RN ADULT MEDICAL SURGICAL NURSING
EXAM QUESTIONS WITH VERIFIED ANSWERS
AND RATIONALES | GRADED A+
A nurse is caring for a client who has a new diagnosis of type 2 diabetes mellitus and
reports difficulty following the diet and remembering to take the prescribed
medication. Which of the following actions should the nurse take to promote client
compliance? (SATA)
A. Ask the dietitian to assist with meal planning
B. Contact the client's support system
C. Assess for age-related cognitive awareness
D. Encourage the use of a daily medication dispenser
E. Provide educational materials for home use - CORRECT ANSWER ✅✅✅A.
Ask the dietitian to assist with meal planning
B. Contact the client's support system
D. Encourage the use of a daily medication dispenser
E. Provide educational materials for home use
A nurse in a health care clinic is evaluating the level of wellness for clients using the
illness-wellness continuum tool. The nurse should identify which of the following
clients as being at the center of the continuum?
A. A college student who has influenza
B. An older adult who has a new diagnosis of type 2 diabetes mellitus
C. A new mother who has a urinary infection
D. A young male who has a long history of well-controlled rheumatoid arthritis -
CORRECT ANSWER ✅✅✅D. A young male who has a long history of well-
controlled rheumatoid arthritis
A nurse is evaluating clients at a health fair for modifiable variables affecting health
and wellness. The nurse should identify which of the following variables as
modifiable? (SATA)
A. Smoking on social occasions
B. BMI of 28
C. Alopecia
D. Trisomy 21
E. History of reflux - CORRECT ANSWER ✅✅✅A. Smoking on social occasions
B. BMI of 28
E. History of reflux
A nurse is caring for a client who was just informed of a new diagnosis of breast
cancer. The nurse evaluates the client's response. Which of the following statements
by the client reflects a lack of understanding of an illness perspective?
,A. "I have no family history of breast cancer."
B. "I need a second opinion. There is no lump."
C. "I am glad we live in the city near several large hospitals."
D. "I will schedule surgery next week, over the holidays." - CORRECT ANSWER
✅✅✅B. "I need a second opinion. There is no lump."
A nurse on a medical-surgical unit is caring for a group of clients. The nurse should
notify the rapid response team for which of the following clients?
A. Client who has a pressure injury of the right heel whose blood glucose is 300
mg/dL
B. Client who reports right calf pain and shortness of breath
C. Client who has blood on a pressure dressing in the femoral area following a
cardiac catheterization
D. Client who has dark red coloration of left toes and absent pedal pulse -
CORRECT ANSWER ✅✅✅B. Client who reports right calf pain and shortness of
breath
A nurse is caring for a client who has ingested a toxic agent. Which of the following
actions should the nurse plan to take? (SATA)
A. Induce vomiting
B. Instill activated charcoal
C. Perform a gastric lavage with aspiration
D. Administer syrup of ipecac
E. Infuse IV fluids - CORRECT ANSWER ✅✅✅B. Instill activated charcoal
C. Perform a gastric lavage with aspiration
E. Infuse IV fluids
A nurse in the emergency department is caring for a client who fell through the ice on
a pond and is unresponsive and breathing slowly. Which of the following actions
should the nurse take? (SATA)
A. Remove wet clothing
B. Maintain normal room temperature
C. Apply warm blankets
D. Use a rapid rewarming water of 40º C (104º to 108º F)
E. Infuse warmed IV fluids - CORRECT ANSWER ✅✅✅A. Remove wet clothing
C. Apply warm blankets
D. Use a rapid rewarming water of 40º C (104º to 108º F)
E. Infuse warmed IV fluids
A nurse in the emergency department is assessing a client who is unresponsive. The
client's partner states, "He was pulling weeds in the yard and slumped to the
ground." Which of the following techniques should the nurse use to open the client's
airway?
