Medical-Surgical Nursing Comprehensive
Final Exam Review | All Questions And
Solutions (Rationales) | Exam Prep Q&A
2026/2027
1. A nurse is caring for a patient admitted with acute heart failure who suddenly develops
severe dyspnea, bilateral crackles, and an oxygen saturation of 82%. Which action should
the nurse take first?
A. Administer the prescribed oral diuretic.
B. Place the patient in high-Fowler's position and initiate emergency respiratory support.
C. Encourage the patient to ambulate to improve circulation.
D. Obtain a detailed dietary history.
Rationale: The findings suggest acute pulmonary edema with severe hypoxemia. Positioning
the patient upright improves lung expansion, while immediate oxygenation and emergency
assistance address the life-threatening respiratory compromise. Other interventions must not
delay stabilization.
2. A patient with type 1 diabetes mellitus is admitted with vomiting, abdominal pain, deep
rapid respirations, and a fruity breath odor. The blood glucose is 460 mg/dL, and
laboratory results reveal metabolic acidosis. Which condition should the nurse suspect?
A. Hyperosmolar hyperglycemic state
B. Hypoglycemia
C. Diabetic ketoacidosis
D. Syndrome of inappropriate antidiuretic hormone secretion
Rationale: Diabetic ketoacidosis results from severe insulin deficiency, leading to
hyperglycemia, ketone production, and metabolic acidosis. Kussmaul respirations represent
respiratory compensation for acidosis. Treatment typically includes isotonic fluids, insulin,
electrolyte monitoring, and careful potassium management.
3. A nurse is preparing to administer digoxin to a patient with heart failure. The patient's
apical pulse is 52 beats/min, and the patient reports nausea and yellow-green visual
disturbances. What is the most appropriate nursing action?
A. Withhold digoxin and notify the prescribing clinician.
B. Administer the medication with food.
,C. Give an additional dose to improve cardiac output.
D. Encourage the patient to increase dietary sodium.
Rationale: Bradycardia, nausea, and visual disturbances are concerning for digoxin toxicity.
The nurse should withhold the dose, promptly notify the clinician, and anticipate assessment
of renal function, serum electrolytes, and digoxin concentration as indicated.
4. A patient with chronic obstructive pulmonary disease (COPD) arrives with increased
work of breathing and an oxygen saturation of 84%. Which intervention is most
appropriate initially?
A. Withhold oxygen because it may suppress respiratory drive.
B. Administer the highest possible oxygen concentration without reassessment.
C. Encourage the patient to lie flat and rest.
D. Administer controlled supplemental oxygen and titrate according to the prescribed target
and clinical response.
Rationale: Hypoxemia requires prompt treatment, including in patients with COPD. Oxygen
should be titrated and reassessed, commonly targeting 88–92% when hypercapnic respiratory
failure is a concern, unless an individualized target is prescribed. Withholding oxygen is
unsafe.
5. A patient develops sudden facial drooping, right arm weakness, and difficulty speaking.
The symptoms began 35 minutes ago. What is the nurse's priority action?
A. Give the patient oral aspirin immediately.
B. Activate the stroke response pathway and establish the last-known-well time.
C. Wait 30 minutes to determine whether the symptoms resolve.
D. Encourage oral fluids to prevent dehydration.
Rationale: Sudden focal neurological deficits indicate a possible acute stroke. Immediate
stroke-team activation, documentation of the last-known-well time, blood glucose
assessment, and urgent brain imaging are essential. Aspirin and oral intake should not be
initiated before the necessary evaluation, including assessment for hemorrhage and
swallowing safety.
6. A patient with chronic kidney disease has a serum potassium concentration of 6.7
mmol/L and develops peaked T waves on the electrocardiogram. Which prescription
should the nurse anticipate as an immediate priority?
A. Oral potassium supplementation
B. A high-potassium diet
C. Intravenous calcium gluconate for cardiac membrane stabilization
D. Fluid restriction alone
,Rationale: Severe hyperkalemia with electrocardiographic changes creates an immediate risk
of fatal dysrhythmias. Intravenous calcium stabilizes the cardiac membrane but does not
lower serum potassium. Additional treatment is required to shift potassium intracellularly
and remove excess potassium from the body.
