NURS230 Medical-Surgical Nursing I Practice Exam Study Guide Updated
2026 | Verified Nursing Questions and Answers with Detailed Rationales |
Cardiovascular, Respiratory, Gastrointestinal, Endocrine and Renal
Disorders, Fluid and Electrolyte Balance, Pain Management, Preoperative
and Postoperative Care, Patient Safety and Infection Control, Clinical
Judgment and NCLEX-Style Questions | Complete Exam Prep Resource for
Nursing Students Success
Question 1: A 68-year-old male patient with a history of hypertension and type 2
diabetes is admitted with chest pain. The nurse notes the patient is diaphoretic,
pale, and reports substernal chest pressure radiating to the left arm. Which action
should the nurse prioritize FIRST?
A. Administer sublingual nitroglycerin as ordered
B. Obtain a 12-lead electrocardiogram
C. Apply oxygen via nasal cannula at 2 L/min
D. Assess the patient's pain level using a 0-10 scale
CORRECT ANSWER: B. Obtain a 12-lead electrocardiogram
Rationale: In a patient presenting with symptoms suggestive of acute coronary
syndrome, obtaining a 12-lead ECG within 10 minutes of arrival is the priority nursing
action per ACC/AHA guidelines. This allows for rapid identification of ST-elevation
myocardial infarction (STEMI) and initiation of time-sensitive interventions such as
percutaneous coronary intervention. While oxygen, pain assessment, and nitroglycerin
are important, diagnostic confirmation via ECG guides all subsequent treatment
decisions.
Question 2: A patient with chronic heart failure is prescribed furosemide 40 mg
orally daily. Which assessment finding should the nurse report immediately to the
healthcare provider?
A. Weight loss of 1 kg over 2 days
B. Serum potassium level of 3.0 mEq/L
C. Blood pressure of 138/88 mm Hg
D. Mild ankle edema in the evening
CORRECT ANSWER: B. Serum potassium level of 3.0 mEq/L
Rationale: Furosemide is a loop diuretic that promotes potassium excretion, placing
patients at high risk for hypokalemia. A serum potassium level of 3.0 mEq/L is below the
normal range (3.5–5.0 mEq/L) and can cause life-threatening cardiac dysrhythmias,
muscle weakness, and fatigue. This requires immediate notification of the healthcare
provider for potassium replacement therapy. Weight loss and mild edema are expected
therapeutic responses, and the blood pressure is within acceptable limits.
,Question 3: A nurse is caring for a patient 24 hours postoperative from a total hip
arthroplasty. Which intervention is MOST important to prevent a common
postoperative complication?
A. Encourage deep breathing and coughing every 2 hours
B. Apply sequential compression devices to lower extremities
C. Administer scheduled opioid analgesics for pain control
D. Assist with early ambulation as tolerated
CORRECT ANSWER: B. Apply sequential compression devices to lower extremities
Rationale: Patients undergoing orthopedic surgery, particularly hip or knee arthroplasty,
are at high risk for venous thromboembolism (VTE) due to immobility, surgical trauma,
and hypercoagulability. Sequential compression devices (SCDs) are a critical
mechanical prophylaxis measure to promote venous return and reduce VTE risk. While
deep breathing, pain control, and ambulation are important, VTE prevention is the
highest priority in the immediate postoperative period for this specific surgery.
Question 4: A patient with type 1 diabetes mellitus presents to the emergency
department with confusion, fruity-smelling breath, and a blood glucose level of 485
mg/dL. Arterial blood gas results show pH 7.25, PaCO2 30 mm Hg, and HCO3- 14
mEq/L. Which condition is the nurse preparing to treat?
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemic unawareness
D. Lactic acidosis
CORRECT ANSWER: B. Diabetic ketoacidosis (DKA)
Rationale: The clinical presentation of hyperglycemia (>250 mg/dL), metabolic acidosis
(pH <7.3, HCO3- <18 mEq/L), ketonemia/ketonuria (suggested by fruity breath), and
altered mental status is classic for diabetic ketoacidosis (DKA). DKA is more common in
type 1 diabetes and results from absolute insulin deficiency. HHS typically presents
with extreme hyperglycemia (>600 mg/dL) without significant ketosis or acidosis.
Hypoglycemia would show low blood glucose, and lactic acidosis has different
etiologies and lab findings.
Question 5: A nurse is assessing a patient with chronic obstructive pulmonary
disease (COPD) who is receiving oxygen via nasal cannula at 2 L/min. Which finding
indicates the oxygen therapy is effective?
