Medical-Surgical Nursing Practice Exam 2026 |
Questions with Verified Answers & Detailed
Rationales | Build Clinical Judgment & Critical
Thinking | Ultimate Med-Surg Success Guide |
Latest Update
Question 1
A 68-year-old client with heart failure is receiving furosemide 40 mg IV push. Which
assessment finding requires immediate intervention by the nurse?
A. Blood pressure 110/70 mmHg
B. Potassium level 3.2 mEq/L
C. Urine output 40 mL/hr
D. Weight loss of 1 kg in 24 hours
Answer: B. Potassium level 3.2 mEq/L
*Rationale: Furosemide is a loop diuretic that causes potassium excretion. A potassium
level of 3.2 mEq/L indicates hypokalemia (normal: 3.5-5.0 mEq/L), which can cause life-
threatening cardiac dysrhythmias, especially in a client with heart failure. This requires
immediate notification of the provider and potassium replacement per protocol. BP
110/70 is acceptable, urine output 40 mL/hr is adequate (>30 mL/hr), and weight loss of
1 kg reflects expected fluid loss with diuretic therapy.
Question 2
The nurse is caring for a client 2 hours post-op from a total knee arthroplasty. Which
finding should the nurse report to the surgeon immediately?
A. Pain rating of 6/10 at the surgical site
B. Capillary refill of 3 seconds in the operative leg
C. Small amount of serosanguinous drainage on the dressing
D. Cool, pale foot with absent pedal pulse on the operative side
Answer: D. Cool, pale foot with absent pedal pulse on the operative side
*Rationale: A cool, pale extremity with absent pulse indicates compromised arterial
circulation, possibly from a thrombus, embolus, or compartment syndrome. This is a
surgical emergency requiring immediate intervention to prevent tissue necrosis or limb
loss. Pain 6/10 is expected post-op, capillary refill of 3 seconds is at upper limit of
normal, and small serosanguinous drainage is expected.
,Question 3
A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The nurse notes the
client is increasingly confused and has a headache. Arterial blood gases show: pH 7.28,
PaCO₂ 68 mmHg, PaO₂ 72 mmHg, HCO₃⁻ 30 mEq/L. Which action should the nurse take
first?
A. Increase oxygen to 4 L/min
B. Notify the healthcare provider immediately
C. Administer prescribed albuterol nebulizer
D. Place the client in high-Fowler's position
Answer: B. Notify the healthcare provider immediately
Rationale: The ABG results indicate acute-on-chronic respiratory acidosis with hypercapnia
(elevated PaCO₂) and hypoxemia. In COPD clients, excessive oxygen can suppress the
hypoxic drive, worsening CO₂ retention. Confusion and headache are signs of CO₂
narcosis. The nurse must notify the provider immediately for possible ventilatory support.
Increasing oxygen could further suppress respiratory drive, bronchodilators help but do not
address life-threatening hypercapnia, and positioning is not the priority for impending
respiratory failure.
Question 4
The nurse is preparing to administer digoxin 0.125 mg PO to a client with atrial
fibrillation. Which assessment finding would require the nurse to hold the dose and
notify the provider?
A. Apical pulse 62 bpm
B. Serum potassium 4.0 mEq/L
C. Serum digoxin level 1.8 ng/mL
D. Blood pressure 128/84 mmHg
Answer: C. Serum digoxin level 1.8 ng/mL
*Rationale: The therapeutic range for digoxin is 0.5-2.0 ng/mL for heart failure, but levels
>1.2 ng/mL increase toxicity risk, especially with electrolyte imbalances. A level of 1.8
ng/mL is high-normal and warrants provider notification before administering another
dose, particularly if the client has symptoms of toxicity. Apical pulse 62 bpm is above
typical hold parameter of <60 bpm, potassium 4.0 mEq/L is normal, and BP 128/84 is
within normal limits.
Question 5
A client with type 1 diabetes reports feeling shaky, diaphoretic, and anxious. Blood
glucose is 52 mg/dL. Which intervention should the nurse implement first?
