Prophecy Relias RN Medical-Surgical Form A Exam
2026/2027 – Questions and Answers | 100% Verified |
Detailed Rationales – Pass Guaranteed – A+ Graded
1. A nurse is assessing a client who is receiving furosemide. Which of the following findings should
the nurse report to the provider immediately?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 138 mEq/L
C) Urine output 60 mL/hr
D) Blood pressure 118/72 mm Hg
Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium loss. A potassium level of 3.1 mEq/L is below
the normal range (3.5–5.0 mEq/L) and places the client at risk for cardiac dysrhythmias, muscle weakness,
and digitalis toxicity. The nurse should notify the provider and anticipate potassium supplementation. The
other findings are within normal limits.
2. A client is admitted with acute decompensated heart failure. Which position should the nurse place
the client in to promote comfort and ease of breathing?
A) Supine
B) High Fowler's
C) Trendelenburg
D) Prone
Answer: B
Rationale: High Fowler's position (head of bed elevated 60–90 degrees) promotes venous return to the
heart, reduces pulmonary congestion, and eases breathing in clients with heart failure. Supine and
Trendelenburg positions worsen pulmonary congestion. Prone position is not appropriate for a client in
respiratory distress.
3. A nurse is teaching a client about a low-sodium diet for hypertension. Which of the following foods
should the nurse instruct the client to avoid?
A) Fresh apples
B) Canned soup
C) Grilled chicken breast
,D) Steamed broccoli
Answer: B
Rationale: Canned soups are high in sodium due to added salt as a preservative. Clients on a low-sodium diet
should avoid processed and canned foods. Fresh fruits, unprocessed meats, and fresh vegetables are low in
sodium. The nurse should teach the client to read nutrition labels and choose low-sodium alternatives.
4. A client is taking warfarin. Which laboratory test should the nurse monitor to evaluate the
effectiveness of the medication?
A) aPTT
B) PT/INR
C) Bleeding time
D) Platelet count
Answer: B
Rationale: Warfarin therapy is monitored using the prothrombin time (PT) and international normalized
ratio (INR). The therapeutic INR for most indications is 2.0–3.0, and 2.5–3.5 for mechanical mitral valves.
aPTT monitors heparin. Bleeding time and platelet count are not used for warfarin monitoring.
5. A client is receiving heparin infusion. Which finding indicates a potential complication?
A) Platelet count drop from 250,000 to 80,000/mm³
B) INR of 2.5
C) Blood pressure 130/80 mm Hg
D) Heart rate 88 beats/min
Answer: A
Rationale: A significant drop in platelet count (30–50% from baseline) after 5–10 days of heparin therapy
suggests heparin-induced thrombocytopenia (HIT). HIT is a life-threatening immune-mediated reaction that
causes thrombosis rather than bleeding. All heparin must be stopped, and a non-heparin anticoagulant
should be started. The other findings are not concerning.
6. A nurse is assessing a client with left-sided heart failure. Which finding should the nurse expect?
A) Jugular venous distention
B) Hepatomegaly
C) Pulmonary crackles
D) Peripheral edema
2
,Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion with crackles, dyspnea, orthopnea, and
paroxysmal nocturnal dyspnea. Right-sided failure causes systemic congestion with jugular venous
distention, hepatomegaly, ascites, and peripheral edema.
7. A client with a myocardial infarction is prescribed morphine. What is the primary purpose of this
medication?
A) To relieve pain and reduce anxiety
B) To prevent platelet aggregation
C) To lower blood pressure
D) To increase heart rate
Answer: A
Rationale: Morphine relieves pain and reduces anxiety in myocardial infarction. It also reduces preload and
afterload through vasodilation. It does not prevent platelet aggregation (aspirin), lower blood pressure as its
primary effect, or increase heart rate.
8. A nurse is caring for a client with a new pacemaker. Which instruction should the nurse include in
discharge teaching?
A) "Avoid using a microwave oven."
B) "Carry a pacemaker identification card at all times."
C) "Perform vigorous arm exercises."
D) "Avoid all physical activity."
Answer: B
Rationale: Clients with pacemakers should carry an identification card at all times in case of emergency.
