This Medical-Surgical Nursing Exam is a comprehensive test preparation resource containing
250 practice questions with detailed rationales. It covers core med- surg topics including:
cardiovascular disorders (heart failure, MI, hypertension), respiratory conditions (COPD,
asthma, pneumonia), endocrine disorders (diabetes, thyroid diseases), renal/urological
conditions (CKD, AKI, UTIs), musculoskeletal disorders (osteoporosis, fractures, gout),
neurological conditions (stroke, seizures), gastrointestinal disorders (GERD, pancreatitis,
cirrhosis), medication management, and nursing interventions. Each question includes the
correct answer and a medium-length rationale explaining the underlying pathophysiology,
nursing considerations, and evidence-based practice. Ideal for NCLEX-RN preparation,
proctored exams, and nursing students seeking to strengthen their clinical judgment and
critical thinking skills in medical-surgical nursing.
1. A nurse is reviewing the cause of gout with a group of nurses. Which of the following
statements should the nurse make?
A. "Uric acid levels drop and calcium forms precipitate."
B. "Tophi form in the kidneys and they impair the excretion of uric acid."
C. "The intra-articular deposition of urate crystals causes inflammation."
D. "Articular cartilage thins, leading to splitting and fragmentation."
Correct Answer: C
Rationale: Gout, or gouty arthritis, develops when urate crystals deposit in joints and tissues
and cause inflammation and pain. The underlying pathophysiology involves hyperuricemia,
which is an elevated serum uric acid level exceeding 6.8 mg/dL. When uric acid reaches
supersaturation levels, monosodium urate crystals precipitate and deposit in synovial fluid,
joint cartilage, and surrounding tissues. This triggers an acute inflammatory response
characterized by the activation of the complement system, phagocytosis by neutrophils, and
the release of pro-inflammatory cytokines such as interleukin-1β. The inflammatory cascade
results in severe pain, redness, swelling, and warmth in the affected joint, most commonly the
1
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great toe (podagra). Clients with gout have hyperuricemia rather than a reduction in uric acid,
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,making option A incorrect. Tophi are deposits of urate crystals that develop in chronic, late-
stage gout in tissues near joints, tendons, and bursae; they are not part of the primary disease
process and do not form in the kidneys to impair uric acid excretion, making option B incorrect.
Gout does not thin and fragment articular cartilage as seen in osteoarthritis, making option D
incorrect. Management of gout includes NSAIDs, colchicine, corticosteroids for acute flares, and
long-term urate-lowering therapy such as allopurinol or febuxostat.
2. A nurse is teaching a group of clients about osteoarthritis. Which of the following
recommendations should the nurse include in the teaching?
A. Use Echinacea to manage joint pain.
B. Apply ice to the joint before exercising.
C. Maintain a recommended body weight.
D. Reduce the amount of purine in the diet.
Correct Answer: C
Rationale: Obesity is a significant risk factor for the development and progression of
osteoarthritis (OA). Excess body weight places increased mechanical stress on weight-bearing
joints, particularly the knees and hips, leading to accelerated cartilage degradation.
Maintenance of an ideal body weight is one of the most effective strategies a client can
implement to prevent added wear and tear on joints and promote overall joint health. Weight
loss of as little as 5-10% of total body weight has been shown to reduce knee joint loads and
improve pain and function in clients with OA. The nurse may include the use of complementary
and alternative therapies in the teaching; however, Echinacea is used for the treatment of the
common cold and upper respiratory infections, not osteoarthritis. Alternative therapies that
have evidence for use in osteoarthritis include glucosamine, chondroitin sulfate, and topical
capsaicin, making option A incorrect. The nurse should recommend that clients begin exercising
immediately following the application of heat, not ice, as heat reduces pain and stiffness,
improves mobility, and allows for increased range-of-motion during exercises. Cold application
may be applied following exercise to decrease discomfort and inflammation, making option B
incorrect. Limiting purine in the diet, which is often found in organ meats, sardines, anchovies,
and shellfish, is recommended for clients who have gout, not osteoarthritis, making option D
incorrect.
3. A nurse is caring for a client who has had a myocardial infarction. Upon his first visit to
cardiac rehabilitation, he tells the nurse that he doesn't understand why he needs to be there
2
because there is nothing more to do, as the damage is done. Which of the following is the
Page
correct nursing response?
