BRUNNER & SUDDARTH MEDICAL-SURGICAL NURSING 14TH
EDITION PRACTICE EXAM–COMPLETE STUDY GUIDE |
PRACTICE QUESTIONS AND ANSWERS-RATIONALES | EXAM
PREP | DOWNLOAD INSTANT PDF | GUARANTEED PASS ||
LATEST EXAM 2026-2027
1. A nurse is assessing a client admitted with a diagnosis of severe dehydration and acute
kidney injury. Which laboratory finding should the nurse anticipate as a primary indicator
of prerenal azotemia?
A. Blood urea nitrogen (BUN) to serum creatinine ratio of 20:1
B. Decreased urine specific gravity fixed at 1.010
C. Elevated serum albumin and decreased hematocrit
D. Decreased fractional excretion of sodium (FENa) above 3 percent
Answer: A
A BUN to serum creatinine ratio exceeding 20:1 is characteristic of prerenal azotemia,
reflecting avid urea reabsorption in the proximal tubules due to decreased renal perfusion,
whereas intrarenal failure typically shows a 10:1 ratio.
2. A nurse is caring for a client receiving total parenteral nutrition (TPN) through a
peripherally inserted central catheter. Which clinical manifestation indicates a potential
complication of rapid infusion or abrupt cessation of TPN?
A. Hypervolemic hyponatremia manifested by peripheral edema and weight gain
B. Hypoglycemia resulting from sudden depletion of exogenous glucose load
C. Hypercalcemia caused by parathyroid suppression during amino acid infusion
D. Metabolic alkalosis secondary to high chloride content in standard TPN solutions
Answer: B
Abrupt cessation of TPN while the pancreas continues to secrete high levels of insulin can
precipitate severe rebound hypoglycemia; TPN must be tapered gradually if discontinued.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen via
nasal cannula at 2 L/min. Arterial blood gas results show pH 7.31, PaCO2 62 mm Hg,
,PaO2 58 mm Hg, and HCO3 32 mEq/L. Which pathophysiological mechanism explains
these findings?
A. Alveolar hyperventilation leading to respiratory alkalosis and renal compensation
B. Chronic respiratory acidosis with metabolic compensation due to long-term carbon dioxide
retention
C. Acute metabolic acidosis caused by tissue hypoxia and lactic acid accumulation
D. Ventilatory failure resulting from unregulated peripheral chemoreceptor stimulation
Answer: B
The client exhibits compensated respiratory acidosis, typical of advanced COPD where
chronic alveolar hypoventilation causes carbon dioxide retention, prompting the kidneys to
retain bicarbonate to buffer pH.
4. A nurse is planning care for a client in the immediate postoperative period following a
thyroidectomy. Which equipment is essential to keep immediately accessible at the
bedside?
A. Mechanical ventilator and humidified circuit
B. Tracheostomy insertion tray and suction apparatus
C. Automatic external defibrillator and emergency pacing wires
D. Central venous pressure monitoring kit and transducer
Answer: B
Following thyroid surgery, laryngeal edema or hemorrhage can rapidly compromise the
airway, making an emergency tracheostomy tray and functioning suction equipment
mandatory bedside safety items.
5. A client with a newly created loop colostomy is observed by the nurse on the second
postoperative day. Which assessment finding requires immediate notification of the
surgeon?
A. Stoma mucosa appears dusky and dark purple in coloration
B. Stoma protrudes approximately 2 cm above the abdominal wall
C. Stoma drains a moderate amount of dark green liquid stool
,D. Stoma appears edematous with mild serosanguineous oozing at the suture line
Answer: A
A dusky, dark purple, or black stoma indicates compromised blood supply and impending
ischemia or necrosis, which is a surgical emergency requiring immediate intervention.
6. A nurse is caring for a client admitted with severe acute pancreatitis. Which serum
laboratory value is the most specific and reliable indicator of acute pancreatic injury?
A. Serum amylase
B. Serum lipase
C. Serum alkaline phosphatase
D. Serum alanine aminotransferase
Answer: B
Serum lipase is more specific to pancreatic injury than amylase because it remains elevated
longer and is less affected by non-pancreatic disorders such as renal failure or salivary
conditions.
7. A client is prescribed digoxin 0.25 mg orally daily and furosemide 40 mg orally daily for
heart failure. Which assessment finding should the nurse prioritize before administering
the digoxin dose?
