MEDICAL-SURGICAL NURSING I CLINICAL JUDGMENT
EXAM |Summer Series Practice Test |June/July
2026|(Questions and Correct Answers)
1. A 68-year-old patient with a history of chronic obstructive
pulmonary disease (COPD) is admitted with acute exacerbation. The
nurse observes the patient using accessory muscles to breathe and
has an oxygen saturation of 88% on room air. Which intervention
should the nurse prioritize?
A. Encourage the patient to cough and deep breathe every hour.
B. Administer a bronchodilator as prescribed.
C. Apply a non-rebreather mask at 15 L/min.
D. Position the patient in a high-Fowler's position.
Correct Answer: C
Explanation: A non-rebreather mask at 15 L/min delivers the highest
concentration of oxygen (up to 90-95%) and is the priority for a patient
with severe hypoxemia (SpO2 <90%). While bronchodilators and
positioning are important, they are secondary to correcting the life-
threatening hypoxemia. Coughing and deep breathing are ineffective
when the patient is in acute respiratory distress.
2. A nurse is caring for a patient with left-sided heart failure. Which
clinical manifestation is most indicative of this condition?
A. Jugular venous distention
B. Peripheral edema
C. Pulmonary congestion
,D. Hepatomegaly
Correct Answer: C
Explanation: Left-sided heart failure leads to a backup of blood into the
pulmonary circulation, resulting in pulmonary congestion and symptoms
like dyspnea, crackles, and orthopnea. Jugular venous distention,
peripheral edema, and hepatomegaly are signs of right-sided heart
failure, as they reflect systemic venous congestion.
3. The nurse is assessing a patient with diabetic ketoacidosis (DKA).
Which laboratory value requires the most immediate intervention?
A. Serum glucose of 450 mg/dL
B. Serum potassium of 2.8 mEq/L
C. Serum sodium of 135 mEq/L
D. Serum bicarbonate of 18 mEq/L
Correct Answer: B
Explanation: A serum potassium of 2.8 mEq/L is critically low and can
lead to life-threatening cardiac dysrhythmias. While hyperglycemia,
hyponatremia, and metabolic acidosis are expected in DKA, severe
hypokalemia must be corrected emergently, especially before insulin is
administered, as insulin can further drive potassium into cells,
worsening the deficiency.
4. A patient is scheduled for a thoracentesis to remove a pleural
effusion. Which nursing action is most important to perform before
the procedure?
A. Instruct the patient to remain NPO for 8 hours.
B. Administer a sedative 30 minutes prior.
,C. Position the patient sitting upright, leaning forward on an overbed
table.
D. Obtain a signed informed consent form.
Correct Answer: D
Explanation: Obtaining a signed informed consent is a legal and ethical
requirement before any invasive procedure like a thoracentesis. While
positioning (C) is correct, it is a procedural action, not the most
important pre-procedure nursing responsibility. NPO status is not
typically required for this procedure, and sedation is not always
standard.
5. A nurse is providing discharge teaching to a patient with a new
colostomy. Which statement indicates that the patient understands
the care of the stoma?
A. "I will notify my doctor if the stoma appears dusky or purple."
B. "I should expect the stoma to shrink in size over the next few
months."
C. "I will clean the stoma with soap and water and apply lotion to the
surrounding skin."
D. "It is normal for the stoma to bleed slightly when I touch it."
Correct Answer: A
Explanation: A dusky or purple stoma indicates ischemia and potential
necrosis, requiring immediate medical attention. While stoma shrinkage
(B) and minor bleeding (D) are normal, the question asks for an
indication of understanding care, and recognizing a sign of complication
is paramount. Lotion should not be used on the peristomal skin, as it can
interfere with appliance adherence.
, 6. The nurse is evaluating the effectiveness of a continuous enteral
feeding. Which finding indicates a complication related to the feeding?
A. A residual volume of 150 mL
B. A blood glucose level of 140 mg/dL
C. A bowel movement every other day
D. A new onset of crackles in the lung bases
Correct Answer: D
Explanation: New onset of crackles in the lung bases is a sign of
pulmonary aspiration of the enteral feeding, which can lead to
aspiration pneumonia. A residual volume of 150 mL (A) is generally
acceptable in many institutions. A blood glucose of 140 mg/dL (B) is
slightly elevated but not a direct complication of the feeding tube itself.
Bowel movement every other day (C) is considered normal.
7. A patient with chronic renal failure is exhibiting signs of uremia.
Which assessment finding is consistent with this condition?
A. Flushed, dry skin
B. Decreased deep tendon reflexes
C. A yellow-gray discoloration of the skin
D. A fruity odor to the breath
Correct Answer: C
Explanation: A yellow-gray or "uremic" discoloration of the skin is a
classic sign of uremia, caused by the accumulation of urochromes in the
skin. Flushed, dry skin (A) is associated with dehydration. Decreased
deep tendon reflexes (B) can be a sign of electrolyte imbalance but not
EXAM |Summer Series Practice Test |June/July
2026|(Questions and Correct Answers)
1. A 68-year-old patient with a history of chronic obstructive
pulmonary disease (COPD) is admitted with acute exacerbation. The
nurse observes the patient using accessory muscles to breathe and
has an oxygen saturation of 88% on room air. Which intervention
should the nurse prioritize?
