ELSEVIER SIMULATION EXAM
MULTIPLE CHOICE QUESTIONS WITH
DETAILED RATIONALES
Questions: 75 multiple-choice and alternate-format items.
Format: Questions with a detailed rationale
Topics: Prioritization, Pharmacology, Fluid & Electrolytes, Cardiac, Respiratory,
Leadership, and Safety.
Elsevier Simulation Exam: Medical-Surgical Nursing
Instructions: Choose the best answer for each question.
1. A nurse is caring for a patient who is 1-hour post-operative following a
transurethral resection of the prostate (TURP). The patient has a continuous
bladder irrigation (CBI) system in place. The nurse observes the urine output is
bright red with multiple large clots, and the drainage bag is filling rapidly. What is
the nurse's priority action?
a) Manually irrigate the catheter.
b) Increase the flow rate of the irrigation fluid.
c) Notify the healthcare provider immediately.
d) Document the findings and continue to monitor.
*Answer: a) Manually irrigate the catheter. *
Rationale: The priority is to maintain catheter patency. Bright red urine with clots and
rapid filling indicates potential catheter occlusion by clots. If the catheter blocks, bladder
,distention can occur, leading to pain, hemorrhage, and increased pressure. The nurse
should first attempt to manually irrigate the catheter to clear the obstruction and restore
drainage. Increasing irrigation flow (b) may help prevent clots but is not the priority if clots
are already occluding. Notification (c) is necessary if irrigation is unsuccessful.
Documentation (d) is important but not the priority action in this escalating situation.
2. The nurse is assessing a patient with heart failure who has been prescribed
furosemide (Lasix) 40 mg IV push. Which laboratory value is most important for
the nurse to review prior to medication administration?
a) Hemoglobin and Hematocrit
b) Serum Potassium
c) Serum Sodium
d) BUN and Creatinine
*Answer: b) Serum Potassium *
*Rationale: Furosemide is a loop diuretic that causes significant excretion of potassium.
Hypokalemia is a common and dangerous side effect that can lead to life-threatening
dysrhythmias. The nurse must review the potassium level to ensure it is not low (< 3.5
mEq/L) before administering the dose. While BUN/Creatinine (d) are important for
assessing renal function and the drug's efficacy, the immediate safety check involves
potassium.*
3. A patient with a new diagnosis of type 1 diabetes mellitus is learning to self-
administer insulin. After the nurse teaches the patient how to mix regular and
NPH insulin in the same syringe, which patient action indicates correct
understanding?
a) Injects air into the NPH vial first, then withdraws the NPH.
b) Injects air into the NPH vial, then injects air into the regular vial and
withdraws the regular insulin first.
c) Injects air into the regular vial first, then withdraws the regular insulin.
, d) Withdraws the NPH insulin first, then withdraws the regular insulin.
*Answer: b) Injects air into the NPH vial, then injects air into the regular vial and
withdraws the regular insulin first. *
Rationale: The correct order (using the "clear before cloudy" principle) is to inject air equal
to the total dose into the NPH (cloudy) vial first without touching the liquid. Then, inject
air equal to the regular (clear) dose into the regular vial and withdraw the prescribed
amount of regular insulin. Finally, withdraw the prescribed amount of NPH insulin. This
prevents contamination of the regular insulin vial with NPH.
4. A patient is admitted with chest pain and shortness of breath. An ECG shows ST-
segment elevation in leads II, III, and aVF. Which artery is most likely occluded?
a) Left anterior descending (LAD)
b) Right coronary artery (RCA)
c) Circumflex artery
d) Left main coronary artery
*Answer: b) Right coronary artery (RCA) *
*Rationale: The ECG leads indicate the location of the myocardial infarction. Leads II, III,
and aVF are the inferior leads. The inferior wall of the heart is primarily supplied by the
right coronary artery (RCA) in most individuals. LAD (a) supplies the anterior wall, seen in
V3-V4. The circumflex (c) supplies the lateral wall, seen in I, aVL, V5-V6.*
5. The nurse is caring for a patient with a pulmonary embolism. The patient is
receiving oxygen at 4 L/min via nasal cannula and is on a heparin drip. Which
assessment finding requires the most immediate action by the nurse?
a) The patient reports chest pain that is pleuritic in nature.
b) The patient's oxygen saturation drops from 94% to 86%.
c) The patient has a small amount of bloody sputum.
d) The patient's aPTT is 75 seconds (therapeutic range 60-80 seconds).