7. A patient with suspected appendicitis reports worsening right lower-quadrant pain,
fever, and abdominal rigidity. Which action should the nurse prioritize?
A. Notify the surgical team promptly and prepare for urgent evaluation.
B. Administer a laxative to relieve abdominal pressure.
C. Apply a heating pad directly over the painful area.
D. Encourage a large meal before further assessment.
Rationale: Worsening pain, fever, and rigidity may indicate perforation and peritonitis.
Urgent surgical evaluation is necessary. Laxatives, direct heat, and oral intake may be
inappropriate when an acute surgical abdomen is suspected.
8. A nurse is caring for a patient receiving a continuous intravenous unfractionated
heparin infusion. The patient develops bleeding gums and blood appears in the urine. What
should the nurse do first?
A. Increase the infusion rate to prevent clot formation.
B. Administer the next scheduled dose of aspirin.
C. Encourage ambulation and reassess at the end of the shift.
D. Stop the infusion according to the bleeding-management protocol and obtain immediate
clinical assistance.
Rationale: New bleeding during heparin therapy suggests a potentially significant
anticoagulant complication. The nurse should promptly interrupt the infusion according to
protocol, assess hemodynamic status, notify the clinician, and obtain appropriate laboratory
tests. Protamine may be prescribed for serious bleeding.
9. A patient with pneumonia has a temperature of 39.4°C, blood pressure of 82/48 mmHg,
respiratory rate of 30/min, and new confusion. Which complication is the priority concern?
A. Uncomplicated dehydration
B. Septic shock
C. Chronic respiratory insufficiency
D. Stable community-acquired pneumonia
Rationale: Suspected infection accompanied by hypotension, tachypnea, and altered mental
status indicates possible sepsis with circulatory dysfunction. Immediate escalation,
assessment of perfusion, lactate measurement, prompt antimicrobials, and appropriate
intravenous crystalloid resuscitation are essential. Vasopressors may be required if
hypotension persists.
, 10. A patient with a history of peptic ulcer disease suddenly develops severe generalized
abdominal pain and a rigid abdomen. Which condition should the nurse suspect?
A. Gastroesophageal reflux
B. Uncomplicated constipation
C. Perforated peptic ulcer
D. Irritable bowel syndrome
Rationale: Sudden severe abdominal pain with rigidity suggests perforation and peritoneal
irritation. This is a surgical emergency requiring immediate assessment, urgent provider
notification, and preparation for diagnostic evaluation and possible surgery.
11. A nurse assesses a patient receiving intravenous morphine after abdominal surgery.
The patient is difficult to arouse, has a respiratory rate of 7/min, and an oxygen saturation
of 86%. Which action is most appropriate?
A. Stop further opioid administration, support ventilation, and initiate emergency assistance.
B. Administer the next dose to maintain pain control.
C. Encourage the patient to sleep without interruption.
D. Give an oral sedative to reduce anxiety.
Rationale: Marked sedation, bradypnea, and hypoxemia indicate potentially life-threatening
opioid-induced respiratory depression. Airway support and assisted ventilation take priority.
Naloxone should be administered according to emergency protocols when indicated, with
continued monitoring because respiratory depression can recur.
12. A patient with cirrhosis becomes increasingly confused and develops a flapping tremor
of the hands. The patient's ammonia concentration is elevated. Which treatment should the
nurse anticipate?
A. High-dose potassium supplementation
B. Restriction of all dietary protein indefinitely
C. Administration of an antidiarrheal medication
D. Lactulose therapy with monitoring of mental status and bowel response
Rationale: Confusion and asterixis in cirrhosis suggest hepatic encephalopathy. Lactulose
reduces intestinal ammonia absorption and promotes its elimination through bowel
movements. The dose is adjusted to the prescribed clinical goal, often two to three soft stools
daily, while hydration and electrolyte status are monitored.
13. A patient with diabetes mellitus is awake, able to swallow, and experiencing shakiness
and diaphoresis. The blood glucose is 54 mg/dL. What should the nurse do first?
