This Medical-Surgical Nursing Exam is a comprehensive test preparation resource containing
250 practice questions with detailed rationales. It covers core med- surg topics including:
cardiovascular disorders (heart failure, MI, hypertension), respiratory conditions (COPD,
asthma, pneumonia), endocrine disorders (diabetes, thyroid diseases), renal/urological
conditions (CKD, AKI, UTIs), musculoskeletal disorders (osteoporosis, fractures, gout),
neurological conditions (stroke, seizures), gastrointestinal disorders (GERD, pancreatitis,
cirrhosis), medication management, and nursing interventions. Each question includes the
correct answer and a medium-length rationale explaining the underlying pathophysiology,
nursing considerations, and evidence-based practice. Ideal for NCLEX-RN preparation,
proctored exams, and nursing students seeking to strengthen their clinical judgment and
critical thinking skills in medical-surgical nursing.
1. A nurse is assessing a client who has deep vein thrombosis (DVT) of the left lower extremity.
Which of the following findings should the nurse expect?
A. Decreased calf circumference
B. Pallor of the affected extremity
C. Unilateral leg edema
D. Bilateral pedal pulses
Correct Answer: C
Rationale: Unilateral leg edema (swelling) is a hallmark finding in a client with deep vein
thrombosis (DVT). The thrombus obstructs venous blood flow, causing increased hydrostatic
pressure in the capillaries and leakage of fluid into the interstitial space, resulting in localized
edema. Other expected findings in DVT include warmth of the affected extremity, erythema
(redness), tenderness, and pain that is often described as a cramp or ache in the calf or thigh.
Homan's sign (pain with dorsiflexion of the foot) is an unreliable finding and is no longer
recommended as a standard assessment for DVT due to its low sensitivity and specificity.
Option A is incorrect because DVT typically causes increased, not decreased, calf circumference
due to edema. Option B is incorrect because the affected extremity is usually erythematous and
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,warm, not pale, due to inflammation and venous congestion. Pallor is more commonly
associated with arterial insufficiency. Option D is incorrect because while pedal pulses may be
present, unilateral findings are expected; the nurse should assess for asymmetry in pulse
strength and compare the affected and unaffected extremities. Risk factors for DVT include
immobility, surgery, trauma, cancer, obesity, pregnancy, oral contraceptive use, and inherited
hypercoagulable conditions.
2. A nurse is providing education to a client who has a new diagnosis of hypertension. Which of
the following dietary recommendations should the nurse include?
A. Increase intake of processed meats
B. Limit sodium intake to 2,300 mg per day
C. Consume alcohol in unlimited amounts
D. Avoid all fruits and vegetables
Correct Answer: B
Rationale: The nurse should recommend that the client limit sodium intake to 2,300 mg per
day or less, as recommended by the Dietary Approaches to Stop Hypertension (DASH) diet
guidelines. For African American clients, clients over 51 years of age, or clients with preexisting
hypertension, diabetes, or chronic kidney disease, the recommendation is to further restrict
sodium to 1,500 mg per day. High sodium intake contributes to fluid retention and increased
blood pressure by increasing extracellular fluid volume and cardiac output. Reducing sodium
intake can significantly lower blood pressure and enhance the effectiveness of antihypertensive
medications. Option A is incorrect because processed meats such as bacon, sausage, ham, and
deli meats are high in sodium and should be limited or avoided. Option C is incorrect because
alcohol consumption should be limited to no more than two drinks per day for men and one
drink per day for women, as excessive alcohol intake can raise blood pressure and contribute to
medication interactions. Option D is incorrect because clients with hypertension should
consume a diet rich in fruits, vegetables, whole grains, and low-fat dairy products. Fruits and
vegetables are high in potassium, magnesium, and fiber, which help lower blood pressure. The
DASH diet has been shown to reduce blood pressure more effectively than a typical Western
diet.
3. A nurse is caring for a client who has a nasogastric (NG) tube set to continuous suction.
Which of the following laboratory values should the nurse monitor closely?