, *Answer: b) The patient's oxygen saturation drops from 94% to 86% *
Rationale: Using the ABCs (Airway, Breathing, Circulation), a sudden drop in oxygen
saturation indicates a critical change in oxygenation and breathing. This suggests a
worsening of the PE or another acute event and requires immediate intervention (e.g.,
increasing oxygen, notifying provider, preparing for possible intubation). Chest pain (a)
and hemoptysis (c) are common findings with PE but are not as immediately life-
threatening as severe hypoxemia. The aPTT (d) is therapeutic, so no change is needed.
6. A patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted with increasing dyspnea and a productive cough. The arterial blood gas
(ABG) results are: pH 7.31, PaCO2 68 mm Hg, HCO3- 32 mEq/L. How should the
nurse interpret these findings?
a) Respiratory Alkalosis, uncompensated
b) Metabolic Acidosis, uncompensated
c) Respiratory Acidosis, partially compensated
d) Metabolic Alkalosis, fully compensated
*Answer: c) Respiratory Acidosis, partially compensated *
*Rationale: The pH is low (7.31) indicating acidosis. The PaCO2 is high (68 mm Hg),
which is the opposite of the pH, confirming the primary disorder is respiratory acidosis.
The HCO3- is high (32 mEq/L), indicating the kidneys are retaining bicarbonate to
compensate for the chronic high CO2. Because the pH is still not in the normal range
(7.35-7.45), the compensation is only partial.*
7. The nurse is administering a blood transfusion to a patient. Fifteen minutes
after the transfusion is started, the patient reports low back pain and appears
flushed. What is the nurse's priority action?
a) Slow the infusion rate and monitor vital signs.
b) Stop the transfusion immediately.
c) Notify the healthcare provider and blood bank.
MULTIPLE CHOICE QUESTIONS WITH
DETAILED RATIONALES
Questions: 75 multiple-choice and alternate-format items.
Format: Questions with a detailed rationale
Topics: Prioritization, Pharmacology, Fluid & Electrolytes, Cardiac, Respiratory,
Leadership, and Safety.
Elsevier Simulation Exam: Medical-Surgical Nursing
Instructions: Choose the best answer for each question.
1. A nurse is caring for a patient who is 1-hour post-operative following a
transurethral resection of the prostate (TURP). The patient has a continuous
bladder irrigation (CBI) system in place. The nurse observes the urine output is
bright red with multiple large clots, and the drainage bag is filling rapidly. What is
the nurse's priority action?
a) Manually irrigate the catheter.
b) Increase the flow rate of the irrigation fluid.
c) Notify the healthcare provider immediately.
d) Document the findings and continue to monitor.
*Answer: a) Manually irrigate the catheter. *
Rationale: The priority is to maintain catheter patency. Bright red urine with clots and
rapid filling indicates potential catheter occlusion by clots. If the catheter blocks, bladder
,distention can occur, leading to pain, hemorrhage, and increased pressure. The nurse
should first attempt to manually irrigate the catheter to clear the obstruction and restore
drainage. Increasing irrigation flow (b) may help prevent clots but is not the priority if clots
are already occluding. Notification (c) is necessary if irrigation is unsuccessful.
Documentation (d) is important but not the priority action in this escalating situation.
2. The nurse is assessing a patient with heart failure who has been prescribed
furosemide (Lasix) 40 mg IV push. Which laboratory value is most important for
the nurse to review prior to medication administration?
a) Hemoglobin and Hematocrit
b) Serum Potassium
c) Serum Sodium
d) BUN and Creatinine
*Answer: b) Serum Potassium *
*Rationale: Furosemide is a loop diuretic that causes significant excretion of potassium.
