MEDICAL-SURGICAL RN A PROPHECY RELIAS 2026
Question 1: A nurse is caring for a client who is 24 hours postoperative following a total hip arthroplasty.
Which of the following findings should the nurse report to the provider?
A. Blood pressure 110/70 mm Hg
B. Heart rate 88/min
C. Shortness of breath and chest pain
D. Urine output 40 mL/hr
ANSWER: C
Rationale A: A blood pressure of 110/70 mm Hg is within the expected reference range and does not
require reporting.
Rationale B: A heart rate of 88/min is within the expected reference range of 60 to 100/min.
Rationale C: Shortness of breath and chest pain indicate a potential pulmonary embolism, a life-
threatening complication requiring immediate intervention.
Rationale D: A urine output of 40 mL/hr is above the minimum expected 30 mL/hr and is an acceptable
finding.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 2: A nurse is assessing a client with diabetic ketoacidosis (DKA). Which of the following
laboratory findings is expected?
A. Blood glucose 250 mg/dL
B. Arterial pH 7.50
C. Bicarbonate 26 mEq/L
D. Urine ketones negative
ANSWER: A
Rationale A: Blood glucose >250 mg/dL is a hallmark diagnostic criterion for DKA.
Rationale B: Arterial pH in DKA is expected to be acidic (<7.35), not alkalotic.
,Rationale C: Bicarbonate is expected to be low (<18 mEq/L) due to metabolic acidosis, not normal.
Rationale D: Urine ketones are expected to be strongly positive in DKA due to fat breakdown.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 3: A nurse is caring for a client experiencing an acute COPD exacerbation. Which action should
the nurse take first?
A. Administer albuterol via nebulizer
B. Place the client in a high-Fowler's position
C. Obtain a sputum culture
D. Initiate oxygen therapy at 2 L/min via nasal cannula
ANSWER: B
Rationale A: Administering albuterol is important but positioning takes immediate priority to maximize
lung expansion.
Rationale B: Placing the client in a high-Fowler's position is the priority action to immediately improve
chest expansion and ease breathing.
Rationale C: Obtaining a sputum culture is necessary but is not the immediate priority over airway and
breathing.
Rationale D: Oxygen therapy is needed, but positioning is the fastest, non-invasive first step to improve
ventilation.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 4: A nurse is reviewing the medical record of a client scheduled for thrombolytic therapy for an
acute ischemic stroke. Which finding is a contraindication to this therapy?
A. Blood pressure 150/90 mm Hg
B. History of ischemic stroke 6 months ago
C. Onset of symptoms 2 hours ago
D. Blood glucose 110 mg/dL
ANSWER: B
Rationale A: Blood pressure must be <185/110 mm Hg for thrombolytic therapy; 150/90 is acceptable.
Rationale B: A history of ischemic stroke within the last 3 months is an absolute contraindication due to
high hemorrhage risk.
Rationale C: Symptom onset within 3 to 4.5 hours is the required time window for thrombolytic
eligibility.
,Rationale D: Blood glucose should be >50 mg/dL to rule out hypoglycemia mimicking stroke; 110 mg/dL
is acceptable.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 5: A nurse is administering a packed RBC transfusion. Fifteen minutes after initiation, the client
reports chills and back pain. Which action should the nurse take first?
A. Administer diphenhydramine
B. Stop the transfusion
C. Notify the provider
D. Obtain a urine specimen
ANSWER: B
Rationale A: Diphenhydramine may be given for allergic reactions, but stopping the transfusion is the
immediate priority.
Rationale B: Stopping the transfusion is the first action to prevent further infusion of incompatible blood
and worsening of the hemolytic reaction.
Rationale C: Notifying the provider is necessary but occurs after the transfusion is stopped and IV line is
kept open with normal saline.
Rationale D: Obtaining a urine specimen is done to check for hemoglobinuria, but only after the
transfusion is halted.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 6: A nurse is caring for a client with a chest tube connected to a water-seal drainage system.
