Complete Dewitt’s meDiCal-surgiCal NursiNg
stuDy guiDe for NursiNg stuDeNts, iN-Depth Notes,
CliNiCal sCeNarios, praCtiCe QuestioNs, eviDeNCe-
BaseD patieNt Care strategies, step-By-step
learNiNg, ati, hesi, NCleX eXam preparatioN, aND
esseNtial skills for suCCess iN aDult NursiNg
Question 1: Which action by the nurse best demonstrates the principle of patient-centered
care in a medical-surgical setting?
A. Completing all nursing tasks efficiently according to the shift schedule
B. Involving the patient in developing their individualized plan of care
C. Prioritizing physician orders over patient preferences
D. Delegating patient education to unlicensed assistive personnel
CORRECT ANSWER: B. Involving the patient in developing their individualized plan of care
RATIONALE: Patient-centered care emphasizes collaboration with patients and families,
respecting their preferences, values, and needs. Involving patients in care planning promotes
autonomy, improves adherence, and enhances outcomes. DeWit's Medical-Surgical Nursing
emphasizes that patient engagement is fundamental to quality care and aligns with QSEN
competencies.
Question 2: When applying the nursing process, which step should the nurse perform first
when admitting a new patient?
A. Planning interventions to address identified problems
B. Implementing prescribed treatments and medications
C. Collecting comprehensive assessment data
D. Evaluating the effectiveness of nursing actions
CORRECT ANSWER: C. Collecting comprehensive assessment data
RATIONALE: The nursing process follows a sequential order: Assessment, Diagnosis, Planning,
Implementation, and Evaluation (ADPIE). Assessment is the foundational first step, as accurate
data collection is essential for identifying patient problems and developing an appropriate care
plan.
Question 3: A nurse is caring for a patient with a serum sodium level of 128 mEq/L. Which
clinical manifestation should the nurse anticipate?
,A. Hyperreflexia and muscle twitching
B. Confusion, headache, and lethargy
C. Increased thirst and dry mucous membranes
D. Hypertension and bounding peripheral pulses
CORRECT ANSWER: B. Confusion, headache, and lethargy
RATIONALE: A sodium level of 128 mEq/L indicates hyponatremia. Neurological symptoms such
as confusion, headache, lethargy, and seizures occur due to cerebral edema from water shifting
into brain cells. Early recognition of these signs is critical for prompt intervention to prevent
complications.
Question 4: Which intravenous solution is classified as isotonic and is commonly used for
intravascular volume expansion?
A. 0.45% sodium chloride
B. 5% dextrose in water (D5W)
C. 0.9% sodium chloride (normal saline)
D. 3% sodium chloride
CORRECT ANSWER: C. 0.9% sodium chloride (normal saline)
RATIONALE: Normal saline (0.9% NaCl) is an isotonic solution with an osmolarity similar to
plasma. It remains in the intravascular space, making it ideal for volume resuscitation in
hypovolemia, hemorrhage, or dehydration. Hypotonic solutions (e.g., 0.45% NaCl) shift fluid into
cells, while hypertonic solutions (e.g., 3% NaCl) draw fluid from cells.
Question 5: The nurse is preparing a patient for surgery. Which preoperative intervention is
most critical to prevent postoperative pulmonary complications?
A. Administering prophylactic antibiotics within 1 hour before incision
B. Teaching deep breathing, coughing, and incentive spirometry techniques
C. Ensuring the patient voids immediately before transfer to the OR
D. Verifying that all consents are signed and in the chart
CORRECT ANSWER: B. Teaching deep breathing, coughing, and incentive spirometry
techniques
RATIONALE: Preoperative teaching of pulmonary hygiene techniques is essential to prevent
atelectasis and pneumonia after surgery. These interventions promote lung expansion, mobilize
secretions, and improve oxygenation. While other options are important, pulmonary
preparation directly reduces respiratory complications.