A. Serum sodium
2
, B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B
Rationale: The nurse should monitor the client's serum potassium level closely because
continuous nasogastric (NG) suction can lead to hypokalemia (low potassium levels). Gastric
secretions contain significant amounts of potassium and other electrolytes. When gastric
contents are continuously removed via NG suction, the client loses potassium, sodium, chloride,
and hydrogen ions. This can result in metabolic alkalosis and electrolyte imbalances, particularly
hypokalemia. Potassium is essential for normal cardiac conduction, muscle contraction, and
nerve function. Hypokalemia can cause cardiac dysrhythmias, muscle weakness, fatigue, and
respiratory compromise. The nurse should assess for signs of hypokalemia, including muscle
cramping, flattened T waves on ECG, and U-wave prominence. Option A is incorrect because
although sodium loss can occur, potassium loss is the most significant concern with continuous
NG suction. Option C is incorrect because calcium is not significantly affected by NG suction.
Option D is incorrect because magnesium loss is less pronounced than potassium loss in this
situation. The nurse should also monitor the client's acid-base balance, as loss of gastric
hydrochloric acid can lead to metabolic alkalosis, characterized by elevated bicarbonate levels
and increased pH.
4. A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The
nurse should identify which of the following medications as the cause of the client's low
potassium level?
A. Furosemide
B. Nitroglycerin
C. Metoprolol
D. Spironolactone
Correct Answer: A
Rationale: Furosemide is a loop (high-ceiling) diuretic that inhibits the reabsorption of sodium
and chloride in the ascending loop of Henle, resulting in significant diuresis. This medication
increases the delivery of sodium and water to the distal nephrons, where sodium is exchanged
for potassium, leading to increased potassium excretion in the urine. Hypokalemia (serum
potassium less than 3.5 mEq/L) is a well-documented adverse effect of furosemide and other
loop diuretics. A potassium level of 2.4 mEq/L represents severe hypokalemia, which places the
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, client at significant risk for cardiac dysrhythmias, muscle weakness, and respiratory
compromise. The nurse should monitor the client's cardiac rhythm, assess for signs of
hypokalemia such as muscle cramping and fatigue, and report this critical laboratory value to
the provider immediately. The provider may prescribe potassium supplements or consider
adjusting the diuretic regimen. Nitroglycerin is a vasodilator medication used to treat angina
and is not associated with hypokalemia, making option B incorrect. Metoprolol is a beta-blocker
that slows the heart rate and improves contractility of the heart muscle; it is not associated
with potassium abnormalities, making option C incorrect. Spironolactone is a potassium-sparing
diuretic that blocks aldosterone receptors, promoting sodium and water excretion while
conserving potassium; hyperkalemia, not hypokalemia, is an adverse effect of this medication,
making option D incorrect.
5. A nurse is caring for a client who is postoperative following an open reduction internal
fixation (ORIF) of a femur fracture. Which of the following parameters should the nurse include
in the evaluation of the neurovascular status of the client's affected extremity? (Select all that
apply.)
A. Color
B. Temperature
C. Ecchymosis
D. Skin integrity
E. Sensation
Correct Answers: A, B, E
Rationale: Clients who have sustained trauma to an extremity, such as a fracture, are at
increased risk for neurovascular compromise due to swelling, bleeding, and potential damage
to nerves and blood vessels. The nurse should perform a comprehensive neurovascular
assessment of the affected extremity, which includes the "6 Ps": pain, pallor, paresthesia,
paralysis, poikilothermia (temperature changes), and pulselessness. Color (option A) is correct;
the nurse should assess the color of the client's affected extremity and identify pallor or
cyanosis as an indication of peripheral neurovascular dysfunction requiring immediate provider
notification. Temperature (option B) is correct; the nurse should monitor the temperature of
the extremity and identify skin that is cool or cold to the touch as having decreased perfusion to
the tissues, which is an indication of peripheral neurovascular dysfunction. Sensation (option E)
is correct; the nurse should assess the client's extremity for numbness or tingling and recognize
diminished pain sensation or paresthesia as an indication of nerve damage or peripheral
neurovascular dysfunction requiring immediate reporting. Ecchymosis (option C) is incorrect;
ecchymosis, or bruising, is an expected finding with leg injuries and is not a component of a
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250 practice questions with detailed rationales. It covers core med- surg topics including:
cardiovascular disorders (heart failure, MI, hypertension), respiratory conditions (COPD,
asthma, pneumonia), endocrine disorders (diabetes, thyroid diseases), renal/urological
conditions (CKD, AKI, UTIs), musculoskeletal disorders (osteoporosis, fractures, gout),
neurological conditions (stroke, seizures), gastrointestinal disorders (GERD, pancreatitis,
cirrhosis), medication management, and nursing interventions. Each question includes the
correct answer and a medium-length rationale explaining the underlying pathophysiology,
nursing considerations, and evidence-based practice. Ideal for NCLEX-RN preparation,
proctored exams, and nursing students seeking to strengthen their clinical judgment and
critical thinking skills in medical-surgical nursing.
