MEDICAL SURGICAL NURSING EXAM – QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
* Cardiovascular Health Systems
* Respiratory Function and Management
* Endocrine System Disorders
* Perioperative Nursing Care
* Renal and Urinary Function
* Gastrointestinal and Nutritional Support
* Neurological Assessment and Care
* Musculoskeletal Integrity
* Pharmacological Interventions
* Legal and Ethical Nursing Practice
Introduction
*The purpose of this examination is to evaluate comprehensive
knowledge and clinical competency in medical-surgical nursing practice. This assessment
measures the candidate’s ability to apply theoretical concepts to real-world clinical
scenarios, emphasizing critical thinking, safety, and evidence-based decision-making. The
structure consists of multiple-choice questions designed to test foundational theory,
professional nursing standards, regulatory compliance, and complex problem-solving skills in
high-acuity settings. Success on this exam demonstrates the proficiency required to provide
safe, effective, and ethical nursing care across diverse patient populations. Candidates must
synthesize data to identify priority interventions and evaluate patient outcomes effectively.*
SECTION ONE: QUESTIONS 1–100
1. A patient is admitted with a diagnosis of acute heart failure. Which clinical
manifestation should the nurse prioritize during the initial assessment? A. Peripheral
edema B. Crackles in the lung bases C. Jugular vein distention D. Abdominal
bloating Explanation: Crackles in the lung bases indicate pulmonary congestion
and fluid overload in the lungs, which is a life-threatening complication that requires
immediate nursing intervention.
2. A patient scheduled for an appendectomy asks the nurse about the risks of
anesthesia. What is the most appropriate response? A. You will be monitored closely
, by the surgical team. B. Anesthesia involves risks such as respiratory depression
or allergic reactions, which the anesthesiologist will discuss with you. C. It is perfectly
safe and you have nothing to worry about. D. The surgeon will choose the best
method for your specific case. Explanation: The nurse must provide accurate,
honest information while deferring specific medical details regarding anesthesia to
the professional responsible for its administration.
3. Which nursing action is essential when caring for a patient receiving continuous
bladder irrigation after a transurethral resection of the prostate (TURP)? A. Maintain
the drainage bag at the level of the bladder. B. Titrate the irrigation rate to keep
the urine light pink in color. C. Clamp the catheter if the patient experiences bladder
spasms. D. Monitor the patient for signs of hypovolemia hourly. Explanation: The
purpose of irrigation is to prevent clot formation; maintaining a light pink color
ensures adequate flow and prevents obstruction.
4. A patient with type 1 diabetes mellitus presents with a blood glucose level of 450
mg/dL. Which finding should the nurse expect to see? A. Kussmaul respirations
B. Bradycardia C. Moist mucous membranes D. Hypertension Explanation:
Kussmaul respirations are a compensatory mechanism in diabetic ketoacidosis (DKA)
to expel excess carbon dioxide and manage metabolic acidosis.
5. During the post-operative care of a patient following a total hip arthroplasty, which
position is contraindicated? A. Supine with a wedge pillow B. Semi-Fowlers position
C. Adduction of the affected hip D. Neutral rotation of the affected leg
Explanation: Adduction of the hip can cause the femoral head to dislocate from the
acetabulum, particularly in the immediate post-operative period.
6. A nurse is reviewing a patient's arterial blood gas (ABG) results: pH 7.28, PaCO2 55
mmHg, HCO3 24 mEq/L. What is the interpretation? A. Metabolic acidosis B.
Respiratory alkalosis C. Respiratory acidosis D. Metabolic alkalosis
Explanation: The low pH indicates acidosis and the elevated PaCO2 confirms that the
cause is respiratory in origin.
7. Which patient is at the highest risk for developing pressure ulcers? A. A patient who
is ambulatory with assistance. B. An elderly patient with a hip fracture who is
immobile. C. A patient who is alert and oriented. D. A patient with a minor surgical
wound. Explanation: Immobility is the primary risk factor for pressure ulcer
development due to constant pressure on skin over bony prominences.
8. A patient is receiving a blood transfusion and begins to experience flank pain, chills,
and fever. What is the priority nursing action? A. Slow the rate of the transfusion. B.
Disconnect the blood tubing and initiate normal saline. C. Notify the health care
provider immediately. D. Administer an antihistamine as ordered. Explanation:
, These symptoms indicate an acute hemolytic transfusion reaction, requiring the
immediate cessation of the blood product to prevent further hemolysis.
