PN Medical-Surgical Nursing Final Exam 2026/2027
Updated Practice Questions + Rationales
Practical/Vocational Medical-Surgical Nursing | Key Domains: PN Scope of Practice & Delegation,
Nursing Care for Common Medical-Surgical Conditions, Medication Administration & Safety,
Postoperative Care & Complications, Fluid & Electrolyte Balance, Wound Care, Pain Management,
and Patient Education within PN Role | Expert-Aligned Structure | Practice Exam & Rationale
Format
Introduction
This structured PN Medical-Surgical Nursing Final Exam for 2026/2027 provides an updated set of
practice questions with correct answers and detailed rationales. It emphasizes the application of
nursing knowledge within the scope of practice for the Practical/Vocational Nurse, focusing on safe
patient care, accurate data collection, medication administration under supervision, and
recognizing findings that must be reported to the RN or provider.
Exam Structure:
• Final Exam Practice Set: (75 QUESTIONS)
Answer Format
All correct answers must appear in bold and cyan blue, accompanied by concise rationales
explaining the PN's appropriate action within their scope, the foundational principle of care for the
condition, the rationale for a specific observation or intervention, and why alternative options are
outside the PN's scope, unsafe, or represent an incorrect delegation of tasks.
1. A client’s morning potassium level is 2.8 mEq/L. What is the PN’s priority action?
A. Administer the scheduled potassium supplement
B. Notify the RN or provider immediately
C. Encourage the client to eat a banana
D. Recheck the potassium level in 4 hours
,B. Notify the RN or provider immediately
A potassium level of 2.8 mEq/L is critically low (hypokalemia) and can cause life-threatening
dysrhythmias. The PN must recognize this abnormal lab value and report it immediately to the RN or
provider. The PN does not independently administer potassium supplements (A) without an order.
Dietary measures (C) are insufficient for severe deficiency. The PN cannot order repeat labs (D).
2. Which task is appropriate for a PN to perform independently?
A. Developing a new plan of care for a client with heart failure
B. Administering IV push medications
C. Performing a sterile wound dressing change
D. Interpreting arterial blood gas results
C. Performing a sterile wound dressing change
Performing sterile dressing changes is within the PN scope of practice, provided the PN is trained and
follows the established care plan. Developing care plans (A), interpreting ABGs (D), and administering
IV push medications (B)—in most states—require RN licensure or additional certification. IV push
meds are often restricted for PNs per state nurse practice acts.
3. A client 1 day post-op from abdominal surgery reports pain of 7/10. The PN has an order
for morphine 2–4 mg IV every 2 hours PRN. What should the PN do first?
A. Administer 4 mg morphine IV
B. Assess vital signs and respiratory rate
C. Offer a warm blanket and reposition
D. Document the pain and continue monitoring
B. Assess vital signs and respiratory rate
Before administering any opioid, the PN must assess baseline vital signs, especially respiratory rate, to
ensure safety. Opioids can cause respiratory depression. Administering without assessment (A) is
,unsafe. Nonpharmacologic measures (C) may be used but are insufficient for severe pain.
Documentation (D) without intervention is inadequate.
4. A client with type 2 diabetes has a capillary blood glucose of 58 mg/dL and is alert but
shaky. What is the PN’s best action?
A. Give 4 oz of orange juice
B. Administer glucagon IM
C. Notify the provider for insulin order
D. Recheck blood glucose in 15 minutes
A. Give 4 oz of orange juice
For a conscious client with hypoglycemia, the PN should provide 15 grams of fast-acting carbohydrate
(e.g., 4 oz juice). Glucagon (B) is for unconscious clients. Insulin (C) would worsen hypoglycemia.
Rechecking (D) without treatment delays care.
