Page |1
BRUNNER & SUDDARTH'S TEXTBOOK OF MEDICAL-
SURGICAL NURSING | JANICE L. HINKLE, KERRY H.
CHEEVER, KRISTEN OVERBAUGH | REVISED EDITION |
STUDY GUIDE | LATEST UPDATE 2026/2027 | PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW
Table of Contents
1. Professional Nursing Practice and Health Education
2. Adult Health Assessment and Perioperative Nursing
3. Fluid, Electrolyte, and Acid-Base Balance
4. Cardiovascular Disorders and Management
5. Respiratory Disorders and Gas Exchange
6. Neurologic Disorders and Sensory Function
7. Gastrointestinal and Hepatic Disorders
8. Endocrine and Metabolic Disorders
9. Renal and Urinary Disorders
10. Musculoskeletal and Connective Tissue Disorders
11. Oncologic and Hematologic Disorders
12. Infectious Diseases and Immunologic Disorders
13. Emergency, Critical, and Palliative Care
, Page |2
Question 1: A 68-year-old client is admitted with a diagnosis of right-sided heart failure. The
nurse should assess the client for which of the following manifestations?
A. Crackles in the lungs and orthopnea
B. Jugular venous distention and peripheral edema
C. Paroxysmal nocturnal dyspnea and hemoptysis
D. Pink, frothy sputum and tachypnea
Correct Answer: B. Jugular venous distention and peripheral edema
Right-sided heart failure results in systemic venous congestion, leading to jugular venous
distention, peripheral edema, hepatomegaly, and weight gain. Left-sided heart failure causes
pulmonary congestion manifested by crackles, orthopnea, and paroxysmal nocturnal
dyspnea.
Question 2: A client with a history of heart failure is prescribed furosemide (Lasix). Which
laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B. Serum potassium
Furosemide is a loop diuretic that causes significant potassium loss, potentially leading to
hypokalemia. Hypokalemia increases the risk of digitalis toxicity and cardiac dysrhythmias in
clients with heart failure. Serum potassium should be monitored closely and supplemented as
prescribed.
Question 3: A client who is scheduled for surgery is instructed to be NPO after midnight. The
nurse understands that this instruction is primarily to:
A. Prevent postoperative nausea and vomiting
B. Reduce the risk of aspiration during anesthesia
C. Maintain fluid and electrolyte balance
D. Prevent dehydration during surgery
Correct Answer: B. Reduce the risk of aspiration during anesthesia
NPO status before surgery is primarily to prevent aspiration of gastric contents during the
induction of anesthesia, when protective airway reflexes are suppressed. Aspiration can cause
aspiration pneumonitis or pneumonia, which are serious complications.
, Page |3
Question 4: A client is recovering from abdominal surgery and has a nasogastric tube in
place. The nurse should assess for which of the following signs of fluid volume deficit?
A. Bounding pulse and hypertension
B. Decreased urine output and dry mucous membranes
C. Crackles in the lungs and peripheral edema
D. Jugular venous distention and weight gain
Correct Answer: B. Decreased urine output and dry mucous membranes
Fluid volume deficit is manifested by decreased urine output, dry mucous membranes, poor
skin turgor, tachycardia, hypotension, and thirst. Nasogastric suctioning removes fluid and
electrolytes, placing the client at risk for hypovolemia and electrolyte imbalances.
Question 5: A client with a new colostomy is being taught about dietary management. Which
statement by the client indicates a need for further teaching?
A. "I should eat foods that are low in fiber to prevent blockage."
B. "I should chew my food thoroughly and eat slowly."
C. "I should avoid foods that cause gas and odor."
D. "I should drink plenty of fluids throughout the day."
Correct Answer: A. "I should eat foods that are low in fiber to prevent blockage."
Clients with a colostomy should gradually increase dietary fiber to promote stool formation
and prevent constipation. Chewing thoroughly, eating slowly, avoiding gas-forming foods,
and maintaining adequate fluid intake are appropriate measures. A low-fiber diet is not
recommended unless specifically indicated.
Question 6: A 55-year-old client is admitted with an acute exacerbation of COPD. Which of
the following is the priority nursing intervention?