A. Respiratory rate of 24 breaths/min
B. Oxygen saturation of 94% on room air
C. Use of accessory muscles during inspiration
D. Arterial blood gas showing PaO2 of 88 mm Hg
CORRECT ANSWER: D. Arterial blood gas showing PaO2 of 88 mm Hg
,Rationale: For patients with COPD, the goal of oxygen therapy is to maintain adequate
oxygenation without suppressing the hypoxic drive to breathe. A PaO2 of 80–100 mm Hg
is within the normal range and indicates effective oxygenation. Oxygen saturation
targets for COPD patients are typically 88–92% to avoid hypercapnia; thus, 94% on
room air is not the goal during therapy. A respiratory rate of 24 is tachypneic, and
accessory muscle use indicates respiratory distress, both suggesting ineffective
therapy.
Question 6: A patient is admitted with a diagnosis of acute pancreatitis. Which
laboratory value should the nurse monitor MOST closely to assess disease
severity?
A. Serum amylase
B. Serum lipase
C. Serum calcium
D. White blood cell count
CORRECT ANSWER: C. Serum calcium
Rationale: While elevated amylase and lipase confirm the diagnosis of pancreatitis,
serum calcium is a key prognostic indicator. Hypocalcemia occurs due to
saponification of fatty acids by pancreatic enzymes and is associated with severe
pancreatitis and poor outcomes per Ranson's criteria and APACHE II scoring.
Monitoring calcium helps identify complications early. WBC elevation indicates
inflammation but is less specific for severity.
Question 7: A nurse is preparing to administer enoxaparin 40 mg subcutaneously to
a patient post-hip replacement surgery. Which action should the nurse take to
ensure safe administration?
A. Massage the injection site after administration
B. Expel the air bubble from the prefilled syringe
C. Inject into the abdomen at least 2 inches from the umbilicus
D. Aspirate before injecting to check for blood return
CORRECT ANSWER: C. Inject into the abdomen at least 2 inches from the umbilicus
Rationale: Enoxaparin, a low-molecular-weight heparin, should be injected
subcutaneously into the abdomen (avoiding the 2-inch area around the umbilicus) to
ensure consistent absorption and minimize bruising. The air bubble should NOT be
expelled as it helps deliver the full dose and prevents medication leakage into
subcutaneous tissue. Massaging the site increases bruising risk, and aspiration is not
recommended for subcutaneous injections of anticoagulants as it can cause tissue
trauma.
Question 8: A patient with a history of peptic ulcer disease reports sudden, severe
abdominal pain described as "tearing." The abdomen is rigid and board-like. Which
complication should the nurse suspect?
, A. Gastric outlet obstruction
B. Perforation
C. Hemorrhage
D. Penetration into adjacent organs
CORRECT ANSWER: B. Perforation
Rationale: Sudden, severe "tearing" abdominal pain with a rigid, board-like abdomen is
classic for perforation of a peptic ulcer, allowing gastric contents to leak into the
peritoneal cavity, causing chemical peritonitis. This is a surgical emergency.
Hemorrhage typically presents with hematemesis or melena, gastric outlet obstruction
with vomiting of undigested food, and penetration with pain radiating to the back
without acute peritonitis signs.
Question 9: A nurse is caring for a patient with a new colostomy. Which statement
by the patient indicates effective teaching about stoma care?
A. "I will clean the stoma with hydrogen peroxide daily."
B. "I should expect the stoma to be dark purple in color."
C. "I will empty the pouch when it is one-third to one-half full."
D. "I can use adhesive removers containing alcohol on the peristomal skin."
CORRECT ANSWER: C. I will empty the pouch when it is one-third to one-half full.
Rationale: Emptying the ostomy pouch when it is one-third to one-half full prevents
excessive weight that could pull the appliance loose and cause skin irritation or
leakage. Hydrogen peroxide is cytotoxic and impairs healing; stoma should be cleaned
with mild soap and water. A healthy stoma is beefy red; dark purple indicates ischemia.
Alcohol-based products dry and irritate peristomal skin; skin barriers should be
alcohol-free.
Question 10: A patient with chronic kidney disease stage 4 has a serum potassium
level of 6.2 mEq/L. Which electrocardiogram (ECG) change should the nurse
anticipate?
A. Prolonged PR interval
B. Tall, peaked T waves
C. ST-segment depression
D. Prominent U waves
CORRECT ANSWER: B. Tall, peaked T waves
Rationale: Hyperkalemia (serum potassium >5.0 mEq/L) causes characteristic ECG
changes starting with tall, peaked T waves due to accelerated repolarization. As
potassium rises further, PR prolongation, QRS widening, and sine wave patterns may
occur. ST depression is associated with ischemia, and prominent U waves are seen in
hypokalemia. Immediate intervention is required for potassium >6.0 mEq/L due to risk
of fatal dysrhythmias.
