KAPLAN MED-SURG 2B PRACTICE TEST 100 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A |STUDY GUIDE| INSTANT DOWNLOAD PDF
Core Domains
*- Respiratory System Management and Critical Care*
*- Renal and Urinary Tract Function*
*- Endocrine System and Metabolic Disorders*
*- Neurological System Assessment and Care*
*- Gastrointestinal System Management*
*- Fluid, Electrolyte, and Acid-Base Balance*
*- Perioperative Nursing Care*
*- Emergency and Critical Care Nursing*
*- Professional Ethics and Legal Compliance in Nursing*
*- Hematological Disorders and Burn Management*
Introduction
This practice exam is designed to assess comprehensive knowledge and clinical decision-making skills essential for medical-surgical nursing
practice at the Adult Health II level. The assessment evaluates critical competencies in patient assessment, pharmacological interventions, nursing
care planning, and evidence-based practice implementation across multiple system disorders. The multiple-choice format includes scenario-based
questions that emphasize real-world application, prioritization, delegation, and professional judgment. Students will demonstrate mastery of
clinical reasoning through complex patient situations requiring critical thinking, ethical decision-making, and adherence to regulatory standards.
This exam prepares nursing professionals for advanced clinical practice and certification requirements.
SECTION ONE: QUESTIONS 1–100
Question 1
A patient with COPD is experiencing increased shortness of breath and is using accessory muscles to breathe. The nurse notes a pH of 7.25, PaCO2 of
55 mmHg, and HCO3 of 28 mEq/L. What is the most appropriate nursing intervention?
A. Administer high-flow oxygen at 6 L/min
B. Encourage pursed-lip breathing and position in high Fowler's
C. Administer intravenous bicarbonate immediately
D. Prepare for immediate intubation and mechanical ventilation
🟢 B. Encourage pursed-lip breathing and position in high Fowler's
,🔴 RATIONALE: The patient is experiencing acute respiratory acidosis (pH 7.25, PaCO2 55) with compensatory metabolic alkalosis (HCO3 28).
Pursed-lip breathing helps slow respiration and improve CO2 elimination, while high Fowler's position maximizes lung expansion. High-flow oxygen
can suppress the hypoxic drive in COPD patients, bicarbonate is not indicated for respiratory acidosis, and intubation is not immediately necessary
without further assessment of response to conservative measures.
Question 2
A patient with diabetes mellitus presents with blood glucose of 450 mg/dL, positive serum ketones, pH of 7.15, and deep rapid breathing. Which
condition does the nurse suspect?
A. Hyperglycemic Hyperosmolar State (HHS)
B. Diabetic Ketoacidosis (DKA)
C. Somogyi effect
D. Lactic acidosis
🟢 B. Diabetic Ketoacidosis (DKA)
🔴 RATIONALE: DKA is characterized by hyperglycemia (>250 mg/dL), positive ketones, acidosis (pH <7.3), and Kussmaul respirations (deep rapid
breathing) as the body attempts to compensate for metabolic acidosis. HHS presents with much higher glucose (>600 mg/dL) without significant
ketosis. The Somogyi effect refers to rebound hyperglycemia following insulin-induced hypoglycemia.
Question 3
Following a thyroidectomy, a patient develops stridor and signs of respiratory distress. What is the nurse's priority action?
A. Administer nebulized epinephrine
B. Prepare for emergency tracheostomy and notify surgeon immediately
C. Encourage slow deep breathing exercises
D. Administer oxygen and reposition to semi-Fowler's
🟢 B. Prepare for emergency tracheostomy and notify surgeon immediately
🔴 RATIONALE: Stridor after thyroidectomy indicates airway obstruction from postoperative edema, hemorrhage, or bilateral nerve damage. This is
a life-threatening complication requiring immediate surgical intervention. Oxygen and positioning alone cannot resolve mechanical airway
obstruction. Epinephrine may be used but does not address the primary problem of airway compromise requiring surgical intervention.
,Question 4
A patient with acute kidney injury has a serum potassium of 6.8 mEq/L. Which medication should the nurse administer first?
A. Furosemide 40 mg IV
B. Sodium polystyrene sulfonate (Kayexalate) 15 g
C. Insulin 10 units IV with dextrose 50 mL
D. Calcium gluconate 10 mL IV
🟢 C. Insulin 10 units IV with dextrose 50 mL
🔴 RATIONALE: Insulin with dextrose rapidly shifts potassium intracellularly within 15-30 minutes, providing the fastest reduction in serum
potassium. Calcium gluconate stabilizes the myocardium but does not lower potassium. Kayexalate takes hours to work. Furosemide promotes
potassium excretion but is less effective in acute kidney injury and takes longer than insulin-dextrose.
Question 5
A patient with a newly placed arteriovenous (AV) fistula for hemodialysis is being taught self-care. Which statement indicates the patient
understands proper care?
