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NRSG 220 Midterm Exam Fall 2025. Questions & Answers, Exams of Nursing

NRSG 220 Midterm Exam Fall 2025. Questions & Answers

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2024/2025

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NRSG 220 Midterm Exam Fall 2025.
Questions & Answers (Answer key below)
1. After a change of shift, you are assigned to care for the following patients. Which patient
should you assess first?
a. A 60-year old patient on a ventilator for whom a sterile sputum specimen must be
sent to the lab.
b. A 55-year old with COPD and a pulse oximetry reading from the previous shift of
90% saturation.
c. A 70-year old with pneumonia who needs to be started on intravenous (IV)
antibiotics.
d. A 50-year old with asthma who complains of shortness of breath after using a
bronchodilator.
2. You are the nurse preparing a patient with iron deficiency anemia for discharge and are
about to complete required teaching. What foods should you suggest the patient eat?
a. Cereal and milk
b. Caesar salad
c. Egg with wheat toast and orange juice
d. Baked potato with butter
3. Select ALL the signs and symptoms that can present in pernicious anemia:
a. Erythema
b. Paresthesia of hands and feet
c. Racing thoughts
d. Extreme hunger
e. Unsteady gait
f. Shortness of breath with activity
4. A newly admitted client has sickle cell crisis. The nurse is planning care based on
assessment of the client. The client is complaining of severe pain in his feet and hands.
The pulse oximetry is 89. Which of the following interventions would be implemented
first? Assume that there are orders for each intervention.
a. Adjust the room temperature
b. Give a bolus of IV fluids
c. Start O2
d. Administer Morphine 2 mg IV push
5. What will the nurse identify as symptoms of hypovolemic shock in a patient? SATA
a. Temperature of 97.6°F (36.4°C)
b. Restlessness
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NRSG 220 Midterm Exam Fall 2025.

Questions & Answers (Answer key below)

  1. After a change of shift, you are assigned to care for the following patients. Which patient should you assess first? a. A 60 - year old patient on a ventilator for whom a sterile sputum specimen must be sent to the lab. b. A 55 - year old with COPD and a pulse oximetry reading from the previous shift of 90% saturation. c. A 70 - year old with pneumonia who needs to be started on intravenous (IV) antibiotics. d. A 50 - year old with asthma who complains of shortness of breath after using a bronchodilator.
  2. You are the nurse preparing a patient with iron deficiency anemia for discharge and are about to complete required teaching. What foods should you suggest the patient eat? a. Cereal and milk b. Caesar salad c. Egg with wheat toast and orange juice d. Baked potato with butter
  3. Select ALL the signs and symptoms that can present in pernicious anemia: a. Erythema b. Paresthesia of hands and feet c. Racing thoughts d. Extreme hunger e. Unsteady gait f. Shortness of breath with activity
  4. A newly admitted client has sickle cell crisis. The nurse is planning care based on assessment of the client. The client is complaining of severe pain in his feet and hands. The pulse oximetry is 89. Which of the following interventions would be implemented first? Assume that there are orders for each intervention. a. Adjust the room temperature b. Give a bolus of IV fluids c. Start O d. Administer Morphine 2 mg IV push
  5. What will the nurse identify as symptoms of hypovolemic shock in a patient? SATA a. Temperature of 97.6°F (36.4°C) b. Restlessness

c. Decrease in blood pressure of 20 mm Hg when the patient sits up d. Capillary refill time greater than 3 seconds e. Sinus bradycardia of 55 beats per minute

  1. What type of solution below can be used to treat cerebral edema? a. Isotonic b. Hypertonic c. Hypotonic
  2. A client shows the nurse two pictures of the same lesion, taken one month apart. Which assessment finding requires nursing intervention? a. The light pink color of the lesion is the same in both photographs. b. The lesion has almost disappeared by the time of the second photograph. c. The lesion borders have expanded and are shaped differently in the second picture. d. The lesion's well-approximated margins and size look no different in either photograph.
  3. The female client admitted for an unrelated diagnosis asks the nurse to check her back because "it itches all the time in that one spot." When the nurse assesses the client's back, the nurse notes an irregular-shaped lesion with some scabbed-over areas surrounding the lesion. Which action should the nurse implement first? a. Notify the HCP to check the lesion on rounds. b. Measure the lesion and note the color. c. Apply lotion to the lesion. d. Instruct the client to make sure the HCP checks the lesion.
  4. You provide care for a patient diagnosed with malignant melanoma. Which treatment do you expect? a. Cryotherapy b. Intralesional vinblastine c. Full thickness surgical removal d. Topical application of fluorouracil
  5. The nurse performs health screenings on a group of clients. The nurse identifies which individual is at greatest risk for developing skin cancer? a. An adolescent with dark skin who works as a lifeguard at the local pool b. An adult client with light skin who works as a cashier at the local store c. A middle age adult client with dark skin who swims daily at a health club d. An older adult client with light skin who worked as a roofer for 40 years

