PN ADULT MED SURG 2026 A 101
DETAILED BOARD STYLE QUESTIONS AND
ANSWERS WITH COMPREHENSIVE
RATIONALES AND EXPLANATIONS
1. A nurse is collecting data from a client who is 24 hours
postoperative following a total thyroidectomy. The client
reports a tingling sensation around their mouth and
muscle twitching in their fingers. Which of the following
actions should the nurse take?
A. Instruct the client to breathe into a paper bag to treat
hyperventilation.
B. Assess the client for a positive Chvostek's sign and
notify the charge nurse.
C. Position the client flat in bed with their legs elevated.
D. Administer a prescribed PRN dose of an oral
potassium supplement.
CORRECT ANSWER: B
RATiONAlE: Severe muscle twitching, cramping, and
perioral numbness (paresthesia) are classic signs of
hypocalcemia. This is a known complication of a
thyroidectomy if the parathyroid glands are
accidentally damaged or removed during surgery,
disrupting calcium regulation. Checking for a positive
,Chvostek's sign (facial twitching when tapping the
facial nerve) or Trousseau's sign confirms acute
hypocalcemia, which requires immediate notification
for IV calcium gluconate therapy.
2. A nurse is collecting data from a client who has
chronic peripheral arterial disease (PAD). Which of the
following findings should the nurse expect?
A. Edema around the ankles and lower legs
B. Thick, rough, brown-pigmented skin on the shins
C. Pain in the calves when walking that is relieved by rest
D. Swollen, painful, and warm varicose veins
CORRECT ANSWER: C
RATiONAlE: Intermittent claudication (ischemic muscle pain
in the calves during activity that resolves with rest) is a hallmark
sign of peripheral arterial disease (PAD) due to inadequate
arterial blood flow. Edema, brownish skin discoloration, and
varicose veins are typical findings of chronic venous
insufficiency.
3. A nurse is reinforcing teaching with a client who has a
new prescription for warfarin. Which of the following
instructions should the nurse include?
A. "Increase your intake of dark green leafy vegetables like
spinach."
B. "Use a hard-bristled toothbrush to ensure your gums stay
,healthy."
C. "Take aspirin if you develop a minor headache."
D. "Report any dark, tarry stools or unexplained bruising
immediately."
CORRECT ANSWER: D
RATiONAlE: Dark, tarry stools (melena) and bruising
indicate abnormal bleeding, a major complication of
anticoagulant therapy. Vitamin K reverses warfarin, so green
leafy vegetables must be kept consistent, not increased. Clients
should use soft-bristled toothbrushes and avoid aspirin due to an
increased risk of bleeding.
4. A nurse is checking a client who is 4 hours
postoperative following a cardiac catheterization via the
right femoral artery. Which of the following findings
requires immediate intervention?
A. The client reports mild discomfort at the insertion site.
B. The right dorsalis pedis pulse is 1+ and the left is 3+.
C. The client's blood pressure is 122/74 mmHg.
D. The client is requesting to have the head of the bed elevated to
45 degrees.
CORRECT ANSWER: B
RATiONAlE: A diminished peripheral pulse (1+ compared to
the unaffected leg's 3+) indicates compromised arterial
circulation distal to the insertion site, possibly due to a
hematoma, thrombus, or arterial spasm. The client must keep
the affected leg straight and flat (typically head of bed less than
30 degrees) to prevent bleeding.
, 5. A nurse is collecting data from a client who is
diagnosed with left-sided heart failure. Which of the
following manifestations should the nurse expect?
A. Jugular vein distention (JVD)
B. Dependent pitting edema in the lower extremities
C. Dyspnea, orthopnea, and crackles in the lungs
D. Weight gain and abdominal distention
CORRECT ANSWER: C
RATiONAlE: Left-sided heart failure causes blood to back up
into the pulmonary vasculature, leading to pulmonary
congestion (dyspnea, orthopnea, crackles, cough). JVD,
dependent edema, and abdominal distention (ascites) are
characteristic manifestations of right-sided heart failure.
6. A nurse is reviewing the laboratory results of a client
who is receiving a continuous intravenous heparin
infusion for a deep vein thrombosis (DVT). Which of the
following laboratory values indicates the therapy is
effective?
A. Prothrombin time (PT) of 12 seconds
B. Activated partial thromboplastin time (aPTT) of 65 seconds
C. International Normalized Ratio (INR) of 3.0
D. Platelet count of 95,000/mm³
CORRECT ANSWER: B
RATiONAlE: Heparin efficacy is monitored using the aPTT. A
therapeutic level is generally 1.5 to 2.5 times the normal
reference range (which translates to roughly 60 to 80 seconds).
