Brunner & Suddarth’s Canadian Textbook of Medical-
Surgical Nursing Study Guide – Comprehensive Exam Prep
Notes, Key Concepts, Practice Questions & Clinical Review
for Med-Surg Nursing Success
Question 1: A Canadian nurse is caring for a postoperative patient who reports sudden onset
of shortness of breath and pleuritic chest pain. Which action should the nurse prioritize?
A. Administer the scheduled oral analgesic
B. Apply oxygen via nasal cannula and notify the healthcare provider immediately
C. Encourage deep breathing and coughing exercises
D. Document the findings and reassess in 30 minutes
CORRECT ANSWER: B. Apply oxygen via nasal cannula and notify the healthcare provider
immediately
Rationale: Sudden dyspnea and pleuritic chest pain postoperatively are classic signs of
pulmonary embolism, a life-threatening emergency. Immediate oxygen administration supports
oxygenation while rapid notification enables urgent diagnostic and therapeutic intervention per
Canadian patient safety priorities.
Question 2: According to the Canadian Nurses Association (CNA) Code of Ethics, which
principle is foundational to nursing practice when a patient refuses a recommended
treatment?
A. Justice
B. Beneficence
C. Respect for human dignity
D. Truthfulness
CORRECT ANSWER: C. Respect for human dignity
Rationale: The CNA Code of Ethics identifies respect for human dignity as a primary value,
which includes upholding a patient's right to self-determination and informed refusal, even
when the decision conflicts with clinical recommendations.
Question 3: When assessing a patient with suspected hypovolemic shock, which clinical
finding is the earliest indicator of compensatory mechanisms?
A. Hypotension
B. Tachycardia
C. Decreased urine output
D. Confusion
CORRECT ANSWER: B. Tachycardia
Rationale: Tachycardia is the earliest compensatory response to decreased intravascular
volume, mediated by sympathetic activation to maintain cardiac output. Hypotension is a late
sign indicating decompensation.
Question 4: A nurse in Ontario is preparing to administer insulin. Which action aligns with the
College of Nurses of Ontario (CNO) medication practice standard?
A. Accepting a verbal order for insulin in a non-emergency situation
B. Double-checking the dose with another regulated health professional for high-alert
medications
,C. Administering insulin based on a sliding scale without verifying the current blood glucose
D. Documenting administration after completing all patient care tasks for the shift
CORRECT ANSWER: B. Double-checking the dose with another regulated health professional
for high-alert medications
Rationale: The CNO and Canadian patient safety guidelines recommend independent double-
checks for high-alert medications like insulin to reduce error risk. Verbal orders should be
minimized, blood glucose must be verified before administration, and documentation should
occur immediately after administration.
Question 5: Which assessment finding in a patient with heart failure requires immediate
nursing intervention?
A. Weight gain of 1 kg over 3 days
B. Bibasilar crackles on auscultation
C. Oxygen saturation of 88% on room air
D. +1 pitting edema in lower extremities
CORRECT ANSWER: C. Oxygen saturation of 88% on room air
Rationale: An SpO₂ of 88% indicates significant hypoxemia requiring immediate oxygen therapy
and clinical reassessment. While other findings reflect fluid overload, they are not immediately
life-threatening like severe hypoxia.
Question 6: In Canadian healthcare, which factor is a key consideration when providing
culturally safe care to Indigenous patients?
A. Assuming all Indigenous patients prefer traditional healing methods
B. Recognizing the impact of historical trauma and systemic barriers on health outcomes
C. Prioritizing biomedical interventions over community-based supports
D. Using family members as interpreters to ensure understanding
CORRECT ANSWER: B. Recognizing the impact of historical trauma and systemic barriers on
health outcomes
Rationale: Culturally safe care in Canada requires understanding the legacy of colonialism,
residential schools, and ongoing inequities affecting Indigenous health. Care must be
individualized, not stereotyped, and professional interpreters—not family—should be used
when language barriers exist.
Question 7: A patient is prescribed warfarin. Which laboratory value does the nurse monitor
to evaluate therapeutic effectiveness?
A. Platelet count
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Hemoglobin
CORRECT ANSWER: B. International Normalized Ratio (INR)
Rationale: Warfarin therapy is monitored using INR to standardize prothrombin time results
across laboratories. Target INR ranges (typically 2.0–3.5) guide dose adjustments to balance
thrombosis prevention and bleeding risk.
Question 8: Which nursing intervention is most effective in preventing ventilator-associated
pneumonia (VAP) in a critically ill patient?
