RN Adult Medical Surgical Proctored Exam
2019 A,B / RN Adult Medical Surgical
Proctored Exam 2019 A,B: Latest
Section 1: Cardiovascular Disorders (Q1–Q22)
Q1. A nurse is assessing a client who has left-sided heart failure. Which of the
following findings should the nurse identify as a manifestation of left-sided heart
failure?
A. Dependent edema
B. Jugular venous distention
C. Frothy sputum
D. Weight gain
Correct Answer: C
Rationale: Frothy sputum, dyspnea, and wheezing are manifestations of left-
sided heart failure due to pulmonary congestion. Dependent edema, JVD, and
weight gain are manifestations of right-sided heart failure resulting from systemic
venous congestion .
Q2. A nurse is caring for a client who has atopic dermatitis and a prescription for
triamcinolone ointment. The nurse should monitor for which of the following
adverse effects?
A. Increased pigmentation
B. Localized hair loss
C. Thinning of the skin
D. Increased sensitivity to the sun
Correct Answer: C
Rationale: Topical glucocorticoid preparations can cause atrophy of the
dermis and epidermis, resulting in thinning of the skin and delayed healing.
,Triamcinolone does not cause photosensitivity; hypopigmentation (not increased
pigmentation) and hypertrichosis (not hair loss) are associated with long-term
glucocorticoid use .
Q3. A nurse is assessing a client who has Cushing's syndrome. Which of the
following findings should the nurse expect?
A. Vitiligo
B. Osteoporosis
C. Myxedema
D. Heat intolerance
Correct Answer: B
Rationale: Osteoporosis is a common finding in Cushing's syndrome due to
mineral loss and nitrogen depletion from excess cortisol. Vitiligo is associated with
adrenal hypofunction, myxedema with hypothyroidism, and heat intolerance with
hyperthyroidism .
Q4. A nurse is providing discharge teaching to a client who has a new prescription
for sublingual nitroglycerin. Which of the following client statements indicates
understanding?
A. "I can keep my medications for 1 year before replacing them."
B. "I should lie down when I take this medication."
C. "I should discontinue this medication if I develop a headache."
D. "I can take up to five tablets in 15 minutes before seeking medical attention."
Correct Answer: B
Rationale: The client should lie down before taking sublingual nitroglycerin
because it can cause hypotension and dizziness. Nitroglycerin tablets expire 6
months after opening. Headache is a common expected effect and is not a reason to
discontinue. The client should take no more than three tablets in 15 minutes before
seeking emergency care .
,Q5. A nurse is planning care for a client following a cardiac catheterization. Which
of the following actions should the nurse take?
A. Keep the client on bed rest for 24 hours
B. Limit the client's fluid intake to 1 L per day
C. Maintain the client's affected extremity in extension
D. Change the client's dressing every 8 hours
Correct Answer: C
Rationale: The affected extremity should be kept straight and in extension to
prevent bleeding at the catheter insertion site. Bed rest is typically 2–6 hours, not
24 hours. Fluids should be encouraged (not restricted) to flush contrast dye. The
dressing is typically an occlusive dressing that remains intact initially .
Q6. A nurse is caring for a client who is scheduled for a mastectomy. The client
states, "I'm not sure I want to have a mastectomy." Which of the following
responses should the nurse make?
A. "I can give you a list of other people who had the same procedure."
B. "You will be cancer-free if you have the procedure."
C. "I can give you additional information about the procedure."
D. "You should get a second opinion regarding the procedure."
Correct Answer: C
Rationale: The nurse should offer additional information to support the
client's informed decision-making without giving false reassurance or unsolicited
advice. Providing a list of other clients violates confidentiality, and guaranteeing a
cure is inaccurate .
Q7. A nurse is caring for a client who has a new prescription for enoxaparin.
Which of the following laboratory values should the nurse monitor?
, A. PT/INR
B. aPTT
C. Platelet count
D. Bleeding time
Correct Answer: C
Rationale: Enoxaparin is a low-molecular-weight heparin that can cause
heparin-induced thrombocytopenia (HIT). Platelet counts should be monitored at
baseline and periodically. PT/INR monitors warfarin, and aPTT monitors
unfractionated heparin .
Q8. A nurse is assessing a client who is postoperative following coronary artery
bypass grafting. Which of the following findings most urgently suggests
impending cardiac tamponade?
A. Muffled heart tones with narrowed pulse pressure and jugular venous distention
B. Bilateral crackles with frothy pink-tinged sputum
C. Sudden tearing chest pain radiating to the back
D. Unilateral calf pain with a positive Homans sign
Correct Answer: A
Rationale: Beck's triad (muffled heart tones, hypotension with narrowed pulse
pressure, and JVD) reflects pericardial fluid compressing the heart. This is the
most immediate post-CABG threat. B indicates pulmonary edema, C suggests
aortic dissection, and D indicates DVT .
Q9. A nurse is teaching a client who has hypertension about dietary modifications.
Which of the following instructions should the nurse include?
