(Prophecy) Relias RN Medical-Surgical Form A
Real Exam Simulation | Latest Version
100 Questions with 100% Correct & Detailed Answers
Q1: A 68-year-old male is post-op day 1 from a laparotomy for bowel resection. The
nurse notes the following vital signs: HR 118, BP 92/58, RR 24, SpO2 94% on 2L NC. The
patient reports feeling "lightheaded and anxious." The urine output for the past 4 hours
is 45 mL. Which action should the nurse take first?
A. Increase the IV fluid rate as permitted by the standing order protocol.
B. Administer PRN furosemide for suspected fluid overload.
C. Assess the surgical dressing and abdomen for signs of active hemorrhage.
[CORRECT]
D. Place the patient in Trendelenburg position to improve cerebral perfusion.
Correct Answer: C
Rationale:
[CLINICAL JUDGMENT PATH]
● Recognize Cues: Tachycardia (HR 118), hypotension (92/58), decreased urine
output (45 mL/4 hours), anxiety, and lightheadedness are classic cues for
hypovolemic shock.
● Analyze Cues/Generate Hypothesis: In a post-operative abdominal surgery
patient, the priority hypothesis is internal or external hemorrhage. The
combination of hypotension and tachycardia indicates compensatory
mechanisms for volume loss.
● Prioritize Hypotheses: Hemorrhage is the most life-threatening and likely cause
in this context, taking priority over other potential causes like sepsis or
medication effects.
● Take Action: The first nursing action must be to assess the most likely
source—the surgical site for external bleeding or the abdomen for internal
bleeding (distention, increasing firmness, pain).
● Why Others Are Wrong: (A) Increasing fluids without first identifying the cause of
shock could mask symptoms or worsen bleeding if the cause is not addressed.
, (B) Furosemide is contraindicated as it would worsen hypovolemia and
potentially cause renal failure. (D) Trendelenburg position is no longer
recommended for hypotensive shock as it can impair respiratory effort and does
not significantly improve cerebral perfusion; supine with leg elevation is preferred
if positioning is needed.
Q2: A 54-year-old female with a history of COPD is admitted with pneumonia. Her
arterial blood gas results on room air are: pH 7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L,
PaO2 62 mmHg. Which interpretation by the nurse is correct?
A. Respiratory acidosis with metabolic compensation. [CORRECT]
B. Respiratory alkalosis with metabolic compensation.
C. Metabolic acidosis with respiratory compensation.
D. Metabolic alkalosis with respiratory compensation.
Correct Answer: A
Rationale:
[CLINICAL JUDGMENT PATH]
● Recognize Cues: pH 7.32 (acidemia), PaCO2 58 mmHg (elevated), HCO3- 30
mEq/L (elevated), PaO2 62 mmHg (hypoxemia).
● Analyze Cues: The low pH indicates acidosis. The elevated PaCO2 (normal 35-45
mmHg) indicates the primary problem is respiratory. The elevated bicarbonate
(normal 22-26 mEq/L) indicates the kidneys are compensating by retaining
bicarbonate.
● Evaluate Outcomes: This is consistent with the patient's COPD history causing
CO2 retention and an acute exacerbation from pneumonia.
● Why Others Are Wrong: (B) Incorrect because the pH is acidic, not alkaline, and
PaCO2 is elevated, not decreased. (C) Incorrect because the primary disturbance
is respiratory (PaCO2), not metabolic (HCO3-). (D) Incorrect because the pH
shows acidosis, not alkalosis.
Q3 (Select All That Apply): A nurse is caring for a patient with diabetic ketoacidosis
(DKA). Which assessment findings would the nurse expect? Select all that apply.
,A. Kussmaul respirations [CORRECT]
B. Fruity breath odor [CORRECT]
C. Blood glucose 450 mg/dL [CORRECT]
D. Serum potassium 3.2 mEq/L [CORRECT]
E. Positive urine ketones [CORRECT]
F. Bradycardia
Correct Answers: A, B, C, D, E
Rationale:
[CLINICAL JUDGMENT PATH]
● Recognize Cues: DKA is characterized by hyperglycemia, ketosis, and metabolic
acidosis.
● Analyze Cues:
○ A: Kussmaul respirations (deep, rapid breathing) are the body's
compensatory mechanism for metabolic acidosis, attempting to blow off
CO2.
○ B: Fruity breath odor (acetone) results from the breakdown of ketones.
○ C: Blood glucose typically exceeds 250 mg/dL in DKA (often 400-800
mg/dL).