Which finding requires immediate intervention?
A. Continuous gentle bubbling in the suction control chamber
B. Intermittent bubbling in the water-seal chamber
C. Continuous vigorous bubbling in the water-seal chamber
D. Tidaling in the water-seal chamber
ANSWER: C
Rationale A: Gentle bubbling in the suction control chamber is an expected finding when wall suction is
applied.
Rationale B: Intermittent bubbling in the water-seal chamber is expected as air escapes during
exhalation or coughing.
Rationale C: Continuous vigorous bubbling in the water-seal chamber indicates an air leak in the system
and requires immediate investigation.
, Rationale D: Tidaling (fluctuation with breathing) is an expected finding indicating the system is patent
and the lung is not fully expanded or is breathing normally.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 7: A client has a nasogastric (NG) tube connected to continuous low-intermittent suction.
Which acid-base imbalance should the nurse monitor for?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
ANSWER: B
Rationale A: Metabolic acidosis is caused by loss of bicarbonate (e.g., diarrhea), not gastric suctioning.
Rationale B: Metabolic alkalosis occurs due to the loss of gastric hydrochloric acid (HCl) from continuous
NG suctioning.
Rationale C: Respiratory acidosis is caused by hypoventilation and CO2 retention, unrelated to NG
suction.
Rationale D: Respiratory alkalosis is caused by hyperventilation and CO2 blow-off, unrelated to NG
suction.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 8: A nurse is caring for a client with Addison's disease who is experiencing an adrenal crisis.
Which prescription should the nurse anticipate?
A. Oral potassium supplements
B. IV hydrocortisone
C. IV furosemide
D. Subcutaneous insulin
ANSWER: B
Rationale A: Potassium is typically elevated in Addison's disease; supplements would worsen
hyperkalemia.
Rationale B: IV hydrocortisone is the priority treatment to replace deficient cortisol and reverse the life-
threatening crisis.
Rationale C: Furosemide would worsen the hypovolemia and hyponatremia already present in an
adrenal crisis.
Question 1: A nurse is caring for a client who is 24 hours postoperative following a total hip arthroplasty.
Which of the following findings should the nurse report to the provider?
A. Blood pressure 110/70 mm Hg
B. Heart rate 88/min
C. Shortness of breath and chest pain
D. Urine output 40 mL/hr
ANSWER: C
Rationale A: A blood pressure of 110/70 mm Hg is within the expected reference range and does not
require reporting.
Rationale B: A heart rate of 88/min is within the expected reference range of 60 to 100/min.
Rationale C: Shortness of breath and chest pain indicate a potential pulmonary embolism, a life-
threatening complication requiring immediate intervention.
Rationale D: A urine output of 40 mL/hr is above the minimum expected 30 mL/hr and is an acceptable
finding.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 2: A nurse is assessing a client with diabetic ketoacidosis (DKA). Which of the following
laboratory findings is expected?
A. Blood glucose 250 mg/dL
B. Arterial pH 7.50
C. Bicarbonate 26 mEq/L
D. Urine ketones negative
ANSWER: A
Rationale A: Blood glucose >250 mg/dL is a hallmark diagnostic criterion for DKA.
Rationale B: Arterial pH in DKA is expected to be acidic (<7.35), not alkalotic.
,Rationale C: Bicarbonate is expected to be low (<18 mEq/L) due to metabolic acidosis, not normal.
Rationale D: Urine ketones are expected to be strongly positive in DKA due to fat breakdown.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 3: A nurse is caring for a client experiencing an acute COPD exacerbation. Which action should
the nurse take first?
A. Administer albuterol via nebulizer
B. Place the client in a high-Fowler's position
C. Obtain a sputum culture
D. Initiate oxygen therapy at 2 L/min via nasal cannula
ANSWER: B
Rationale A: Administering albuterol is important but positioning takes immediate priority to maximize
lung expansion.
Rationale B: Placing the client in a high-Fowler's position is the priority action to immediately improve
chest expansion and ease breathing.
