Brunner & Suddarth’s Textbook of Medical-Surgical
Nursing Study Guide Bundle – Comprehensive Exam Prep
Notes, Chapter Summaries, Key Concepts, Practice
Questions & NCLEX-Focused Review for Medical-Surgical
Nursing Success
Question 1: A patient with heart failure is prescribed furosemide 40 mg IV. Which assessment
finding requires the nurse to hold the medication and notify the provider?
A. Blood pressure 138/86 mm Hg
B. Serum potassium 3.2 mEq/L
C. Urine output 45 mL/hr
D. Weight gain of 1 kg in 24 hours
CORRECT ANSWER: B. Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that promotes potassium excretion, increasing risk for
hypokalemia. A serum potassium level of 3.2 mEq/L is below the normal range (3.5–5.0 mEq/L)
and may cause cardiac dysrhythmias, muscle weakness, or fatigue. The nurse should hold the
dose and notify the provider before administering additional potassium-wasting diuretics.
Blood pressure, urine output, and modest weight gain are expected findings in heart failure
management and do not contraindicate furosemide administration.
Question 2: During preoperative teaching for a patient scheduled for coronary artery bypass
graft (CABG) surgery, which statement by the patient indicates a need for further education?
A. "I will use my incentive spirometer every hour while awake after surgery."
B. "I should expect to have chest tubes draining fluid after the procedure."
C. "I can resume driving my car within 3 days after discharge."
D. "I will report any signs of infection at my incision site immediately."
CORRECT ANSWER: C. "I can resume driving my car within 3 days after discharge."
Rationale: After CABG surgery, patients are typically restricted from driving for 4–6 weeks to
allow sternal healing and reduce risk of injury from sudden movements or airbag deployment.
Statements A, B, and D reflect accurate understanding of postoperative care: incentive
spirometry prevents atelectasis, chest tubes are standard for drainage, and infection
monitoring is critical. The misconception about driving indicates a need for additional teaching.
Question 3: A patient with type 1 diabetes mellitus presents with confusion, diaphoresis, and
tremors. Blood glucose is 48 mg/dL. What is the nurse's priority action?
A. Administer 15 g of fast-acting carbohydrate orally
B. Prepare intravenous dextrose 50% per protocol
C. Recheck blood glucose in 15 minutes
D. Offer a snack containing protein and complex carbohydrates
CORRECT ANSWER: B. Prepare intravenous dextrose 50% per protocol
Rationale: The patient exhibits neuroglycopenic symptoms (confusion) with severe
hypoglycemia (glucose <50 mg/dL), indicating impaired ability to safely swallow oral
carbohydrates. IV dextrose 50% is the priority intervention to rapidly raise blood glucose and
prevent seizures or loss of consciousness. Oral carbohydrates (A, D) are appropriate only for
conscious patients able to protect their airway. Rechecking glucose (C) delays definitive
treatment in an emergency.
,Question 4: Which finding in a patient with chronic kidney disease (CKD) stage 4 requires
immediate nursing intervention?
A. Serum creatinine 3.8 mg/dL
B. Potassium 6.1 mEq/L
C. Hemoglobin 10.2 g/dL
D. Blood pressure 148/92 mm Hg
CORRECT ANSWER: B. Potassium 6.1 mEq/L
Rationale: Hyperkalemia (potassium >5.0 mEq/L) in CKD is life-threatening due to risk of fatal
cardiac dysrhythmias. A level of 6.1 mEq/L requires immediate intervention such as calcium
gluconate, insulin/glucose, or dialysis. Elevated creatinine (A) and anemia (C) are expected in
stage 4 CKD and managed chronically. Hypertension (D) is common but not immediately life-
threatening at this level.
Question 5: A postoperative patient receiving morphine via patient-controlled analgesia
(PCA) has a respiratory rate of 8 breaths/min and is difficult to arouse. What is the nurse's
first action?
A. Administer naloxone 0.4 mg IV push
B. Stop the PCA infusion
C. Stimulate the patient and encourage deep breathing
D. Notify the rapid response team
CORRECT ANSWER: B. Stop the PCA infusion
Rationale: The priority in opioid-induced respiratory depression is to immediately stop the
source of opioid delivery (PCA pump) to prevent further sedation. Then, stimulate the patient,
administer oxygen, and prepare naloxone if needed. While naloxone (A) may be required,
stopping the infusion is the fastest, least invasive first step. Notifying the team (D) is important
but follows immediate intervention. Stimulation alone (C) is insufficient without halting opioid
administration.