A. Apical pulse rate of 52 beats per minute
B. Blood pressure reading of 132/84 mm Hg
C. Serum sodium level of 138 mEq/L
D. Daily weight gain of 0.5 kg over 24 hours
Answer: A
Digoxin slows conduction through the atrioventricular node; an apical pulse below 60 beats
per minute indicates potential toxicity or excessive drug effect, requiring the nurse to withhold
the medication and notify the provider.
8. A nurse is developing a teaching plan for a client with newly diagnosed type 1 diabetes
mellitus regarding sick-day management. Which instruction should be included?
A. Omit insulin doses if unable to eat solid meals to prevent profound hypoglycemia
, B. Test blood glucose levels every 2 to 4 hours when illness symptoms are present
C. Consume high-calorie carbohydrate beverages exclusively to maintain energy balance
D. Restrict fluid intake to prevent fluid overload during febrile episodes
Answer: B
During illness, counterregulatory stress hormones elevate blood glucose levels; frequent
monitoring every 2 to 4 hours is vital to detect hyperglycemia and prevent diabetic
ketoacidosis.
9. A client with portal hypertension and cirrhosis is scheduled for a paracentesis. Which
pre-procedure nursing intervention is essential to prevent complications?
A. Administer a cleansing enema to reduce bowel perforation risks
B. Have the client empty their urinary bladder immediately prior to the procedure
C. Position the client in the high Fowler position throughout the puncture
D. Infuse 500 mL of 0.9% sodium chloride rapidly to expand intravascular volume
Answer: B
An empty bladder significantly reduces the risk of accidental bladder laceration and
perforation during the insertion of the paracentesis needle into the peritoneal cavity.
10. A nurse is monitoring a client receiving a transfusion of packed red blood cells (PRBCs)
who develops lower back pain, chills, and fever 15 minutes after initiation. What is the
nurse's immediate priority action?
A. Slow the infusion rate by half and notify the blood bank
B. Administer diphenhydramine hydrochloride IV as prescribed
C. Stop the transfusion immediately and disconnect the tubing at the catheter hub
D. Flush the intravenous line with 0.9% sodium chloride solution
Answer: C
Lower back pain, chills, and fever are classic signs of an acute hemolytic transfusion reaction;
stopping the infusion immediately and maintaining the IV line with normal saline using new
tubing prevents further infusion of incompatible blood.
EDITION PRACTICE EXAM–COMPLETE STUDY GUIDE |
PRACTICE QUESTIONS AND ANSWERS-RATIONALES | EXAM
PREP | DOWNLOAD INSTANT PDF | GUARANTEED PASS ||
LATEST EXAM 2026-2027
1. A nurse is assessing a client admitted with a diagnosis of severe dehydration and acute
kidney injury. Which laboratory finding should the nurse anticipate as a primary indicator
of prerenal azotemia?
A. Blood urea nitrogen (BUN) to serum creatinine ratio of 20:1
B. Decreased urine specific gravity fixed at 1.010
C. Elevated serum albumin and decreased hematocrit
D. Decreased fractional excretion of sodium (FENa) above 3 percent
Answer: A
A BUN to serum creatinine ratio exceeding 20:1 is characteristic of prerenal azotemia,
reflecting avid urea reabsorption in the proximal tubules due to decreased renal perfusion,
whereas intrarenal failure typically shows a 10:1 ratio.
2. A nurse is caring for a client receiving total parenteral nutrition (TPN) through a
peripherally inserted central catheter. Which clinical manifestation indicates a potential
complication of rapid infusion or abrupt cessation of TPN?
A. Hypervolemic hyponatremia manifested by peripheral edema and weight gain
B. Hypoglycemia resulting from sudden depletion of exogenous glucose load
C. Hypercalcemia caused by parathyroid suppression during amino acid infusion
D. Metabolic alkalosis secondary to high chloride content in standard TPN solutions
Answer: B
Abrupt cessation of TPN while the pancreas continues to secrete high levels of insulin can
precipitate severe rebound hypoglycemia; TPN must be tapered gradually if discontinued.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen via
nasal cannula at 2 L/min. Arterial blood gas results show pH 7.31, PaCO2 62 mm Hg,
,PaO2 58 mm Hg, and HCO3 32 mEq/L. Which pathophysiological mechanism explains
these findings?
