CONCEPTS FOR CLINICAL JUDGMENT AND
COLLABORATIVE CARE IN MED-SURG NURSING
QUESTIONS AND CORRECT ANSWERS 2026
1. A patient with acute decompensated heart failure presents with severe dyspnea,
crackles in all lung fields, and an SpO2 of 84% on room air. Which intervention
should the nurse implement FIRST?
A. Prepare for endotracheal intubation
B. Place the patient in high-Fowler’s position
C. Administer intravenous furosemide
D. Start a dopamine infusion
Correct Answer: B
Explanation: High-Fowler’s position reduces preload and improves ventilation by
decreasing venous return and allowing diaphragmatic expansion. Intubation (A)
may be needed later. Furosemide (C) is important but not the first action.
Dopamine (D) is used in cardiogenic shock with hypotension, not as first-line.
2. A nurse is caring for a patient with acute pancreatitis. Which laboratory finding is
most consistent with this diagnosis?
A. Elevated serum amylase and lipase
B. Elevated liver transaminases only
C. Decreased serum calcium
D. Elevated alkaline phosphatase
Correct Answer: A
Explanation: Amylase and lipase rise within 24–48 hours of onset and are hallmark
findings. Liver transaminases (B) may be normal or mildly elevated. Hypocalcemia
(C) can occur in severe pancreatitis but is not diagnostic. Alkaline phosphatase (D)
suggests biliary obstruction, not pancreatitis directly.
,3. Which clinical manifestation distinguishes hypovolemic shock from cardiogenic
shock?
A. Decreased cardiac output
B. Tachycardia
C. Flat jugular veins
D. Cool, clammy skin
Correct Answer: C
Explanation: Flat jugular veins indicate reduced preload, characteristic of
hypovolemic shock. Cardiogenic shock typically presents with distended jugular
veins due to fluid backup. Both (A) and (B) occur in both types. Cool clammy skin
(D) is common in both hypovolemic and cardiogenic shock.
4. A patient with chronic obstructive pulmonary disease (COPD) has an arterial
blood gas (ABG) of pH 7.32, PaCO2 68 mm Hg, HCO3- 30 mEq/L. Which
interpretation is correct?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer: B
*Explanation: Elevated PaCO2 indicates respiratory acidosis. Elevated HCO3-
suggests renal compensation (chronic). pH is acidic but only mildly decreased
given the high PaCO2, indicating chronicity. Acute respiratory acidosis (A) would
have a normal or near-normal HCO3-. (C) and (D) are incorrect based on pH and
PaCO2.*
5. The nurse is assessing a patient 4 hours after a thoracentesis. Which finding
requires immediate intervention?
A. Respiratory rate of 22 breaths per minute
B. Pulse oximetry 94% on room air
C. Tracheal deviation toward the unaffected side
D. Mild pain at the puncture site
Correct Answer: C
*Explanation: Tracheal deviation away from the affected side suggests tension
, pneumothorax, a life-threatening complication. Mild tachypnea (A) and 94% O2
saturation (B) may be expected post-procedure. Mild pain (D) is common and can
be managed with analgesics.*
6. A patient with diabetes mellitus type 2 is started on metformin. Which instruction
should the nurse include in discharge teaching?
A. “Take this medication when you feel your blood sugar is high.”
B. “You may continue drinking alcohol as usual.”
C. “Report any unusual muscle pain or weakness.”
D. “Take metformin only on days you eat a large meal.”
Correct Answer: C
Explanation: Metformin can cause lactic acidosis, especially in renal impairment.
Muscle pain/weakness may be an early sign. (A) and (D) are incorrect—metformin
must be taken regularly. (B) is incorrect because alcohol increases lactic acidosis
risk.
7. A patient is receiving continuous renal replacement therapy (CRRT) for acute
kidney injury. Which complication should the nurse monitor for most closely?