Question 6: Which laboratory value is most indicative of acute pancreatitis?
A. Elevated serum amylase and lipase
B. Decreased serum calcium
C. Elevated white blood cell count
D. Increased blood urea nitrogen
CORRECT ANSWER: A. Elevated serum amylase and lipase
Rationale: Serum amylase and lipase are specific enzymes released during pancreatic
inflammation; lipase is more specific and remains elevated longer. While hypocalcemia (B),
leukocytosis (C), and elevated BUN (D) may occur in severe pancreatitis, they are nonspecific
and can result from other conditions. Elevated pancreatic enzymes are diagnostic hallmarks per
clinical guidelines.
Question 7: A patient with a newly applied long-arm cast reports severe pain unrelieved by
medication, numbness in fingers, and pallor. What is the nurse's priority action?
A. Elevate the extremity above heart level
B. Administer additional analgesic as ordered
C. Assess capillary refill and prepare to bivalve the cast
D. Apply ice packs around the cast edges
,CORRECT ANSWER: C. Assess capillary refill and prepare to bivalve the cast
Rationale: These symptoms suggest compartment syndrome, a surgical emergency caused by
increased pressure within a fascial compartment. Immediate assessment of neurovascular
status (capillary refill, sensation, movement) and cast bivalving are critical to restore perfusion
and prevent permanent damage. Elevation (A) may worsen ischemia in compartment
syndrome. Analgesics (B) mask symptoms without addressing the cause. Ice (D) is
contraindicated as it may further impair circulation.
Question 8: Which intervention is most effective in preventing ventilator-associated
pneumonia (VAP) in a mechanically ventilated patient?
A. Administering prophylactic antibiotics daily
B. Performing oral care with chlorhexidine every 4 hours
C. Keeping the head of the bed elevated to 30–45 degrees
D. Suctioning the endotracheal tube every hour
CORRECT ANSWER: C. Keeping the head of the bed elevated to 30–45 degrees
Rationale: Elevating the head of the bed reduces aspiration of gastric contents, a primary
mechanism of VAP. This is a core component of the VAP prevention bundle endorsed by CDC
and professional societies. Chlorhexidine oral care (B) is also recommended but secondary to
positioning. Prophylactic antibiotics (A) increase resistance risk and are not standard. Routine
suctioning (D) is not indicated and may cause mucosal trauma.
Question 9: A patient with systemic lupus erythematosus (SLE) is prescribed
hydroxychloroquine. Which teaching point is essential for the nurse to include?
A. "Take this medication with food to prevent nausea."
B. "Report any visual changes or difficulty reading immediately."
C. "Avoid sunlight exposure and use broad-spectrum sunscreen."
D. "This medication may cause your urine to turn orange."
CORRECT ANSWER: B. "Report any visual changes or difficulty reading immediately."
Rationale: Hydroxychloroquine can cause retinal toxicity with prolonged use, leading to
irreversible vision loss. Baseline and annual ophthalmologic exams are required, and patients
must report visual symptoms promptly. While photosensitivity (C) is relevant to SLE itself, it is
not the priority teaching for hydroxychloroquine. Nausea (A) is a minor side effect. Orange
urine (D) is associated with rifampin, not hydroxychloroquine.
Question 10: Which assessment finding in a patient with a suspected pulmonary embolism
requires immediate intervention?
A. Pleuritic chest pain
B. Tachycardia with heart rate 118 bpm
C. Oxygen saturation 88% on room air
D. Mild dyspnea on exertion
CORRECT ANSWER: C. Oxygen saturation 88% on room air
Rationale: Hypoxemia (SpO₂ <90%) indicates significant ventilation-perfusion mismatch and
requires immediate oxygen therapy and further intervention. While tachycardia (B), pleuritic
pain (A), and dyspnea (D) are common in PE, they are less immediately life-threatening than
severe hypoxia, which can rapidly progress to respiratory failure or cardiac arrest.
, Question 11: A patient with cirrhosis has a serum ammonia level of 98 µg/dL (normal: 15–45
µg/dL). Which medication should the nurse anticipate administering?