PT and INR are used to monitor warfarin therapy. A platelet
DETAILED BOARD STYLE QUESTIONS AND
ANSWERS WITH COMPREHENSIVE
RATIONALES AND EXPLANATIONS
1. A nurse is collecting data from a client who is 24 hours
postoperative following a total thyroidectomy. The client
reports a tingling sensation around their mouth and
muscle twitching in their fingers. Which of the following
actions should the nurse take?
A. Instruct the client to breathe into a paper bag to treat
hyperventilation.
B. Assess the client for a positive Chvostek's sign and
notify the charge nurse.
C. Position the client flat in bed with their legs elevated.
D. Administer a prescribed PRN dose of an oral
potassium supplement.
CORRECT ANSWER: B
RATiONAlE: Severe muscle twitching, cramping, and
perioral numbness (paresthesia) are classic signs of
hypocalcemia. This is a known complication of a
thyroidectomy if the parathyroid glands are
accidentally damaged or removed during surgery,
disrupting calcium regulation. Checking for a positive
,Chvostek's sign (facial twitching when tapping the
facial nerve) or Trousseau's sign confirms acute
hypocalcemia, which requires immediate notification
for IV calcium gluconate therapy.
2. A nurse is collecting data from a client who has
chronic peripheral arterial disease (PAD). Which of the
following findings should the nurse expect?
A. Edema around the ankles and lower legs
B. Thick, rough, brown-pigmented skin on the shins
C. Pain in the calves when walking that is relieved by rest
D. Swollen, painful, and warm varicose veins
CORRECT ANSWER: C
RATiONAlE: Intermittent claudication (ischemic muscle pain
in the calves during activity that resolves with rest) is a hallmark
sign of peripheral arterial disease (PAD) due to inadequate
arterial blood flow. Edema, brownish skin discoloration, and
varicose veins are typical findings of chronic venous
insufficiency.
3. A nurse is reinforcing teaching with a client who has a
new prescription for warfarin. Which of the following
instructions should the nurse include?
A. "Increase your intake of dark green leafy vegetables like
spinach."
B. "Use a hard-bristled toothbrush to ensure your gums stay
,healthy."
C. "Take aspirin if you develop a minor headache."
D. "Report any dark, tarry stools or unexplained bruising
immediately."
CORRECT ANSWER: D
RATiONAlE: Dark, tarry stools (melena) and bruising
indicate abnormal bleeding, a major complication of
anticoagulant therapy. Vitamin K reverses warfarin, so green
leafy vegetables must be kept consistent, not increased. Clients
should use soft-bristled toothbrushes and avoid aspirin due to an
increased risk of bleeding.
4. A nurse is checking a client who is 4 hours
postoperative following a cardiac catheterization via the
right femoral artery. Which of the following findings
requires immediate intervention?
A. The client reports mild discomfort at the insertion site.
B. The right dorsalis pedis pulse is 1+ and the left is 3+.
C. The client's blood pressure is 122/74 mmHg.
D. The client is requesting to have the head of the bed elevated to
45 degrees.
CORRECT ANSWER: B
RATiONAlE: A diminished peripheral pulse (1+ compared to
the unaffected leg's 3+) indicates compromised arterial
circulation distal to the insertion site, possibly due to a
hematoma, thrombus, or arterial spasm. The client must keep
the affected leg straight and flat (typically head of bed less than
30 degrees) to prevent bleeding.
, 5. A nurse is collecting data from a client who is
diagnosed with left-sided heart failure. Which of the
following manifestations should the nurse expect?
A. Jugular vein distention (JVD)
B. Dependent pitting edema in the lower extremities
C. Dyspnea, orthopnea, and crackles in the lungs
D. Weight gain and abdominal distention
CORRECT ANSWER: C
RATiONAlE: Left-sided heart failure causes blood to back up
into the pulmonary vasculature, leading to pulmonary
congestion (dyspnea, orthopnea, crackles, cough). JVD,
dependent edema, and abdominal distention (ascites) are
characteristic manifestations of right-sided heart failure.
6. A nurse is reviewing the laboratory results of a client
who is receiving a continuous intravenous heparin
infusion for a deep vein thrombosis (DVT). Which of the
following laboratory values indicates the therapy is
effective?
A. Prothrombin time (PT) of 12 seconds
B. Activated partial thromboplastin time (aPTT) of 65 seconds
C. International Normalized Ratio (INR) of 3.0
D. Platelet count of 95,000/mm³
CORRECT ANSWER: B
RATiONAlE: Heparin efficacy is monitored using the aPTT. A
therapeutic level is generally 1.5 to 2.5 times the normal
reference range (which translates to roughly 60 to 80 seconds).
PT and INR are used to monitor warfarin therapy. A platelet