Hypokalemia is a common and dangerous side effect that can lead to life-threatening
dysrhythmias. The nurse must review the potassium level to ensure it is not low (< 3.5
mEq/L) before administering the dose. While BUN/Creatinine (d) are important for
assessing renal function and the drug's efficacy, the immediate safety check involves
potassium.*
3. A patient with a new diagnosis of type 1 diabetes mellitus is learning to self-
administer insulin. After the nurse teaches the patient how to mix regular and
NPH insulin in the same syringe, which patient action indicates correct
understanding?
a) Injects air into the NPH vial first, then withdraws the NPH.
b) Injects air into the NPH vial, then injects air into the regular vial and
withdraws the regular insulin first.
c) Injects air into the regular vial first, then withdraws the regular insulin.
, d) Withdraws the NPH insulin first, then withdraws the regular insulin.
*Answer: b) Injects air into the NPH vial, then injects air into the regular vial and
withdraws the regular insulin first. *
Rationale: The correct order (using the "clear before cloudy" principle) is to inject air equal
to the total dose into the NPH (cloudy) vial first without touching the liquid. Then, inject
air equal to the regular (clear) dose into the regular vial and withdraw the prescribed
amount of regular insulin. Finally, withdraw the prescribed amount of NPH insulin. This
prevents contamination of the regular insulin vial with NPH.
4. A patient is admitted with chest pain and shortness of breath. An ECG shows ST-
segment elevation in leads II, III, and aVF. Which artery is most likely occluded?
a) Left anterior descending (LAD)
b) Right coronary artery (RCA)
c) Circumflex artery
d) Left main coronary artery
*Answer: b) Right coronary artery (RCA) *
*Rationale: The ECG leads indicate the location of the myocardial infarction. Leads II, III,
and aVF are the inferior leads. The inferior wall of the heart is primarily supplied by the
right coronary artery (RCA) in most individuals. LAD (a) supplies the anterior wall, seen in
V3-V4. The circumflex (c) supplies the lateral wall, seen in I, aVL, V5-V6.*
5. The nurse is caring for a patient with a pulmonary embolism. The patient is
receiving oxygen at 4 L/min via nasal cannula and is on a heparin drip. Which
assessment finding requires the most immediate action by the nurse?
a) The patient reports chest pain that is pleuritic in nature.
b) The patient's oxygen saturation drops from 94% to 86%.
c) The patient has a small amount of bloody sputum.
d) The patient's aPTT is 75 seconds (therapeutic range 60-80 seconds).
, *Answer: b) The patient's oxygen saturation drops from 94% to 86% *
Rationale: Using the ABCs (Airway, Breathing, Circulation), a sudden drop in oxygen
saturation indicates a critical change in oxygenation and breathing. This suggests a
worsening of the PE or another acute event and requires immediate intervention (e.g.,
increasing oxygen, notifying provider, preparing for possible intubation). Chest pain (a)
and hemoptysis (c) are common findings with PE but are not as immediately life-
threatening as severe hypoxemia. The aPTT (d) is therapeutic, so no change is needed.
6. A patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted with increasing dyspnea and a productive cough. The arterial blood gas
(ABG) results are: pH 7.31, PaCO2 68 mm Hg, HCO3- 32 mEq/L. How should the
nurse interpret these findings?
a) Respiratory Alkalosis, uncompensated
b) Metabolic Acidosis, uncompensated
c) Respiratory Acidosis, partially compensated
d) Metabolic Alkalosis, fully compensated
*Answer: c) Respiratory Acidosis, partially compensated *
*Rationale: The pH is low (7.31) indicating acidosis. The PaCO2 is high (68 mm Hg),
which is the opposite of the pH, confirming the primary disorder is respiratory acidosis.
The HCO3- is high (32 mEq/L), indicating the kidneys are retaining bicarbonate to
compensate for the chronic high CO2. Because the pH is still not in the normal range
(7.35-7.45), the compensation is only partial.*
7. The nurse is administering a blood transfusion to a patient. Fifteen minutes
after the transfusion is started, the patient reports low back pain and appears
flushed. What is the nurse's priority action?
a) Slow the infusion rate and monitor vital signs.
b) Stop the transfusion immediately.
c) Notify the healthcare provider and blood bank.