A. Lactulose
B. Omeprazole
C. Spironolactone
D. Metoclopramide
CORRECT ANSWER: A. Lactulose
Rationale: Lactulose reduces ammonia production in the gut by acidifying the colon and
promoting excretion, making it first-line for hepatic encephalopathy associated with elevated
ammonia. Omeprazole (B) reduces gastric acid but does not lower ammonia. Spironolactone (C)
manages ascites. Metoclopramide (D) treats nausea but is not indicated for hyperammonemia.
Question 12: During a blood transfusion, a patient develops chills, fever, and back pain. What
is the nurse's priority action?
A. Stop the transfusion and keep the vein open with normal saline
B. Administer acetaminophen for fever
C. Obtain blood cultures from the patient
D. Notify the blood bank immediately
CORRECT ANSWER: A. Stop the transfusion and keep the vein open with normal saline
Rationale: These symptoms suggest an acute hemolytic transfusion reaction, a medical
emergency. The immediate action is to stop the transfusion to prevent further infusion of
incompatible blood, maintain IV access with saline for emergency medications, and then notify
the blood bank and provider. Administering antipyretics (B) or obtaining cultures (C) occurs
after stopping the transfusion. Notification (D) is critical but follows the immediate safety
action.
Question 13: Which finding indicates effective treatment for a patient in diabetic ketoacidosis
(DKA)?
A. Serum glucose 180 mg/dL
B. Serum bicarbonate 18 mEq/L
C. Anion gap 16 mEq/L
D. Urine ketones negative
CORRECT ANSWER: A. Serum glucose 180 mg/dL
Rationale: In DKA management, glucose should gradually decrease to 200–250 mg/dL before
adding dextrose to IV fluids to prevent cerebral edema while continuing insulin to resolve
ketosis. A glucose of 180 mg/dL indicates appropriate control. Bicarbonate (B) and anion gap
(C) should normalize (bicarbonate >18, gap <12) to confirm resolution of acidosis, but glucose
control is an early indicator. Urine ketones (D) may remain positive despite clinical
improvement due to delayed clearance.
Question 14: A patient with a T5 spinal cord injury develops a severe headache, hypertension
(190/110 mm Hg), and bradycardia. What is the nurse's priority intervention?
A. Administer antihypertensive medication
B. Assess for bladder distention or fecal impaction
Nursing Study Guide Bundle – Comprehensive Exam Prep
Notes, Chapter Summaries, Key Concepts, Practice
Questions & NCLEX-Focused Review for Medical-Surgical
Nursing Success
Question 1: A patient with heart failure is prescribed furosemide 40 mg IV. Which assessment
finding requires the nurse to hold the medication and notify the provider?
A. Blood pressure 138/86 mm Hg
B. Serum potassium 3.2 mEq/L
C. Urine output 45 mL/hr
D. Weight gain of 1 kg in 24 hours
CORRECT ANSWER: B. Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that promotes potassium excretion, increasing risk for
hypokalemia. A serum potassium level of 3.2 mEq/L is below the normal range (3.5–5.0 mEq/L)
and may cause cardiac dysrhythmias, muscle weakness, or fatigue. The nurse should hold the
dose and notify the provider before administering additional potassium-wasting diuretics.
Blood pressure, urine output, and modest weight gain are expected findings in heart failure
management and do not contraindicate furosemide administration.
Question 2: During preoperative teaching for a patient scheduled for coronary artery bypass
graft (CABG) surgery, which statement by the patient indicates a need for further education?
A. "I will use my incentive spirometer every hour while awake after surgery."
B. "I should expect to have chest tubes draining fluid after the procedure."
C. "I can resume driving my car within 3 days after discharge."
D. "I will report any signs of infection at my incision site immediately."
CORRECT ANSWER: C. "I can resume driving my car within 3 days after discharge."
Rationale: After CABG surgery, patients are typically restricted from driving for 4–6 weeks to
allow sternal healing and reduce risk of injury from sudden movements or airbag deployment.
Statements A, B, and D reflect accurate understanding of postoperative care: incentive
spirometry prevents atelectasis, chest tubes are standard for drainage, and infection
monitoring is critical. The misconception about driving indicates a need for additional teaching.
Question 3: A patient with type 1 diabetes mellitus presents with confusion, diaphoresis, and
tremors. Blood glucose is 48 mg/dL. What is the nurse's priority action?
