1
NUR170 / NUR 170 Exam 2 Concepts of Medical-
Surgical Nursing Actual Exam 2026/2027 | Complete
Exam-Style Questions | 100% Verified – Detailed
Rationales – Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Foundations of Medical-Surgical Nursing | Q1 – Q15
Section 2 | Cardiovascular and Respiratory Disorders | Q16 – Q30
Section 3 | Gastrointestinal and Renal Disorders | Q31 – Q45
Section 4 | Neurological and Musculoskeletal Disorders | Q46 – Q60
Section 5 | Endocrine, Hematologic, and Multisystem Disorders | Q61 – Q75
SECTION 1: FOUNDATIONS OF MEDICAL-SURGICAL NURSING
Question 1 of 75
A 68-year-old male is admitted to the medical-surgical unit with a diagnosis of community-
acquired pneumonia. His vital signs are: temperature 38.9°C (102.0°F), heart rate 102 bpm,
respiratory rate 24/min, blood pressure 142/88 mmHg, and oxygen saturation 91% on room air.
Laboratory values reveal WBC 14,500/mm³, hemoglobin 12.8 g/dL, and platelets 210,000/mm³.
The nurse auscultates diminished breath sounds in the right lower lobe and notes crackles on
inspiration. The healthcare provider orders sputum cultures, blood cultures, and initiation of
empiric antibiotic therapy. The nurse is preparing to administer the first dose of ceftriaxone 1 g
IV and recognizes that which nursing action is the priority before antibiotic administration?
A. Obtain a complete set of vital signs and document them in the electronic health record
B. Ensure that blood and sputum cultures have been collected prior to the first antibiotic dose
C. Assess the patient's allergy history and verify the five rights of medication administration
D. Insert a peripheral IV catheter using aseptic technique and flush with normal saline
B. Ensure that blood and sputum cultures have been collected prior to the first antibiotic dose ✓
CORRECT
Correct Answer: B
Rationale: Obtaining blood and sputum cultures before administering the first dose of antibiotics
is essential because antibiotic administration can rapidly alter culture results, leading to false-
,2
negative findings and impeding identification of the causative organism. While assessing for
allergies and verifying the five rights is a critical safety step for every medication administration,
it does not take precedence over preserving the diagnostic integrity of culture specimens in the
context of suspected sepsis or serious infection. In clinical practice, delays in obtaining cultures
before antibiotics are associated with increased mortality in septic patients, making this a high-
priority NCLEX concept.
Question 2 of 75
A 54-year-old female is postoperative day 2 following an open cholecystectomy and is being
transferred from the post-anesthesia care unit to the medical-surgical floor. Her vital signs are
stable: temperature 37.2°C (99.0°F), heart rate 88 bpm, respiratory rate 18/min, blood pressure
128/76 mmHg, and oxygen saturation 96% on 2 L nasal cannula. The nurse receives handoff
report that the patient received morphine 4 mg IV 30 minutes ago for incisional pain rated 7/10.
Upon initial assessment, the nurse notes that the patient is drowsy but arousable, her respiratory
rate has decreased to 10/min, and her oxygen saturation has dropped to 89%. Which intervention
should the nurse implement first?
A. Apply a non-rebreather mask at 15 L/min to increase oxygen delivery
B. Stimulate the patient verbally and physically to increase her respiratory rate
C. Administer naloxone 0.4 mg IV per protocol to reverse opioid-induced respiratory depression
D. Elevate the head of the bed to 45 degrees and encourage deep breathing exercises
C. Administer naloxone 0.4 mg IV per protocol to reverse opioid-induced respiratory depression
✓ CORRECT
Correct Answer: C
Rationale: The patient exhibits classic signs of opioid-induced respiratory depression with a
respiratory rate of 10/min and declining oxygen saturation following recent morphine
administration, requiring immediate pharmacologic reversal with naloxone to prevent respiratory
arrest. While stimulating the patient and repositioning may provide temporary improvement, they
do not address the underlying pathophysiology of opioid receptor agonism causing central
respiratory depression. In the clinical setting, nurses must act swiftly when respiratory rate falls
below 12/min post-opioid administration, as delayed intervention can lead to hypoxic brain
injury or cardiac arrest.