○ D: Although total body potassium is depleted, serum potassium may be
normal or low due to osmotic diuresis and acidosis causing intracellular
shift. 3.2 mEq/L indicates hypokalemia, which is common and dangerous
in DKA.
○ E: Ketones spill into urine due to the inability to use glucose for energy,
causing fat metabolism.
● Why F is Wrong: Tachycardia, not bradycardia, is expected due to dehydration,
acidosis, and compensatory mechanisms. Bradycardia would be an ominous
sign of severe hyperkalemia or impending cardiac arrest.
Q4: A nurse is assessing a patient 2 hours after a percutaneous coronary intervention
(PCI) with stent placement via the right femoral artery. The patient complains of right
leg pain rated 6/10. Which finding requires immediate nursing intervention?
A. The patient has a 2+ dorsalis pedis pulse in the right foot.
B. The right foot is cool, pale, and capillary refill is 4 seconds. [CORRECT]
, C. The patient reports mild discomfort at the insertion site.
D. The right leg is extended and immobilized per protocol.
Correct Answer: B
Rationale:
[CLINICAL JUDGMENT PATH]
● Recognize Cues: Post-PCI femoral access, leg pain, and the specific findings of
coolness, pallor, and delayed capillary refill (>3 seconds).
● Analyze Cues/Generate Hypothesis: These findings indicate acute arterial
occlusion, likely from thrombus formation, arterial dissection, or hematoma
compression at the insertion site. This is a vascular emergency threatening limb
viability.
● Prioritize Hypotheses: Arterial occlusion takes priority over expected
post-procedure discomfort or normal findings.
● Take Action: Immediate notification of the physician, assessment of the groin
site for hematoma, and preparation for possible emergent intervention are
required.
● Why Others Are Wrong: (A) A 2+ pulse is normal and expected. (C) Mild insertion
site discomfort is expected after arterial puncture. (D) Leg immobilization is
standard protocol to prevent bleeding from the femoral access site.
Q5 (Drag-and-Drop - Ordered Response): Place the following nursing interventions in the
priority order for managing a patient with acute chest pain suspected of myocardial
infarction.
Interventions to Order:
● Administer aspirin 325 mg chewable
● Obtain 12-lead EKG
● Start IV access with normal saline
● Administer sublingual nitroglycerin
● Administer morphine sulfate 2-4 mg IV
Correct Order:
Real Exam Simulation | Latest Version
100 Questions with 100% Correct & Detailed Answers
Q1: A 68-year-old male is post-op day 1 from a laparotomy for bowel resection. The
nurse notes the following vital signs: HR 118, BP 92/58, RR 24, SpO2 94% on 2L NC. The
patient reports feeling "lightheaded and anxious." The urine output for the past 4 hours
is 45 mL. Which action should the nurse take first?
A. Increase the IV fluid rate as permitted by the standing order protocol.
B. Administer PRN furosemide for suspected fluid overload.
C. Assess the surgical dressing and abdomen for signs of active hemorrhage.
[CORRECT]
D. Place the patient in Trendelenburg position to improve cerebral perfusion.
Correct Answer: C
Rationale:
[CLINICAL JUDGMENT PATH]
● Recognize Cues: Tachycardia (HR 118), hypotension (92/58), decreased urine
output (45 mL/4 hours), anxiety, and lightheadedness are classic cues for
hypovolemic shock.
● Analyze Cues/Generate Hypothesis: In a post-operative abdominal surgery
patient, the priority hypothesis is internal or external hemorrhage. The
combination of hypotension and tachycardia indicates compensatory
mechanisms for volume loss.
● Prioritize Hypotheses: Hemorrhage is the most life-threatening and likely cause
in this context, taking priority over other potential causes like sepsis or
medication effects.
● Take Action: The first nursing action must be to assess the most likely
source—the surgical site for external bleeding or the abdomen for internal
bleeding (distention, increasing firmness, pain).
● Why Others Are Wrong: (A) Increasing fluids without first identifying the cause of
shock could mask symptoms or worsen bleeding if the cause is not addressed.
, (B) Furosemide is contraindicated as it would worsen hypovolemia and
potentially cause renal failure. (D) Trendelenburg position is no longer
recommended for hypotensive shock as it can impair respiratory effort and does
not significantly improve cerebral perfusion; supine with leg elevation is preferred
if positioning is needed.
Q2: A 54-year-old female with a history of COPD is admitted with pneumonia. Her
arterial blood gas results on room air are: pH 7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L,
PaO2 62 mmHg. Which interpretation by the nurse is correct?
