaired gas exchange. An oxygen saturation of 99% would be unusually high in this context and not reflective of the expected findings in acute asthma distress.
After the IV catheter has been inserted through the patient’s skin and into the vein, what would the nurse do next?
- Flush the cannula with normal saline.
- Advance the cannula until the hub rests at the insertion site.
- Look for blood return in the flash-back chamber.
- Stabilize the cannula and release the tourniquet.
Explanation
Explanation
Once the IV catheter has been inserted through the skin and into the vein, the nurse must confirm correct placement by checking for blood return in the flash-back chamber. This confirms that the catheter tip is in the vein. Only after this verification can the nurse proceed with advancing the cannula, stabilizing it, releasing the tourniquet, and flushing with saline.Correct Answer Is:
C. Look for blood return in the flash-back chamber.Why the other options are incorrect:
A. Flush the cannula with normal salineFlushing comes much later, after proper placement has been confirmed and the cannula is secured. Doing this first could risk infiltration if the catheter is not in the vein.
B. Advance the cannula until the hub rests at the insertion site
Advancement is only done after blood return is seen in the flash-back chamber, ensuring the vein is entered. Advancing prematurely may push the catheter through the vessel wall.
D. Stabilize the cannula and release the tourniquet
This step is important, but it comes after blood return has been confirmed and the catheter advanced properly.
Which action should the nurse perform prior to administering a preoperative medication to a patient going to surgery?
- Pack all personal belongings
- Say goodbye to family members
- Transfer to the OR stretcher
- Check the chart for the signed consent
Explanation
Explanation
Before giving preoperative medications, the nurse must confirm that informed consent has been obtained and documented. Once preoperative medications are administered, the patient may be sedated or impaired, making it invalid to obtain consent afterward. Ensuring the consent form is signed is a legal and ethical responsibility prior to surgery.Correct Answer Is:
D. Check the chart for the signed consentWhy the other options are incorrect:
A. Pack all personal belongingsThis is part of routine preparation for transfer to surgery but is not a priority before giving preoperative medications.
B. Say goodbye to family members
Patients should have the opportunity to see family, but this is not a legal or priority action before giving medication.
C. Transfer to the OR stretcher
The patient is only transferred after preoperative preparations are completed, including confirming informed consent and medication administration.
A patient with kidney cancer had a nephrectomy. Which nursing interventions are appropriate in the immediate post-op period? Select all that apply.
- Monitor intake and output.
- Position patient flat for 24 hours.
- Monitor signs of infection.
- Assess for signs of hemorrhage.
- Encourage high-protein diet.
Explanation
Explanation
Monitor intake and outputAfter nephrectomy, monitoring urine output is essential to assess the function of the remaining kidney. Strict fluid balance ensures early recognition of renal impairment and guides postoperative management.
Monitor signs of infection
Surgical sites and urinary catheters increase infection risk. Monitoring for fever, redness, purulent drainage, or elevated WBC count helps detect infection early and initiate treatment promptly.
Assess for signs of hemorrhage
Kidneys are highly vascular, so hemorrhage is a major risk after nephrectomy. Monitoring vital signs, surgical drainage, and hemoglobin/hematocrit levels is critical to detect bleeding quickly.
Correct Answer Is:
Monitor intake and outputMonitor signs of infection
Assess for signs of hemorrhage
Why the other options are incorrect:
Position patient flat for 24 hoursThis is incorrect because patients are not kept flat for 24 hours after nephrectomy. They are generally encouraged to turn, cough, and deep breathe to prevent atelectasis. Prolonged immobility increases risks of pulmonary and circulatory complications.
Encourage high-protein diet
This is incorrect in the immediate postoperative period. A high-protein diet may stress the remaining kidney. Initially, fluid balance and renal function are the priority, and dietary modifications come later once stability is ensured.
Using the attached diagram, the nurse identifies #3 as which of the following on a patient’s EKG?

- PR Interval
- QRS Complex
- QT Interval
- ST Segment
Explanation
Explanation
On an EKG, the QRS complex represents ventricular depolarization, which leads to ventricular contraction. In the diagram, label #3 is pointing to the tall, sharp deflection corresponding to the QRS complex. This portion is critical to assess because abnormalities in QRS duration or morphology can indicate conduction disturbances, bundle branch blocks, or ventricular arrhythmias. Recognizing the QRS complex is fundamental to interpreting cardiac rhythm and function.Correct Answer Is:
QRS ComplexWhy the other options are incorrect:
PR IntervalThis is incorrect because the PR interval extends from the beginning of the P wave to the beginning of the QRS complex. It represents atrial depolarization and conduction through the AV node. The diagram shows #3 at the sharp ventricular deflection, not the space before it, making this option incorrect.
QT Interval
This is incorrect because the QT interval begins at the start of the QRS complex and ends at the end of the T wave. It represents total ventricular depolarization and repolarization. While #3 lies within this interval, it specifically points to the QRS complex, not the entire interval.
ST Segment
This is incorrect because the ST segment follows the QRS complex and extends to the beginning of the T wave. It reflects the period when the ventricles are depolarized before repolarization begins. Since #3 clearly identifies the tall deflection of ventricular depolarization, it cannot be the ST segment.
Prescribed: Begin Heparin IV infusion at 1,050 units/hr
Available: Heparin 25,000 units/500 mL NS
How many mL/hr will the nurse program the IV pump? Record your answer in whole number.
- 18 mL/hr
- 21 mL/hr
- 25 mL/hr
- 30 mL/hr
Explanation
Explanation
Using the formula:mL/hr =
mL/hr =
The nurse should program the IV pump at 21 mL/hr.
Correct Answer Is:
21 mL/hrWhy the other options are incorrect:
18 mL/hr – Would deliver fewer units (900 units/hr), which underdoses the patient.25 mL/hr – Would deliver 1,250 units/hr, overdosing the patient.
30 mL/hr – Would deliver 1,500 units/hr, significantly overdosing the patient.
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