d. Auscultation of breath sounds every 4 hours.

  1. A patient is presenting with chronic obstructive pulmonary disease. The patient has a chronic productive cough with dyspnea on exertion. Arterial blood gasses show a low oxygen level and high carbon dioxide level in the blood. On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. Based on your nursing knowledge and the patient’s symptoms, you suspect the patient suffers from what type of COPD? a. Emphysema b. Pneumonia c. Chronic bronchitis d. Pneumothorax
  2. A patient with asthma is prescribed to take inhaled Salmeterol and Fluticasone for long- term management of asthma. You observe the patient taking these medications. Which option below best describes the correct order in how to take these medications? a. The patient inhales the Salmeterol first and then waits 5 minutes before inhaling the Fluticasone. b. The patient inhales the Fluticasone first and then waits 5 minutes before inhaling the Salmeterol. c. The patient inhales the Salmeterol first and then waits 1 minute before inhaling the Fluticasone. d. The patient inhales the Fluticasone and immediately inhales the Salmeterol.
  3. An alarm beeps notifying you that one of your patient’s oxygen saturation is reading 89%. You arrive to the patient’s room, and see the patient comfortably resting in bed watching television. The patient is already on 2 L of oxygen via nasal cannula. The patient is admitted for COPD exacerbation. Your next nursing action would be: a. Continue to monitor the patient b. Increase the patient’s oxygen level to 3 L c. Notify the doctor for further orders d. Turn off the alarm settings
  4. The client diagnosed with diverticulitis is complaining of severe pain in the left lower quadrant and has an oral temperature of 100.6 degrees Fahrenheit. Which intervention should the nurse implement first? a. Notify the HCP b. Document the findings in the chart c. Administer an oral antipyretic d. Assess the client's abdomen
  1. The nurse is teaching the client diagnosed with diverticulosis. Which instruction should the nurse include in the teaching session? a. Discuss the importance of drinking 1,000mL of water daily b. Instruct the client to avoid exercise c. Teach the client about eating a low-residue diet d. Explain the need to have daily bowel movements
  2. The client is admitted to the medical unit with a diagnosis of acute diverticulitis. Which health-care provider's order should the nurse question? a. Insert a nasogastric tube. b. Start IV fluids c. Put the client on a full liquid diet. d. Place the client on bed rest with bathroom privileges.
  3. The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement? a. Provide a high fiber diet b. Rest the client's bowels c. Assess vital signs daily d. Administer antacids orally
  4. What are the characteristics of Crohn’s Disease? SATA a. Lead Pipe Appearance b. Cobblestone Appearance c. Primarily affects ileum (RLQ), but also impacts whole GI tract d. Primary affects sigmoid colon and rectum e. Steatorrhea f. Bloody Diarrhea g. Surgery is curative h. Surgery is not curative
  5. You’re providing education to a group of nursing students about the care of a patient with appendicitis. Which statement by a nursing student requires re-education about your teaching? a. “After an appendectomy the patient may have a nasogastric tube to remove stomach fluids and swallowed air.” b. “Non-pharmacological techniques for a patient with appendicitis include application of heat to the abdomen and the side-lying position.” c. “The nurse should monitor the patient for signs and symptoms of peritonitis which includes increased heart rate, respirations, temperature, abdominal distention, and intense abdominal pain.” d. “It is normal for some patients to have shoulder pain after a laparoscopic appendectomy.”
  1. B C D. Restlessness: This is a common early sign of hypovolemic shock due to decreased oxygen supply to the brain, so this is a symptom. Decrease in blood pressure of 20 mm Hg when the patient sits up: A drop in blood pressure (orthostatic hypotension) upon sitting or standing is a sign of hypovolemic shock, so this is a symptom. Capillary refill time greater than 3 seconds: Delayed capillary refill indicates poor perfusion, which is a sign of hypovolemic shock, so this is a symptom.
  2. B. Hypertonic solutions (e.g., 3% saline) help to draw fluid out of the swollen brain cells and into the bloodstream due to the higher concentration of solutes in the solution. This reduces swelling and pressure within the brain.