Question 3 of 75
A 72-year-old male with a history of heart failure and type 2 diabetes mellitus is admitted to the
medical-surgical unit for exacerbation of lower extremity edema. His vital signs are: temperature
36.8°C (98.2°F), heart rate 76 bpm, respiratory rate 20/min, blood pressure 154/92 mmHg, and
oxygen saturation 94% on room air. Laboratory values include sodium 132 mEq/L, potassium
,3
3.2 mEq/L, creatinine 1.4 mg/dL, BUN 28 mg/dL, and glucose 198 mg/dL. The healthcare
provider orders furosemide 40 mg IV push twice daily and restricts oral fluid intake to 1,500 mL
per day. On the second day of admission, the nurse notes that the patient has had only 800 mL of
urine output in the past 24 hours and reports dizziness upon standing. Which assessment finding
warrants the most immediate nursing intervention?
A. The patient's blood pressure is 138/84 mmHg while supine and 108/68 mmHg while standing
B. The patient's potassium level has decreased from 3.2 mEq/L to 2.9 mEq/L
C. The patient's blood glucose is 210 mg/dL two hours after breakfast
D. The patient's lower extremities demonstrate 2+ pitting edema bilaterally
A. The patient's blood pressure is 138/84 mmHg while supine and 108/68 mmHg while standing
✓ CORRECT
Correct Answer: A
Rationale: A drop in systolic blood pressure of 30 mmHg upon standing indicates significant
orthostatic hypotension, which places the patient at immediate risk for falls, syncope, and
cerebral hypoperfusion, particularly in the context of aggressive diuresis and fluid restriction.
While hypokalemia is concerning and requires monitoring, a potassium of 2.9 mEq/L, though
low, does not pose the same imminent threat to patient safety as hemodynamic instability leading
to falls. In medical-surgical nursing, orthostatic vital signs must be assessed routinely in patients
receiving diuretics, and fall precautions should be instituted immediately when significant
postural changes are detected.
Question 4 of 75
A 45-year-old female is admitted to the medical-surgical unit following a motor vehicle accident
with a diagnosis of multiple rib fractures and a small hemopneumothorax. Her vital signs are:
temperature 37.0°C (98.6°F), heart rate 110 bpm, respiratory rate 26/min, blood pressure 136/82
mmHg, and oxygen saturation 92% on 4 L nasal cannula. A chest tube is inserted in the right
pleural space and connected to a water-seal drainage system with 20 cm H₂O suction. During the
nurse's hourly assessment, the water-seal chamber is observed to be bubbling continuously and
vigorously. Which action by the nurse is most appropriate?
A. Check all connections for leaks and ensure the drainage system is intact
B. Increase the suction pressure to 30 cm H₂O to enhance air evacuation
C. Clamp the chest tube immediately to prevent a tension pneumothorax
D. Document the finding as expected and continue routine monitoring
A. Check all connections for leaks and ensure the drainage system is intact ✓ CORRECT
, 4
Correct Answer: A
Rationale: Continuous vigorous bubbling in the water-seal chamber indicates an air leak within
the drainage system or at the insertion site, necessitating immediate inspection of all connections,
the chest tube insertion site, and the tubing to locate and address the source. Increasing suction
pressure may worsen the leak and cause tissue damage, while clamping the chest tube is
contraindicated as it can trap air in the pleural space and precipitate a tension pneumothorax. In
clinical practice, nurses should systematically assess for air leaks by briefly clamping the tubing
near the patient and observing if bubbling ceases, which helps differentiate between a system
leak and a patient-related air leak.
