Brunner & Suddarth’S textBook of Medical-
Surgical Nursing Study Guides, Notes, Summaries,
and Exam Prep Resources – Adult Health
Nursing, Pathophysiology, Clinical Case Studies,
Nursing Interventions, Evidence-Based Practice,
and High-Quality Learning Materials for Nursing
Students
Question 1: A patient with chronic heart failure is prescribed furosemide 40 mg orally daily. Which
assessment finding should the nurse prioritize monitoring to evaluate the effectiveness of this
medication?
A. Blood pressure reading of 110/70 mm Hg
B. Daily weight reduction of 1 kg over 24 hours
C. Serum potassium level of 3.2 mEq/L
D. Respiratory rate of 22 breaths per minute
CORRECT ANSWER: B. Daily weight reduction of 1 kg over 24 hours
RATIONALE: Furosemide is a loop diuretic used to reduce fluid volume overload in heart failure. A
weight loss of approximately 1 kg (2.2 lb) correlates with the loss of 1 liter of fluid, making daily weight
the most sensitive and reliable indicator of diuretic effectiveness and fluid status changes. While blood
pressure, potassium levels, and respiratory rate are important monitoring parameters, they do not
directly measure the diuretic's primary therapeutic goal of fluid removal.
Question 2: During the immediate postoperative period following a total hip arthroplasty, which
nursing intervention is most critical to prevent dislocation of the prosthesis?
A. Administering prescribed anticoagulant therapy
B. Maintaining hip abduction with an abduction pillow
C. Encouraging ankle pump exercises every hour
D. Assessing neurovascular status of the affected extremity
CORRECT ANSWER: B. Maintaining hip abduction with an abduction pillow
RATIONALE: Following total hip arthroplasty, particularly with a posterior approach, maintaining hip
abduction prevents adduction and internal rotation, which are primary mechanisms of prosthetic
dislocation. While anticoagulation, ankle pumps, and neurovascular assessment are essential
postoperative interventions, they address thromboembolism prevention and circulation monitoring
rather than direct prevention of prosthesis dislocation.
Question 3: A patient with type 1 diabetes mellitus presents to the emergency department with
nausea, vomiting, abdominal pain, fruity breath odor, and a blood glucose level of 485 mg/dL. Which
laboratory finding would the nurse anticipate confirming diabetic ketoacidosis (DKA)?
,A. Serum bicarbonate level of 26 mEq/L
B. Arterial blood pH of 7.48
C. Serum ketones positive at 1:2 dilution
D. Anion gap of 8 mEq/L
CORRECT ANSWER: C. Serum ketones positive at 1:2 dilution
RATIONALE: Diabetic ketoacidosis is characterized by hyperglycemia, ketonemia/ketonuria, and
metabolic acidosis. Positive serum ketones confirm fat breakdown and ketone production, a hallmark of
DKA. Options A and B reflect normal or alkalotic values inconsistent with DKA's metabolic acidosis
(expected bicarbonate <18 mEq/L, pH <7.3). An anion gap of 8 mEq/L is within normal range (8-12
mEq/L); DKA typically presents with an elevated anion gap (>12 mEq/L) due to accumulation of
ketoacids.
Question 4: When administering a blood transfusion, which action should the nurse perform
immediately before initiating the infusion to ensure patient safety?
A. Prime the blood administration set with normal saline
B. Verify the blood product with another registered nurse at the bedside
C. Obtain baseline vital signs including temperature
D. Assess the patient's intravenous site for patency
CORRECT ANSWER: B. Verify the blood product with another registered nurse at the bedside
RATIONALE: The most critical safety step immediately before initiating a blood transfusion is the
two-nurse verification process at the bedside to confirm patient identity, blood product compatibility,
expiration date, and ABO/Rh match. This final check prevents fatal hemolytic transfusion reactions.
While priming the tubing, obtaining baseline vitals, and assessing IV patency are essential preparatory
steps, they occur earlier in the process and do not constitute the final safety verification required
immediately before infusion.
Question 5: A patient diagnosed with syndrome of inappropriate antidiuretic hormone secretion
(SIADH) is likely to exhibit which electrolyte imbalance?
A. Hypernatremia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
CORRECT ANSWER: C. Hyponatremia
RATIONALE: SIADH causes excessive release of antidiuretic hormone, leading to water retention and
dilutional hyponatremia. The retained water expands extracellular fluid volume while diluting serum
sodium concentration. Hypernatremia occurs with water loss or sodium gain; hypokalemia and
hypercalcemia are not primary features of SIADH pathophysiology.
Question 6: Which clinical manifestation should the nurse recognize as an early sign of hypovolemic
shock in a postoperative patient?
