NURS 320 MEDICAL SURGICAL NURSING EXAM
2026–2027 | (50 QUESTIONS AND CORRECT
ANSWERS) | ALREADY GRADED A+ | 100%
VERIFIED
Introduction
This structured NURS 320 Medical Surgical Nursing Exam format for 2026–2027 provides
the complete layout for generating high-quality exam-style questions with correct answers
and rationales. It emphasizes clinical judgment, patient safety, comprehensive medical-
surgical nursing principles, and evidence-based practice critical to professional nursing
practice and successful course completion.
1. A patient presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 25 mEq/L.
Which acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Rationale: A pH below 7.35 indicates acidosis. The elevated PaCO2 (>45 mmHg) confirms a
respiratory cause, as the CO2 is being retained.
2. Which assessment finding is the most sensitive early indicator of increased
intracranial pressure (ICP)?
A. Pupillary dilation
B. Change in level of consciousness
C. Cushing's Triad
D. Projectile vomiting
Rationale: Changes in LOC, such as restlessness or agitation, occur before physical signs
like pupillary changes or bradycardia as brain tissue is highly sensitive to oxygen and
pressure shifts.
,3. A nurse is preparing to administer Warfarin. Which laboratory value is the priority
to monitor for this patient?
A. aPTT
B. PT/INR
C. Platelet count
D. WBC count
Rationale: PT/INR is the standardized measurement for monitoring the therapeutic effect
of Warfarin. aPTT is used for Heparin.
4. What is the hallmark clinical manifestation of right-sided heart failure?
A. Pulmonary crackles
B. S3 heart sound
C. Jugular Venous Distention (JVD)
D. Orthopnea
Rationale: Right-sided failure causes blood to back up into the systemic circulation, leading
to JVD, peripheral edema, and hepatomegaly.
5. A patient has a serum potassium level of 6.5 mEq/L. Which EKG change is most
characteristic of this finding?
A. Presence of U-waves
B. Tall, peaked T-waves
C. ST-segment depression
D. Shortened PR interval
Rationale: Hyperkalemia affects ventricular repolarization, causing characteristic tall,
peaked T-waves on the EKG.
6. Which of the following is the priority nursing action when a chest tube becomes
accidentally disconnected from the drainage system?
, A. Call the provider immediately
B. Place the end of the tube in sterile water
C. Tape the tube to the patient's skin
D. Clamp the tube with two clamps
Rationale: Submerging the end in sterile water creates a temporary water seal that
prevents atmospheric air from entering the pleural space and causing a tension
pneumothorax.
7. A patient with Type 1 Diabetes presents with Kussmaul respirations and a fruity
breath odor. What is the first-line IV fluid intervention?
A. D5W
B. 0.45% Normal Saline
C. 0.9% Normal Saline
D. Lactated Ringer's
Rationale: In Diabetic Ketoacidosis (DKA), aggressive volume expansion with isotonic
saline (0.9% NS) is required to restore perfusion and reduce glucose levels before starting
insulin.
8. Which of the following is a classic sign of 'beck's triad' in cardiac tamponade?
A. Tachycardia
B. Hypotension with narrowed pulse pressure
C. Fever
D. Pulmonary edema
Rationale: Beck's triad consists of hypotension, JVD, and muffled heart sounds, reflecting
the compression of the heart by fluid in the pericardial sac.
9. A patient is prescribed Lisinopril. The nurse should monitor for which life-
threatening adverse effect?
A. Constipation
2026–2027 | (50 QUESTIONS AND CORRECT
ANSWERS) | ALREADY GRADED A+ | 100%
VERIFIED
Introduction
This structured NURS 320 Medical Surgical Nursing Exam format for 2026–2027 provides
the complete layout for generating high-quality exam-style questions with correct answers
and rationales. It emphasizes clinical judgment, patient safety, comprehensive medical-
surgical nursing principles, and evidence-based practice critical to professional nursing
practice and successful course completion.
1. A patient presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 25 mEq/L.
Which acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Rationale: A pH below 7.35 indicates acidosis. The elevated PaCO2 (>45 mmHg) confirms a
respiratory cause, as the CO2 is being retained.
2. Which assessment finding is the most sensitive early indicator of increased
intracranial pressure (ICP)?
A. Pupillary dilation
B. Change in level of consciousness
C. Cushing's Triad
D. Projectile vomiting
Rationale: Changes in LOC, such as restlessness or agitation, occur before physical signs
like pupillary changes or bradycardia as brain tissue is highly sensitive to oxygen and
pressure shifts.
,3. A nurse is preparing to administer Warfarin. Which laboratory value is the priority
to monitor for this patient?
A. aPTT
B. PT/INR
C. Platelet count
D. WBC count
Rationale: PT/INR is the standardized measurement for monitoring the therapeutic effect
of Warfarin. aPTT is used for Heparin.
4. What is the hallmark clinical manifestation of right-sided heart failure?
A. Pulmonary crackles
B. S3 heart sound
C. Jugular Venous Distention (JVD)
D. Orthopnea
Rationale: Right-sided failure causes blood to back up into the systemic circulation, leading
to JVD, peripheral edema, and hepatomegaly.
5. A patient has a serum potassium level of 6.5 mEq/L. Which EKG change is most
characteristic of this finding?
A. Presence of U-waves
B. Tall, peaked T-waves
C. ST-segment depression
D. Shortened PR interval
Rationale: Hyperkalemia affects ventricular repolarization, causing characteristic tall,
peaked T-waves on the EKG.
6. Which of the following is the priority nursing action when a chest tube becomes
accidentally disconnected from the drainage system?
, A. Call the provider immediately
B. Place the end of the tube in sterile water
C. Tape the tube to the patient's skin
D. Clamp the tube with two clamps
Rationale: Submerging the end in sterile water creates a temporary water seal that
prevents atmospheric air from entering the pleural space and causing a tension
pneumothorax.
7. A patient with Type 1 Diabetes presents with Kussmaul respirations and a fruity
breath odor. What is the first-line IV fluid intervention?
A. D5W
B. 0.45% Normal Saline
C. 0.9% Normal Saline
D. Lactated Ringer's
Rationale: In Diabetic Ketoacidosis (DKA), aggressive volume expansion with isotonic
saline (0.9% NS) is required to restore perfusion and reduce glucose levels before starting
insulin.
8. Which of the following is a classic sign of 'beck's triad' in cardiac tamponade?
A. Tachycardia
B. Hypotension with narrowed pulse pressure
C. Fever
D. Pulmonary edema
Rationale: Beck's triad consists of hypotension, JVD, and muffled heart sounds, reflecting
the compression of the heart by fluid in the pericardial sac.
9. A patient is prescribed Lisinopril. The nurse should monitor for which life-
threatening adverse effect?
A. Constipation