Microwave ovens are generally safe. Vigorous arm exercises should be avoided initially to prevent lead
dislodgement. Physical activity should be encouraged within limits.
9. A nurse is assessing a client with peripheral arterial disease (PAD). Which finding should the nurse
expect?
A) Warm, edematous extremities
B) Brownish discoloration at the ankles
C) Cool, pale extremities with diminished pulses
D) Bounding pulses
3
, Answer: C
Rationale: PAD causes reduced arterial blood flow, leading to cool, pale extremities, diminished or absent
pulses, hair loss, and shiny skin. Warm, edematous extremities and brownish discoloration suggest venous
insufficiency. Bounding pulses suggest hyperdynamic circulation.
10. A client is admitted with an abdominal aortic aneurysm (AAA). Which finding should the nurse
report immediately?
A) Blood pressure 120/80 mm Hg
B) Pulsatile abdominal mass with bruit
C) Heart rate 80 beats/min
D) Respiratory rate 18 breaths/min
Answer: B
Rationale: A pulsatile abdominal mass with a bruit is characteristic of AAA and should be reported
immediately. It may indicate an expanding or leaking aneurysm. Blood pressure 120/80, heart rate 80, and
respiratory rate 18 are within normal limits.
11. A nurse is caring for a client with deep vein thrombosis (DVT). Which action should the nurse
take?
A) Massage the affected leg
B) Apply warm compresses
C) Maintain bed rest and elevate the affected leg
D) Encourage ambulation
Answer: C
Rationale: For DVT, the nurse should maintain bed rest and elevate the affected leg to reduce swelling and
prevent clot dislodgement. Massaging the leg is contraindicated because it can dislodge the clot and cause
pulmonary embolism. Warm compresses and ambulation are not appropriate until the diagnosis is
confirmed and treatment is initiated.
12. A client is taking digoxin. Which finding indicates digoxin toxicity?
A) Heart rate 80 beats/min
B) Nausea and visual changes
C) Blood pressure 120/80 mm Hg
D) Respiratory rate 18 breaths/min
4
2026/2027 – Questions and Answers | 100% Verified |
Detailed Rationales – Pass Guaranteed – A+ Graded
1. A nurse is assessing a client who is receiving furosemide. Which of the following findings should
the nurse report to the provider immediately?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 138 mEq/L
C) Urine output 60 mL/hr
D) Blood pressure 118/72 mm Hg
Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium loss. A potassium level of 3.1 mEq/L is below
the normal range (3.5–5.0 mEq/L) and places the client at risk for cardiac dysrhythmias, muscle weakness,
and digitalis toxicity. The nurse should notify the provider and anticipate potassium supplementation. The
other findings are within normal limits.
2. A client is admitted with acute decompensated heart failure. Which position should the nurse place
the client in to promote comfort and ease of breathing?
A) Supine
B) High Fowler's
C) Trendelenburg
D) Prone
Answer: B
Rationale: High Fowler's position (head of bed elevated 60–90 degrees) promotes venous return to the
heart, reduces pulmonary congestion, and eases breathing in clients with heart failure. Supine and
Trendelenburg positions worsen pulmonary congestion. Prone position is not appropriate for a client in
respiratory distress.
3. A nurse is teaching a client about a low-sodium diet for hypertension. Which of the following foods
should the nurse instruct the client to avoid?
A) Fresh apples
B) Canned soup
C) Grilled chicken breast
,D) Steamed broccoli
Answer: B
Rationale: Canned soups are high in sodium due to added salt as a preservative. Clients on a low-sodium diet
should avoid processed and canned foods. Fresh fruits, unprocessed meats, and fresh vegetables are low in
sodium. The nurse should teach the client to read nutrition labels and choose low-sodium alternatives.
4. A client is taking warfarin. Which laboratory test should the nurse monitor to evaluate the
effectiveness of the medication?
A) aPTT
B) PT/INR
C) Bleeding time
D) Platelet count
Answer: B
Rationale: Warfarin therapy is monitored using the prothrombin time (PT) and international normalized
ratio (INR). The therapeutic INR for most indications is 2.0–3.0, and 2.5–3.5 for mechanical mitral valves.
aPTT monitors heparin. Bleeding time and platelet count are not used for warfarin monitoring.
