RN Adult Medical-Surgical (Med-Surg) 2026 |
Ultimate Study Guide and Practice Test 3 VERSIONS
This study guide covers the major adult health nursing concepts
commonly encountered in medical-surgical nursing, including
cardiovascular, respiratory, neurological, endocrine,
gastrointestinal, renal, musculoskeletal, and hematologic
disorders. Students will review patient assessment, clinical
manifestations, diagnostic testing, pharmacological therapies,
nursing interventions, priority setting, delegation, and evidence-
based management of acute and chronic health conditions. The
material is designed to strengthen clinical judgment, enhance
critical-thinking skills, and support success on nursing
examinations, comprehensive predictors, and NCLEX-style
assessments
SECTION 1: CARDIOVASCULAR DISORDERS
(Questions 1–12)
1. A nurse is caring for a client who is 24 hours post-myocardial
infarction. The client's cardiac monitor shows frequent premature
ventricular contractions (PVCs). Which action should the nurse take
FIRST?
A) Administer amiodarone as prescribed
B) Assess the client's oxygen saturation and vital signs
C) Notify the provider immediately
D) Prepare for synchronized cardioversion
,Answer: B) Assess the client's oxygen saturation and vital signs
Rationale: The nurse should first assess the client's oxygen saturation and
vital signs to determine the clinical significance of the PVCs. Frequent PVCs
can indicate ischemia, hypoxia, or electrolyte imbalances (especially
hypokalemia). Assessment guides further intervention. The provider should be
notified after assessment.
2. A client with chronic heart failure is prescribed carvedilol. The nurse
should monitor for which adverse effect during the initial phase of
therapy?
A) Hypertension
B) Bradycardia
C) Hyperglycemia
D) Tachycardia
Answer: B) Bradycardia
Rationale: Carvedilol is a beta-blocker that can cause bradycardia and
hypotension, especially during the initial titration phase. Heart rate and blood
pressure should be monitored closely. The medication is started at a low dose
and gradually increased to minimize adverse effects.
3. A nurse is caring for a client with a new diagnosis of hypertension.
Which lifestyle modification should the nurse recommend FIRST?
A) Reduce dietary sodium intake
B) Begin a daily exercise program
C) Stop smoking
D) Limit alcohol consumption
,Answer: A) Reduce dietary sodium intake
Rationale: Reducing dietary sodium intake is the most effective initial lifestyle
modification for hypertension. The DASH diet (Dietary Approaches to Stop
Hypertension) is recommended. All lifestyle modifications are important, but
sodium reduction has the most immediate impact on blood pressure.
4. A client with a history of deep vein thrombosis (DVT) is prescribed
warfarin. The client's INR is 1.5. Which action should the nurse take?
A) Administer the warfarin as ordered
B) Hold the warfarin and notify the provider
C) Administer vitamin K
D) Increase the warfarin dose
Answer: A) Administer the warfarin as ordered
Rationale: The therapeutic INR range for DVT is typically 2.0-3.0. An INR of
1.5 is below the therapeutic range, indicating the client is not adequately
anticoagulated. However, the nurse should administer the prescribed dose
and notify the provider for possible dose adjustment. Vitamin K is used for
INR > 5.0 with bleeding.
5. A nurse is caring for a client with a permanent pacemaker. Which
finding indicates the pacemaker is functioning properly?
A) Heart rate of 88 beats/min
B) The client reports palpitations
C) ECG shows a spike before each QRS complex
D) The client has a bounding pulse
Answer: C) ECG shows a spike before each QRS complex
Rationale: A properly functioning pacemaker shows a pacing spike on the
, ECG before each QRS complex, indicating the pacemaker is capturing the
ventricle. A heart rate of 88 bpm may be the paced rate. Palpitations may
indicate malfunction. A bounding pulse is not specific to pacemaker function.
6. A client with peripheral vascular disease (PVD) has a non-healing
ulcer on the left foot. Which finding is most consistent with arterial
insufficiency?
A) Warm, erythematous foot
B) Edema and weeping drainage
C) Diminished or absent pedal pulses
D) Pain relieved by elevation
Answer: C) Diminished or absent pedal pulses
Rationale: Diminished or absent pedal pulses are a hallmark sign of arterial
insufficiency. The foot may be cool, pale, and hairless. Pain worsens with
elevation and is relieved by dangling the leg. Edema and weeping drainage
are more consistent with venous insufficiency.
7. A client is prescribed a calcium channel blocker for hypertension.
Which adverse effect should the nurse monitor for?
