RN ADULT MEDICAL SURGICAL 2019 EXAM
with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Cardiovascular and Hematologic Alterations
2. Respiratory Dysfunction and Gas Exchange
3. Neurosensory and Musculoskeletal Disorders
4. Endocrine and Metabolic Regulation
5. Gastrointestinal, Hepatic, and Biliary Function
6. Renal and Urinary System Management
7. Integumentary and Immunological Integrity
8. Oncology and Palliative Care
9. Perioperative Nursing and Pain Management
10. Fluid, Electrolyte, and Acid-Base Homeostasis
1. A nurse is caring for a client with a history of heart failure who is receiving an infusion of 0.9%
sodium chloride at 150 mL/hr. The nurse notes the client has developed a cough and crackles in
the bases of the lungs. What is the priority nursing action?
A. Administer a PRN dose of furosemide.
B. Decrease the IV infusion rate and notify the provider.
, C. Position the client in the supine position.
D. Increase the oxygen flow rate to 6 L/min.
CORRECT ANSWER : B
Rationale: The client is exhibiting signs of fluid volume overload, a serious risk for clients with
heart failure. Reducing the intake (IV rate) is the most immediate way to manage the volume
overload, while notifying the provider allows for potential adjustment of diuretic therapy.
Administering furosemide requires a prescription, and the supine position would worsen
respiratory effort.
2. A nurse is caring for a client 24 hours post-thyroidectomy. The client reports tingling in the
fingers and circumoral numbness. Which intervention should the nurse perform first?
A. Assess the surgical site for hematoma.
B. Check for a positive Trousseau’s sign.
C. Administer an analgesic for pain.
D. Encourage the client to perform deep breathing exercises.
CORRECT ANSWER : B
Rationale: Tingling in the fingers and around the mouth (paresthesias) are classic symptoms of
hypocalcemia, a potential complication following a thyroidectomy due to accidental injury to the
parathyroid glands. Checking for Trousseau’s or Chvostek’s sign validates neuromuscular
irritability, which is critical before initiating calcium replacement.
3. A nurse is managing a client with a chest tube drainage system. The nurse observes that the fluid
in the water-seal chamber stops fluctuating with the client's respirations. What does this finding
indicate?
A. The system has developed an air leak.
B. The lung may have re-expanded or the tubing is obstructed.
C. The client is experiencing a tension pneumothorax.
D. The suction pressure is set too low.
CORRECT ANSWER : B
Rationale: Tidaling in the water-seal chamber represents pressure changes in the pleural space
during respiration. When this stops, it suggests either the lung has fully re-expanded and no
, longer requires drainage, or there is a physical obstruction (kinking) in the tubing, requiring
immediate assessment of the tubing and the client's breath sounds.
4. A nurse is caring for a client with type 1 diabetes mellitus who is brought to the emergency
department with a blood glucose of 450 mg/dL and Kussmaul respirations. What is the priority
nursing intervention?
A. Administer 50% dextrose IV.
B. Initiate an infusion of 0.9% sodium chloride.
C. Administer subcutaneous NPH insulin.
D. Encourage the client to drink orange juice.
CORRECT ANSWER : B
Rationale: The client is in diabetic ketoacidosis (DKA), which causes severe dehydration. The
priority is volume resuscitation with isotonic fluids to restore perfusion before insulin therapy is
initiated, as insulin will shift potassium into cells and worsen dehydration. Dextrose and orange
juice would exacerbate the hyperglycemia.
5. A nurse is caring for a client 2 hours following an open cholecystectomy who has a T-tube in
place. What is the expected assessment finding?
A. Bloody drainage of 500 mL in the first 2 hours.
B. Dark green to brownish drainage in the collection bag.
C. Clear, straw-colored drainage.
D. Absence of drainage in the bag.
CORRECT ANSWER : B
Rationale: The T-tube is placed to maintain patency of the common bile duct and allow for
drainage of bile following surgery. Bile is typically dark green, brown, or golden-yellow, and it
is normal to see this drainage in the postoperative period.
6. A nurse is preparing a client with a suspected diagnosis of acute pancreatitis for diagnostic
testing. Which lab result should the nurse expect to be elevated?
A. Serum calcium.
B. Serum amylase and lipase.
, C. Serum albumin.
D. Serum glucose (decreased).
CORRECT ANSWER : B
Rationale: Acute pancreatitis results in the leakage of pancreatic enzymes into the bloodstream.
Elevations in serum amylase and lipase are the diagnostic hallmarks of the condition. Calcium is
typically decreased due to fat necrosis.
7. A nurse is providing discharge teaching to a client with a new diagnosis of peripheral arterial
disease (PAD). Which instruction should the nurse include?
A. "Keep your legs elevated above the level of the heart when sitting."
B. "Walk until you feel pain, then rest until it subsides."
C. "Apply heat pads to your feet to improve circulation."
D. "Wear compression stockings at all times."
CORRECT ANSWER : B
Rationale: Walking (exercise) promotes the development of collateral circulation in PAD.
Elevating the legs is for venous insufficiency, not PAD, and heat pads can cause severe burns on
feet with poor sensation and perfusion.
8. A nurse is caring for a client with a spinal cord injury at the T3 level who is experiencing
autonomic dysreflexia. What is the nurse's priority action?