A. Administer a high-flow oxygen via non-rebreather mask
B. Position the client in a high Fowler's position
C. Administer prescribed bronchodilators and corticosteroids
D. Obtain an arterial blood gas sample
Correct Answer: B. Position the client in a high Fowler's position
Positioning the client in high Fowler's position is a priority intervention that facilitates lung
expansion and improves ventilation by maximizing diaphragmatic excursion. Oxygen should
be administered at low flow rates (1–2 L/min) to avoid suppressing the hypoxic drive.
, Page |4
Bronchodilators and corticosteroids should be administered, but positioning is the immediate
priority.
Question 7: A client with a tracheostomy is being suctioned. The nurse should limit each
suction pass to no more than:
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Correct Answer: B. 10 seconds
Suctioning should be limited to 10 seconds per pass to prevent hypoxia and tissue trauma.
Prolonged suctioning can cause hypoxemia, cardiac dysrhythmias, and mucosal damage. The
client should be hyperoxygenated before and between suction passes.
Question 8: A client is prescribed warfarin (Coumadin) for atrial fibrillation. Which
instruction should the nurse include in the teaching plan?
A. "Increase your intake of green, leafy vegetables."
B. "Use a soft-bristled toothbrush and an electric razor."
C. "Take aspirin for headaches or minor aches."
D. "Double the dose if you miss a dose."
Correct Answer: B. "Use a soft-bristled toothbrush and an electric razor."
Warfarin is an anticoagulant that increases bleeding risk. Clients should use soft-bristled
toothbrushes and electric razors to minimize bleeding. Green, leafy vegetables are high in
vitamin K, which antagonizes warfarin, and intake should be consistent, not increased.
Aspirin increases bleeding risk and should be avoided unless prescribed. Missed doses
should not be doubled.
Question 9: A client is admitted with a diagnosis of acute pancreatitis. Which laboratory
value is most indicative of this condition?
A. Elevated serum amylase and lipase
B. Elevated BUN and creatinine
C. Elevated AST and ALT
D. Decreased serum calcium
BRUNNER & SUDDARTH'S TEXTBOOK OF MEDICAL-
SURGICAL NURSING | JANICE L. HINKLE, KERRY H.
CHEEVER, KRISTEN OVERBAUGH | REVISED EDITION |
STUDY GUIDE | LATEST UPDATE 2026/2027 | PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW
Table of Contents
1. Professional Nursing Practice and Health Education
2. Adult Health Assessment and Perioperative Nursing
3. Fluid, Electrolyte, and Acid-Base Balance
4. Cardiovascular Disorders and Management
5. Respiratory Disorders and Gas Exchange
6. Neurologic Disorders and Sensory Function
7. Gastrointestinal and Hepatic Disorders
8. Endocrine and Metabolic Disorders
9. Renal and Urinary Disorders
10. Musculoskeletal and Connective Tissue Disorders
11. Oncologic and Hematologic Disorders
12. Infectious Diseases and Immunologic Disorders
13. Emergency, Critical, and Palliative Care
, Page |2
Question 1: A 68-year-old client is admitted with a diagnosis of right-sided heart failure. The
nurse should assess the client for which of the following manifestations?
A. Crackles in the lungs and orthopnea
B. Jugular venous distention and peripheral edema
C. Paroxysmal nocturnal dyspnea and hemoptysis
D. Pink, frothy sputum and tachypnea
Correct Answer: B. Jugular venous distention and peripheral edema
Right-sided heart failure results in systemic venous congestion, leading to jugular venous
distention, peripheral edema, hepatomegaly, and weight gain. Left-sided heart failure causes
pulmonary congestion manifested by crackles, orthopnea, and paroxysmal nocturnal
dyspnea.
Question 2: A client with a history of heart failure is prescribed furosemide (Lasix). Which
laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B. Serum potassium
Furosemide is a loop diuretic that causes significant potassium loss, potentially leading to
hypokalemia. Hypokalemia increases the risk of digitalis toxicity and cardiac dysrhythmias in
clients with heart failure. Serum potassium should be monitored closely and supplemented as
prescribed.