A. Administer the scheduled insulin dose.
B. Give approximately 15 g of fast-acting carbohydrate and recheck glucose in 15 minutes.
Final Exam Review | All Questions And
Solutions (Rationales) | Exam Prep Q&A
2026/2027
1. A nurse is caring for a patient admitted with acute heart failure who suddenly develops
severe dyspnea, bilateral crackles, and an oxygen saturation of 82%. Which action should
the nurse take first?
A. Administer the prescribed oral diuretic.
B. Place the patient in high-Fowler's position and initiate emergency respiratory support.
C. Encourage the patient to ambulate to improve circulation.
D. Obtain a detailed dietary history.
Rationale: The findings suggest acute pulmonary edema with severe hypoxemia. Positioning
the patient upright improves lung expansion, while immediate oxygenation and emergency
assistance address the life-threatening respiratory compromise. Other interventions must not
delay stabilization.
2. A patient with type 1 diabetes mellitus is admitted with vomiting, abdominal pain, deep
rapid respirations, and a fruity breath odor. The blood glucose is 460 mg/dL, and
laboratory results reveal metabolic acidosis. Which condition should the nurse suspect?
A. Hyperosmolar hyperglycemic state
B. Hypoglycemia
C. Diabetic ketoacidosis
D. Syndrome of inappropriate antidiuretic hormone secretion
Rationale: Diabetic ketoacidosis results from severe insulin deficiency, leading to
hyperglycemia, ketone production, and metabolic acidosis. Kussmaul respirations represent
respiratory compensation for acidosis. Treatment typically includes isotonic fluids, insulin,
electrolyte monitoring, and careful potassium management.
3. A nurse is preparing to administer digoxin to a patient with heart failure. The patient's
apical pulse is 52 beats/min, and the patient reports nausea and yellow-green visual
disturbances. What is the most appropriate nursing action?
A. Withhold digoxin and notify the prescribing clinician.
B. Administer the medication with food.
,C. Give an additional dose to improve cardiac output.
D. Encourage the patient to increase dietary sodium.
Rationale: Bradycardia, nausea, and visual disturbances are concerning for digoxin toxicity.
The nurse should withhold the dose, promptly notify the clinician, and anticipate assessment
of renal function, serum electrolytes, and digoxin concentration as indicated.
4. A patient with chronic obstructive pulmonary disease (COPD) arrives with increased
work of breathing and an oxygen saturation of 84%. Which intervention is most
appropriate initially?
A. Withhold oxygen because it may suppress respiratory drive.
B. Administer the highest possible oxygen concentration without reassessment.
C. Encourage the patient to lie flat and rest.
D. Administer controlled supplemental oxygen and titrate according to the prescribed target
and clinical response.
Rationale: Hypoxemia requires prompt treatment, including in patients with COPD. Oxygen
should be titrated and reassessed, commonly targeting 88–92% when hypercapnic respiratory
failure is a concern, unless an individualized target is prescribed. Withholding oxygen is
unsafe.
5. A patient develops sudden facial drooping, right arm weakness, and difficulty speaking.
The symptoms began 35 minutes ago. What is the nurse's priority action?
A. Give the patient oral aspirin immediately.
B. Activate the stroke response pathway and establish the last-known-well time.
C. Wait 30 minutes to determine whether the symptoms resolve.
D. Encourage oral fluids to prevent dehydration.
Rationale: Sudden focal neurological deficits indicate a possible acute stroke. Immediate
stroke-team activation, documentation of the last-known-well time, blood glucose
assessment, and urgent brain imaging are essential. Aspirin and oral intake should not be
initiated before the necessary evaluation, including assessment for hemorrhage and
swallowing safety.
6. A patient with chronic kidney disease has a serum potassium concentration of 6.7
mmol/L and develops peaked T waves on the electrocardiogram. Which prescription
should the nurse anticipate as an immediate priority?
A. Oral potassium supplementation
B. A high-potassium diet
C. Intravenous calcium gluconate for cardiac membrane stabilization
D. Fluid restriction alone
,Rationale: Severe hyperkalemia with electrocardiographic changes creates an immediate risk
of fatal dysrhythmias. Intravenous calcium stabilizes the cardiac membrane but does not
lower serum potassium. Additional treatment is required to shift potassium intracellularly
and remove excess potassium from the body.