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, A. "Cardiac rehabilitation cannot undo the damage to your heart but it can help you get back
to your previous level of activity safely."
B. "It's not unusual to feel that way at first, but once you learn the routine, you'll enjoy it."
C. "Exercise is good for you and good for your heart."
D. "Your doctor is the expert here, and I'm sure he would only recommend what is best for
you."
Correct Answer: A
Rationale: With this response, the nurse uses the therapeutic communication technique of
presenting reality by indicating her perception of the situation for the client. This response
acknowledges the client's feelings while providing accurate information about the purpose and
benefits of cardiac rehabilitation. Cardiac rehabilitation is a comprehensive program that
includes supervised exercise training, cardiac risk factor modification, nutritional counseling,
stress management, and education about heart-healthy living. While it cannot reverse
myocardial damage, it has been shown to reduce mortality, decrease hospital readmissions,
improve functional capacity, and enhance quality of life in clients following a myocardial
infarction. The nurse validates the client's concern while offering hope and direction. Option B
illustrates the nontherapeutic communication technique of giving reassurance, which
discourages the client from further communication and minimizes their feelings. Option C
demonstrates nontherapeutic techniques of disagreeing and giving advice, which can make the
client feel dismissed and defensive. Option D illustrates the nontherapeutic technique of
defending, which places the nurse in a defensive position and does not address the client's
underlying concerns or fears about their condition and recovery.
4. A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The
nurse should identify which of the following medications as the cause of the client's low
potassium level?
A. Furosemide
B. Nitroglycerin
C. Metoprolol
D. Spironolactone
Correct Answer: A
Rationale: Furosemide is a loop (high-ceiling) diuretic that inhibits the reabsorption of sodium
3
and chloride in the ascending loop of Henle, resulting in significant diuresis. This medication
Page
increases the delivery of sodium and water to the distal nephrons, where sodium is exchanged
Page | 3
, for potassium, leading to increased potassium excretion in the urine. Hypokalemia (serum
potassium less than 3.5 mEq/L) is a well-documented adverse effect of furosemide and other
loop diuretics. A potassium level of 2.4 mEq/L represents severe hypokalemia, which places the
client at significant risk for cardiac dysrhythmias, muscle weakness, and respiratory
compromise. The nurse should monitor the client's cardiac rhythm, assess for signs of
hypokalemia such as muscle cramping and fatigue, and report this critical laboratory value to
the provider immediately. The provider may prescribe potassium supplements or consider
adjusting the diuretic regimen. Nitroglycerin is a vasodilator medication used to treat angina
and is not associated with hypokalemia, making option B incorrect. Metoprolol is a beta-blocker
that slows the heart rate and improves contractility of the heart muscle; it is not associated
with potassium abnormalities, making option C incorrect. Spironolactone is a potassium-sparing
diuretic that blocks aldosterone receptors, promoting sodium and water excretion while
conserving potassium; hyperkalemia, not hypokalemia, is an adverse effect of this medication,
making option D incorrect.
5. A nurse is caring for a client who is postoperative following an open reduction internal
fixation (ORIF) of a femur fracture. Which of the following parameters should the nurse include
in the evaluation of the neurovascular status of the client's affected extremity? (Select all that
apply.)
A. Color
B. Temperature
C. Ecchymosis
D. Skin integrity
E. Sensation
Correct Answers: A, B, E
Rationale: Clients who have sustained trauma to an extremity, such as a fracture, are at
increased risk for neurovascular compromise due to swelling, bleeding, and potential damage
to nerves and blood vessels. The nurse should perform a comprehensive neurovascular
assessment of the affected extremity, which includes the "6 Ps": pain, pallor, paresthesia,
paralysis, poikilothermia (temperature changes), and pulselessness. Color (option A) is correct;
the nurse should assess the color of the client's affected extremity and identify pallor or
cyanosis as an indication of peripheral neurovascular dysfunction requiring immediate provider
notification. Temperature (option B) is correct; the nurse should monitor the temperature of
the extremity and identify skin that is cool or cold to the touch as having decreased perfusion to
4
the tissues, which is an indication of peripheral neurovascular dysfunction. Sensation (option E)
Page
is correct; the nurse should assess the client's extremity for numbness or tingling and recognize
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250 practice questions with detailed rationales. It covers core med- surg topics including:
cardiovascular disorders (heart failure, MI, hypertension), respiratory conditions (COPD,
asthma, pneumonia), endocrine disorders (diabetes, thyroid diseases), renal/urological
conditions (CKD, AKI, UTIs), musculoskeletal disorders (osteoporosis, fractures, gout),
neurological conditions (stroke, seizures), gastrointestinal disorders (GERD, pancreatitis,
cirrhosis), medication management, and nursing interventions. Each question includes the
correct answer and a medium-length rationale explaining the underlying pathophysiology,
nursing considerations, and evidence-based practice. Ideal for NCLEX-RN preparation,
proctored exams, and nursing students seeking to strengthen their clinical judgment and
critical thinking skills in medical-surgical nursing.
