Comprehensive Test Bank for Davis Advantage for
Medical-Surgical Nursing: 3rd Edition 200 High-Yield
NCLEX-Style Questions with Answers and Detailed
Rationales
Introduction
This test bank is designed to complement the Davis Advantage for Medical-Surgical
Nursing: Making Connections to Practice, 3rd Edition textbook. It contains 200 original,
exam-style questions (with additional questions available to reach 200) that reflect the
difficulty, content emphasis, and clinical reasoning focus of the NCLEX-RN examination.
Question 1
A patient with heart failure reports waking up at night gasping for air. The nurse
documents this finding as:
a) Dyspnea on exertion
b) Orthopnea
c) Paroxysmal nocturnal dyspnea
d) Kussmaul breathing
Answer: c) Paroxysmal nocturnal dyspnea
Rationale: Paroxysmal nocturnal dyspnea occurs when fluid shifts from the legs to the
lungs while lying flat, causing sudden awakening with shortness of breath.
Question 2
Which assessment finding in a patient with pneumonia requires the nurse to intervene
immediately?
,a) Temperature of 38.3°C (101°F)
b) Oxygen saturation of 86% on room air
c) Respiratory rate of 24 breaths per minute
d) Productive cough with green sputum
Answer: b) Oxygen saturation of 86% on room air
Rationale: An oxygen saturation below 88% indicates severe hypoxemia requiring
immediate oxygen therapy to prevent tissue damage and respiratory failure.
Question 3
The nurse is teaching a patient with chronic kidney disease about a low-phosphorus
diet. Which food choice indicates effective learning?
a) Small baked potato with skin removed
b) Cup of low-fat yogurt
c) One ounce of cheddar cheese
d) Chocolate pudding snack
Answer: a) Small baked potato with skin removed
Rationale: Potatoes are lower in phosphorus than dairy products, cheese, and
chocolate, all of which are high-phosphorus foods to restrict in kidney disease.
Question 4
A patient receiving a blood transfusion develops chills, fever, and lower back pain. The
nurse’s priority action is to:
a) Slow the infusion rate to 10 mL per hour
b) Stop the transfusion immediately
,c) Administer acetaminophen as prescribed
d) Notify the healthcare provider after 30 minutes
Answer: b) Stop the transfusion immediately
Rationale: Chills, fever, and back pain suggest an acute hemolytic reaction, and
stopping the transfusion prevents further destruction of red blood cells.
Question 5
Which arterial blood gas finding is consistent with uncompensated metabolic alkalosis?
a) pH 7.32, PaCO2 48, HCO3 22
b) pH 7.38, PaCO2 40, HCO3 24
c) pH 7.50, PaCO2 44, HCO3 32
d) pH 7.25, PaCO2 28, HCO3 14
Answer: c) pH 7.50, PaCO2 44, HCO3 32
Rationale: A high pH with elevated bicarbonate indicates metabolic alkalosis, and
normal PaCO2 shows no respiratory compensation yet.
Question 6
The nurse is caring for a patient after a thyroidectomy. Which finding is most concerning
for thyroid storm?
a) Heart rate of 88 beats per minute
b) Temperature of 39.4°C (103°F)
c) Blood pressure 110/70 mm Hg
d) Mild tremors in both hands
, Answer: b) Temperature of 39.4°C (103°F)
Rationale: Hyperpyrexia above 101°F is a hallmark of thyroid storm, a life-threatening
condition requiring immediate medical intervention.
Question 7
A patient with diabetes insipidus is receiving desmopressin acetate. Which outcome
indicates the medication is effective?
a) *Urine output decreases from 300 mL/hour to 60 mL/hour*
b) Blood glucose level decreases from 180 to 110 mg/dL
c) Serum sodium level drops from 150 to 130 mEq/L
d) Thirst increases and skin turgor becomes poor
*Answer: a) Urine output decreases from 300 mL/hour to 60 mL/hour*
Rationale: Desmopressin replaces antidiuretic hormone, reducing excessive urine
output and preventing dehydration in diabetes insipidus.
Question 8
The nurse is assessing a patient with small bowel obstruction. Which finding requires
immediate surgical notification?
a) Intermittent, colicky abdominal pain
b) Rigid, board-like abdomen with rebound tenderness
c) Nausea with vomiting of greenish fluid
d) Hypoactive bowel sounds in all four quadrants
Answer: b) Rigid, board-like abdomen with rebound tenderness
Rationale: A rigid abdomen with rebound tenderness suggests peritonitis or bowel
perforation, which are surgical emergencies requiring prompt intervention.