,A. Bradycardia
B. Hypotension
C. Tachycardia
D. Warm, flushed skin
CORRECT ANSWER: C. Tachycardia
RATIONALE: Tachycardia is an early compensatory mechanism in hypovolemic shock as the
sympathetic nervous system increases heart rate to maintain cardiac output despite reduced circulating
volume. Hypotension is a late sign indicating decompensation. Bradycardia is not typical in early
hypovolemic shock. Warm, flushed skin characterizes distributive shock (e.g., septic, neurogenic), not
hypovolemic shock, which typically presents with cool, clammy skin.
Question 7: A patient with a newly applied long-arm cast reports severe pain unrelieved by prescribed
analgesics, along with numbness and tingling in the fingers. Which complication should the nurse
suspect?
A. Deep vein thrombosis
B. Compartment syndrome
C. Fat embolism syndrome
D. Pressure ulcer formation
CORRECT ANSWER: B. Compartment syndrome
RATIONALE: The classic presentation of compartment syndrome includes the "6 P's": pain (out of
proportion and unrelieved by medication), paresthesia (numbness/tingling), pallor, paralysis,
pulselessness, and pressure. Pain unrelieved by analgesics with neurovascular changes
(numbness/tingling) in a casted extremity is highly suggestive of compartment syndrome, a surgical
emergency. DVT presents with unilateral swelling and calf pain; fat embolism involves respiratory and
neurological symptoms; pressure ulcers develop over time with prolonged pressure.
Question 8: When teaching a patient about warfarin therapy, which statement by the patient
indicates a need for further education?
A. "I will use an electric razor instead of a blade razor."
B. "I will avoid foods high in vitamin K like spinach and kale."
C. "I will take my warfarin at the same time every day."
D. "I can take ibuprofen for headaches if needed."
CORRECT ANSWER: D. "I can take ibuprofen for headaches if needed."
RATIONALE: Ibuprofen and other NSAIDs increase the risk of bleeding when combined with warfarin
by inhibiting platelet function and potentially displacing warfarin from protein-binding sites. Patients
should use acetaminophen for pain relief instead. Options A, B, and C reflect correct understanding:
electric razors reduce bleeding risk, consistent vitamin K intake (not necessarily avoidance) stabilizes
INR, and consistent dosing time maintains therapeutic levels.
, Question 9: A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via nasal
cannula at 2 L/min. Which assessment finding indicates the oxygen therapy is effective?
A. Respiratory rate decreased from 28 to 20 breaths per minute
B. Oxygen saturation increased from 88% to 94%
C. Patient reports decreased shortness of breath
D. All of the above
CORRECT ANSWER: D. All of the above
RATIONALE: Effective oxygen therapy in COPD should improve oxygenation (increased SpO₂), reduce
work of breathing (decreased respiratory rate), and alleviate subjective dyspnea. While target SpO₂ for
COPD patients is typically 88-92% to avoid suppressing the hypoxic drive, an increase from 88% to 94%
with clinical improvement suggests appropriate titration. All three indicators together provide
comprehensive evidence of therapeutic effectiveness.
Question 10: Which nursing action is most appropriate when caring for a patient with a chest tube
connected to a water-seal drainage system?
A. Clamp the chest tube during ambulation to prevent air leaks
B. Keep the drainage system below the level of the patient's chest
C. Empty the collection chamber when it is completely full
D. Strip the chest tube hourly to maintain patency
CORRECT ANSWER: B. Keep the drainage system below the level of the patient's chest
RATIONALE: Maintaining the drainage system below chest level prevents backflow of drainage into
the pleural space, reducing infection risk and ensuring proper gravitational drainage. Clamping a chest
tube without specific orders can cause tension pneumothorax. The collection chamber should be
emptied when half to two-thirds full to avoid compromising the water seal. Stripping chest tubes is no
longer routinely recommended due to evidence of increased intrapleural pressure and tissue trauma.
Question 11: A patient with acute pancreatitis is NPO and has a nasogastric tube to low intermittent
suction. What is the primary RATIONALE for this intervention?
A. To prevent aspiration pneumonia
B. To decompress the stomach and reduce pancreatic stimulation
C. To monitor gastric bleeding
D. To facilitate enteral nutrition administration
CORRECT ANSWER: B. To decompress the stomach and reduce pancreatic stimulation
RATIONALE: Nasogastric suction in acute pancreatitis helps decompress the stomach, reduce
vomiting, and minimize gastric acid and food entry into the duodenum, thereby decreasing stimulation
of pancreatic enzyme secretion. This supports pancreatic rest, a cornerstone of acute pancreatitis
management. While aspiration prevention is a benefit, it is not the primary RATIONALE. NG tubes are
not primarily for bleeding monitoring in pancreatitis, and enteral nutrition is typically administered via
jejunal tube, not gastric, in severe cases.
