NURS 201 – INTERMEDIATE MED-SURG MIDTERM
PRACTICE <A DOCUMENT STRUCTURED WITH USEFUL
QUESTIONS &ANSWERS ,RATIONALES>2026 LATEST
RELEASE IN THE MARKET !!
1. Acute Respiratory Failure – Priority Care
A 64-year-old client with a history of chronic obstructive pulmonary disease (COPD) is admitted with worsening
dyspnea, confusion, and fatigue. Assessment reveals RR 32/min, use of accessory muscles, SpO₂ 86% on 2 L nasal
cannula, and diminished breath sounds bilaterally. Arterial blood gases show pH 7.28, PaCO₂ 58 mmHg, PaO₂ 60
mmHg. Which intervention is the priority?
A. Increase oxygen to 6 L/min via nasal cannula to rapidly correct hypoxemia
B. Initiate noninvasive positive pressure ventilation (BiPAP) as prescribed
C. Encourage coughing and deep breathing exercises every hour
D. Administer a sedative to reduce anxiety and respiratory effort
Answer: B
Rationale: The patient is in acute respiratory failure (hypercapnic). BiPAP improves ventilation and CO₂
removal. High-flow oxygen alone (A) may suppress respiratory drive in COPD. Sedatives (D) worsen
hypoventilation.
2. Sepsis Progression
A hospitalized patient with a urinary tract infection develops hypotension (BP 84/50), tachycardia (HR 120), fever
(39°C), and decreased urine output. Lactate is elevated. Which action should the nurse implement first?
A. Administer broad-spectrum antibiotics
B. Initiate rapid IV fluid resuscitation with isotonic fluids
C. Insert a urinary catheter for strict output monitoring
D. Administer antipyretics
Answer: B
Rationale: In septic shock, restoring perfusion with fluids is priority. Antibiotics follow quickly but
circulation must be stabilized first.
3. Cardiac – Acute Coronary Syndrome
A patient presents with chest pressure radiating to the jaw, nausea, and diaphoresis. ECG changes suggest
myocardial infarction. Which nursing action is priority?
,A. Administer morphine for pain control
B. Provide supplemental oxygen
C. Obtain cardiac enzymes
D. Prepare for cardiac catheterization
Answer: B
Rationale: Oxygenation improves myocardial perfusion and is an immediate priority.
4. Electrolyte Imbalance – Hyperkalemia
A patient with renal failure has potassium level 6.8 mEq/L and ECG shows peaked T waves. Which intervention is
most urgent?
A. Administer potassium supplements
B. Prepare to give IV calcium gluconate
C. Encourage potassium-rich foods
D. Restrict fluids
Answer: B
Rationale: Calcium stabilizes cardiac membranes, preventing fatal arrhythmias.
5. Neurological – Increased ICP
A patient with a head injury develops bradycardia, hypertension, and irregular respirations. What is the nurse’s
priority action?
A. Lower the head of the bed
B. Maintain airway and prepare for possible intubation
C. Provide oral fluids
D. Encourage stimulation
Answer: B
Rationale: Signs of increased intracranial pressure (Cushing’s triad) require airway protection.
6. Postoperative Complication – Hemorrhage
A patient 6 hours post-abdominal surgery has HR 124, BP 88/56, pale cool skin, and decreased urine output. What
should the nurse do first?
A. Administer pain medication
B. Increase IV fluids and notify provider
C. Encourage ambulation
D. Document findings
Answer: B
Rationale: Signs of shock/bleeding → immediate fluid resuscitation.
, 7. Diabetes – DKA Management
A patient with type 1 diabetes presents with Kussmaul respirations, glucose 520 mg/dL, and positive ketones. What
is the first priority?
A. Start insulin infusion
B. Administer IV fluids
C. Give potassium
D. Administer bicarbonate
Answer: B
Rationale: Fluid replacement restores perfusion before insulin.
8. Respiratory – Pneumothorax
A patient suddenly develops chest pain, dyspnea, and tracheal deviation. What is the nurse’s priority?
A. Administer oxygen
B. Prepare for needle decompression
C. Obtain chest X-ray
D. Encourage deep breathing
Answer: B
Rationale: Tension pneumothorax is life-threatening → immediate decompression.
9. Renal – Acute Kidney Injury
A patient with AKI has decreased urine output and rising creatinine. Which finding requires immediate action?
A. Mild edema
B. Potassium 6.5 mEq/L
C. BUN 40
D. Fatigue
Answer: B
Rationale: Hyperkalemia → risk of arrhythmia.
10. GI Bleed
A patient presents with hematemesis and hypotension. What is the nurse’s first action?
A. Administer proton pump inhibitor
B. Insert NG tube
C. Establish large-bore IV access
D. Take history
Answer: C
Rationale: Stabilize circulation in active bleeding.