A. Administer 1 mg glucagon IM
B. Provide 4 oz of orange juice
,C. Recheck blood glucose in 15 minutes
D. Offer a snack with protein and complex carbohydrates
Answer: B. Provide 4 oz of orange juice
*Rationale: The client is conscious and able to swallow, so the fastest-acting treatment
for mild-moderate hypoglycemia is 15g of simple carbohydrate (e.g., 4 oz fruit juice).
This follows the "15-15 rule": 15g carbs, wait 15 minutes, recheck glucose. Glucagon is
for unconscious clients or those unable to swallow. Rechecking is important but
treatment must come first. Protein/complex carbs are for follow-up after initial glucose
correction
Question 6
The nurse is caring for four clients. Which client should the nurse assess first?
A. Client with pneumonia requesting pain medication for pleuritic chest pain
B. Client with DVT who reports sudden shortness of breath and chest pain
C. Client with gastroenteritis who has had 3 episodes of diarrhea this shift
D. Client with hypertension whose BP is 158/92 mmHg
Answer: B. Client with DVT who reports sudden shortness of breath and chest pain
Rationale: Sudden dyspnea and chest pain in a client with DVT suggest pulmonary
embolism (PE), a life-threatening emergency requiring immediate assessment and
intervention (oxygen, notify provider, prepare for imaging/anticoagulation). This takes
priority using ABCs and stability assessment. Pain management is important but not
immediately life-threatening, diarrhea requires monitoring but is not emergent without
signs of dehydration, and elevated BP needs monitoring but is not acute without
symptoms.
Question 7
A client is receiving a blood transfusion. After 15 minutes, the client develops chills, low
back pain, and a temperature of 101.2°F (38.4°C). Which action should the nurse take
first?
A. Administer acetaminophen as prescribed
B. Stop the transfusion and keep the vein open with normal saline
C. Notify the blood bank and healthcare provider
D. Obtain a urine specimen to check for hemoglobin
Answer: B. Stop the transfusion and keep the vein open with normal saline
Rationale: These symptoms indicate a possible acute hemolytic transfusion reaction, a
medical emergency. The nurse must immediately stop the transfusion to prevent further
infusion of incompatible blood, maintain IV access with normal saline for medication/fluid
administration, and then notify the provider and blood bank. Antipyretics treat symptoms
, but do not address the life-threatening reaction. Notification and urine specimen are
important subsequent steps but follow stopping the transfusion.
Question 8
The nurse is teaching a client newly prescribed warfarin. Which statement by the client
indicates a need for further teaching?
A. "I will use an electric razor instead of a blade razor."
B. "I will avoid foods high in vitamin K like spinach and broccoli."
C. "I will take my warfarin at the same time every day."
D. "I will report any unusual bruising or bleeding to my provider."
Answer: B. "I will avoid foods high in vitamin K like spinach and broccoli."
Rationale: Clients on warfarin do not need to avoid vitamin K foods but should maintain a
consistent intake. Sudden increases or decreases in vitamin K can alter INR stability.
Teaching should focus on consistency, not elimination, of vitamin K-rich foods. The other
statements reflect correct understanding of warfarin safety: bleeding precautions,
adherence, and monitoring for complications.
Question 9
A client with a closed head injury has a sudden increase in blood pressure, bradycardia,
and irregular respirations. Which complication should the nurse suspect?
A. Neurogenic shock
B. Cushing's triad
C. Autonomic dysreflexia
D. Syndrome of inappropriate antidiuretic hormone (SIADH)
Answer: B. Cushing's triad
Rationale: Cushing's triad (hypertension with widened pulse pressure, bradycardia, and
irregular respirations) is a classic sign of increased intracranial pressure (ICP) and
impending herniation in head injury. This requires immediate intervention to reduce ICP.
Neurogenic shock presents with hypotension and bradycardia due to spinal cord injury.
Autonomic dysreflexia occurs in spinal cord injuries above T6 with hypertension and
bradycardia but is triggered by noxious stimuli below the injury. SIADH causes
hyponatremia and fluid retention, not this vital sign pattern.
Question 10
The nurse is caring for a client with acute pancreatitis. Which laboratory finding is most
indicative of this condition?
