MED-SURG II FINAL EXAM ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A client with acute pancreatitis reports severe epigastric pain radiating to
the back. Which action should the nurse take first?
A. Offer small, frequent meals
B. Administer prescribed IV opioids
C. Encourage ambulation
D. Provide a heating pad to the abdomen
Correct Answer: B
Rationale: Acute pancreatitis pain is severe due to autodigestion of the pancreas;
IV opioids are the priority for pain control. The patient should be NPO, so meals
are contraindicated. Heat can worsen inflammation.
2. A postoperative patient suddenly develops shortness of breath, tachycardia,
and chest pain. The nurse suspects a pulmonary embolism. What is the
priority intervention?
A. Start chest physiotherapy
B. Place patient in high Fowler’s position
C. Encourage coughing and deep breathing
D. Administer oral anticoagulants
Correct Answer: B
Rationale: High Fowler’s maximizes lung expansion during acute respiratory
distress. Anticoagulants are needed but not oral or immediate.
,3. A patient with chronic kidney disease has lab results: K⁺ 6.1 mEq/L, peaked
T waves on ECG. The nurse anticipates which treatment?
A. IV insulin and dextrose
B. IV furosemide
C. Oral Kayexalate
D. Increase dietary potassium
Correct Answer: A
Rationale: Insulin + D50 quickly shifts potassium intracellularly to stabilize the
heart. Kayexalate acts slowly; furosemide may not be effective with CKD.
4. Which finding indicates improvement in a patient with left-sided heart
failure?
A. Increased crackles
B. Decreased BNP
C. Frothy sputum
D. Increased tachypnea
Correct Answer: B
Rationale: BNP decreases when ventricular strain decreases. Crackles and frothy
sputum reflect worsening pulmonary congestion.
5. A patient with pneumonia has SpO₂ 87% on room air and is confused.
Which intervention is priority?
A. Increase IV fluids
B. Obtain a STAT chest X-ray
C. Apply oxygen
D. Encourage incentive spirometry
Correct Answer: C
Rationale: Hypoxia + confusion = oxygen first to correct impaired gas exchange.
,6. A patient with COPD is receiving 4 L/min O₂. They become drowsy with
decreased respirations. What should the nurse do?
A. Increase oxygen to 6 L/min
B. Decrease oxygen flow
C. Stop oxygen immediately
D. Place patient supine
Correct Answer: B
Rationale: High O₂ can suppress a COPD patient’s hypoxic respiratory drive.
Reduce flow to 1–2 L/min.
7. A client with a chest tube for pneumothorax has continuous bubbling in the
water-seal chamber. What does this indicate?
A. Air leak
B. Normal function
C. Lung re-expansion
D. Blocked tube
Correct Answer: A
Rationale: Continuous bubbling = air leak. Intermittent is expected with
pneumothorax.
8. A patient with cirrhosis has abdominal distention and SOB. Which nursing
intervention is priority?
A. Place in low Fowler’s
B. Restrict protein
C. Prepare for paracentesis
D. Increase oral fluids
Correct Answer: C
Rationale: Ascites causing respiratory compromise requires paracentesis for
relief.
, 9. Which assessment finding indicates a worsening stroke in a patient being
monitored on a neuro unit?
A. Mild headache
B. New-onset anisocoria (unequal pupils)
C. Slight weakness in hand grip
D. BP 150/90
Correct Answer: B
Rationale: Unequal pupils = increased ICP or herniation risk → emergency.
10. A client with diabetic ketoacidosis receives IV insulin. Which electrolyte
must be monitored most closely?
A. Sodium
B. Calcium
C. Potassium
D. Chloride
Correct Answer: C
Rationale: Insulin pushes K⁺ into cells, causing hypokalemia.
11. Which symptom suggests myasthenic crisis rather than cholinergic crisis?
A. Diarrhea
B. Bronchial secretions
C. Muscle weakness improves with Tensilon test
D. Muscle twitching
Correct Answer: C
Rationale: Tensilon improves strength in myasthenic crisis but worsens
cholinergic crisis.
