Medical-Surgical RN A
Prophecy / Relias 2026-2027 Latest Questions and Answers
Verified Answers with Comprehensive Clinical Rationales
Total Questions 100
Sections 9
Cognitive Mix 30% Recall | 50% Application | 20% Analysis
Question Style 75% Scenario-based | 20% Direct recall | 5% Clinical analysis
Pass Standard A+ graded verified answers with distractor analysis
Frameworks ABC + Safety | Evidence-Based Practice | Scope of Practice
Section 1: Patient Safety, Infection Control, and Legal/Ethical Issues
HIPAA, PPE, Isolation Precautions, and Professional Practice
Q1: A group of nurses on a medical-surgical unit take a photograph in the staff breakroom during a
birthday celebration and post it on a personal social media account. No patients are visible, no
patient names are mentioned, and no Protected Health Information (PHI) appears in the image. What
is the most appropriate action regarding this post?
A. Remove the post immediately because any workplace image violates HIPAA regardless of content
B. Tag the hospital so the public can verify the unit where nurses work
C. No action is necessary because no PHI is visible and no patients are identifiable in the
photograph [CORRECT]
D. Blur the background of the breakroom before keeping the post public
Correct Answer: C
Rationale: HIPAA protects individually identifiable health information (PHI). A photograph taken in a
non-patient-care area, with no patients or PHI visible, does not constitute a HIPAA violation, so no remedial action
is required. Posting workplace images may still violate employer social media policy, so nurses should follow
facility rules, but HIPAA itself is not triggered. Options A, B, and D misapply HIPAA by treating any workplace
image as a violation, exposing the employer to public scrutiny, or implying PHI exists where it does not.
,Q2: A 68-year-old Mandarin-speaking patient is admitted to the medical-surgical unit with acute
cholecystitis. The patient speaks limited English and appears anxious. The admitting nurse needs
to obtain informed consent for an IV antibiotic and gather the admission health history. What is the
most appropriate method to communicate with this patient during the admission assessment?
A. Ask the patient's adult daughter who arrived with her to interpret the admission questions
B. Use the organization's interpreter services, either in-person or via telephonic/video interpreter, to
conduct the admission assessment [CORRECT]
C. Use medical terminology with hand gestures and short sentences to convey key points
D. Defer the admission assessment until the provider makes rounds the following morning
Correct Answer: B
Rationale: Patients with Limited English Proficiency (LEP) have a right to language assistance services under Title
VI of the Civil Rights Act, and Joint Commission standards require use of qualified medical interpreters for consent,
teaching, and assessment. Family members (option A) are not qualified interpreters and may filter, omit, or add
information, compromising accuracy and confidentiality. Hand gestures (option C) and deferring assessment
(option D) violate standards of care, increase liability, and delay necessary treatment.
Q3: The emergency department charge nurse is assigning rooms to incoming patients. Which new
admission requires airborne precautions in addition to a private negative-pressure room?
A. A 45-year-old with cellulitis and a draining wound positive for MRSA
B. A 62-year-old with a 3-week history of progressive cough, unintentional weight loss of 12 pounds,
night sweats, and blood-tinged sputum [CORRECT]
C. A 28-year-old with influenza A confirmed by rapid testing and a temperature of 101.4 F
D. A 70-year-old with Clostridioides difficile colitis and profuse watery diarrhea
Correct Answer: B
Rationale: The combination of chronic productive cough, hemoptysis (bloody sputum), night sweats, and
significant unintentional weight loss is the classic presentation of pulmonary tuberculosis, which is transmitted via
airborne droplet nuclei and requires airborne precautions with a negative-pressure room and N95 respirators.
MRSA cellulitis (A) requires contact precautions, influenza (C) requires droplet precautions, and C. difficile (D)
requires contact precautions with soap-and-water hand hygiene.
Q4: A medical-surgical nurse is caring for a patient with an active MRSA infection in a sacral wound.
Which combination of personal protective equipment (PPE) must the nurse don before entering the
patient's room to perform a dressing change?
