MEDICAL-SURGICAL RN A PROPHECY TEST 2026 |
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Clinical Assessment & Diagnostic Findings
Q1: A patient with heart failure presents with dyspnea, crackles bilaterally, and
jugular venous distension. Which additional finding would the nurse expect?
A. Bradycardia and hypotension
B. Decreased respiratory rate
C. Weight gain of 3 pounds in 2 days and an S3 gallop [CORRECT]
D. Clear lung fields on auscultation
Correct Answer: C
Rationale: Weight gain indicates fluid retention, and an S3 gallop indicates
ventricular volume overload—both classic findings in acute decompensated heart
failure. Bradycardia and hypotension are not typical; heart failure usually presents
with tachycardia. Crackles and JVD rule out clear lung fields.
Q2: A patient with COPD has the following ABG: pH 7.34, PaCO2 52, HCO3 30, PaO2
58. Which acid-base disorder is present?
A. Metabolic acidosis
B. Respiratory acidosis with metabolic compensation [CORRECT]
C. Respiratory alkalosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: The elevated PaCO2 indicates respiratory acidosis, and the elevated HCO3
,shows renal compensation. This is a chronic pattern seen in COPD patients with CO2
retention. The pH is near normal because the kidneys have compensated over time.
Q3: A patient with acute kidney injury has a potassium level of 6.2 mEq/L. Which ECG
change would the nurse anticipate?
A. Flat T waves and U waves
B. Peaked T waves and widened QRS complexes [CORRECT]
C. ST-segment elevation
D. Shortened QT interval
Correct Answer: B
Rationale: Hyperkalemia causes peaked T waves, PR prolongation, and QRS
widening as it progresses. Flat T waves and U waves are seen in hypokalemia, not
hyperkalemia. ST elevation suggests MI, and QT shortening is seen in hypercalcemia.
Q4: A patient post-MI develops sudden onset dyspnea, tachycardia, and pleuritic
chest pain. Which complication is most likely?
A. Cardiac tamponade
B. Pulmonary embolism [CORRECT]
C. Ventricular aneurysm
D. Papillary muscle rupture
Correct Answer: B
Rationale: Post-MI patients are immobile and at high risk for DVT and subsequent
PE. The sudden dyspnea, tachycardia, and pleuritic pain are classic PE symptoms.
Cardiac tamponade presents with Beck's triad; papillary muscle rupture causes acute
mitral regurgitation and pulmonary edema.
,Q5: A patient with pancreatitis presents with severe epigastric pain radiating to the
back, nausea, and vomiting. Which lab value would the nurse expect to be
significantly elevated?
A. Amylase and lipase [CORRECT]
B. ALT and AST
C. BUN and creatinine
D. Hemoglobin and hematocrit
Correct Answer: A
Rationale: Amylase and lipase are the hallmark elevated enzymes in acute
pancreatitis. While BUN may rise with dehydration and hemoconcentration may
occur, the diagnostic enzymes are amylase and lipase. Elevated ALT/AST would
suggest hepatic involvement.
Q6: A patient with diabetes presents with blood glucose of 520 mg/dL, pH 7.28, and
positive urine ketones. Which condition is present?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis [CORRECT]
C. Hypoglycemia
D. Normal metabolic state
Correct Answer: B
Rationale: DKA is characterized by hyperglycemia (>250), metabolic acidosis (pH
<7.30), and ketonemia/ketonuria. HHNS has much higher glucose without ketones or
acidosis. The acidosis and ketones distinguish DKA from HHNS.
Q7: A patient with hypothyroidism presents with fatigue, weight gain, constipation,
and bradycardia. Which additional finding would support this diagnosis?
A. Heat intolerance and tremors
B. Elevated TSH and decreased free T4 [CORRECT]
, C. Exophthalmos and goiter
D. Tachycardia and diarrhea
Correct Answer: B
Rationale: Primary hypothyroidism shows elevated TSH (pituitary trying to stimulate
the thyroid) and low free T4. Heat intolerance, tremors, and tachycardia are
hyperthyroid signs. Exophthalmos is specific to Graves' disease, a hyperthyroid
condition.
Q8: A patient with cellulitis has erythema, warmth, and swelling of the left lower
extremity. Which assessment finding would indicate worsening infection?
A. Decreased pain at the site
B. Red streaks extending proximally and fever of 101.5°F [CORRECT]
C. Improved range of motion
D. Decreased erythema
Correct Answer: B
Rationale: Lymphangitis (red streaks) and systemic fever indicate spreading infection
requiring urgent intervention. Decreased pain, improved ROM, and decreased
erythema would indicate improvement, not worsening.
Q9: A patient with a bowel obstruction has abdominal distension, high-pitched
tinkling bowel sounds, and vomiting. Which electrolyte imbalance is most likely?
A. Hyperkalemia
B. Hypokalemia and metabolic alkalosis [CORRECT]
C. Hypernatremia
D. Respiratory acidosis
Correct Answer: B
Rationale: Vomiting causes loss of gastric acid (HCl), leading to metabolic alkalosis,
and loss of potassium in vomitus leads to hypokalemia. This is a classic pattern in
small bowel obstruction with persistent vomiting.