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A client with acute pancreatitis reports severe epigastric pain radiating to
the back. Which action should the nurse take first?
A. Offer small, frequent meals
B. Administer prescribed IV opioids
C. Encourage ambulation
D. Provide a heating pad to the abdomen
Correct Answer: B
Rationale: Acute pancreatitis pain is severe due to autodigestion of the pancreas;
IV opioids are the priority for pain control. The patient should be NPO, so meals
are contraindicated. Heat can worsen inflammation.
2. A postoperative patient suddenly develops shortness of breath, tachycardia,
and chest pain. The nurse suspects a pulmonary embolism. What is the
priority intervention?
A. Start chest physiotherapy
B. Place patient in high Fowler’s position
C. Encourage coughing and deep breathing
D. Administer oral anticoagulants
Correct Answer: B
Rationale: High Fowler’s maximizes lung expansion during acute respiratory
distress. Anticoagulants are needed but not oral or immediate.
,3. A patient with chronic kidney disease has lab results: K⁺ 6.1 mEq/L, peaked
T waves on ECG. The nurse anticipates which treatment?
A. IV insulin and dextrose
B. IV furosemide
C. Oral Kayexalate
D. Increase dietary potassium
Correct Answer: A
Rationale: Insulin + D50 quickly shifts potassium intracellularly to stabilize the
heart. Kayexalate acts slowly; furosemide may not be effective with CKD.
4. Which finding indicates improvement in a patient with left-sided heart
failure?
A. Increased crackles
B. Decreased BNP
C. Frothy sputum
D. Increased tachypnea
Correct Answer: B
Rationale: BNP decreases when ventricular strain decreases. Crackles and frothy
sputum reflect worsening pulmonary congestion.
5. A patient with pneumonia has SpO₂ 87% on room air and is confused.
Which intervention is priority?
A. Increase IV fluids
B. Obtain a STAT chest X-ray
C. Apply oxygen
D. Encourage incentive spirometry
Correct Answer: C
Rationale: Hypoxia + confusion = oxygen first to correct impaired gas exchange.
,6. A patient with COPD is receiving 4 L/min O₂. They become drowsy with
decreased respirations. What should the nurse do?
A. Increase oxygen to 6 L/min
B. Decrease oxygen flow
C. Stop oxygen immediately
D. Place patient supine
Correct Answer: B
Rationale: High O₂ can suppress a COPD patient’s hypoxic respiratory drive.
Reduce flow to 1–2 L/min.
7. A client with a chest tube for pneumothorax has continuous bubbling in the
water-seal chamber. What does this indicate?
A. Air leak
B. Normal function
C. Lung re-expansion
D. Blocked tube
Correct Answer: A
Rationale: Continuous bubbling = air leak. Intermittent is expected with
pneumothorax.
8. A patient with cirrhosis has abdominal distention and SOB. Which nursing
intervention is priority?
A. Place in low Fowler’s
B. Restrict protein
C. Prepare for paracentesis
D. Increase oral fluids
Correct Answer: C
Rationale: Ascites causing respiratory compromise requires paracentesis for
relief.
, 9. Which assessment finding indicates a worsening stroke in a patient being
monitored on a neuro unit?
A. Mild headache
B. New-onset anisocoria (unequal pupils)
C. Slight weakness in hand grip
D. BP 150/90
Correct Answer: B
Rationale: Unequal pupils = increased ICP or herniation risk → emergency.
10. A client with diabetic ketoacidosis receives IV insulin. Which electrolyte
must be monitored most closely?
A. Sodium
B. Calcium
C. Potassium
D. Chloride
Correct Answer: C
Rationale: Insulin pushes K⁺ into cells, causing hypokalemia.
11. Which symptom suggests myasthenic crisis rather than cholinergic crisis?
A. Diarrhea
B. Bronchial secretions
C. Muscle weakness improves with Tensilon test
D. Muscle twitching
Correct Answer: C
Rationale: Tensilon improves strength in myasthenic crisis but worsens
cholinergic crisis.
