RN Adult Medical-Surgical (Med-Surg) 2026 | Ultimate
Study Guide and Practice Test 2 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
1. A nurse is caring for a client with acute decompensated heart failure who is
receiving IV furosemide. Which assessment finding indicates the medication is
having the desired therapeutic effect?
A) Decreased urine output
B) Increased blood pressure
C) Decreased shortness of breath
D) Increased jugular venous distention
Answer: C) Decreased shortness of breath
Rationale: Furosemide is a loop diuretic used to reduce fluid volume in heart failure. The
desired effect is decreased shortness of breath, decreased edema, and improved
oxygenation as pulmonary congestion resolves. Increased urine output is expected, and
decreased JVD indicates reduced fluid volume.
2. A client with a history of myocardial infarction is prescribed low-dose aspirin
daily. The nurse explains that the purpose of this medication is to:
,A) Relieve chest pain
B) Prevent thrombus formation
C) Lower blood pressure
D) Reduce cholesterol levels
Answer: B) Prevent thrombus formation
Rationale: Low-dose aspirin irreversibly inhibits platelet aggregation, reducing the risk of
thrombus formation and preventing recurrent myocardial infarction or stroke. It is a
cornerstone of secondary prevention in cardiovascular disease. It does not relieve pain,
lower blood pressure, or reduce cholesterol.
3. A nurse is assessing a client who is 6 hours post-cardiac catheterization via the
femoral artery. Which finding requires immediate intervention?
A) Pulse of 88 beats/min
B) Blood pressure of 120/78 mmHg
C) The insertion site is cool and pale
D) The client reports mild discomfort at the site
Answer: C) The insertion site is cool and pale
Rationale: A cool, pale insertion site indicates compromised circulation, which may suggest
a hematoma or thrombus formation. This requires immediate intervention and
notification of the provider. Mild discomfort is expected. Vital signs are within normal
limits.
4. A client with a new diagnosis of atrial fibrillation is prescribed warfarin. Which
statement by the client indicates understanding of the medication teaching?
A) "I will take ibuprofen if I have a headache."
B) "I will have my INR checked regularly."
C) "I can stop the medication if my heart rate is normal."
D) "I will eat more green leafy vegetables."
Answer: B) "I will have my INR checked regularly."
Rationale: Warfarin requires regular INR monitoring to maintain therapeutic levels and
prevent bleeding complications. Clients should avoid NSAIDs like ibuprofen, maintain
,consistent vitamin K intake (not increase or decrease suddenly), and never stop the
medication abruptly.
5. A nurse is caring for a client with a new permanent pacemaker. Which finding
indicates a potential complication?
A) Heart rate of 72 beats/min
B) Incision site is clean and dry
C) The client reports hiccups
D) The client has a palpable pulse
Answer: C) The client reports hiccups
Rationale: Hiccups in a client with a new pacemaker may indicate diaphragmatic
stimulation from the pacemaker lead. This should be reported to the provider. A heart rate
of 72 bpm and a clean, dry incision are expected. A palpable pulse is normal.
6. A client with peripheral artery disease (PAD) is being discharged. Which
instruction should the nurse include in the discharge teaching?
A) "Apply heat to your feet to improve circulation."
B) "Walk until you experience pain, then rest."
C) "Elevate your legs above your heart."
D) "Wear tight, constrictive socks."
Answer: B) "Walk until you experience pain, then rest."
Rationale: Clients with PAD should exercise until pain occurs, then rest until pain resolves,
then repeat. This promotes collateral circulation. Heat should be avoided due to decreased
sensation and risk of burns. Legs should be in a dependent position, not elevated. Tight
socks should be avoided.
7. A nurse is assessing a client with pericarditis. Which finding is most
characteristic of this condition?
, A) Chest pain relieved by leaning forward
B) Chest pain that worsens with inspiration
C) Pericardial friction rub
D) All of the above
Answer: D) All of the above
Rationale: Pericarditis is characterized by chest pain that is relieved by leaning forward
and worsens with inspiration and lying flat. A pericardial friction rub is a hallmark sign.
The pain is often sharp and pleuritic. NSAIDs are the mainstay of treatment.
8. A client is prescribed amiodarone for a cardiac arrhythmia. Which assessment
finding indicates a serious adverse effect of this medication?
A) Constipation
B) Blue-gray skin discoloration
C) Pulmonary crackles
D) Photosensitivity
Answer: C) Pulmonary crackles
Rationale: Amiodarone can cause pulmonary fibrosis, which may present as crackles,
dyspnea, and non-productive cough. This is a serious adverse effect requiring immediate
evaluation. Blue-gray skin discoloration, photosensitivity, and constipation are also side
effects but are not as immediately life-threatening.
9. A nurse is caring for a client with a suspected myocardial infarction. Which
laboratory value is most indicative of cardiac muscle damage?
A) Troponin I
B) CK-MB
C) Myoglobin
D) BNP
Answer: A) Troponin I
Rationale: Troponin I is a highly specific and sensitive marker for cardiac muscle damage.
It remains elevated for 7-10 days after an MI. CK-MB and myoglobin are less specific. BNP
is a marker for heart failure, not MI.
