Advanced Medical-Surgical Nursing Multiple
Choice Questions (MCQs) with Answers and
Explanations for BSc Nursing and
Professional Licensing Exams
1. A patient admitted with acute decompensated heart failure develops worsening dyspnea
and bilateral crackles. Which intervention should the nurse prioritize to improve
oxygenation?
A. Encourage oral fluid intake
B. Place the patient in Trendelenburg position
C. Administer intravenous isotonic fluids
D. Position the patient in high Fowler's position and administer supplemental oxygen
Explanation: High Fowler's position decreases venous return and improves lung expansion,
while supplemental oxygen helps correct hypoxemia associated with pulmonary congestion.
2. A patient receiving intravenous heparin for deep vein thrombosis develops bleeding gums
and hematuria. Which medication should the nurse anticipate administering?
A. Vitamin K
B. Tranexamic acid
C. Desmopressin
D. Protamine sulfate
Explanation: Protamine sulfate is the specific antidote for heparin toxicity and rapidly
neutralizes its anticoagulant effects.
3. A patient with chronic kidney disease has serum potassium of 6.8 mEq/L and peaked T
waves on the electrocardiogram. Which intervention has the highest priority?
A. Restrict dietary sodium
B. Administer oral ferrous sulfate
C. Encourage increased protein intake
, D. Administer intravenous calcium gluconate as prescribed
Explanation: Severe hyperkalemia with electrocardiographic changes is life-threatening.
Calcium gluconate stabilizes cardiac membranes and reduces the risk of fatal arrhythmias.
4. Which assessment finding in a patient with increased intracranial pressure requires
immediate intervention?
A. Blood pressure 140/88 mmHg
B. Headache rated 5/10
C. Temperature of 37.4°C
D. Decreased level of consciousness with unequal pupils
Explanation: Altered consciousness and pupillary changes suggest neurological deterioration
and possible brain herniation, requiring urgent evaluation.
5. A patient with acute pancreatitis reports severe epigastric pain radiating to the back.
Which nursing intervention is most appropriate?
A. Encourage a high-fat diet
B. Place the patient flat after meals
C. Promote early ambulation immediately after eating
D. Maintain the patient NPO and administer prescribed intravenous fluids
Explanation: Bowel rest and aggressive fluid replacement help reduce pancreatic stimulation
and prevent complications associated with acute pancreatitis.
6. A patient with chronic obstructive pulmonary disease has arterial blood gases showing
pH 7.32, PaCO₂ 56 mmHg, and HCO₃⁻ 29 mEq/L. Which acid-base imbalance is
present?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Partially compensated respiratory acidosis
Choice Questions (MCQs) with Answers and
Explanations for BSc Nursing and
Professional Licensing Exams
1. A patient admitted with acute decompensated heart failure develops worsening dyspnea
and bilateral crackles. Which intervention should the nurse prioritize to improve
oxygenation?
A. Encourage oral fluid intake
B. Place the patient in Trendelenburg position
C. Administer intravenous isotonic fluids
D. Position the patient in high Fowler's position and administer supplemental oxygen
Explanation: High Fowler's position decreases venous return and improves lung expansion,
while supplemental oxygen helps correct hypoxemia associated with pulmonary congestion.
2. A patient receiving intravenous heparin for deep vein thrombosis develops bleeding gums
and hematuria. Which medication should the nurse anticipate administering?
A. Vitamin K
B. Tranexamic acid
C. Desmopressin
D. Protamine sulfate
Explanation: Protamine sulfate is the specific antidote for heparin toxicity and rapidly
neutralizes its anticoagulant effects.
3. A patient with chronic kidney disease has serum potassium of 6.8 mEq/L and peaked T
waves on the electrocardiogram. Which intervention has the highest priority?
A. Restrict dietary sodium
B. Administer oral ferrous sulfate
C. Encourage increased protein intake
, D. Administer intravenous calcium gluconate as prescribed
Explanation: Severe hyperkalemia with electrocardiographic changes is life-threatening.
Calcium gluconate stabilizes cardiac membranes and reduces the risk of fatal arrhythmias.
4. Which assessment finding in a patient with increased intracranial pressure requires
immediate intervention?
A. Blood pressure 140/88 mmHg
B. Headache rated 5/10
C. Temperature of 37.4°C
D. Decreased level of consciousness with unequal pupils
Explanation: Altered consciousness and pupillary changes suggest neurological deterioration
and possible brain herniation, requiring urgent evaluation.
5. A patient with acute pancreatitis reports severe epigastric pain radiating to the back.
Which nursing intervention is most appropriate?
A. Encourage a high-fat diet
B. Place the patient flat after meals
C. Promote early ambulation immediately after eating
D. Maintain the patient NPO and administer prescribed intravenous fluids
Explanation: Bowel rest and aggressive fluid replacement help reduce pancreatic stimulation
and prevent complications associated with acute pancreatitis.
6. A patient with chronic obstructive pulmonary disease has arterial blood gases showing
pH 7.32, PaCO₂ 56 mmHg, and HCO₃⁻ 29 mEq/L. Which acid-base imbalance is
present?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Partially compensated respiratory acidosis
