Comprehensive Medical-Surgical Nursing
Exam Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
1. A nurse is caring for a patient with acute left-sided heart failure. Which
assessment finding requires the most immediate intervention?
A. Dependent ankle edema
B. Weight gain of 2 kg over 1 week
C. Bilateral crackles with severe dyspnea
D. Fatigue during ambulation
Answer: C. Bilateral crackles with severe dyspnea
Rationale: Bilateral crackles accompanied by severe dyspnea indicate pulmonary
congestion and possible acute pulmonary edema, which can rapidly impair
oxygenation. The nurse should prioritize airway and breathing, provide oxygen as
prescribed, position the patient upright, and promptly notify the healthcare
provider. Dependent edema and weight gain are important manifestations of fluid
retention but are generally less immediately life-threatening. Fatigue is common in
heart failure but does not represent the same immediate threat to oxygenation.
2. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen
therapy. Which nursing action is most appropriate?
A. Administer oxygen at the highest possible flow rate
B. Maintain oxygen therapy according to the prescribed target saturation
C. Discontinue oxygen if the respiratory rate decreases
D. Encourage the patient to breathe rapidly and deeply
Answer: B. Maintain oxygen therapy according to the prescribed target saturation
,Rationale: Patients with COPD may require carefully titrated oxygen therapy to
maintain adequate oxygenation while avoiding unnecessary excessive oxygen
administration. Oxygen should be administered according to the prescribed target
range and the patient's clinical condition. The nurse should continuously assess
respiratory status, oxygen saturation, mental status, and work of breathing. High-
flow oxygen without appropriate assessment may worsen hypercapnia in
susceptible patients. Rapid shallow breathing increases respiratory effort and is not
therapeutic.
3. A patient with suspected myocardial infarction reports crushing substernal chest
pain. Which intervention should the nurse prioritize?
A. Encourage ambulation to improve circulation
B. Obtain a 12-lead electrocardiogram promptly
C. Give the patient a large meal
D. Place the patient in the Trendelenburg position
Answer: B. Obtain a 12-lead electrocardiogram promptly
Rationale: A 12-lead electrocardiogram is a priority diagnostic assessment in
suspected acute coronary syndrome because it can identify ischemic changes and
help guide urgent treatment. The patient should be placed at rest and continuously
assessed for vital-sign changes and deterioration. Ambulation increases myocardial
oxygen demand. A meal is inappropriate during acute chest pain because the
patient may require urgent procedures. Trendelenburg positioning does not treat
acute myocardial ischemia.
4. A patient receiving digoxin has an apical pulse of 52 beats/minute. What should
the nurse do?
A. Administer the medication as scheduled
B. Double the next dose
C. Hold the medication and notify the healthcare provider
D. Give the medication with an antacid
Answer: C. Hold the medication and notify the healthcare provider
,Rationale: Digoxin can cause bradycardia and other cardiac dysrhythmias. Before
administering digoxin, the nurse should assess the apical pulse for a full minute. An
adult pulse below the facility's established safe threshold, commonly less than 60
beats/minute, generally warrants holding the medication and notifying the
healthcare provider. The nurse should also assess for toxicity manifestations such as
nausea, vomiting, anorexia, visual disturbances, and dysrhythmias.
5. A patient with hypertension asks why lifestyle modification is important even
when antihypertensive medication is prescribed. Which response is best?
A. “Lifestyle changes are unnecessary once medication is started.”
B. “Lifestyle changes can improve blood pressure control and reduce cardiovascular
risk.”
C. “Lifestyle changes are only needed when blood pressure is extremely high.”
D. “Medication works only when you exercise every day.”
Answer: B. “Lifestyle changes can improve blood pressure control and reduce
cardiovascular risk.”
Rationale: Hypertension management commonly requires both pharmacologic and
nonpharmacologic strategies. Appropriate dietary patterns, sodium reduction,
physical activity, weight management when indicated, avoidance of tobacco,
moderation of alcohol, and adherence to prescribed therapy can improve blood
pressure control and reduce complications such as stroke, heart failure, kidney
disease, and coronary artery disease. Lifestyle interventions complement rather
than automatically replace medication.
