NRSG 327 FINAL EXAM STUDY GUIDE
2025 COMPREHENSIVE NURSING
PRACTICE QUESTIONS RATIONALES
AND REVIEW NOTES
NRSG 327 Final Exam: Advanced Medical-Surgical Nursing
1. A nurse is caring for a patient who is 12 hours postoperative
following abdominal surgery. Which clinical manifestation should
the nurse prioritize for immediate intervention?
a) Pulse rate of 88 beats/min
b) Urinary output of 20 mL/hr for the past 2 hours
c) Incisional pain rated as 6 on a 1-10 scale
d) Hypoactive bowel sounds in all four quadrants
Correct Answer: b) Urinary output of 20 mL/hr for the
past 2 hours
Rationale: Standard postoperative urinary output should be at
least 30 mL/hr. Output below this threshold may indicate
hypovolemia or acute kidney injury, requiring immediate
provider notification and fluid resuscitation.
2. A patient with advanced cirrhosis presents with ascites and a
weight gain of 2 kg in 24 hours. What is the nurse's priority
assessment?
a) Measure abdominal girth
b) Check for peripheral edema
c) Assess respiratory status and breath sounds
d) Monitor serum albumin levels
Correct Answer: c) Assess respiratory status and breath
sounds
Rationale: Significant ascites can push the diaphragm upward,
leading to respiratory distress or atelectasis. While other
assessments are relevant for cirrhosis, maintaining adequate
oxygenation and ventilation is the priority.
3. Which medication should the nurse anticipate administering to a
patient with active bleeding from esophageal varices?
a) Acetaminophen
b) Octreotide
, c) Ketoconazole
d) Valproic acid
Correct Answer: b) Octreotide
Rationale: Octreotide is a synthetic analogue of somatostatin that
causes splanchnic vasoconstriction, which helps reduce portal
pressure and control variceal bleeding.
4. A patient with Addison’s disease is admitted with a blood pressure
of 82/40 mmHg. Which action should the nurse take first?
a) Administer oral fludrocortisone
b) Start a rapid infusion of 0.9% Normal Saline
c) Check the patient’s blood glucose level
d) Document the findings in the medical record
Correct Answer: b) Start a rapid infusion of 0.9% Normal
Saline
Rationale: Severe hypotension in Addison's indicates a life-
threatening adrenal crisis. Immediate fluid resuscitation is
critical to stabilize hemodynamic status before administering
hormone replacements.
5. A nurse is educating a client who is prescribed sulfasalazine for
Crohn’s disease. Which side effect should the nurse instruct the
client to report immediately?
a) Orange-yellow discoloration of the urine
b) Increased sensitivity to sunlight
c) High temperature and a new skin rash
d) Occasional nausea after taking the medication
Correct Answer: c) High temperature and a new skin rash
Rationale: Fever and rash can be signs of serum sickness or a
severe hypersensitivity reaction to sulfasalazine, requiring the
medication to be stopped immediately.
6. After a liver biopsy, in which position should the nurse place the
patient?
a) Left lateral position
b) Right lateral position
c) Supine with the head of the bed flat
d) Semi-Fowler’s position
Correct Answer: b) Right lateral position
Rationale: Placing the patient on the right side applies pressure to
the biopsy site against the chest wall, which helps minimize the
risk of post-procedural bleeding.
,7. A patient presents with Trousseau's sign and Chvostek's sign.
Which laboratory value does the nurse anticipate?
a) Serum Calcium 7.2 mg/dL
b) Serum Potassium 5.5 mEq/L
c) Serum Sodium 148 mEq/L
d) Serum Magnesium 2.5 mg/dL
Correct Answer: a) Serum Calcium 7.2 mg/dL
Rationale: Trousseau's and Chvostek's signs are classic clinical
indicators of hypocalcemia (normal range is 8.5–10.5 mg/dL),
which increases neuromuscular excitability.
8. Which diagnostic test result is a primary indicator of a malignant
liver tumor?
a) Elevated serum amylase
b) Elevated alpha-fetoprotein (AFP)
c) Decreased alkaline phosphatase
d) Increased serum albumin
Correct Answer: b) Elevated alpha-fetoprotein (AFP)
Rationale: AFP is a tumor marker frequently elevated in primary
hepatocellular carcinoma; it is used in the screening and
monitoring of liver cancer.
9. A patient with COPD is experiencing acute respiratory distress.
The nurse should use which oxygen delivery device to ensure a
precise concentration of oxygen?
a) Nasal cannula
b) Simple face mask
c) Venturi mask
d) Non-rebreather mask
Correct Answer: c) Venturi mask
Rationale: The Venturi mask is the most accurate device for
delivering a specific, fixed concentration of oxygen, which is
essential for patients with COPD who may rely on a hypoxic drive
to breathe.
