FOCUS ON ADULT HEALTH MEDICAL
SURGICAL NURSING CERTIFICATION
EXAMINATION 2026 COMPREHENSIVE STUDY
SHEET
◉ A nurse teaches a client with gastroesophageal reflux disease
(GERD) about measures to manage the disease. What does the nurse
encourage the client to do to obtain relief of the symptoms? Select all
that apply. Answer: Use chewing gum and oral lozenges
Elevate the head of the bed at least 6 to 8 inches (15 to 20 cm) for
sleep
Rationale: The discomfort of reflux is aggravated by positions that
compress the abdomen and the stomach. These positions include
lying prone or supine, especially after a meal. The client should be
advised to elevate the head of the bed at least 6 to 8 inches (15 to 20
cm) for sleep. The client is also encouraged to eat four to six small
meals a day to prevent abdominal fullness and subsequent reflux.
The client is also taught to avoid foods, such as chocolate,
peppermint, tomatoes, coffee, and tea, because they that decrease
lower esophageal sphincter pressure and increase the likelihood of
reflux. Chewing gum or oral lozenges, may help clients with mild
symptoms of GERD because it increases saliva production.
◉ A nurse performs a fingerstick glucose test on a client who is
receiving (Total)parenteral nutrition (TPN) and obtains a reading of
,410 mg/dL(22.8 mmol/L). On the basis of this finding, the nurse
would most appropriately: Answer: Notify the health care provider
Rationale: Hyperglycemia is one complication of TPN. Because the
glucose reading is increased, the nurse would immediately notify the
health care provider and await further instructions. Stopping the
TPN feeding, decreasing the flow rate of the TPN feeding, and
administering a dose of NPH insulin would not be implemented
without a health care provider's prescription. A sliding-scale dose of
regular (not NPH) insulin might be prescribed to keep the blood
glucose level between 180 and 200 mg/dL (10 to 11.1 mmol/L).
◉ A nurse is administering a dose of oral pyridostigmine bromide to
a client with myasthenia gravis. What does the nurse ask the client
to do before administering the medication? Answer: Take sips of
water
Rationale: Myasthenia gravis can affect the ability to swallow, so the
nurse must determine the client's ability to swallow before
administering oral medication. In this situation, there is no reason
for the client to lie on her right side or to look to the ceiling to
swallow medication. Likewise, there is no specific reason for the
client to void before taking this medication.
◉ A nurse provides instructions to a client who is taking allopurinol
for the treatment of gout. Which statements by the client indicate an
understanding of the medication? Select all that apply. Answer: "I
shouldn't drink coffee or tea anymore."
"I need to drink at least 8 glasses of fluid every day."
,Rationale: Clients taking allopurinol are encouraged to drink at least
8 glasses of fluid a day. Coffee and tea are avoided because they can
increase the level of uric acid in the body. Allopurinol is to be given
with milk or immediately after meals to ease gastric distress. If the
client experiences a rash, irritation of the eyes, or swelling of the lips
or mouth, he or she should contact the health care provider, because
these are all signs of hypersensitivity. The client should not take
large doses of vitamin C while taking allopurinol, because kidney
stones could develop.
◉ A client with phantom limb pain has decided to use
transcutaneous electrical nerve stimulation (TENS) as prescribed by
the health care provider, and the nurse provides instructions
regarding the use of the TENS unit. Which statements by the client
indicate a need for further instruction regarding this pain-relief
measure? Select all that apply. Answer: "I need to put the electrodes
on the areas that you marked."
"I'm not happy about having to stay in the hospital for this
treatment."
Rationale: The TENS unit is a battery-powered stimulator that is
worn externally. The purpose of electrical stimulation is to modify
the pain stimulus by blocking or changing a painful stimulus with
stimulation, causing the client to perceive it as less painful. The
client controls the system, thus reducing the need for analgesics. It is
attached to the skin with the use of electrodes. The client needs to
learn to adjust placement of the surface electrodes and the intensity
and timing of the stimuli to maximize pain reduction or relief. It is
, not necessary that the client remain in the hospital for this
treatment.
◉ A hospitalized client has just been found to have acute kidney
injury (AKI). The laboratory calls the nursing unit and reports that
the client has a serum potassium level of 6.4 mEq/L (6.4 mmol/L).
On the basis of this laboratory finding, the nurse should first:
Answer: Call the health care provider
Rationale: The normal serum potassium level is 3.5 to 5.0 mEq/L
(3.5-5.0 mmol/L). The client with hyperkalemia is at risk for cardiac
dysrhythmias and resultant cardiac arrest. Because of this, the
health care provider must be notified at once so that the client may
receive definitive treatment. The nurse would check the client's
sodium level and encourage the client to decrease intake of
potassium-rich foods, but these are not priority nursing
interventions. Fluid intake would not be increased, because this
would contribute to fluid overload and wouldn't effectively lower the
serum potassium level.
◉ A nurse is caring for a client who has just had a plaster leg cast
applied. Which measure does the nurse implement to prevent the
development of compartment syndrome? Answer: Elevating the
limb and applying ice to the affected leg
Rationale: Controlling edema helps prevent compartment syndrome.
This is best achieved with the use of elevation and the application of
ice. The other options are incorrect.