Surgical Nursing Study Guides, Notes, Summaries,
and Exam Prep Resources – Adult Health
Nursing, Pathophysiology, Clinical Case Studies,
Nursing Interventions, Evidence-Based Practice,
and High-Quality Learning Materials for Nursing
Students
Question 1: A patient with chronic heart failure is prescribed furosemide 40 mg orally daily. Which
assessment finding should the nurse prioritize monitoring to evaluate the effectiveness of this
medication?
A. Blood pressure reading of 110/70 mm Hg
B. Daily weight reduction of 1 kg over 24 hours
C. Serum potassium level of 3.2 mEq/L
D. Respiratory rate of 22 breaths per minute
CORRECT ANSWER: B. Daily weight reduction of 1 kg over 24 hours
RATIONALE: Furosemide is a loop diuretic used to reduce fluid volume overload in heart failure. A
weight loss of approximately 1 kg (2.2 lb) correlates with the loss of 1 liter of fluid, making daily weight
the most sensitive and reliable indicator of diuretic effectiveness and fluid status changes. While blood
pressure, potassium levels, and respiratory rate are important monitoring parameters, they do not
directly measure the diuretic's primary therapeutic goal of fluid removal.
Question 2: During the immediate postoperative period following a total hip arthroplasty, which
nursing intervention is most critical to prevent dislocation of the prosthesis?
A. Administering prescribed anticoagulant therapy
B. Maintaining hip abduction with an abduction pillow
C. Encouraging ankle pump exercises every hour
D. Assessing neurovascular status of the affected extremity
CORRECT ANSWER: B. Maintaining hip abduction with an abduction pillow
RATIONALE: Following total hip arthroplasty, particularly with a posterior approach, maintaining hip
abduction prevents adduction and internal rotation, which are primary mechanisms of prosthetic
dislocation. While anticoagulation, ankle pumps, and neurovascular assessment are essential
postoperative interventions, they address thromboembolism prevention and circulation monitoring
rather than direct prevention of prosthesis dislocation.
Question 3: A patient with type 1 diabetes mellitus presents to the emergency department with
nausea, vomiting, abdominal pain, fruity breath odor, and a blood glucose level of 485 mg/dL. Which
laboratory finding would the nurse anticipate confirming diabetic ketoacidosis (DKA)?
,A. Serum bicarbonate level of 26 mEq/L
B. Arterial blood pH of 7.48
C. Serum ketones positive at 1:2 dilution
D. Anion gap of 8 mEq/L
CORRECT ANSWER: C. Serum ketones positive at 1:2 dilution
RATIONALE: Diabetic ketoacidosis is characterized by hyperglycemia, ketonemia/ketonuria, and
metabolic acidosis. Positive serum ketones confirm fat breakdown and ketone production, a hallmark of
DKA. Options A and B reflect normal or alkalotic values inconsistent with DKA's metabolic acidosis
(expected bicarbonate <18 mEq/L, pH <7.3). An anion gap of 8 mEq/L is within normal range (8-12
mEq/L); DKA typically presents with an elevated anion gap (>12 mEq/L) due to accumulation of
ketoacids.
Question 4: When administering a blood transfusion, which action should the nurse perform
immediately before initiating the infusion to ensure patient safety?
A. Prime the blood administration set with normal saline
B. Verify the blood product with another registered nurse at the bedside
C. Obtain baseline vital signs including temperature
D. Assess the patient's intravenous site for patency
CORRECT ANSWER: B. Verify the blood product with another registered nurse at the bedside
RATIONALE: The most critical safety step immediately before initiating a blood transfusion is the
two-nurse verification process at the bedside to confirm patient identity, blood product compatibility,
expiration date, and ABO/Rh match. This final check prevents fatal hemolytic transfusion reactions.
While priming the tubing, obtaining baseline vitals, and assessing IV patency are essential preparatory
steps, they occur earlier in the process and do not constitute the final safety verification required
immediately before infusion.
Question 5: A patient diagnosed with syndrome of inappropriate antidiuretic hormone secretion
(SIADH) is likely to exhibit which electrolyte imbalance?
A. Hypernatremia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
CORRECT ANSWER: C. Hyponatremia
RATIONALE: SIADH causes excessive release of antidiuretic hormone, leading to water retention and
dilutional hyponatremia. The retained water expands extracellular fluid volume while diluting serum
sodium concentration. Hypernatremia occurs with water loss or sodium gain; hypokalemia and
hypercalcemia are not primary features of SIADH pathophysiology.
Question 6: Which clinical manifestation should the nurse recognize as an early sign of hypovolemic
shock in a postoperative patient?
