NEWEST JERSY COLLEGE MED
SURG 1 RN MIDTERM EXAM
2026/2027 ACCURATE TEST AND
STUDY GUIDE COMPLETE
EXAM
Question 1:
A client is admitted with a serum sodium level of 128 mEq/L. Which assessment finding
would the nurse expect?
A) Thirst and dry mucous membranes
B) Muscle twitching and seizures
C) Edema and hypertension
D) Bradycardia and hypotension
Correct Answer: B) Muscle twitching and seizures
Rationale: Hyponatremia (sodium <135 mEq/L) can cause neurological symptoms
including muscle twitching, seizures, confusion, and coma due to cerebral edema. Thirst
and dry mucous membranes are signs of hypernatremia .
Question 2:
A patient presents with abdominal pain and a rigid abdomen. What should the nurse do
first?
A) Assess vital signs
B) Prepare the patient for surgery
C) Administer pain medication
D) Obtain a complete history
Correct Answer: A) Assess vital signs
Rationale: A rigid abdomen may indicate peritonitis, which is life-threatening. Vital
signs help determine the patient’s stability .
Question 3:
A client with chronic kidney disease has a serum phosphorus level of 6.2 mg/dL. Which
medication should the nurse anticipate administering?
A) Calcium acetate
B) Epoetin alfa
,C) Calcitriol
D) Furosemide
Correct Answer: A) Calcium acetate
Rationale: Calcium acetate is a phosphate binder that helps lower serum phosphorus by
binding dietary phosphate in the gut .
Question 4:
A patient with deep vein thrombosis (DVT) is started on warfarin. Which laboratory value
should the nurse monitor to determine the medication's effectiveness?
A) Platelet count
B) International Normalized Ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Hemoglobin
Correct Answer: B) International Normalized Ratio (INR)
Rationale: INR is used to monitor the therapeutic effect of warfarin .
Question 5:
The nurse is preparing to administer an IV medication to a patient. What is the nurse’s
first action before administration?
A) Verify the patient’s allergies
B) Assess the IV site for patency
C) Check the medication dose and label
D) Wash hands thoroughly
Correct Answer: D) Wash hands thoroughly
Rationale: Hand hygiene is the first and most crucial step in preventing infection when
administering any medication
6. A patient is post-operative day 1 after a right total knee
arthroplasty. Which finding requires immediate notification of the
healthcare provider?
A) Pain level of 6 on a 0–10 scale
B) Temperature of 99.8°F (37.7°C)
,C) Oxygen saturation of 89% on room air
D) Small amount of serosanguineous drainage on dressing
Correct Answer: C) Oxygen saturation of 89% on room air
Rationale: An SpO2 of 89% indicates hypoxemia and may be a sign of pulmonary
embolism (PE), a life-threatening complication after orthopedic surgery. Pain, low-grade
fever, and minimal drainage are expected findings.
7. A client with heart failure is prescribed furosemide 40 mg IV
push. Which laboratory value should the nurse monitor most
closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B) Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
can lead to cardiac dysrhythmias.
8. The nurse is caring for a client with cirrhosis who develops
asterixis. What is the priority nursing intervention?
A) Administer lactulose as prescribed
B) Restrict dietary protein intake
, C) Prepare for paracentesis
D) Elevate the head of the bed
Correct Answer: A) Administer lactulose as prescribed
Rationale: Asterixis (liver flap) is a sign of hepatic encephalopathy due to elevated
ammonia levels. Lactulose helps excrete ammonia.
9. A patient receiving a blood transfusion develops chills, fever,
and back pain 30 minutes after initiation. What is the nurse’s
priority action?
A) Administer acetaminophen
B) Slow the transfusion rate
C) Stop the transfusion immediately
D) Notify the healthcare provider
Correct Answer: C) Stop the transfusion immediately
Rationale: These symptoms suggest an acute hemolytic transfusion reaction. The
transfusion must be stopped immediately, then the IV line kept open with saline, and
the provider notified.
10. Which assessment finding in a client with chronic obstructive
pulmonary disease (COPD) indicates worsening respiratory status?