A) Peripheral edema
B) Hyperkalemia
C) Bradycardia
D) Persistent cough
Answer: A) Peripheral edema
Rationale: Peripheral edema is a common adverse effect of dihydropyridine
calcium channel blockers (e.g., amlodipine) due to vasodilation. Bradycardia
is more common with non-dihydropyridine calcium channel blockers (e.g.,
Ultimate Study Guide and Practice Test 3 VERSIONS
This study guide covers the major adult health nursing concepts
commonly encountered in medical-surgical nursing, including
cardiovascular, respiratory, neurological, endocrine,
gastrointestinal, renal, musculoskeletal, and hematologic
disorders. Students will review patient assessment, clinical
manifestations, diagnostic testing, pharmacological therapies,
nursing interventions, priority setting, delegation, and evidence-
based management of acute and chronic health conditions. The
material is designed to strengthen clinical judgment, enhance
critical-thinking skills, and support success on nursing
examinations, comprehensive predictors, and NCLEX-style
assessments
SECTION 1: CARDIOVASCULAR DISORDERS
(Questions 1–12)
1. A nurse is caring for a client who is 24 hours post-myocardial
infarction. The client's cardiac monitor shows frequent premature
ventricular contractions (PVCs). Which action should the nurse take
FIRST?
A) Administer amiodarone as prescribed
B) Assess the client's oxygen saturation and vital signs
C) Notify the provider immediately
D) Prepare for synchronized cardioversion
,Answer: B) Assess the client's oxygen saturation and vital signs
Rationale: The nurse should first assess the client's oxygen saturation and
vital signs to determine the clinical significance of the PVCs. Frequent PVCs
can indicate ischemia, hypoxia, or electrolyte imbalances (especially
hypokalemia). Assessment guides further intervention. The provider should be
notified after assessment.
2. A client with chronic heart failure is prescribed carvedilol. The nurse
should monitor for which adverse effect during the initial phase of
therapy?
A) Hypertension
B) Bradycardia
C) Hyperglycemia
D) Tachycardia
Answer: B) Bradycardia
Rationale: Carvedilol is a beta-blocker that can cause bradycardia and
hypotension, especially during the initial titration phase. Heart rate and blood
pressure should be monitored closely. The medication is started at a low dose
and gradually increased to minimize adverse effects.
3. A nurse is caring for a client with a new diagnosis of hypertension.
Which lifestyle modification should the nurse recommend FIRST?
A) Reduce dietary sodium intake
B) Begin a daily exercise program
C) Stop smoking
D) Limit alcohol consumption
,Answer: A) Reduce dietary sodium intake
Rationale: Reducing dietary sodium intake is the most effective initial lifestyle
modification for hypertension. The DASH diet (Dietary Approaches to Stop
Hypertension) is recommended. All lifestyle modifications are important, but
sodium reduction has the most immediate impact on blood pressure.
4. A client with a history of deep vein thrombosis (DVT) is prescribed
warfarin. The client's INR is 1.5. Which action should the nurse take?
A) Administer the warfarin as ordered
B) Hold the warfarin and notify the provider
C) Administer vitamin K
D) Increase the warfarin dose
Answer: A) Administer the warfarin as ordered
Rationale: The therapeutic INR range for DVT is typically 2.0-3.0. An INR of
1.5 is below the therapeutic range, indicating the client is not adequately
anticoagulated. However, the nurse should administer the prescribed dose
and notify the provider for possible dose adjustment. Vitamin K is used for
INR > 5.0 with bleeding.
5. A nurse is caring for a client with a permanent pacemaker. Which
finding indicates the pacemaker is functioning properly?
A) Heart rate of 88 beats/min
B) The client reports palpitations
C) ECG shows a spike before each QRS complex
D) The client has a bounding pulse
Answer: C) ECG shows a spike before each QRS complex
Rationale: A properly functioning pacemaker shows a pacing spike on the
, ECG before each QRS complex, indicating the pacemaker is capturing the
ventricle. A heart rate of 88 bpm may be the paced rate. Palpitations may
indicate malfunction. A bounding pulse is not specific to pacemaker function.
6. A client with peripheral vascular disease (PVD) has a non-healing
ulcer on the left foot. Which finding is most consistent with arterial
insufficiency?
A) Warm, erythematous foot
B) Edema and weeping drainage
C) Diminished or absent pedal pulses
D) Pain relieved by elevation
Answer: C) Diminished or absent pedal pulses
Rationale: Diminished or absent pedal pulses are a hallmark sign of arterial
insufficiency. The foot may be cool, pale, and hairless. Pain worsens with
elevation and is relieved by dangling the leg. Edema and weeping drainage
are more consistent with venous insufficiency.
7. A client is prescribed a calcium channel blocker for hypertension.
Which adverse effect should the nurse monitor for?
A) Peripheral edema
B) Hyperkalemia
C) Bradycardia
D) Persistent cough
Answer: A) Peripheral edema
Rationale: Peripheral edema is a common adverse effect of dihydropyridine
calcium channel blockers (e.g., amlodipine) due to vasodilation. Bradycardia
is more common with non-dihydropyridine calcium channel blockers (e.g.,