7. A patient with suspected appendicitis reports worsening right lower-quadrant pain,
fever, and abdominal rigidity. Which action should the nurse prioritize?
A. Notify the surgical team promptly and prepare for urgent evaluation.
B. Administer a laxative to relieve abdominal pressure.
C. Apply a heating pad directly over the painful area.
D. Encourage a large meal before further assessment.
Rationale: Worsening pain, fever, and rigidity may indicate perforation and peritonitis.
Urgent surgical evaluation is necessary. Laxatives, direct heat, and oral intake may be
inappropriate when an acute surgical abdomen is suspected.
8. A nurse is caring for a patient receiving a continuous intravenous unfractionated
heparin infusion. The patient develops bleeding gums and blood appears in the urine. What
should the nurse do first?
A. Increase the infusion rate to prevent clot formation.
B. Administer the next scheduled dose of aspirin.
C. Encourage ambulation and reassess at the end of the shift.
D. Stop the infusion according to the bleeding-management protocol and obtain immediate
clinical assistance.
Rationale: New bleeding during heparin therapy suggests a potentially significant
anticoagulant complication. The nurse should promptly interrupt the infusion according to
protocol, assess hemodynamic status, notify the clinician, and obtain appropriate laboratory
tests. Protamine may be prescribed for serious bleeding.
9. A patient with pneumonia has a temperature of 39.4°C, blood pressure of 82/48 mmHg,
respiratory rate of 30/min, and new confusion. Which complication is the priority concern?
A. Uncomplicated dehydration
B. Septic shock
C. Chronic respiratory insufficiency
D. Stable community-acquired pneumonia
Rationale: Suspected infection accompanied by hypotension, tachypnea, and altered mental
status indicates possible sepsis with circulatory dysfunction. Immediate escalation,
assessment of perfusion, lactate measurement, prompt antimicrobials, and appropriate
intravenous crystalloid resuscitation are essential. Vasopressors may be required if
hypotension persists.
, 10. A patient with a history of peptic ulcer disease suddenly develops severe generalized
abdominal pain and a rigid abdomen. Which condition should the nurse suspect?
A. Gastroesophageal reflux
B. Uncomplicated constipation
C. Perforated peptic ulcer
D. Irritable bowel syndrome
Rationale: Sudden severe abdominal pain with rigidity suggests perforation and peritoneal
irritation. This is a surgical emergency requiring immediate assessment, urgent provider
notification, and preparation for diagnostic evaluation and possible surgery.
11. A nurse assesses a patient receiving intravenous morphine after abdominal surgery.
The patient is difficult to arouse, has a respiratory rate of 7/min, and an oxygen saturation
of 86%. Which action is most appropriate?
A. Stop further opioid administration, support ventilation, and initiate emergency assistance.
B. Administer the next dose to maintain pain control.
C. Encourage the patient to sleep without interruption.
D. Give an oral sedative to reduce anxiety.
Rationale: Marked sedation, bradypnea, and hypoxemia indicate potentially life-threatening
opioid-induced respiratory depression. Airway support and assisted ventilation take priority.
Naloxone should be administered according to emergency protocols when indicated, with
continued monitoring because respiratory depression can recur.
12. A patient with cirrhosis becomes increasingly confused and develops a flapping tremor
of the hands. The patient's ammonia concentration is elevated. Which treatment should the
nurse anticipate?
A. High-dose potassium supplementation
B. Restriction of all dietary protein indefinitely
C. Administration of an antidiarrheal medication
D. Lactulose therapy with monitoring of mental status and bowel response
Rationale: Confusion and asterixis in cirrhosis suggest hepatic encephalopathy. Lactulose
reduces intestinal ammonia absorption and promotes its elimination through bowel
movements. The dose is adjusted to the prescribed clinical goal, often two to three soft stools
daily, while hydration and electrolyte status are monitored.
13. A patient with diabetes mellitus is awake, able to swallow, and experiencing shakiness
and diaphoresis. The blood glucose is 54 mg/dL. What should the nurse do first?
A. Administer the scheduled insulin dose.
B. Give approximately 15 g of fast-acting carbohydrate and recheck glucose in 15 minutes.
