Medical-Surgical Nursing Test Bank
100 Questions & Answers (Latest Edition)
Cardiovascular System
1. A patient with heart failure is prescribed furosemide. Which electrolyte imbalance should
the nurse monitor for most closely?
a) Hypernatremia
b) Hypokalemia ✓
c) Hypercalcemia
d) Hypomagnesemia
Rationale: Loop diuretics like furosemide cause significant potassium loss, increasing the risk of
hypokalemia, which can precipitate dysrhythmias.
2. The nurse is caring for a patient with an acute myocardial infarction (MI) who is receiving
tissue plasminogen activator (tPA). Which assessment finding requires immediate action?
a) Blood pressure of 110/70 mmHg
b) Sudden onset of slurred speech ✓
c) Heart rate of 98 bpm
d) Mild nausea
Rationale: Sudden neurological changes may indicate intracerebral hemorrhage, a serious
complication of thrombolytic therapy.
3. A patient with atrial fibrillation has a new prescription for warfarin. The nurse teaches the
patient that the therapeutic effect is monitored by which laboratory test?
a) Prothrombin time (PT) and International Normalized Ratio (INR) ✓
b) Activated partial thromboplastin time (aPTT)
c) Platelet count
d) Bleeding time
Rationale: Warfarin therapy is monitored using the PT/INR to ensure the anticoagulant effect is
within the therapeutic range.
4. When assessing a patient with peripheral arterial disease (PAD), the nurse would expect to
find which symptom?
a) Pulses that are present but diminished
b) Swelling (edema) of the lower extremities
c) Pain that worsens with elevation of the legs ✓
,d) Brownish discoloration of the ankles
Rationale: In PAD, elevation decreases blood flow further, worsening ischemic pain. Dependent
positioning often relieves it.
5. A patient with hypertension is prescribed lisinopril. The nurse should instruct the patient to
report which potential side effect immediately?
a) Dry cough
b) Persistent headache
c) Swelling of the lips or tongue ✓
d) Mild dizziness upon standing
Rationale: Angioedema (swelling of the face, lips, tongue) is a rare but life-threatening adverse
effect of ACE inhibitors.
Respiratory System
6. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. The nurse understands this flow rate is appropriate to avoid which
complication?
a) Oxygen toxicity
b) Respiratory acidosis
c) Depression of the hypoxic drive ✓
d) Barotrauma
Rationale: Patients with severe COPD may rely on low oxygen levels (hypoxia) to stimulate
breathing. High-flow oxygen can suppress this drive, leading to CO2 retention and respiratory
acidosis.
7. The nurse is preparing to administer the first dose of tuberculin skin test (PPD) to a newly
hired employee. Which site and technique are correct?
a) Subcutaneous injection on the outer aspect of the upper arm
b) Intradermal injection on the ventral forearm
c) Intramuscular injection in the deltoid
d) Intradermal injection on the volar surface of the forearm ✓
Rationale: The Mantoux test (PPD) is administered as an intradermal injection on the inner
surface of the forearm to create a wheal.
8. A patient with a chest tube connected to a water-seal drainage system is being transported.
The chest tube accidentally disconnects from the drainage system. What is the nurse's priority
action?
a) Clamp the chest tube
b) Reconnect it to the drainage system
,c) Immerse the end of the chest tube in sterile water ✓
d) Notify the provider immediately
Rationale: To prevent tension pneumothorax, the priority is to re-establish the water seal by
submerging the end of the tube in sterile water (creating a temporary water seal) before
reconnecting.
9. Which finding in a patient with asthma indicates that treatment is effective?
a) Wheezing that becomes louder
b) Use of accessory muscles
c) Increased peak expiratory flow rate (PEFR) ✓
d) Silent chest on auscultation
Rationale: An increasing PEFR indicates improvement in airflow. Louder wheezing may actually
indicate improved air movement initially, but PEFR is an objective measure. A silent chest is a
danger sign of severe obstruction.
10. The nurse is caring for a patient with a suspected pulmonary embolism. Which finding is
most characteristic of this condition?
a) Productive cough with yellow sputum
b) Pleuritic chest pain and dyspnea ✓
c) Barrel-shaped chest
d) Bibasilar crackles
Rationale: Sudden onset of dyspnea and sharp, stabbing chest pain that worsens on inspiration
(pleuritic) are classic signs of pulmonary embolism.
