RN VATI Adult Medical Surgical Assessment Exam QUESTIONS
AND ANSWERS ALREADY GRADED A+. 100% Verified Solutions
| Updated Per Latest Guidelines | Graded A+
SECTION 1: FOUNDATIONS OF ADULT MEDICAL-SURGICAL
NURSING (Questions 1-15)
Question 1
A nurse is caring for a client 24 hours postoperatively following an open
cholecystectomy. The client reports sudden onset of shortness of breath and pleuritic
chest pain. Vital signs: HR 118, RR 28, BP 138/86, SpO2 88% on room air. What is the
priority nursing action?
A. Administer prescribed morphine 2 mg IV
B. Place the client in Trendelenburg position
C. Apply oxygen and notify the provider immediately
D. Encourage the client to cough and deep breathe
Correct Answer: C
Rationale: The client's presentation—sudden dyspnea, pleuritic chest pain, tachycardia,
tachypnea, and hypoxemia—is highly suggestive of pulmonary embolism (PE), a life-
threatening postoperative complication. The priority is to apply oxygen and notify the
provider immediately. Morphine may be ordered later for pain, but oxygenation and
notification are the priority . Coughing and deep breathing (D) would be appropriate for
atelectasis prevention but is insufficient for a suspected PE.
Question 2
A client with heart failure is receiving furosemide 40 mg IV push. Which assessment
finding indicates a therapeutic response to the medication?
A. Decreased heart rate from 110 to 88 bpm
B. Increased urine output of 200 mL in 2 hours
,C. Decreased blood pressure from 148/92 to 130/80 mmHg
D. Clear lung sounds on auscultation
Correct Answer: B
Rationale: Furosemide is a loop diuretic. The primary therapeutic effect is increased
urine output (diuresis), which reduces fluid volume overload. Clear lung sounds (D) and
decreased BP (C) are secondary effects of fluid removal but are not the direct measure
of the medication's therapeutic response . Decreased heart rate (A) may occur but is not
the primary indicator of diuretic effectiveness.
Question 3
A nurse is caring for a client who has a newly inserted chest tube following a
thoracotomy. Which finding requires immediate intervention?
A. Fluctuation of fluid in the water seal chamber with respiration
B. Continuous bubbling in the suction control chamber
C. Continuous bubbling in the water seal chamber
D. Drainage of 75 mL of serosanguineous fluid in the first hour
Correct Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
chest tube system. This requires immediate assessment to locate and seal the leak to
prevent tension pneumothorax. Fluctuation (tidaling) in the water seal chamber (A) is
normal and indicates the system is patent. Bubbling in the suction control chamber (B) is
expected when suction is applied. Drainage of 75 mL (D) is within acceptable limits (up
to 100 mL/hour is acceptable postoperatively) .
Question 4
A nurse is providing teaching to a client with cirrhosis and ascites who has developed
confusion, asterixis, and a serum ammonia of 90 μmol/L. Which medication order
requires clarification before administration?
,A. Lactulose 30 mL orally every 6 hours
B. Rifaximin 550 mg orally twice daily
C. Polyethylene glycol 3350 17 g orally once daily
D. Acetaminophen 650 mg orally every 6 hours as needed for fever
Correct Answer: D
Rationale: Acetaminophen can be hepatotoxic, especially in cirrhosis, and is not the
first-line treatment for fever in hepatic encephalopathy. The client is displaying signs of
hepatic encephalopathy (confusion, asterixis, elevated ammonia). Lactulose (A) and
rifaximin (B) are appropriate treatments to reduce ammonia. Polyethylene glycol (C) may
be used for constipation. Acetaminophen should be used cautiously or avoided .
Question 5
A nurse is assessing a client who has atopic dermatitis and a prescription for
triamcinolone ointment. Which adverse effect should the nurse monitor for?