  3. C. Changes in the size, shape, or border of a lesion can be signs of malignancy, such as melanoma. Asymmetry, border irregularity, color variation, diameter increase, and evolving appearance are key warning signs (often summarized as the ABCDEs of melanoma). Therefore, a change in the borders and shape should prompt further evaluation by a healthcare provider.
  4. B. This assessment is crucial for documenting the size, shape, color, and any other notable characteristics (such as the scabbed areas) of the lesion. This information is essential for tracking any changes and providing detailed information to the healthcare provider. Once the assessment is completed, the nurse should notify the healthcare provider during rounds, as an irregular-shaped lesion with scabbing may indicate a possible skin condition that needs further evaluation (e.g., skin cancer or infection).
  5. C. This is the standard treatment for malignant melanoma, especially in its early stages. It involves removing the entire lesion along with a margin of healthy tissue to ensure complete removal of cancerous cells.
  6. D. This client has several significant risk factors for skin cancer: Older age: Skin cancer risk increases with age due to cumulative sun exposure over time. Light skin: People with fair or light skin have less melanin, which provides less protection from the harmful effects of UV radiation. Occupation as a roofer: This job involves prolonged, direct exposure to sunlight for many years, significantly increasing the risk of skin cancer, including squamous cell carcinoma, basal cell carcinoma, and melanoma.
  7. D. Psoriasis is a chronic skin disorder characterized by the rapid turnover of skin cells, leading to the formation of thick, silvery-white scales over red, inflamed plaques. These commonly appear on areas like the scalp, elbows, knees, and lower back (sacral region).
  8. C. According to The American Academy of Dermatology A sunscreen with a SPF of 30 or higher should be worn on all sun-exposed skin surfaces is recommended as a protection against ultraviolet A (UVA) and ultraviolet B (UVB) rays.
  1. C. Before taking any further action, it is crucial to assess the client to confirm whether they are experiencing hypoglycemia. Symptoms such as headache and altered behavior could be indicative of low blood sugar, but assessing the client directly will provide important information to guide appropriate treatment.
  2. C. HHNS is characterized by extremely high blood glucose levels and severe dehydration without significant ketosis. This condition often presents with: Dry mucous membranes due to dehydration and fluid loss. Altered mental status or coma, as seen in the client’s presentation in the ICU. The other symptoms are more characteristic of ketoacidosis
  3. A. Infuse 0.9% normal saline intravenously: This is a critical intervention for HHNS, as it addresses severe dehydration and helps to restore fluid balance. IV fluids are essential to correct the dehydration and help dilute the high blood glucose concentration.
  4. A. This task involves helping the patient achieve a position that may facilitate better breathing and comfort, which is a suitable task for a nursing assistant.
  5. C. Based on the patient’s symptoms and the arterial blood gas results, the patient is most likely suffering from chronic bronchitis. Remember blue bloaters are with Bronchitis. Risk factors for COPD, smoking pack years, Genetic
  6. A. Salmeterol is a long-acting bronchodilator that works by relaxing the muscles around the airways to help open them up. It should be taken first to help ensure that the airways are open for better delivery of the corticosteroid. Fluticasone is a corticosteroid that works by reducing inflammation in the airways. It is more effective when it can reach deeper into the lungs, so taking it after Salmeterol helps maximize its effectiveness.
  7. A. Given that the patient is comfortable and not showing signs of distress, continuing to monitor the patient closely is appropriate. You would ensure that you keep observing their condition and oxygen saturation, watch for any changes, and be ready to take further action if necessary.
  8. D. Assess the client's abdomen: This is the most immediate action to gather more information about the client’s current condition. It helps to evaluate the severity and nature of the abdominal pain, which is crucial for determining the next steps in management and treatment.
  9. D. Regular bowel movements: Maintaining regular bowel habits is crucial for managing diverticulosis. This helps to prevent constipation and the subsequent formation of more diverticula or complications. Regular bowel movements reduce pressure in the colon, which is important for managing diverticulosis and preventing its progression to diverticulitis