NUR 242 MED SURG EXAM 3 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Burns and Burn Injury Management
Immobility and Mobility Disorders
Skin Integrity and Wound Care
Oncology Nursing Principles
Hematology and Blood Disorders
Immunology and Immune Responses
Introduction
This comprehensive practice exam is designed to prepare nursing students for medical-surgical nursing
assessments covering critical clinical concepts. The purpose is to evaluate mastery of foundational theory,
applied professional knowledge, regulatory compliance, ethics, and real-world clinical decision-making skills.
The exam consists of 100 multiple-choice and scenario-based questions that emphasize real-world
application, requiring students to analyze patient situations and make sound clinical judgments. Success on
this assessment demonstrates readiness for professional nursing practice where critical thinking determines
patient outcomes.
SECTION ONE: QUESTIONS 1–100*
,Question 1
A patient with a 40% total body surface area (TBSA) burn presents 6 hours post-injury. Which finding requires
immediate intervention?
A. Urine output of 25 mL/hr
B. Heart rate of 110 bpm
C. Blood pressure of 105/65 mmHg
D. Serous exudate from burn wound
🟢 Correct answer: A
🔴 RATIONALE: Urine output below 30 mL/hr indicates inadequate fluid resuscitation and potential
hypovolemic shock in burn patients. The rule of thumb is 0.5-1 mL/kg/hr for burn patients. Heart rate and BP
are expected findings in the acute burn phase due to fluid loss, and serous exudate is normal.
Question 2
Which nursing action is most appropriate for a patient with deep vein thrombosis (DVT) on anticoagulation
therapy?
A. Apply warm compresses to the affected leg
B. Elevate the leg above heart level
C. Massage the affected leg gently
D. Restrict fluid intake to 1 L/day
🟢 Correct answer: B
,🔴 RATIONALE: Elevating the leg above heart level promotes venous return and reduces edema in DVT
patients. Warm compresses may be used but elevation is priority. Leg massage is contraindicated as it may
dislodge the clot. Fluid restriction is not indicated.
Question 3
A patient with leukemia develops febrile neutropenia. Which intervention is the priority?
A. Administer broad-spectrum antibiotics within 1 hour
B. Obtain blood cultures from one site
C. Administer antipyretics immediately
D. Place patient in negative-pressure room
🟢 Correct answer: A
🔴 RATIONALE: Febrile neutropenia is life-threatening; broad-spectrum antibiotics must be administered
within 1 hour of fever onset to prevent sepsis. Blood cultures should be obtained from multiple sites before
antibiotics, but not delay treatment. Antipyretics are secondary. Negative-pressure rooms are for
immunocompromised patients but not the priority intervention.
Question 4
Which wound classification indicates the highest risk for infection?
A. Class I: Clean wound
B. Class II: Clean-contaminated wound
C. Class III: Contaminated wound
D. Class IV: Dirty-infected wound
, 🟢 Correct answer: D
🔴 RATIONALE: Class IV (dirty-infected) wounds have established infection with organisms present,
representing the highest infection risk. Class I has no infection risk. Class II and III have increasing but lower
risk than Class IV.
Question 5
A patient with multiple myeloma is at risk for which complication?
A. Hypercalcemia
B. Hypocalcemia
C. Hyperkalemia
D. Hypokalemia
🟢 Correct answer: A
🔴 RATIONALE: Multiple myeloma causes bone destruction leading to calcium release into blood, causing
hypercalcemia. This is a classic complication requiring monitoring and management. Hypocalcemia,
hyperkalemia, and hypokalemia are not typical complications.
Question 6
Which assessment finding indicates pressure ulcer development in an immobile patient?
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Burns and Burn Injury Management
Immobility and Mobility Disorders
Skin Integrity and Wound Care
Oncology Nursing Principles
Hematology and Blood Disorders
Immunology and Immune Responses
Introduction
This comprehensive practice exam is designed to prepare nursing students for medical-surgical nursing
assessments covering critical clinical concepts. The purpose is to evaluate mastery of foundational theory,
applied professional knowledge, regulatory compliance, ethics, and real-world clinical decision-making skills.
The exam consists of 100 multiple-choice and scenario-based questions that emphasize real-world
application, requiring students to analyze patient situations and make sound clinical judgments. Success on
this assessment demonstrates readiness for professional nursing practice where critical thinking determines
patient outcomes.
SECTION ONE: QUESTIONS 1–100*
,Question 1
A patient with a 40% total body surface area (TBSA) burn presents 6 hours post-injury. Which finding requires
immediate intervention?
A. Urine output of 25 mL/hr
B. Heart rate of 110 bpm
C. Blood pressure of 105/65 mmHg
D. Serous exudate from burn wound
🟢 Correct answer: A
🔴 RATIONALE: Urine output below 30 mL/hr indicates inadequate fluid resuscitation and potential
hypovolemic shock in burn patients. The rule of thumb is 0.5-1 mL/kg/hr for burn patients. Heart rate and BP
are expected findings in the acute burn phase due to fluid loss, and serous exudate is normal.
Question 2
Which nursing action is most appropriate for a patient with deep vein thrombosis (DVT) on anticoagulation
therapy?
A. Apply warm compresses to the affected leg
B. Elevate the leg above heart level
C. Massage the affected leg gently
D. Restrict fluid intake to 1 L/day
🟢 Correct answer: B
,🔴 RATIONALE: Elevating the leg above heart level promotes venous return and reduces edema in DVT
patients. Warm compresses may be used but elevation is priority. Leg massage is contraindicated as it may
dislodge the clot. Fluid restriction is not indicated.
Question 3
A patient with leukemia develops febrile neutropenia. Which intervention is the priority?
A. Administer broad-spectrum antibiotics within 1 hour
B. Obtain blood cultures from one site
C. Administer antipyretics immediately
D. Place patient in negative-pressure room
🟢 Correct answer: A
🔴 RATIONALE: Febrile neutropenia is life-threatening; broad-spectrum antibiotics must be administered
within 1 hour of fever onset to prevent sepsis. Blood cultures should be obtained from multiple sites before
antibiotics, but not delay treatment. Antipyretics are secondary. Negative-pressure rooms are for
immunocompromised patients but not the priority intervention.
Question 4
Which wound classification indicates the highest risk for infection?
A. Class I: Clean wound
B. Class II: Clean-contaminated wound
C. Class III: Contaminated wound
D. Class IV: Dirty-infected wound
, 🟢 Correct answer: D
🔴 RATIONALE: Class IV (dirty-infected) wounds have established infection with organisms present,
representing the highest infection risk. Class I has no infection risk. Class II and III have increasing but lower
risk than Class IV.
Question 5
A patient with multiple myeloma is at risk for which complication?
A. Hypercalcemia
B. Hypocalcemia
C. Hyperkalemia
D. Hypokalemia
🟢 Correct answer: A
🔴 RATIONALE: Multiple myeloma causes bone destruction leading to calcium release into blood, causing
hypercalcemia. This is a classic complication requiring monitoring and management. Hypocalcemia,
hyperkalemia, and hypokalemia are not typical complications.
Question 6
Which assessment finding indicates pressure ulcer development in an immobile patient?