A. Hypopigmentation
B. Excessive hair growth
C. Thinning of the skin
D. All of the above
Correct Answer: D
Rationale: Topical glucocorticoids such as triamcinolone can cause adverse effects
including thinning of the skin, hypopigmentation, and excessive hair growth
(hypertrichosis). The nurse should apply the ointment only to dry patches of the skin to
avoid atrophy. All three effects listed (A, B, C) are potential adverse effects of topical
steroids .
Question 6
A client is 24 hours postoperative following a total proctocolectomy with permanent
ileostomy. Which finding should the nurse report to the provider immediately?
, A. The stoma appears pale and dry
B. The stoma appears red and shiny
C. 200 mL of dark green output from the stoma
D. 50 mL of serosanguinous drainage from the stoma
Correct Answer: A
Rationale: If there is adequate blood supply to the stoma, the color is pink or red, and
the stoma is moist due to mucous production. A pale, dry color suggests ischemia of the
stoma or bowel and must be reported immediately. With an ileostomy, the output is
initially a loose, dark green liquid that may contain some blood. The ileostomy usually
begins to drain within 24 hours of surgery at more than one liter per day .
Question 7
A nurse is changing a client's ileostomy appliance and notices the peristomal skin is
irritated. Which action is appropriate before reapplying the appliance?
A. Wash the area with antiseptic soap and water
B. Clean the site with Dakin's solution
C. Use a solid skin barrier
D. Obtain an order for a topical antibiotic
Correct Answer: C
Rationale: Using a solid skin barrier (skin barrier wafer) is appropriate for protecting
irritated peristomal skin. Antiseptic soap (A) and Dakin's solution (B) are too harsh and
can further irritate the skin. Topical antibiotics (D) require an order and are not the first-
line intervention for mild peristomal irritation .
Question 8
A nurse is reviewing medication prescriptions for a patient with type 2 diabetes
undergoing elective surgery. The patient takes metformin 1000 mg twice daily, insulin
glargine 20 units at bedtime, and insulin aspart with meals. Which prescription should
the nurse question?
AND ANSWERS ALREADY GRADED A+. 100% Verified Solutions
| Updated Per Latest Guidelines | Graded A+
SECTION 1: FOUNDATIONS OF ADULT MEDICAL-SURGICAL
NURSING (Questions 1-15)
Question 1
A nurse is caring for a client 24 hours postoperatively following an open
cholecystectomy. The client reports sudden onset of shortness of breath and pleuritic
chest pain. Vital signs: HR 118, RR 28, BP 138/86, SpO2 88% on room air. What is the
priority nursing action?
A. Administer prescribed morphine 2 mg IV
B. Place the client in Trendelenburg position
C. Apply oxygen and notify the provider immediately
D. Encourage the client to cough and deep breathe
Correct Answer: C
Rationale: The client's presentation—sudden dyspnea, pleuritic chest pain, tachycardia,
tachypnea, and hypoxemia—is highly suggestive of pulmonary embolism (PE), a life-
threatening postoperative complication. The priority is to apply oxygen and notify the
provider immediately. Morphine may be ordered later for pain, but oxygenation and
notification are the priority . Coughing and deep breathing (D) would be appropriate for
atelectasis prevention but is insufficient for a suspected PE.
Question 2
A client with heart failure is receiving furosemide 40 mg IV push. Which assessment
finding indicates a therapeutic response to the medication?
A. Decreased heart rate from 110 to 88 bpm
B. Increased urine output of 200 mL in 2 hours
,C. Decreased blood pressure from 148/92 to 130/80 mmHg
D. Clear lung sounds on auscultation
Correct Answer: B
Rationale: Furosemide is a loop diuretic. The primary therapeutic effect is increased
urine output (diuresis), which reduces fluid volume overload. Clear lung sounds (D) and
decreased BP (C) are secondary effects of fluid removal but are not the direct measure
of the medication's therapeutic response . Decreased heart rate (A) may occur but is not
the primary indicator of diuretic effectiveness.
