Med-Surg Nursing Exam Pack – Complete
Exam 11 with Verified Answers (2026 Edition)
Question 1: A client is admitted with acute decompensated heart failure. Which assessment finding is
most concerning?
A) Weight gain of 2 lbs in 24 hours
B) Crackles auscultated in the lung bases
C) Orthopnea and paroxysmal nocturnal dyspnea
D) Pink, frothy sputum
Answer: D) Pink, frothy sputum
Rationale: Pink, frothy sputum indicates pulmonary edema, a life-threatening complication of acute
heart failure. This finding requires immediate intervention, including high-flow oxygen, diuretics, and
positioning. While weight gain, crackles, and orthopnea are signs of heart failure exacerbation, pink
frothy sputum indicates severe fluid accumulation in the alveoli and impending respiratory failure.
Question 2: A client with community-acquired pneumonia is prescribed azithromycin. Which finding
indicates the medication is effective?
A) Decreased fever and improved breath sounds
B) Increased white blood cell count
C) Persistent productive cough
D) Oxygen saturation of 90%
Answer: A) Decreased fever and improved breath sounds
Rationale: Azithromycin is a macrolide antibiotic effective against typical and atypical respiratory
pathogens. Effectiveness is demonstrated by resolution of fever, improved breath sounds, decreased
sputum production, and improved oxygen saturation. An elevated WBC count indicates ongoing
infection, while a persistent cough may take weeks to resolve. Oxygen saturation below 92% indicates
persistent hypoxemia.
Question 3: A client with chronic obstructive pulmonary disease (COPD) is being discharged. Which
instruction should the nurse prioritize?
A) "Use your rescue inhaler daily even if you feel well."
B) "Avoid all physical activity to conserve energy."
C) "Report any increase in sputum production or change in color."
D) "Limit your fluid intake to 1 liter per day."
,Answer: C) "Report any increase in sputum production or change in color."
Rationale: Increased sputum production or change in color (yellow, green, or blood-tinged) indicates an
exacerbation or infection, requiring prompt medical attention. Rescue inhalers should be used as needed,
not daily prophylactically. Physical activity should be encouraged within tolerance to maintain muscle
strength. Fluid intake should be adequate (2-3 L/day) unless contraindicated by heart failure.
Question 4: A nurse is caring for a client with a pulmonary embolism (PE). Which finding indicates the
client is experiencing a complication?
A) Chest pain that is relieved by rest
B) Respiratory rate of 18 breaths per minute
C) Sudden onset of hemoptysis
D) Heart rate of 80 beats per minute
Answer: C) Sudden onset of hemoptysis
Rationale: Hemoptysis (coughing up blood) indicates pulmonary infarction or severe PE and requires
immediate intervention. Chest pain that is relieved by rest is not typical of PE. A respiratory rate of 18
and heart rate of 80 are within normal limits and would not indicate a complication in a PE client.
Question 5: A client with asthma is prescribed a long-acting beta-agonist (LABA) and an inhaled
corticosteroid (ICS). Which instruction should the nurse include?
A) "Use the LABA inhaler for acute asthma attacks."
B) "Use the ICS inhaler as needed for symptom relief."
C) "Use the LABA inhaler first, then the ICS inhaler."
D) "Use the ICS inhaler daily for maintenance therapy."
Answer: D) "Use the ICS inhaler daily for maintenance therapy."
Rationale: Inhaled corticosteroids (ICS) are the cornerstone of asthma maintenance therapy and should
be used daily to reduce airway inflammation. LABAs should never be used alone for asthma due to the
risk of asthma-related death; they should be used in combination with ICS. LABAs are not for acute
symptom relief. The ICS should be used first, followed by the LABA, or as a combination inhaler.
Question 6: A client with acute respiratory distress syndrome (ARDS) is on a mechanical ventilator.
Which finding indicates the client is developing a complication?