5. Which finding in a postoperative client requires immediate reporting to the RN?
A. Temperature of 99.8°F (37.7°C)
B. Incisional pain of 4/10
C. Urine output of 20 mL/hr for the past 2 hours
D. Mild redness around the IV site
C. Urine output of 20 mL/hr for the past 2 hours
Urine output <30 mL/hr in an adult may indicate hypovolemia, acute kidney injury, or
obstruction—especially postoperatively. This requires prompt RN assessment. Low-grade fever (A) and
mild pain (B) are common. Mild IV redness (D) may be irritation but is less urgent than oliguria.
6. A PN is assigned to care for four clients. Which client should the PN assess first?
, A. Client with COPD, SpO₂ 92% on 2 L/min O₂
B. Client with heart failure, +2 pitting edema
C. Client 2 hours post-op, BP 88/50 mm Hg, HR 118 bpm
D. Client with UTI, complaining of dysuria
C. Client 2 hours post-op, BP 88/50 mm Hg, HR 118 bpm
This client shows signs of hypovolemic or septic shock (hypotension, tachycardia) and is at highest risk
for deterioration. ABCs and hemodynamic stability take priority. The other clients are stable: COPD (A)
is within target SpO₂, edema (B) is chronic, and UTI (D) is uncomfortable but not emergent.
7. A client is prescribed enoxaparin (Lovenox) 40 mg subcutaneously daily. What is the
correct technique for the PN?
A. Inject into the deltoid muscle
B. Massage the site after injection
C. Inject into the abdominal fat, do not aspirate, do not massage
D. Use a 25-gauge, 1-inch needle
C. Inject into the abdominal fat, do not aspirate, do not massage
Low-molecular-weight heparins like enoxaparin are given subcutaneously in the abdomen. Aspiration
is unnecessary and may cause tissue trauma. Massaging can increase bruising and hematoma. A
25–27-gauge, ½–5/8-inch needle is used—not 1 inch (D). It is not given IM (A).
8. A client with a stage 2 pressure injury has a shallow open ulcer with a red wound bed.
What is the most appropriate dressing for the PN to apply?
A. Dry gauze
B. Hydrocolloid
Updated Practice Questions + Rationales
Practical/Vocational Medical-Surgical Nursing | Key Domains: PN Scope of Practice & Delegation,
Nursing Care for Common Medical-Surgical Conditions, Medication Administration & Safety,
Postoperative Care & Complications, Fluid & Electrolyte Balance, Wound Care, Pain Management,
and Patient Education within PN Role | Expert-Aligned Structure | Practice Exam & Rationale
Format
Introduction
This structured PN Medical-Surgical Nursing Final Exam for 2026/2027 provides an updated set of
practice questions with correct answers and detailed rationales. It emphasizes the application of
nursing knowledge within the scope of practice for the Practical/Vocational Nurse, focusing on safe
patient care, accurate data collection, medication administration under supervision, and
recognizing findings that must be reported to the RN or provider.
Exam Structure:
• Final Exam Practice Set: (75 QUESTIONS)
Answer Format
All correct answers must appear in bold and cyan blue, accompanied by concise rationales
explaining the PN's appropriate action within their scope, the foundational principle of care for the
condition, the rationale for a specific observation or intervention, and why alternative options are
outside the PN's scope, unsafe, or represent an incorrect delegation of tasks.
1. A client’s morning potassium level is 2.8 mEq/L. What is the PN’s priority action?
A. Administer the scheduled potassium supplement
B. Notify the RN or provider immediately
C. Encourage the client to eat a banana
D. Recheck the potassium level in 4 hours
,B. Notify the RN or provider immediately
A potassium level of 2.8 mEq/L is critically low (hypokalemia) and can cause life-threatening
dysrhythmias. The PN must recognize this abnormal lab value and report it immediately to the RN or
provider. The PN does not independently administer potassium supplements (A) without an order.
Dietary measures (C) are insufficient for severe deficiency. The PN cannot order repeat labs (D).