A. Increase intake of processed meats
B. Limit sodium intake to less than 2,300 mg/day
C. Add salt to food at the table
D. Increase intake of canned soups
2019 A,B / RN Adult Medical Surgical
Proctored Exam 2019 A,B: Latest
Section 1: Cardiovascular Disorders (Q1–Q22)
Q1. A nurse is assessing a client who has left-sided heart failure. Which of the
following findings should the nurse identify as a manifestation of left-sided heart
failure?
A. Dependent edema
B. Jugular venous distention
C. Frothy sputum
D. Weight gain
Correct Answer: C
Rationale: Frothy sputum, dyspnea, and wheezing are manifestations of left-
sided heart failure due to pulmonary congestion. Dependent edema, JVD, and
weight gain are manifestations of right-sided heart failure resulting from systemic
venous congestion .
Q2. A nurse is caring for a client who has atopic dermatitis and a prescription for
triamcinolone ointment. The nurse should monitor for which of the following
adverse effects?
A. Increased pigmentation
B. Localized hair loss
C. Thinning of the skin
D. Increased sensitivity to the sun
Correct Answer: C
Rationale: Topical glucocorticoid preparations can cause atrophy of the
dermis and epidermis, resulting in thinning of the skin and delayed healing.
,Triamcinolone does not cause photosensitivity; hypopigmentation (not increased
pigmentation) and hypertrichosis (not hair loss) are associated with long-term
glucocorticoid use .
Q3. A nurse is assessing a client who has Cushing's syndrome. Which of the
following findings should the nurse expect?
A. Vitiligo
B. Osteoporosis
C. Myxedema
D. Heat intolerance
Correct Answer: B
Rationale: Osteoporosis is a common finding in Cushing's syndrome due to
mineral loss and nitrogen depletion from excess cortisol. Vitiligo is associated with
adrenal hypofunction, myxedema with hypothyroidism, and heat intolerance with
hyperthyroidism .
Q4. A nurse is providing discharge teaching to a client who has a new prescription
for sublingual nitroglycerin. Which of the following client statements indicates
understanding?
A. "I can keep my medications for 1 year before replacing them."
B. "I should lie down when I take this medication."
C. "I should discontinue this medication if I develop a headache."
D. "I can take up to five tablets in 15 minutes before seeking medical attention."
Correct Answer: B
Rationale: The client should lie down before taking sublingual nitroglycerin
because it can cause hypotension and dizziness. Nitroglycerin tablets expire 6
months after opening. Headache is a common expected effect and is not a reason to
discontinue. The client should take no more than three tablets in 15 minutes before
seeking emergency care .
,Q5. A nurse is planning care for a client following a cardiac catheterization. Which
of the following actions should the nurse take?
A. Keep the client on bed rest for 24 hours
B. Limit the client's fluid intake to 1 L per day
C. Maintain the client's affected extremity in extension
D. Change the client's dressing every 8 hours
Correct Answer: C
Rationale: The affected extremity should be kept straight and in extension to
prevent bleeding at the catheter insertion site. Bed rest is typically 2–6 hours, not
24 hours. Fluids should be encouraged (not restricted) to flush contrast dye. The
dressing is typically an occlusive dressing that remains intact initially .
Q6. A nurse is caring for a client who is scheduled for a mastectomy. The client
states, "I'm not sure I want to have a mastectomy." Which of the following
responses should the nurse make?
A. "I can give you a list of other people who had the same procedure."
B. "You will be cancer-free if you have the procedure."
C. "I can give you additional information about the procedure."
D. "You should get a second opinion regarding the procedure."
Correct Answer: C
Rationale: The nurse should offer additional information to support the
client's informed decision-making without giving false reassurance or unsolicited
advice. Providing a list of other clients violates confidentiality, and guaranteeing a
cure is inaccurate .
Q7. A nurse is caring for a client who has a new prescription for enoxaparin.
Which of the following laboratory values should the nurse monitor?
, A. PT/INR
B. aPTT
C. Platelet count
D. Bleeding time
Correct Answer: C
Rationale: Enoxaparin is a low-molecular-weight heparin that can cause
heparin-induced thrombocytopenia (HIT). Platelet counts should be monitored at
baseline and periodically. PT/INR monitors warfarin, and aPTT monitors
unfractionated heparin .
Q8. A nurse is assessing a client who is postoperative following coronary artery
bypass grafting. Which of the following findings most urgently suggests
impending cardiac tamponade?
A. Muffled heart tones with narrowed pulse pressure and jugular venous distention
B. Bilateral crackles with frothy pink-tinged sputum
C. Sudden tearing chest pain radiating to the back
D. Unilateral calf pain with a positive Homans sign
Correct Answer: A
Rationale: Beck's triad (muffled heart tones, hypotension with narrowed pulse
pressure, and JVD) reflects pericardial fluid compressing the heart. This is the
most immediate post-CABG threat. B indicates pulmonary edema, C suggests
aortic dissection, and D indicates DVT .
Q9. A nurse is teaching a client who has hypertension about dietary modifications.
Which of the following instructions should the nurse include?
A. Increase intake of processed meats
B. Limit sodium intake to less than 2,300 mg/day
C. Add salt to food at the table
D. Increase intake of canned soups