A. Hyperkalemia
B. Hypothermia
C. Metabolic alkalosis
D. Hyperphosphatemia
Correct Answer: B
Explanation: CRRT involves extracorporeal blood flow and large-volume fluid
replacement, predisposing to hypothermia. Hyperkalemia (A) and
hyperphosphatemia (D) are less likely because CRRT corrects these. Metabolic
alkalosis (C) can occur but is less common than hypothermia.
8. A patient with cirrhosis develops asterixis, confusion, and a serum ammonia level
of 180 mcg/dL (normal 15–60). Which dietary modification is most appropriate?
A. High-protein diet to promote healing
, B. Low-sodium diet only
C. Low-protein diet with vegetable proteins
D. High-carbohydrate, high-fat diet
Correct Answer: C
Explanation: Hepatic encephalopathy requires reduced ammonia production.
Vegetable proteins are better tolerated than animal proteins. High protein (A)
worsens ammonia. Low sodium (B) treats ascites, not encephalopathy. High-carb
high-fat (D) is not indicated.
9. The nurse administers alteplase to a patient with acute ischemic stroke. Which
post-administration assessment finding is most concerning?
A. Mild headache
B. Blood pressure 145/90 mm Hg
C. Sudden severe back pain
D. Heart rate 88 beats per minute
Correct Answer: C
*Explanation: Sudden severe back pain may indicate retroperitoneal bleeding, a
serious complication of thrombolytics. Mild headache (A) and BP 145/90 (B) are
common. HR 88 (D) is normal.*
10. A patient with myasthenia gravis reports increasing muscle weakness and
difficulty swallowing. The nurse notes a heart rate of 52 beats per minute. Which
action is most appropriate?
A. Administer pyridostigmine as ordered
B. Hold the next dose of pyridostigmine and notify the provider
C. Increase the pyridostigmine dose
D. Administer atropine immediately
Correct Answer: B
Explanation: Bradycardia + worsening weakness suggests cholinergic crisis
(overmedication). Holding the next dose prevents worsening. Giving more
pyridostigmine (A or C) would be dangerous. Atropine (D) treats bradycardia but
not the underlying crisis.
COLLABORATIVE CARE IN MED-SURG NURSING
QUESTIONS AND CORRECT ANSWERS 2026
1. A patient with acute decompensated heart failure presents with severe dyspnea,
crackles in all lung fields, and an SpO2 of 84% on room air. Which intervention
should the nurse implement FIRST?
A. Prepare for endotracheal intubation
B. Place the patient in high-Fowler’s position
C. Administer intravenous furosemide
D. Start a dopamine infusion
Correct Answer: B
Explanation: High-Fowler’s position reduces preload and improves ventilation by
decreasing venous return and allowing diaphragmatic expansion. Intubation (A)
may be needed later. Furosemide (C) is important but not the first action.
Dopamine (D) is used in cardiogenic shock with hypotension, not as first-line.
2. A nurse is caring for a patient with acute pancreatitis. Which laboratory finding is
most consistent with this diagnosis?
A. Elevated serum amylase and lipase
B. Elevated liver transaminases only
C. Decreased serum calcium
D. Elevated alkaline phosphatase
Correct Answer: A
Explanation: Amylase and lipase rise within 24–48 hours of onset and are hallmark
findings. Liver transaminases (B) may be normal or mildly elevated. Hypocalcemia
(C) can occur in severe pancreatitis but is not diagnostic. Alkaline phosphatase (D)
suggests biliary obstruction, not pancreatitis directly.
,3. Which clinical manifestation distinguishes hypovolemic shock from cardiogenic
shock?
A. Decreased cardiac output
B. Tachycardia
C. Flat jugular veins
D. Cool, clammy skin
Correct Answer: C
Explanation: Flat jugular veins indicate reduced preload, characteristic of
hypovolemic shock. Cardiogenic shock typically presents with distended jugular
veins due to fluid backup. Both (A) and (B) occur in both types. Cool clammy skin
(D) is common in both hypovolemic and cardiogenic shock.
