Relias Medical Surgical Nursing Exam Questions
and Answers Latest Update | Comprehensive
Relias Med-Surg Study Guide, Test Bank, Practice
Questions with Verified Answers and Detailed
Rationales for Nursing Students Preparing for
Medical-Surgical Nursing Assessments
Question 1: A patient with heart failure is prescribed furosemide. Which assessment finding indicates
the medication is effective?
A. Increased peripheral edema
B. Weight gain of 2 kg in 24 hours
C. Decreased crackles in lung fields
D. Elevated blood pressure
CORRECT ANSWER: C. Decreased crackles in lung fields
RATIONALE: Furosemide is a loop diuretic that promotes fluid elimination, reducing pulmonary
congestion in heart failure. Decreased crackles indicate improved fluid status and effective medication
action. Increased edema, weight gain, or elevated BP would suggest treatment failure or worsening
condition.
Question 2: Which intervention is priority for a patient experiencing an acute asthma exacerbation?
A. Administer prescribed albuterol via nebulizer
B. Obtain a detailed allergy history
C. Schedule pulmonary function testing
D. Provide discharge education materials
CORRECT ANSWER: A. Administer prescribed albuterol via nebulizer
RATIONALE: During an acute asthma exacerbation, immediate bronchodilation is critical to reverse
airway constriction and improve oxygenation. Albuterol, a short-acting beta-agonist, is first-line
treatment. Assessment and education are important but secondary to stabilizing the airway.
Question 3: A postoperative patient reports sudden chest pain and dyspnea. Which condition should
the nurse suspect first?
A. Pneumonia
B. Pulmonary embolism
C. Atelectasis
D. Myocardial infarction
CORRECT ANSWER: B. Pulmonary embolism
RATIONALE: Sudden onset chest pain and dyspnea in a postoperative patient are classic signs of
pulmonary embolism, a life-threatening complication related to immobility and hypercoagulability.
While other options are possible, PE requires immediate intervention to prevent mortality.
,Question 4: Which laboratory value is most indicative of acute kidney injury?
A. Serum potassium 3.5 mEq/L
B. Blood urea nitrogen 10 mg/dL
C. Serum creatinine 3.2 mg/dL
D. Sodium 140 mEq/L
CORRECT ANSWER: C. Serum creatinine 3.2 mg/dL
RATIONALE: Elevated serum creatinine reflects decreased glomerular filtration rate and is a key
diagnostic indicator of acute kidney injury. Normal creatinine ranges from 0.6-1.2 mg/dL. Potassium,
BUN, and sodium values listed are within normal limits and less specific for AKI diagnosis.
Question 5: A patient with type 1 diabetes exhibits confusion, diaphoresis, and tremors. What is the
nurse's first action?
A. Administer scheduled insulin dose
B. Check blood glucose level
C. Provide complex carbohydrate snack
D. Notify the healthcare provider
CORRECT ANSWER: B. Check blood glucose level
RATIONALE: These symptoms suggest hypoglycemia, a medical emergency in diabetes. Assessment of
blood glucose must precede intervention to confirm the diagnosis and guide appropriate treatment.
Administering insulin without confirmation could be fatal.
Question 6: Which finding in a patient with a closed head injury requires immediate notification of the
provider?
A. Pupils equal and reactive at 3 mm
B. Glasgow Coma Scale score decrease from 14 to 10
C. Report of mild headache
D. Blood pressure 130/85 mmHg
CORRECT ANSWER: B. Glasgow Coma Scale score decrease from 14 to 10
RATIONALE: A declining GCS score indicates neurological deterioration and possible increased
intracranial pressure, requiring urgent intervention. Equal pupils, mild headache, and stable BP are
expected findings that do not indicate acute crisis.
Question 7: What is the priority nursing intervention for a patient with a new tracheostomy?
