LATEST KAPLAN MEDICAL SURGICAL INTEGRATED EXAM 2026/2027
COMPLETE ACCURATE EXAM ACTUAL QUESTIONS AND CORRECT VERIFIED
SOLUTIONS WITH DETAILED RATIONALES (A NEW UPDATED VERSION 2026
EDITION) |GUARANTEED PASS A+ (BRAND NEW!) FULL REVISED KAPLAN
MEDICAL SURGICAL INTEGRATED EXAM
1. A client with cirrhosis of the liver develops ascites and hepatic encephalopathy.
Which assessment finding requires immediate intervention by the nurse?
A. Asterisks
B. Serum ammonia level of 120 mcg/ld.
C. Blood glucose level of 65 mg/ld.
D. Abdominal girth increase of 2 cm in 24 hours
Correct Answer: B. Serum ammonia level of 120 mcg/ld.
Rationale: CORRECT ANSWER A serum ammonia level of 120 mcg/ld. is
significantly elevated (normal 15-45 mcg/ld.) and directly correlates with
worsening hepatic encephalopathy, which can progress to coma. Immediate
intervention is required to reduce ammonia levels. Asterisks (A) is a sign of
encephalopathy but does not require immediate action as much as a critical lab
value. Hypoglycemia (C) needs intervention but is not the priority in this context.
Increased abdominal girth (D) indicates ascites progression but is not an
emergency.
2. A patient is admitted with acute exacerbation of chronic obstructive pulmonary
disease (COPD) and has an oxygen saturation of 88% on room air. Which oxygen
delivery device should the nurse initiate first?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 6 L/min
C. Nasal cannula at 2 L/min
,D. Ventura mask at 24%
Correct Answer: C. Nasal cannula at 2 L/min
Rationale: CORRECT ANSWER in COPD patients, low-flow oxygen (nasal
cannula 1-2 L/min) is preferred to avoid suppressing the hypoxic drive. Starting at
2 L/min allows titration to achieve SpO2 of 88-92%. Non-rebreather (A) provides
too high FiO2. Simple mask (B) delivers inconsistent FiO2. Ventura mask (D) is
precise but typically used for higher FiO2 needs; initial low-flow is standard.
3. A nurse is caring for a client with acute kidney injury (AKI) in the oliguria
phase. Which laboratory finding is most concerning?
A. Serum potassium 6.2 me/L
B. Serum creatinine 3.1 mg/ld.
C. Blood urea nitrogen 55 mg/ld.
D. Serum sodium 130 me/L
Correct Answer: A. Serum potassium 6.2 me/L
Rationale: CORRECT ANSWER Hyperkalemia (K+ >5.5 me/L) in oliguria AKI
poses immediate risk for fatal cardiac dysrhythmias. This level (6.2) requires
emergency intervention (calcium gluconate, insulin, glucose). Elevated creatinine
(B) and BUN (C) indicate kidney dysfunction but are not immediately life-
threatening. Hyponatremia (D) requires monitoring but is less urgent.
4. Which finding in a client with diabetic ketoacidosis (DKA) indicates that
treatment with intravenous insulin is effective?
A. Serum glucose decreases from 450 to 200 mg/ld.
B. Serum potassium increases from 4.0 to 4.5 me/L
C. Anion gap narrows from 25 to 12 me/L
D. Urine output increases from 20 to 50 mL/hr.
,Correct Answer: C. Anion gap narrows from 25 to 12 me/L
Rationale: CORRECT ANSWER The primary goal in DKA is resolution of
ketosis, reflected by a normalizing anion gap (normal 8-12). Narrowing indicates
decreased ketoacidosis. Glucose decrease (A) is expected but insulin must continue
until gap closes. Potassium increase (B) may occur with repletion but not the best
indicator. Urine output (D) improves with hydration but does not confirm ketosis
resolution.
5. A client post–myocardial infarction (MI) develops crackles in lung bases,
jugular vein distention, and an S3 heart sound. Which action should the nurse take
first?