1. A nurse is assessing a client who has deep vein thrombosis (DVT) of the left lower extremity.
Which of the following findings should the nurse expect?
A. Decreased calf circumference
B. Pallor of the affected extremity
C. Unilateral leg edema
D. Bilateral pedal pulses
Correct Answer: C
Rationale: Unilateral leg edema (swelling) is a hallmark finding in a client with deep vein
thrombosis (DVT). The thrombus obstructs venous blood flow, causing increased hydrostatic
pressure in the capillaries and leakage of fluid into the interstitial space, resulting in localized
edema. Other expected findings in DVT include warmth of the affected extremity, erythema
(redness), tenderness, and pain that is often described as a cramp or ache in the calf or thigh.
Homan's sign (pain with dorsiflexion of the foot) is an unreliable finding and is no longer
recommended as a standard assessment for DVT due to its low sensitivity and specificity.
Option A is incorrect because DVT typically causes increased, not decreased, calf circumference
due to edema. Option B is incorrect because the affected extremity is usually erythematous and
1
,warm, not pale, due to inflammation and venous congestion. Pallor is more commonly
associated with arterial insufficiency. Option D is incorrect because while pedal pulses may be
present, unilateral findings are expected; the nurse should assess for asymmetry in pulse
strength and compare the affected and unaffected extremities. Risk factors for DVT include
immobility, surgery, trauma, cancer, obesity, pregnancy, oral contraceptive use, and inherited
hypercoagulable conditions.
2. A nurse is providing education to a client who has a new diagnosis of hypertension. Which of
the following dietary recommendations should the nurse include?
A. Increase intake of processed meats
B. Limit sodium intake to 2,300 mg per day
C. Consume alcohol in unlimited amounts
D. Avoid all fruits and vegetables
Correct Answer: B
Rationale: The nurse should recommend that the client limit sodium intake to 2,300 mg per
day or less, as recommended by the Dietary Approaches to Stop Hypertension (DASH) diet
guidelines. For African American clients, clients over 51 years of age, or clients with preexisting
hypertension, diabetes, or chronic kidney disease, the recommendation is to further restrict
sodium to 1,500 mg per day. High sodium intake contributes to fluid retention and increased
blood pressure by increasing extracellular fluid volume and cardiac output. Reducing sodium
intake can significantly lower blood pressure and enhance the effectiveness of antihypertensive
medications. Option A is incorrect because processed meats such as bacon, sausage, ham, and
deli meats are high in sodium and should be limited or avoided. Option C is incorrect because
alcohol consumption should be limited to no more than two drinks per day for men and one
drink per day for women, as excessive alcohol intake can raise blood pressure and contribute to
medication interactions. Option D is incorrect because clients with hypertension should
consume a diet rich in fruits, vegetables, whole grains, and low-fat dairy products. Fruits and
vegetables are high in potassium, magnesium, and fiber, which help lower blood pressure. The
DASH diet has been shown to reduce blood pressure more effectively than a typical Western
diet.
3. A nurse is caring for a client who has a nasogastric (NG) tube set to continuous suction.
Which of the following laboratory values should the nurse monitor closely?