A. Surgical mask and eye protection only
B. Gown and gloves, with hand hygiene before donning and after removing [CORRECT]
C. N95 respirator, gown, and gloves
D. Gown, gloves, surgical mask, and eye protection
Correct Answer: B
Rationale: Active MRSA infections require contact precautions, which mandate a gown and gloves in addition to
standard hand hygiene. An N95 respirator (C) is reserved for airborne pathogens such as TB, measles, or
varicella. A surgical mask and eye protection (A) are insufficient for contact transmission. Option D adds
unnecessary PPE unless splashing of blood or body fluids is anticipated during the dressing change.
,Q5: A postoperative patient is scheduled for an exploratory laparotomy. The surgeon has not yet
visited the patient, and the patient asks the bedside nurse to explain the surgical procedure,
including risks and benefits, and then sign the surgical consent form. What is the most appropriate
nursing response?
A. Explain the procedure based on the operative note and co-sign the consent as a witness
B. Explain risks, benefits, and alternatives, then have the patient sign and the nurse sign as witness
C. Notify the surgeon that the patient needs the procedure explained and the consent obtained by
the provider, as this is outside the nurse's scope of practice [CORRECT]
D. Refuse to discuss the procedure at all and tell the patient to wait until after surgery
Correct Answer: C
Rationale: Informed consent requires that the provider performing the procedure explain the nature of the
procedure, risks, benefits, and alternatives so the patient can make an informed decision. The nurse's role is to
witness the patient's signature and verify comprehension, not to provide the explanation or obtain consent. Options
A, B, and D exceed nursing scope, create legal liability for invalid consent, or leave the patient uninformed.
Q6: A 54-year-old patient who is a Jehovah's Witness is admitted with an upper GI bleed and
hemoglobin of 6.8 g/dL. The provider has ordered 2 units of packed red blood cells. The patient
states, 'I cannot receive blood transfusions because of my religious beliefs.' What is the most
appropriate nursing action?
A. Administer the blood transfusion because the patient's life is in danger
B. Respect the patient's wishes, notify the provider of the refusal, and document the refusal and the
provider's notification [CORRECT]
C. Administer only half of the ordered blood to honor the patient's wishes partially
D. Have the patient sign an Against Medical Advice form and discharge her immediately
Correct Answer: B
Rationale: Competent adult patients have the legal and ethical right to refuse any medical treatment, including
life-saving blood transfusions, based on religious or personal beliefs. The nurse must respect the refusal, notify the
provider so alternative treatments (such as iron, erythropoietin, or volume expanders) can be considered, and
document the refusal, the patient's capacity, and the provider notification. Options A and C violate informed
consent and battery; option D is an inappropriate escalation.
Q7: An 82-year-old patient with advanced dementia is admitted from a long-term care facility
weighing 92 pounds (BMI 16.1). The patient is unbathed, has feces in the perineal area, and has a
stage 4 pressure injury on the sacrum with necrotic tissue. The patient's daughter states, 'I do my
best, but I cannot keep up.' What is the nurse's priority action?
A. Confront the daughter about possible neglect and ask her to leave the unit
B. Notify the charge nurse and social worker to initiate an evaluation for suspected elder abuse or
neglect [CORRECT]
C. Bathe the patient, document the wound, and discharge the patient back to the daughter's care
D. File a report with adult protective services without telling anyone on the care team
Correct Answer: B
Rationale: The presentation of failure to thrive, advanced dementia, severe underweight status, poor hygiene, and
a stage 4 pressure injury is highly suggestive of elder neglect. The nurse's role is to notify the charge nurse and
social worker, who will coordinate the investigation and reporting process per facility policy and state law.
Confronting the daughter (A) may escalate the situation, while options C and D bypass the interdisciplinary team
and may delay protective interventions.
, Q8: A nurse working on the medical-surgical unit observes a coworker accessing the electronic
medical record of a patient who is not assigned to their care and is not being consulted on. The
coworker states, 'I am just curious because I heard this patient was admitted.' What is the most
appropriate action for the observing nurse?
A. Report the coworker's actions to the nurse manager or supervisor, as this violates HIPAA and the
need-to-know principle [CORRECT]
B. Ignore the behavior because the coworker did not share the information with anyone outside the hospital
C. Confront the coworker privately but take no further action if the coworker agrees to stop
D. Wait to see if the coworker accesses additional records before deciding to report
Correct Answer: A
Rationale: HIPAA requires that PHI be accessed only on a need-to-know basis for treatment, payment, or
operations. Curiosity-based access is a violation, even if no information is shared externally, and auditable
electronic records make these violations easily detectable. The nurse's responsibility is to report the violation up
the chain of command so it can be investigated and addressed through the facility's HIPAA privacy officer. Options
B, C, and D enable continued violations and may expose the observing nurse to liability.
