MEDS_301: Medical-Surgical Nursing Exam
Prep with Detailed Rationales
Course Code: MEDS_301
Course Name: Medical-Surgical Nursing
Topic: Adult Medical Surgical Comprehensive Exam Bank
Academic Year: 2026/2027
1. A nurse is caring for a client with heart failure who presents with acute
dyspnea, jugular venous distension, and bilateral crackles. The provider
prescribes furosemide intravenously. Which finding indicates the
therapeutic response to this medication?
A. Decreased bilateral lung crackles and increased urine output.
B. Elevated blood pressure and increased heart rate.
C. Decreased serum potassium and increased hemoglobin.
D. Weight gain of 2 kg over 24 hours.
CORRECT ANSWER: A. Decreased bilateral lung crackles and increased
urine output.
RATIONALE: Furosemide is a loop diuretic that promotes the excretion of
sodium and water, reducing fluid overload associated with heart failure. A
therapeutic response is evidenced by clear lung sounds (decreased crackles) and
diuresis (increased urine output). Elevated blood pressure, weight gain, and
worsening labs do not reflect therapeutic diuresis. Hypokalemia is an adverse
effect, not a therapeutic goal.
2. A nurse is assessing a client admitted with myocardial infarction (MI). The
client reports substernal chest pressure radiating to the left arm. Which
diagnostic laboratory test is the most specific and sensitive indicator of
myocardial cell damage?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Troponin T or I
D. C-reactive protein (CRP)
, CORRECT ANSWER: C. Troponin T or I
RATIONALE: Troponin is a cardiac-specific protein that remains elevated for
1 to 3 weeks following an MI, making it the gold standard and most
sensitive/specific biomarker for myocardial necrosis. CK-MB is also cardiac-
specific but less sensitive than troponin in the early and late windows. Myoglobin
rises early but lacks cardiac specificity. CRP indicates systemic inflammation
rather than acute cardiac injury.
3. A client with type 1 diabetes mellitus is found unresponsive, cool, and
diaphoretic. A point-of-care blood glucose is 45 mg/dL. Which action is the
immediate priority nursing intervention?
A. Administer regular insulin subcutaneously.
B. Administer 50% dextrose intravenous push as prescribed.
C. Provide an oral carbohydrate and protein snack.
D. Obtain a baseline HbA1c laboratory draw.
CORRECT ANSWER: B. Administer 50% dextrose intravenous push as
prescribed.
RATIONALE: The client is experiencing severe hypoglycemia and is
unresponsive, meaning oral intake is contraindicated due to the risk of aspiration.
The immediate priority is parenteral administration of 50% dextrose intravenous
push. Insulin lowers glucose further and is dangerous here. Oral snacks are safe
only for conscious clients. HbA1c assesses long-term control, not acute
emergencies.
4. A nurse is monitoring a client post-thyroidectomy. The client exhibits
muscle twitching, numbness around the mouth, and a positive Trousseau’s
sign. Which electrolyte imbalance is the underlying cause of these
findings?
A. Hypercalcemia
B. Hyperkalemia
C. Hypocalcemia
D. Hyponatremia
CORRECT ANSWER: C. Hypocalcemia
RATIONALE: Hypocalcemia can occur secondary to inadvertent trauma or
removal of the parathyroid glands during a thyroidectomy. It manifests as
neuromuscular irritability, including circumoral numbness, muscle tetany, and
,positive Trousseau’s and Chvostek’s signs. Hypercalcemia causes lethargy and
muscle weakness. Potassium and sodium alterations do not cause these classic
tetanic symptoms.
5. A client with chronic kidney disease (CKD) has a serum potassium level of
6.2 mEq/L and peaked T waves on the electrocardiogram (ECG). Which
medication should the nurse anticipate administering first to protect the
myocardium?
A. Calcium gluconate intravenous
B. Sodium polystyrene sulfonate oral
C. Regular insulin with dextrose
D. Furosemide intravenous
CORRECT ANSWER: A. Calcium gluconate intravenous
RATIONALE: Severe hyperkalemia with ECG changes (peaked T waves)
requires immediate myocardial membrane stabilization, which is achieved rapidly
by administering calcium gluconate intravenous. While insulin, sodium
polystyrene sulfonate, and loop diuretics actively lower serum potassium levels
over time, calcium acts instantly to protect the heart from lethal dysrhythmias like
ventricular fibrillation.
6. A client presents with acute right lower quadrant abdominal pain, rebound
tenderness, and low-grade fever, suggesting acute appendicitis. Which
diagnostic intervention should the nurse avoid to prevent potential
perforation?
