NURSING REVISION MASTER SERIES
MEDICAL-SURGICAL NURSING
Medical-Surgical Nursing • Systems Review, Prioritization and Clinical Judgment
200 Multiple-Choice Questions
Four options per question • Correct answer highlighted in green • Rationale highlighted in blue
Designed for BSN-level revision, clinical judgment, and exam practice
How to use this guide
Try each question before looking at the answer. Read every rationale, including for items you answered correctly. Use your
course materials and current clinical guidelines to verify local protocols, drug doses, and policy-dependent procedures. This
resource supports study and does not replace clinical supervision or institutional guidance.
Contents
• Cardiovascular
• Respiratory
• Renal and urinary
• GI and liver
• Endocrine and hematology
• Neurologic
• Perioperative and safety
BSN Nursing Revision • Educational study resource Page 1
,Question 1 | Respiratory
A patient with pneumonia has oxygen saturation 86%, confusion, and increased work of breathing. What is
the priority?
A. Encourage sleep and reassess in four hours.
B. Offer a large meal.
C. Rapid respiratory assessment, oxygen per protocol, and urgent escalation.
D. Discontinue monitoring.
Correct answer: C. Rapid respiratory assessment, oxygen per protocol, and urgent escalation.
Rationale: Hypoxemia, confusion, and increased work of breathing indicate deterioration; support oxygenation and
escalate promptly.
Question 2 | Cardiovascular
Which assessment is most consistent with left-sided heart failure?
A. Pulmonary crackles and orthopnea.
B. Increased visual acuity.
C. Unilateral ear pain.
D. Isolated itchy rash.
Correct answer: A. Pulmonary crackles and orthopnea.
Rationale: Left-sided heart failure commonly causes pulmonary congestion, crackles, dyspnea, and orthopnea.
Question 3 | Renal/cardiovascular
A patient taking a loop diuretic reports weakness and palpitations. Which laboratory value is especially
important?
A. Potassium
B. Hemoglobin A1c only
C. Bilirubin only
D. Amylase only
Correct answer: A. Potassium
Rationale: Loop diuretics can cause hypokalemia, which may cause weakness and dysrhythmias. Assess electrolytes
and ECG as indicated.
BSN Nursing Revision • Educational study resource Page 2
,Question 4 | Gastrointestinal
Which finding in a patient with a possible bowel obstruction needs urgent escalation?
A. Normal appetite and stool.
B. Improved bowel function.
C. Persistent vomiting, abdominal distension, and severe pain.
D. Mild transient burping.
Correct answer: C. Persistent vomiting, abdominal distension, and severe pain.
Rationale: Obstruction can progress to ischemia, perforation, and fluid/electrolyte disturbances. Severe pain, vomiting,
distension, or peritonitis are concerning.
Question 5 | GI/ostomy
Which action is important for a patient with a new colostomy?
A. Cut the pouch opening much larger than the stoma.
B. Assess stoma color, output, peristomal skin, and patient learning needs.
C. Avoid discussing self-care.
D. Assume a dusky stoma is normal.
Correct answer: B. Assess stoma color, output, peristomal skin, and patient learning needs.
Rationale: A healthy stoma is generally pink to red and moist. Dusky, pale, or black tissue needs prompt assessment; fit
the appliance to protect skin.
Question 6 | Renal
A patient with chronic kidney disease should be taught to:
A. Use salt substitutes without checking.
B. Follow individualized advice on sodium, fluids, potassium, phosphorus, and medications.
C. Stop all prescribed medicines.
D. Take NSAIDs freely.
Correct answer: B. Follow individualized advice on sodium, fluids, potassium, phosphorus, and medications.
Rationale: CKD management is individualized to labs, stage, and comorbidities. Avoid nephrotoxins and consult the care
team before supplements or salt substitutes.
Question 7 | Electrolytes
Which clinical finding is typical of hypocalcemia?
A. Markedly increased clotting in every case.
B. Blue sclera as the only sign.
C. Perioral tingling and muscle spasms.
D. No neuromuscular symptoms ever.
Correct answer: C. Perioral tingling and muscle spasms.