Endocrine System
11. A patient with Type 1 diabetes mellitus has a blood glucose level of 52 mg/dL. The patient
is awake but confused. What should the nurse administer first?
a) 1 mg of glucagon IM
b) 4 oz of fruit juice orally ✓
c) 10 units of regular insulin subcutaneously
d) A complex carbohydrate and protein snack
Rationale: For a conscious patient with hypoglycemia, the fast-acting carbohydrate (15-20g) like
fruit juice is given first to rapidly raise blood glucose. Reassessment in 15 minutes is required.
12. Which instruction is most important for a patient newly diagnosed with Graves' disease
(hyperthyroidism)?
a) "Use cool compresses for eye discomfort."
b) "Report any episodes of fever or sore throat immediately." ✓
c) "Increase your intake of calcium-rich foods."
, d) "Weigh yourself weekly."
Rationale: Patients on antithyroid medications (like methimazole) are at risk for agranulocytosis.
Fever and sore throat are early signs of this life-threatening complication.
13. The nurse is assessing a patient with Cushing's syndrome. Which finding is consistent with
this disorder?
a) Hypotension and weight loss
b) Hyperpigmentation of skin creases
c) "Moon face" and "buffalo hump" ✓
d) Fine tremors and exophthalmos
Rationale: Central obesity, moon face, and dorsocervical fat pad (buffalo hump) are classic
manifestations of excessive cortisol.
14. A patient with diabetes insipidus is at greatest risk for which electrolyte imbalance?
a) Hyperkalemia
b) Hypernatremia ✓
c) Hypocalcemia
d) Hyponatremia
Rationale: Diabetes insipidus results in the excretion of large volumes of dilute urine, leading to
dehydration and hypernatremia due to water loss.
15. When teaching a patient about sick day management for Type 1 diabetes, the nurse
should include which crucial instruction?
a) Stop taking all insulin if you cannot eat.
b) Monitor blood glucose every 1-2 hours.
c) Continue taking your insulin or oral agents as prescribed. ✓
d) Exercise to help lower elevated blood sugar.
Rationale: Insulin needs often increase during illness due to stress hormones. Never stop
insulin; frequent monitoring (every 2-4 hours) and contacting the provider are key.
Gastrointestinal System
16. A patient with cirrhosis has significant ascites. Which position would best promote
respiratory comfort?
a) High Fowler's position ✓
b) Left lateral position
c) Trendelenburg position
d) Supine with legs elevated
Rationale: High Fowler's position uses gravity to keep abdominal contents from pressing on the
diaphragm, easing breathing.
100 Questions & Answers (Latest Edition)
Cardiovascular System
1. A patient with heart failure is prescribed furosemide. Which electrolyte imbalance should
the nurse monitor for most closely?
a) Hypernatremia
b) Hypokalemia ✓
c) Hypercalcemia
d) Hypomagnesemia
Rationale: Loop diuretics like furosemide cause significant potassium loss, increasing the risk of
hypokalemia, which can precipitate dysrhythmias.
2. The nurse is caring for a patient with an acute myocardial infarction (MI) who is receiving
tissue plasminogen activator (tPA). Which assessment finding requires immediate action?
a) Blood pressure of 110/70 mmHg
b) Sudden onset of slurred speech ✓
c) Heart rate of 98 bpm
d) Mild nausea
Rationale: Sudden neurological changes may indicate intracerebral hemorrhage, a serious
complication of thrombolytic therapy.
3. A patient with atrial fibrillation has a new prescription for warfarin. The nurse teaches the
patient that the therapeutic effect is monitored by which laboratory test?
a) Prothrombin time (PT) and International Normalized Ratio (INR) ✓
b) Activated partial thromboplastin time (aPTT)
c) Platelet count
d) Bleeding time
Rationale: Warfarin therapy is monitored using the PT/INR to ensure the anticoagulant effect is
within the therapeutic range.
4. When assessing a patient with peripheral arterial disease (PAD), the nurse would expect to
find which symptom?
a) Pulses that are present but diminished
b) Swelling (edema) of the lower extremities
c) Pain that worsens with elevation of the legs ✓
,d) Brownish discoloration of the ankles
Rationale: In PAD, elevation decreases blood flow further, worsening ischemic pain. Dependent
positioning often relieves it.
5. A patient with hypertension is prescribed lisinopril. The nurse should instruct the patient to
report which potential side effect immediately?
a) Dry cough
b) Persistent headache
c) Swelling of the lips or tongue ✓
d) Mild dizziness upon standing
Rationale: Angioedema (swelling of the face, lips, tongue) is a rare but life-threatening adverse
effect of ACE inhibitors.
