N108 Med Surg Final Mock Exam | Questions
and Answers with Rationales | 2026/2027
Updated | 100% Correct - Eastwick College.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
98 exam-style multiple-choice questions. Each question includes the correct answer and a complete rationale
for focused revision.
COVERAGE
This comprehensive final mock exam assesses mastery of medical-surgical nursing across the adult lifespan,
emphasizing clinical judgment, evidence-based practice, and safe patient management in acute and complex
care settings. Questions integrate pathophysiology, assessment, pharmacology, and prioritization aligned with
the NCLEX-RN 2026 test plan and QSEN competencies.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 75% (standardized).
HIGHP - Page 1 of 32
,1. A patient with acute decompensated heart failure is prescribed IV furosemide. Which
assessment finding most urgently indicates a need to hold the dose and notify the
provider?
[ ] A. Serum potassium 3.1 mEq/L
[ ] B. Urine output 40 mL/hr
[ ] C. Blood pressure 102/68 mm Hg
[ ] D. Respiratory rate 22 breaths/min
CORRECT: A. Serum potassium 3.1 mEq/L
Loop diuretics like furosemide can cause hypokalemia, and a potassium of 3.1 mEq/L increases the risk of
dysrhythmias; the dose should be held and the provider notified. The other findings are not immediate
contraindications to administration.
2. Which arterial blood gas value is most consistent with uncompensated respiratory
alkalosis?
[ ] A. pH 7.48, PaCO2 30 mm Hg, HCO3- 24 mEq/L
[ ] B. pH 7.30, PaCO2 50 mm Hg, HCO3- 26 mEq/L
[ ] C. pH 7.32, PaCO2 30 mm Hg, HCO3- 18 mEq/L
[ ] D. pH 7.50, PaCO2 48 mm Hg, HCO3- 30 mEq/L
CORRECT: A. pH 7.48, PaCO2 30 mm Hg, HCO3- 24 mEq/L
Uncompensated respiratory alkalosis is characterized by an elevated pH, decreased PaCO2, and normal
HCO3-. Option A shows a pH >7.45, PaCO2 <35, and normal bicarbonate, fitting this pattern. The other
options reflect respiratory acidosis, metabolic acidosis, or metabolic alkalosis.
3. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mm Hg.
Which intervention should the nurse implement first?
[ ] A. Administer mannitol 0.5 g/kg IV as prescribed
[ ] B. Elevate the head of the bed to 30 degrees
[ ] C. Perform endotracheal suctioning to clear secretions
[ ] D. Increase the rate of the prescribed IV normal saline infusion
CORRECT: B. Elevate the head of the bed to 30 degrees
Elevating the head of the bed to 30 degrees promotes venous drainage and can rapidly lower ICP. Mannitol is
appropriate but not the first immediate action; suctioning can increase ICP; and increasing IV fluids may
worsen cerebral edema.
4. Which finding in a patient with acute pancreatitis requires immediate nursing
intervention?
[ ] A. Serum lipase 350 U/L
HIGHP - Page 2 of 32
, [ ] B. Heart rate 118 beats/min and blood pressure 88/54 mm Hg
[ ] C. Nausea and vomiting after oral intake
[ ] D. Grey Turner's sign on the flank
CORRECT: B. Heart rate 118 beats/min and blood pressure 88/54 mm Hg
Tachycardia and hypotension suggest hypovolemic shock due to third-spacing, a life-threatening complication
of acute pancreatitis. The other findings are common but do not require immediate intervention.
5. A patient with chronic kidney disease has a hemoglobin of 9.2 g/dL and is prescribed
epoetin alfa. Which laboratory value must the nurse monitor most closely during therapy?
[ ] A. Serum potassium
[ ] B. Serum creatinine
[ ] C. Hemoglobin and hematocrit
[ ] D. White blood cell count
CORRECT: C. Hemoglobin and hematocrit
Epoetin alfa stimulates erythropoiesis, and the therapeutic goal is to increase hemoglobin to 10-12 g/dL;
exceeding this increases thrombotic risk. Monitoring hemoglobin and hematocrit is essential to adjust dosage
and prevent complications.
6. Which assessment finding in a patient with a below-the-knee amputation indicates
possible compartment syndrome?
[ ] A. Pain relieved by opioid administration
[ ] B. Pulse present but diminished
[ ] C. Severe pain out of proportion to the injury, worsened by passive stretch
[ ] D. Mild swelling at the surgical site
CORRECT: C. Severe pain out of proportion to the injury, worsened by passive stretch
Compartment syndrome is characterized by severe, unrelenting pain that is exacerbated by passive stretch
of the affected muscles, often unrelieved by opioids. Diminished pulses are a late finding; mild swelling and
pain relieved by opioids are not indicative.
7. A patient is receiving a blood transfusion and develops fever, chills, and flank pain.
Which action should the nurse take first?
