MEDICAL SURGICAL NURSING – QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
• Core Domains:*
• Fluid, Electrolyte, and Acid-Base Balance*
• Perioperative Patient Care*
• Cardiovascular and Circulatory Disorders*
• Respiratory and Ventilation Management*
• Neurological and Cognitive Alterations*
• Endocrine and Metabolic Disorders*
• Gastrointestinal and Nutritional Health*
• Renal and Urological Systems*
• Musculoskeletal and Integumentary Care*
• Immunological, Hematological, and Oncological Disorders*
• Introduction*
• This comprehensive examination assessment is designed to evaluate advanced
clinical competency, theoretical understanding, and critical thinking skills required in
medical-surgical nursing practice. The assessment focuses on the synthesis of
foundational pathophysiology, nursing process application, evidence-based
interventions, and regulatory compliance frameworks. Utilizing a rigorous multiple-
choice and scenario-based layout, the exam challenges candidates to analyze
complex clinical presentations, prioritize nursing interventions, and make defensible,
ethical decisions. Emphasis is placed heavily on real-world clinical application, patient
safety, and optimal therapeutic outcomes, preparing individuals for high-stakes
licensure and professional certification standards in adult health environments.*
Section One: Questions 1–100
Question 1
A client is admitted with an exacerbation of chronic obstructive pulmonary disease (COPD).
The nurse notes the client has a respiratory rate of 28 breaths per minute, uses accessory
muscles, and has an oxygen saturation of 88% on room air. Which oxygen delivery device
should the nurse initiate first?
A. Simple face mask at 6 L/min B. Nasal cannula at 6 L/min C. Venturi mask at 28%
fraction of inspired oxygen (FiO2) D. Non-rebreather mask at 15 L/min
, Explanation: The Venturi mask is the most accurate device for delivering specified,
controlled concentrations of oxygen, which is critical for clients with COPD who rely on a
hypoxic drive to breathe. High concentrations delivered by non-rebreather or high-flow nasal
cannulas can suppress this respiratory drive.
Question 2
The nurse reviews the arterial blood gas (ABG) results for a client with severe persistent
vomiting: pH 7.49, PaCO2 47 mmHg, HCO3 34 mEq/L. How should the nurse interpret these
findings?
A. Metabolic acidosis, fully compensated B. Metabolic alkalosis, partially compensated C.
Respiratory alkalosis, uncompensated D. Metabolic alkalosis, uncompensated
Explanation: The pH is elevated (greater than 7.45), indicating alkalosis. The HCO3 is
elevated (greater than 26 mEq/L), indicating a metabolic origin. The PaCO2 is elevated
(greater than 45 mmHg), which means the lungs are attempting to retain carbon dioxide to
compensate, making it partially compensated.
Question 3
A client undergoing a thyroidectomy signs the surgical consent form. Right before
transferring to the operating suite, the client states, "I am really not sure what they mean by
removing my parathyroid glands too if needed." Which action must the nurse take
immediately?
A. Notify the surgeon to return and explain the procedure to the client. B. Explain the
function of the parathyroid glands and reassure the client. C. Document that the client has
questions but wishes to proceed with surgery. D. Witness the signature again after
answering the client's questions.
Explanation: The surgeon is legally responsible for obtaining informed consent and
explaining the details, risks, and benefits of the surgical procedure. The nurse's role is to
witness the signature and verify the client's understanding; if the client lacks understanding,
the surgeon must be recalled.
Question 4
An older adult client with a history of heart failure is receiving intravenous (IV) normal saline
at 125 mL/h. During the assessment, the nurse notes new-onset crackles in the lung bases,
bounding peripheral pulses, and jugular venous distention. Which action is the priority?
A. Check the client's lower extremities for pitting edema. B. Administer a scheduled dose of
oral potassium chloride. C. Slow the intravenous infusion rate and notify the healthcare
provider. D. Place the client in a supine position with legs elevated.
, Explanation: The client is exhibiting classic manifestations of fluid volume excess (fluid
overload), which risks pulmonary edema, especially given the history of heart failure. The
immediate priority is to minimize further fluid intake by slowing the IV rate and alerting the
provider for potential diuretic orders.
Question 6
A nurse cares for a client post-cardiac catheterization via the right femoral artery approach.
The nurse notes the right pedal pulse is faint and the right foot is cool to the touch
compared to the left foot. What is the nurse's immediate action?
A. Elevate the right leg on two pillows. B. Notify the healthcare provider or rapid
response team. C. Apply a warm compress to the right lower extremity. D. Document the
findings and reassess in 15 minutes.
Explanation: A diminished or absent pulse and a cool extremity post-arterial
catheterization indicate arterial occlusion or thrombosis, which is a surgical emergency. The
healthcare provider must be notified immediately to preserve limb perfusion.
Question 7
A client presents to the emergency department reporting crushing substernal chest pain
radiating to the left arm. The electrocardiogram (ECG) reveals ST-segment elevation in leads
V1 through V4. Which area of the myocardium is affected?
A. Anterior wall B. Inferior wall C. Lateral wall D. Posterior wall
Explanation: ST-segment elevation in leads V1 to V4 signifies an acute anterior wall
myocardial infarction, typically involving the left anterior descending (LAD) coronary artery.
Question 8
The nurse receives a prescription to administer potassium chloride 20 mEq intravenously to
a client with a serum potassium level of 2.9 mEq/L. Which administration method is safe?
A. Infuse via an intravenous push injection over 2 minutes. B. Dilute in 50 mL of normal
saline and infuse over 15 minutes. C. Dilute in 100 mL of normal saline and infuse via
pump over 2 hours. D. Add directly to an existing maintenance fluid bag and mix thoroughly
by hand.
Explanation: Potassium chloride must never be given via IV push or rapid infusion
because it can cause fatal cardiac arrhythmias. It must be diluted and administered at a
controlled rate, typically not exceeding 10 mEq/h through peripheral lines or 20 mEq/h
through central lines via an infusion pump.
Question 9
, A client with type 1 diabetes mellitus is found unresponsive, sweating profusely, and
tachycardic. The bedside blood glucose monitor reads "Low." The client does not have
intravenous access established. Which medication should the nurse administer first?
A. 50 mL of 50% Dextrose intravenously B. 1 mg of Glucagon subcutaneously or
intramuscularly C. 10 units of Regular insulin subcutaneously D. 4 ounces of orange juice
orally
Explanation: Because the client is unresponsive, oral carbohydrates cannot be safely
given due to aspiration risk. Without IV access, the fastest method to raise blood glucose is
administering glucagon intramuscularly or subcutaneously to stimulate hepatic glucose
release.
Question 10
Following a total hip arthroplasty, a client reports sudden-onset pleuritic chest pain and
shortness of breath. The nurse notes an oxygen saturation of 89% and a heart rate of 112
beats per minute. Which complication should the nurse suspect?
A. Pulmonary embolism B. Atelectasis C. Myocardial infarction D. Pneumothorax
Explanation: Postoperative orthopedic clients are at very high risk for deep vein
thrombosis, which can dislodge and cause a pulmonary embolism. The classic triad of
symptoms includes sudden dyspnea, pleuritic chest pain, and tachycardia.
Question 11
The nurse is reviewing the laboratory results of a client scheduled for an elective
cholecystectomy in two hours. Which laboratory value requires immediate notification to
the surgeon?
A. Hemoglobin 12.5 g/dL B. White blood cell count 10,500/mm³ C. Platelet count
45,000/mm³ D. Serum creatinine 0.9 mg/dL
Explanation: A platelet count below 50,000/mm³ (thrombocytopenia) poses a severe risk
for intraoperative and postoperative hemorrhage. The surgeon must be notified immediately
to evaluate if the procedure needs to be postponed or if platelets should be transfused.
Question 12
A client with chronic kidney disease (CKD) presents with a serum potassium level of 6.8
mEq/L and tall, tented T waves on the ECG. Which medication should the nurse anticipate
administering first to protect the myocardium?