, A. Administering prophylactic antibiotics daily
B. Maintaining the head of the bed at 30–45 degrees
C. Suctioning the endotracheal tube every hour
D. Using sterile saline for oral care every 2 hours
CORRECT ANSWER: B. Maintaining the head of the bed at 30–45 degrees
Rationale: Elevating the head of the bed reduces aspiration risk, a key mechanism in VAP
development. This is a core component of the Canadian Critical Care Society's VAP prevention
bundle. Oral care with chlorhexidine (not saline) is also recommended, but positioning is
foundational.
Question 9: A patient with chronic kidney disease has a serum potassium level of 6.8 mEq/L.
Which ECG change should the nurse anticipate?
A. Prolonged PR interval
B. Peaked T waves
C. ST-segment depression
D. U waves
CORRECT ANSWER: B. Peaked T waves
Rationale: Hyperkalemia causes characteristic ECG changes beginning with tall, peaked T waves
due to altered myocardial repolarization. This is a medical emergency requiring immediate
intervention to prevent fatal arrhythmias.
Question 10: When developing a discharge plan for an elderly patient with multiple
comorbidities, which action best supports transitional care in the Canadian system?
A. Providing a written medication list without follow-up arrangements
B. Coordinating with home and community care services prior to discharge
C. Scheduling all follow-up appointments with specialists only
D. Assuming family will manage all post-discharge needs
CORRECT ANSWER: B. Coordinating with home and community care services prior to
discharge
Rationale: Canadian best practices emphasize interprofessional coordination with provincial
home and community care programs (e.g., Home and Community Care Support Services in
Ontario) to reduce readmissions and support safe transitions, especially for complex elderly
patients.
Question 11: Which statement by a patient with type 2 diabetes indicates effective teaching
about hypoglycemia management?
A. "If I feel shaky, I will wait until my next meal to eat."
B. "I will drink a regular soft drink if my blood sugar is below 4.0 mmol/L."
C. "I should take an extra dose of my oral medication if I skip a meal."
D. "Hypoglycemia only happens if I exercise too much."
CORRECT ANSWER: B. "I will drink a regular soft drink if my blood sugar is below 4.0
mmol/L."
Rationale: Canadian Diabetes Association guidelines recommend 15 g of fast-acting
carbohydrate (e.g., 150 mL regular soda) for blood glucose <4.0 mmol/L, followed by
Surgical Nursing Study Guide – Comprehensive Exam Prep
Notes, Key Concepts, Practice Questions & Clinical Review
for Med-Surg Nursing Success
Question 1: A Canadian nurse is caring for a postoperative patient who reports sudden onset
of shortness of breath and pleuritic chest pain. Which action should the nurse prioritize?
A. Administer the scheduled oral analgesic
B. Apply oxygen via nasal cannula and notify the healthcare provider immediately
C. Encourage deep breathing and coughing exercises
D. Document the findings and reassess in 30 minutes
CORRECT ANSWER: B. Apply oxygen via nasal cannula and notify the healthcare provider
immediately
Rationale: Sudden dyspnea and pleuritic chest pain postoperatively are classic signs of
pulmonary embolism, a life-threatening emergency. Immediate oxygen administration supports
oxygenation while rapid notification enables urgent diagnostic and therapeutic intervention per
Canadian patient safety priorities.
Question 2: According to the Canadian Nurses Association (CNA) Code of Ethics, which
principle is foundational to nursing practice when a patient refuses a recommended
treatment?
A. Justice
B. Beneficence
C. Respect for human dignity
D. Truthfulness
CORRECT ANSWER: C. Respect for human dignity
Rationale: The CNA Code of Ethics identifies respect for human dignity as a primary value,
which includes upholding a patient's right to self-determination and informed refusal, even
when the decision conflicts with clinical recommendations.
Question 3: When assessing a patient with suspected hypovolemic shock, which clinical
finding is the earliest indicator of compensatory mechanisms?
A. Hypotension
B. Tachycardia
C. Decreased urine output
D. Confusion
CORRECT ANSWER: B. Tachycardia
Rationale: Tachycardia is the earliest compensatory response to decreased intravascular
volume, mediated by sympathetic activation to maintain cardiac output. Hypotension is a late
sign indicating decompensation.
Question 4: A nurse in Ontario is preparing to administer insulin. Which action aligns with the
College of Nurses of Ontario (CNO) medication practice standard?