A. Alveolar hyperventilation leading to respiratory alkalosis and renal compensation
B. Chronic respiratory acidosis with metabolic compensation due to long-term carbon dioxide
retention
C. Acute metabolic acidosis caused by tissue hypoxia and lactic acid accumulation
D. Ventilatory failure resulting from unregulated peripheral chemoreceptor stimulation
Answer: B
The client exhibits compensated respiratory acidosis, typical of advanced COPD where
chronic alveolar hypoventilation causes carbon dioxide retention, prompting the kidneys to
retain bicarbonate to buffer pH.
4. A nurse is planning care for a client in the immediate postoperative period following a
thyroidectomy. Which equipment is essential to keep immediately accessible at the
bedside?
A. Mechanical ventilator and humidified circuit
B. Tracheostomy insertion tray and suction apparatus
C. Automatic external defibrillator and emergency pacing wires
D. Central venous pressure monitoring kit and transducer
Answer: B
Following thyroid surgery, laryngeal edema or hemorrhage can rapidly compromise the
airway, making an emergency tracheostomy tray and functioning suction equipment
mandatory bedside safety items.
5. A client with a newly created loop colostomy is observed by the nurse on the second
postoperative day. Which assessment finding requires immediate notification of the
surgeon?
A. Stoma mucosa appears dusky and dark purple in coloration
B. Stoma protrudes approximately 2 cm above the abdominal wall
C. Stoma drains a moderate amount of dark green liquid stool
,D. Stoma appears edematous with mild serosanguineous oozing at the suture line
Answer: A
A dusky, dark purple, or black stoma indicates compromised blood supply and impending
ischemia or necrosis, which is a surgical emergency requiring immediate intervention.
6. A nurse is caring for a client admitted with severe acute pancreatitis. Which serum
laboratory value is the most specific and reliable indicator of acute pancreatic injury?
A. Serum amylase
B. Serum lipase
C. Serum alkaline phosphatase
D. Serum alanine aminotransferase
Answer: B
Serum lipase is more specific to pancreatic injury than amylase because it remains elevated
longer and is less affected by non-pancreatic disorders such as renal failure or salivary
conditions.
7. A client is prescribed digoxin 0.25 mg orally daily and furosemide 40 mg orally daily for
heart failure. Which assessment finding should the nurse prioritize before administering
the digoxin dose?
A. Apical pulse rate of 52 beats per minute
B. Blood pressure reading of 132/84 mm Hg
C. Serum sodium level of 138 mEq/L
D. Daily weight gain of 0.5 kg over 24 hours
Answer: A
Digoxin slows conduction through the atrioventricular node; an apical pulse below 60 beats
per minute indicates potential toxicity or excessive drug effect, requiring the nurse to withhold
the medication and notify the provider.
8. A nurse is developing a teaching plan for a client with newly diagnosed type 1 diabetes
mellitus regarding sick-day management. Which instruction should be included?
A. Omit insulin doses if unable to eat solid meals to prevent profound hypoglycemia
, B. Test blood glucose levels every 2 to 4 hours when illness symptoms are present
C. Consume high-calorie carbohydrate beverages exclusively to maintain energy balance
D. Restrict fluid intake to prevent fluid overload during febrile episodes
Answer: B
During illness, counterregulatory stress hormones elevate blood glucose levels; frequent
monitoring every 2 to 4 hours is vital to detect hyperglycemia and prevent diabetic
ketoacidosis.
9. A client with portal hypertension and cirrhosis is scheduled for a paracentesis. Which
pre-procedure nursing intervention is essential to prevent complications?
A. Administer a cleansing enema to reduce bowel perforation risks
B. Have the client empty their urinary bladder immediately prior to the procedure
C. Position the client in the high Fowler position throughout the puncture
D. Infuse 500 mL of 0.9% sodium chloride rapidly to expand intravascular volume
Answer: B
An empty bladder significantly reduces the risk of accidental bladder laceration and
perforation during the insertion of the paracentesis needle into the peritoneal cavity.
10. A nurse is monitoring a client receiving a transfusion of packed red blood cells (PRBCs)
who develops lower back pain, chills, and fever 15 minutes after initiation. What is the
nurse's immediate priority action?
A. Slow the infusion rate by half and notify the blood bank
B. Administer diphenhydramine hydrochloride IV as prescribed
C. Stop the transfusion immediately and disconnect the tubing at the catheter hub
D. Flush the intravenous line with 0.9% sodium chloride solution
Answer: C
Lower back pain, chills, and fever are classic signs of an acute hemolytic transfusion reaction;
stopping the infusion immediately and maintaining the IV line with normal saline using new
tubing prevents further infusion of incompatible blood.