A. Administer IV furosemide
B. Place the client in high Fowler’s position
C. Check oxygen saturation
D. Increase IV fluid rate
Correct Answer: B. Place the client in high Fowler’s position
Rationale: CORRECT ANSWER The client shows signs of acute heart failure
(pulmonary congestion, JVD, S3). Positioning in high Fowler’s reduces preload
and improves breathing immediately before further interventions. Administering
furosemide (A) is important but not first. Checking oxygen saturation (C) can be
done simultaneously but positioning is the initial priority. Increasing IV fluids (D)
would worsen overload.
6. A patient with severe pancreatitis has a nasogastric (NG) tube to low
intermittent suction. Which assessment finding suggests the development of a
complication?
A. Gastric output of 400 mL in 4 hours
B. Serum calcium level of 7.2 mg/ld.
, C. Serum amylase level of 200 U/L
D. Abdominal pain rated 4 on 0-10 scale
Correct Answer: B. Serum calcium level of 7.2 mg/ld.
Rationale: CORRECT ANSWER Hypocalcemia (normal 8.5-10.2) in pancreatitis
indicates fat saponification and necrosis (poor prognosis). This critically low level
requires calcium replacement. NG output (A) is expected. Amylase (C) may
remain elevated but is not an acute complication. Pain (D) is expected.
7. The nurse is assessing a client receiving a blood transfusion. Which finding
indicates a hemolytic transfusion reaction?
A. Urticarial and itching
B. Fever and chills
C. Low back pain and dark urine
D. Wheezing and dyspnea
Correct Answer: C. Low back pain and dark urine
Rationale: CORRECT ANSWER Hemolytic reaction occurs from ABO
incompatibility; hemoglobinuria causes dark urine, and back pain results from
inflammatory response. Urticarial (A) indicates allergic reaction. Fever with chills
(B) suggests febrile reaction. Wheezing (D) indicates anaphylaxis.
8. A client with chronic heart failure is prescribed carvedilol. Which statement by
the client indicates a need for further teaching?
A. “I will take my pulse before each dose.”
B. “I can stop this medicine if I feel dizzy.”
C. “This medicine helps reduce my heart’s workload.”
D. “It may take several weeks to feel the full effect.”
COMPLETE ACCURATE EXAM ACTUAL QUESTIONS AND CORRECT VERIFIED
SOLUTIONS WITH DETAILED RATIONALES (A NEW UPDATED VERSION 2026
EDITION) |GUARANTEED PASS A+ (BRAND NEW!) FULL REVISED KAPLAN
MEDICAL SURGICAL INTEGRATED EXAM
1. A client with cirrhosis of the liver develops ascites and hepatic encephalopathy.
Which assessment finding requires immediate intervention by the nurse?
A. Asterisks
B. Serum ammonia level of 120 mcg/ld.
C. Blood glucose level of 65 mg/ld.
D. Abdominal girth increase of 2 cm in 24 hours
Correct Answer: B. Serum ammonia level of 120 mcg/ld.
Rationale: CORRECT ANSWER A serum ammonia level of 120 mcg/ld. is
significantly elevated (normal 15-45 mcg/ld.) and directly correlates with
worsening hepatic encephalopathy, which can progress to coma. Immediate
intervention is required to reduce ammonia levels. Asterisks (A) is a sign of
encephalopathy but does not require immediate action as much as a critical lab
value. Hypoglycemia (C) needs intervention but is not the priority in this context.
Increased abdominal girth (D) indicates ascites progression but is not an
emergency.
2. A patient is admitted with acute exacerbation of chronic obstructive pulmonary
disease (COPD) and has an oxygen saturation of 88% on room air. Which oxygen
delivery device should the nurse initiate first?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 6 L/min
C. Nasal cannula at 2 L/min
,D. Ventura mask at 24%
Correct Answer: C. Nasal cannula at 2 L/min
Rationale: CORRECT ANSWER in COPD patients, low-flow oxygen (nasal
cannula 1-2 L/min) is preferred to avoid suppressing the hypoxic drive. Starting at
2 L/min allows titration to achieve SpO2 of 88-92%. Non-rebreather (A) provides
too high FiO2. Simple mask (B) delivers inconsistent FiO2. Ventura mask (D) is
precise but typically used for higher FiO2 needs; initial low-flow is standard.
3. A nurse is caring for a client with acute kidney injury (AKI) in the oliguria
phase. Which laboratory finding is most concerning?
A. Serum potassium 6.2 me/L
B. Serum creatinine 3.1 mg/ld.
C. Blood urea nitrogen 55 mg/ld.
D. Serum sodium 130 me/L
Correct Answer: A. Serum potassium 6.2 me/L
Rationale: CORRECT ANSWER Hyperkalemia (K+ >5.5 me/L) in oliguria AKI
poses immediate risk for fatal cardiac dysrhythmias. This level (6.2) requires
emergency intervention (calcium gluconate, insulin, glucose). Elevated creatinine
(B) and BUN (C) indicate kidney dysfunction but are not immediately life-
threatening. Hyponatremia (D) requires monitoring but is less urgent.
4. Which finding in a client with diabetic ketoacidosis (DKA) indicates that
treatment with intravenous insulin is effective?
A. Serum glucose decreases from 450 to 200 mg/ld.
B. Serum potassium increases from 4.0 to 4.5 me/L
C. Anion gap narrows from 25 to 12 me/L
D. Urine output increases from 20 to 50 mL/hr.
,Correct Answer: C. Anion gap narrows from 25 to 12 me/L
Rationale: CORRECT ANSWER The primary goal in DKA is resolution of
ketosis, reflected by a normalizing anion gap (normal 8-12). Narrowing indicates
decreased ketoacidosis. Glucose decrease (A) is expected but insulin must continue
until gap closes. Potassium increase (B) may occur with repletion but not the best
indicator. Urine output (D) improves with hydration but does not confirm ketosis
resolution.
5. A client post–myocardial infarction (MI) develops crackles in lung bases,
jugular vein distention, and an S3 heart sound. Which action should the nurse take
first?
A. Administer IV furosemide
B. Place the client in high Fowler’s position
C. Check oxygen saturation
D. Increase IV fluid rate
Correct Answer: B. Place the client in high Fowler’s position
Rationale: CORRECT ANSWER The client shows signs of acute heart failure
(pulmonary congestion, JVD, S3). Positioning in high Fowler’s reduces preload
and improves breathing immediately before further interventions. Administering
furosemide (A) is important but not first. Checking oxygen saturation (C) can be
done simultaneously but positioning is the initial priority. Increasing IV fluids (D)
would worsen overload.
6. A patient with severe pancreatitis has a nasogastric (NG) tube to low
intermittent suction. Which assessment finding suggests the development of a
complication?
A. Gastric output of 400 mL in 4 hours
B. Serum calcium level of 7.2 mg/ld.
, C. Serum amylase level of 200 U/L
D. Abdominal pain rated 4 on 0-10 scale
Correct Answer: B. Serum calcium level of 7.2 mg/ld.
Rationale: CORRECT ANSWER Hypocalcemia (normal 8.5-10.2) in pancreatitis
indicates fat saponification and necrosis (poor prognosis). This critically low level
requires calcium replacement. NG output (A) is expected. Amylase (C) may
remain elevated but is not an acute complication. Pain (D) is expected.
7. The nurse is assessing a client receiving a blood transfusion. Which finding
indicates a hemolytic transfusion reaction?
A. Urticarial and itching
B. Fever and chills
C. Low back pain and dark urine
D. Wheezing and dyspnea
Correct Answer: C. Low back pain and dark urine
Rationale: CORRECT ANSWER Hemolytic reaction occurs from ABO
incompatibility; hemoglobinuria causes dark urine, and back pain results from
inflammatory response. Urticarial (A) indicates allergic reaction. Fever with chills
(B) suggests febrile reaction. Wheezing (D) indicates anaphylaxis.
8. A client with chronic heart failure is prescribed carvedilol. Which statement by
the client indicates a need for further teaching?
A. “I will take my pulse before each dose.”
B. “I can stop this medicine if I feel dizzy.”
C. “This medicine helps reduce my heart’s workload.”
D. “It may take several weeks to feel the full effect.”