Rationale C: Obtaining a sputum culture is necessary but is not the immediate priority over airway and
breathing.
Rationale D: Oxygen therapy is needed, but positioning is the fastest, non-invasive first step to improve
ventilation.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 4: A nurse is reviewing the medical record of a client scheduled for thrombolytic therapy for an
acute ischemic stroke. Which finding is a contraindication to this therapy?
A. Blood pressure 150/90 mm Hg
B. History of ischemic stroke 6 months ago
C. Onset of symptoms 2 hours ago
D. Blood glucose 110 mg/dL
ANSWER: B
Rationale A: Blood pressure must be <185/110 mm Hg for thrombolytic therapy; 150/90 is acceptable.
Rationale B: A history of ischemic stroke within the last 3 months is an absolute contraindication due to
high hemorrhage risk.
Rationale C: Symptom onset within 3 to 4.5 hours is the required time window for thrombolytic
eligibility.
,Rationale D: Blood glucose should be >50 mg/dL to rule out hypoglycemia mimicking stroke; 110 mg/dL
is acceptable.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 5: A nurse is administering a packed RBC transfusion. Fifteen minutes after initiation, the client
reports chills and back pain. Which action should the nurse take first?
A. Administer diphenhydramine
B. Stop the transfusion
C. Notify the provider
D. Obtain a urine specimen
ANSWER: B
Rationale A: Diphenhydramine may be given for allergic reactions, but stopping the transfusion is the
immediate priority.
Rationale B: Stopping the transfusion is the first action to prevent further infusion of incompatible blood
and worsening of the hemolytic reaction.
Rationale C: Notifying the provider is necessary but occurs after the transfusion is stopped and IV line is
kept open with normal saline.
Rationale D: Obtaining a urine specimen is done to check for hemoglobinuria, but only after the
transfusion is halted.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 6: A nurse is caring for a client with a chest tube connected to a water-seal drainage system.
Which finding requires immediate intervention?
A. Continuous gentle bubbling in the suction control chamber
B. Intermittent bubbling in the water-seal chamber
C. Continuous vigorous bubbling in the water-seal chamber
D. Tidaling in the water-seal chamber
ANSWER: C
Rationale A: Gentle bubbling in the suction control chamber is an expected finding when wall suction is
applied.
Rationale B: Intermittent bubbling in the water-seal chamber is expected as air escapes during
exhalation or coughing.
Rationale C: Continuous vigorous bubbling in the water-seal chamber indicates an air leak in the system
and requires immediate investigation.
, Rationale D: Tidaling (fluctuation with breathing) is an expected finding indicating the system is patent
and the lung is not fully expanded or is breathing normally.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 7: A client has a nasogastric (NG) tube connected to continuous low-intermittent suction.
Which acid-base imbalance should the nurse monitor for?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
ANSWER: B
Rationale A: Metabolic acidosis is caused by loss of bicarbonate (e.g., diarrhea), not gastric suctioning.
Rationale B: Metabolic alkalosis occurs due to the loss of gastric hydrochloric acid (HCl) from continuous
NG suctioning.
Rationale C: Respiratory acidosis is caused by hypoventilation and CO2 retention, unrelated to NG
suction.
Rationale D: Respiratory alkalosis is caused by hyperventilation and CO2 blow-off, unrelated to NG
suction.
MEDICAL-SURGICAL RN A PROPHECY RELIAS
Question 8: A nurse is caring for a client with Addison's disease who is experiencing an adrenal crisis.
Which prescription should the nurse anticipate?
A. Oral potassium supplements
B. IV hydrocortisone
C. IV furosemide
D. Subcutaneous insulin
ANSWER: B
Rationale A: Potassium is typically elevated in Addison's disease; supplements would worsen
hyperkalemia.
Rationale B: IV hydrocortisone is the priority treatment to replace deficient cortisol and reverse the life-
threatening crisis.
Rationale C: Furosemide would worsen the hypovolemia and hyponatremia already present in an
adrenal crisis.
