Advanced Concepts in Medical-Surgical
Nursing Exam 1 Actual Exam 2026/2027
100% Verified | Detailed Rationales –
Pass Guaranteed – A+ Graded
Content Area Overview:
This actual examination reflects the advanced nursing knowledge and clinical reasoning required for
success on the Advanced Concepts in Medical-Surgical Nursing Exam 1. It is designed to evaluate the
student's ability to apply evidence-based practice, prioritize complex patient care, and demonstrate
clinical judgment across multiple organ systems. Questions are structured to assess recall of
pathophysiology, application of nursing interventions, and analysis of complex clinical scenarios. This
authentic question bank represents the real exams used in the course and serves as a comprehensive
resource for students demonstrating mastery of advanced medical-surgical nursing content.
Section 1: Fluid, Electrolyte, and Acid-Base Imbalances (Questions 1–9)
Q1. A 68-year-old male is admitted with severe vomiting and diarrhea for 3 days. His laboratory values
show: sodium 152 mEq/L, potassium 3.2 mEq/L, chloride 110 mEq/L, and BUN 45 mg/dL. His urine
specific gravity is 1.030. Based on these findings, the nurse should prioritize which intervention?
A. Administer a potassium-sparing diuretic
B. Administer IV 0.45% normal saline at a slow rate
C. Administer IV 0.9% normal saline with potassium replacement
D. Restrict oral fluids and monitor intake and output
Rationale: The best answer is C. This patient has hypernatremia (sodium 152), hypokalemia (potassium
3.2), and elevated BUN with high urine specific gravity, all consistent with hypovolemic hypernatremia
from GI losses. The priority is volume replacement with isotonic saline plus potassium replacement,
since both sodium and potassium deficits need correction. Hypotonic saline would be inappropriate
here because it could cause rapid fluid shifts and cerebral edema in a volume-depleted patient.
Correct Answer: C
,Q2. A patient with chronic kidney disease has the following ABG results: pH 7.32, PaCO₂ 30 mmHg,
HCO₃⁻ 16 mEq/L. The nurse recognizes this as:
A. Respiratory acidosis with metabolic compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory alkalosis with metabolic compensation
D. Metabolic alkalosis with respiratory compensation
Rationale: The best answer is B. The pH is low (acidosis), the HCO₃⁻ is low (metabolic acidosis), and the
PaCO₂ is low (respiratory compensation via hyperventilation). In metabolic acidosis, the body
compensates by blowing off CO₂ through increased respiratory rate to raise the pH back toward normal.
The low PaCO₂ confirms the lungs are doing their compensatory job, but the pH remains below normal
because the compensation is incomplete.
Correct Answer: B
Q3. A patient receiving IV potassium chloride at 20 mEq/hr suddenly develops peaked T waves on the
cardiac monitor and reports numbness and tingling in the extremities. The nurse's priority action is:
A. Increase the IV rate to dilute the potassium
B. Stop the potassium infusion immediately and notify the provider
C. Administer calcium gluconate and continue the infusion
D. Draw a stat potassium level and wait for results before acting
Rationale: The best answer is B. Peaked T waves are an early sign of hyperkalemia, and the patient's
symptoms combined with the rapid infusion rate strongly suggest potassium toxicity. The infusion must
be stopped immediately to prevent progression to life-threatening arrhythmias. While calcium
gluconate may be needed later to stabilize cardiac membranes, stopping the source of excess potassium
is the absolute first priority—waiting for lab confirmation could be fatal.
Correct Answer: B
Q4. A patient with heart failure is receiving furosemide 80 mg IV twice daily. The nurse should monitor
for which electrolyte imbalance most commonly associated with this therapy?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
, Rationale: The best answer is B. Loop diuretics like furosemide cause potassium wasting in the kidneys,
leading to hypokalemia. This is one of the most common and clinically significant side effects of loop
diuretic therapy. The nurse should monitor potassium levels regularly and ensure the patient receives
potassium supplementation or a potassium-sparing agent as ordered. Hypokalemia can precipitate
dangerous cardiac arrhythmias, especially in patients with underlying heart disease.
Correct Answer: B
Q5. A patient has the following ABG: pH 7.50, PaCO₂ 48 mmHg, HCO₃⁻ 36 mEq/L. Which acid-base
disturbance is present?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Metabolic acidosis
Rationale: The best answer is B. The elevated pH (alkalosis) with an elevated HCO₃⁻ (metabolic alkalosis)
and an elevated PaCO₂ (respiratory compensation via hypoventilation) indicates metabolic alkalosis with
partial respiratory compensation. The kidneys retain bicarbonate, and the lungs compensate by
retaining CO₂. Common causes include prolonged vomiting, NG suctioning, or excessive diuretic use.
Correct Answer: B
Q6. A postoperative patient has a serum calcium of 7.8 mg/dL (normal 8.5–10.5). The nurse observes
muscle twitching and a positive Chvostek's sign. Which intervention is most appropriate?
A. Administer IV calcium gluconate as ordered
B. Administer a loop diuretic to increase calcium excretion
C. Increase phosphate intake
D. Restrict oral calcium supplements
Rationale: The best answer is A. Hypocalcemia with neuromuscular irritability (Chvostek's sign, muscle
twitching) requires calcium replacement, typically with IV calcium gluconate for symptomatic patients.
This is especially common after thyroid or parathyroid surgery when the parathyroid glands may be
temporarily damaged. Increasing phosphate or restricting calcium would worsen the hypocalcemia, and
diuretics would further deplete calcium.