,Question 6: During the intraoperative phase, which team member is primarily responsible for
maintaining the sterile field?
A. Surgeon
B. Anesthesiologist
C. Circulating nurse
D. Scrub nurse or surgical technologist
CORRECT ANSWER: D. Scrub nurse or surgical technologist
RATIONALE: The scrub nurse or surgical technologist works within the sterile field, passing
instruments and supplies to the surgeon while maintaining sterility. The circulating nurse
manages the overall environment but remains non-sterile. Clear role delineation ensures
patient safety and infection prevention.
Question 7: A postoperative patient reports sudden onset of chest pain and dyspnea. The
nurse suspects pulmonary embolism. Which action should the nurse take first?
A. Administer prescribed morphine for pain relief
B. Apply oxygen via nasal cannula and notify the provider
C. Obtain a stat chest x-ray
D. Encourage the patient to ambulate to improve circulation
CORRECT ANSWER: B. Apply oxygen via nasal cannula and notify the provider
RATIONALE: Pulmonary embolism is a life-threatening emergency. Immediate priorities include
supporting oxygenation and ventilation while activating the rapid response team. Administering
oxygen improves tissue perfusion, and prompt notification ensures timely diagnostic testing and
anticoagulant therapy.
Question 8: Which practice is most effective in preventing healthcare-associated infections
(HAIs) in medical-surgical patients?
A. Wearing gloves for all patient contact
B. Performing hand hygiene before and after patient contact
C. Using antimicrobial soap for all handwashing
D. Placing all patients in private rooms
CORRECT ANSWER: B. Performing hand hygiene before and after patient contact
RATIONALE: Hand hygiene is the single most effective measure to prevent transmission of
pathogens in healthcare settings. According to CDC and DeWit's guidelines, alcohol-based hand
rubs or soap and water must be used before and after patient contact, after touching
contaminated surfaces, and before aseptic procedures.
, Question 9: A patient with chronic pain rates their pain as 8/10. Which nursing intervention
aligns with current pain management guidelines?
A. Administering the prescribed opioid analgesic promptly
B. Encouraging the patient to "tough it out" to avoid addiction
C. Waiting 30 minutes to reassess before intervening
D. Offering only nonpharmacologic interventions first
CORRECT ANSWER: A. Administering the prescribed opioid analgesic promptly
RATIONALE: Unrelieved pain causes physiological stress and impairs recovery. Current
guidelines emphasize timely administration of prescribed analgesics based on patient report.
Multimodal approaches combining pharmacologic and nonpharmacologic strategies are ideal,
but severe pain requires prompt medication.
Question 10: Which laboratory finding is most indicative of tumor lysis syndrome in a patient
receiving chemotherapy?
A. Hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia
B. Hypokalemia, hypouricemia, hypophosphatemia, and hypercalcemia
C. Elevated white blood cell count with left shift
D. Decreased hemoglobin and hematocrit
CORRECT ANSWER: A. Hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia
RATIONALE: Tumor lysis syndrome occurs when rapid cancer cell death releases intracellular
contents into the bloodstream. This causes electrolyte imbalances: high potassium, phosphate,
and uric acid, with secondary hypocalcemia. Early recognition and interventions (hydration,
allopurinol) prevent renal failure and cardiac complications.
Question 11: A patient with end-stage renal disease is being discharged to home
hemodialysis. Which statement by the patient indicates understanding of self-management?
A. "I can skip dialysis sessions if I feel well."
B. "I will monitor my weight daily and report gains over 2 kg."
C. "I should increase my potassium intake to maintain energy."
D. "Fluid restrictions do not apply when I am at home."
CORRECT ANSWER: B. "I will monitor my weight daily and report gains over 2 kg."