A. Elevated serum amylase and lipase
B. Decreased serum calcium
Questions with Verified Answers & Detailed
Rationales | Build Clinical Judgment & Critical
Thinking | Ultimate Med-Surg Success Guide |
Latest Update
Question 1
A 68-year-old client with heart failure is receiving furosemide 40 mg IV push. Which
assessment finding requires immediate intervention by the nurse?
A. Blood pressure 110/70 mmHg
B. Potassium level 3.2 mEq/L
C. Urine output 40 mL/hr
D. Weight loss of 1 kg in 24 hours
Answer: B. Potassium level 3.2 mEq/L
*Rationale: Furosemide is a loop diuretic that causes potassium excretion. A potassium
level of 3.2 mEq/L indicates hypokalemia (normal: 3.5-5.0 mEq/L), which can cause life-
threatening cardiac dysrhythmias, especially in a client with heart failure. This requires
immediate notification of the provider and potassium replacement per protocol. BP
110/70 is acceptable, urine output 40 mL/hr is adequate (>30 mL/hr), and weight loss of
1 kg reflects expected fluid loss with diuretic therapy.
Question 2
The nurse is caring for a client 2 hours post-op from a total knee arthroplasty. Which
finding should the nurse report to the surgeon immediately?
A. Pain rating of 6/10 at the surgical site
B. Capillary refill of 3 seconds in the operative leg
C. Small amount of serosanguinous drainage on the dressing
D. Cool, pale foot with absent pedal pulse on the operative side
Answer: D. Cool, pale foot with absent pedal pulse on the operative side
*Rationale: A cool, pale extremity with absent pulse indicates compromised arterial
circulation, possibly from a thrombus, embolus, or compartment syndrome. This is a
surgical emergency requiring immediate intervention to prevent tissue necrosis or limb
loss. Pain 6/10 is expected post-op, capillary refill of 3 seconds is at upper limit of
normal, and small serosanguinous drainage is expected.
,Question 3
A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The nurse notes the
client is increasingly confused and has a headache. Arterial blood gases show: pH 7.28,
PaCO₂ 68 mmHg, PaO₂ 72 mmHg, HCO₃⁻ 30 mEq/L. Which action should the nurse take
first?
A. Increase oxygen to 4 L/min
B. Notify the healthcare provider immediately
C. Administer prescribed albuterol nebulizer
D. Place the client in high-Fowler's position
Answer: B. Notify the healthcare provider immediately
Rationale: The ABG results indicate acute-on-chronic respiratory acidosis with hypercapnia
(elevated PaCO₂) and hypoxemia. In COPD clients, excessive oxygen can suppress the
hypoxic drive, worsening CO₂ retention. Confusion and headache are signs of CO₂
narcosis. The nurse must notify the provider immediately for possible ventilatory support.
Increasing oxygen could further suppress respiratory drive, bronchodilators help but do not
address life-threatening hypercapnia, and positioning is not the priority for impending
respiratory failure.
Question 4
The nurse is preparing to administer digoxin 0.125 mg PO to a client with atrial
fibrillation. Which assessment finding would require the nurse to hold the dose and
notify the provider?
A. Apical pulse 62 bpm
B. Serum potassium 4.0 mEq/L
C. Serum digoxin level 1.8 ng/mL
D. Blood pressure 128/84 mmHg
Answer: C. Serum digoxin level 1.8 ng/mL
*Rationale: The therapeutic range for digoxin is 0.5-2.0 ng/mL for heart failure, but levels
>1.2 ng/mL increase toxicity risk, especially with electrolyte imbalances. A level of 1.8
ng/mL is high-normal and warrants provider notification before administering another
dose, particularly if the client has symptoms of toxicity. Apical pulse 62 bpm is above
typical hold parameter of <60 bpm, potassium 4.0 mEq/L is normal, and BP 128/84 is
within normal limits.
Question 5
A client with type 1 diabetes reports feeling shaky, diaphoretic, and anxious. Blood
glucose is 52 mg/dL. Which intervention should the nurse implement first?