Medical-Surgical Nursing: 3rd Edition 200 High-Yield
NCLEX-Style Questions with Answers and Detailed
Rationales
Introduction
This test bank is designed to complement the Davis Advantage for Medical-Surgical
Nursing: Making Connections to Practice, 3rd Edition textbook. It contains 200 original,
exam-style questions (with additional questions available to reach 200) that reflect the
difficulty, content emphasis, and clinical reasoning focus of the NCLEX-RN examination.
Question 1
A patient with heart failure reports waking up at night gasping for air. The nurse
documents this finding as:
a) Dyspnea on exertion
b) Orthopnea
c) Paroxysmal nocturnal dyspnea
d) Kussmaul breathing
Answer: c) Paroxysmal nocturnal dyspnea
Rationale: Paroxysmal nocturnal dyspnea occurs when fluid shifts from the legs to the
lungs while lying flat, causing sudden awakening with shortness of breath.
Question 2
Which assessment finding in a patient with pneumonia requires the nurse to intervene
immediately?
,a) Temperature of 38.3°C (101°F)
b) Oxygen saturation of 86% on room air
c) Respiratory rate of 24 breaths per minute
d) Productive cough with green sputum
Answer: b) Oxygen saturation of 86% on room air
Rationale: An oxygen saturation below 88% indicates severe hypoxemia requiring
immediate oxygen therapy to prevent tissue damage and respiratory failure.
Question 3
The nurse is teaching a patient with chronic kidney disease about a low-phosphorus
diet. Which food choice indicates effective learning?
a) Small baked potato with skin removed
b) Cup of low-fat yogurt
c) One ounce of cheddar cheese
d) Chocolate pudding snack
Answer: a) Small baked potato with skin removed
Rationale: Potatoes are lower in phosphorus than dairy products, cheese, and
chocolate, all of which are high-phosphorus foods to restrict in kidney disease.
Question 4
A patient receiving a blood transfusion develops chills, fever, and lower back pain. The
nurse’s priority action is to:
a) Slow the infusion rate to 10 mL per hour
b) Stop the transfusion immediately
,c) Administer acetaminophen as prescribed
d) Notify the healthcare provider after 30 minutes
Answer: b) Stop the transfusion immediately
Rationale: Chills, fever, and back pain suggest an acute hemolytic reaction, and
stopping the transfusion prevents further destruction of red blood cells.
Question 5
Which arterial blood gas finding is consistent with uncompensated metabolic alkalosis?
a) pH 7.32, PaCO2 48, HCO3 22
b) pH 7.38, PaCO2 40, HCO3 24
c) pH 7.50, PaCO2 44, HCO3 32
d) pH 7.25, PaCO2 28, HCO3 14
Answer: c) pH 7.50, PaCO2 44, HCO3 32
Rationale: A high pH with elevated bicarbonate indicates metabolic alkalosis, and
normal PaCO2 shows no respiratory compensation yet.
Question 6
The nurse is caring for a patient after a thyroidectomy. Which finding is most concerning
for thyroid storm?
a) Heart rate of 88 beats per minute
b) Temperature of 39.4°C (103°F)
c) Blood pressure 110/70 mm Hg
d) Mild tremors in both hands
, Answer: b) Temperature of 39.4°C (103°F)
Rationale: Hyperpyrexia above 101°F is a hallmark of thyroid storm, a life-threatening
condition requiring immediate medical intervention.
Question 7
A patient with diabetes insipidus is receiving desmopressin acetate. Which outcome
indicates the medication is effective?
a) *Urine output decreases from 300 mL/hour to 60 mL/hour*
b) Blood glucose level decreases from 180 to 110 mg/dL
c) Serum sodium level drops from 150 to 130 mEq/L
d) Thirst increases and skin turgor becomes poor
*Answer: a) Urine output decreases from 300 mL/hour to 60 mL/hour*
Rationale: Desmopressin replaces antidiuretic hormone, reducing excessive urine
output and preventing dehydration in diabetes insipidus.
Question 8
The nurse is assessing a patient with small bowel obstruction. Which finding requires
immediate surgical notification?
a) Intermittent, colicky abdominal pain
b) Rigid, board-like abdomen with rebound tenderness
c) Nausea with vomiting of greenish fluid
d) Hypoactive bowel sounds in all four quadrants
Answer: b) Rigid, board-like abdomen with rebound tenderness
Rationale: A rigid abdomen with rebound tenderness suggests peritonitis or bowel
perforation, which are surgical emergencies requiring prompt intervention.