Correct Answer: A
Nursing Exam 1 Actual Exam 2026/2027
100% Verified | Detailed Rationales –
Pass Guaranteed – A+ Graded
Content Area Overview:
This actual examination reflects the advanced nursing knowledge and clinical reasoning required for
success on the Advanced Concepts in Medical-Surgical Nursing Exam 1. It is designed to evaluate the
student's ability to apply evidence-based practice, prioritize complex patient care, and demonstrate
clinical judgment across multiple organ systems. Questions are structured to assess recall of
pathophysiology, application of nursing interventions, and analysis of complex clinical scenarios. This
authentic question bank represents the real exams used in the course and serves as a comprehensive
resource for students demonstrating mastery of advanced medical-surgical nursing content.
Section 1: Fluid, Electrolyte, and Acid-Base Imbalances (Questions 1–9)
Q1. A 68-year-old male is admitted with severe vomiting and diarrhea for 3 days. His laboratory values
show: sodium 152 mEq/L, potassium 3.2 mEq/L, chloride 110 mEq/L, and BUN 45 mg/dL. His urine
specific gravity is 1.030. Based on these findings, the nurse should prioritize which intervention?
A. Administer a potassium-sparing diuretic
B. Administer IV 0.45% normal saline at a slow rate
C. Administer IV 0.9% normal saline with potassium replacement
D. Restrict oral fluids and monitor intake and output
Rationale: The best answer is C. This patient has hypernatremia (sodium 152), hypokalemia (potassium
3.2), and elevated BUN with high urine specific gravity, all consistent with hypovolemic hypernatremia
from GI losses. The priority is volume replacement with isotonic saline plus potassium replacement,
since both sodium and potassium deficits need correction. Hypotonic saline would be inappropriate
here because it could cause rapid fluid shifts and cerebral edema in a volume-depleted patient.
Correct Answer: C
,Q2. A patient with chronic kidney disease has the following ABG results: pH 7.32, PaCO₂ 30 mmHg,
HCO₃⁻ 16 mEq/L. The nurse recognizes this as:
A. Respiratory acidosis with metabolic compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory alkalosis with metabolic compensation
D. Metabolic alkalosis with respiratory compensation
Rationale: The best answer is B. The pH is low (acidosis), the HCO₃⁻ is low (metabolic acidosis), and the
PaCO₂ is low (respiratory compensation via hyperventilation). In metabolic acidosis, the body
compensates by blowing off CO₂ through increased respiratory rate to raise the pH back toward normal.
The low PaCO₂ confirms the lungs are doing their compensatory job, but the pH remains below normal
because the compensation is incomplete.
Correct Answer: B
Q3. A patient receiving IV potassium chloride at 20 mEq/hr suddenly develops peaked T waves on the
cardiac monitor and reports numbness and tingling in the extremities. The nurse's priority action is:
A. Increase the IV rate to dilute the potassium
B. Stop the potassium infusion immediately and notify the provider
C. Administer calcium gluconate and continue the infusion
D. Draw a stat potassium level and wait for results before acting
Rationale: The best answer is B. Peaked T waves are an early sign of hyperkalemia, and the patient's
symptoms combined with the rapid infusion rate strongly suggest potassium toxicity. The infusion must
be stopped immediately to prevent progression to life-threatening arrhythmias. While calcium
gluconate may be needed later to stabilize cardiac membranes, stopping the source of excess potassium
is the absolute first priority—waiting for lab confirmation could be fatal.
Correct Answer: B
Q4. A patient with heart failure is receiving furosemide 80 mg IV twice daily. The nurse should monitor
for which electrolyte imbalance most commonly associated with this therapy?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
, Rationale: The best answer is B. Loop diuretics like furosemide cause potassium wasting in the kidneys,
leading to hypokalemia. This is one of the most common and clinically significant side effects of loop
diuretic therapy. The nurse should monitor potassium levels regularly and ensure the patient receives
potassium supplementation or a potassium-sparing agent as ordered. Hypokalemia can precipitate
dangerous cardiac arrhythmias, especially in patients with underlying heart disease.
Correct Answer: B
Q5. A patient has the following ABG: pH 7.50, PaCO₂ 48 mmHg, HCO₃⁻ 36 mEq/L. Which acid-base
disturbance is present?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Metabolic acidosis
Rationale: The best answer is B. The elevated pH (alkalosis) with an elevated HCO₃⁻ (metabolic alkalosis)
and an elevated PaCO₂ (respiratory compensation via hypoventilation) indicates metabolic alkalosis with
partial respiratory compensation. The kidneys retain bicarbonate, and the lungs compensate by
retaining CO₂. Common causes include prolonged vomiting, NG suctioning, or excessive diuretic use.
Correct Answer: B
Q6. A postoperative patient has a serum calcium of 7.8 mg/dL (normal 8.5–10.5). The nurse observes
muscle twitching and a positive Chvostek's sign. Which intervention is most appropriate?
A. Administer IV calcium gluconate as ordered
B. Administer a loop diuretic to increase calcium excretion
C. Increase phosphate intake
D. Restrict oral calcium supplements
Rationale: The best answer is A. Hypocalcemia with neuromuscular irritability (Chvostek's sign, muscle
twitching) requires calcium replacement, typically with IV calcium gluconate for symptomatic patients.
This is especially common after thyroid or parathyroid surgery when the parathyroid glands may be
temporarily damaged. Increasing phosphate or restricting calcium would worsen the hypocalcemia, and
diuretics would further deplete calcium.
Correct Answer: A