9. Which finding in a patient with a chest tube indicates a potential air leak? A.
Continuous bubbling in the water seal chamber. B. Oscillation of the fluid in the
water seal chamber. C. Absence of drainage in the collection chamber. D. Tidaling
with respiration. Explanation: Continuous bubbling in the water seal chamber
suggests air is escaping from the system or the patient's pleural space, indicating a
leak.
10. A nurse is assessing a patient with a suspected bowel obstruction. Which clinical
finding is a hallmark sign? A. Hyperactive bowel sounds in all four quadrants. B.
High-pitched, tinkling bowel sounds above the obstruction. C. Soft, non-distended
abdomen. D. Normal passage of flatus. Explanation: High-pitched, tinkling sounds
occur as the bowel attempts to push contents past an obstruction, followed by
silence later.
11. A nurse is caring for a patient with hypokalemia. Which medication would the nurse
anticipate the provider will order? A. Spironolactone B. Potassium chloride C.
Lisinopril D. Sodium polystyrene sulfonate Explanation: Potassium chloride is the
standard replacement therapy for correcting low serum potassium levels.
12. A patient with cirrhosis develops ascites. Which dietary modification should the
nurse instruct the patient to follow? A. High-protein diet B. Low-sodium diet C.
Increased fluid intake D. High-fat diet Explanation: Sodium restriction is
necessary to manage fluid retention and ascites caused by portal hypertension and
hypoalbuminemia.
13. What is the priority assessment for a patient returning from a thyroidectomy? A.
Monitoring for stridor or respiratory distress. B. Checking the incision site for
redness. C. Assessing the patient's ability to swallow. D. Monitoring for signs of
surgical pain. Explanation: Laryngeal edema or hematoma formation can rapidly
compromise the airway after thyroid surgery, making respiratory status the priority.
14. A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. Which
medication should the nurse be prepared to administer? A. Furosemide B.
Sodium polystyrene sulfonate C. Digoxin D. Calcium gluconate Explanation:
Sodium polystyrene sulfonate is a cation exchange resin used to reduce serum
potassium levels by excreting it through the gastrointestinal tract.
15. When providing discharge teaching to a patient with a new colostomy, which
statement by the patient indicates an understanding of self-care? A. I should change
the appliance every day. B. I will clean the skin around the stoma with warm
DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
* Cardiovascular Health Systems
* Respiratory Function and Management
* Endocrine System Disorders
* Perioperative Nursing Care
* Renal and Urinary Function
* Gastrointestinal and Nutritional Support
* Neurological Assessment and Care
* Musculoskeletal Integrity
* Pharmacological Interventions
* Legal and Ethical Nursing Practice
Introduction
*The purpose of this examination is to evaluate comprehensive
knowledge and clinical competency in medical-surgical nursing practice. This assessment
measures the candidate’s ability to apply theoretical concepts to real-world clinical
scenarios, emphasizing critical thinking, safety, and evidence-based decision-making. The
structure consists of multiple-choice questions designed to test foundational theory,
professional nursing standards, regulatory compliance, and complex problem-solving skills in
high-acuity settings. Success on this exam demonstrates the proficiency required to provide
safe, effective, and ethical nursing care across diverse patient populations. Candidates must
synthesize data to identify priority interventions and evaluate patient outcomes effectively.*
SECTION ONE: QUESTIONS 1–100
1. A patient is admitted with a diagnosis of acute heart failure. Which clinical
manifestation should the nurse prioritize during the initial assessment? A. Peripheral
edema B. Crackles in the lung bases C. Jugular vein distention D. Abdominal
bloating Explanation: Crackles in the lung bases indicate pulmonary congestion
and fluid overload in the lungs, which is a life-threatening complication that requires
immediate nursing intervention.
2. A patient scheduled for an appendectomy asks the nurse about the risks of
anesthesia. What is the most appropriate response? A. You will be monitored closely
, by the surgical team. B. Anesthesia involves risks such as respiratory depression
or allergic reactions, which the anesthesiologist will discuss with you. C. It is perfectly
safe and you have nothing to worry about. D. The surgeon will choose the best
method for your specific case. Explanation: The nurse must provide accurate,
honest information while deferring specific medical details regarding anesthesia to
the professional responsible for its administration.
3. Which nursing action is essential when caring for a patient receiving continuous
bladder irrigation after a transurethral resection of the prostate (TURP)? A. Maintain
the drainage bag at the level of the bladder. B. Titrate the irrigation rate to keep
the urine light pink in color. C. Clamp the catheter if the patient experiences bladder
spasms. D. Monitor the patient for signs of hypovolemia hourly. Explanation: The
purpose of irrigation is to prevent clot formation; maintaining a light pink color
ensures adequate flow and prevents obstruction.
