RN Adult Medical-Surgical Nursing Proctored Exam 2026
Educational Assessment & Practice Question Sets
Paper 1: RN Adult Medical-Surgical Nursing Proctored Exam 2026 – Assessment Set A
Part I: Multiple Choice Questions (including NGN Items)
Question 1: A nurse is caring for a client who is 12 hours post-thyroidectomy. The client complains of
numbness and tingling around the mouth and fingers. Which physical assessment should the nurse
perform immediately?
A. Check for Kernig's sign
B. Assess for Chvostek's sign
C. Inspect the surgical site for drainage
D. Perform a Romberg test
Answer & Rationale:
Correct Answer: B
Rationale: Numbness and tingling periorally and in the fingertips are classic early signs of hypocalcemia, caused by
accidental trauma or surgical removal of the parathyroid glands. Tapping the facial nerve (Chvostek's sign) or inflating
a blood pressure cuff (Trousseau's sign) assesses for neuromuscular excitability related to hypocalcemia.
Question 2: A nurse is caring for a client with a chest tube attached to a closed chest drainage system. The
nurse notes continuous bubbling in the water seal chamber. How should the nurse interpret this finding?
A. The system is functioning normally.
B. There is an air leak in the system or patient's thoracic cavity.
C. The lung has fully re-expanded.
D. Suction pressure is set too high.
Answer & Rationale:
Correct Answer: B
Rationale: Intermittent bubbling in the water seal chamber during exhalation, coughing, or sneezing is expected
when a pneumothorax is present. Continuous bubbling indicates an air leak in the system or around the insertion site.
Question 3: A nurse is assessing a client admitted with acute pancreatitis. Which laboratory finding should
the nurse expect to be elevated?
, A. Serum calcium
B. Serum lipase and amylase
C. Serum albumin
D. Red blood cell count
Answer & Rationale:
Correct Answer: B
Rationale: Acute pancreatitis causes pancreatic cell autodigestion, leading to elevated pancreatic enzymes (serum
lipase and amylase). Serum lipase remains elevated for up to 14 days and is more specific to pancreatic injury.
Question 4: [NGN Clinical Scenario] A nurse is caring for a client who underwent a total hip arthroplasty 24
hours ago. The client suddenly reports acute shortness of breath and chest pain upon inspiration, with an
SpO2 dropping to 88% on room air. Which action is the nurse's priority?
A. Administer supplemental oxygen via non-rebreather mask
B. Obtain an immediate 12-lead ECG
C. Notify the orthopedic surgeon
D. Encourage the use of an incentive spirometer
Answer & Rationale:
Correct Answer: A
Rationale: Sudden dyspnea, pleuritic chest pain, and hypoxia following major orthopedic surgery strongly suggest a
pulmonary embolism (PE). Maintaining oxygenation and airway stability is always the immediate priority before
diagnostic testing or reporting.
Question 15: A nurse is preparing to administer IV piggyback potassium chloride 20 mEq in 100 mL normal
saline over 1 hour. Which action is essential prior to initiating the infusion?
A. Verify adequate renal function and urine output
B. Administer an IV bolus of normal saline first
C. Place the client in a Trendelenburg position
D. Warm the solution to body temperature
Answer & Rationale:
Correct Answer: A
Rationale: Potassium is excreted primarily by the kidneys. Administering potassium to a client with oliguria or anuria
can lead to hyperkalemia and lethal cardiac dysrhythmias. Urine output should be verified (>30 mL/hr) prior to
administration.
Educational Assessment & Practice Question Sets
Paper 1: RN Adult Medical-Surgical Nursing Proctored Exam 2026 – Assessment Set A
Part I: Multiple Choice Questions (including NGN Items)
Question 1: A nurse is caring for a client who is 12 hours post-thyroidectomy. The client complains of
numbness and tingling around the mouth and fingers. Which physical assessment should the nurse
perform immediately?
A. Check for Kernig's sign
B. Assess for Chvostek's sign
C. Inspect the surgical site for drainage
D. Perform a Romberg test
Answer & Rationale:
Correct Answer: B
Rationale: Numbness and tingling periorally and in the fingertips are classic early signs of hypocalcemia, caused by
accidental trauma or surgical removal of the parathyroid glands. Tapping the facial nerve (Chvostek's sign) or inflating
a blood pressure cuff (Trousseau's sign) assesses for neuromuscular excitability related to hypocalcemia.
Question 2: A nurse is caring for a client with a chest tube attached to a closed chest drainage system. The
nurse notes continuous bubbling in the water seal chamber. How should the nurse interpret this finding?
A. The system is functioning normally.
B. There is an air leak in the system or patient's thoracic cavity.
C. The lung has fully re-expanded.
D. Suction pressure is set too high.
Answer & Rationale:
Correct Answer: B
Rationale: Intermittent bubbling in the water seal chamber during exhalation, coughing, or sneezing is expected
when a pneumothorax is present. Continuous bubbling indicates an air leak in the system or around the insertion site.
Question 3: A nurse is assessing a client admitted with acute pancreatitis. Which laboratory finding should
the nurse expect to be elevated?
, A. Serum calcium
B. Serum lipase and amylase
C. Serum albumin
D. Red blood cell count
Answer & Rationale:
Correct Answer: B
Rationale: Acute pancreatitis causes pancreatic cell autodigestion, leading to elevated pancreatic enzymes (serum
lipase and amylase). Serum lipase remains elevated for up to 14 days and is more specific to pancreatic injury.
Question 4: [NGN Clinical Scenario] A nurse is caring for a client who underwent a total hip arthroplasty 24
hours ago. The client suddenly reports acute shortness of breath and chest pain upon inspiration, with an
SpO2 dropping to 88% on room air. Which action is the nurse's priority?
A. Administer supplemental oxygen via non-rebreather mask
B. Obtain an immediate 12-lead ECG
C. Notify the orthopedic surgeon
D. Encourage the use of an incentive spirometer
Answer & Rationale:
Correct Answer: A
Rationale: Sudden dyspnea, pleuritic chest pain, and hypoxia following major orthopedic surgery strongly suggest a
pulmonary embolism (PE). Maintaining oxygenation and airway stability is always the immediate priority before
diagnostic testing or reporting.
Question 15: A nurse is preparing to administer IV piggyback potassium chloride 20 mEq in 100 mL normal
saline over 1 hour. Which action is essential prior to initiating the infusion?
A. Verify adequate renal function and urine output
B. Administer an IV bolus of normal saline first
C. Place the client in a Trendelenburg position
D. Warm the solution to body temperature
Answer & Rationale:
Correct Answer: A
Rationale: Potassium is excreted primarily by the kidneys. Administering potassium to a client with oliguria or anuria
can lead to hyperkalemia and lethal cardiac dysrhythmias. Urine output should be verified (>30 mL/hr) prior to
administration.