A. "I will check for the bruit daily and report if it disappears"
B. "I can lift heavy objects with this arm to strengthen it"
C. "I will apply direct pressure to the fistula site for 10 minutes daily"
D. "I can have blood drawn from this arm if needed"
🟢 A. "I will check for the bruit daily and report if it disappears"
🔴 RATIONALE: A bruit indicates blood flow through the fistula; loss of bruit suggests thrombosis requiring immediate intervention. Heavy lifting
can cause fistula damage or bleeding. Direct pressure is only applied during bleeding emergencies, not routinely. Blood draws and IVs should never
be performed in the arm with an AV fistula to prevent damage and infection.
Question 6
A patient presents with severe epigastric pain radiating to the back, nausea, and vomiting. Laboratory results show elevated amylase and lipase. What
is the most likely diagnosis?
, A. Cholecystitis
B. Acute pancreatitis
C. Peptic ulcer disease
D. Gastroesophageal reflux disease
🟢 B. Acute pancreatitis
🔴 RATIONALE: Elevated amylase and lipase are diagnostic for acute pancreatitis, which presents with epigastric pain radiating to the back, nausea,
and vomiting. Cholecystitis presents with right upper quadrant pain and fever. Peptic ulcer disease causes epigastric pain but without enzyme
elevation. GERD presents with heartburn and regurgitation.
Question 7
A patient with multiple sclerosis is experiencing worsening weakness and difficulty swallowing. Which complication should the nurse monitor for
most closely?
A. Pulmonary embolism
B. Respiratory failure and aspiration
C. Deep vein thrombosis
D. Urinary tract infection
🟢 B. Respiratory failure and aspiration
🔴 RATIONALE: Progressive weakness in multiple sclerosis, especially with dysphagia (difficulty swallowing), indicates potential involvement of
respiratory muscles and risk for aspiration. Respiratory failure is a life-threatening complication requiring immediate intervention. While DVT, PE,
and UTI are concerns in MS patients, respiratory failure and aspiration are the most urgent with these specific symptoms.
Question 8
A postoperative patient has a urine output of 15 mL/hr for the past 2 hours. The blood pressure is 90/58 mmHg and heart rate is 118 bpm. What is
the nurse's first action?
A. Administer prescribed pain medication
B. Increase the IV fluid rate and notify the surgeon
C. Document findings as normal postoperative changes
D. Apply a warm blanket to promote comfort
RATIONALES 2026 Q&A |STUDY GUIDE| INSTANT DOWNLOAD PDF
Core Domains
*- Respiratory System Management and Critical Care*
*- Renal and Urinary Tract Function*
*- Endocrine System and Metabolic Disorders*
*- Neurological System Assessment and Care*
*- Gastrointestinal System Management*
*- Fluid, Electrolyte, and Acid-Base Balance*
*- Perioperative Nursing Care*
*- Emergency and Critical Care Nursing*
*- Professional Ethics and Legal Compliance in Nursing*
*- Hematological Disorders and Burn Management*
Introduction
This practice exam is designed to assess comprehensive knowledge and clinical decision-making skills essential for medical-surgical nursing
practice at the Adult Health II level. The assessment evaluates critical competencies in patient assessment, pharmacological interventions, nursing
care planning, and evidence-based practice implementation across multiple system disorders. The multiple-choice format includes scenario-based
questions that emphasize real-world application, prioritization, delegation, and professional judgment. Students will demonstrate mastery of
clinical reasoning through complex patient situations requiring critical thinking, ethical decision-making, and adherence to regulatory standards.
This exam prepares nursing professionals for advanced clinical practice and certification requirements.
SECTION ONE: QUESTIONS 1–100
Question 1
A patient with COPD is experiencing increased shortness of breath and is using accessory muscles to breathe. The nurse notes a pH of 7.25, PaCO2 of
55 mmHg, and HCO3 of 28 mEq/L. What is the most appropriate nursing intervention?
A. Administer high-flow oxygen at 6 L/min
B. Encourage pursed-lip breathing and position in high Fowler's
C. Administer intravenous bicarbonate immediately
D. Prepare for immediate intubation and mechanical ventilation
🟢 B. Encourage pursed-lip breathing and position in high Fowler's
,🔴 RATIONALE: The patient is experiencing acute respiratory acidosis (pH 7.25, PaCO2 55) with compensatory metabolic alkalosis (HCO3 28).
Pursed-lip breathing helps slow respiration and improve CO2 elimination, while high Fowler's position maximizes lung expansion. High-flow oxygen
can suppress the hypoxic drive in COPD patients, bicarbonate is not indicated for respiratory acidosis, and intubation is not immediately necessary
without further assessment of response to conservative measures.
Question 2
A patient with diabetes mellitus presents with blood glucose of 450 mg/dL, positive serum ketones, pH of 7.15, and deep rapid breathing. Which
condition does the nurse suspect?
