NU 126 LEVEL II COMPREHENSIVE
MEDICAL SURGICAL NURSING REVIEW
NEWEST 2026
1. A patient with heart failure presents with crackles in bilateral lung bases,
jugular venous distention, and 3+ pitting edema in the lower extremities. Which
medication should the nurse anticipate administering first?
• A) Digoxin
• B) Furosemide
• C) Metoprolol
• D) Spironolactone
Answer: B) Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces fluid overload by
promoting diuresis, directly addressing the patient's symptoms of pulmonary
congestion and edema. Digoxin and metoprolol are long-term management drugs;
spironolactone is a potassium-sparing diuretic used adjunctively.
2. A patient with COPD has an arterial blood gas (ABG) showing pH 7.30, PaCO2
68 mmHg, HCO3 32 mEq/L. Which interpretation is correct?
• A) Acute respiratory acidosis
• B) Chronic respiratory acidosis with metabolic compensation
• C) Metabolic alkalosis with respiratory compensation
• D) Mixed acidosis
Answer: B) Chronic respiratory acidosis with metabolic compensation
Rationale: The low pH indicates acidosis. Elevated PaCO2 indicates respiratory
,acidosis. The HCO3 is elevated (normal 22-26), indicating metabolic
compensation, which takes 3-5 days, suggesting a chronic process.
3. A patient post-MI develops chest pain unrelieved by nitroglycerin, with BP
90/60 mmHg and HR 110 bpm. ECG shows ST-elevation in V1-V4. Which
intervention is the priority?
• A) Administer morphine IV
• B) Prepare for emergent percutaneous coronary intervention (PCI)
• C) Increase oxygen to 10 L/min via non-rebreather
• D) Administer amiodarone IV
Answer: B) Prepare for emergent percutaneous coronary intervention (PCI)
Rationale: ST-elevation in V1-V4 indicates an anterior STEMI. Emergent PCI is the
gold standard for reperfusion and is the priority. Morphine and oxygen are
supportive but do not restore blood flow.
4. A nurse is caring for a patient with acute pancreatitis. Which assessment
finding indicates a potential complication of hypocalcemia?
• A) Trousseau's sign positive
• B) Hyperactive bowel sounds
• C) Bilateral crackles
• D) Temperature 101.2°F
Answer: A) Trousseau's sign positive
Rationale: Trousseau's sign (carpal spasm when BP cuff inflated) indicates
hypocalcemia, a complication of acute pancreatitis due to saponification of
calcium in necrotic fat. This requires immediate intervention.
,5. Which patient assignment is most appropriate for an LPN under the
supervision of an RN on a medical-surgical unit?
• A) A patient with new-onset atrial fibrillation on a continuous cardiac
monitor
• B) A stable patient with a tracheostomy requiring routine suctioning every 4
hours
• C) A patient returning from the PACU after abdominal surgery with an
epidural infusion
• D) A patient with sepsis receiving IV vasopressors
Answer: B) A stable patient with a tracheostomy requiring routine suctioning
every 4 hours
Rationale: LPNs can care for stable patients with predictable outcomes and
perform routine tracheostomy suctioning. Unstable patients (A, C, D) requiring
complex assessment or titration of vasopressors must be assigned to an RN.
6. A patient with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. Which ECG change should the nurse monitor for?
• A) Prolonged PR interval
• B) Prominent U waves
• C) Peaked T waves
• D) ST-segment depression
Answer: C) Peaked T waves
Rationale: Hyperkalemia (K+ > 5.5) causes peaked (tall, tented) T waves on ECG.
Prolonged PR and widened QRS occur with severe hyperkalemia. Prominent U
waves are seen in hypokalemia.
, 7. A patient is 2 days post-op from a total hip replacement. The nurse notes
sudden onset of dyspnea, pleuritic chest pain, and HR 120 bpm. What is the
priority action?
• A) Administer oxygen and notify the provider
• B) Ambulate the patient to prevent atelectasis
• C) Administer subcutaneous heparin as ordered
• D) Perform a 12-lead ECG
Answer: A) Administer oxygen and notify the provider
Rationale: These symptoms suggest a pulmonary embolism (PE), a life-
threatening post-op complication. The priority is to stabilize oxygenation and
notify the provider immediately for further diagnostics and treatment.
8. A patient with diabetes insipidus is receiving desmopressin (DDAVP). Which
finding indicates the medication is effective?
• A) Urine output decreases and urine specific gravity increases
• B) Serum sodium decreases to 130 mEq/L
• C) Blood glucose rises above 200 mg/dL
• D) Urine output increases to 300 mL/hr
Answer: A) Urine output decreases and urine specific gravity increases
Rationale: Desmopressin is a synthetic ADH that reduces urine output and
increases urine concentration (specific gravity) in diabetes insipidus. This indicates
therapeutic effect.
9. A patient with cirrhosis has an ammonia level of 120 mcg/dL and is confused.
Which medication should the nurse anticipate administering?
