RN VATI ADULT MEDICAL SURGICAL ASSESSMENT EXAM – QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST
EXAM UPDATE
Core Domains
1. Cardiovascular and Hematologic Disorders
2. Respiratory Disorders
3. Gastrointestinal and Nutritional Disorders
4. Renal and Genitourinary Disorders
5. Neurological and Sensory Disorders
6. Musculoskeletal and Integumentary Disorders
7. Endocrine and Metabolic Disorders
8. Immunologic and Infectious Disorders
9. Perioperative and Critical Care Nursing
10. Leadership, Ethics, and Legal Standards of Care
Introduction
This comprehensive assessment is meticulously designed to evaluate the advanced knowledge, clinical
judgment, and critical thinking skills essential for the proficient practice of adult medical-surgical
nursing. The examination covers a wide spectrum of core domains, integrating foundational
pathophysiological concepts with applied therapeutic interventions and complex patient management
scenarios. The following questions are structured to mirror the cognitive rigor of the licensure
examination, challenging the test-taker to synthesize information, prioritize care, and make sound
clinical decisions in a variety of healthcare settings. Emphasis is placed on real-world application,
regulatory compliance, ethical considerations, and the delivery of safe, patient-centered care. This test
bank serves as a definitive resource for exam preparation and professional development.
SECTION ONE: QUESTIONS 1 – 100
1. A nurse is caring for a client with a new diagnosis of heart failure who has been prescribed
furosemide. Which of the following assessment findings indicates the medication is having the
desired therapeutic effect?
A. Increased jugular venous distention
B. Decreased pedal edema
C. Increased serum potassium level
D. Decreased urinary output
🟢B
🔴 Explanation: Furosemide is a loop diuretic that promotes fluid excretion. A decrease in pedal
edema indicates a reduction in fluid volume overload, which is the desired therapeutic effect of the
medication for heart failure.
,2. A nurse is preparing to administer a blood transfusion to a client. Which of the following
actions is most important to prevent a transfusion reaction?
A. Verify the client's identity and blood compatibility with another licensed nurse.
B. Pre-medicate the client with an antihistamine.
C. Infuse the blood product over a period of 4 hours.
D. Check the client's vital signs every 15 minutes during the first hour.
🟢A
🔴 Explanation: The most critical action to prevent a transfusion reaction is to verify the client's
identity and the compatibility of the blood product with another licensed nurse, per the two-nurse
verification process. This ensures the correct blood is given to the correct patient.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via
nasal cannula. The nurse assesses the client and notes a respiratory rate of 8 breaths per minute
and lethargy. Which of the following actions should the nurse take first?
A. Increase the oxygen flow rate to 4 L/min.
B. Prepare for intubation.
C. Place the client in a high-Fowler's position.
D. Decrease the oxygen flow rate.
🟢D
🔴 Explanation: Clients with severe COPD may have a hypoxic drive to breathe. Administering high
concentrations of oxygen can eliminate this drive, leading to respiratory depression and apnea. The
nurse should first decrease the oxygen flow rate to maintain a target oxygen saturation of 88-92%.
4. A nurse is providing teaching to a client who is post-operative following a total hip
arthroplasty. Which of the following instructions is most important to prevent dislocation of the
new joint?
A. Avoid crossing your legs at the ankles or knees.
B. Use a raised toilet seat.
C. Sleep with a pillow between your legs.
D. Perform ankle pumps and foot exercises every hour.
🟢A
🔴 Explanation: Preventing adduction and internal rotation of the hip is paramount. The instruction
to avoid crossing the legs is the most critical to prevent dislocation, as it prevents the new hip joint
from moving into a vulnerable position.
5. A client is prescribed warfarin for the prevention of a stroke. The nurse should plan to monitor
which of the following laboratory values to evaluate the therapeutic effect of the medication?
A. Platelet count
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Bleeding time
🟢C
, 🔴 Explanation: Warfarin therapy is monitored and adjusted based on the INR, which reflects the
client's prothrombin time standardized to ensure therapeutic anticoagulation for stroke prevention.
