APEA Med-Surg Testbank 2025 – 150 Questions with
Rationales & Clinical Scenarios
1. A 58-year-old patient with type 2 diabetes presents with fruity breath, nausea, and
rapid breathing. Blood glucose is 380 mg/dL. What is the priority nursing action?
A. Administer rapid-acting insulin as prescribed
B. Encourage oral fluids
C. Call dietary services
D. Monitor vital signs only
Answer: A
Rationale: The patient shows signs of diabetic ketoacidosis (DKA). Rapid-acting insulin
is essential to lower blood glucose and prevent life-threatening complications.
2. Normal adult fasting blood glucose is:
A. 70–100 mg/dL
B. 110–150 mg/dL
C. 50–70 mg/dL
D. 120–140 mg/dL
Answer: A
Rationale: Fasting glucose levels above 100 mg/dL may indicate hyperglycemia or
diabetes.
3. A 72-year-old patient with chronic heart failure reports sudden shortness of breath
and pink frothy sputum. Which action should the nurse take first?
A. Place the patient in high-Fowler’s position
B. Administer diuretics
C. Monitor oxygen saturation
D. Encourage ambulation
Answer: A
,Rationale: High-Fowler’s improves oxygenation by reducing venous return and
alleviating pulmonary edema.
4. A 30-year-old postpartum patient reports severe headache and visual disturbances.
BP is 180/110 mmHg. What is the nurse’s priority intervention?
A. Administer antihypertensive medication as prescribed
B. Provide oral fluids
C. Encourage rest
D. Monitor temperature
Answer: A
Rationale: The patient shows signs of postpartum preeclampsia; controlling blood
pressure is critical to prevent stroke or seizure.
5. Which lab value is most concerning for a patient with chronic kidney disease?
A. Potassium 6.2 mmol/L
B. Sodium 140 mmol/L
C. Calcium 9.5 mg/dL
D. Glucose 100 mg/dL
Answer: A
Rationale: Hyperkalemia can lead to life-threatening arrhythmias; immediate
intervention is necessary.
6. A 35-year-old patient with asthma presents with severe wheezing and accessory
muscle use. Priority nursing action?
A. Administer short-acting bronchodilator
B. Place the patient in supine position
C. Encourage deep breathing
D. Monitor oxygen saturation only
Answer: A
,Rationale: Acute bronchospasm requires rapid bronchodilation to improve airway
patency.
7. Which of the following is a sign of hypoglycemia?
A. Sweating, shakiness, confusion
B. Fruity breath, nausea
C. Polyuria and polydipsia
D. Hyperventilation
Answer: A
Rationale: Hypoglycemia presents with autonomic symptoms and CNS effects.
8. Normal adult respiratory rate is:
A. 12–20 breaths/min
B. 8–12 breaths/min
C. 20–30 breaths/min
D. 30–40 breaths/min
Answer: A
Rationale: Normal adult respiratory rate ranges from 12–20 breaths/min.
9. A patient presents with sudden left-sided weakness and slurred speech. Which action
is most important initially?
A. Ensure patient safety and prevent falls
B. Administer aspirin
C. Encourage ambulation
D. Give oral fluids
Answer: A
Rationale: Safety is the priority due to neurological deficits from a possible stroke.
, 10. A 40-year-old patient post-MI reports chest pain 30 minutes after nitroglycerin
administration. First nursing action?
A. Notify the physician immediately
B. Encourage ambulation
C. Give oral fluids
D. Monitor vital signs only
Answer: A
Rationale: Persistent chest pain after nitroglycerin may indicate ongoing ischemia;
urgent evaluation is required.
11. Which lab indicates renal impairment?
A. Elevated BUN and creatinine
B. Low potassium
C. High calcium
D. Low sodium
Answer: A
Rationale: Impaired kidney function leads to accumulation of nitrogenous waste
products.
12. A patient with COPD presents with increasing shortness of breath and wheezing.
First intervention?
A. Administer short-acting bronchodilator
B. Place supine
C. Monitor only
D. Encourage ambulation
Answer: A
Rationale: Bronchodilators relieve acute airway constriction.