[ ] A. Slow the transfusion rate
[ ] B. Administer acetaminophen as prescribed
[ ] C. Stop the transfusion immediately
[ ] D. Obtain a urine specimen for hemoglobinuria
HIGHP - Page 3 of 32
, CORRECT: C. Stop the transfusion immediately
These symptoms suggest an acute hemolytic transfusion reaction, which requires immediate cessation of the
transfusion to prevent further hemolysis and potential renal failure. Slowing the rate or treating symptoms
without stopping the transfusion is unsafe.
8. A patient with type 1 diabetes has a blood glucose of 42 mg/dL and is unresponsive.
Which intervention is the priority?
[ ] A. Administer 50% dextrose IV per protocol
[ ] B. Give 15 g of oral glucose gel
[ ] C. Administer glucagon subcutaneously
[ ] D. Recheck blood glucose in 15 minutes
CORRECT: A. Administer 50% dextrose IV per protocol
For an unresponsive patient with hypoglycemia, IV dextrose is the fastest and most reliable treatment. Oral
glucose is contraindicated due to aspiration risk; glucagon is an alternative if IV access is unavailable;
rechecking delays treatment.
9. A patient with a new colostomy has a dusky, edematous stoma. What is the nurse's
priority action?
[ ] A. Document the finding as normal post-operative appearance
[ ] B. Notify the surgeon immediately
[ ] C. Apply a tight ostomy pouch to reduce swelling
[ ] D. Gently cleanse the stoma with hydrogen peroxide
CORRECT: B. Notify the surgeon immediately
A dusky, edematous stoma may indicate ischemia and requires immediate surgical evaluation. Normal
stomas are pink to red and moist; cleansing with hydrogen peroxide is contraindicated as it can damage
tissue.
10. A patient with acute decompensated heart failure is receiving furosemide. Which
assessment finding most specifically indicates that the diuretic has produced effective
decongestion rather than merely a fluid shift?
[ ] A. Urine output of 1.5 L over the past 8 hours
[ ] B. Reduction in jugular venous pressure from 14 to 7 cm H2O
[ ] C. Weight loss of 1.2 kg since admission
[ ] D. Serum potassium decrease from 4.0 to 3.4 mEq/L
CORRECT: B. Reduction in jugular venous pressure from 14 to 7 cm H2O
Jugular venous pressure directly reflects right-heart filling pressure and volume status; a fall to 8 cm H2O is
HIGHP - Page 4 of 32
and Answers with Rationales | 2026/2027
Updated | 100% Correct - Eastwick College.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
98 exam-style multiple-choice questions. Each question includes the correct answer and a complete rationale
for focused revision.
COVERAGE
This comprehensive final mock exam assesses mastery of medical-surgical nursing across the adult lifespan,
emphasizing clinical judgment, evidence-based practice, and safe patient management in acute and complex
care settings. Questions integrate pathophysiology, assessment, pharmacology, and prioritization aligned with
the NCLEX-RN 2026 test plan and QSEN competencies.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 75% (standardized).
HIGHP - Page 1 of 32
,1. A patient with acute decompensated heart failure is prescribed IV furosemide. Which
assessment finding most urgently indicates a need to hold the dose and notify the
provider?
[ ] A. Serum potassium 3.1 mEq/L
[ ] B. Urine output 40 mL/hr
[ ] C. Blood pressure 102/68 mm Hg
[ ] D. Respiratory rate 22 breaths/min
CORRECT: A. Serum potassium 3.1 mEq/L
Loop diuretics like furosemide can cause hypokalemia, and a potassium of 3.1 mEq/L increases the risk of
dysrhythmias; the dose should be held and the provider notified. The other findings are not immediate
contraindications to administration.
2. Which arterial blood gas value is most consistent with uncompensated respiratory
alkalosis?
[ ] A. pH 7.48, PaCO2 30 mm Hg, HCO3- 24 mEq/L
[ ] B. pH 7.30, PaCO2 50 mm Hg, HCO3- 26 mEq/L
[ ] C. pH 7.32, PaCO2 30 mm Hg, HCO3- 18 mEq/L
[ ] D. pH 7.50, PaCO2 48 mm Hg, HCO3- 30 mEq/L
CORRECT: A. pH 7.48, PaCO2 30 mm Hg, HCO3- 24 mEq/L
Uncompensated respiratory alkalosis is characterized by an elevated pH, decreased PaCO2, and normal
HCO3-. Option A shows a pH >7.45, PaCO2 <35, and normal bicarbonate, fitting this pattern. The other
options reflect respiratory acidosis, metabolic acidosis, or metabolic alkalosis.
3. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mm Hg.
Which intervention should the nurse implement first?