Rationale: Low calcium increases neuromuscular excitability, causing tingling, cramps, tetany, or seizures in severe
cases.
BSN Nursing Revision • Educational study resource Page 3
, Question 8 | Cardiovascular
A patient with a suspected acute myocardial infarction should receive which nursing priority?
A. Give an unprescribed medication.
B. Delay ECG until the next shift.
C. Encourage the patient to drive home.
D. Rapid ECG and activation of the appropriate emergency pathway.
Correct answer: D. Rapid ECG and activation of the appropriate emergency pathway.
Rationale: Rapid ECG and protocol-driven assessment support timely reperfusion and management of acute coronary
syndrome.
Question 9 | Neurologic
Which finding can indicate worsening intracranial pressure?
A. Normal conversation.
B. Declining level of consciousness and new pupillary changes.
C. Stable neurologic examination.
D. Improved orientation.
Correct answer: B. Declining level of consciousness and new pupillary changes.
Rationale: A declining level of consciousness is an important early sign of neurologic deterioration; pupillary changes and
abnormal posturing are serious findings.
Question 10 | Neurologic
Which nursing action is appropriate for a patient with a seizure?
A. Put an object in the mouth.
B. Protect from injury, time the seizure, and maintain airway safety; do not restrain.
C. Hold limbs down forcefully.
D. Offer oral medication during convulsions.
Correct answer: B. Protect from injury, time the seizure, and maintain airway safety; do not restrain.
Rationale: During a seizure, protect from injury, time activity, turn to the side when possible, and never place objects in
the mouth or restrain.
Question 11 | Renal/urinary
Which finding suggests an upper urinary tract infection rather than simple cystitis?
A. Mild urgency only.
B. Frequency alone without systemic symptoms.
C. Clear urine after hydration.
D. Fever and flank pain.
Correct answer: D. Fever and flank pain.
Rationale: Pyelonephritis commonly presents with fever, flank pain, and systemic symptoms, requiring prompt evaluation.
BSN Nursing Revision • Educational study resource Page 4
MEDICAL-SURGICAL NURSING
Medical-Surgical Nursing • Systems Review, Prioritization and Clinical Judgment
200 Multiple-Choice Questions
Four options per question • Correct answer highlighted in green • Rationale highlighted in blue
Designed for BSN-level revision, clinical judgment, and exam practice
How to use this guide
Try each question before looking at the answer. Read every rationale, including for items you answered correctly. Use your
course materials and current clinical guidelines to verify local protocols, drug doses, and policy-dependent procedures. This
resource supports study and does not replace clinical supervision or institutional guidance.
Contents
• Cardiovascular
• Respiratory
• Renal and urinary
• GI and liver
• Endocrine and hematology
• Neurologic
• Perioperative and safety
BSN Nursing Revision • Educational study resource Page 1
,Question 1 | Respiratory
A patient with pneumonia has oxygen saturation 86%, confusion, and increased work of breathing. What is
the priority?
A. Encourage sleep and reassess in four hours.
B. Offer a large meal.
C. Rapid respiratory assessment, oxygen per protocol, and urgent escalation.
D. Discontinue monitoring.
Correct answer: C. Rapid respiratory assessment, oxygen per protocol, and urgent escalation.
Rationale: Hypoxemia, confusion, and increased work of breathing indicate deterioration; support oxygenation and
escalate promptly.
Question 2 | Cardiovascular
Which assessment is most consistent with left-sided heart failure?
A. Pulmonary crackles and orthopnea.
B. Increased visual acuity.
C. Unilateral ear pain.
D. Isolated itchy rash.
Correct answer: A. Pulmonary crackles and orthopnea.
Rationale: Left-sided heart failure commonly causes pulmonary congestion, crackles, dyspnea, and orthopnea.
Question 3 | Renal/cardiovascular
A patient taking a loop diuretic reports weakness and palpitations. Which laboratory value is especially
important?