Question 5 of 75
A 59-year-old male with a history of chronic obstructive pulmonary disease (COPD) is admitted
to the medical-surgical unit with an acute exacerbation. His vital signs are: temperature 37.6°C
(99.7°F), heart rate 96 bpm, respiratory rate 28/min, blood pressure 148/90 mmHg, and oxygen
saturation 84% on room air. Arterial blood gas results on room air reveal pH 7.32, PaCO₂ 58
mmHg, PaO₂ 52 mmHg, and HCO₃⁻ 30 mEq/L. The healthcare provider orders oxygen therapy
to maintain SpO₂ between 88% and 92%. The nurse observes that the patient is using accessory
muscles to breathe and appears anxious. Which nursing intervention is the priority at this time?
A. Administer a benzodiazepine to reduce anxiety and decrease the respiratory rate
B. Apply a high-flow nasal cannula at 40 L/min with 50% FiO₂
C. Initiate low-flow oxygen via nasal cannula at 2 L/min and titrate slowly
D. Prepare the patient for immediate endotracheal intubation and mechanical ventilation
C. Initiate low-flow oxygen via nasal cannola at 2 L/min and titrate slowly ✓ CORRECT
Correct Answer: C
Rationale: In patients with COPD and chronic hypercapnia, excessive oxygen administration can
suppress the hypoxic drive, leading to worsening hypercapnia and respiratory acidosis, so low-
flow oxygen titrated to maintain SpO₂ between 88% and 92% is the evidence-based approach.
Administering benzodiazepines is contraindicated in acute respiratory distress as it can further
depress respiratory drive and precipitate respiratory failure. High-flow oxygen or high
concentrations of FiO₂ would be inappropriate for this patient population and could cause CO₂
narcosis, a critical concept tested frequently on the NCLEX examination.
Question 6 of 75
A 63-year-old female is postoperative day 1 following a total abdominal hysterectomy and
bilateral salpingo-oophorectomy for ovarian cancer. Her vital signs are: temperature 37.4°C
(99.3°F), heart rate 92 bpm, respiratory rate 18/min, blood pressure 118/72 mmHg, and oxygen
NUR170 / NUR 170 Exam 2 Concepts of Medical-
Surgical Nursing Actual Exam 2026/2027 | Complete
Exam-Style Questions | 100% Verified – Detailed
Rationales – Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Foundations of Medical-Surgical Nursing | Q1 – Q15
Section 2 | Cardiovascular and Respiratory Disorders | Q16 – Q30
Section 3 | Gastrointestinal and Renal Disorders | Q31 – Q45
Section 4 | Neurological and Musculoskeletal Disorders | Q46 – Q60
Section 5 | Endocrine, Hematologic, and Multisystem Disorders | Q61 – Q75
SECTION 1: FOUNDATIONS OF MEDICAL-SURGICAL NURSING
Question 1 of 75
A 68-year-old male is admitted to the medical-surgical unit with a diagnosis of community-
acquired pneumonia. His vital signs are: temperature 38.9°C (102.0°F), heart rate 102 bpm,
respiratory rate 24/min, blood pressure 142/88 mmHg, and oxygen saturation 91% on room air.
Laboratory values reveal WBC 14,500/mm³, hemoglobin 12.8 g/dL, and platelets 210,000/mm³.
The nurse auscultates diminished breath sounds in the right lower lobe and notes crackles on
inspiration. The healthcare provider orders sputum cultures, blood cultures, and initiation of
empiric antibiotic therapy. The nurse is preparing to administer the first dose of ceftriaxone 1 g
IV and recognizes that which nursing action is the priority before antibiotic administration?
A. Obtain a complete set of vital signs and document them in the electronic health record
B. Ensure that blood and sputum cultures have been collected prior to the first antibiotic dose
C. Assess the patient's allergy history and verify the five rights of medication administration
D. Insert a peripheral IV catheter using aseptic technique and flush with normal saline
B. Ensure that blood and sputum cultures have been collected prior to the first antibiotic dose ✓
CORRECT
Correct Answer: B
Rationale: Obtaining blood and sputum cultures before administering the first dose of antibiotics
is essential because antibiotic administration can rapidly alter culture results, leading to false-
,2
negative findings and impeding identification of the causative organism. While assessing for
allergies and verifying the five rights is a critical safety step for every medication administration,
it does not take precedence over preserving the diagnostic integrity of culture specimens in the
context of suspected sepsis or serious infection. In clinical practice, delays in obtaining cultures
before antibiotics are associated with increased mortality in septic patients, making this a high-
priority NCLEX concept.