A. Administer 1 mg glucagon IM
B. Provide 4 oz of orange juice
,C. Recheck blood glucose in 15 minutes
D. Offer a snack with protein and complex carbohydrates
Answer: B. Provide 4 oz of orange juice
*Rationale: The client is conscious and able to swallow, so the fastest-acting treatment
for mild-moderate hypoglycemia is 15g of simple carbohydrate (e.g., 4 oz fruit juice).
This follows the "15-15 rule": 15g carbs, wait 15 minutes, recheck glucose. Glucagon is
for unconscious clients or those unable to swallow. Rechecking is important but
treatment must come first. Protein/complex carbs are for follow-up after initial glucose
correction
Question 6
The nurse is caring for four clients. Which client should the nurse assess first?
A. Client with pneumonia requesting pain medication for pleuritic chest pain
B. Client with DVT who reports sudden shortness of breath and chest pain
C. Client with gastroenteritis who has had 3 episodes of diarrhea this shift
D. Client with hypertension whose BP is 158/92 mmHg
Answer: B. Client with DVT who reports sudden shortness of breath and chest pain
Rationale: Sudden dyspnea and chest pain in a client with DVT suggest pulmonary
embolism (PE), a life-threatening emergency requiring immediate assessment and
intervention (oxygen, notify provider, prepare for imaging/anticoagulation). This takes
priority using ABCs and stability assessment. Pain management is important but not
immediately life-threatening, diarrhea requires monitoring but is not emergent without
signs of dehydration, and elevated BP needs monitoring but is not acute without
symptoms.
Question 7
A client is receiving a blood transfusion. After 15 minutes, the client develops chills, low
back pain, and a temperature of 101.2°F (38.4°C). Which action should the nurse take
first?
A. Administer acetaminophen as prescribed
B. Stop the transfusion and keep the vein open with normal saline
C. Notify the blood bank and healthcare provider
D. Obtain a urine specimen to check for hemoglobin
Answer: B. Stop the transfusion and keep the vein open with normal saline
Rationale: These symptoms indicate a possible acute hemolytic transfusion reaction, a
medical emergency. The nurse must immediately stop the transfusion to prevent further
infusion of incompatible blood, maintain IV access with normal saline for medication/fluid
administration, and then notify the provider and blood bank. Antipyretics treat symptoms
, but do not address the life-threatening reaction. Notification and urine specimen are
important subsequent steps but follow stopping the transfusion.
Question 8
The nurse is teaching a client newly prescribed warfarin. Which statement by the client
indicates a need for further teaching?
A. "I will use an electric razor instead of a blade razor."
B. "I will avoid foods high in vitamin K like spinach and broccoli."
C. "I will take my warfarin at the same time every day."
D. "I will report any unusual bruising or bleeding to my provider."
Answer: B. "I will avoid foods high in vitamin K like spinach and broccoli."
Rationale: Clients on warfarin do not need to avoid vitamin K foods but should maintain a
consistent intake. Sudden increases or decreases in vitamin K can alter INR stability.
Teaching should focus on consistency, not elimination, of vitamin K-rich foods. The other
statements reflect correct understanding of warfarin safety: bleeding precautions,
adherence, and monitoring for complications.
Question 9
A client with a closed head injury has a sudden increase in blood pressure, bradycardia,
and irregular respirations. Which complication should the nurse suspect?
A. Neurogenic shock
B. Cushing's triad
C. Autonomic dysreflexia
D. Syndrome of inappropriate antidiuretic hormone (SIADH)
Answer: B. Cushing's triad
Rationale: Cushing's triad (hypertension with widened pulse pressure, bradycardia, and
irregular respirations) is a classic sign of increased intracranial pressure (ICP) and
impending herniation in head injury. This requires immediate intervention to reduce ICP.
Neurogenic shock presents with hypotension and bradycardia due to spinal cord injury.
Autonomic dysreflexia occurs in spinal cord injuries above T6 with hypertension and
bradycardia but is triggered by noxious stimuli below the injury. SIADH causes
hyponatremia and fluid retention, not this vital sign pattern.
Question 10
The nurse is caring for a client with acute pancreatitis. Which laboratory finding is most
indicative of this condition?
A. Elevated serum amylase and lipase
B. Decreased serum calcium