Rationales & Clinical Scenarios
1. A 58-year-old patient with type 2 diabetes presents with fruity breath, nausea, and
rapid breathing. Blood glucose is 380 mg/dL. What is the priority nursing action?
A. Administer rapid-acting insulin as prescribed
B. Encourage oral fluids
C. Call dietary services
D. Monitor vital signs only
Answer: A
Rationale: The patient shows signs of diabetic ketoacidosis (DKA). Rapid-acting insulin
is essential to lower blood glucose and prevent life-threatening complications.
2. Normal adult fasting blood glucose is:
A. 70–100 mg/dL
B. 110–150 mg/dL
C. 50–70 mg/dL
D. 120–140 mg/dL
Answer: A
Rationale: Fasting glucose levels above 100 mg/dL may indicate hyperglycemia or
diabetes.
3. A 72-year-old patient with chronic heart failure reports sudden shortness of breath
and pink frothy sputum. Which action should the nurse take first?
A. Place the patient in high-Fowler’s position
B. Administer diuretics
C. Monitor oxygen saturation
D. Encourage ambulation
Answer: A
,Rationale: High-Fowler’s improves oxygenation by reducing venous return and
alleviating pulmonary edema.
4. A 30-year-old postpartum patient reports severe headache and visual disturbances.
BP is 180/110 mmHg. What is the nurse’s priority intervention?
A. Administer antihypertensive medication as prescribed
B. Provide oral fluids
C. Encourage rest
D. Monitor temperature
Answer: A
Rationale: The patient shows signs of postpartum preeclampsia; controlling blood
pressure is critical to prevent stroke or seizure.
5. Which lab value is most concerning for a patient with chronic kidney disease?
A. Potassium 6.2 mmol/L
B. Sodium 140 mmol/L
C. Calcium 9.5 mg/dL
D. Glucose 100 mg/dL
Answer: A
Rationale: Hyperkalemia can lead to life-threatening arrhythmias; immediate
intervention is necessary.
6. A 35-year-old patient with asthma presents with severe wheezing and accessory
muscle use. Priority nursing action?
A. Administer short-acting bronchodilator
B. Place the patient in supine position
C. Encourage deep breathing
D. Monitor oxygen saturation only
Answer: A
,Rationale: Acute bronchospasm requires rapid bronchodilation to improve airway
patency.
7. Which of the following is a sign of hypoglycemia?
A. Sweating, shakiness, confusion
B. Fruity breath, nausea
C. Polyuria and polydipsia
D. Hyperventilation
Answer: A
Rationale: Hypoglycemia presents with autonomic symptoms and CNS effects.
8. Normal adult respiratory rate is:
A. 12–20 breaths/min
B. 8–12 breaths/min
C. 20–30 breaths/min
D. 30–40 breaths/min
Answer: A
Rationale: Normal adult respiratory rate ranges from 12–20 breaths/min.
9. A patient presents with sudden left-sided weakness and slurred speech. Which action
is most important initially?
A. Ensure patient safety and prevent falls
B. Administer aspirin
C. Encourage ambulation
D. Give oral fluids
Answer: A
Rationale: Safety is the priority due to neurological deficits from a possible stroke.
, 10. A 40-year-old patient post-MI reports chest pain 30 minutes after nitroglycerin
administration. First nursing action?
A. Notify the physician immediately
B. Encourage ambulation
C. Give oral fluids
D. Monitor vital signs only
Answer: A
Rationale: Persistent chest pain after nitroglycerin may indicate ongoing ischemia;
urgent evaluation is required.
11. Which lab indicates renal impairment?
A. Elevated BUN and creatinine
B. Low potassium
C. High calcium
D. Low sodium
Answer: A
Rationale: Impaired kidney function leads to accumulation of nitrogenous waste
products.
12. A patient with COPD presents with increasing shortness of breath and wheezing.
First intervention?
A. Administer short-acting bronchodilator
B. Place supine
C. Monitor only
D. Encourage ambulation
Answer: A
Rationale: Bronchodilators relieve acute airway constriction.