6. A nurse is caring for a client with a chest tube attached to a closed-chest drainage system.
Which of the following findings requires immediate intervention by the nurse?
A. Continuous bubbling in the water seal chamber.
B. Tidaling in the water seal chamber.
C. Gentle bubbling in the suction control chamber.
D. A small amount of serosanguinous drainage in the collection chamber.
🟢A
🔴 Explanation: Continuous bubbling in the water seal chamber indicates an air leak in the system,
which could be due to a leak in the tubing or at the insertion site. This is an abnormal finding
requiring immediate assessment and intervention.
7. A client with a diagnosis of diabetes mellitus type 1 is experiencing nausea and vomiting and
is unable to tolerate oral intake. The client's blood glucose is 210 mg/dL. The nurse should
anticipate a prescription for which of the following?
A. Regular insulin via intravenous (IV) infusion.
B. NPH insulin subcutaneously.
C. An IV bolus of 50% dextrose.
D. An oral hypoglycemic agent.
🟢A
🔴 Explanation: A client who is sick and unable to eat still requires insulin to prevent diabetic
ketoacidosis. Regular insulin IV infusion is used for rapid glycemic control in acute situations like
illness where the client is not tolerating oral intake.
8. A nurse is assessing a client's risk for falls. Which of the following is a significant intrinsic
factor increasing this risk?
A. Cluttered environment in the client's room.
B. Use of a new cane for ambulation.
C. Orthostatic hypotension.
D. Lack of grab bars in the bathroom.
🟢C
🔴 Explanation: Orthostatic hypotension is an intrinsic factor (related to the client's internal state)
that can cause dizziness and syncope, significantly increasing the risk of falls. Environmental factors
like cluttered rooms or lack of grab bars are extrinsic.
9. A client is receiving a continuous enteral feeding via a nasogastric tube. The nurse should
place the client in which of the following positions to minimize the risk of aspiration?
A. Supine
B. High-Fowler's
C. Left lateral
D. Trendelenburg
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST
EXAM UPDATE
Core Domains
1. Cardiovascular and Hematologic Disorders
2. Respiratory Disorders
3. Gastrointestinal and Nutritional Disorders
4. Renal and Genitourinary Disorders
5. Neurological and Sensory Disorders
6. Musculoskeletal and Integumentary Disorders
7. Endocrine and Metabolic Disorders
8. Immunologic and Infectious Disorders
9. Perioperative and Critical Care Nursing
10. Leadership, Ethics, and Legal Standards of Care
Introduction
This comprehensive assessment is meticulously designed to evaluate the advanced knowledge, clinical
judgment, and critical thinking skills essential for the proficient practice of adult medical-surgical
nursing. The examination covers a wide spectrum of core domains, integrating foundational
pathophysiological concepts with applied therapeutic interventions and complex patient management
scenarios. The following questions are structured to mirror the cognitive rigor of the licensure
examination, challenging the test-taker to synthesize information, prioritize care, and make sound
clinical decisions in a variety of healthcare settings. Emphasis is placed on real-world application,
regulatory compliance, ethical considerations, and the delivery of safe, patient-centered care. This test
bank serves as a definitive resource for exam preparation and professional development.
SECTION ONE: QUESTIONS 1 – 100
1. A nurse is caring for a client with a new diagnosis of heart failure who has been prescribed
furosemide. Which of the following assessment findings indicates the medication is having the
desired therapeutic effect?
A. Increased jugular venous distention
B. Decreased pedal edema
C. Increased serum potassium level
D. Decreased urinary output
🟢B
🔴 Explanation: Furosemide is a loop diuretic that promotes fluid excretion. A decrease in pedal
edema indicates a reduction in fluid volume overload, which is the desired therapeutic effect of the
medication for heart failure.
,2. A nurse is preparing to administer a blood transfusion to a client. Which of the following
actions is most important to prevent a transfusion reaction?