6. A patient with atrial fibrillation is prescribed an anticoagulant. What is the
primary purpose of anticoagulation?
A. To restore normal sinus rhythm immediately
B. To increase ventricular contraction strength
C. To reduce the risk of thromboembolic stroke
D. To eliminate all irregular heartbeats
Answer: C. To reduce the risk of thromboembolic stroke
, Rationale: Atrial fibrillation causes ineffective atrial contraction and blood stasis,
particularly in the left atrial appendage. This can promote thrombus formation and
systemic embolization. Anticoagulants reduce the risk of clot formation and
ischemic stroke. Anticoagulants do not directly convert atrial fibrillation to sinus
rhythm and do not necessarily eliminate the irregular rhythm.
7. A patient with peripheral arterial disease reports severe calf pain when walking
that improves with rest. How should the nurse interpret this finding?
A. Intermittent claudication
B. Venous stasis
C. Neuropathic pain
D. Acute compartment syndrome
Answer: A. Intermittent claudication
Rationale: Intermittent claudication is ischemic muscle pain caused by inadequate
arterial blood flow during activity. It typically occurs with exercise and improves
with rest because oxygen demand decreases. Peripheral arterial disease may also
cause diminished pulses, cool extremities, delayed capillary refill, and trophic skin
changes. Venous disease more commonly causes edema and aching that may
worsen with prolonged standing. Acute compartment syndrome is a medical
emergency characterized by severe pain, swelling, and neurovascular compromise.
8. A patient develops sudden unilateral weakness and difficulty speaking. What is
the nurse's priority?
A. Give oral fluids
B. Determine the exact time symptoms began
C. Encourage the patient to sleep
D. Place the patient in a walking program
Answer: B. Determine the exact time symptoms began
Rationale: Sudden unilateral weakness and speech difficulty are classic warning
signs of acute stroke. The exact time the patient was last known well is critically
important because eligibility for time-sensitive reperfusion therapies depends partly
Exam Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
1. A nurse is caring for a patient with acute left-sided heart failure. Which
assessment finding requires the most immediate intervention?
A. Dependent ankle edema
B. Weight gain of 2 kg over 1 week
C. Bilateral crackles with severe dyspnea
D. Fatigue during ambulation
Answer: C. Bilateral crackles with severe dyspnea
Rationale: Bilateral crackles accompanied by severe dyspnea indicate pulmonary
congestion and possible acute pulmonary edema, which can rapidly impair
oxygenation. The nurse should prioritize airway and breathing, provide oxygen as
prescribed, position the patient upright, and promptly notify the healthcare
provider. Dependent edema and weight gain are important manifestations of fluid
retention but are generally less immediately life-threatening. Fatigue is common in
heart failure but does not represent the same immediate threat to oxygenation.
2. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen
therapy. Which nursing action is most appropriate?
A. Administer oxygen at the highest possible flow rate
B. Maintain oxygen therapy according to the prescribed target saturation
C. Discontinue oxygen if the respiratory rate decreases
D. Encourage the patient to breathe rapidly and deeply
Answer: B. Maintain oxygen therapy according to the prescribed target saturation
,Rationale: Patients with COPD may require carefully titrated oxygen therapy to
maintain adequate oxygenation while avoiding unnecessary excessive oxygen
administration. Oxygen should be administered according to the prescribed target
range and the patient's clinical condition. The nurse should continuously assess
respiratory status, oxygen saturation, mental status, and work of breathing. High-
flow oxygen without appropriate assessment may worsen hypercapnia in
susceptible patients. Rapid shallow breathing increases respiratory effort and is not
therapeutic.
3. A patient with suspected myocardial infarction reports crushing substernal chest
pain. Which intervention should the nurse prioritize?