A. Suction the airway as needed
B. Change tracheostomy ties daily
C. Provide humidified oxygen
D. Maintain cuff pressure at 20-25 cm H2O
CORRECT ANSWER: A. Suction the airway as needed
,RATIONALE: Airway patency is the highest priority. Suctioning removes secretions that could obstruct
the tracheostomy tube. While cuff pressure, humidification, and tie changes are important, they do not
take precedence over maintaining a clear airway.
Question 8: A patient receiving vancomycin develops redness and itching on the neck and upper torso.
What is the nurse's priority action?
A. Document the finding and continue infusion
B. Stop the infusion immediately
C. Administer diphenhydramine as ordered
D. Apply cool compresses to affected areas
CORRECT ANSWER: B. Stop the infusion immediately
RATIONALE: These symptoms suggest Red Man Syndrome, a vancomycin infusion reaction. Stopping
the infusion prevents progression to anaphylaxis. Antihistamines and comfort measures follow after the
infusion is halted.
Question 9: Which assessment finding indicates effective treatment for a patient with diabetic
ketoacidosis?
A. Blood glucose 450 mg/dL
B. Serum bicarbonate 10 mEq/L
C. Arterial pH 7.25
D. Blood glucose 180 mg/dL with anion gap closing
CORRECT ANSWER: D. Blood glucose 180 mg/dL with anion gap closing
RATIONALE: Resolution of DKA is indicated by decreasing blood glucose toward target range, closing
anion gap, and normalization of pH and bicarbonate. Options A, B, and C reflect ongoing metabolic
acidosis and inadequate treatment response.
Question 10: A patient with cirrhosis has ascites. Which intervention helps manage fluid
accumulation?
A. Restrict dietary protein to 20 g/day
B. Administer spironolactone as prescribed
C. Encourage oral fluid intake of 3 L/day
D. Position supine with legs elevated
CORRECT ANSWER: B. Administer spironolactone as prescribed
RATIONALE: Spironolactone, a potassium-sparing diuretic, is first-line pharmacologic treatment for
ascites in cirrhosis. Protein restriction is not indicated unless hepatic encephalopathy is present; fluid
restriction may be needed; positioning does not resolve ascites.
Question 11: Which sign is most suggestive of compartment syndrome in a patient with a casted
forearm fracture?
, A. Mild swelling at cast edges
B. Pain unrelieved by opioid analgesics
C. Capillary refill of 2 seconds
D. Ability to wiggle fingers
CORRECT ANSWER: B. Pain unrelieved by opioid analgesics
RATIONALE: Disproportionate, unrelenting pain is the earliest and most reliable indicator of
compartment syndrome. Other classic signs include paresthesia, pallor, paralysis, and pulselessness (late
sign). Mild swelling and normal neurovascular checks are expected post-fracture.
Question 12: A patient with chronic obstructive pulmonary disease is prescribed oxygen at 2 L/min via
nasal cannula. Why is higher flow contraindicated?
A. Risk of oxygen toxicity
B. Suppression of hypoxic drive
C. Increased carbon dioxide retention
D. Both B and C
CORRECT ANSWER: D. Both B and C
RATIONALE: COPD patients may rely on hypoxic drive for ventilation. High-flow oxygen can suppress
this drive and worsen CO2 retention, leading to respiratory acidosis and potential failure. Oxygen
toxicity is a concern with prolonged high concentrations but not the primary issue here.
Question 13: Which laboratory result requires immediate intervention in a patient receiving warfarin?
A. INR 2.5
B. INR 5.8
C. PT 14 seconds
D. aPTT 30 seconds
CORRECT ANSWER: B. INR 5.8
RATIONALE: Therapeutic INR for most indications is 2.0-3.0 (or 2.5-3.5 for mechanical valves). An INR of
5.8 indicates excessive anticoagulation and high bleeding risk, requiring dose hold and possible reversal.
PT and aPTT are not primary monitors for warfarin.
Question 14: A postoperative patient has not voided 8 hours after surgery. What is the nurse's first
action?
