Medical-Surgical Nursing Midterm
Exam Complete Review 100 Actual
Adult Health Questions and
Rationales
**Question 1:** A patient with a 10-year history of type 2 diabetes presents with a foot ulcer that is not
healing. The wound has a clean base but no signs of infection. Which intervention is the most important
to promote healing?
,A. Apply a dry gauze dressing and change it daily.
B. Administer systemic antibiotics.
C. Offload pressure from the ulcer and maintain a moist wound environment.
D. Soak the foot in warm water twice a day.
**Answer: C. Offload pressure from the ulcer and maintain a moist wound environment.**
**Rationale:** For diabetic foot ulcers, offloading pressure (e.g., with special footwear or a total contact
cast) and maintaining a moist wound environment are essential for healing. Dry dressings can desiccate
tissue, antibiotics are not indicated without infection, and soaking can macerate the skin .
**Question 2:** Which abnormal lab finding indicates that a client with diabetes needs further
evaluation for diabetic nephropathy?
A. Hypokalemia
B. Microalbuminuria
C. Elevated serum lipids
D. Ketonuria
**Answer: B. Microalbuminuria**
**Rationale:** Microalbuminuria is the earliest sign of nephropathy in diabetes and warrants further
evaluation. Hypokalemia is not typical; hyperkalemia may occur in end-stage renal disease. Elevated
lipids and ketonuria do not specifically indicate nephropathy .
**Question 3:** A patient with type 2 diabetes is on metformin and is scheduled for surgery. Which
instruction regarding the metformin is most important?
A. Take the metformin as usual the morning of surgery.
B. Hold the metformin for 24 hours before and after surgery due to the risk of lactic acidosis.
C. Double the dose the day before surgery.
D. Switch to insulin the day of surgery.
,**Answer: B. Hold the metformin for 24 hours before and after surgery.**
**Rationale:** Metformin should be held prior to and after surgery because of the risk of contrast-
induced nephropathy (if contrast is used) and the increased risk of lactic acidosis during surgery. The
patient's blood glucose should be managed with insulin if needed.
**Question 4:** The nurse is teaching a patient with type 1 diabetes about sick day management.
Which statement indicates understanding?
A. "I will stop my insulin if I am not eating."
B. "I will check my blood glucose every 4 hours and check for ketones."
C. "I will only drink clear liquids and avoid solid food."
D. "I will skip my short-acting insulin but continue my long-acting."
**Answer: B. "I will check my blood glucose every 4 hours and check for ketones."**
**Rationale:** During illness, patients with type 1 diabetes should check blood glucose and ketones
frequently. Insulin should never be stopped completely, as this can lead to DKA. Patients should try to
maintain carbohydrate intake or follow a sick-day plan from their provider.
**Question 5:** A patient with diabetes is prescribed propranolol for hypertension. The nurse should
teach the patient that this medication may:
A. Increase blood glucose levels significantly.
B. Mask the symptoms of hypoglycemia (tachycardia, shakiness).
C. Increase insulin production.
D. Cause weight loss.
**Answer: B. Mask the symptoms of hypoglycemia.**
**Rationale:** Beta-blockers like propranolol can block the sympathetic response to hypoglycemia
(tachycardia, tremor, anxiety), masking early warning signs. Patients with diabetes using beta-blockers
should be taught to monitor blood glucose closely and watch for other signs like sweating.
, ### Section 2: Heart Failure & Fluid Balance (6-15)
**Question 6:** A patient with chronic heart failure reports a weight gain of 3 kg (6.6 lbs) over 2 days
and increased dyspnea. Which action should the nurse take first?
A. Document the weight and continue monitoring.
B. Assess breath sounds and oxygen saturation.
C. Instruct the patient to limit fluid intake to 1 L per day.
D. Administer the prescribed diuretic and notify the provider.
**Answer: B. Assess breath sounds and oxygen saturation.**
**Rationale:** Weight gain and dyspnea indicate worsening fluid overload. The nurse must first assess
respiratory status to determine the severity of the condition before administering medication or
notifying the provider .
**Question 7:** A patient with heart failure is receiving furosemide (Lasix) IV push. The nurse monitors
for which most common electrolyte disturbance?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
**Answer: B. Hypokalemia**
**Rationale:** Loop diuretics like furosemide cause potassium wasting, making hypokalemia a common
side effect. This can increase the risk of digoxin toxicity and cardiac arrhythmias. Hyperkalemia is
associated with potassium-sparing diuretics .