A. Potassium
B. Hemoglobin A1c only
C. Bilirubin only
D. Amylase only
Correct answer: A. Potassium
Rationale: Loop diuretics can cause hypokalemia, which may cause weakness and dysrhythmias. Assess electrolytes
and ECG as indicated.
BSN Nursing Revision • Educational study resource Page 2
,Question 4 | Gastrointestinal
Which finding in a patient with a possible bowel obstruction needs urgent escalation?
A. Normal appetite and stool.
B. Improved bowel function.
C. Persistent vomiting, abdominal distension, and severe pain.
D. Mild transient burping.
Correct answer: C. Persistent vomiting, abdominal distension, and severe pain.
Rationale: Obstruction can progress to ischemia, perforation, and fluid/electrolyte disturbances. Severe pain, vomiting,
distension, or peritonitis are concerning.
Question 5 | GI/ostomy
Which action is important for a patient with a new colostomy?
A. Cut the pouch opening much larger than the stoma.
B. Assess stoma color, output, peristomal skin, and patient learning needs.
C. Avoid discussing self-care.
D. Assume a dusky stoma is normal.
Correct answer: B. Assess stoma color, output, peristomal skin, and patient learning needs.
Rationale: A healthy stoma is generally pink to red and moist. Dusky, pale, or black tissue needs prompt assessment; fit
the appliance to protect skin.
Question 6 | Renal
A patient with chronic kidney disease should be taught to:
A. Use salt substitutes without checking.
B. Follow individualized advice on sodium, fluids, potassium, phosphorus, and medications.
C. Stop all prescribed medicines.
D. Take NSAIDs freely.
Correct answer: B. Follow individualized advice on sodium, fluids, potassium, phosphorus, and medications.
Rationale: CKD management is individualized to labs, stage, and comorbidities. Avoid nephrotoxins and consult the care
team before supplements or salt substitutes.
Question 7 | Electrolytes
Which clinical finding is typical of hypocalcemia?
A. Markedly increased clotting in every case.
B. Blue sclera as the only sign.
C. Perioral tingling and muscle spasms.
D. No neuromuscular symptoms ever.
Correct answer: C. Perioral tingling and muscle spasms.
Rationale: Low calcium increases neuromuscular excitability, causing tingling, cramps, tetany, or seizures in severe
cases.
BSN Nursing Revision • Educational study resource Page 3
, Question 8 | Cardiovascular
A patient with a suspected acute myocardial infarction should receive which nursing priority?
A. Give an unprescribed medication.
B. Delay ECG until the next shift.
C. Encourage the patient to drive home.
D. Rapid ECG and activation of the appropriate emergency pathway.
Correct answer: D. Rapid ECG and activation of the appropriate emergency pathway.
Rationale: Rapid ECG and protocol-driven assessment support timely reperfusion and management of acute coronary
syndrome.
Question 9 | Neurologic
Which finding can indicate worsening intracranial pressure?
A. Normal conversation.
B. Declining level of consciousness and new pupillary changes.
C. Stable neurologic examination.
D. Improved orientation.
Correct answer: B. Declining level of consciousness and new pupillary changes.
Rationale: A declining level of consciousness is an important early sign of neurologic deterioration; pupillary changes and
abnormal posturing are serious findings.
Question 10 | Neurologic
Which nursing action is appropriate for a patient with a seizure?
A. Put an object in the mouth.
B. Protect from injury, time the seizure, and maintain airway safety; do not restrain.
C. Hold limbs down forcefully.
D. Offer oral medication during convulsions.
Correct answer: B. Protect from injury, time the seizure, and maintain airway safety; do not restrain.
Rationale: During a seizure, protect from injury, time activity, turn to the side when possible, and never place objects in
the mouth or restrain.
Question 11 | Renal/urinary
Which finding suggests an upper urinary tract infection rather than simple cystitis?
A. Mild urgency only.
B. Frequency alone without systemic symptoms.
C. Clear urine after hydration.
D. Fever and flank pain.
Correct answer: D. Fever and flank pain.
Rationale: Pyelonephritis commonly presents with fever, flank pain, and systemic symptoms, requiring prompt evaluation.
BSN Nursing Revision • Educational study resource Page 4
