PN Adult Medical-Surgical Nursing Edition 12.0 Actual Exam
2026/2027: Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular & Hematologic Disorders | Q1 – Q10
Section 2 | Respiratory & Acid-Base Disorders | Q11 – Q20
Section 3 | Gastrointestinal, Hepatic & Endocrine Disorders | Q21 – Q30
Section 4 | Renal, Genitourinary & Reproductive Disorders | Q31 – Q40
Section 5 | Neurologic, Musculoskeletal & Integumentary Disorders | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old client is admitted to the telemetry unit with chest pain and is diagnosed
with an acute anterior wall myocardial infarction. The nurse is preparing to administer
the first dose of metoprolol 25 mg PO as ordered. Before giving the medication, the
nurse checks the client's vital signs and notes a blood pressure of 92/58 mmHg and a
heart rate of 58 beats per minute. What is the nurse's best action?
A. Administer the metoprolol as ordered to reduce myocardial oxygen demand
B. Hold the metoprolol and contact the prescriber to report the findings ✓ CORRECT
C. Administer half the dose and reassess the blood pressure in 30 minutes
D. Give the metoprolol with a full glass of water to prevent hypotension
Correct Answer: B
Rationale: Metoprolol is a beta-blocker that further reduces heart rate and blood
pressure, so administering it with a heart rate below 60 bpm and systolic pressure under
100 mmHg could precipitate dangerous bradycardia or cardiogenic shock. Option A is
,incorrect because giving the full dose despite low vitals ignores standard beta-blocker
hold parameters and places the client at serious risk. In practice, nurses must always
verify hold parameters before administering cardiac medications and document the
reason for withholding.
Question 2 of 50
A 58-year-old client with a history of heart failure is being discharged home on
furosemide 40 mg daily and digoxin 0.25 mg daily. During discharge teaching, the client
asks the nurse why it is important to eat foods high in potassium. What is the nurse's
best response?
A. "Potassium helps prevent digoxin toxicity, which can occur if your levels drop too
low." ✓ CORRECT
B. "Potassium will help your digoxin work faster when your heart rate is elevated."
C. "High potassium intake is needed to counteract the sodium in your diet."
D. "Potassium prevents furosemide from causing excessive urination at night."
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium wasting, and
hypokalemia increases myocardial sensitivity to digoxin, raising the risk of
life-threatening arrhythmias from digoxin toxicity. Option B is tempting because digoxin
does slow heart rate, but potassium does not speed its onset of action; this
misrepresents the drug interaction. Clients on this combination should be taught to
recognize early signs of hypokalemia such as muscle weakness and to have periodic
electrolyte monitoring.
Question 3 of 50
A 45-year-old client with a history of deep vein thrombosis is started on warfarin 5 mg
daily. The nurse is reviewing the client's current medications and notes he takes
,ibuprofen 400 mg three times daily for chronic knee pain. What is the priority nursing
action?
A. Instruct the client to increase his warfarin dose to counteract the ibuprofen
B. Teach the client to take the ibuprofen with food to protect his stomach
C. Contact the prescriber to discuss possible discontinuation of ibuprofen ✓ CORRECT
D. Recommend switching the ibuprofen to acetaminophen without notifying the
prescriber
Correct Answer: C
Rationale: NSAIDs like ibuprofen increase the risk of gastrointestinal bleeding and can
displace warfarin from protein binding sites, significantly raising INR and bleeding risk,
so the prescriber must be notified to evaluate safer alternatives. Option D seems
reasonable because acetaminophen is generally safer with warfarin, but nurses cannot
independently change prescriptions; prescriber collaboration is required. This
interaction is particularly dangerous because bleeding from supratherapeutic warfarin
may present insidiously before becoming life-threatening.
Question 4 of 50
A 67-year-old client is recovering in the cardiac step-down unit after coronary artery
bypass grafting performed two days ago. The nurse notes the client's chest tube
drainage has increased from 50 mL to 180 mL over the past hour, and the drainage is
bright red. The client's blood pressure is dropping and heart rate is rising. What is the
nurse's priority intervention?