RATIONALE: Daily weight monitoring helps detect fluid retention between dialysis sessions. A
gain of more than 1-2 kg may indicate nonadherence to fluid restrictions and increases risk for
hypertension, pulmonary edema, and heart failure. Patient education on self-monitoring is
critical for chronic illness management.
stuDy guiDe for NursiNg stuDeNts, iN-Depth Notes,
CliNiCal sCeNarios, praCtiCe QuestioNs, eviDeNCe-
BaseD patieNt Care strategies, step-By-step
learNiNg, ati, hesi, NCleX eXam preparatioN, aND
esseNtial skills for suCCess iN aDult NursiNg
Question 1: Which action by the nurse best demonstrates the principle of patient-centered
care in a medical-surgical setting?
A. Completing all nursing tasks efficiently according to the shift schedule
B. Involving the patient in developing their individualized plan of care
C. Prioritizing physician orders over patient preferences
D. Delegating patient education to unlicensed assistive personnel
CORRECT ANSWER: B. Involving the patient in developing their individualized plan of care
RATIONALE: Patient-centered care emphasizes collaboration with patients and families,
respecting their preferences, values, and needs. Involving patients in care planning promotes
autonomy, improves adherence, and enhances outcomes. DeWit's Medical-Surgical Nursing
emphasizes that patient engagement is fundamental to quality care and aligns with QSEN
competencies.
Question 2: When applying the nursing process, which step should the nurse perform first
when admitting a new patient?
A. Planning interventions to address identified problems
B. Implementing prescribed treatments and medications
C. Collecting comprehensive assessment data
D. Evaluating the effectiveness of nursing actions
CORRECT ANSWER: C. Collecting comprehensive assessment data
RATIONALE: The nursing process follows a sequential order: Assessment, Diagnosis, Planning,
Implementation, and Evaluation (ADPIE). Assessment is the foundational first step, as accurate
data collection is essential for identifying patient problems and developing an appropriate care
plan.
Question 3: A nurse is caring for a patient with a serum sodium level of 128 mEq/L. Which
clinical manifestation should the nurse anticipate?
,A. Hyperreflexia and muscle twitching
B. Confusion, headache, and lethargy
C. Increased thirst and dry mucous membranes
D. Hypertension and bounding peripheral pulses
CORRECT ANSWER: B. Confusion, headache, and lethargy
RATIONALE: A sodium level of 128 mEq/L indicates hyponatremia. Neurological symptoms such
as confusion, headache, lethargy, and seizures occur due to cerebral edema from water shifting
into brain cells. Early recognition of these signs is critical for prompt intervention to prevent
complications.
Question 4: Which intravenous solution is classified as isotonic and is commonly used for
intravascular volume expansion?
A. 0.45% sodium chloride
B. 5% dextrose in water (D5W)
C. 0.9% sodium chloride (normal saline)
D. 3% sodium chloride
CORRECT ANSWER: C. 0.9% sodium chloride (normal saline)
RATIONALE: Normal saline (0.9% NaCl) is an isotonic solution with an osmolarity similar to
plasma. It remains in the intravascular space, making it ideal for volume resuscitation in
hypovolemia, hemorrhage, or dehydration. Hypotonic solutions (e.g., 0.45% NaCl) shift fluid into
cells, while hypertonic solutions (e.g., 3% NaCl) draw fluid from cells.
Question 5: The nurse is preparing a patient for surgery. Which preoperative intervention is
most critical to prevent postoperative pulmonary complications?
A. Administering prophylactic antibiotics within 1 hour before incision
B. Teaching deep breathing, coughing, and incentive spirometry techniques
C. Ensuring the patient voids immediately before transfer to the OR
D. Verifying that all consents are signed and in the chart
CORRECT ANSWER: B. Teaching deep breathing, coughing, and incentive spirometry
techniques
RATIONALE: Preoperative teaching of pulmonary hygiene techniques is essential to prevent
atelectasis and pneumonia after surgery. These interventions promote lung expansion, mobilize
secretions, and improve oxygenation. While other options are important, pulmonary
preparation directly reduces respiratory complications.
,Question 6: During the intraoperative phase, which team member is primarily responsible for
maintaining the sterile field?