• A) Lactulose
MEDICAL SURGICAL NURSING REVIEW
NEWEST 2026
1. A patient with heart failure presents with crackles in bilateral lung bases,
jugular venous distention, and 3+ pitting edema in the lower extremities. Which
medication should the nurse anticipate administering first?
• A) Digoxin
• B) Furosemide
• C) Metoprolol
• D) Spironolactone
Answer: B) Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces fluid overload by
promoting diuresis, directly addressing the patient's symptoms of pulmonary
congestion and edema. Digoxin and metoprolol are long-term management drugs;
spironolactone is a potassium-sparing diuretic used adjunctively.
2. A patient with COPD has an arterial blood gas (ABG) showing pH 7.30, PaCO2
68 mmHg, HCO3 32 mEq/L. Which interpretation is correct?
• A) Acute respiratory acidosis
• B) Chronic respiratory acidosis with metabolic compensation
• C) Metabolic alkalosis with respiratory compensation
• D) Mixed acidosis
Answer: B) Chronic respiratory acidosis with metabolic compensation
Rationale: The low pH indicates acidosis. Elevated PaCO2 indicates respiratory
,acidosis. The HCO3 is elevated (normal 22-26), indicating metabolic
compensation, which takes 3-5 days, suggesting a chronic process.
3. A patient post-MI develops chest pain unrelieved by nitroglycerin, with BP
90/60 mmHg and HR 110 bpm. ECG shows ST-elevation in V1-V4. Which
intervention is the priority?
• A) Administer morphine IV
• B) Prepare for emergent percutaneous coronary intervention (PCI)
• C) Increase oxygen to 10 L/min via non-rebreather
• D) Administer amiodarone IV
Answer: B) Prepare for emergent percutaneous coronary intervention (PCI)
Rationale: ST-elevation in V1-V4 indicates an anterior STEMI. Emergent PCI is the
gold standard for reperfusion and is the priority. Morphine and oxygen are
supportive but do not restore blood flow.
4. A nurse is caring for a patient with acute pancreatitis. Which assessment
finding indicates a potential complication of hypocalcemia?
• A) Trousseau's sign positive
• B) Hyperactive bowel sounds
• C) Bilateral crackles
• D) Temperature 101.2°F
Answer: A) Trousseau's sign positive
Rationale: Trousseau's sign (carpal spasm when BP cuff inflated) indicates
hypocalcemia, a complication of acute pancreatitis due to saponification of
calcium in necrotic fat. This requires immediate intervention.
,5. Which patient assignment is most appropriate for an LPN under the
supervision of an RN on a medical-surgical unit?
• A) A patient with new-onset atrial fibrillation on a continuous cardiac
monitor
• B) A stable patient with a tracheostomy requiring routine suctioning every 4
hours
• C) A patient returning from the PACU after abdominal surgery with an
epidural infusion
• D) A patient with sepsis receiving IV vasopressors
Answer: B) A stable patient with a tracheostomy requiring routine suctioning
every 4 hours
Rationale: LPNs can care for stable patients with predictable outcomes and
perform routine tracheostomy suctioning. Unstable patients (A, C, D) requiring
complex assessment or titration of vasopressors must be assigned to an RN.
6. A patient with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. Which ECG change should the nurse monitor for?
• A) Prolonged PR interval
• B) Prominent U waves
• C) Peaked T waves
• D) ST-segment depression
Answer: C) Peaked T waves
Rationale: Hyperkalemia (K+ > 5.5) causes peaked (tall, tented) T waves on ECG.
Prolonged PR and widened QRS occur with severe hyperkalemia. Prominent U
waves are seen in hypokalemia.
, 7. A patient is 2 days post-op from a total hip replacement. The nurse notes
sudden onset of dyspnea, pleuritic chest pain, and HR 120 bpm. What is the
priority action?
• A) Administer oxygen and notify the provider
• B) Ambulate the patient to prevent atelectasis
• C) Administer subcutaneous heparin as ordered
• D) Perform a 12-lead ECG
Answer: A) Administer oxygen and notify the provider
Rationale: These symptoms suggest a pulmonary embolism (PE), a life-
threatening post-op complication. The priority is to stabilize oxygenation and
notify the provider immediately for further diagnostics and treatment.
8. A patient with diabetes insipidus is receiving desmopressin (DDAVP). Which
finding indicates the medication is effective?
• A) Urine output decreases and urine specific gravity increases
• B) Serum sodium decreases to 130 mEq/L
• C) Blood glucose rises above 200 mg/dL
• D) Urine output increases to 300 mL/hr
Answer: A) Urine output decreases and urine specific gravity increases
Rationale: Desmopressin is a synthetic ADH that reduces urine output and
increases urine concentration (specific gravity) in diabetes insipidus. This indicates
therapeutic effect.
9. A patient with cirrhosis has an ammonia level of 120 mcg/dL and is confused.
Which medication should the nurse anticipate administering?
• A) Lactulose