A. Sodium polystyrene sulfonate orally B. Calcium gluconate intravenously C. Regular
insulin and dextrose intravenously D. Furosemide intravenously
DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
• Core Domains:*
• Fluid, Electrolyte, and Acid-Base Balance*
• Perioperative Patient Care*
• Cardiovascular and Circulatory Disorders*
• Respiratory and Ventilation Management*
• Neurological and Cognitive Alterations*
• Endocrine and Metabolic Disorders*
• Gastrointestinal and Nutritional Health*
• Renal and Urological Systems*
• Musculoskeletal and Integumentary Care*
• Immunological, Hematological, and Oncological Disorders*
• Introduction*
• This comprehensive examination assessment is designed to evaluate advanced
clinical competency, theoretical understanding, and critical thinking skills required in
medical-surgical nursing practice. The assessment focuses on the synthesis of
foundational pathophysiology, nursing process application, evidence-based
interventions, and regulatory compliance frameworks. Utilizing a rigorous multiple-
choice and scenario-based layout, the exam challenges candidates to analyze
complex clinical presentations, prioritize nursing interventions, and make defensible,
ethical decisions. Emphasis is placed heavily on real-world clinical application, patient
safety, and optimal therapeutic outcomes, preparing individuals for high-stakes
licensure and professional certification standards in adult health environments.*
Section One: Questions 1–100
Question 1
A client is admitted with an exacerbation of chronic obstructive pulmonary disease (COPD).
The nurse notes the client has a respiratory rate of 28 breaths per minute, uses accessory
muscles, and has an oxygen saturation of 88% on room air. Which oxygen delivery device
should the nurse initiate first?
A. Simple face mask at 6 L/min B. Nasal cannula at 6 L/min C. Venturi mask at 28%
fraction of inspired oxygen (FiO2) D. Non-rebreather mask at 15 L/min
, Explanation: The Venturi mask is the most accurate device for delivering specified,
controlled concentrations of oxygen, which is critical for clients with COPD who rely on a
hypoxic drive to breathe. High concentrations delivered by non-rebreather or high-flow nasal
cannulas can suppress this respiratory drive.
Question 2
The nurse reviews the arterial blood gas (ABG) results for a client with severe persistent
vomiting: pH 7.49, PaCO2 47 mmHg, HCO3 34 mEq/L. How should the nurse interpret these
findings?
A. Metabolic acidosis, fully compensated B. Metabolic alkalosis, partially compensated C.
Respiratory alkalosis, uncompensated D. Metabolic alkalosis, uncompensated
Explanation: The pH is elevated (greater than 7.45), indicating alkalosis. The HCO3 is
elevated (greater than 26 mEq/L), indicating a metabolic origin. The PaCO2 is elevated
(greater than 45 mmHg), which means the lungs are attempting to retain carbon dioxide to
compensate, making it partially compensated.
Question 3
A client undergoing a thyroidectomy signs the surgical consent form. Right before
transferring to the operating suite, the client states, "I am really not sure what they mean by
removing my parathyroid glands too if needed." Which action must the nurse take
immediately?
A. Notify the surgeon to return and explain the procedure to the client. B. Explain the
function of the parathyroid glands and reassure the client. C. Document that the client has
questions but wishes to proceed with surgery. D. Witness the signature again after
answering the client's questions.
Explanation: The surgeon is legally responsible for obtaining informed consent and
explaining the details, risks, and benefits of the surgical procedure. The nurse's role is to
witness the signature and verify the client's understanding; if the client lacks understanding,
the surgeon must be recalled.
Question 4
An older adult client with a history of heart failure is receiving intravenous (IV) normal saline
at 125 mL/h. During the assessment, the nurse notes new-onset crackles in the lung bases,
bounding peripheral pulses, and jugular venous distention. Which action is the priority?
A. Check the client's lower extremities for pitting edema. B. Administer a scheduled dose of
oral potassium chloride. C. Slow the intravenous infusion rate and notify the healthcare
provider. D. Place the client in a supine position with legs elevated.
, Explanation: The client is exhibiting classic manifestations of fluid volume excess (fluid
overload), which risks pulmonary edema, especially given the history of heart failure. The
immediate priority is to minimize further fluid intake by slowing the IV rate and alerting the
provider for potential diuretic orders.