Study Guide and Practice Test 2 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
1. A nurse is caring for a client with acute decompensated heart failure who is
receiving IV furosemide. Which assessment finding indicates the medication is
having the desired therapeutic effect?
A) Decreased urine output
B) Increased blood pressure
C) Decreased shortness of breath
D) Increased jugular venous distention
Answer: C) Decreased shortness of breath
Rationale: Furosemide is a loop diuretic used to reduce fluid volume in heart failure. The
desired effect is decreased shortness of breath, decreased edema, and improved
oxygenation as pulmonary congestion resolves. Increased urine output is expected, and
decreased JVD indicates reduced fluid volume.
2. A client with a history of myocardial infarction is prescribed low-dose aspirin
daily. The nurse explains that the purpose of this medication is to:
,A) Relieve chest pain
B) Prevent thrombus formation
C) Lower blood pressure
D) Reduce cholesterol levels
Answer: B) Prevent thrombus formation
Rationale: Low-dose aspirin irreversibly inhibits platelet aggregation, reducing the risk of
thrombus formation and preventing recurrent myocardial infarction or stroke. It is a
cornerstone of secondary prevention in cardiovascular disease. It does not relieve pain,
lower blood pressure, or reduce cholesterol.
3. A nurse is assessing a client who is 6 hours post-cardiac catheterization via the
femoral artery. Which finding requires immediate intervention?
A) Pulse of 88 beats/min
B) Blood pressure of 120/78 mmHg
C) The insertion site is cool and pale
D) The client reports mild discomfort at the site
Answer: C) The insertion site is cool and pale
Rationale: A cool, pale insertion site indicates compromised circulation, which may suggest
a hematoma or thrombus formation. This requires immediate intervention and
notification of the provider. Mild discomfort is expected. Vital signs are within normal
limits.
4. A client with a new diagnosis of atrial fibrillation is prescribed warfarin. Which
statement by the client indicates understanding of the medication teaching?
A) "I will take ibuprofen if I have a headache."
B) "I will have my INR checked regularly."
C) "I can stop the medication if my heart rate is normal."
D) "I will eat more green leafy vegetables."
Answer: B) "I will have my INR checked regularly."
Rationale: Warfarin requires regular INR monitoring to maintain therapeutic levels and
prevent bleeding complications. Clients should avoid NSAIDs like ibuprofen, maintain
,consistent vitamin K intake (not increase or decrease suddenly), and never stop the
medication abruptly.
5. A nurse is caring for a client with a new permanent pacemaker. Which finding
indicates a potential complication?
A) Heart rate of 72 beats/min
B) Incision site is clean and dry
C) The client reports hiccups
D) The client has a palpable pulse
Answer: C) The client reports hiccups
Rationale: Hiccups in a client with a new pacemaker may indicate diaphragmatic
stimulation from the pacemaker lead. This should be reported to the provider. A heart rate
of 72 bpm and a clean, dry incision are expected. A palpable pulse is normal.
6. A client with peripheral artery disease (PAD) is being discharged. Which
instruction should the nurse include in the discharge teaching?
A) "Apply heat to your feet to improve circulation."
B) "Walk until you experience pain, then rest."
C) "Elevate your legs above your heart."
D) "Wear tight, constrictive socks."
Answer: B) "Walk until you experience pain, then rest."
Rationale: Clients with PAD should exercise until pain occurs, then rest until pain resolves,
then repeat. This promotes collateral circulation. Heat should be avoided due to decreased
sensation and risk of burns. Legs should be in a dependent position, not elevated. Tight
socks should be avoided.
7. A nurse is assessing a client with pericarditis. Which finding is most
characteristic of this condition?
, A) Chest pain relieved by leaning forward
B) Chest pain that worsens with inspiration
C) Pericardial friction rub
D) All of the above
Answer: D) All of the above
Rationale: Pericarditis is characterized by chest pain that is relieved by leaning forward
and worsens with inspiration and lying flat. A pericardial friction rub is a hallmark sign.
The pain is often sharp and pleuritic. NSAIDs are the mainstay of treatment.
8. A client is prescribed amiodarone for a cardiac arrhythmia. Which assessment
finding indicates a serious adverse effect of this medication?
A) Constipation
B) Blue-gray skin discoloration
C) Pulmonary crackles
D) Photosensitivity
Answer: C) Pulmonary crackles
Rationale: Amiodarone can cause pulmonary fibrosis, which may present as crackles,
dyspnea, and non-productive cough. This is a serious adverse effect requiring immediate
evaluation. Blue-gray skin discoloration, photosensitivity, and constipation are also side
effects but are not as immediately life-threatening.
9. A nurse is caring for a client with a suspected myocardial infarction. Which
laboratory value is most indicative of cardiac muscle damage?
A) Troponin I
B) CK-MB
C) Myoglobin
D) BNP
Answer: A) Troponin I
Rationale: Troponin I is a highly specific and sensitive marker for cardiac muscle damage.
It remains elevated for 7-10 days after an MI. CK-MB and myoglobin are less specific. BNP
is a marker for heart failure, not MI.