Question 3
A nurse is caring for a client who has a newly inserted chest tube following a
thoracotomy. Which finding requires immediate intervention?
A. Fluctuation of fluid in the water seal chamber with respiration
B. Continuous bubbling in the suction control chamber
C. Continuous bubbling in the water seal chamber
D. Drainage of 75 mL of serosanguineous fluid in the first hour
Correct Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
chest tube system. This requires immediate assessment to locate and seal the leak to
prevent tension pneumothorax. Fluctuation (tidaling) in the water seal chamber (A) is
normal and indicates the system is patent. Bubbling in the suction control chamber (B) is
expected when suction is applied. Drainage of 75 mL (D) is within acceptable limits (up
to 100 mL/hour is acceptable postoperatively) .
Question 4
A nurse is providing teaching to a client with cirrhosis and ascites who has developed
confusion, asterixis, and a serum ammonia of 90 μmol/L. Which medication order
requires clarification before administration?
,A. Lactulose 30 mL orally every 6 hours
B. Rifaximin 550 mg orally twice daily
C. Polyethylene glycol 3350 17 g orally once daily
D. Acetaminophen 650 mg orally every 6 hours as needed for fever
Correct Answer: D
Rationale: Acetaminophen can be hepatotoxic, especially in cirrhosis, and is not the
first-line treatment for fever in hepatic encephalopathy. The client is displaying signs of
hepatic encephalopathy (confusion, asterixis, elevated ammonia). Lactulose (A) and
rifaximin (B) are appropriate treatments to reduce ammonia. Polyethylene glycol (C) may
be used for constipation. Acetaminophen should be used cautiously or avoided .
Question 5
A nurse is assessing a client who has atopic dermatitis and a prescription for
triamcinolone ointment. Which adverse effect should the nurse monitor for?
A. Hypopigmentation
B. Excessive hair growth
C. Thinning of the skin
D. All of the above
Correct Answer: D
Rationale: Topical glucocorticoids such as triamcinolone can cause adverse effects
including thinning of the skin, hypopigmentation, and excessive hair growth
(hypertrichosis). The nurse should apply the ointment only to dry patches of the skin to
avoid atrophy. All three effects listed (A, B, C) are potential adverse effects of topical
steroids .
Question 6
A client is 24 hours postoperative following a total proctocolectomy with permanent
ileostomy. Which finding should the nurse report to the provider immediately?
, A. The stoma appears pale and dry
B. The stoma appears red and shiny
C. 200 mL of dark green output from the stoma
D. 50 mL of serosanguinous drainage from the stoma
Correct Answer: A
Rationale: If there is adequate blood supply to the stoma, the color is pink or red, and
the stoma is moist due to mucous production. A pale, dry color suggests ischemia of the
stoma or bowel and must be reported immediately. With an ileostomy, the output is
initially a loose, dark green liquid that may contain some blood. The ileostomy usually
begins to drain within 24 hours of surgery at more than one liter per day .
Question 7
A nurse is changing a client's ileostomy appliance and notices the peristomal skin is
irritated. Which action is appropriate before reapplying the appliance?
A. Wash the area with antiseptic soap and water
B. Clean the site with Dakin's solution
C. Use a solid skin barrier
D. Obtain an order for a topical antibiotic
Correct Answer: C
Rationale: Using a solid skin barrier (skin barrier wafer) is appropriate for protecting
irritated peristomal skin. Antiseptic soap (A) and Dakin's solution (B) are too harsh and
can further irritate the skin. Topical antibiotics (D) require an order and are not the first-
line intervention for mild peristomal irritation .
Question 8
A nurse is reviewing medication prescriptions for a patient with type 2 diabetes
undergoing elective surgery. The patient takes metformin 1000 mg twice daily, insulin
glargine 20 units at bedtime, and insulin aspart with meals. Which prescription should
the nurse question?