Question 6
A nurse cares for a client post-cardiac catheterization via the right femoral artery approach.
The nurse notes the right pedal pulse is faint and the right foot is cool to the touch
compared to the left foot. What is the nurse's immediate action?
A. Elevate the right leg on two pillows. B. Notify the healthcare provider or rapid
response team. C. Apply a warm compress to the right lower extremity. D. Document the
findings and reassess in 15 minutes.
Explanation: A diminished or absent pulse and a cool extremity post-arterial
catheterization indicate arterial occlusion or thrombosis, which is a surgical emergency. The
healthcare provider must be notified immediately to preserve limb perfusion.
Question 7
A client presents to the emergency department reporting crushing substernal chest pain
radiating to the left arm. The electrocardiogram (ECG) reveals ST-segment elevation in leads
V1 through V4. Which area of the myocardium is affected?
A. Anterior wall B. Inferior wall C. Lateral wall D. Posterior wall
Explanation: ST-segment elevation in leads V1 to V4 signifies an acute anterior wall
myocardial infarction, typically involving the left anterior descending (LAD) coronary artery.
Question 8
The nurse receives a prescription to administer potassium chloride 20 mEq intravenously to
a client with a serum potassium level of 2.9 mEq/L. Which administration method is safe?
A. Infuse via an intravenous push injection over 2 minutes. B. Dilute in 50 mL of normal
saline and infuse over 15 minutes. C. Dilute in 100 mL of normal saline and infuse via
pump over 2 hours. D. Add directly to an existing maintenance fluid bag and mix thoroughly
by hand.
Explanation: Potassium chloride must never be given via IV push or rapid infusion
because it can cause fatal cardiac arrhythmias. It must be diluted and administered at a
controlled rate, typically not exceeding 10 mEq/h through peripheral lines or 20 mEq/h
through central lines via an infusion pump.
Question 9
, A client with type 1 diabetes mellitus is found unresponsive, sweating profusely, and
tachycardic. The bedside blood glucose monitor reads "Low." The client does not have
intravenous access established. Which medication should the nurse administer first?
A. 50 mL of 50% Dextrose intravenously B. 1 mg of Glucagon subcutaneously or
intramuscularly C. 10 units of Regular insulin subcutaneously D. 4 ounces of orange juice
orally
Explanation: Because the client is unresponsive, oral carbohydrates cannot be safely
given due to aspiration risk. Without IV access, the fastest method to raise blood glucose is
administering glucagon intramuscularly or subcutaneously to stimulate hepatic glucose
release.
Question 10
Following a total hip arthroplasty, a client reports sudden-onset pleuritic chest pain and
shortness of breath. The nurse notes an oxygen saturation of 89% and a heart rate of 112
beats per minute. Which complication should the nurse suspect?
A. Pulmonary embolism B. Atelectasis C. Myocardial infarction D. Pneumothorax
Explanation: Postoperative orthopedic clients are at very high risk for deep vein
thrombosis, which can dislodge and cause a pulmonary embolism. The classic triad of
symptoms includes sudden dyspnea, pleuritic chest pain, and tachycardia.
Question 11
The nurse is reviewing the laboratory results of a client scheduled for an elective
cholecystectomy in two hours. Which laboratory value requires immediate notification to
the surgeon?
A. Hemoglobin 12.5 g/dL B. White blood cell count 10,500/mm³ C. Platelet count
45,000/mm³ D. Serum creatinine 0.9 mg/dL
Explanation: A platelet count below 50,000/mm³ (thrombocytopenia) poses a severe risk
for intraoperative and postoperative hemorrhage. The surgeon must be notified immediately
to evaluate if the procedure needs to be postponed or if platelets should be transfused.
Question 12
A client with chronic kidney disease (CKD) presents with a serum potassium level of 6.8
mEq/L and tall, tented T waves on the ECG. Which medication should the nurse anticipate
administering first to protect the myocardium?
A. Sodium polystyrene sulfonate orally B. Calcium gluconate intravenously C. Regular
insulin and dextrose intravenously D. Furosemide intravenously