A. Respiratory acidosis with metabolic compensation. [CORRECT]
B. Respiratory alkalosis with metabolic compensation.
C. Metabolic acidosis with respiratory compensation.
D. Metabolic alkalosis with respiratory compensation.
Correct Answer: A
Rationale:
[CLINICAL JUDGMENT PATH]
● Recognize Cues: pH 7.32 (acidemia), PaCO2 58 mmHg (elevated), HCO3- 30
mEq/L (elevated), PaO2 62 mmHg (hypoxemia).
● Analyze Cues: The low pH indicates acidosis. The elevated PaCO2 (normal 35-45
mmHg) indicates the primary problem is respiratory. The elevated bicarbonate
(normal 22-26 mEq/L) indicates the kidneys are compensating by retaining
bicarbonate.
● Evaluate Outcomes: This is consistent with the patient's COPD history causing
CO2 retention and an acute exacerbation from pneumonia.
● Why Others Are Wrong: (B) Incorrect because the pH is acidic, not alkaline, and
PaCO2 is elevated, not decreased. (C) Incorrect because the primary disturbance
is respiratory (PaCO2), not metabolic (HCO3-). (D) Incorrect because the pH
shows acidosis, not alkalosis.
Q3 (Select All That Apply): A nurse is caring for a patient with diabetic ketoacidosis
(DKA). Which assessment findings would the nurse expect? Select all that apply.
,A. Kussmaul respirations [CORRECT]
B. Fruity breath odor [CORRECT]
C. Blood glucose 450 mg/dL [CORRECT]
D. Serum potassium 3.2 mEq/L [CORRECT]
E. Positive urine ketones [CORRECT]
F. Bradycardia
Correct Answers: A, B, C, D, E
Rationale:
[CLINICAL JUDGMENT PATH]
● Recognize Cues: DKA is characterized by hyperglycemia, ketosis, and metabolic
acidosis.
● Analyze Cues:
○ A: Kussmaul respirations (deep, rapid breathing) are the body's
compensatory mechanism for metabolic acidosis, attempting to blow off
CO2.
○ B: Fruity breath odor (acetone) results from the breakdown of ketones.
○ C: Blood glucose typically exceeds 250 mg/dL in DKA (often 400-800
mg/dL).
○ D: Although total body potassium is depleted, serum potassium may be
normal or low due to osmotic diuresis and acidosis causing intracellular
shift. 3.2 mEq/L indicates hypokalemia, which is common and dangerous
in DKA.
○ E: Ketones spill into urine due to the inability to use glucose for energy,
causing fat metabolism.
● Why F is Wrong: Tachycardia, not bradycardia, is expected due to dehydration,
acidosis, and compensatory mechanisms. Bradycardia would be an ominous
sign of severe hyperkalemia or impending cardiac arrest.
Q4: A nurse is assessing a patient 2 hours after a percutaneous coronary intervention
(PCI) with stent placement via the right femoral artery. The patient complains of right
leg pain rated 6/10. Which finding requires immediate nursing intervention?
A. The patient has a 2+ dorsalis pedis pulse in the right foot.
B. The right foot is cool, pale, and capillary refill is 4 seconds. [CORRECT]
, C. The patient reports mild discomfort at the insertion site.
D. The right leg is extended and immobilized per protocol.
Correct Answer: B
Rationale:
[CLINICAL JUDGMENT PATH]
● Recognize Cues: Post-PCI femoral access, leg pain, and the specific findings of
coolness, pallor, and delayed capillary refill (>3 seconds).
● Analyze Cues/Generate Hypothesis: These findings indicate acute arterial
occlusion, likely from thrombus formation, arterial dissection, or hematoma
compression at the insertion site. This is a vascular emergency threatening limb
viability.
● Prioritize Hypotheses: Arterial occlusion takes priority over expected
post-procedure discomfort or normal findings.
● Take Action: Immediate notification of the physician, assessment of the groin
site for hematoma, and preparation for possible emergent intervention are
required.
● Why Others Are Wrong: (A) A 2+ pulse is normal and expected. (C) Mild insertion
site discomfort is expected after arterial puncture. (D) Leg immobilization is
standard protocol to prevent bleeding from the femoral access site.
Q5 (Drag-and-Drop - Ordered Response): Place the following nursing interventions in the
priority order for managing a patient with acute chest pain suspected of myocardial
infarction.
Interventions to Order:
● Administer aspirin 325 mg chewable
● Obtain 12-lead EKG
● Start IV access with normal saline
● Administer sublingual nitroglycerin
● Administer morphine sulfate 2-4 mg IV
Correct Order:
