MED SURG 201 FINAL EXAM 300 ACTUAL CORRECT
QUESTIONS AND VERIFIED ANSWERS WITH RATIONALE
LATEST 2026 ALREADY GRADED A+
This comprehensive set of 300 multiple-choice questions is designed as a
rigorous review for MED SURG 201, covering essential topics in medical-
surgical nursing. The questions address a wide spectrum of conditions
including cardiovascular, respiratory, renal, gastrointestinal, endocrine,
neurological, and hematological disorders. Key areas emphasized include
critical lab value interpretation, emergency interventions, medication
mechanisms and adverse effects, acid-base imbalances, postoperative care,
and complication recognition. Each question is followed by the correct answer
and a detailed rationale explaining the clinical reasoning. No questions are
repeated, ensuring broad content coverage suitable for exam preparation,
NCLEX-style practice, and reinforcement of safe, evidence-based nursing
practice.
1. A patient with chronic kidney disease is scheduled for hemodialysis. Which
laboratory value should the nurse monitor most closely before the procedure?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B
Rationale: In chronic kidney disease, potassium excretion is impaired, leading to
hyperkalemia. Before hemodialysis, serum potassium must be closely monitored
because elevated levels (above 5.5 mEq/L) can cause life-threatening cardiac
dysrhythmias. Hemodialysis removes excess potassium, but knowing the pre-
dialysis level guides the dialysis prescription and emergency interventions if
critical hyperkalemia is present.
2. The nurse is caring for a patient with heart failure who complains of sudden
shortness of breath and coughing up pink, frothy sputum. Which action should the
nurse take first?
A. Administer oxygen via non-rebreather mask
B. Place the patient in high Fowler's position
C. Notify the healthcare provider immediately
,D. Check the patient's oxygen saturation
Answer: B
Rationale: Pink, frothy sputum and sudden dyspnea indicate acute pulmonary
edema, a medical emergency. The priority action is to place the patient in high
Fowler's position to reduce venous return to the heart, decrease pulmonary
congestion, and facilitate breathing using accessory muscles. While oxygen and
provider notification are critical, positioning is the immediate nursing intervention
that can be done simultaneously before other measures.
3. A patient with cirrhosis develops ascites. Which dietary modification is most
important for the nurse to emphasize?
A. High-protein diet
B. Low-sodium diet
C. High-carbohydrate diet
D. Fluid restriction to 1 liter per day
Answer: B
Rationale: Ascites in cirrhosis results from portal hypertension and decreased
plasma albumin, leading to fluid accumulation in the peritoneal cavity. A low-
sodium diet is the most important dietary modification because sodium retention
exacerbates fluid retention. Restricting sodium to 2 grams or less per day helps
reduce ascites by decreasing osmotic pressure that pulls water into the abdominal
cavity.
4. The nurse is assessing a patient with diabetic ketoacidosis (DKA). Which
finding indicates that treatment is effective?
A. Serum glucose decreases from 600 mg/dL to 300 mg/dL
B. Serum bicarbonate increases from 10 mEq/L to 18 mEq/L
C. Serum potassium decreases from 5.5 mEq/L to 4.0 mEq/L
D. Urine output increases from 20 mL/hr to 50 mL/hr
Answer: B
Rationale: In DKA, the body produces ketone bodies, which deplete bicarbonate
buffer, causing metabolic acidosis with low serum bicarbonate. An increase in
bicarbonate toward normal (22-26 mEq/L) indicates that insulin therapy is working
to stop ketogenesis and that the acidosis is resolving. While glucose reduction and
potassium changes also occur, bicarbonate improvement is the most direct
indicator of resolving acidosis.
5. A patient with chronic obstructive pulmonary disease (COPD) has an arterial
blood gas (ABG) result showing pH 7.30, PaCO2 58 mmHg, HCO3 26 mEq/L.
Which interpretation is correct?
,A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: C
Rationale: The pH is low (7.30), indicating acidosis. The PaCO2 is elevated above
normal (35-45 mmHg), which is the primary respiratory parameter. In COPD,
chronic airflow obstruction leads to carbon dioxide retention. The HCO3 is slightly
elevated (normal 22-26 mEq/L), suggesting partial renal compensation, but the
primary problem is respiratory acidosis due to hypoventilation and CO2 buildup.
6. The nurse is preparing to administer digoxin to a patient with atrial fibrillation.
Which assessment finding would cause the nurse to hold the medication and notify
the provider?
A. Heart rate 68 beats per minute
B. Serum potassium 3.2 mEq/L
C. Blood pressure 130/80 mmHg
D. Respiratory rate 16 breaths per minute
Answer: B
Rationale: Digoxin toxicity is potentiated by hypokalemia (serum potassium below
3.5 mEq/L). Low potassium increases the risk of fatal cardiac dysrhythmias
because digoxin binds to the same sodium-potassium ATPase pump. A potassium
level of 3.2 mEq/L requires holding digoxin, correcting the potassium, and
notifying the provider before administration.
7. A patient with acute pancreatitis reports severe abdominal pain that radiates to
the back. Which position should the nurse encourage to reduce pain?
A. Supine with legs flat
B. Side-lying with knees flexed
C. Prone position
D. Sitting upright leaning forward
Answer: D
Rationale: In acute pancreatitis, the inflamed pancreas lies retroperitoneally.
Leaning forward while sitting reduces tension on the abdominal organs and
decreases pressure on the pancreas from the stomach and omentum. This position
often provides significant pain relief, whereas supine or prone positions increase
intra-abdominal pressure and worsen pain.
8. The nurse is caring for a patient with a nasogastric tube on continuous suction.
Which electrolyte imbalance is the patient at highest risk for developing?
, A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypermagnesemia
Answer: B
Rationale: Continuous nasogastric suction removes gastric secretions that are rich
in hydrochloric acid and potassium. Loss of gastric fluid depletes total body
potassium and hydrogen ions, leading to hypokalemia and metabolic alkalosis.
Potassium replacement is often required to prevent cardiac and neuromuscular
complications.
9. A patient with sickle cell crisis is admitted with severe pain and fever. Which
intervention should the nurse prioritize?
A. Apply cold compresses to painful joints
B. Administer oxygen at 2 liters per nasal cannula
C. Encourage oral fluid intake of at least 4 liters per day
D. Administer meperidine for pain relief
Answer: C
Rationale: In sickle cell crisis, sickled red blood cells obstruct microcirculation,
causing ischemia and pain. Hydration is the priority intervention because
dehydration promotes sickling and worsens vaso-occlusion. Encouraging 4-6 liters
of oral fluids daily reduces blood viscosity, improves circulation, and helps reverse
the sickling process. Oxygen may be given if hypoxic, but hydration is more
directly preventive.
10. A patient with acute myocardial infarction is prescribed morphine sulfate.
What is the primary therapeutic purpose of this medication in this setting?
A. To sedate the patient and reduce anxiety
B. To decrease preload and afterload
C. To relieve chest pain and decrease myocardial oxygen demand
D. To prevent coughing and respiratory distress
Answer: C
Rationale: Morphine is given in acute MI primarily to relieve severe chest pain and
reduce myocardial oxygen demand. It achieves this by causing venodilation
(reducing preload), arteriodilation (reducing afterload), and decreasing systemic
vascular resistance. It also has mild sedative effects, but pain relief and reduction
of cardiac workload are the primary therapeutic goals.
11. A patient with chronic liver disease has an elevated ammonia level. Which
medication would the nurse expect to administer to lower ammonia?
QUESTIONS AND VERIFIED ANSWERS WITH RATIONALE
LATEST 2026 ALREADY GRADED A+
This comprehensive set of 300 multiple-choice questions is designed as a
rigorous review for MED SURG 201, covering essential topics in medical-
surgical nursing. The questions address a wide spectrum of conditions
including cardiovascular, respiratory, renal, gastrointestinal, endocrine,
neurological, and hematological disorders. Key areas emphasized include
critical lab value interpretation, emergency interventions, medication
mechanisms and adverse effects, acid-base imbalances, postoperative care,
and complication recognition. Each question is followed by the correct answer
and a detailed rationale explaining the clinical reasoning. No questions are
repeated, ensuring broad content coverage suitable for exam preparation,
NCLEX-style practice, and reinforcement of safe, evidence-based nursing
practice.
1. A patient with chronic kidney disease is scheduled for hemodialysis. Which
laboratory value should the nurse monitor most closely before the procedure?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B
Rationale: In chronic kidney disease, potassium excretion is impaired, leading to
hyperkalemia. Before hemodialysis, serum potassium must be closely monitored
because elevated levels (above 5.5 mEq/L) can cause life-threatening cardiac
dysrhythmias. Hemodialysis removes excess potassium, but knowing the pre-
dialysis level guides the dialysis prescription and emergency interventions if
critical hyperkalemia is present.
2. The nurse is caring for a patient with heart failure who complains of sudden
shortness of breath and coughing up pink, frothy sputum. Which action should the
nurse take first?
A. Administer oxygen via non-rebreather mask
B. Place the patient in high Fowler's position
C. Notify the healthcare provider immediately
,D. Check the patient's oxygen saturation
Answer: B
Rationale: Pink, frothy sputum and sudden dyspnea indicate acute pulmonary
edema, a medical emergency. The priority action is to place the patient in high
Fowler's position to reduce venous return to the heart, decrease pulmonary
congestion, and facilitate breathing using accessory muscles. While oxygen and
provider notification are critical, positioning is the immediate nursing intervention
that can be done simultaneously before other measures.
3. A patient with cirrhosis develops ascites. Which dietary modification is most
important for the nurse to emphasize?
A. High-protein diet
B. Low-sodium diet
C. High-carbohydrate diet
D. Fluid restriction to 1 liter per day
Answer: B
Rationale: Ascites in cirrhosis results from portal hypertension and decreased
plasma albumin, leading to fluid accumulation in the peritoneal cavity. A low-
sodium diet is the most important dietary modification because sodium retention
exacerbates fluid retention. Restricting sodium to 2 grams or less per day helps
reduce ascites by decreasing osmotic pressure that pulls water into the abdominal
cavity.
4. The nurse is assessing a patient with diabetic ketoacidosis (DKA). Which
finding indicates that treatment is effective?
A. Serum glucose decreases from 600 mg/dL to 300 mg/dL
B. Serum bicarbonate increases from 10 mEq/L to 18 mEq/L
C. Serum potassium decreases from 5.5 mEq/L to 4.0 mEq/L
D. Urine output increases from 20 mL/hr to 50 mL/hr
Answer: B
Rationale: In DKA, the body produces ketone bodies, which deplete bicarbonate
buffer, causing metabolic acidosis with low serum bicarbonate. An increase in
bicarbonate toward normal (22-26 mEq/L) indicates that insulin therapy is working
to stop ketogenesis and that the acidosis is resolving. While glucose reduction and
potassium changes also occur, bicarbonate improvement is the most direct
indicator of resolving acidosis.
5. A patient with chronic obstructive pulmonary disease (COPD) has an arterial
blood gas (ABG) result showing pH 7.30, PaCO2 58 mmHg, HCO3 26 mEq/L.
Which interpretation is correct?
,A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: C
Rationale: The pH is low (7.30), indicating acidosis. The PaCO2 is elevated above
normal (35-45 mmHg), which is the primary respiratory parameter. In COPD,
chronic airflow obstruction leads to carbon dioxide retention. The HCO3 is slightly
elevated (normal 22-26 mEq/L), suggesting partial renal compensation, but the
primary problem is respiratory acidosis due to hypoventilation and CO2 buildup.
6. The nurse is preparing to administer digoxin to a patient with atrial fibrillation.
Which assessment finding would cause the nurse to hold the medication and notify
the provider?
A. Heart rate 68 beats per minute
B. Serum potassium 3.2 mEq/L
C. Blood pressure 130/80 mmHg
D. Respiratory rate 16 breaths per minute
Answer: B
Rationale: Digoxin toxicity is potentiated by hypokalemia (serum potassium below
3.5 mEq/L). Low potassium increases the risk of fatal cardiac dysrhythmias
because digoxin binds to the same sodium-potassium ATPase pump. A potassium
level of 3.2 mEq/L requires holding digoxin, correcting the potassium, and
notifying the provider before administration.
7. A patient with acute pancreatitis reports severe abdominal pain that radiates to
the back. Which position should the nurse encourage to reduce pain?
A. Supine with legs flat
B. Side-lying with knees flexed
C. Prone position
D. Sitting upright leaning forward
Answer: D
Rationale: In acute pancreatitis, the inflamed pancreas lies retroperitoneally.
Leaning forward while sitting reduces tension on the abdominal organs and
decreases pressure on the pancreas from the stomach and omentum. This position
often provides significant pain relief, whereas supine or prone positions increase
intra-abdominal pressure and worsen pain.
8. The nurse is caring for a patient with a nasogastric tube on continuous suction.
Which electrolyte imbalance is the patient at highest risk for developing?
, A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypermagnesemia
Answer: B
Rationale: Continuous nasogastric suction removes gastric secretions that are rich
in hydrochloric acid and potassium. Loss of gastric fluid depletes total body
potassium and hydrogen ions, leading to hypokalemia and metabolic alkalosis.
Potassium replacement is often required to prevent cardiac and neuromuscular
complications.
9. A patient with sickle cell crisis is admitted with severe pain and fever. Which
intervention should the nurse prioritize?
A. Apply cold compresses to painful joints
B. Administer oxygen at 2 liters per nasal cannula
C. Encourage oral fluid intake of at least 4 liters per day
D. Administer meperidine for pain relief
Answer: C
Rationale: In sickle cell crisis, sickled red blood cells obstruct microcirculation,
causing ischemia and pain. Hydration is the priority intervention because
dehydration promotes sickling and worsens vaso-occlusion. Encouraging 4-6 liters
of oral fluids daily reduces blood viscosity, improves circulation, and helps reverse
the sickling process. Oxygen may be given if hypoxic, but hydration is more
directly preventive.
10. A patient with acute myocardial infarction is prescribed morphine sulfate.
What is the primary therapeutic purpose of this medication in this setting?
A. To sedate the patient and reduce anxiety
B. To decrease preload and afterload
C. To relieve chest pain and decrease myocardial oxygen demand
D. To prevent coughing and respiratory distress
Answer: C
Rationale: Morphine is given in acute MI primarily to relieve severe chest pain and
reduce myocardial oxygen demand. It achieves this by causing venodilation
(reducing preload), arteriodilation (reducing afterload), and decreasing systemic
vascular resistance. It also has mild sedative effects, but pain relief and reduction
of cardiac workload are the primary therapeutic goals.
11. A patient with chronic liver disease has an elevated ammonia level. Which
medication would the nurse expect to administer to lower ammonia?