A. Complete blood count with differential
B. Computed tomography (CT) scan of the abdomen
C. Pre-operative warm water enema or laxative administration
D. Abdominal ultrasound
CORRECT ANSWER: C. Pre-operative warm water enema or laxative
administration
RATIONALE: Administering enemas or laxatives to a client with suspected
acute appendicitis increases intraluminal pressure and can lead to acute
appendiceal perforation and peritonitis. Blood work, CT scans, and ultrasound
are safe, standard diagnostic modalities used to confirm inflammation without
physical risk to the organ.
, 7. A nurse is caring for a client with a chest tube attached to a water-seal
system. The nurse notes continuous bubbling in the water-seal chamber.
What is the correct interpretation of this finding?
A. The lung has fully re-expanded.
B. This is a normal, expected physiological finding during expiration.
C. There is an air leak in the chest tube system.
D. The suction control motor is turned off.
CORRECT ANSWER: C. There is an air leak in the chest tube system.
RATIONALE: Continuous bubbling in the water-seal chamber indicates an
air leak in the drainage system or at the insertion site. Intermittent bubbling that
corresponds with exhalation or coughing is normal until the lung re-expands. A
completely stagnant water-seal chamber without bubbling usually indicates lung
re-expansion or an obstruction in the tubing.
8. A client is admitted with diabetic ketoacidosis (DKA). Initial laboratory
results show pH 7.21, serum bicarbonate 14 mEq/L, and blood glucose 420
mg/dL. Which intravenous fluid should the nurse initiate first?
A. 0.9% Sodium chloride (Normal Saline)
B. 5% Dextrose in 0.45% Normal Saline
C. 0.45% Sodium chloride (Half Normal Saline)
D. 5% Dextrose in Water (D5W)
CORRECT ANSWER: A. 0.9% Sodium chloride (Normal Saline)
RATIONALE: The immediate fluid resuscitation goal in diabetic ketoacidosis
(DKA) is to restore intravascular volume and renal perfusion. 0.9% Sodium
chloride (Normal Saline) is infused first. Dextrose-containing solutions are added
later when blood glucose reaches 200 to 250 mg/dL to prevent hypoglycemia and
cerebral edema. Half-normal saline is used after initial isotonic expansion if
sodium levels permit.
9. A client with cirrhosis develops massive ascites and respiratory distress.
The provider performs a paracentesis. Which nursing action is a priority
during or immediately after the procedure?
A. Place the client in a high-Fowler's position.
B. Monitor blood pressure closely for hypovolemic shock.
C. Encourage immediate vigorous ambulation.
D. Infuse 50% dextrose rapidly through a peripheral line.
Prep with Detailed Rationales
Course Code: MEDS_301
Course Name: Medical-Surgical Nursing
Topic: Adult Medical Surgical Comprehensive Exam Bank
Academic Year: 2026/2027
1. A nurse is caring for a client with heart failure who presents with acute
dyspnea, jugular venous distension, and bilateral crackles. The provider
prescribes furosemide intravenously. Which finding indicates the
therapeutic response to this medication?
A. Decreased bilateral lung crackles and increased urine output.
B. Elevated blood pressure and increased heart rate.
C. Decreased serum potassium and increased hemoglobin.
D. Weight gain of 2 kg over 24 hours.
CORRECT ANSWER: A. Decreased bilateral lung crackles and increased
urine output.
RATIONALE: Furosemide is a loop diuretic that promotes the excretion of
sodium and water, reducing fluid overload associated with heart failure. A
therapeutic response is evidenced by clear lung sounds (decreased crackles) and
diuresis (increased urine output). Elevated blood pressure, weight gain, and
worsening labs do not reflect therapeutic diuresis. Hypokalemia is an adverse
effect, not a therapeutic goal.
2. A nurse is assessing a client admitted with myocardial infarction (MI). The
client reports substernal chest pressure radiating to the left arm. Which
diagnostic laboratory test is the most specific and sensitive indicator of
myocardial cell damage?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Troponin T or I
D. C-reactive protein (CRP)
, CORRECT ANSWER: C. Troponin T or I
RATIONALE: Troponin is a cardiac-specific protein that remains elevated for
1 to 3 weeks following an MI, making it the gold standard and most
sensitive/specific biomarker for myocardial necrosis. CK-MB is also cardiac-
specific but less sensitive than troponin in the early and late windows. Myoglobin
rises early but lacks cardiac specificity. CRP indicates systemic inflammation
rather than acute cardiac injury.
3. A client with type 1 diabetes mellitus is found unresponsive, cool, and
diaphoretic. A point-of-care blood glucose is 45 mg/dL. Which action is the
immediate priority nursing intervention?
A. Administer regular insulin subcutaneously.
B. Administer 50% dextrose intravenous push as prescribed.
C. Provide an oral carbohydrate and protein snack.
D. Obtain a baseline HbA1c laboratory draw.
CORRECT ANSWER: B. Administer 50% dextrose intravenous push as
prescribed.