A. Clamp the chest tube to prevent further blood loss
B. Administer the prescribed PRN dose of morphine for pain
C. Notify the surgeon immediately and prepare for possible emergency re-exploration ✓
CORRECT
D. Reposition the client to the affected side to promote drainage
Correct Answer: C
, Rationale: A sudden increase in bright red chest tube drainage exceeding 100 mL per
hour, accompanied by hypotension and tachycardia, indicates active hemorrhage and
possible cardiac tamponade requiring immediate surgical intervention. Option A is a
dangerous error because clamping a chest tube with active bleeding can cause a
tension pneumothorax or tamponade and is never appropriate. Postoperative nurses
must maintain vigilance for hemorrhage in the first 48 hours and have blood products
readily available.
Question 5 of 50
A 34-year-old client with sickle cell disease presents to the emergency department with
severe pain in the lower back and legs, a temperature of 38.9°C (102°F), and a heart rate
of 118 beats per minute. The client states the pain started six hours ago after working
outside in hot weather. What is the nurse's priority intervention?
A. Apply warm compresses to the painful areas to promote vasodilation
B. Administer opioid analgesics as ordered and initiate intravenous hydration ✓
CORRECT
C. Encourage the client to ambulate to improve circulation to the extremities
D. Administer aspirin 325 mg to reduce inflammation and prevent clotting
Correct Answer: B
Rationale: This client is experiencing a vaso-occlusive sickle cell crisis triggered by
dehydration and heat exposure, so rapid IV hydration restores intravascular volume to
reduce red blood cell sickling, while opioids address the severe ischemic pain. Option A
is incorrect because warmth is generally avoided during acute crisis since it increases
metabolic demand in already hypoxic tissues; moreover, fever suggests possible
infection requiring evaluation. Hydration protocols typically target 1.5 times
maintenance fluid rates, and nurses must monitor for signs of acute chest syndrome.
Question 6 of 50
2026/2027: Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular & Hematologic Disorders | Q1 – Q10
Section 2 | Respiratory & Acid-Base Disorders | Q11 – Q20
Section 3 | Gastrointestinal, Hepatic & Endocrine Disorders | Q21 – Q30
Section 4 | Renal, Genitourinary & Reproductive Disorders | Q31 – Q40
Section 5 | Neurologic, Musculoskeletal & Integumentary Disorders | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old client is admitted to the telemetry unit with chest pain and is diagnosed
with an acute anterior wall myocardial infarction. The nurse is preparing to administer
the first dose of metoprolol 25 mg PO as ordered. Before giving the medication, the
nurse checks the client's vital signs and notes a blood pressure of 92/58 mmHg and a
heart rate of 58 beats per minute. What is the nurse's best action?
A. Administer the metoprolol as ordered to reduce myocardial oxygen demand
B. Hold the metoprolol and contact the prescriber to report the findings ✓ CORRECT
C. Administer half the dose and reassess the blood pressure in 30 minutes
D. Give the metoprolol with a full glass of water to prevent hypotension
Correct Answer: B
Rationale: Metoprolol is a beta-blocker that further reduces heart rate and blood
pressure, so administering it with a heart rate below 60 bpm and systolic pressure under
100 mmHg could precipitate dangerous bradycardia or cardiogenic shock. Option A is
,incorrect because giving the full dose despite low vitals ignores standard beta-blocker
hold parameters and places the client at serious risk. In practice, nurses must always
verify hold parameters before administering cardiac medications and document the
reason for withholding.
Question 2 of 50
A 58-year-old client with a history of heart failure is being discharged home on
furosemide 40 mg daily and digoxin 0.25 mg daily. During discharge teaching, the client
asks the nurse why it is important to eat foods high in potassium. What is the nurse's
best response?