A. Accepting a verbal order for insulin in a non-emergency situation
B. Double-checking the dose with another regulated health professional for high-alert
medications
,C. Administering insulin based on a sliding scale without verifying the current blood glucose
D. Documenting administration after completing all patient care tasks for the shift
CORRECT ANSWER: B. Double-checking the dose with another regulated health professional
for high-alert medications
Rationale: The CNO and Canadian patient safety guidelines recommend independent double-
checks for high-alert medications like insulin to reduce error risk. Verbal orders should be
minimized, blood glucose must be verified before administration, and documentation should
occur immediately after administration.
Question 5: Which assessment finding in a patient with heart failure requires immediate
nursing intervention?
A. Weight gain of 1 kg over 3 days
B. Bibasilar crackles on auscultation
C. Oxygen saturation of 88% on room air
D. +1 pitting edema in lower extremities
CORRECT ANSWER: C. Oxygen saturation of 88% on room air
Rationale: An SpO₂ of 88% indicates significant hypoxemia requiring immediate oxygen therapy
and clinical reassessment. While other findings reflect fluid overload, they are not immediately
life-threatening like severe hypoxia.
Question 6: In Canadian healthcare, which factor is a key consideration when providing
culturally safe care to Indigenous patients?
A. Assuming all Indigenous patients prefer traditional healing methods
B. Recognizing the impact of historical trauma and systemic barriers on health outcomes
C. Prioritizing biomedical interventions over community-based supports
D. Using family members as interpreters to ensure understanding
CORRECT ANSWER: B. Recognizing the impact of historical trauma and systemic barriers on
health outcomes
Rationale: Culturally safe care in Canada requires understanding the legacy of colonialism,
residential schools, and ongoing inequities affecting Indigenous health. Care must be
individualized, not stereotyped, and professional interpreters—not family—should be used
when language barriers exist.
Question 7: A patient is prescribed warfarin. Which laboratory value does the nurse monitor
to evaluate therapeutic effectiveness?
A. Platelet count
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Hemoglobin
CORRECT ANSWER: B. International Normalized Ratio (INR)
Rationale: Warfarin therapy is monitored using INR to standardize prothrombin time results
across laboratories. Target INR ranges (typically 2.0–3.5) guide dose adjustments to balance
thrombosis prevention and bleeding risk.
Question 8: Which nursing intervention is most effective in preventing ventilator-associated
pneumonia (VAP) in a critically ill patient?
, A. Administering prophylactic antibiotics daily
B. Maintaining the head of the bed at 30–45 degrees
C. Suctioning the endotracheal tube every hour
D. Using sterile saline for oral care every 2 hours
CORRECT ANSWER: B. Maintaining the head of the bed at 30–45 degrees
Rationale: Elevating the head of the bed reduces aspiration risk, a key mechanism in VAP
development. This is a core component of the Canadian Critical Care Society's VAP prevention
bundle. Oral care with chlorhexidine (not saline) is also recommended, but positioning is
foundational.
Question 9: A patient with chronic kidney disease has a serum potassium level of 6.8 mEq/L.
Which ECG change should the nurse anticipate?
A. Prolonged PR interval
B. Peaked T waves
C. ST-segment depression
D. U waves
CORRECT ANSWER: B. Peaked T waves
Rationale: Hyperkalemia causes characteristic ECG changes beginning with tall, peaked T waves
due to altered myocardial repolarization. This is a medical emergency requiring immediate
intervention to prevent fatal arrhythmias.
Question 10: When developing a discharge plan for an elderly patient with multiple
comorbidities, which action best supports transitional care in the Canadian system?
A. Providing a written medication list without follow-up arrangements
B. Coordinating with home and community care services prior to discharge
C. Scheduling all follow-up appointments with specialists only
D. Assuming family will manage all post-discharge needs
CORRECT ANSWER: B. Coordinating with home and community care services prior to
discharge
Rationale: Canadian best practices emphasize interprofessional coordination with provincial
home and community care programs (e.g., Home and Community Care Support Services in
Ontario) to reduce readmissions and support safe transitions, especially for complex elderly
patients.
Question 11: Which statement by a patient with type 2 diabetes indicates effective teaching
about hypoglycemia management?
A. "If I feel shaky, I will wait until my next meal to eat."
B. "I will drink a regular soft drink if my blood sugar is below 4.0 mmol/L."
C. "I should take an extra dose of my oral medication if I skip a meal."
D. "Hypoglycemia only happens if I exercise too much."
CORRECT ANSWER: B. "I will drink a regular soft drink if my blood sugar is below 4.0
mmol/L."
Rationale: Canadian Diabetes Association guidelines recommend 15 g of fast-acting
carbohydrate (e.g., 150 mL regular soda) for blood glucose <4.0 mmol/L, followed by