A. Verify the client's identity and blood compatibility with another licensed nurse.
B. Pre-medicate the client with an antihistamine.
C. Infuse the blood product over a period of 4 hours.
D. Check the client's vital signs every 15 minutes during the first hour.
🟢A
🔴 Explanation: The most critical action to prevent a transfusion reaction is to verify the client's
identity and the compatibility of the blood product with another licensed nurse, per the two-nurse
verification process. This ensures the correct blood is given to the correct patient.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via
nasal cannula. The nurse assesses the client and notes a respiratory rate of 8 breaths per minute
and lethargy. Which of the following actions should the nurse take first?
A. Increase the oxygen flow rate to 4 L/min.
B. Prepare for intubation.
C. Place the client in a high-Fowler's position.
D. Decrease the oxygen flow rate.
🟢D
🔴 Explanation: Clients with severe COPD may have a hypoxic drive to breathe. Administering high
concentrations of oxygen can eliminate this drive, leading to respiratory depression and apnea. The
nurse should first decrease the oxygen flow rate to maintain a target oxygen saturation of 88-92%.
4. A nurse is providing teaching to a client who is post-operative following a total hip
arthroplasty. Which of the following instructions is most important to prevent dislocation of the
new joint?
A. Avoid crossing your legs at the ankles or knees.
B. Use a raised toilet seat.
C. Sleep with a pillow between your legs.
D. Perform ankle pumps and foot exercises every hour.
🟢A
🔴 Explanation: Preventing adduction and internal rotation of the hip is paramount. The instruction
to avoid crossing the legs is the most critical to prevent dislocation, as it prevents the new hip joint
from moving into a vulnerable position.
5. A client is prescribed warfarin for the prevention of a stroke. The nurse should plan to monitor
which of the following laboratory values to evaluate the therapeutic effect of the medication?
A. Platelet count
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Bleeding time
🟢C
, 🔴 Explanation: Warfarin therapy is monitored and adjusted based on the INR, which reflects the
client's prothrombin time standardized to ensure therapeutic anticoagulation for stroke prevention.
6. A nurse is caring for a client with a chest tube attached to a closed-chest drainage system.
Which of the following findings requires immediate intervention by the nurse?
A. Continuous bubbling in the water seal chamber.
B. Tidaling in the water seal chamber.
C. Gentle bubbling in the suction control chamber.
D. A small amount of serosanguinous drainage in the collection chamber.
🟢A
🔴 Explanation: Continuous bubbling in the water seal chamber indicates an air leak in the system,
which could be due to a leak in the tubing or at the insertion site. This is an abnormal finding
requiring immediate assessment and intervention.
7. A client with a diagnosis of diabetes mellitus type 1 is experiencing nausea and vomiting and
is unable to tolerate oral intake. The client's blood glucose is 210 mg/dL. The nurse should
anticipate a prescription for which of the following?
A. Regular insulin via intravenous (IV) infusion.
B. NPH insulin subcutaneously.
C. An IV bolus of 50% dextrose.
D. An oral hypoglycemic agent.
🟢A
🔴 Explanation: A client who is sick and unable to eat still requires insulin to prevent diabetic
ketoacidosis. Regular insulin IV infusion is used for rapid glycemic control in acute situations like
illness where the client is not tolerating oral intake.
8. A nurse is assessing a client's risk for falls. Which of the following is a significant intrinsic
factor increasing this risk?
A. Cluttered environment in the client's room.
B. Use of a new cane for ambulation.
C. Orthostatic hypotension.
D. Lack of grab bars in the bathroom.
🟢C
🔴 Explanation: Orthostatic hypotension is an intrinsic factor (related to the client's internal state)
that can cause dizziness and syncope, significantly increasing the risk of falls. Environmental factors
like cluttered rooms or lack of grab bars are extrinsic.
9. A client is receiving a continuous enteral feeding via a nasogastric tube. The nurse should
place the client in which of the following positions to minimize the risk of aspiration?
A. Supine
B. High-Fowler's
C. Left lateral
D. Trendelenburg