,A. Bradycardia
B. Hypotension
C. Tachycardia
D. Warm, flushed skin
CORRECT ANSWER: C. Tachycardia
RATIONALE: Tachycardia is an early compensatory mechanism in hypovolemic shock as the
sympathetic nervous system increases heart rate to maintain cardiac output despite reduced circulating
volume. Hypotension is a late sign indicating decompensation. Bradycardia is not typical in early
hypovolemic shock. Warm, flushed skin characterizes distributive shock (e.g., septic, neurogenic), not
hypovolemic shock, which typically presents with cool, clammy skin.
Question 7: A patient with a newly applied long-arm cast reports severe pain unrelieved by prescribed
analgesics, along with numbness and tingling in the fingers. Which complication should the nurse
suspect?
A. Deep vein thrombosis
B. Compartment syndrome
C. Fat embolism syndrome
D. Pressure ulcer formation
CORRECT ANSWER: B. Compartment syndrome
RATIONALE: The classic presentation of compartment syndrome includes the "6 P's": pain (out of
proportion and unrelieved by medication), paresthesia (numbness/tingling), pallor, paralysis,
pulselessness, and pressure. Pain unrelieved by analgesics with neurovascular changes
(numbness/tingling) in a casted extremity is highly suggestive of compartment syndrome, a surgical
emergency. DVT presents with unilateral swelling and calf pain; fat embolism involves respiratory and
neurological symptoms; pressure ulcers develop over time with prolonged pressure.
Question 8: When teaching a patient about warfarin therapy, which statement by the patient
indicates a need for further education?
A. "I will use an electric razor instead of a blade razor."
B. "I will avoid foods high in vitamin K like spinach and kale."
C. "I will take my warfarin at the same time every day."
D. "I can take ibuprofen for headaches if needed."
CORRECT ANSWER: D. "I can take ibuprofen for headaches if needed."
RATIONALE: Ibuprofen and other NSAIDs increase the risk of bleeding when combined with warfarin
by inhibiting platelet function and potentially displacing warfarin from protein-binding sites. Patients
should use acetaminophen for pain relief instead. Options A, B, and C reflect correct understanding:
electric razors reduce bleeding risk, consistent vitamin K intake (not necessarily avoidance) stabilizes
INR, and consistent dosing time maintains therapeutic levels.
, Question 9: A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via nasal
cannula at 2 L/min. Which assessment finding indicates the oxygen therapy is effective?
A. Respiratory rate decreased from 28 to 20 breaths per minute
B. Oxygen saturation increased from 88% to 94%
C. Patient reports decreased shortness of breath
D. All of the above
CORRECT ANSWER: D. All of the above
RATIONALE: Effective oxygen therapy in COPD should improve oxygenation (increased SpO₂), reduce
work of breathing (decreased respiratory rate), and alleviate subjective dyspnea. While target SpO₂ for
COPD patients is typically 88-92% to avoid suppressing the hypoxic drive, an increase from 88% to 94%
with clinical improvement suggests appropriate titration. All three indicators together provide
comprehensive evidence of therapeutic effectiveness.
Question 10: Which nursing action is most appropriate when caring for a patient with a chest tube
connected to a water-seal drainage system?
A. Clamp the chest tube during ambulation to prevent air leaks
B. Keep the drainage system below the level of the patient's chest
C. Empty the collection chamber when it is completely full
D. Strip the chest tube hourly to maintain patency
CORRECT ANSWER: B. Keep the drainage system below the level of the patient's chest
RATIONALE: Maintaining the drainage system below chest level prevents backflow of drainage into
the pleural space, reducing infection risk and ensuring proper gravitational drainage. Clamping a chest
tube without specific orders can cause tension pneumothorax. The collection chamber should be
emptied when half to two-thirds full to avoid compromising the water seal. Stripping chest tubes is no
longer routinely recommended due to evidence of increased intrapleural pressure and tissue trauma.
Question 11: A patient with acute pancreatitis is NPO and has a nasogastric tube to low intermittent
suction. What is the primary RATIONALE for this intervention?
A. To prevent aspiration pneumonia
B. To decompress the stomach and reduce pancreatic stimulation
C. To monitor gastric bleeding
D. To facilitate enteral nutrition administration
CORRECT ANSWER: B. To decompress the stomach and reduce pancreatic stimulation
RATIONALE: Nasogastric suction in acute pancreatitis helps decompress the stomach, reduce
vomiting, and minimize gastric acid and food entry into the duodenum, thereby decreasing stimulation
of pancreatic enzyme secretion. This supports pancreatic rest, a cornerstone of acute pancreatitis
management. While aspiration prevention is a benefit, it is not the primary RATIONALE. NG tubes are
not primarily for bleeding monitoring in pancreatitis, and enteral nutrition is typically administered via
jejunal tube, not gastric, in severe cases.