[ ] A. Administer mannitol 0.5 g/kg IV as prescribed
[ ] B. Elevate the head of the bed to 30 degrees
[ ] C. Perform endotracheal suctioning to clear secretions
[ ] D. Increase the rate of the prescribed IV normal saline infusion
CORRECT: B. Elevate the head of the bed to 30 degrees
Elevating the head of the bed to 30 degrees promotes venous drainage and can rapidly lower ICP. Mannitol is
appropriate but not the first immediate action; suctioning can increase ICP; and increasing IV fluids may
worsen cerebral edema.
4. Which finding in a patient with acute pancreatitis requires immediate nursing
intervention?
[ ] A. Serum lipase 350 U/L
HIGHP - Page 2 of 32
, [ ] B. Heart rate 118 beats/min and blood pressure 88/54 mm Hg
[ ] C. Nausea and vomiting after oral intake
[ ] D. Grey Turner's sign on the flank
CORRECT: B. Heart rate 118 beats/min and blood pressure 88/54 mm Hg
Tachycardia and hypotension suggest hypovolemic shock due to third-spacing, a life-threatening complication
of acute pancreatitis. The other findings are common but do not require immediate intervention.
5. A patient with chronic kidney disease has a hemoglobin of 9.2 g/dL and is prescribed
epoetin alfa. Which laboratory value must the nurse monitor most closely during therapy?
[ ] A. Serum potassium
[ ] B. Serum creatinine
[ ] C. Hemoglobin and hematocrit
[ ] D. White blood cell count
CORRECT: C. Hemoglobin and hematocrit
Epoetin alfa stimulates erythropoiesis, and the therapeutic goal is to increase hemoglobin to 10-12 g/dL;
exceeding this increases thrombotic risk. Monitoring hemoglobin and hematocrit is essential to adjust dosage
and prevent complications.
6. Which assessment finding in a patient with a below-the-knee amputation indicates
possible compartment syndrome?
[ ] A. Pain relieved by opioid administration
[ ] B. Pulse present but diminished
[ ] C. Severe pain out of proportion to the injury, worsened by passive stretch
[ ] D. Mild swelling at the surgical site
CORRECT: C. Severe pain out of proportion to the injury, worsened by passive stretch
Compartment syndrome is characterized by severe, unrelenting pain that is exacerbated by passive stretch
of the affected muscles, often unrelieved by opioids. Diminished pulses are a late finding; mild swelling and
pain relieved by opioids are not indicative.
7. A patient is receiving a blood transfusion and develops fever, chills, and flank pain.
Which action should the nurse take first?
[ ] A. Slow the transfusion rate
[ ] B. Administer acetaminophen as prescribed
[ ] C. Stop the transfusion immediately
[ ] D. Obtain a urine specimen for hemoglobinuria
HIGHP - Page 3 of 32
, CORRECT: C. Stop the transfusion immediately
These symptoms suggest an acute hemolytic transfusion reaction, which requires immediate cessation of the
transfusion to prevent further hemolysis and potential renal failure. Slowing the rate or treating symptoms
without stopping the transfusion is unsafe.
8. A patient with type 1 diabetes has a blood glucose of 42 mg/dL and is unresponsive.
Which intervention is the priority?
[ ] A. Administer 50% dextrose IV per protocol
[ ] B. Give 15 g of oral glucose gel
[ ] C. Administer glucagon subcutaneously
[ ] D. Recheck blood glucose in 15 minutes
CORRECT: A. Administer 50% dextrose IV per protocol
For an unresponsive patient with hypoglycemia, IV dextrose is the fastest and most reliable treatment. Oral
glucose is contraindicated due to aspiration risk; glucagon is an alternative if IV access is unavailable;
rechecking delays treatment.
9. A patient with a new colostomy has a dusky, edematous stoma. What is the nurse's
priority action?
[ ] A. Document the finding as normal post-operative appearance
[ ] B. Notify the surgeon immediately
[ ] C. Apply a tight ostomy pouch to reduce swelling
[ ] D. Gently cleanse the stoma with hydrogen peroxide
CORRECT: B. Notify the surgeon immediately
A dusky, edematous stoma may indicate ischemia and requires immediate surgical evaluation. Normal
stomas are pink to red and moist; cleansing with hydrogen peroxide is contraindicated as it can damage
tissue.
10. A patient with acute decompensated heart failure is receiving furosemide. Which
assessment finding most specifically indicates that the diuretic has produced effective
decongestion rather than merely a fluid shift?
[ ] A. Urine output of 1.5 L over the past 8 hours
[ ] B. Reduction in jugular venous pressure from 14 to 7 cm H2O
[ ] C. Weight loss of 1.2 kg since admission
[ ] D. Serum potassium decrease from 4.0 to 3.4 mEq/L
CORRECT: B. Reduction in jugular venous pressure from 14 to 7 cm H2O
Jugular venous pressure directly reflects right-heart filling pressure and volume status; a fall to 8 cm H2O is
HIGHP - Page 4 of 32