A) Plateau pressure of 25 cm H₂O
B) PaO₂/FiO₂ ratio of 250
C) Peak inspiratory pressure of 40 cm H₂O
D) Tidal volume of 6 mL/kg ideal body weight
Answer: C) Peak inspiratory pressure of 40 cm H₂O
, Rationale: High peak inspiratory pressures (>35 cm H₂O) indicate increased airway resistance or
decreased lung compliance, which can lead to barotrauma and volutrauma. Plateau pressure should be
<30 cm H₂O to prevent ventilator-induced lung injury. A PaO₂/FiO₂ ratio <300 indicates impaired
oxygenation, but 250 is expected in ARDS. A tidal volume of 6 mL/kg is appropriate lung-protective
ventilation.
Question 7: A nurse is assessing a client with a chest tube connected to a closed drainage system. The
nurse notes continuous bubbling in the water seal chamber. Which action should the nurse take?
A) Clamp the chest tube immediately
B) Notify the healthcare provider
C) Check for air leaks at the connection sites
D) Increase the suction pressure
Answer: C) Check for air leaks at the connection sites
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. The nurse should first
check all connections and the insertion site for air leaks. Clamping the chest tube is not recommended as
it can cause tension pneumothorax. The healthcare provider should be notified if the air leak persists, but
the first step is assessment. Suction pressure should not be increased without an order.
Question 8: A client with tuberculosis (TB) is prescribed a four-drug regimen. Which finding indicates the
client is adhering to the treatment regimen?
A) Conversion of sputum cultures to negative
B) Resolution of all symptoms within 2 weeks
C) Completion of the prescribed medication course
D) Negative purified protein derivative (PPD) test
Answer: A) Conversion of sputum cultures to negative
Rationale: Conversion of sputum cultures to negative is the most reliable indicator of effective TB
treatment and adherence. Symptoms may take weeks to resolve, and the full course of treatment (6-12
months) must be completed. A negative PPD indicates no infection, not effectiveness of treatment.
Question 9: A client with heart failure is prescribed digoxin. The client's potassium level is 3.2 mEq/L.
Which action should the nurse take?
A) Administer the digoxin as prescribed
B) Hold the digoxin and notify the healthcare provider
C) Administer potassium supplement with the digoxin
D) Monitor the client for signs of digoxin toxicity
Answer: B) Hold the digoxin and notify the healthcare provider
Exam 11 with Verified Answers (2026 Edition)
Question 1: A client is admitted with acute decompensated heart failure. Which assessment finding is
most concerning?
A) Weight gain of 2 lbs in 24 hours
B) Crackles auscultated in the lung bases
C) Orthopnea and paroxysmal nocturnal dyspnea
D) Pink, frothy sputum
Answer: D) Pink, frothy sputum
Rationale: Pink, frothy sputum indicates pulmonary edema, a life-threatening complication of acute
heart failure. This finding requires immediate intervention, including high-flow oxygen, diuretics, and
positioning. While weight gain, crackles, and orthopnea are signs of heart failure exacerbation, pink
frothy sputum indicates severe fluid accumulation in the alveoli and impending respiratory failure.
Question 2: A client with community-acquired pneumonia is prescribed azithromycin. Which finding
indicates the medication is effective?
A) Decreased fever and improved breath sounds
B) Increased white blood cell count
C) Persistent productive cough
D) Oxygen saturation of 90%
Answer: A) Decreased fever and improved breath sounds
Rationale: Azithromycin is a macrolide antibiotic effective against typical and atypical respiratory
pathogens. Effectiveness is demonstrated by resolution of fever, improved breath sounds, decreased
sputum production, and improved oxygen saturation. An elevated WBC count indicates ongoing
infection, while a persistent cough may take weeks to resolve. Oxygen saturation below 92% indicates
persistent hypoxemia.
Question 3: A client with chronic obstructive pulmonary disease (COPD) is being discharged. Which
instruction should the nurse prioritize?
A) "Use your rescue inhaler daily even if you feel well."
B) "Avoid all physical activity to conserve energy."
C) "Report any increase in sputum production or change in color."
D) "Limit your fluid intake to 1 liter per day."
,Answer: C) "Report any increase in sputum production or change in color."
Rationale: Increased sputum production or change in color (yellow, green, or blood-tinged) indicates an
exacerbation or infection, requiring prompt medical attention. Rescue inhalers should be used as needed,
not daily prophylactically. Physical activity should be encouraged within tolerance to maintain muscle
strength. Fluid intake should be adequate (2-3 L/day) unless contraindicated by heart failure.