A. Hyperglycemic Hyperosmolar State (HHS)
B. Diabetic Ketoacidosis (DKA)
C. Somogyi effect
D. Lactic acidosis
🟢 B. Diabetic Ketoacidosis (DKA)
🔴 RATIONALE: DKA is characterized by hyperglycemia (>250 mg/dL), positive ketones, acidosis (pH <7.3), and Kussmaul respirations (deep rapid
breathing) as the body attempts to compensate for metabolic acidosis. HHS presents with much higher glucose (>600 mg/dL) without significant
ketosis. The Somogyi effect refers to rebound hyperglycemia following insulin-induced hypoglycemia.
Question 3
Following a thyroidectomy, a patient develops stridor and signs of respiratory distress. What is the nurse's priority action?
A. Administer nebulized epinephrine
B. Prepare for emergency tracheostomy and notify surgeon immediately
C. Encourage slow deep breathing exercises
D. Administer oxygen and reposition to semi-Fowler's
🟢 B. Prepare for emergency tracheostomy and notify surgeon immediately
🔴 RATIONALE: Stridor after thyroidectomy indicates airway obstruction from postoperative edema, hemorrhage, or bilateral nerve damage. This is
a life-threatening complication requiring immediate surgical intervention. Oxygen and positioning alone cannot resolve mechanical airway
obstruction. Epinephrine may be used but does not address the primary problem of airway compromise requiring surgical intervention.
,Question 4
A patient with acute kidney injury has a serum potassium of 6.8 mEq/L. Which medication should the nurse administer first?
A. Furosemide 40 mg IV
B. Sodium polystyrene sulfonate (Kayexalate) 15 g
C. Insulin 10 units IV with dextrose 50 mL
D. Calcium gluconate 10 mL IV
🟢 C. Insulin 10 units IV with dextrose 50 mL
🔴 RATIONALE: Insulin with dextrose rapidly shifts potassium intracellularly within 15-30 minutes, providing the fastest reduction in serum
potassium. Calcium gluconate stabilizes the myocardium but does not lower potassium. Kayexalate takes hours to work. Furosemide promotes
potassium excretion but is less effective in acute kidney injury and takes longer than insulin-dextrose.
Question 5
A patient with a newly placed arteriovenous (AV) fistula for hemodialysis is being taught self-care. Which statement indicates the patient
understands proper care?
A. "I will check for the bruit daily and report if it disappears"
B. "I can lift heavy objects with this arm to strengthen it"
C. "I will apply direct pressure to the fistula site for 10 minutes daily"
D. "I can have blood drawn from this arm if needed"
🟢 A. "I will check for the bruit daily and report if it disappears"
🔴 RATIONALE: A bruit indicates blood flow through the fistula; loss of bruit suggests thrombosis requiring immediate intervention. Heavy lifting
can cause fistula damage or bleeding. Direct pressure is only applied during bleeding emergencies, not routinely. Blood draws and IVs should never
be performed in the arm with an AV fistula to prevent damage and infection.
Question 6
A patient presents with severe epigastric pain radiating to the back, nausea, and vomiting. Laboratory results show elevated amylase and lipase. What
is the most likely diagnosis?
, A. Cholecystitis
B. Acute pancreatitis
C. Peptic ulcer disease
D. Gastroesophageal reflux disease
🟢 B. Acute pancreatitis
🔴 RATIONALE: Elevated amylase and lipase are diagnostic for acute pancreatitis, which presents with epigastric pain radiating to the back, nausea,
and vomiting. Cholecystitis presents with right upper quadrant pain and fever. Peptic ulcer disease causes epigastric pain but without enzyme
elevation. GERD presents with heartburn and regurgitation.
Question 7
A patient with multiple sclerosis is experiencing worsening weakness and difficulty swallowing. Which complication should the nurse monitor for
most closely?
A. Pulmonary embolism
B. Respiratory failure and aspiration
C. Deep vein thrombosis
D. Urinary tract infection
🟢 B. Respiratory failure and aspiration
🔴 RATIONALE: Progressive weakness in multiple sclerosis, especially with dysphagia (difficulty swallowing), indicates potential involvement of
respiratory muscles and risk for aspiration. Respiratory failure is a life-threatening complication requiring immediate intervention. While DVT, PE,
and UTI are concerns in MS patients, respiratory failure and aspiration are the most urgent with these specific symptoms.
Question 8
A postoperative patient has a urine output of 15 mL/hr for the past 2 hours. The blood pressure is 90/58 mmHg and heart rate is 118 bpm. What is
the nurse's first action?
A. Administer prescribed pain medication
B. Increase the IV fluid rate and notify the surgeon
C. Document findings as normal postoperative changes
D. Apply a warm blanket to promote comfort