A. Encourage the patient to cough and deep breathe every hour.
B. Administer a bronchodilator as prescribed.
C. Apply a non-rebreather mask at 15 L/min.
D. Position the patient in a high-Fowler's position.
Correct Answer: C
Explanation: A non-rebreather mask at 15 L/min delivers the highest
concentration of oxygen (up to 90-95%) and is the priority for a patient
with severe hypoxemia (SpO2 <90%). While bronchodilators and
positioning are important, they are secondary to correcting the life-
threatening hypoxemia. Coughing and deep breathing are ineffective
when the patient is in acute respiratory distress.
2. A nurse is caring for a patient with left-sided heart failure. Which
clinical manifestation is most indicative of this condition?
A. Jugular venous distention
B. Peripheral edema
C. Pulmonary congestion
,D. Hepatomegaly
Correct Answer: C
Explanation: Left-sided heart failure leads to a backup of blood into the
pulmonary circulation, resulting in pulmonary congestion and symptoms
like dyspnea, crackles, and orthopnea. Jugular venous distention,
peripheral edema, and hepatomegaly are signs of right-sided heart
failure, as they reflect systemic venous congestion.
3. The nurse is assessing a patient with diabetic ketoacidosis (DKA).
Which laboratory value requires the most immediate intervention?
A. Serum glucose of 450 mg/dL
B. Serum potassium of 2.8 mEq/L
C. Serum sodium of 135 mEq/L
D. Serum bicarbonate of 18 mEq/L
Correct Answer: B
Explanation: A serum potassium of 2.8 mEq/L is critically low and can
lead to life-threatening cardiac dysrhythmias. While hyperglycemia,
hyponatremia, and metabolic acidosis are expected in DKA, severe
hypokalemia must be corrected emergently, especially before insulin is
administered, as insulin can further drive potassium into cells,
worsening the deficiency.
4. A patient is scheduled for a thoracentesis to remove a pleural
effusion. Which nursing action is most important to perform before
the procedure?
A. Instruct the patient to remain NPO for 8 hours.
B. Administer a sedative 30 minutes prior.
,C. Position the patient sitting upright, leaning forward on an overbed
table.
D. Obtain a signed informed consent form.
Correct Answer: D
Explanation: Obtaining a signed informed consent is a legal and ethical
requirement before any invasive procedure like a thoracentesis. While
positioning (C) is correct, it is a procedural action, not the most
important pre-procedure nursing responsibility. NPO status is not
typically required for this procedure, and sedation is not always
standard.
5. A nurse is providing discharge teaching to a patient with a new
colostomy. Which statement indicates that the patient understands
the care of the stoma?
A. "I will notify my doctor if the stoma appears dusky or purple."
B. "I should expect the stoma to shrink in size over the next few
months."
C. "I will clean the stoma with soap and water and apply lotion to the
surrounding skin."
D. "It is normal for the stoma to bleed slightly when I touch it."
Correct Answer: A
Explanation: A dusky or purple stoma indicates ischemia and potential
necrosis, requiring immediate medical attention. While stoma shrinkage
(B) and minor bleeding (D) are normal, the question asks for an
indication of understanding care, and recognizing a sign of complication
is paramount. Lotion should not be used on the peristomal skin, as it can
interfere with appliance adherence.
, 6. The nurse is evaluating the effectiveness of a continuous enteral
feeding. Which finding indicates a complication related to the feeding?
A. A residual volume of 150 mL
B. A blood glucose level of 140 mg/dL
C. A bowel movement every other day
D. A new onset of crackles in the lung bases
Correct Answer: D
Explanation: New onset of crackles in the lung bases is a sign of
pulmonary aspiration of the enteral feeding, which can lead to
aspiration pneumonia. A residual volume of 150 mL (A) is generally
acceptable in many institutions. A blood glucose of 140 mg/dL (B) is
slightly elevated but not a direct complication of the feeding tube itself.
Bowel movement every other day (C) is considered normal.
7. A patient with chronic renal failure is exhibiting signs of uremia.
Which assessment finding is consistent with this condition?
A. Flushed, dry skin
B. Decreased deep tendon reflexes
C. A yellow-gray discoloration of the skin
D. A fruity odor to the breath
Correct Answer: C
Explanation: A yellow-gray or "uremic" discoloration of the skin is a
classic sign of uremia, caused by the accumulation of urochromes in the
skin. Flushed, dry skin (A) is associated with dehydration. Decreased
deep tendon reflexes (B) can be a sign of electrolyte imbalance but not