A. Surgeon
B. Anesthesiologist
C. Circulating nurse
D. Scrub nurse or surgical technologist
CORRECT ANSWER: D. Scrub nurse or surgical technologist
RATIONALE: The scrub nurse or surgical technologist works within the sterile field, passing
instruments and supplies to the surgeon while maintaining sterility. The circulating nurse
manages the overall environment but remains non-sterile. Clear role delineation ensures
patient safety and infection prevention.
Question 7: A postoperative patient reports sudden onset of chest pain and dyspnea. The
nurse suspects pulmonary embolism. Which action should the nurse take first?
A. Administer prescribed morphine for pain relief
B. Apply oxygen via nasal cannula and notify the provider
C. Obtain a stat chest x-ray
D. Encourage the patient to ambulate to improve circulation
CORRECT ANSWER: B. Apply oxygen via nasal cannula and notify the provider
RATIONALE: Pulmonary embolism is a life-threatening emergency. Immediate priorities include
supporting oxygenation and ventilation while activating the rapid response team. Administering
oxygen improves tissue perfusion, and prompt notification ensures timely diagnostic testing and
anticoagulant therapy.
Question 8: Which practice is most effective in preventing healthcare-associated infections
(HAIs) in medical-surgical patients?
A. Wearing gloves for all patient contact
B. Performing hand hygiene before and after patient contact
C. Using antimicrobial soap for all handwashing
D. Placing all patients in private rooms
CORRECT ANSWER: B. Performing hand hygiene before and after patient contact
RATIONALE: Hand hygiene is the single most effective measure to prevent transmission of
pathogens in healthcare settings. According to CDC and DeWit's guidelines, alcohol-based hand
rubs or soap and water must be used before and after patient contact, after touching
contaminated surfaces, and before aseptic procedures.
, Question 9: A patient with chronic pain rates their pain as 8/10. Which nursing intervention
aligns with current pain management guidelines?
A. Administering the prescribed opioid analgesic promptly
B. Encouraging the patient to "tough it out" to avoid addiction
C. Waiting 30 minutes to reassess before intervening
D. Offering only nonpharmacologic interventions first
CORRECT ANSWER: A. Administering the prescribed opioid analgesic promptly
RATIONALE: Unrelieved pain causes physiological stress and impairs recovery. Current
guidelines emphasize timely administration of prescribed analgesics based on patient report.
Multimodal approaches combining pharmacologic and nonpharmacologic strategies are ideal,
but severe pain requires prompt medication.
Question 10: Which laboratory finding is most indicative of tumor lysis syndrome in a patient
receiving chemotherapy?
A. Hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia
B. Hypokalemia, hypouricemia, hypophosphatemia, and hypercalcemia
C. Elevated white blood cell count with left shift
D. Decreased hemoglobin and hematocrit
CORRECT ANSWER: A. Hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia
RATIONALE: Tumor lysis syndrome occurs when rapid cancer cell death releases intracellular
contents into the bloodstream. This causes electrolyte imbalances: high potassium, phosphate,
and uric acid, with secondary hypocalcemia. Early recognition and interventions (hydration,
allopurinol) prevent renal failure and cardiac complications.
Question 11: A patient with end-stage renal disease is being discharged to home
hemodialysis. Which statement by the patient indicates understanding of self-management?
A. "I can skip dialysis sessions if I feel well."
B. "I will monitor my weight daily and report gains over 2 kg."
C. "I should increase my potassium intake to maintain energy."
D. "Fluid restrictions do not apply when I am at home."
CORRECT ANSWER: B. "I will monitor my weight daily and report gains over 2 kg."
RATIONALE: Daily weight monitoring helps detect fluid retention between dialysis sessions. A
gain of more than 1-2 kg may indicate nonadherence to fluid restrictions and increases risk for
hypertension, pulmonary edema, and heart failure. Patient education on self-monitoring is
critical for chronic illness management.