PRACTICE <A DOCUMENT STRUCTURED WITH USEFUL
QUESTIONS &ANSWERS ,RATIONALES>2026 LATEST
RELEASE IN THE MARKET !!
1. Acute Respiratory Failure – Priority Care
A 64-year-old client with a history of chronic obstructive pulmonary disease (COPD) is admitted with worsening
dyspnea, confusion, and fatigue. Assessment reveals RR 32/min, use of accessory muscles, SpO₂ 86% on 2 L nasal
cannula, and diminished breath sounds bilaterally. Arterial blood gases show pH 7.28, PaCO₂ 58 mmHg, PaO₂ 60
mmHg. Which intervention is the priority?
A. Increase oxygen to 6 L/min via nasal cannula to rapidly correct hypoxemia
B. Initiate noninvasive positive pressure ventilation (BiPAP) as prescribed
C. Encourage coughing and deep breathing exercises every hour
D. Administer a sedative to reduce anxiety and respiratory effort
Answer: B
Rationale: The patient is in acute respiratory failure (hypercapnic). BiPAP improves ventilation and CO₂
removal. High-flow oxygen alone (A) may suppress respiratory drive in COPD. Sedatives (D) worsen
hypoventilation.
2. Sepsis Progression
A hospitalized patient with a urinary tract infection develops hypotension (BP 84/50), tachycardia (HR 120), fever
(39°C), and decreased urine output. Lactate is elevated. Which action should the nurse implement first?
A. Administer broad-spectrum antibiotics
B. Initiate rapid IV fluid resuscitation with isotonic fluids
C. Insert a urinary catheter for strict output monitoring
D. Administer antipyretics
Answer: B
Rationale: In septic shock, restoring perfusion with fluids is priority. Antibiotics follow quickly but
circulation must be stabilized first.
3. Cardiac – Acute Coronary Syndrome
A patient presents with chest pressure radiating to the jaw, nausea, and diaphoresis. ECG changes suggest
myocardial infarction. Which nursing action is priority?
,A. Administer morphine for pain control
B. Provide supplemental oxygen
C. Obtain cardiac enzymes
D. Prepare for cardiac catheterization
Answer: B
Rationale: Oxygenation improves myocardial perfusion and is an immediate priority.
4. Electrolyte Imbalance – Hyperkalemia
A patient with renal failure has potassium level 6.8 mEq/L and ECG shows peaked T waves. Which intervention is
most urgent?
A. Administer potassium supplements
B. Prepare to give IV calcium gluconate
C. Encourage potassium-rich foods
D. Restrict fluids
Answer: B
Rationale: Calcium stabilizes cardiac membranes, preventing fatal arrhythmias.
5. Neurological – Increased ICP
A patient with a head injury develops bradycardia, hypertension, and irregular respirations. What is the nurse’s
priority action?
A. Lower the head of the bed
B. Maintain airway and prepare for possible intubation
C. Provide oral fluids
D. Encourage stimulation
Answer: B
Rationale: Signs of increased intracranial pressure (Cushing’s triad) require airway protection.
6. Postoperative Complication – Hemorrhage
A patient 6 hours post-abdominal surgery has HR 124, BP 88/56, pale cool skin, and decreased urine output. What
should the nurse do first?
A. Administer pain medication
B. Increase IV fluids and notify provider
C. Encourage ambulation
D. Document findings
Answer: B
Rationale: Signs of shock/bleeding → immediate fluid resuscitation.
, 7. Diabetes – DKA Management
A patient with type 1 diabetes presents with Kussmaul respirations, glucose 520 mg/dL, and positive ketones. What
is the first priority?
A. Start insulin infusion
B. Administer IV fluids
C. Give potassium
D. Administer bicarbonate
Answer: B
Rationale: Fluid replacement restores perfusion before insulin.
8. Respiratory – Pneumothorax
A patient suddenly develops chest pain, dyspnea, and tracheal deviation. What is the nurse’s priority?
A. Administer oxygen
B. Prepare for needle decompression
C. Obtain chest X-ray
D. Encourage deep breathing
Answer: B
Rationale: Tension pneumothorax is life-threatening → immediate decompression.
9. Renal – Acute Kidney Injury
A patient with AKI has decreased urine output and rising creatinine. Which finding requires immediate action?
A. Mild edema
B. Potassium 6.5 mEq/L
C. BUN 40
D. Fatigue
Answer: B
Rationale: Hyperkalemia → risk of arrhythmia.
10. GI Bleed
A patient presents with hematemesis and hypotension. What is the nurse’s first action?
A. Administer proton pump inhibitor
B. Insert NG tube
C. Establish large-bore IV access
D. Take history
Answer: C
Rationale: Stabilize circulation in active bleeding.