1. A nurse is reviewing the cause of gout with a group of nurses. Which of the following
statements should the nurse make?
A. "Uric acid levels drop and calcium forms precipitate."
B. "Tophi form in the kidneys and they impair the excretion of uric acid."
C. "The intra-articular deposition of urate crystals causes inflammation."
D. "Articular cartilage thins, leading to splitting and fragmentation."
Correct Answer: C
Rationale: Gout, or gouty arthritis, develops when urate crystals deposit in joints and tissues
and cause inflammation and pain. The underlying pathophysiology involves hyperuricemia,
which is an elevated serum uric acid level exceeding 6.8 mg/dL. When uric acid reaches
supersaturation levels, monosodium urate crystals precipitate and deposit in synovial fluid,
joint cartilage, and surrounding tissues. This triggers an acute inflammatory response
characterized by the activation of the complement system, phagocytosis by neutrophils, and
the release of pro-inflammatory cytokines such as interleukin-1β. The inflammatory cascade
results in severe pain, redness, swelling, and warmth in the affected joint, most commonly the
1
Page
great toe (podagra). Clients with gout have hyperuricemia rather than a reduction in uric acid,
Page | 1
,making option A incorrect. Tophi are deposits of urate crystals that develop in chronic, late-
stage gout in tissues near joints, tendons, and bursae; they are not part of the primary disease
process and do not form in the kidneys to impair uric acid excretion, making option B incorrect.
Gout does not thin and fragment articular cartilage as seen in osteoarthritis, making option D
incorrect. Management of gout includes NSAIDs, colchicine, corticosteroids for acute flares, and
long-term urate-lowering therapy such as allopurinol or febuxostat.
2. A nurse is teaching a group of clients about osteoarthritis. Which of the following
recommendations should the nurse include in the teaching?
A. Use Echinacea to manage joint pain.
B. Apply ice to the joint before exercising.
C. Maintain a recommended body weight.
D. Reduce the amount of purine in the diet.
Correct Answer: C
Rationale: Obesity is a significant risk factor for the development and progression of
osteoarthritis (OA). Excess body weight places increased mechanical stress on weight-bearing
joints, particularly the knees and hips, leading to accelerated cartilage degradation.
Maintenance of an ideal body weight is one of the most effective strategies a client can
implement to prevent added wear and tear on joints and promote overall joint health. Weight
loss of as little as 5-10% of total body weight has been shown to reduce knee joint loads and
improve pain and function in clients with OA. The nurse may include the use of complementary
and alternative therapies in the teaching; however, Echinacea is used for the treatment of the
common cold and upper respiratory infections, not osteoarthritis. Alternative therapies that
have evidence for use in osteoarthritis include glucosamine, chondroitin sulfate, and topical
capsaicin, making option A incorrect. The nurse should recommend that clients begin exercising
immediately following the application of heat, not ice, as heat reduces pain and stiffness,
improves mobility, and allows for increased range-of-motion during exercises. Cold application
may be applied following exercise to decrease discomfort and inflammation, making option B
incorrect. Limiting purine in the diet, which is often found in organ meats, sardines, anchovies,
and shellfish, is recommended for clients who have gout, not osteoarthritis, making option D
incorrect.
3. A nurse is caring for a client who has had a myocardial infarction. Upon his first visit to
cardiac rehabilitation, he tells the nurse that he doesn't understand why he needs to be there
2
because there is nothing more to do, as the damage is done. Which of the following is the
Page
correct nursing response?