A. Straight catheterize the patient
B. Assess for bladder distension
C. Encourage increased oral fluids
D. Notify the surgeon
CORRECT ANSWER: B. Assess for bladder distension
and Answers Latest Update | Comprehensive
Relias Med-Surg Study Guide, Test Bank, Practice
Questions with Verified Answers and Detailed
Rationales for Nursing Students Preparing for
Medical-Surgical Nursing Assessments
Question 1: A patient with heart failure is prescribed furosemide. Which assessment finding indicates
the medication is effective?
A. Increased peripheral edema
B. Weight gain of 2 kg in 24 hours
C. Decreased crackles in lung fields
D. Elevated blood pressure
CORRECT ANSWER: C. Decreased crackles in lung fields
RATIONALE: Furosemide is a loop diuretic that promotes fluid elimination, reducing pulmonary
congestion in heart failure. Decreased crackles indicate improved fluid status and effective medication
action. Increased edema, weight gain, or elevated BP would suggest treatment failure or worsening
condition.
Question 2: Which intervention is priority for a patient experiencing an acute asthma exacerbation?
A. Administer prescribed albuterol via nebulizer
B. Obtain a detailed allergy history
C. Schedule pulmonary function testing
D. Provide discharge education materials
CORRECT ANSWER: A. Administer prescribed albuterol via nebulizer
RATIONALE: During an acute asthma exacerbation, immediate bronchodilation is critical to reverse
airway constriction and improve oxygenation. Albuterol, a short-acting beta-agonist, is first-line
treatment. Assessment and education are important but secondary to stabilizing the airway.
Question 3: A postoperative patient reports sudden chest pain and dyspnea. Which condition should
the nurse suspect first?
A. Pneumonia
B. Pulmonary embolism
C. Atelectasis
D. Myocardial infarction
CORRECT ANSWER: B. Pulmonary embolism
RATIONALE: Sudden onset chest pain and dyspnea in a postoperative patient are classic signs of
pulmonary embolism, a life-threatening complication related to immobility and hypercoagulability.
While other options are possible, PE requires immediate intervention to prevent mortality.
,Question 4: Which laboratory value is most indicative of acute kidney injury?
A. Serum potassium 3.5 mEq/L
B. Blood urea nitrogen 10 mg/dL
C. Serum creatinine 3.2 mg/dL
D. Sodium 140 mEq/L
CORRECT ANSWER: C. Serum creatinine 3.2 mg/dL
RATIONALE: Elevated serum creatinine reflects decreased glomerular filtration rate and is a key
diagnostic indicator of acute kidney injury. Normal creatinine ranges from 0.6-1.2 mg/dL. Potassium,
BUN, and sodium values listed are within normal limits and less specific for AKI diagnosis.
Question 5: A patient with type 1 diabetes exhibits confusion, diaphoresis, and tremors. What is the
nurse's first action?
A. Administer scheduled insulin dose
B. Check blood glucose level
C. Provide complex carbohydrate snack
D. Notify the healthcare provider
CORRECT ANSWER: B. Check blood glucose level
RATIONALE: These symptoms suggest hypoglycemia, a medical emergency in diabetes. Assessment of
blood glucose must precede intervention to confirm the diagnosis and guide appropriate treatment.
Administering insulin without confirmation could be fatal.
Question 6: Which finding in a patient with a closed head injury requires immediate notification of the
provider?
A. Pupils equal and reactive at 3 mm
B. Glasgow Coma Scale score decrease from 14 to 10
C. Report of mild headache
D. Blood pressure 130/85 mmHg
CORRECT ANSWER: B. Glasgow Coma Scale score decrease from 14 to 10
RATIONALE: A declining GCS score indicates neurological deterioration and possible increased
intracranial pressure, requiring urgent intervention. Equal pupils, mild headache, and stable BP are
expected findings that do not indicate acute crisis.
Question 7: What is the priority nursing intervention for a patient with a new tracheostomy?