2026 | Verified Nursing Questions and Answers with Detailed Rationales |
Cardiovascular, Respiratory, Gastrointestinal, Endocrine and Renal
Disorders, Fluid and Electrolyte Balance, Pain Management, Preoperative
and Postoperative Care, Patient Safety and Infection Control, Clinical
Judgment and NCLEX-Style Questions | Complete Exam Prep Resource for
Nursing Students Success
Question 1: A 68-year-old male patient with a history of hypertension and type 2
diabetes is admitted with chest pain. The nurse notes the patient is diaphoretic,
pale, and reports substernal chest pressure radiating to the left arm. Which action
should the nurse prioritize FIRST?
A. Administer sublingual nitroglycerin as ordered
B. Obtain a 12-lead electrocardiogram
C. Apply oxygen via nasal cannula at 2 L/min
D. Assess the patient's pain level using a 0-10 scale
CORRECT ANSWER: B. Obtain a 12-lead electrocardiogram
Rationale: In a patient presenting with symptoms suggestive of acute coronary
syndrome, obtaining a 12-lead ECG within 10 minutes of arrival is the priority nursing
action per ACC/AHA guidelines. This allows for rapid identification of ST-elevation
myocardial infarction (STEMI) and initiation of time-sensitive interventions such as
percutaneous coronary intervention. While oxygen, pain assessment, and nitroglycerin
are important, diagnostic confirmation via ECG guides all subsequent treatment
decisions.
Question 2: A patient with chronic heart failure is prescribed furosemide 40 mg
orally daily. Which assessment finding should the nurse report immediately to the
healthcare provider?
A. Weight loss of 1 kg over 2 days
B. Serum potassium level of 3.0 mEq/L
C. Blood pressure of 138/88 mm Hg
D. Mild ankle edema in the evening
CORRECT ANSWER: B. Serum potassium level of 3.0 mEq/L
Rationale: Furosemide is a loop diuretic that promotes potassium excretion, placing
patients at high risk for hypokalemia. A serum potassium level of 3.0 mEq/L is below the
normal range (3.5–5.0 mEq/L) and can cause life-threatening cardiac dysrhythmias,
muscle weakness, and fatigue. This requires immediate notification of the healthcare
provider for potassium replacement therapy. Weight loss and mild edema are expected
therapeutic responses, and the blood pressure is within acceptable limits.
,Question 3: A nurse is caring for a patient 24 hours postoperative from a total hip
arthroplasty. Which intervention is MOST important to prevent a common
postoperative complication?
A. Encourage deep breathing and coughing every 2 hours
B. Apply sequential compression devices to lower extremities
C. Administer scheduled opioid analgesics for pain control
D. Assist with early ambulation as tolerated
CORRECT ANSWER: B. Apply sequential compression devices to lower extremities
Rationale: Patients undergoing orthopedic surgery, particularly hip or knee arthroplasty,
are at high risk for venous thromboembolism (VTE) due to immobility, surgical trauma,
and hypercoagulability. Sequential compression devices (SCDs) are a critical
mechanical prophylaxis measure to promote venous return and reduce VTE risk. While
deep breathing, pain control, and ambulation are important, VTE prevention is the
highest priority in the immediate postoperative period for this specific surgery.
Question 4: A patient with type 1 diabetes mellitus presents to the emergency
department with confusion, fruity-smelling breath, and a blood glucose level of 485
mg/dL. Arterial blood gas results show pH 7.25, PaCO2 30 mm Hg, and HCO3- 14
mEq/L. Which condition is the nurse preparing to treat?
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemic unawareness
D. Lactic acidosis
CORRECT ANSWER: B. Diabetic ketoacidosis (DKA)
Rationale: The clinical presentation of hyperglycemia (>250 mg/dL), metabolic acidosis
(pH <7.3, HCO3- <18 mEq/L), ketonemia/ketonuria (suggested by fruity breath), and
altered mental status is classic for diabetic ketoacidosis (DKA). DKA is more common in
type 1 diabetes and results from absolute insulin deficiency. HHS typically presents
with extreme hyperglycemia (>600 mg/dL) without significant ketosis or acidosis.
Hypoglycemia would show low blood glucose, and lactic acidosis has different
etiologies and lab findings.
Question 5: A nurse is assessing a patient with chronic obstructive pulmonary
disease (COPD) who is receiving oxygen via nasal cannula at 2 L/min. Which finding
indicates the oxygen therapy is effective?