10. A nurse is caring for a patient with Type 1 diabetes who is
diaphoretic and shaky. The blood glucose is 54 mg/dL. What is the
nurse's first action?
a) Administer 10 units of Regular insulin
b) Provide 15 grams of simple carbohydrates (e.g., 4 oz orange
juice)
c) Call the rapid response team
, d) Re-test the blood glucose in 1 hour
Correct Answer: b) Provide 15 grams of simple
carbohydrates (e.g., 4 oz orange juice)
Rationale: For conscious patients with hypoglycemia, the "15-15
rule" (15g of carbs, wait 15 minutes) is the standard intervention
to raise blood glucose levels safely.
11. A patient in the operating room develops a temperature of 103°F,
muscle rigidity, and tachycardia. Which medication should the nurse
prepare to administer?
a) Atropine
b) Dantrolene sodium
c) Furosemide
d) Magnesium sulfate
Correct Answer: b) Dantrolene sodium
Rationale: These are classic signs of malignant hyperthermia, a life-
threatening reaction to general anesthesia. Dantrolene is the specific
skeletal muscle relaxant used to treat this crisis.
12. When obtaining informed consent for a surgical procedure, what is
the nurse’s primary responsibility?
a) Explaining the risks and benefits of the surgery
b) Choosing the surgical approach for the patient
c) Witnessing the patient’s signature and verifying understanding
d) Ensuring the patient has stopped all medications for 48 hours
Correct Answer: c) Witnessing the patient’s signature and
verifying understanding
Rationale: The surgeon is responsible for explaining the procedure. The
nurse acts as a witness to the signature and ensures the patient is
competent to sign.
13. A patient is 2 days postoperative following a total hip arthroplasty.
The patient suddenly complains of chest pain and shortness of breath.
What is the priority nursing action?
a) Administer an oral analgesic
b) Encourage the use of the incentive spirometer
c) Apply supplemental oxygen and notify the provider
d) Assist the patient to dangle at the bedside
Correct Answer: c) Apply supplemental oxygen and notify the
provider
Rationale: Sudden chest pain and dyspnea postoperatively suggest a
2025 COMPREHENSIVE NURSING
PRACTICE QUESTIONS RATIONALES
AND REVIEW NOTES
NRSG 327 Final Exam: Advanced Medical-Surgical Nursing
1. A nurse is caring for a patient who is 12 hours postoperative
following abdominal surgery. Which clinical manifestation should
the nurse prioritize for immediate intervention?
a) Pulse rate of 88 beats/min
b) Urinary output of 20 mL/hr for the past 2 hours
c) Incisional pain rated as 6 on a 1-10 scale
d) Hypoactive bowel sounds in all four quadrants
Correct Answer: b) Urinary output of 20 mL/hr for the
past 2 hours
Rationale: Standard postoperative urinary output should be at
least 30 mL/hr. Output below this threshold may indicate
hypovolemia or acute kidney injury, requiring immediate
provider notification and fluid resuscitation.
2. A patient with advanced cirrhosis presents with ascites and a
weight gain of 2 kg in 24 hours. What is the nurse's priority
assessment?
a) Measure abdominal girth
b) Check for peripheral edema
c) Assess respiratory status and breath sounds
d) Monitor serum albumin levels
Correct Answer: c) Assess respiratory status and breath
sounds
Rationale: Significant ascites can push the diaphragm upward,
leading to respiratory distress or atelectasis. While other
assessments are relevant for cirrhosis, maintaining adequate
oxygenation and ventilation is the priority.
3. Which medication should the nurse anticipate administering to a
patient with active bleeding from esophageal varices?
a) Acetaminophen
b) Octreotide
, c) Ketoconazole
d) Valproic acid
Correct Answer: b) Octreotide
Rationale: Octreotide is a synthetic analogue of somatostatin that
causes splanchnic vasoconstriction, which helps reduce portal
pressure and control variceal bleeding.
4. A patient with Addison’s disease is admitted with a blood pressure
of 82/40 mmHg. Which action should the nurse take first?
a) Administer oral fludrocortisone
b) Start a rapid infusion of 0.9% Normal Saline
c) Check the patient’s blood glucose level
d) Document the findings in the medical record
Correct Answer: b) Start a rapid infusion of 0.9% Normal
Saline
Rationale: Severe hypotension in Addison's indicates a life-
threatening adrenal crisis. Immediate fluid resuscitation is
critical to stabilize hemodynamic status before administering
hormone replacements.