Question 3: A client who is scheduled for surgery is instructed to be NPO after midnight. The
nurse understands that this instruction is primarily to:
A. Prevent postoperative nausea and vomiting
B. Reduce the risk of aspiration during anesthesia
C. Maintain fluid and electrolyte balance
D. Prevent dehydration during surgery
Correct Answer: B. Reduce the risk of aspiration during anesthesia
NPO status before surgery is primarily to prevent aspiration of gastric contents during the
induction of anesthesia, when protective airway reflexes are suppressed. Aspiration can cause
aspiration pneumonitis or pneumonia, which are serious complications.
, Page |3
Question 4: A client is recovering from abdominal surgery and has a nasogastric tube in
place. The nurse should assess for which of the following signs of fluid volume deficit?
A. Bounding pulse and hypertension
B. Decreased urine output and dry mucous membranes
C. Crackles in the lungs and peripheral edema
D. Jugular venous distention and weight gain
Correct Answer: B. Decreased urine output and dry mucous membranes
Fluid volume deficit is manifested by decreased urine output, dry mucous membranes, poor
skin turgor, tachycardia, hypotension, and thirst. Nasogastric suctioning removes fluid and
electrolytes, placing the client at risk for hypovolemia and electrolyte imbalances.
Question 5: A client with a new colostomy is being taught about dietary management. Which
statement by the client indicates a need for further teaching?
A. "I should eat foods that are low in fiber to prevent blockage."
B. "I should chew my food thoroughly and eat slowly."
C. "I should avoid foods that cause gas and odor."
D. "I should drink plenty of fluids throughout the day."
Correct Answer: A. "I should eat foods that are low in fiber to prevent blockage."
Clients with a colostomy should gradually increase dietary fiber to promote stool formation
and prevent constipation. Chewing thoroughly, eating slowly, avoiding gas-forming foods,
and maintaining adequate fluid intake are appropriate measures. A low-fiber diet is not
recommended unless specifically indicated.
Question 6: A 55-year-old client is admitted with an acute exacerbation of COPD. Which of
the following is the priority nursing intervention?
A. Administer a high-flow oxygen via non-rebreather mask
B. Position the client in a high Fowler's position
C. Administer prescribed bronchodilators and corticosteroids
D. Obtain an arterial blood gas sample
Correct Answer: B. Position the client in a high Fowler's position
Positioning the client in high Fowler's position is a priority intervention that facilitates lung
expansion and improves ventilation by maximizing diaphragmatic excursion. Oxygen should
be administered at low flow rates (1–2 L/min) to avoid suppressing the hypoxic drive.
, Page |4
Bronchodilators and corticosteroids should be administered, but positioning is the immediate
priority.
Question 7: A client with a tracheostomy is being suctioned. The nurse should limit each
suction pass to no more than:
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Correct Answer: B. 10 seconds
Suctioning should be limited to 10 seconds per pass to prevent hypoxia and tissue trauma.
Prolonged suctioning can cause hypoxemia, cardiac dysrhythmias, and mucosal damage. The
client should be hyperoxygenated before and between suction passes.
Question 8: A client is prescribed warfarin (Coumadin) for atrial fibrillation. Which
instruction should the nurse include in the teaching plan?
A. "Increase your intake of green, leafy vegetables."
B. "Use a soft-bristled toothbrush and an electric razor."
C. "Take aspirin for headaches or minor aches."
D. "Double the dose if you miss a dose."
Correct Answer: B. "Use a soft-bristled toothbrush and an electric razor."
Warfarin is an anticoagulant that increases bleeding risk. Clients should use soft-bristled
toothbrushes and electric razors to minimize bleeding. Green, leafy vegetables are high in
vitamin K, which antagonizes warfarin, and intake should be consistent, not increased.
Aspirin increases bleeding risk and should be avoided unless prescribed. Missed doses
should not be doubled.
Question 9: A client is admitted with a diagnosis of acute pancreatitis. Which laboratory
value is most indicative of this condition?
A. Elevated serum amylase and lipase
B. Elevated BUN and creatinine
C. Elevated AST and ALT
D. Decreased serum calcium