A. Encourage ambulation to improve circulation
B. Obtain a 12-lead electrocardiogram promptly
C. Give the patient a large meal
D. Place the patient in the Trendelenburg position
Answer: B. Obtain a 12-lead electrocardiogram promptly
Rationale: A 12-lead electrocardiogram is a priority diagnostic assessment in
suspected acute coronary syndrome because it can identify ischemic changes and
help guide urgent treatment. The patient should be placed at rest and continuously
assessed for vital-sign changes and deterioration. Ambulation increases myocardial
oxygen demand. A meal is inappropriate during acute chest pain because the
patient may require urgent procedures. Trendelenburg positioning does not treat
acute myocardial ischemia.
4. A patient receiving digoxin has an apical pulse of 52 beats/minute. What should
the nurse do?
A. Administer the medication as scheduled
B. Double the next dose
C. Hold the medication and notify the healthcare provider
D. Give the medication with an antacid
Answer: C. Hold the medication and notify the healthcare provider
,Rationale: Digoxin can cause bradycardia and other cardiac dysrhythmias. Before
administering digoxin, the nurse should assess the apical pulse for a full minute. An
adult pulse below the facility's established safe threshold, commonly less than 60
beats/minute, generally warrants holding the medication and notifying the
healthcare provider. The nurse should also assess for toxicity manifestations such as
nausea, vomiting, anorexia, visual disturbances, and dysrhythmias.
5. A patient with hypertension asks why lifestyle modification is important even
when antihypertensive medication is prescribed. Which response is best?
A. “Lifestyle changes are unnecessary once medication is started.”
B. “Lifestyle changes can improve blood pressure control and reduce cardiovascular
risk.”
C. “Lifestyle changes are only needed when blood pressure is extremely high.”
D. “Medication works only when you exercise every day.”
Answer: B. “Lifestyle changes can improve blood pressure control and reduce
cardiovascular risk.”
Rationale: Hypertension management commonly requires both pharmacologic and
nonpharmacologic strategies. Appropriate dietary patterns, sodium reduction,
physical activity, weight management when indicated, avoidance of tobacco,
moderation of alcohol, and adherence to prescribed therapy can improve blood
pressure control and reduce complications such as stroke, heart failure, kidney
disease, and coronary artery disease. Lifestyle interventions complement rather
than automatically replace medication.
6. A patient with atrial fibrillation is prescribed an anticoagulant. What is the
primary purpose of anticoagulation?
A. To restore normal sinus rhythm immediately
B. To increase ventricular contraction strength
C. To reduce the risk of thromboembolic stroke
D. To eliminate all irregular heartbeats
Answer: C. To reduce the risk of thromboembolic stroke
, Rationale: Atrial fibrillation causes ineffective atrial contraction and blood stasis,
particularly in the left atrial appendage. This can promote thrombus formation and
systemic embolization. Anticoagulants reduce the risk of clot formation and
ischemic stroke. Anticoagulants do not directly convert atrial fibrillation to sinus
rhythm and do not necessarily eliminate the irregular rhythm.
7. A patient with peripheral arterial disease reports severe calf pain when walking
that improves with rest. How should the nurse interpret this finding?
A. Intermittent claudication
B. Venous stasis
C. Neuropathic pain
D. Acute compartment syndrome
Answer: A. Intermittent claudication
Rationale: Intermittent claudication is ischemic muscle pain caused by inadequate
arterial blood flow during activity. It typically occurs with exercise and improves
with rest because oxygen demand decreases. Peripheral arterial disease may also
cause diminished pulses, cool extremities, delayed capillary refill, and trophic skin
changes. Venous disease more commonly causes edema and aching that may
worsen with prolonged standing. Acute compartment syndrome is a medical
emergency characterized by severe pain, swelling, and neurovascular compromise.
8. A patient develops sudden unilateral weakness and difficulty speaking. What is
the nurse's priority?
A. Give oral fluids
B. Determine the exact time symptoms began
C. Encourage the patient to sleep
D. Place the patient in a walking program
Answer: B. Determine the exact time symptoms began
Rationale: Sudden unilateral weakness and speech difficulty are classic warning
signs of acute stroke. The exact time the patient was last known well is critically
important because eligibility for time-sensitive reperfusion therapies depends partly