A. Head-tilt, chin-lift
,B. Modified jaw thrust
C. Hyperextension of the head
D. Flexion of the head - CORRECT ANSWER ✅✅✅A. Head-tilt, chin-lift
A nurse is reviewing the common emergency management protocol for clients who
have asystole. Which of the following actions should the nurse plan to take during
this cardiac emergency?
A. Perform defibrillation
B. Prepare for transcutaneous pacing
C. Administer IV epinephrine
D. Elevate the client's lower extremities - CORRECT ANSWER ✅✅✅C.
Administer IV epinephrine
A nurse is caring for a client who is postprocedure following lumbar puncture and
reports a throbbing headache when sitting upright. Which of the following actions
should the nurse take? (SATA)
A. Use the Glasgow Coma Scale when assessing the client
B. Assist the client to a supine position
C. Administer an opioid medication
D. Encourage the client to increase fluid intake
E. Instruct the client to perform deep breathing and coughing exercises - CORRECT
ANSWER ✅✅✅B. Assist the client to a supine position
C. Administer an opioid medication
D. Encourage the client to increase fluid intake
A nurse is caring for a client who experienced a traumatic head injury and has an
intraventricular catheter (ventriculostomy) for ICP monitoring. The nurse should
monitor the client for which of the following complications related to the
ventriculostomy?
A. Headache
B. Infection
C. Aphasia
D. Hypertension - CORRECT ANSWER ✅✅✅B. Infection
A nurse is assessing a client for changes in the level of consciousness using the
Glasgow Coma Scale (GCS). The client opens his eyes when spoken to, speaks
incoherently, and moves his extremities when pain is applied. Which of the following
GCS scores should the nurse document?
A. E2 + V3 + M5 = 10
B. E3 +. V4 + M4 = 11
C. E4 + V5 + M6 = 15
D. E2 + V2+ M4 = 8 - CORRECT ANSWER ✅✅✅B. E3 + V4 + M4 = 11
, A nurse is developing a plan of care for a client who is scheduled for cerebral
angiography with contrast media. Which of the following statements by the client
should the nurse report to the provider? (SATA)
A. "I think I might be pregnant."
B. "I take warfarin."
C. "I take antihypertensive medication."
D. "I am allergic to shrimp."
E. "I ate a light breakfast this morning." - CORRECT ANSWER ✅✅✅A. "I think I
might be pregnant."
B. "I take warfarin."
D. "I am allergic to shrimp."
E. "I ate a light breakfast this morning."
A nurse is providing education to a client who is to undergo an
electroencephalogram (EEG) the next day. Which of the following information should
the nurse include in the teaching?
A. "Do not wash your hair the morning of the procedure."
B. "Try to stay awake most of the night prior to the procedure."
C. "The procedure will take approximately 15 minutes."
D. "You will need to lie flat for 4 hours after the procedure." - CORRECT ANSWER
✅✅✅B. "Try to stay awake most of the night prior to the procedure."
A nurse is caring for a client who is experiencing mild acute pain after spraining an
ankle. Which of the following analgesics should the nurse expect to administer?
A. Ketorolac
B. Ketamine
C. Meperidine
D. Methadone - CORRECT ANSWER ✅✅✅A. Ketorolac
A nurse at a clinic is talking with a client who has cancer and takes extended-release
opioids twice daily. The client reports an increase in localized, achy pain over the last
few days. How should the nurse document this increase in pain?
A. Phantom limb pain
B. Mixed pain
C. Breakthrough pain
D. Neuropathic pain - CORRECT ANSWER ✅✅✅C. Breakthrough pain
A nurse is caring for a client who is receiving morphine via a patient-controlled
analgesia (PCA) infusion device after abdominal surgery. Which of the following
client statements indicates that the client understands how to use the device?