A. Respiratory rate of 24 breaths/min
B. Oxygen saturation of 94% on room air
C. Use of accessory muscles during inspiration
D. Arterial blood gas showing PaO2 of 88 mm Hg
CORRECT ANSWER: D. Arterial blood gas showing PaO2 of 88 mm Hg
,Rationale: For patients with COPD, the goal of oxygen therapy is to maintain adequate
oxygenation without suppressing the hypoxic drive to breathe. A PaO2 of 80–100 mm Hg
is within the normal range and indicates effective oxygenation. Oxygen saturation
targets for COPD patients are typically 88–92% to avoid hypercapnia; thus, 94% on
room air is not the goal during therapy. A respiratory rate of 24 is tachypneic, and
accessory muscle use indicates respiratory distress, both suggesting ineffective
therapy.
Question 6: A patient is admitted with a diagnosis of acute pancreatitis. Which
laboratory value should the nurse monitor MOST closely to assess disease
severity?
A. Serum amylase
B. Serum lipase
C. Serum calcium
D. White blood cell count
CORRECT ANSWER: C. Serum calcium
Rationale: While elevated amylase and lipase confirm the diagnosis of pancreatitis,
serum calcium is a key prognostic indicator. Hypocalcemia occurs due to
saponification of fatty acids by pancreatic enzymes and is associated with severe
pancreatitis and poor outcomes per Ranson's criteria and APACHE II scoring.
Monitoring calcium helps identify complications early. WBC elevation indicates
inflammation but is less specific for severity.
Question 7: A nurse is preparing to administer enoxaparin 40 mg subcutaneously to
a patient post-hip replacement surgery. Which action should the nurse take to
ensure safe administration?
A. Massage the injection site after administration
B. Expel the air bubble from the prefilled syringe
C. Inject into the abdomen at least 2 inches from the umbilicus
D. Aspirate before injecting to check for blood return
CORRECT ANSWER: C. Inject into the abdomen at least 2 inches from the umbilicus
Rationale: Enoxaparin, a low-molecular-weight heparin, should be injected
subcutaneously into the abdomen (avoiding the 2-inch area around the umbilicus) to
ensure consistent absorption and minimize bruising. The air bubble should NOT be
expelled as it helps deliver the full dose and prevents medication leakage into
subcutaneous tissue. Massaging the site increases bruising risk, and aspiration is not
recommended for subcutaneous injections of anticoagulants as it can cause tissue
trauma.
Question 8: A patient with a history of peptic ulcer disease reports sudden, severe
abdominal pain described as "tearing." The abdomen is rigid and board-like. Which
complication should the nurse suspect?
, A. Gastric outlet obstruction
B. Perforation
C. Hemorrhage
D. Penetration into adjacent organs
CORRECT ANSWER: B. Perforation
Rationale: Sudden, severe "tearing" abdominal pain with a rigid, board-like abdomen is
classic for perforation of a peptic ulcer, allowing gastric contents to leak into the
peritoneal cavity, causing chemical peritonitis. This is a surgical emergency.
Hemorrhage typically presents with hematemesis or melena, gastric outlet obstruction
with vomiting of undigested food, and penetration with pain radiating to the back
without acute peritonitis signs.
Question 9: A nurse is caring for a patient with a new colostomy. Which statement
by the patient indicates effective teaching about stoma care?
A. "I will clean the stoma with hydrogen peroxide daily."
B. "I should expect the stoma to be dark purple in color."
C. "I will empty the pouch when it is one-third to one-half full."
D. "I can use adhesive removers containing alcohol on the peristomal skin."
CORRECT ANSWER: C. I will empty the pouch when it is one-third to one-half full.
Rationale: Emptying the ostomy pouch when it is one-third to one-half full prevents
excessive weight that could pull the appliance loose and cause skin irritation or
leakage. Hydrogen peroxide is cytotoxic and impairs healing; stoma should be cleaned
with mild soap and water. A healthy stoma is beefy red; dark purple indicates ischemia.
Alcohol-based products dry and irritate peristomal skin; skin barriers should be
alcohol-free.
Question 10: A patient with chronic kidney disease stage 4 has a serum potassium
level of 6.2 mEq/L. Which electrocardiogram (ECG) change should the nurse
anticipate?
A. Prolonged PR interval
B. Tall, peaked T waves
C. ST-segment depression
D. Prominent U waves
CORRECT ANSWER: B. Tall, peaked T waves
Rationale: Hyperkalemia (serum potassium >5.0 mEq/L) causes characteristic ECG
changes starting with tall, peaked T waves due to accelerated repolarization. As
potassium rises further, PR prolongation, QRS widening, and sine wave patterns may
occur. ST depression is associated with ischemia, and prominent U waves are seen in
hypokalemia. Immediate intervention is required for potassium >6.0 mEq/L due to risk
of fatal dysrhythmias.