Relias Learning Answered | Complete Q&A | Pass
Guaranteed - A+ Graded
Clinical Assessment & Diagnostic Findings
Q1: A patient with heart failure presents with dyspnea, crackles bilaterally, and
jugular venous distension. Which additional finding would the nurse expect?
A. Bradycardia and hypotension
B. Decreased respiratory rate
C. Weight gain of 3 pounds in 2 days and an S3 gallop [CORRECT]
D. Clear lung fields on auscultation
Correct Answer: C
Rationale: Weight gain indicates fluid retention, and an S3 gallop indicates
ventricular volume overload—both classic findings in acute decompensated heart
failure. Bradycardia and hypotension are not typical; heart failure usually presents
with tachycardia. Crackles and JVD rule out clear lung fields.
Q2: A patient with COPD has the following ABG: pH 7.34, PaCO2 52, HCO3 30, PaO2
58. Which acid-base disorder is present?
A. Metabolic acidosis
B. Respiratory acidosis with metabolic compensation [CORRECT]
C. Respiratory alkalosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: The elevated PaCO2 indicates respiratory acidosis, and the elevated HCO3
,shows renal compensation. This is a chronic pattern seen in COPD patients with CO2
retention. The pH is near normal because the kidneys have compensated over time.
Q3: A patient with acute kidney injury has a potassium level of 6.2 mEq/L. Which ECG
change would the nurse anticipate?
A. Flat T waves and U waves
B. Peaked T waves and widened QRS complexes [CORRECT]
C. ST-segment elevation
D. Shortened QT interval
Correct Answer: B
Rationale: Hyperkalemia causes peaked T waves, PR prolongation, and QRS
widening as it progresses. Flat T waves and U waves are seen in hypokalemia, not
hyperkalemia. ST elevation suggests MI, and QT shortening is seen in hypercalcemia.
Q4: A patient post-MI develops sudden onset dyspnea, tachycardia, and pleuritic
chest pain. Which complication is most likely?
A. Cardiac tamponade
B. Pulmonary embolism [CORRECT]
C. Ventricular aneurysm
D. Papillary muscle rupture
Correct Answer: B
Rationale: Post-MI patients are immobile and at high risk for DVT and subsequent
PE. The sudden dyspnea, tachycardia, and pleuritic pain are classic PE symptoms.
Cardiac tamponade presents with Beck's triad; papillary muscle rupture causes acute
mitral regurgitation and pulmonary edema.
,Q5: A patient with pancreatitis presents with severe epigastric pain radiating to the
back, nausea, and vomiting. Which lab value would the nurse expect to be
significantly elevated?
A. Amylase and lipase [CORRECT]
B. ALT and AST
C. BUN and creatinine
D. Hemoglobin and hematocrit
Correct Answer: A
Rationale: Amylase and lipase are the hallmark elevated enzymes in acute
pancreatitis. While BUN may rise with dehydration and hemoconcentration may
occur, the diagnostic enzymes are amylase and lipase. Elevated ALT/AST would
suggest hepatic involvement.
Q6: A patient with diabetes presents with blood glucose of 520 mg/dL, pH 7.28, and
positive urine ketones. Which condition is present?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis [CORRECT]
C. Hypoglycemia
D. Normal metabolic state
Correct Answer: B
Rationale: DKA is characterized by hyperglycemia (>250), metabolic acidosis (pH
<7.30), and ketonemia/ketonuria. HHNS has much higher glucose without ketones or
acidosis. The acidosis and ketones distinguish DKA from HHNS.
Q7: A patient with hypothyroidism presents with fatigue, weight gain, constipation,
and bradycardia. Which additional finding would support this diagnosis?
A. Heat intolerance and tremors
B. Elevated TSH and decreased free T4 [CORRECT]
, C. Exophthalmos and goiter
D. Tachycardia and diarrhea
Correct Answer: B
Rationale: Primary hypothyroidism shows elevated TSH (pituitary trying to stimulate
the thyroid) and low free T4. Heat intolerance, tremors, and tachycardia are
hyperthyroid signs. Exophthalmos is specific to Graves' disease, a hyperthyroid
condition.
Q8: A patient with cellulitis has erythema, warmth, and swelling of the left lower
extremity. Which assessment finding would indicate worsening infection?
A. Decreased pain at the site
B. Red streaks extending proximally and fever of 101.5°F [CORRECT]
C. Improved range of motion
D. Decreased erythema
Correct Answer: B
Rationale: Lymphangitis (red streaks) and systemic fever indicate spreading infection
requiring urgent intervention. Decreased pain, improved ROM, and decreased
erythema would indicate improvement, not worsening.
Q9: A patient with a bowel obstruction has abdominal distension, high-pitched
tinkling bowel sounds, and vomiting. Which electrolyte imbalance is most likely?
A. Hyperkalemia
B. Hypokalemia and metabolic alkalosis [CORRECT]
C. Hypernatremia
D. Respiratory acidosis
Correct Answer: B
Rationale: Vomiting causes loss of gastric acid (HCl), leading to metabolic alkalosis,
and loss of potassium in vomitus leads to hypokalemia. This is a classic pattern in
small bowel obstruction with persistent vomiting.