A. "I'll wait to use the device until it's absolutely necessary."
B. "I'll be careful about pushing the button so I don't get an overdose."
C. "I should tell the nurse if the pain doesn't stop after I use this device."
EXAM QUESTIONS WITH VERIFIED ANSWERS
AND RATIONALES | GRADED A+
A nurse is caring for a client who has a new diagnosis of type 2 diabetes mellitus and
reports difficulty following the diet and remembering to take the prescribed
medication. Which of the following actions should the nurse take to promote client
compliance? (SATA)
A. Ask the dietitian to assist with meal planning
B. Contact the client's support system
C. Assess for age-related cognitive awareness
D. Encourage the use of a daily medication dispenser
E. Provide educational materials for home use - CORRECT ANSWER ✅✅✅A.
Ask the dietitian to assist with meal planning
B. Contact the client's support system
D. Encourage the use of a daily medication dispenser
E. Provide educational materials for home use
A nurse in a health care clinic is evaluating the level of wellness for clients using the
illness-wellness continuum tool. The nurse should identify which of the following
clients as being at the center of the continuum?
A. A college student who has influenza
B. An older adult who has a new diagnosis of type 2 diabetes mellitus
C. A new mother who has a urinary infection
D. A young male who has a long history of well-controlled rheumatoid arthritis -
CORRECT ANSWER ✅✅✅D. A young male who has a long history of well-
controlled rheumatoid arthritis
A nurse is evaluating clients at a health fair for modifiable variables affecting health
and wellness. The nurse should identify which of the following variables as
modifiable? (SATA)
A. Smoking on social occasions
B. BMI of 28
C. Alopecia
D. Trisomy 21
E. History of reflux - CORRECT ANSWER ✅✅✅A. Smoking on social occasions
B. BMI of 28
E. History of reflux
A nurse is caring for a client who was just informed of a new diagnosis of breast
cancer. The nurse evaluates the client's response. Which of the following statements
by the client reflects a lack of understanding of an illness perspective?
,A. "I have no family history of breast cancer."
B. "I need a second opinion. There is no lump."
C. "I am glad we live in the city near several large hospitals."
D. "I will schedule surgery next week, over the holidays." - CORRECT ANSWER
✅✅✅B. "I need a second opinion. There is no lump."
A nurse on a medical-surgical unit is caring for a group of clients. The nurse should
notify the rapid response team for which of the following clients?
A. Client who has a pressure injury of the right heel whose blood glucose is 300
mg/dL
B. Client who reports right calf pain and shortness of breath
C. Client who has blood on a pressure dressing in the femoral area following a
cardiac catheterization
D. Client who has dark red coloration of left toes and absent pedal pulse -
CORRECT ANSWER ✅✅✅B. Client who reports right calf pain and shortness of
breath
A nurse is caring for a client who has ingested a toxic agent. Which of the following
actions should the nurse plan to take? (SATA)
A. Induce vomiting
B. Instill activated charcoal
C. Perform a gastric lavage with aspiration
D. Administer syrup of ipecac
E. Infuse IV fluids - CORRECT ANSWER ✅✅✅B. Instill activated charcoal
C. Perform a gastric lavage with aspiration
E. Infuse IV fluids
A nurse in the emergency department is caring for a client who fell through the ice on
a pond and is unresponsive and breathing slowly. Which of the following actions
should the nurse take? (SATA)
A. Remove wet clothing
B. Maintain normal room temperature
C. Apply warm blankets
D. Use a rapid rewarming water of 40º C (104º to 108º F)
E. Infuse warmed IV fluids - CORRECT ANSWER ✅✅✅A. Remove wet clothing
C. Apply warm blankets
D. Use a rapid rewarming water of 40º C (104º to 108º F)
E. Infuse warmed IV fluids
A nurse in the emergency department is assessing a client who is unresponsive. The
client's partner states, "He was pulling weeds in the yard and slumped to the
ground." Which of the following techniques should the nurse use to open the client's
airway?