A. Administer 15 g of fast-acting carbohydrate orally
B. Prepare intravenous dextrose 50% per protocol
C. Recheck blood glucose in 15 minutes
D. Offer a snack containing protein and complex carbohydrates
CORRECT ANSWER: B. Prepare intravenous dextrose 50% per protocol
Rationale: The patient exhibits neuroglycopenic symptoms (confusion) with severe
hypoglycemia (glucose <50 mg/dL), indicating impaired ability to safely swallow oral
carbohydrates. IV dextrose 50% is the priority intervention to rapidly raise blood glucose and
prevent seizures or loss of consciousness. Oral carbohydrates (A, D) are appropriate only for
conscious patients able to protect their airway. Rechecking glucose (C) delays definitive
treatment in an emergency.
,Question 4: Which finding in a patient with chronic kidney disease (CKD) stage 4 requires
immediate nursing intervention?
A. Serum creatinine 3.8 mg/dL
B. Potassium 6.1 mEq/L
C. Hemoglobin 10.2 g/dL
D. Blood pressure 148/92 mm Hg
CORRECT ANSWER: B. Potassium 6.1 mEq/L
Rationale: Hyperkalemia (potassium >5.0 mEq/L) in CKD is life-threatening due to risk of fatal
cardiac dysrhythmias. A level of 6.1 mEq/L requires immediate intervention such as calcium
gluconate, insulin/glucose, or dialysis. Elevated creatinine (A) and anemia (C) are expected in
stage 4 CKD and managed chronically. Hypertension (D) is common but not immediately life-
threatening at this level.
Question 5: A postoperative patient receiving morphine via patient-controlled analgesia
(PCA) has a respiratory rate of 8 breaths/min and is difficult to arouse. What is the nurse's
first action?
A. Administer naloxone 0.4 mg IV push
B. Stop the PCA infusion
C. Stimulate the patient and encourage deep breathing
D. Notify the rapid response team
CORRECT ANSWER: B. Stop the PCA infusion
Rationale: The priority in opioid-induced respiratory depression is to immediately stop the
source of opioid delivery (PCA pump) to prevent further sedation. Then, stimulate the patient,
administer oxygen, and prepare naloxone if needed. While naloxone (A) may be required,
stopping the infusion is the fastest, least invasive first step. Notifying the team (D) is important
but follows immediate intervention. Stimulation alone (C) is insufficient without halting opioid
administration.
Question 6: Which laboratory value is most indicative of acute pancreatitis?
A. Elevated serum amylase and lipase
B. Decreased serum calcium
C. Elevated white blood cell count
D. Increased blood urea nitrogen
CORRECT ANSWER: A. Elevated serum amylase and lipase
Rationale: Serum amylase and lipase are specific enzymes released during pancreatic
inflammation; lipase is more specific and remains elevated longer. While hypocalcemia (B),
leukocytosis (C), and elevated BUN (D) may occur in severe pancreatitis, they are nonspecific
and can result from other conditions. Elevated pancreatic enzymes are diagnostic hallmarks per
clinical guidelines.
Question 7: A patient with a newly applied long-arm cast reports severe pain unrelieved by
medication, numbness in fingers, and pallor. What is the nurse's priority action?
A. Elevate the extremity above heart level
B. Administer additional analgesic as ordered
C. Assess capillary refill and prepare to bivalve the cast
D. Apply ice packs around the cast edges
,CORRECT ANSWER: C. Assess capillary refill and prepare to bivalve the cast
Rationale: These symptoms suggest compartment syndrome, a surgical emergency caused by
increased pressure within a fascial compartment. Immediate assessment of neurovascular
status (capillary refill, sensation, movement) and cast bivalving are critical to restore perfusion
and prevent permanent damage. Elevation (A) may worsen ischemia in compartment
syndrome. Analgesics (B) mask symptoms without addressing the cause. Ice (D) is
contraindicated as it may further impair circulation.
Question 8: Which intervention is most effective in preventing ventilator-associated
pneumonia (VAP) in a mechanically ventilated patient?
A. Administering prophylactic antibiotics daily
B. Performing oral care with chlorhexidine every 4 hours
C. Keeping the head of the bed elevated to 30–45 degrees
D. Suctioning the endotracheal tube every hour
CORRECT ANSWER: C. Keeping the head of the bed elevated to 30–45 degrees
Rationale: Elevating the head of the bed reduces aspiration of gastric contents, a primary
mechanism of VAP. This is a core component of the VAP prevention bundle endorsed by CDC
and professional societies. Chlorhexidine oral care (B) is also recommended but secondary to
positioning. Prophylactic antibiotics (A) increase resistance risk and are not standard. Routine
suctioning (D) is not indicated and may cause mucosal trauma.