A. Serum sodium
2
, B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B
Rationale: The nurse should monitor the client's serum potassium level closely because
continuous nasogastric (NG) suction can lead to hypokalemia (low potassium levels). Gastric
secretions contain significant amounts of potassium and other electrolytes. When gastric
contents are continuously removed via NG suction, the client loses potassium, sodium, chloride,
and hydrogen ions. This can result in metabolic alkalosis and electrolyte imbalances, particularly
hypokalemia. Potassium is essential for normal cardiac conduction, muscle contraction, and
nerve function. Hypokalemia can cause cardiac dysrhythmias, muscle weakness, fatigue, and
respiratory compromise. The nurse should assess for signs of hypokalemia, including muscle
cramping, flattened T waves on ECG, and U-wave prominence. Option A is incorrect because
although sodium loss can occur, potassium loss is the most significant concern with continuous
NG suction. Option C is incorrect because calcium is not significantly affected by NG suction.
Option D is incorrect because magnesium loss is less pronounced than potassium loss in this
situation. The nurse should also monitor the client's acid-base balance, as loss of gastric
hydrochloric acid can lead to metabolic alkalosis, characterized by elevated bicarbonate levels
and increased pH.
4. A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The
nurse should identify which of the following medications as the cause of the client's low
potassium level?
A. Furosemide
B. Nitroglycerin
C. Metoprolol
D. Spironolactone
Correct Answer: A
Rationale: Furosemide is a loop (high-ceiling) diuretic that inhibits the reabsorption of sodium
and chloride in the ascending loop of Henle, resulting in significant diuresis. This medication
increases the delivery of sodium and water to the distal nephrons, where sodium is exchanged
for potassium, leading to increased potassium excretion in the urine. Hypokalemia (serum
potassium less than 3.5 mEq/L) is a well-documented adverse effect of furosemide and other
loop diuretics. A potassium level of 2.4 mEq/L represents severe hypokalemia, which places the
3
, client at significant risk for cardiac dysrhythmias, muscle weakness, and respiratory
compromise. The nurse should monitor the client's cardiac rhythm, assess for signs of
hypokalemia such as muscle cramping and fatigue, and report this critical laboratory value to
the provider immediately. The provider may prescribe potassium supplements or consider
adjusting the diuretic regimen. Nitroglycerin is a vasodilator medication used to treat angina
and is not associated with hypokalemia, making option B incorrect. Metoprolol is a beta-blocker
that slows the heart rate and improves contractility of the heart muscle; it is not associated
with potassium abnormalities, making option C incorrect. Spironolactone is a potassium-sparing
diuretic that blocks aldosterone receptors, promoting sodium and water excretion while
conserving potassium; hyperkalemia, not hypokalemia, is an adverse effect of this medication,
making option D incorrect.
5. A nurse is caring for a client who is postoperative following an open reduction internal
fixation (ORIF) of a femur fracture. Which of the following parameters should the nurse include
in the evaluation of the neurovascular status of the client's affected extremity? (Select all that
apply.)
A. Color
B. Temperature
C. Ecchymosis
D. Skin integrity
E. Sensation
Correct Answers: A, B, E
Rationale: Clients who have sustained trauma to an extremity, such as a fracture, are at
increased risk for neurovascular compromise due to swelling, bleeding, and potential damage
to nerves and blood vessels. The nurse should perform a comprehensive neurovascular
assessment of the affected extremity, which includes the "6 Ps": pain, pallor, paresthesia,
paralysis, poikilothermia (temperature changes), and pulselessness. Color (option A) is correct;
the nurse should assess the color of the client's affected extremity and identify pallor or
cyanosis as an indication of peripheral neurovascular dysfunction requiring immediate provider
notification. Temperature (option B) is correct; the nurse should monitor the temperature of
the extremity and identify skin that is cool or cold to the touch as having decreased perfusion to
the tissues, which is an indication of peripheral neurovascular dysfunction. Sensation (option E)
is correct; the nurse should assess the client's extremity for numbness or tingling and recognize
diminished pain sensation or paresthesia as an indication of nerve damage or peripheral
neurovascular dysfunction requiring immediate reporting. Ecchymosis (option C) is incorrect;
ecchymosis, or bruising, is an expected finding with leg injuries and is not a component of a
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