Respiratory System
6. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. The nurse understands this flow rate is appropriate to avoid which
complication?
a) Oxygen toxicity
b) Respiratory acidosis
c) Depression of the hypoxic drive ✓
d) Barotrauma
Rationale: Patients with severe COPD may rely on low oxygen levels (hypoxia) to stimulate
breathing. High-flow oxygen can suppress this drive, leading to CO2 retention and respiratory
acidosis.
7. The nurse is preparing to administer the first dose of tuberculin skin test (PPD) to a newly
hired employee. Which site and technique are correct?
a) Subcutaneous injection on the outer aspect of the upper arm
b) Intradermal injection on the ventral forearm
c) Intramuscular injection in the deltoid
d) Intradermal injection on the volar surface of the forearm ✓
Rationale: The Mantoux test (PPD) is administered as an intradermal injection on the inner
surface of the forearm to create a wheal.
8. A patient with a chest tube connected to a water-seal drainage system is being transported.
The chest tube accidentally disconnects from the drainage system. What is the nurse's priority
action?
a) Clamp the chest tube
b) Reconnect it to the drainage system
,c) Immerse the end of the chest tube in sterile water ✓
d) Notify the provider immediately
Rationale: To prevent tension pneumothorax, the priority is to re-establish the water seal by
submerging the end of the tube in sterile water (creating a temporary water seal) before
reconnecting.
9. Which finding in a patient with asthma indicates that treatment is effective?
a) Wheezing that becomes louder
b) Use of accessory muscles
c) Increased peak expiratory flow rate (PEFR) ✓
d) Silent chest on auscultation
Rationale: An increasing PEFR indicates improvement in airflow. Louder wheezing may actually
indicate improved air movement initially, but PEFR is an objective measure. A silent chest is a
danger sign of severe obstruction.
10. The nurse is caring for a patient with a suspected pulmonary embolism. Which finding is
most characteristic of this condition?
a) Productive cough with yellow sputum
b) Pleuritic chest pain and dyspnea ✓
c) Barrel-shaped chest
d) Bibasilar crackles
Rationale: Sudden onset of dyspnea and sharp, stabbing chest pain that worsens on inspiration
(pleuritic) are classic signs of pulmonary embolism.
Endocrine System
11. A patient with Type 1 diabetes mellitus has a blood glucose level of 52 mg/dL. The patient
is awake but confused. What should the nurse administer first?
a) 1 mg of glucagon IM
b) 4 oz of fruit juice orally ✓
c) 10 units of regular insulin subcutaneously
d) A complex carbohydrate and protein snack
Rationale: For a conscious patient with hypoglycemia, the fast-acting carbohydrate (15-20g) like
fruit juice is given first to rapidly raise blood glucose. Reassessment in 15 minutes is required.
12. Which instruction is most important for a patient newly diagnosed with Graves' disease
(hyperthyroidism)?
a) "Use cool compresses for eye discomfort."
b) "Report any episodes of fever or sore throat immediately." ✓
c) "Increase your intake of calcium-rich foods."
, d) "Weigh yourself weekly."
Rationale: Patients on antithyroid medications (like methimazole) are at risk for agranulocytosis.
Fever and sore throat are early signs of this life-threatening complication.
13. The nurse is assessing a patient with Cushing's syndrome. Which finding is consistent with
this disorder?
a) Hypotension and weight loss
b) Hyperpigmentation of skin creases
c) "Moon face" and "buffalo hump" ✓
d) Fine tremors and exophthalmos
Rationale: Central obesity, moon face, and dorsocervical fat pad (buffalo hump) are classic
manifestations of excessive cortisol.
14. A patient with diabetes insipidus is at greatest risk for which electrolyte imbalance?
a) Hyperkalemia
b) Hypernatremia ✓
c) Hypocalcemia
d) Hyponatremia
Rationale: Diabetes insipidus results in the excretion of large volumes of dilute urine, leading to
dehydration and hypernatremia due to water loss.
15. When teaching a patient about sick day management for Type 1 diabetes, the nurse
should include which crucial instruction?
a) Stop taking all insulin if you cannot eat.
b) Monitor blood glucose every 1-2 hours.
c) Continue taking your insulin or oral agents as prescribed. ✓
d) Exercise to help lower elevated blood sugar.
Rationale: Insulin needs often increase during illness due to stress hormones. Never stop
insulin; frequent monitoring (every 2-4 hours) and contacting the provider are key.
Gastrointestinal System
16. A patient with cirrhosis has significant ascites. Which position would best promote
respiratory comfort?
a) High Fowler's position ✓
b) Left lateral position
c) Trendelenburg position
d) Supine with legs elevated
Rationale: High Fowler's position uses gravity to keep abdominal contents from pressing on the
diaphragm, easing breathing.
