MED-SURG I FINAL EXAM ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A client with pneumonia is increasingly short of breath and has an SpO₂ of
88% on 2 L/min nasal cannula. What is the nurse’s priority action?
A. Increase oxygen to 4 L/min
B. Call the provider
C. Encourage deep breathing and coughing
D. Position the client in high Fowler’s
Correct answer: D
Rationale: Improving ventilation takes priority. Positioning maximizes lung
expansion before increasing oxygen or calling the provider.
2. A postoperative client reports sudden chest pain and dyspnea. The nurse
notes tachycardia and anxiety. What condition does the nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Pleural effusion
Correct answer: B
Rationale: Sudden chest pain, dyspnea, tachycardia, and anxiety strongly indicate
pulmonary embolism.
,3. A client with heart failure on furosemide has a potassium level of 2.9
mEq/L. Which finding requires immediate intervention?
A. Muscle weakness
B. Flat T waves
C. Irregular pulse
D. Leg cramps
Correct answer: C
Rationale: Hypokalemia can cause dangerous dysrhythmias; irregular pulse
suggests cardiac instability.
4. A client with COPD receives teaching about home oxygen therapy. Which
statement shows understanding?
A. “I will increase my oxygen if I feel short of breath.”
B. “I can stop smoking as long as I’m not near oxygen equipment.”
C. “I will use water-based lubricants around my nostrils.”
D. “I’ll clean the nasal cannula with alcohol daily.”
Correct answer: C
Rationale: Water-based lubricants are safe; petroleum products are flammable.
5. A client with DKA is receiving IV insulin. What lab value requires the
nurse to stop the insulin infusion?
A. Blood glucose 250 mg/dL
B. Potassium 3.4 mEq/L
C. Potassium 2.9 mEq/L
D. Blood pH 7.28
Correct answer: C
Rationale: Insulin shifts potassium into cells, worsening hypokalemia. Stop
insulin and correct potassium <3.3.
,6. A client with pancreatitis has severe epigastric pain radiating to the back.
Which lab finding confirms the diagnosis?
A. Elevated AST/ALT
B. Low albumin
C. Elevated amylase and lipase
D. Increased bilirubin
Correct answer: C
Rationale: Amylase and lipase rise early and are the most reliable pancreatitis
markers.
7. A client with a new colostomy reports gas and abdominal cramping. What
should the nurse recommend?
A. Increase carbonated drinks
B. Eat foods like cabbage and beans
C. Chew food slowly and avoid swallowing air
D. Skip meals to reduce gas
Correct answer: C
Rationale: Slow eating reduces swallowed air and gas production.
8. A client receiving IV vancomycin reports flushing and itching of the
face/neck during infusion. What should the nurse do first?
A. Stop the infusion
B. Increase the infusion rate
C. Administer epinephrine
D. Call the provider
Correct answer: A
Rationale: These are signs of Red Man Syndrome, related to rapid infusion. Stop
infusion first.
, 9. A client with cirrhosis has ascites. Which assessment finding indicates
worsening condition?
A. Weight gain
B. Abdominal distention
C. Decreased urine output
D. Crackles in the lungs
Correct answer: D
Rationale: Crackles indicate fluid overload and possible pulmonary edema—more
severe than increasing ascites.
10. A client with hypertension is prescribed lisinopril. Which finding requires
immediate follow-up?
A. Persistent dry cough
B. Serum potassium 5.8 mEq/L
C. Blood pressure 118/76
D. Mild dizziness
Correct answer: B
Rationale: ACE inhibitors can cause dangerous hyperkalemia.
11. A diabetic client becomes confused and diaphoretic. What is the nurse’s
first priority?
A. Administer glucagon IM
B. Check blood glucose
C. Call a rapid response
D. Give juice
Correct answer: B
Rationale: Always check glucose before administering treatment unless the client
is unconscious.
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A client with pneumonia is increasingly short of breath and has an SpO₂ of
88% on 2 L/min nasal cannula. What is the nurse’s priority action?
A. Increase oxygen to 4 L/min
B. Call the provider
C. Encourage deep breathing and coughing
D. Position the client in high Fowler’s
Correct answer: D
Rationale: Improving ventilation takes priority. Positioning maximizes lung
expansion before increasing oxygen or calling the provider.
2. A postoperative client reports sudden chest pain and dyspnea. The nurse
notes tachycardia and anxiety. What condition does the nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Pleural effusion
Correct answer: B
Rationale: Sudden chest pain, dyspnea, tachycardia, and anxiety strongly indicate
pulmonary embolism.
,3. A client with heart failure on furosemide has a potassium level of 2.9
mEq/L. Which finding requires immediate intervention?
A. Muscle weakness
B. Flat T waves
C. Irregular pulse
D. Leg cramps
Correct answer: C
Rationale: Hypokalemia can cause dangerous dysrhythmias; irregular pulse
suggests cardiac instability.
4. A client with COPD receives teaching about home oxygen therapy. Which
statement shows understanding?
A. “I will increase my oxygen if I feel short of breath.”
B. “I can stop smoking as long as I’m not near oxygen equipment.”
C. “I will use water-based lubricants around my nostrils.”
D. “I’ll clean the nasal cannula with alcohol daily.”
Correct answer: C
Rationale: Water-based lubricants are safe; petroleum products are flammable.
5. A client with DKA is receiving IV insulin. What lab value requires the
nurse to stop the insulin infusion?
A. Blood glucose 250 mg/dL
B. Potassium 3.4 mEq/L
C. Potassium 2.9 mEq/L
D. Blood pH 7.28
Correct answer: C
Rationale: Insulin shifts potassium into cells, worsening hypokalemia. Stop
insulin and correct potassium <3.3.
,6. A client with pancreatitis has severe epigastric pain radiating to the back.
Which lab finding confirms the diagnosis?
A. Elevated AST/ALT
B. Low albumin
C. Elevated amylase and lipase
D. Increased bilirubin
Correct answer: C
Rationale: Amylase and lipase rise early and are the most reliable pancreatitis
markers.
7. A client with a new colostomy reports gas and abdominal cramping. What
should the nurse recommend?
A. Increase carbonated drinks
B. Eat foods like cabbage and beans
C. Chew food slowly and avoid swallowing air
D. Skip meals to reduce gas
Correct answer: C
Rationale: Slow eating reduces swallowed air and gas production.
8. A client receiving IV vancomycin reports flushing and itching of the
face/neck during infusion. What should the nurse do first?
A. Stop the infusion
B. Increase the infusion rate
C. Administer epinephrine
D. Call the provider
Correct answer: A
Rationale: These are signs of Red Man Syndrome, related to rapid infusion. Stop
infusion first.
, 9. A client with cirrhosis has ascites. Which assessment finding indicates
worsening condition?
A. Weight gain
B. Abdominal distention
C. Decreased urine output
D. Crackles in the lungs
Correct answer: D
Rationale: Crackles indicate fluid overload and possible pulmonary edema—more
severe than increasing ascites.
10. A client with hypertension is prescribed lisinopril. Which finding requires
immediate follow-up?
A. Persistent dry cough
B. Serum potassium 5.8 mEq/L
C. Blood pressure 118/76
D. Mild dizziness
Correct answer: B
Rationale: ACE inhibitors can cause dangerous hyperkalemia.
11. A diabetic client becomes confused and diaphoretic. What is the nurse’s
first priority?
A. Administer glucagon IM
B. Check blood glucose
C. Call a rapid response
D. Give juice
Correct answer: B
Rationale: Always check glucose before administering treatment unless the client
is unconscious.