4. A patient with type 1 diabetes mellitus presents with a blood glucose level of 450
mg/dL. Which finding should the nurse expect to see? A. Kussmaul respirations
B. Bradycardia C. Moist mucous membranes D. Hypertension Explanation:
Kussmaul respirations are a compensatory mechanism in diabetic ketoacidosis (DKA)
to expel excess carbon dioxide and manage metabolic acidosis.
5. During the post-operative care of a patient following a total hip arthroplasty, which
position is contraindicated? A. Supine with a wedge pillow B. Semi-Fowlers position
C. Adduction of the affected hip D. Neutral rotation of the affected leg
Explanation: Adduction of the hip can cause the femoral head to dislocate from the
acetabulum, particularly in the immediate post-operative period.
6. A nurse is reviewing a patient's arterial blood gas (ABG) results: pH 7.28, PaCO2 55
mmHg, HCO3 24 mEq/L. What is the interpretation? A. Metabolic acidosis B.
Respiratory alkalosis C. Respiratory acidosis D. Metabolic alkalosis
Explanation: The low pH indicates acidosis and the elevated PaCO2 confirms that the
cause is respiratory in origin.
7. Which patient is at the highest risk for developing pressure ulcers? A. A patient who
is ambulatory with assistance. B. An elderly patient with a hip fracture who is
immobile. C. A patient who is alert and oriented. D. A patient with a minor surgical
wound. Explanation: Immobility is the primary risk factor for pressure ulcer
development due to constant pressure on skin over bony prominences.
8. A patient is receiving a blood transfusion and begins to experience flank pain, chills,
and fever. What is the priority nursing action? A. Slow the rate of the transfusion. B.
Disconnect the blood tubing and initiate normal saline. C. Notify the health care
provider immediately. D. Administer an antihistamine as ordered. Explanation:
, These symptoms indicate an acute hemolytic transfusion reaction, requiring the
immediate cessation of the blood product to prevent further hemolysis.
9. Which finding in a patient with a chest tube indicates a potential air leak? A.
Continuous bubbling in the water seal chamber. B. Oscillation of the fluid in the
water seal chamber. C. Absence of drainage in the collection chamber. D. Tidaling
with respiration. Explanation: Continuous bubbling in the water seal chamber
suggests air is escaping from the system or the patient's pleural space, indicating a
leak.
10. A nurse is assessing a patient with a suspected bowel obstruction. Which clinical
finding is a hallmark sign? A. Hyperactive bowel sounds in all four quadrants. B.
High-pitched, tinkling bowel sounds above the obstruction. C. Soft, non-distended
abdomen. D. Normal passage of flatus. Explanation: High-pitched, tinkling sounds
occur as the bowel attempts to push contents past an obstruction, followed by
silence later.
11. A nurse is caring for a patient with hypokalemia. Which medication would the nurse
anticipate the provider will order? A. Spironolactone B. Potassium chloride C.
Lisinopril D. Sodium polystyrene sulfonate Explanation: Potassium chloride is the
standard replacement therapy for correcting low serum potassium levels.
12. A patient with cirrhosis develops ascites. Which dietary modification should the
nurse instruct the patient to follow? A. High-protein diet B. Low-sodium diet C.
Increased fluid intake D. High-fat diet Explanation: Sodium restriction is
necessary to manage fluid retention and ascites caused by portal hypertension and
hypoalbuminemia.
13. What is the priority assessment for a patient returning from a thyroidectomy? A.
Monitoring for stridor or respiratory distress. B. Checking the incision site for
redness. C. Assessing the patient's ability to swallow. D. Monitoring for signs of
surgical pain. Explanation: Laryngeal edema or hematoma formation can rapidly
compromise the airway after thyroid surgery, making respiratory status the priority.
14. A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. Which
medication should the nurse be prepared to administer? A. Furosemide B.
Sodium polystyrene sulfonate C. Digoxin D. Calcium gluconate Explanation:
Sodium polystyrene sulfonate is a cation exchange resin used to reduce serum
potassium levels by excreting it through the gastrointestinal tract.
15. When providing discharge teaching to a patient with a new colostomy, which
statement by the patient indicates an understanding of self-care? A. I should change
the appliance every day. B. I will clean the skin around the stoma with warm