Question 4: A nurse is caring for a client with a pulmonary embolism (PE). Which finding indicates the
client is experiencing a complication?
A) Chest pain that is relieved by rest
B) Respiratory rate of 18 breaths per minute
C) Sudden onset of hemoptysis
D) Heart rate of 80 beats per minute
Answer: C) Sudden onset of hemoptysis
Rationale: Hemoptysis (coughing up blood) indicates pulmonary infarction or severe PE and requires
immediate intervention. Chest pain that is relieved by rest is not typical of PE. A respiratory rate of 18
and heart rate of 80 are within normal limits and would not indicate a complication in a PE client.
Question 5: A client with asthma is prescribed a long-acting beta-agonist (LABA) and an inhaled
corticosteroid (ICS). Which instruction should the nurse include?
A) "Use the LABA inhaler for acute asthma attacks."
B) "Use the ICS inhaler as needed for symptom relief."
C) "Use the LABA inhaler first, then the ICS inhaler."
D) "Use the ICS inhaler daily for maintenance therapy."
Answer: D) "Use the ICS inhaler daily for maintenance therapy."
Rationale: Inhaled corticosteroids (ICS) are the cornerstone of asthma maintenance therapy and should
be used daily to reduce airway inflammation. LABAs should never be used alone for asthma due to the
risk of asthma-related death; they should be used in combination with ICS. LABAs are not for acute
symptom relief. The ICS should be used first, followed by the LABA, or as a combination inhaler.
Question 6: A client with acute respiratory distress syndrome (ARDS) is on a mechanical ventilator.
Which finding indicates the client is developing a complication?
A) Plateau pressure of 25 cm H₂O
B) PaO₂/FiO₂ ratio of 250
C) Peak inspiratory pressure of 40 cm H₂O
D) Tidal volume of 6 mL/kg ideal body weight
Answer: C) Peak inspiratory pressure of 40 cm H₂O
, Rationale: High peak inspiratory pressures (>35 cm H₂O) indicate increased airway resistance or
decreased lung compliance, which can lead to barotrauma and volutrauma. Plateau pressure should be
<30 cm H₂O to prevent ventilator-induced lung injury. A PaO₂/FiO₂ ratio <300 indicates impaired
oxygenation, but 250 is expected in ARDS. A tidal volume of 6 mL/kg is appropriate lung-protective
ventilation.
Question 7: A nurse is assessing a client with a chest tube connected to a closed drainage system. The
nurse notes continuous bubbling in the water seal chamber. Which action should the nurse take?
A) Clamp the chest tube immediately
B) Notify the healthcare provider
C) Check for air leaks at the connection sites
D) Increase the suction pressure
Answer: C) Check for air leaks at the connection sites
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. The nurse should first
check all connections and the insertion site for air leaks. Clamping the chest tube is not recommended as
it can cause tension pneumothorax. The healthcare provider should be notified if the air leak persists, but
the first step is assessment. Suction pressure should not be increased without an order.
Question 8: A client with tuberculosis (TB) is prescribed a four-drug regimen. Which finding indicates the
client is adhering to the treatment regimen?
A) Conversion of sputum cultures to negative
B) Resolution of all symptoms within 2 weeks
C) Completion of the prescribed medication course
D) Negative purified protein derivative (PPD) test
Answer: A) Conversion of sputum cultures to negative
Rationale: Conversion of sputum cultures to negative is the most reliable indicator of effective TB
treatment and adherence. Symptoms may take weeks to resolve, and the full course of treatment (6-12
months) must be completed. A negative PPD indicates no infection, not effectiveness of treatment.
Question 9: A client with heart failure is prescribed digoxin. The client's potassium level is 3.2 mEq/L.
Which action should the nurse take?
A) Administer the digoxin as prescribed
B) Hold the digoxin and notify the healthcare provider
C) Administer potassium supplement with the digoxin
D) Monitor the client for signs of digoxin toxicity
Answer: B) Hold the digoxin and notify the healthcare provider