SURGICAL NURSING CERTIFICATION
EXAMINATION 2026 COMPREHENSIVE STUDY
SHEET
◉ A nurse teaches a client with gastroesophageal reflux disease
(GERD) about measures to manage the disease. What does the nurse
encourage the client to do to obtain relief of the symptoms? Select all
that apply. Answer: Use chewing gum and oral lozenges
Elevate the head of the bed at least 6 to 8 inches (15 to 20 cm) for
sleep
Rationale: The discomfort of reflux is aggravated by positions that
compress the abdomen and the stomach. These positions include
lying prone or supine, especially after a meal. The client should be
advised to elevate the head of the bed at least 6 to 8 inches (15 to 20
cm) for sleep. The client is also encouraged to eat four to six small
meals a day to prevent abdominal fullness and subsequent reflux.
The client is also taught to avoid foods, such as chocolate,
peppermint, tomatoes, coffee, and tea, because they that decrease
lower esophageal sphincter pressure and increase the likelihood of
reflux. Chewing gum or oral lozenges, may help clients with mild
symptoms of GERD because it increases saliva production.
◉ A nurse performs a fingerstick glucose test on a client who is
receiving (Total)parenteral nutrition (TPN) and obtains a reading of
,410 mg/dL(22.8 mmol/L). On the basis of this finding, the nurse
would most appropriately: Answer: Notify the health care provider
Rationale: Hyperglycemia is one complication of TPN. Because the
glucose reading is increased, the nurse would immediately notify the
health care provider and await further instructions. Stopping the
TPN feeding, decreasing the flow rate of the TPN feeding, and
administering a dose of NPH insulin would not be implemented
without a health care provider's prescription. A sliding-scale dose of
regular (not NPH) insulin might be prescribed to keep the blood
glucose level between 180 and 200 mg/dL (10 to 11.1 mmol/L).
◉ A nurse is administering a dose of oral pyridostigmine bromide to
a client with myasthenia gravis. What does the nurse ask the client
to do before administering the medication? Answer: Take sips of
water
Rationale: Myasthenia gravis can affect the ability to swallow, so the
nurse must determine the client's ability to swallow before
administering oral medication. In this situation, there is no reason
for the client to lie on her right side or to look to the ceiling to
swallow medication. Likewise, there is no specific reason for the
client to void before taking this medication.
◉ A nurse provides instructions to a client who is taking allopurinol
for the treatment of gout. Which statements by the client indicate an
understanding of the medication? Select all that apply. Answer: "I
shouldn't drink coffee or tea anymore."
"I need to drink at least 8 glasses of fluid every day."
,Rationale: Clients taking allopurinol are encouraged to drink at least
8 glasses of fluid a day. Coffee and tea are avoided because they can
increase the level of uric acid in the body. Allopurinol is to be given
with milk or immediately after meals to ease gastric distress. If the
client experiences a rash, irritation of the eyes, or swelling of the lips
or mouth, he or she should contact the health care provider, because
these are all signs of hypersensitivity. The client should not take
large doses of vitamin C while taking allopurinol, because kidney
stones could develop.
◉ A client with phantom limb pain has decided to use
transcutaneous electrical nerve stimulation (TENS) as prescribed by
the health care provider, and the nurse provides instructions
regarding the use of the TENS unit. Which statements by the client
indicate a need for further instruction regarding this pain-relief
measure? Select all that apply. Answer: "I need to put the electrodes
on the areas that you marked."
"I'm not happy about having to stay in the hospital for this
treatment."
Rationale: The TENS unit is a battery-powered stimulator that is
worn externally. The purpose of electrical stimulation is to modify
the pain stimulus by blocking or changing a painful stimulus with
stimulation, causing the client to perceive it as less painful. The
client controls the system, thus reducing the need for analgesics. It is
attached to the skin with the use of electrodes. The client needs to
learn to adjust placement of the surface electrodes and the intensity
and timing of the stimuli to maximize pain reduction or relief. It is
, not necessary that the client remain in the hospital for this
treatment.
◉ A hospitalized client has just been found to have acute kidney
injury (AKI). The laboratory calls the nursing unit and reports that
the client has a serum potassium level of 6.4 mEq/L (6.4 mmol/L).
On the basis of this laboratory finding, the nurse should first:
Answer: Call the health care provider
Rationale: The normal serum potassium level is 3.5 to 5.0 mEq/L
(3.5-5.0 mmol/L). The client with hyperkalemia is at risk for cardiac
dysrhythmias and resultant cardiac arrest. Because of this, the
health care provider must be notified at once so that the client may
receive definitive treatment. The nurse would check the client's
sodium level and encourage the client to decrease intake of
potassium-rich foods, but these are not priority nursing
interventions. Fluid intake would not be increased, because this
would contribute to fluid overload and wouldn't effectively lower the
serum potassium level.
◉ A nurse is caring for a client who has just had a plaster leg cast
applied. Which measure does the nurse implement to prevent the
development of compartment syndrome? Answer: Elevating the
limb and applying ice to the affected leg
Rationale: Controlling edema helps prevent compartment syndrome.
This is best achieved with the use of elevation and the application of
ice. The other options are incorrect.