RATIONALE: The client is experiencing severe hypoglycemia and is
unresponsive, meaning oral intake is contraindicated due to the risk of aspiration.
The immediate priority is parenteral administration of 50% dextrose intravenous
push. Insulin lowers glucose further and is dangerous here. Oral snacks are safe
only for conscious clients. HbA1c assesses long-term control, not acute
emergencies.
4. A nurse is monitoring a client post-thyroidectomy. The client exhibits
muscle twitching, numbness around the mouth, and a positive Trousseau’s
sign. Which electrolyte imbalance is the underlying cause of these
findings?
A. Hypercalcemia
B. Hyperkalemia
C. Hypocalcemia
D. Hyponatremia
CORRECT ANSWER: C. Hypocalcemia
RATIONALE: Hypocalcemia can occur secondary to inadvertent trauma or
removal of the parathyroid glands during a thyroidectomy. It manifests as
neuromuscular irritability, including circumoral numbness, muscle tetany, and
,positive Trousseau’s and Chvostek’s signs. Hypercalcemia causes lethargy and
muscle weakness. Potassium and sodium alterations do not cause these classic
tetanic symptoms.
5. A client with chronic kidney disease (CKD) has a serum potassium level of
6.2 mEq/L and peaked T waves on the electrocardiogram (ECG). Which
medication should the nurse anticipate administering first to protect the
myocardium?
A. Calcium gluconate intravenous
B. Sodium polystyrene sulfonate oral
C. Regular insulin with dextrose
D. Furosemide intravenous
CORRECT ANSWER: A. Calcium gluconate intravenous
RATIONALE: Severe hyperkalemia with ECG changes (peaked T waves)
requires immediate myocardial membrane stabilization, which is achieved rapidly
by administering calcium gluconate intravenous. While insulin, sodium
polystyrene sulfonate, and loop diuretics actively lower serum potassium levels
over time, calcium acts instantly to protect the heart from lethal dysrhythmias like
ventricular fibrillation.
6. A client presents with acute right lower quadrant abdominal pain, rebound
tenderness, and low-grade fever, suggesting acute appendicitis. Which
diagnostic intervention should the nurse avoid to prevent potential
perforation?
A. Complete blood count with differential
B. Computed tomography (CT) scan of the abdomen
C. Pre-operative warm water enema or laxative administration
D. Abdominal ultrasound
CORRECT ANSWER: C. Pre-operative warm water enema or laxative
administration
RATIONALE: Administering enemas or laxatives to a client with suspected
acute appendicitis increases intraluminal pressure and can lead to acute
appendiceal perforation and peritonitis. Blood work, CT scans, and ultrasound
are safe, standard diagnostic modalities used to confirm inflammation without
physical risk to the organ.
, 7. A nurse is caring for a client with a chest tube attached to a water-seal
system. The nurse notes continuous bubbling in the water-seal chamber.
What is the correct interpretation of this finding?
A. The lung has fully re-expanded.
B. This is a normal, expected physiological finding during expiration.
C. There is an air leak in the chest tube system.
D. The suction control motor is turned off.
CORRECT ANSWER: C. There is an air leak in the chest tube system.
RATIONALE: Continuous bubbling in the water-seal chamber indicates an
air leak in the drainage system or at the insertion site. Intermittent bubbling that
corresponds with exhalation or coughing is normal until the lung re-expands. A
completely stagnant water-seal chamber without bubbling usually indicates lung
re-expansion or an obstruction in the tubing.
8. A client is admitted with diabetic ketoacidosis (DKA). Initial laboratory
results show pH 7.21, serum bicarbonate 14 mEq/L, and blood glucose 420
mg/dL. Which intravenous fluid should the nurse initiate first?
A. 0.9% Sodium chloride (Normal Saline)
B. 5% Dextrose in 0.45% Normal Saline
C. 0.45% Sodium chloride (Half Normal Saline)
D. 5% Dextrose in Water (D5W)
CORRECT ANSWER: A. 0.9% Sodium chloride (Normal Saline)
RATIONALE: The immediate fluid resuscitation goal in diabetic ketoacidosis
(DKA) is to restore intravascular volume and renal perfusion. 0.9% Sodium
chloride (Normal Saline) is infused first. Dextrose-containing solutions are added
later when blood glucose reaches 200 to 250 mg/dL to prevent hypoglycemia and
cerebral edema. Half-normal saline is used after initial isotonic expansion if
sodium levels permit.
9. A client with cirrhosis develops massive ascites and respiratory distress.
The provider performs a paracentesis. Which nursing action is a priority
during or immediately after the procedure?
A. Place the client in a high-Fowler's position.
B. Monitor blood pressure closely for hypovolemic shock.
C. Encourage immediate vigorous ambulation.
D. Infuse 50% dextrose rapidly through a peripheral line.