5. A nurse is educating a client who is prescribed sulfasalazine for
Crohn’s disease. Which side effect should the nurse instruct the
client to report immediately?
a) Orange-yellow discoloration of the urine
b) Increased sensitivity to sunlight
c) High temperature and a new skin rash
d) Occasional nausea after taking the medication
Correct Answer: c) High temperature and a new skin rash
Rationale: Fever and rash can be signs of serum sickness or a
severe hypersensitivity reaction to sulfasalazine, requiring the
medication to be stopped immediately.
6. After a liver biopsy, in which position should the nurse place the
patient?
a) Left lateral position
b) Right lateral position
c) Supine with the head of the bed flat
d) Semi-Fowler’s position
Correct Answer: b) Right lateral position
Rationale: Placing the patient on the right side applies pressure to
the biopsy site against the chest wall, which helps minimize the
risk of post-procedural bleeding.
,7. A patient presents with Trousseau's sign and Chvostek's sign.
Which laboratory value does the nurse anticipate?
a) Serum Calcium 7.2 mg/dL
b) Serum Potassium 5.5 mEq/L
c) Serum Sodium 148 mEq/L
d) Serum Magnesium 2.5 mg/dL
Correct Answer: a) Serum Calcium 7.2 mg/dL
Rationale: Trousseau's and Chvostek's signs are classic clinical
indicators of hypocalcemia (normal range is 8.5–10.5 mg/dL),
which increases neuromuscular excitability.
8. Which diagnostic test result is a primary indicator of a malignant
liver tumor?
a) Elevated serum amylase
b) Elevated alpha-fetoprotein (AFP)
c) Decreased alkaline phosphatase
d) Increased serum albumin
Correct Answer: b) Elevated alpha-fetoprotein (AFP)
Rationale: AFP is a tumor marker frequently elevated in primary
hepatocellular carcinoma; it is used in the screening and
monitoring of liver cancer.
9. A patient with COPD is experiencing acute respiratory distress.
The nurse should use which oxygen delivery device to ensure a
precise concentration of oxygen?
a) Nasal cannula
b) Simple face mask
c) Venturi mask
d) Non-rebreather mask
Correct Answer: c) Venturi mask
Rationale: The Venturi mask is the most accurate device for
delivering a specific, fixed concentration of oxygen, which is
essential for patients with COPD who may rely on a hypoxic drive
to breathe.
10. A nurse is caring for a patient with Type 1 diabetes who is
diaphoretic and shaky. The blood glucose is 54 mg/dL. What is the
nurse's first action?
a) Administer 10 units of Regular insulin
b) Provide 15 grams of simple carbohydrates (e.g., 4 oz orange
juice)
c) Call the rapid response team
, d) Re-test the blood glucose in 1 hour
Correct Answer: b) Provide 15 grams of simple
carbohydrates (e.g., 4 oz orange juice)
Rationale: For conscious patients with hypoglycemia, the "15-15
rule" (15g of carbs, wait 15 minutes) is the standard intervention
to raise blood glucose levels safely.
11. A patient in the operating room develops a temperature of 103°F,
muscle rigidity, and tachycardia. Which medication should the nurse
prepare to administer?
a) Atropine
b) Dantrolene sodium
c) Furosemide
d) Magnesium sulfate
Correct Answer: b) Dantrolene sodium
Rationale: These are classic signs of malignant hyperthermia, a life-
threatening reaction to general anesthesia. Dantrolene is the specific
skeletal muscle relaxant used to treat this crisis.
12. When obtaining informed consent for a surgical procedure, what is
the nurse’s primary responsibility?
a) Explaining the risks and benefits of the surgery
b) Choosing the surgical approach for the patient
c) Witnessing the patient’s signature and verifying understanding
d) Ensuring the patient has stopped all medications for 48 hours
Correct Answer: c) Witnessing the patient’s signature and
verifying understanding
Rationale: The surgeon is responsible for explaining the procedure. The
nurse acts as a witness to the signature and ensures the patient is
competent to sign.
13. A patient is 2 days postoperative following a total hip arthroplasty.
The patient suddenly complains of chest pain and shortness of breath.
What is the priority nursing action?
a) Administer an oral analgesic
b) Encourage the use of the incentive spirometer
c) Apply supplemental oxygen and notify the provider
d) Assist the patient to dangle at the bedside
Correct Answer: c) Apply supplemental oxygen and notify the
provider
Rationale: Sudden chest pain and dyspnea postoperatively suggest a