A. Suction the airway as needed
B. Change tracheostomy ties daily
C. Provide humidified oxygen
D. Maintain cuff pressure at 20-25 cm H2O
CORRECT ANSWER: A. Suction the airway as needed
,RATIONALE: Airway patency is the highest priority. Suctioning removes secretions that could obstruct
the tracheostomy tube. While cuff pressure, humidification, and tie changes are important, they do not
take precedence over maintaining a clear airway.
Question 8: A patient receiving vancomycin develops redness and itching on the neck and upper torso.
What is the nurse's priority action?
A. Document the finding and continue infusion
B. Stop the infusion immediately
C. Administer diphenhydramine as ordered
D. Apply cool compresses to affected areas
CORRECT ANSWER: B. Stop the infusion immediately
RATIONALE: These symptoms suggest Red Man Syndrome, a vancomycin infusion reaction. Stopping
the infusion prevents progression to anaphylaxis. Antihistamines and comfort measures follow after the
infusion is halted.
Question 9: Which assessment finding indicates effective treatment for a patient with diabetic
ketoacidosis?
A. Blood glucose 450 mg/dL
B. Serum bicarbonate 10 mEq/L
C. Arterial pH 7.25
D. Blood glucose 180 mg/dL with anion gap closing
CORRECT ANSWER: D. Blood glucose 180 mg/dL with anion gap closing
RATIONALE: Resolution of DKA is indicated by decreasing blood glucose toward target range, closing
anion gap, and normalization of pH and bicarbonate. Options A, B, and C reflect ongoing metabolic
acidosis and inadequate treatment response.
Question 10: A patient with cirrhosis has ascites. Which intervention helps manage fluid
accumulation?
A. Restrict dietary protein to 20 g/day
B. Administer spironolactone as prescribed
C. Encourage oral fluid intake of 3 L/day
D. Position supine with legs elevated
CORRECT ANSWER: B. Administer spironolactone as prescribed
RATIONALE: Spironolactone, a potassium-sparing diuretic, is first-line pharmacologic treatment for
ascites in cirrhosis. Protein restriction is not indicated unless hepatic encephalopathy is present; fluid
restriction may be needed; positioning does not resolve ascites.
Question 11: Which sign is most suggestive of compartment syndrome in a patient with a casted
forearm fracture?
, A. Mild swelling at cast edges
B. Pain unrelieved by opioid analgesics
C. Capillary refill of 2 seconds
D. Ability to wiggle fingers
CORRECT ANSWER: B. Pain unrelieved by opioid analgesics
RATIONALE: Disproportionate, unrelenting pain is the earliest and most reliable indicator of
compartment syndrome. Other classic signs include paresthesia, pallor, paralysis, and pulselessness (late
sign). Mild swelling and normal neurovascular checks are expected post-fracture.
Question 12: A patient with chronic obstructive pulmonary disease is prescribed oxygen at 2 L/min via
nasal cannula. Why is higher flow contraindicated?
A. Risk of oxygen toxicity
B. Suppression of hypoxic drive
C. Increased carbon dioxide retention
D. Both B and C
CORRECT ANSWER: D. Both B and C
RATIONALE: COPD patients may rely on hypoxic drive for ventilation. High-flow oxygen can suppress
this drive and worsen CO2 retention, leading to respiratory acidosis and potential failure. Oxygen
toxicity is a concern with prolonged high concentrations but not the primary issue here.
Question 13: Which laboratory result requires immediate intervention in a patient receiving warfarin?
A. INR 2.5
B. INR 5.8
C. PT 14 seconds
D. aPTT 30 seconds
CORRECT ANSWER: B. INR 5.8
RATIONALE: Therapeutic INR for most indications is 2.0-3.0 (or 2.5-3.5 for mechanical valves). An INR of
5.8 indicates excessive anticoagulation and high bleeding risk, requiring dose hold and possible reversal.
PT and aPTT are not primary monitors for warfarin.
Question 14: A postoperative patient has not voided 8 hours after surgery. What is the nurse's first
action?
A. Straight catheterize the patient
B. Assess for bladder distension
C. Encourage increased oral fluids
D. Notify the surgeon
CORRECT ANSWER: B. Assess for bladder distension