4. A patient with chronic obstructive pulmonary disease (COPD) has an arterial
blood gas (ABG) of pH 7.32, PaCO2 68 mm Hg, HCO3- 30 mEq/L. Which
interpretation is correct?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer: B
*Explanation: Elevated PaCO2 indicates respiratory acidosis. Elevated HCO3-
suggests renal compensation (chronic). pH is acidic but only mildly decreased
given the high PaCO2, indicating chronicity. Acute respiratory acidosis (A) would
have a normal or near-normal HCO3-. (C) and (D) are incorrect based on pH and
PaCO2.*
5. The nurse is assessing a patient 4 hours after a thoracentesis. Which finding
requires immediate intervention?
A. Respiratory rate of 22 breaths per minute
B. Pulse oximetry 94% on room air
C. Tracheal deviation toward the unaffected side
D. Mild pain at the puncture site
Correct Answer: C
*Explanation: Tracheal deviation away from the affected side suggests tension
, pneumothorax, a life-threatening complication. Mild tachypnea (A) and 94% O2
saturation (B) may be expected post-procedure. Mild pain (D) is common and can
be managed with analgesics.*
6. A patient with diabetes mellitus type 2 is started on metformin. Which instruction
should the nurse include in discharge teaching?
A. “Take this medication when you feel your blood sugar is high.”
B. “You may continue drinking alcohol as usual.”
C. “Report any unusual muscle pain or weakness.”
D. “Take metformin only on days you eat a large meal.”
Correct Answer: C
Explanation: Metformin can cause lactic acidosis, especially in renal impairment.
Muscle pain/weakness may be an early sign. (A) and (D) are incorrect—metformin
must be taken regularly. (B) is incorrect because alcohol increases lactic acidosis
risk.
7. A patient is receiving continuous renal replacement therapy (CRRT) for acute
kidney injury. Which complication should the nurse monitor for most closely?
A. Hyperkalemia
B. Hypothermia
C. Metabolic alkalosis
D. Hyperphosphatemia
Correct Answer: B
Explanation: CRRT involves extracorporeal blood flow and large-volume fluid
replacement, predisposing to hypothermia. Hyperkalemia (A) and
hyperphosphatemia (D) are less likely because CRRT corrects these. Metabolic
alkalosis (C) can occur but is less common than hypothermia.
8. A patient with cirrhosis develops asterixis, confusion, and a serum ammonia level
of 180 mcg/dL (normal 15–60). Which dietary modification is most appropriate?
A. High-protein diet to promote healing
, B. Low-sodium diet only
C. Low-protein diet with vegetable proteins
D. High-carbohydrate, high-fat diet
Correct Answer: C
Explanation: Hepatic encephalopathy requires reduced ammonia production.
Vegetable proteins are better tolerated than animal proteins. High protein (A)
worsens ammonia. Low sodium (B) treats ascites, not encephalopathy. High-carb
high-fat (D) is not indicated.
9. The nurse administers alteplase to a patient with acute ischemic stroke. Which
post-administration assessment finding is most concerning?
A. Mild headache
B. Blood pressure 145/90 mm Hg
C. Sudden severe back pain
D. Heart rate 88 beats per minute
Correct Answer: C
*Explanation: Sudden severe back pain may indicate retroperitoneal bleeding, a
serious complication of thrombolytics. Mild headache (A) and BP 145/90 (B) are
common. HR 88 (D) is normal.*
10. A patient with myasthenia gravis reports increasing muscle weakness and
difficulty swallowing. The nurse notes a heart rate of 52 beats per minute. Which
action is most appropriate?
A. Administer pyridostigmine as ordered
B. Hold the next dose of pyridostigmine and notify the provider
C. Increase the pyridostigmine dose
D. Administer atropine immediately
Correct Answer: B
Explanation: Bradycardia + worsening weakness suggests cholinergic crisis
(overmedication). Holding the next dose prevents worsening. Giving more
pyridostigmine (A or C) would be dangerous. Atropine (D) treats bradycardia but
not the underlying crisis.