Question 2 of 75
A 54-year-old female is postoperative day 2 following an open cholecystectomy and is being
transferred from the post-anesthesia care unit to the medical-surgical floor. Her vital signs are
stable: temperature 37.2°C (99.0°F), heart rate 88 bpm, respiratory rate 18/min, blood pressure
128/76 mmHg, and oxygen saturation 96% on 2 L nasal cannula. The nurse receives handoff
report that the patient received morphine 4 mg IV 30 minutes ago for incisional pain rated 7/10.
Upon initial assessment, the nurse notes that the patient is drowsy but arousable, her respiratory
rate has decreased to 10/min, and her oxygen saturation has dropped to 89%. Which intervention
should the nurse implement first?
A. Apply a non-rebreather mask at 15 L/min to increase oxygen delivery
B. Stimulate the patient verbally and physically to increase her respiratory rate
C. Administer naloxone 0.4 mg IV per protocol to reverse opioid-induced respiratory depression
D. Elevate the head of the bed to 45 degrees and encourage deep breathing exercises
C. Administer naloxone 0.4 mg IV per protocol to reverse opioid-induced respiratory depression
✓ CORRECT
Correct Answer: C
Rationale: The patient exhibits classic signs of opioid-induced respiratory depression with a
respiratory rate of 10/min and declining oxygen saturation following recent morphine
administration, requiring immediate pharmacologic reversal with naloxone to prevent respiratory
arrest. While stimulating the patient and repositioning may provide temporary improvement, they
do not address the underlying pathophysiology of opioid receptor agonism causing central
respiratory depression. In the clinical setting, nurses must act swiftly when respiratory rate falls
below 12/min post-opioid administration, as delayed intervention can lead to hypoxic brain
injury or cardiac arrest.
Question 3 of 75
A 72-year-old male with a history of heart failure and type 2 diabetes mellitus is admitted to the
medical-surgical unit for exacerbation of lower extremity edema. His vital signs are: temperature
36.8°C (98.2°F), heart rate 76 bpm, respiratory rate 20/min, blood pressure 154/92 mmHg, and
oxygen saturation 94% on room air. Laboratory values include sodium 132 mEq/L, potassium
,3
3.2 mEq/L, creatinine 1.4 mg/dL, BUN 28 mg/dL, and glucose 198 mg/dL. The healthcare
provider orders furosemide 40 mg IV push twice daily and restricts oral fluid intake to 1,500 mL
per day. On the second day of admission, the nurse notes that the patient has had only 800 mL of
urine output in the past 24 hours and reports dizziness upon standing. Which assessment finding
warrants the most immediate nursing intervention?
A. The patient's blood pressure is 138/84 mmHg while supine and 108/68 mmHg while standing
B. The patient's potassium level has decreased from 3.2 mEq/L to 2.9 mEq/L
C. The patient's blood glucose is 210 mg/dL two hours after breakfast
D. The patient's lower extremities demonstrate 2+ pitting edema bilaterally
A. The patient's blood pressure is 138/84 mmHg while supine and 108/68 mmHg while standing
✓ CORRECT
Correct Answer: A
Rationale: A drop in systolic blood pressure of 30 mmHg upon standing indicates significant
orthostatic hypotension, which places the patient at immediate risk for falls, syncope, and
cerebral hypoperfusion, particularly in the context of aggressive diuresis and fluid restriction.