Q9: A 77-year-old patient with metastatic cancer is admitted with sepsis. The patient states, 'I do not
want to be resuscitated if my heart stops. I want to be a DNR.' The medical record currently shows
the patient as full code. What is the nurse's most appropriate action?
A. Document the patient's statement and take no further action because only the provider can change code
status
B. Discuss the patient's code status wishes, then follow up with the provider to ensure the medical
record and code status order reflect the patient's wishes [CORRECT]
C. Honor the verbal wishes and place a DNR sign on the door without provider notification
D. Notify the ethics committee and wait for their recommendation before discussing further
Correct Answer: B
Rationale: Code status is a clinical order requiring both patient autonomy and provider documentation. The
nurse's role is to have a clear, nonjudgmental conversation with the patient about their wishes, communicate those
wishes to the provider, and ensure the medical record and code status order are updated. Simply documenting
without follow-up (A) leaves the patient with an inaccurate code status, while option C bypasses the required
provider order, and option D delays necessary action.
Q10: Before administering a scheduled dose of oral metoprolol to a patient, what is the most
appropriate method for the nurse to verify the patient's identity?
A. Ask the patient to state their name and confirm it against the medication administration record (MAR)
B. Verify the patient's room and bed number against the MAR
C. Use at least two patient identifiers, such as full name and date of birth, and compare them to the
wristband and MAR [CORRECT]
D. Ask a family member at the bedside to confirm the patient's identity
Correct Answer: C
Rationale: The Joint Commission National Patient Safety Goal 1 requires two patient identifiers (neither of which
may be the room or bed number) before administering medications, blood products, or performing procedures. Full
name and date of birth, verified against the wristband and the MAR, are the standard. Option A uses only one
identifier, option B uses the room number which is not acceptable, and option D relies on a non-patient source that
may not always be available.
Prophecy / Relias 2026-2027 Latest Questions and Answers
Verified Answers with Comprehensive Clinical Rationales
Total Questions 100
Sections 9
Cognitive Mix 30% Recall | 50% Application | 20% Analysis
Question Style 75% Scenario-based | 20% Direct recall | 5% Clinical analysis
Pass Standard A+ graded verified answers with distractor analysis
Frameworks ABC + Safety | Evidence-Based Practice | Scope of Practice
Section 1: Patient Safety, Infection Control, and Legal/Ethical Issues
HIPAA, PPE, Isolation Precautions, and Professional Practice
Q1: A group of nurses on a medical-surgical unit take a photograph in the staff breakroom during a
birthday celebration and post it on a personal social media account. No patients are visible, no
patient names are mentioned, and no Protected Health Information (PHI) appears in the image. What
is the most appropriate action regarding this post?
A. Remove the post immediately because any workplace image violates HIPAA regardless of content
B. Tag the hospital so the public can verify the unit where nurses work
C. No action is necessary because no PHI is visible and no patients are identifiable in the
photograph [CORRECT]
D. Blur the background of the breakroom before keeping the post public
Correct Answer: C
Rationale: HIPAA protects individually identifiable health information (PHI). A photograph taken in a
non-patient-care area, with no patients or PHI visible, does not constitute a HIPAA violation, so no remedial action
is required. Posting workplace images may still violate employer social media policy, so nurses should follow
facility rules, but HIPAA itself is not triggered. Options A, B, and D misapply HIPAA by treating any workplace
image as a violation, exposing the employer to public scrutiny, or implying PHI exists where it does not.
,Q2: A 68-year-old Mandarin-speaking patient is admitted to the medical-surgical unit with acute
cholecystitis. The patient speaks limited English and appears anxious. The admitting nurse needs
to obtain informed consent for an IV antibiotic and gather the admission health history. What is the
most appropriate method to communicate with this patient during the admission assessment?
A. Ask the patient's adult daughter who arrived with her to interpret the admission questions
B. Use the organization's interpreter services, either in-person or via telephonic/video interpreter, to
conduct the admission assessment [CORRECT]
C. Use medical terminology with hand gestures and short sentences to convey key points
D. Defer the admission assessment until the provider makes rounds the following morning
Correct Answer: B
Rationale: Patients with Limited English Proficiency (LEP) have a right to language assistance services under Title
VI of the Civil Rights Act, and Joint Commission standards require use of qualified medical interpreters for consent,
teaching, and assessment. Family members (option A) are not qualified interpreters and may filter, omit, or add
information, compromising accuracy and confidentiality. Hand gestures (option C) and deferring assessment
(option D) violate standards of care, increase liability, and delay necessary treatment.
Q3: The emergency department charge nurse is assigning rooms to incoming patients. Which new
admission requires airborne precautions in addition to a private negative-pressure room?
A. A 45-year-old with cellulitis and a draining wound positive for MRSA
B. A 62-year-old with a 3-week history of progressive cough, unintentional weight loss of 12 pounds,
night sweats, and blood-tinged sputum [CORRECT]
C. A 28-year-old with influenza A confirmed by rapid testing and a temperature of 101.4 F
D. A 70-year-old with Clostridioides difficile colitis and profuse watery diarrhea
Correct Answer: B
Rationale: The combination of chronic productive cough, hemoptysis (bloody sputum), night sweats, and
significant unintentional weight loss is the classic presentation of pulmonary tuberculosis, which is transmitted via
airborne droplet nuclei and requires airborne precautions with a negative-pressure room and N95 respirators.
MRSA cellulitis (A) requires contact precautions, influenza (C) requires droplet precautions, and C. difficile (D)
requires contact precautions with soap-and-water hand hygiene.
Q4: A medical-surgical nurse is caring for a patient with an active MRSA infection in a sacral wound.
Which combination of personal protective equipment (PPE) must the nurse don before entering the
patient's room to perform a dressing change?
A. Surgical mask and eye protection only
B. Gown and gloves, with hand hygiene before donning and after removing [CORRECT]
C. N95 respirator, gown, and gloves
D. Gown, gloves, surgical mask, and eye protection
Correct Answer: B
Rationale: Active MRSA infections require contact precautions, which mandate a gown and gloves in addition to
standard hand hygiene. An N95 respirator (C) is reserved for airborne pathogens such as TB, measles, or
varicella. A surgical mask and eye protection (A) are insufficient for contact transmission. Option D adds
unnecessary PPE unless splashing of blood or body fluids is anticipated during the dressing change.
,Q5: A postoperative patient is scheduled for an exploratory laparotomy. The surgeon has not yet
visited the patient, and the patient asks the bedside nurse to explain the surgical procedure,
including risks and benefits, and then sign the surgical consent form. What is the most appropriate
nursing response?
A. Explain the procedure based on the operative note and co-sign the consent as a witness
B. Explain risks, benefits, and alternatives, then have the patient sign and the nurse sign as witness
C. Notify the surgeon that the patient needs the procedure explained and the consent obtained by
the provider, as this is outside the nurse's scope of practice [CORRECT]
D. Refuse to discuss the procedure at all and tell the patient to wait until after surgery
Correct Answer: C
Rationale: Informed consent requires that the provider performing the procedure explain the nature of the
procedure, risks, benefits, and alternatives so the patient can make an informed decision. The nurse's role is to
witness the patient's signature and verify comprehension, not to provide the explanation or obtain consent. Options
A, B, and D exceed nursing scope, create legal liability for invalid consent, or leave the patient uninformed.
Q6: A 54-year-old patient who is a Jehovah's Witness is admitted with an upper GI bleed and
hemoglobin of 6.8 g/dL. The provider has ordered 2 units of packed red blood cells. The patient
states, 'I cannot receive blood transfusions because of my religious beliefs.' What is the most
appropriate nursing action?
A. Administer the blood transfusion because the patient's life is in danger
B. Respect the patient's wishes, notify the provider of the refusal, and document the refusal and the
provider's notification [CORRECT]
C. Administer only half of the ordered blood to honor the patient's wishes partially
D. Have the patient sign an Against Medical Advice form and discharge her immediately
Correct Answer: B
Rationale: Competent adult patients have the legal and ethical right to refuse any medical treatment, including
life-saving blood transfusions, based on religious or personal beliefs. The nurse must respect the refusal, notify the
provider so alternative treatments (such as iron, erythropoietin, or volume expanders) can be considered, and
document the refusal, the patient's capacity, and the provider notification. Options A and C violate informed
consent and battery; option D is an inappropriate escalation.
Q7: An 82-year-old patient with advanced dementia is admitted from a long-term care facility
weighing 92 pounds (BMI 16.1). The patient is unbathed, has feces in the perineal area, and has a
stage 4 pressure injury on the sacrum with necrotic tissue. The patient's daughter states, 'I do my
best, but I cannot keep up.' What is the nurse's priority action?
A. Confront the daughter about possible neglect and ask her to leave the unit
B. Notify the charge nurse and social worker to initiate an evaluation for suspected elder abuse or
neglect [CORRECT]
C. Bathe the patient, document the wound, and discharge the patient back to the daughter's care
D. File a report with adult protective services without telling anyone on the care team
Correct Answer: B
Rationale: The presentation of failure to thrive, advanced dementia, severe underweight status, poor hygiene, and
a stage 4 pressure injury is highly suggestive of elder neglect. The nurse's role is to notify the charge nurse and
social worker, who will coordinate the investigation and reporting process per facility policy and state law.
Confronting the daughter (A) may escalate the situation, while options C and D bypass the interdisciplinary team
and may delay protective interventions.
, Q8: A nurse working on the medical-surgical unit observes a coworker accessing the electronic
medical record of a patient who is not assigned to their care and is not being consulted on. The
coworker states, 'I am just curious because I heard this patient was admitted.' What is the most
appropriate action for the observing nurse?
A. Report the coworker's actions to the nurse manager or supervisor, as this violates HIPAA and the
need-to-know principle [CORRECT]
B. Ignore the behavior because the coworker did not share the information with anyone outside the hospital
C. Confront the coworker privately but take no further action if the coworker agrees to stop
D. Wait to see if the coworker accesses additional records before deciding to report
Correct Answer: A
Rationale: HIPAA requires that PHI be accessed only on a need-to-know basis for treatment, payment, or
operations. Curiosity-based access is a violation, even if no information is shared externally, and auditable
electronic records make these violations easily detectable. The nurse's responsibility is to report the violation up
the chain of command so it can be investigated and addressed through the facility's HIPAA privacy officer. Options
B, C, and D enable continued violations and may expose the observing nurse to liability.
Q9: A 77-year-old patient with metastatic cancer is admitted with sepsis. The patient states, 'I do not
want to be resuscitated if my heart stops. I want to be a DNR.' The medical record currently shows
the patient as full code. What is the nurse's most appropriate action?
A. Document the patient's statement and take no further action because only the provider can change code
status
B. Discuss the patient's code status wishes, then follow up with the provider to ensure the medical
record and code status order reflect the patient's wishes [CORRECT]
C. Honor the verbal wishes and place a DNR sign on the door without provider notification
D. Notify the ethics committee and wait for their recommendation before discussing further
Correct Answer: B
Rationale: Code status is a clinical order requiring both patient autonomy and provider documentation. The
nurse's role is to have a clear, nonjudgmental conversation with the patient about their wishes, communicate those
wishes to the provider, and ensure the medical record and code status order are updated. Simply documenting
without follow-up (A) leaves the patient with an inaccurate code status, while option C bypasses the required
provider order, and option D delays necessary action.
Q10: Before administering a scheduled dose of oral metoprolol to a patient, what is the most
appropriate method for the nurse to verify the patient's identity?
A. Ask the patient to state their name and confirm it against the medication administration record (MAR)
B. Verify the patient's room and bed number against the MAR
C. Use at least two patient identifiers, such as full name and date of birth, and compare them to the
wristband and MAR [CORRECT]
D. Ask a family member at the bedside to confirm the patient's identity
Correct Answer: C
Rationale: The Joint Commission National Patient Safety Goal 1 requires two patient identifiers (neither of which
may be the room or bed number) before administering medications, blood products, or performing procedures. Full
name and date of birth, verified against the wristband and the MAR, are the standard. Option A uses only one
identifier, option B uses the room number which is not acceptable, and option D relies on a non-patient source that
may not always be available.