A. Administer an antihypertensive medication.
B. Elevate the head of the bed to a high-Fowler’s position.
C. Notify the surgical team.
D. Catheterize the client for a urine sample.
CORRECT ANSWER : B
Rationale: Autonomic dysreflexia is a medical emergency caused by a noxious stimulus, leading
to life-threatening hypertension. Placing the client in an upright position immediately utilizes
orthostatic forces to reduce blood pressure, which is the most critical initial intervention before
addressing the cause (e.g., full bladder).
with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Cardiovascular and Hematologic Alterations
2. Respiratory Dysfunction and Gas Exchange
3. Neurosensory and Musculoskeletal Disorders
4. Endocrine and Metabolic Regulation
5. Gastrointestinal, Hepatic, and Biliary Function
6. Renal and Urinary System Management
7. Integumentary and Immunological Integrity
8. Oncology and Palliative Care
9. Perioperative Nursing and Pain Management
10. Fluid, Electrolyte, and Acid-Base Homeostasis
1. A nurse is caring for a client with a history of heart failure who is receiving an infusion of 0.9%
sodium chloride at 150 mL/hr. The nurse notes the client has developed a cough and crackles in
the bases of the lungs. What is the priority nursing action?
A. Administer a PRN dose of furosemide.
B. Decrease the IV infusion rate and notify the provider.
, C. Position the client in the supine position.
D. Increase the oxygen flow rate to 6 L/min.
CORRECT ANSWER : B
Rationale: The client is exhibiting signs of fluid volume overload, a serious risk for clients with
heart failure. Reducing the intake (IV rate) is the most immediate way to manage the volume
overload, while notifying the provider allows for potential adjustment of diuretic therapy.
Administering furosemide requires a prescription, and the supine position would worsen
respiratory effort.
2. A nurse is caring for a client 24 hours post-thyroidectomy. The client reports tingling in the
fingers and circumoral numbness. Which intervention should the nurse perform first?
A. Assess the surgical site for hematoma.
B. Check for a positive Trousseau’s sign.
C. Administer an analgesic for pain.
D. Encourage the client to perform deep breathing exercises.
CORRECT ANSWER : B
Rationale: Tingling in the fingers and around the mouth (paresthesias) are classic symptoms of
hypocalcemia, a potential complication following a thyroidectomy due to accidental injury to the
parathyroid glands. Checking for Trousseau’s or Chvostek’s sign validates neuromuscular
irritability, which is critical before initiating calcium replacement.
3. A nurse is managing a client with a chest tube drainage system. The nurse observes that the fluid
in the water-seal chamber stops fluctuating with the client's respirations. What does this finding
indicate?
A. The system has developed an air leak.
B. The lung may have re-expanded or the tubing is obstructed.
C. The client is experiencing a tension pneumothorax.
D. The suction pressure is set too low.
CORRECT ANSWER : B
Rationale: Tidaling in the water-seal chamber represents pressure changes in the pleural space
during respiration. When this stops, it suggests either the lung has fully re-expanded and no
, longer requires drainage, or there is a physical obstruction (kinking) in the tubing, requiring
immediate assessment of the tubing and the client's breath sounds.
4. A nurse is caring for a client with type 1 diabetes mellitus who is brought to the emergency
department with a blood glucose of 450 mg/dL and Kussmaul respirations. What is the priority
nursing intervention?
A. Administer 50% dextrose IV.
B. Initiate an infusion of 0.9% sodium chloride.
C. Administer subcutaneous NPH insulin.
D. Encourage the client to drink orange juice.
CORRECT ANSWER : B
Rationale: The client is in diabetic ketoacidosis (DKA), which causes severe dehydration. The
priority is volume resuscitation with isotonic fluids to restore perfusion before insulin therapy is
initiated, as insulin will shift potassium into cells and worsen dehydration. Dextrose and orange
juice would exacerbate the hyperglycemia.
5. A nurse is caring for a client 2 hours following an open cholecystectomy who has a T-tube in
place. What is the expected assessment finding?
A. Bloody drainage of 500 mL in the first 2 hours.
B. Dark green to brownish drainage in the collection bag.
C. Clear, straw-colored drainage.
D. Absence of drainage in the bag.
CORRECT ANSWER : B
Rationale: The T-tube is placed to maintain patency of the common bile duct and allow for
drainage of bile following surgery. Bile is typically dark green, brown, or golden-yellow, and it
is normal to see this drainage in the postoperative period.
6. A nurse is preparing a client with a suspected diagnosis of acute pancreatitis for diagnostic
testing. Which lab result should the nurse expect to be elevated?
A. Serum calcium.
B. Serum amylase and lipase.
, C. Serum albumin.
D. Serum glucose (decreased).
CORRECT ANSWER : B
Rationale: Acute pancreatitis results in the leakage of pancreatic enzymes into the bloodstream.
Elevations in serum amylase and lipase are the diagnostic hallmarks of the condition. Calcium is
typically decreased due to fat necrosis.
7. A nurse is providing discharge teaching to a client with a new diagnosis of peripheral arterial
disease (PAD). Which instruction should the nurse include?
A. "Keep your legs elevated above the level of the heart when sitting."
B. "Walk until you feel pain, then rest until it subsides."
C. "Apply heat pads to your feet to improve circulation."
D. "Wear compression stockings at all times."
CORRECT ANSWER : B
Rationale: Walking (exercise) promotes the development of collateral circulation in PAD.
Elevating the legs is for venous insufficiency, not PAD, and heat pads can cause severe burns on
feet with poor sensation and perfusion.
8. A nurse is caring for a client with a spinal cord injury at the T3 level who is experiencing
autonomic dysreflexia. What is the nurse's priority action?
A. Administer an antihypertensive medication.
B. Elevate the head of the bed to a high-Fowler’s position.
C. Notify the surgical team.
D. Catheterize the client for a urine sample.
CORRECT ANSWER : B
Rationale: Autonomic dysreflexia is a medical emergency caused by a noxious stimulus, leading
to life-threatening hypertension. Placing the client in an upright position immediately utilizes
orthostatic forces to reduce blood pressure, which is the most critical initial intervention before
addressing the cause (e.g., full bladder).