A. "Potassium helps prevent digoxin toxicity, which can occur if your levels drop too
low." ✓ CORRECT
B. "Potassium will help your digoxin work faster when your heart rate is elevated."
C. "High potassium intake is needed to counteract the sodium in your diet."
D. "Potassium prevents furosemide from causing excessive urination at night."
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium wasting, and
hypokalemia increases myocardial sensitivity to digoxin, raising the risk of
life-threatening arrhythmias from digoxin toxicity. Option B is tempting because digoxin
does slow heart rate, but potassium does not speed its onset of action; this
misrepresents the drug interaction. Clients on this combination should be taught to
recognize early signs of hypokalemia such as muscle weakness and to have periodic
electrolyte monitoring.
Question 3 of 50
A 45-year-old client with a history of deep vein thrombosis is started on warfarin 5 mg
daily. The nurse is reviewing the client's current medications and notes he takes
,ibuprofen 400 mg three times daily for chronic knee pain. What is the priority nursing
action?
A. Instruct the client to increase his warfarin dose to counteract the ibuprofen
B. Teach the client to take the ibuprofen with food to protect his stomach
C. Contact the prescriber to discuss possible discontinuation of ibuprofen ✓ CORRECT
D. Recommend switching the ibuprofen to acetaminophen without notifying the
prescriber
Correct Answer: C
Rationale: NSAIDs like ibuprofen increase the risk of gastrointestinal bleeding and can
displace warfarin from protein binding sites, significantly raising INR and bleeding risk,
so the prescriber must be notified to evaluate safer alternatives. Option D seems
reasonable because acetaminophen is generally safer with warfarin, but nurses cannot
independently change prescriptions; prescriber collaboration is required. This
interaction is particularly dangerous because bleeding from supratherapeutic warfarin
may present insidiously before becoming life-threatening.
Question 4 of 50
A 67-year-old client is recovering in the cardiac step-down unit after coronary artery
bypass grafting performed two days ago. The nurse notes the client's chest tube
drainage has increased from 50 mL to 180 mL over the past hour, and the drainage is
bright red. The client's blood pressure is dropping and heart rate is rising. What is the
nurse's priority intervention?
A. Clamp the chest tube to prevent further blood loss
B. Administer the prescribed PRN dose of morphine for pain
C. Notify the surgeon immediately and prepare for possible emergency re-exploration ✓
CORRECT
D. Reposition the client to the affected side to promote drainage
Correct Answer: C
, Rationale: A sudden increase in bright red chest tube drainage exceeding 100 mL per
hour, accompanied by hypotension and tachycardia, indicates active hemorrhage and
possible cardiac tamponade requiring immediate surgical intervention. Option A is a
dangerous error because clamping a chest tube with active bleeding can cause a
tension pneumothorax or tamponade and is never appropriate. Postoperative nurses
must maintain vigilance for hemorrhage in the first 48 hours and have blood products
readily available.
Question 5 of 50
A 34-year-old client with sickle cell disease presents to the emergency department with
severe pain in the lower back and legs, a temperature of 38.9°C (102°F), and a heart rate
of 118 beats per minute. The client states the pain started six hours ago after working
outside in hot weather. What is the nurse's priority intervention?
A. Apply warm compresses to the painful areas to promote vasodilation
B. Administer opioid analgesics as ordered and initiate intravenous hydration ✓
CORRECT
C. Encourage the client to ambulate to improve circulation to the extremities
D. Administer aspirin 325 mg to reduce inflammation and prevent clotting
Correct Answer: B
Rationale: This client is experiencing a vaso-occlusive sickle cell crisis triggered by
dehydration and heat exposure, so rapid IV hydration restores intravascular volume to
reduce red blood cell sickling, while opioids address the severe ischemic pain. Option A
is incorrect because warmth is generally avoided during acute crisis since it increases
metabolic demand in already hypoxic tissues; moreover, fever suggests possible
infection requiring evaluation. Hydration protocols typically target 1.5 times
maintenance fluid rates, and nurses must monitor for signs of acute chest syndrome.
Question 6 of 50