While hypokalemia is concerning and requires monitoring, a potassium of 2.9 mEq/L, though
low, does not pose the same imminent threat to patient safety as hemodynamic instability leading
to falls. In medical-surgical nursing, orthostatic vital signs must be assessed routinely in patients
receiving diuretics, and fall precautions should be instituted immediately when significant
postural changes are detected.
Question 4 of 75
A 45-year-old female is admitted to the medical-surgical unit following a motor vehicle accident
with a diagnosis of multiple rib fractures and a small hemopneumothorax. Her vital signs are:
temperature 37.0°C (98.6°F), heart rate 110 bpm, respiratory rate 26/min, blood pressure 136/82
mmHg, and oxygen saturation 92% on 4 L nasal cannula. A chest tube is inserted in the right
pleural space and connected to a water-seal drainage system with 20 cm H₂O suction. During the
nurse's hourly assessment, the water-seal chamber is observed to be bubbling continuously and
vigorously. Which action by the nurse is most appropriate?
A. Check all connections for leaks and ensure the drainage system is intact
B. Increase the suction pressure to 30 cm H₂O to enhance air evacuation
C. Clamp the chest tube immediately to prevent a tension pneumothorax
D. Document the finding as expected and continue routine monitoring
A. Check all connections for leaks and ensure the drainage system is intact ✓ CORRECT
, 4
Correct Answer: A
Rationale: Continuous vigorous bubbling in the water-seal chamber indicates an air leak within
the drainage system or at the insertion site, necessitating immediate inspection of all connections,
the chest tube insertion site, and the tubing to locate and address the source. Increasing suction
pressure may worsen the leak and cause tissue damage, while clamping the chest tube is
contraindicated as it can trap air in the pleural space and precipitate a tension pneumothorax. In
clinical practice, nurses should systematically assess for air leaks by briefly clamping the tubing
near the patient and observing if bubbling ceases, which helps differentiate between a system
leak and a patient-related air leak.
Question 5 of 75
A 59-year-old male with a history of chronic obstructive pulmonary disease (COPD) is admitted
to the medical-surgical unit with an acute exacerbation. His vital signs are: temperature 37.6°C
(99.7°F), heart rate 96 bpm, respiratory rate 28/min, blood pressure 148/90 mmHg, and oxygen
saturation 84% on room air. Arterial blood gas results on room air reveal pH 7.32, PaCO₂ 58
mmHg, PaO₂ 52 mmHg, and HCO₃⁻ 30 mEq/L. The healthcare provider orders oxygen therapy
to maintain SpO₂ between 88% and 92%. The nurse observes that the patient is using accessory
muscles to breathe and appears anxious. Which nursing intervention is the priority at this time?
A. Administer a benzodiazepine to reduce anxiety and decrease the respiratory rate
B. Apply a high-flow nasal cannula at 40 L/min with 50% FiO₂
C. Initiate low-flow oxygen via nasal cannula at 2 L/min and titrate slowly
D. Prepare the patient for immediate endotracheal intubation and mechanical ventilation
C. Initiate low-flow oxygen via nasal cannola at 2 L/min and titrate slowly ✓ CORRECT
Correct Answer: C
Rationale: In patients with COPD and chronic hypercapnia, excessive oxygen administration can
suppress the hypoxic drive, leading to worsening hypercapnia and respiratory acidosis, so low-
flow oxygen titrated to maintain SpO₂ between 88% and 92% is the evidence-based approach.
Administering benzodiazepines is contraindicated in acute respiratory distress as it can further
depress respiratory drive and precipitate respiratory failure. High-flow oxygen or high
concentrations of FiO₂ would be inappropriate for this patient population and could cause CO₂
narcosis, a critical concept tested frequently on the NCLEX examination.
Question 6 of 75
A 63-year-old female is postoperative day 1 following a total abdominal hysterectomy and
bilateral salpingo-oophorectomy for ovarian cancer. Her vital signs are: temperature 37.4°C
(99.3°F), heart rate 92 bpm, respiratory rate 18/min, blood pressure 118/72 mmHg, and oxygen