5. A client is receiving heparin infusion. Which finding indicates a potential complication?
A) Platelet count drop from 250,000 to 80,000/mm³
B) INR of 2.5
C) Blood pressure 130/80 mm Hg
D) Heart rate 88 beats/min
Answer: A
Rationale: A significant drop in platelet count (30–50% from baseline) after 5–10 days of heparin therapy
suggests heparin-induced thrombocytopenia (HIT). HIT is a life-threatening immune-mediated reaction that
causes thrombosis rather than bleeding. All heparin must be stopped, and a non-heparin anticoagulant
should be started. The other findings are not concerning.
6. A nurse is assessing a client with left-sided heart failure. Which finding should the nurse expect?
A) Jugular venous distention
B) Hepatomegaly
C) Pulmonary crackles
D) Peripheral edema
2
,Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion with crackles, dyspnea, orthopnea, and
paroxysmal nocturnal dyspnea. Right-sided failure causes systemic congestion with jugular venous
distention, hepatomegaly, ascites, and peripheral edema.
7. A client with a myocardial infarction is prescribed morphine. What is the primary purpose of this
medication?
A) To relieve pain and reduce anxiety
B) To prevent platelet aggregation
C) To lower blood pressure
D) To increase heart rate
Answer: A
Rationale: Morphine relieves pain and reduces anxiety in myocardial infarction. It also reduces preload and
afterload through vasodilation. It does not prevent platelet aggregation (aspirin), lower blood pressure as its
primary effect, or increase heart rate.
8. A nurse is caring for a client with a new pacemaker. Which instruction should the nurse include in
discharge teaching?
A) "Avoid using a microwave oven."
B) "Carry a pacemaker identification card at all times."
C) "Perform vigorous arm exercises."
D) "Avoid all physical activity."
Answer: B
Rationale: Clients with pacemakers should carry an identification card at all times in case of emergency.
Microwave ovens are generally safe. Vigorous arm exercises should be avoided initially to prevent lead
dislodgement. Physical activity should be encouraged within limits.
9. A nurse is assessing a client with peripheral arterial disease (PAD). Which finding should the nurse
expect?
A) Warm, edematous extremities
B) Brownish discoloration at the ankles
C) Cool, pale extremities with diminished pulses
D) Bounding pulses
3
, Answer: C
Rationale: PAD causes reduced arterial blood flow, leading to cool, pale extremities, diminished or absent
pulses, hair loss, and shiny skin. Warm, edematous extremities and brownish discoloration suggest venous
insufficiency. Bounding pulses suggest hyperdynamic circulation.
10. A client is admitted with an abdominal aortic aneurysm (AAA). Which finding should the nurse
report immediately?
A) Blood pressure 120/80 mm Hg
B) Pulsatile abdominal mass with bruit
C) Heart rate 80 beats/min
D) Respiratory rate 18 breaths/min
Answer: B
Rationale: A pulsatile abdominal mass with a bruit is characteristic of AAA and should be reported
immediately. It may indicate an expanding or leaking aneurysm. Blood pressure 120/80, heart rate 80, and
respiratory rate 18 are within normal limits.
11. A nurse is caring for a client with deep vein thrombosis (DVT). Which action should the nurse
take?
A) Massage the affected leg
B) Apply warm compresses
C) Maintain bed rest and elevate the affected leg
D) Encourage ambulation
Answer: C
Rationale: For DVT, the nurse should maintain bed rest and elevate the affected leg to reduce swelling and
prevent clot dislodgement. Massaging the leg is contraindicated because it can dislodge the clot and cause
pulmonary embolism. Warm compresses and ambulation are not appropriate until the diagnosis is
confirmed and treatment is initiated.
12. A client is taking digoxin. Which finding indicates digoxin toxicity?
A) Heart rate 80 beats/min
B) Nausea and visual changes
C) Blood pressure 120/80 mm Hg
D) Respiratory rate 18 breaths/min
4