A) Increased anteroposterior chest diameter
B) Use of accessory muscles
SURG 1 RN MIDTERM EXAM
2026/2027 ACCURATE TEST AND
STUDY GUIDE COMPLETE
EXAM
Question 1:
A client is admitted with a serum sodium level of 128 mEq/L. Which assessment finding
would the nurse expect?
A) Thirst and dry mucous membranes
B) Muscle twitching and seizures
C) Edema and hypertension
D) Bradycardia and hypotension
Correct Answer: B) Muscle twitching and seizures
Rationale: Hyponatremia (sodium <135 mEq/L) can cause neurological symptoms
including muscle twitching, seizures, confusion, and coma due to cerebral edema. Thirst
and dry mucous membranes are signs of hypernatremia .
Question 2:
A patient presents with abdominal pain and a rigid abdomen. What should the nurse do
first?
A) Assess vital signs
B) Prepare the patient for surgery
C) Administer pain medication
D) Obtain a complete history
Correct Answer: A) Assess vital signs
Rationale: A rigid abdomen may indicate peritonitis, which is life-threatening. Vital
signs help determine the patient’s stability .
Question 3:
A client with chronic kidney disease has a serum phosphorus level of 6.2 mg/dL. Which
medication should the nurse anticipate administering?
A) Calcium acetate
B) Epoetin alfa
,C) Calcitriol
D) Furosemide
Correct Answer: A) Calcium acetate
Rationale: Calcium acetate is a phosphate binder that helps lower serum phosphorus by
binding dietary phosphate in the gut .
Question 4:
A patient with deep vein thrombosis (DVT) is started on warfarin. Which laboratory value
should the nurse monitor to determine the medication's effectiveness?
A) Platelet count
B) International Normalized Ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Hemoglobin
Correct Answer: B) International Normalized Ratio (INR)
Rationale: INR is used to monitor the therapeutic effect of warfarin .
Question 5:
The nurse is preparing to administer an IV medication to a patient. What is the nurse’s
first action before administration?
A) Verify the patient’s allergies
B) Assess the IV site for patency
C) Check the medication dose and label
D) Wash hands thoroughly
Correct Answer: D) Wash hands thoroughly
Rationale: Hand hygiene is the first and most crucial step in preventing infection when
administering any medication
6. A patient is post-operative day 1 after a right total knee
arthroplasty. Which finding requires immediate notification of the
healthcare provider?
A) Pain level of 6 on a 0–10 scale
B) Temperature of 99.8°F (37.7°C)
,C) Oxygen saturation of 89% on room air
D) Small amount of serosanguineous drainage on dressing
Correct Answer: C) Oxygen saturation of 89% on room air
Rationale: An SpO2 of 89% indicates hypoxemia and may be a sign of pulmonary
embolism (PE), a life-threatening complication after orthopedic surgery. Pain, low-grade
fever, and minimal drainage are expected findings.
7. A client with heart failure is prescribed furosemide 40 mg IV
push. Which laboratory value should the nurse monitor most
closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B) Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
can lead to cardiac dysrhythmias.
8. The nurse is caring for a client with cirrhosis who develops
asterixis. What is the priority nursing intervention?
A) Administer lactulose as prescribed
B) Restrict dietary protein intake
, C) Prepare for paracentesis
D) Elevate the head of the bed
Correct Answer: A) Administer lactulose as prescribed
Rationale: Asterixis (liver flap) is a sign of hepatic encephalopathy due to elevated
ammonia levels. Lactulose helps excrete ammonia.
9. A patient receiving a blood transfusion develops chills, fever,
and back pain 30 minutes after initiation. What is the nurse’s
priority action?
A) Administer acetaminophen
B) Slow the transfusion rate
C) Stop the transfusion immediately
D) Notify the healthcare provider
Correct Answer: C) Stop the transfusion immediately
Rationale: These symptoms suggest an acute hemolytic transfusion reaction. The
transfusion must be stopped immediately, then the IV line kept open with saline, and
the provider notified.
10. Which assessment finding in a client with chronic obstructive
pulmonary disease (COPD) indicates worsening respiratory status?
A) Increased anteroposterior chest diameter
B) Use of accessory muscles