Exam Complete Review 100 Actual
Adult Health Questions and
Rationales
**Question 1:** A patient with a 10-year history of type 2 diabetes presents with a foot ulcer that is not
healing. The wound has a clean base but no signs of infection. Which intervention is the most important
to promote healing?
,A. Apply a dry gauze dressing and change it daily.
B. Administer systemic antibiotics.
C. Offload pressure from the ulcer and maintain a moist wound environment.
D. Soak the foot in warm water twice a day.
**Answer: C. Offload pressure from the ulcer and maintain a moist wound environment.**
**Rationale:** For diabetic foot ulcers, offloading pressure (e.g., with special footwear or a total contact
cast) and maintaining a moist wound environment are essential for healing. Dry dressings can desiccate
tissue, antibiotics are not indicated without infection, and soaking can macerate the skin .
**Question 2:** Which abnormal lab finding indicates that a client with diabetes needs further
evaluation for diabetic nephropathy?
A. Hypokalemia
B. Microalbuminuria
C. Elevated serum lipids
D. Ketonuria
**Answer: B. Microalbuminuria**
**Rationale:** Microalbuminuria is the earliest sign of nephropathy in diabetes and warrants further
evaluation. Hypokalemia is not typical; hyperkalemia may occur in end-stage renal disease. Elevated
lipids and ketonuria do not specifically indicate nephropathy .
**Question 3:** A patient with type 2 diabetes is on metformin and is scheduled for surgery. Which
instruction regarding the metformin is most important?
A. Take the metformin as usual the morning of surgery.
B. Hold the metformin for 24 hours before and after surgery due to the risk of lactic acidosis.
C. Double the dose the day before surgery.
D. Switch to insulin the day of surgery.
,**Answer: B. Hold the metformin for 24 hours before and after surgery.**
**Rationale:** Metformin should be held prior to and after surgery because of the risk of contrast-
induced nephropathy (if contrast is used) and the increased risk of lactic acidosis during surgery. The
patient's blood glucose should be managed with insulin if needed.
**Question 4:** The nurse is teaching a patient with type 1 diabetes about sick day management.
Which statement indicates understanding?
A. "I will stop my insulin if I am not eating."
B. "I will check my blood glucose every 4 hours and check for ketones."
C. "I will only drink clear liquids and avoid solid food."
D. "I will skip my short-acting insulin but continue my long-acting."
**Answer: B. "I will check my blood glucose every 4 hours and check for ketones."**
**Rationale:** During illness, patients with type 1 diabetes should check blood glucose and ketones
frequently. Insulin should never be stopped completely, as this can lead to DKA. Patients should try to
maintain carbohydrate intake or follow a sick-day plan from their provider.
**Question 5:** A patient with diabetes is prescribed propranolol for hypertension. The nurse should
teach the patient that this medication may:
A. Increase blood glucose levels significantly.
B. Mask the symptoms of hypoglycemia (tachycardia, shakiness).
C. Increase insulin production.
D. Cause weight loss.
**Answer: B. Mask the symptoms of hypoglycemia.**
**Rationale:** Beta-blockers like propranolol can block the sympathetic response to hypoglycemia
(tachycardia, tremor, anxiety), masking early warning signs. Patients with diabetes using beta-blockers
should be taught to monitor blood glucose closely and watch for other signs like sweating.
, ### Section 2: Heart Failure & Fluid Balance (6-15)
**Question 6:** A patient with chronic heart failure reports a weight gain of 3 kg (6.6 lbs) over 2 days
and increased dyspnea. Which action should the nurse take first?
A. Document the weight and continue monitoring.
B. Assess breath sounds and oxygen saturation.
C. Instruct the patient to limit fluid intake to 1 L per day.
D. Administer the prescribed diuretic and notify the provider.
**Answer: B. Assess breath sounds and oxygen saturation.**
**Rationale:** Weight gain and dyspnea indicate worsening fluid overload. The nurse must first assess
respiratory status to determine the severity of the condition before administering medication or
notifying the provider .
**Question 7:** A patient with heart failure is receiving furosemide (Lasix) IV push. The nurse monitors
for which most common electrolyte disturbance?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
**Answer: B. Hypokalemia**
**Rationale:** Loop diuretics like furosemide cause potassium wasting, making hypokalemia a common
side effect. This can increase the risk of digoxin toxicity and cardiac arrhythmias. Hyperkalemia is
associated with potassium-sparing diuretics .