2. Which task is appropriate for a PN to perform independently?
A. Developing a new plan of care for a client with heart failure
B. Administering IV push medications
C. Performing a sterile wound dressing change
D. Interpreting arterial blood gas results
C. Performing a sterile wound dressing change
Performing sterile dressing changes is within the PN scope of practice, provided the PN is trained and
follows the established care plan. Developing care plans (A), interpreting ABGs (D), and administering
IV push medications (B)—in most states—require RN licensure or additional certification. IV push
meds are often restricted for PNs per state nurse practice acts.
3. A client 1 day post-op from abdominal surgery reports pain of 7/10. The PN has an order
for morphine 2–4 mg IV every 2 hours PRN. What should the PN do first?
A. Administer 4 mg morphine IV
B. Assess vital signs and respiratory rate
C. Offer a warm blanket and reposition
D. Document the pain and continue monitoring
B. Assess vital signs and respiratory rate
Before administering any opioid, the PN must assess baseline vital signs, especially respiratory rate, to
ensure safety. Opioids can cause respiratory depression. Administering without assessment (A) is
,unsafe. Nonpharmacologic measures (C) may be used but are insufficient for severe pain.
Documentation (D) without intervention is inadequate.
4. A client with type 2 diabetes has a capillary blood glucose of 58 mg/dL and is alert but
shaky. What is the PN’s best action?
A. Give 4 oz of orange juice
B. Administer glucagon IM
C. Notify the provider for insulin order
D. Recheck blood glucose in 15 minutes
A. Give 4 oz of orange juice
For a conscious client with hypoglycemia, the PN should provide 15 grams of fast-acting carbohydrate
(e.g., 4 oz juice). Glucagon (B) is for unconscious clients. Insulin (C) would worsen hypoglycemia.
Rechecking (D) without treatment delays care.
5. Which finding in a postoperative client requires immediate reporting to the RN?
A. Temperature of 99.8°F (37.7°C)
B. Incisional pain of 4/10
C. Urine output of 20 mL/hr for the past 2 hours
D. Mild redness around the IV site
C. Urine output of 20 mL/hr for the past 2 hours
Urine output <30 mL/hr in an adult may indicate hypovolemia, acute kidney injury, or
obstruction—especially postoperatively. This requires prompt RN assessment. Low-grade fever (A) and
mild pain (B) are common. Mild IV redness (D) may be irritation but is less urgent than oliguria.
6. A PN is assigned to care for four clients. Which client should the PN assess first?
, A. Client with COPD, SpO₂ 92% on 2 L/min O₂
B. Client with heart failure, +2 pitting edema
C. Client 2 hours post-op, BP 88/50 mm Hg, HR 118 bpm
D. Client with UTI, complaining of dysuria
C. Client 2 hours post-op, BP 88/50 mm Hg, HR 118 bpm
This client shows signs of hypovolemic or septic shock (hypotension, tachycardia) and is at highest risk
for deterioration. ABCs and hemodynamic stability take priority. The other clients are stable: COPD (A)
is within target SpO₂, edema (B) is chronic, and UTI (D) is uncomfortable but not emergent.
7. A client is prescribed enoxaparin (Lovenox) 40 mg subcutaneously daily. What is the
correct technique for the PN?
A. Inject into the deltoid muscle
B. Massage the site after injection
C. Inject into the abdominal fat, do not aspirate, do not massage
D. Use a 25-gauge, 1-inch needle
C. Inject into the abdominal fat, do not aspirate, do not massage
Low-molecular-weight heparins like enoxaparin are given subcutaneously in the abdomen. Aspiration
is unnecessary and may cause tissue trauma. Massaging can increase bruising and hematoma. A
25–27-gauge, ½–5/8-inch needle is used—not 1 inch (D). It is not given IM (A).
8. A client with a stage 2 pressure injury has a shallow open ulcer with a red wound bed.
What is the most appropriate dressing for the PN to apply?
A. Dry gauze
B. Hydrocolloid