Page | 2
, A. "Cardiac rehabilitation cannot undo the damage to your heart but it can help you get back
to your previous level of activity safely."
B. "It's not unusual to feel that way at first, but once you learn the routine, you'll enjoy it."
C. "Exercise is good for you and good for your heart."
D. "Your doctor is the expert here, and I'm sure he would only recommend what is best for
you."
Correct Answer: A
Rationale: With this response, the nurse uses the therapeutic communication technique of
presenting reality by indicating her perception of the situation for the client. This response
acknowledges the client's feelings while providing accurate information about the purpose and
benefits of cardiac rehabilitation. Cardiac rehabilitation is a comprehensive program that
includes supervised exercise training, cardiac risk factor modification, nutritional counseling,
stress management, and education about heart-healthy living. While it cannot reverse
myocardial damage, it has been shown to reduce mortality, decrease hospital readmissions,
improve functional capacity, and enhance quality of life in clients following a myocardial
infarction. The nurse validates the client's concern while offering hope and direction. Option B
illustrates the nontherapeutic communication technique of giving reassurance, which
discourages the client from further communication and minimizes their feelings. Option C
demonstrates nontherapeutic techniques of disagreeing and giving advice, which can make the
client feel dismissed and defensive. Option D illustrates the nontherapeutic technique of
defending, which places the nurse in a defensive position and does not address the client's
underlying concerns or fears about their condition and recovery.
4. A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The
nurse should identify which of the following medications as the cause of the client's low
potassium level?
A. Furosemide
B. Nitroglycerin
C. Metoprolol
D. Spironolactone
Correct Answer: A
Rationale: Furosemide is a loop (high-ceiling) diuretic that inhibits the reabsorption of sodium
3
and chloride in the ascending loop of Henle, resulting in significant diuresis. This medication
Page
increases the delivery of sodium and water to the distal nephrons, where sodium is exchanged
Page | 3
, for potassium, leading to increased potassium excretion in the urine. Hypokalemia (serum
potassium less than 3.5 mEq/L) is a well-documented adverse effect of furosemide and other
loop diuretics. A potassium level of 2.4 mEq/L represents severe hypokalemia, which places the
client at significant risk for cardiac dysrhythmias, muscle weakness, and respiratory
compromise. The nurse should monitor the client's cardiac rhythm, assess for signs of
hypokalemia such as muscle cramping and fatigue, and report this critical laboratory value to
the provider immediately. The provider may prescribe potassium supplements or consider
adjusting the diuretic regimen. Nitroglycerin is a vasodilator medication used to treat angina
and is not associated with hypokalemia, making option B incorrect. Metoprolol is a beta-blocker
that slows the heart rate and improves contractility of the heart muscle; it is not associated
with potassium abnormalities, making option C incorrect. Spironolactone is a potassium-sparing
diuretic that blocks aldosterone receptors, promoting sodium and water excretion while
conserving potassium; hyperkalemia, not hypokalemia, is an adverse effect of this medication,
making option D incorrect.
5. A nurse is caring for a client who is postoperative following an open reduction internal
fixation (ORIF) of a femur fracture. Which of the following parameters should the nurse include
in the evaluation of the neurovascular status of the client's affected extremity? (Select all that
apply.)
A. Color
B. Temperature
C. Ecchymosis
D. Skin integrity
E. Sensation
Correct Answers: A, B, E
Rationale: Clients who have sustained trauma to an extremity, such as a fracture, are at
increased risk for neurovascular compromise due to swelling, bleeding, and potential damage
to nerves and blood vessels. The nurse should perform a comprehensive neurovascular
assessment of the affected extremity, which includes the "6 Ps": pain, pallor, paresthesia,
paralysis, poikilothermia (temperature changes), and pulselessness. Color (option A) is correct;
the nurse should assess the color of the client's affected extremity and identify pallor or
cyanosis as an indication of peripheral neurovascular dysfunction requiring immediate provider
notification. Temperature (option B) is correct; the nurse should monitor the temperature of
the extremity and identify skin that is cool or cold to the touch as having decreased perfusion to
4
the tissues, which is an indication of peripheral neurovascular dysfunction. Sensation (option E)
Page
is correct; the nurse should assess the client's extremity for numbness or tingling and recognize
Page | 4