A. Head-tilt, chin-lift
,B. Modified jaw thrust
C. Hyperextension of the head
D. Flexion of the head - CORRECT ANSWER ✅✅✅A. Head-tilt, chin-lift
A nurse is reviewing the common emergency management protocol for clients who
have asystole. Which of the following actions should the nurse plan to take during
this cardiac emergency?
A. Perform defibrillation
B. Prepare for transcutaneous pacing
C. Administer IV epinephrine
D. Elevate the client's lower extremities - CORRECT ANSWER ✅✅✅C.
Administer IV epinephrine
A nurse is caring for a client who is postprocedure following lumbar puncture and
reports a throbbing headache when sitting upright. Which of the following actions
should the nurse take? (SATA)
A. Use the Glasgow Coma Scale when assessing the client
B. Assist the client to a supine position
C. Administer an opioid medication
D. Encourage the client to increase fluid intake
E. Instruct the client to perform deep breathing and coughing exercises - CORRECT
ANSWER ✅✅✅B. Assist the client to a supine position
C. Administer an opioid medication
D. Encourage the client to increase fluid intake
A nurse is caring for a client who experienced a traumatic head injury and has an
intraventricular catheter (ventriculostomy) for ICP monitoring. The nurse should
monitor the client for which of the following complications related to the
ventriculostomy?
A. Headache
B. Infection
C. Aphasia
D. Hypertension - CORRECT ANSWER ✅✅✅B. Infection
A nurse is assessing a client for changes in the level of consciousness using the
Glasgow Coma Scale (GCS). The client opens his eyes when spoken to, speaks
incoherently, and moves his extremities when pain is applied. Which of the following
GCS scores should the nurse document?
A. E2 + V3 + M5 = 10
B. E3 +. V4 + M4 = 11
C. E4 + V5 + M6 = 15
D. E2 + V2+ M4 = 8 - CORRECT ANSWER ✅✅✅B. E3 + V4 + M4 = 11
, A nurse is developing a plan of care for a client who is scheduled for cerebral
angiography with contrast media. Which of the following statements by the client
should the nurse report to the provider? (SATA)
A. "I think I might be pregnant."
B. "I take warfarin."
C. "I take antihypertensive medication."
D. "I am allergic to shrimp."
E. "I ate a light breakfast this morning." - CORRECT ANSWER ✅✅✅A. "I think I
might be pregnant."
B. "I take warfarin."
D. "I am allergic to shrimp."
E. "I ate a light breakfast this morning."
A nurse is providing education to a client who is to undergo an
electroencephalogram (EEG) the next day. Which of the following information should
the nurse include in the teaching?
A. "Do not wash your hair the morning of the procedure."
B. "Try to stay awake most of the night prior to the procedure."
C. "The procedure will take approximately 15 minutes."
D. "You will need to lie flat for 4 hours after the procedure." - CORRECT ANSWER
✅✅✅B. "Try to stay awake most of the night prior to the procedure."
A nurse is caring for a client who is experiencing mild acute pain after spraining an
ankle. Which of the following analgesics should the nurse expect to administer?
A. Ketorolac
B. Ketamine
C. Meperidine
D. Methadone - CORRECT ANSWER ✅✅✅A. Ketorolac
A nurse at a clinic is talking with a client who has cancer and takes extended-release
opioids twice daily. The client reports an increase in localized, achy pain over the last
few days. How should the nurse document this increase in pain?
A. Phantom limb pain
B. Mixed pain
C. Breakthrough pain
D. Neuropathic pain - CORRECT ANSWER ✅✅✅C. Breakthrough pain
A nurse is caring for a client who is receiving morphine via a patient-controlled
analgesia (PCA) infusion device after abdominal surgery. Which of the following
client statements indicates that the client understands how to use the device?
A. "I'll wait to use the device until it's absolutely necessary."
B. "I'll be careful about pushing the button so I don't get an overdose."
C. "I should tell the nurse if the pain doesn't stop after I use this device."