Question 9: A patient with systemic lupus erythematosus (SLE) is prescribed
hydroxychloroquine. Which teaching point is essential for the nurse to include?
A. "Take this medication with food to prevent nausea."
B. "Report any visual changes or difficulty reading immediately."
C. "Avoid sunlight exposure and use broad-spectrum sunscreen."
D. "This medication may cause your urine to turn orange."
CORRECT ANSWER: B. "Report any visual changes or difficulty reading immediately."
Rationale: Hydroxychloroquine can cause retinal toxicity with prolonged use, leading to
irreversible vision loss. Baseline and annual ophthalmologic exams are required, and patients
must report visual symptoms promptly. While photosensitivity (C) is relevant to SLE itself, it is
not the priority teaching for hydroxychloroquine. Nausea (A) is a minor side effect. Orange
urine (D) is associated with rifampin, not hydroxychloroquine.
Question 10: Which assessment finding in a patient with a suspected pulmonary embolism
requires immediate intervention?
A. Pleuritic chest pain
B. Tachycardia with heart rate 118 bpm
C. Oxygen saturation 88% on room air
D. Mild dyspnea on exertion
CORRECT ANSWER: C. Oxygen saturation 88% on room air
Rationale: Hypoxemia (SpO₂ <90%) indicates significant ventilation-perfusion mismatch and
requires immediate oxygen therapy and further intervention. While tachycardia (B), pleuritic
pain (A), and dyspnea (D) are common in PE, they are less immediately life-threatening than
severe hypoxia, which can rapidly progress to respiratory failure or cardiac arrest.
, Question 11: A patient with cirrhosis has a serum ammonia level of 98 µg/dL (normal: 15–45
µg/dL). Which medication should the nurse anticipate administering?
A. Lactulose
B. Omeprazole
C. Spironolactone
D. Metoclopramide
CORRECT ANSWER: A. Lactulose
Rationale: Lactulose reduces ammonia production in the gut by acidifying the colon and
promoting excretion, making it first-line for hepatic encephalopathy associated with elevated
ammonia. Omeprazole (B) reduces gastric acid but does not lower ammonia. Spironolactone (C)
manages ascites. Metoclopramide (D) treats nausea but is not indicated for hyperammonemia.
Question 12: During a blood transfusion, a patient develops chills, fever, and back pain. What
is the nurse's priority action?
A. Stop the transfusion and keep the vein open with normal saline
B. Administer acetaminophen for fever
C. Obtain blood cultures from the patient
D. Notify the blood bank immediately
CORRECT ANSWER: A. Stop the transfusion and keep the vein open with normal saline
Rationale: These symptoms suggest an acute hemolytic transfusion reaction, a medical
emergency. The immediate action is to stop the transfusion to prevent further infusion of
incompatible blood, maintain IV access with saline for emergency medications, and then notify
the blood bank and provider. Administering antipyretics (B) or obtaining cultures (C) occurs
after stopping the transfusion. Notification (D) is critical but follows the immediate safety
action.
Question 13: Which finding indicates effective treatment for a patient in diabetic ketoacidosis
(DKA)?
A. Serum glucose 180 mg/dL
B. Serum bicarbonate 18 mEq/L
C. Anion gap 16 mEq/L
D. Urine ketones negative
CORRECT ANSWER: A. Serum glucose 180 mg/dL
Rationale: In DKA management, glucose should gradually decrease to 200–250 mg/dL before
adding dextrose to IV fluids to prevent cerebral edema while continuing insulin to resolve
ketosis. A glucose of 180 mg/dL indicates appropriate control. Bicarbonate (B) and anion gap
(C) should normalize (bicarbonate >18, gap <12) to confirm resolution of acidosis, but glucose
control is an early indicator. Urine ketones (D) may remain positive despite clinical
improvement due to delayed clearance.
Question 14: A patient with a T5 spinal cord injury develops a severe headache, hypertension
(190/110 mm Hg), and bradycardia. What is the nurse's priority intervention?
A. Administer antihypertensive medication
B. Assess for bladder distention or fecal impaction
