BSN3A Medical-Surgical Nursing Comprehensive Exam
Review with Questions, Answers and Rationales
2026/2027 Update
Section 1: Cardiovascular Disorders & Hemodynamic Monitoring
Question 1
A nurse is caring for a client admitted with acute decompensated heart failure who presents with
severe dyspnea, orthopnea, and pink, frothy sputum. Which of the following is the nurse's
immediate priority intervention?
A. Administer high-flow oxygen via non-rebreather mask and position the client upright with
legs dangling.
B. Obtain a twelve-lead electrocardiogram and draw a baseline complete metabolic panel.
C. Insert an indwelling urinary catheter to accurately measure hourly urine output.
D. Encourage the client to perform pursed-lip breathing exercises and ambulate in the
hallway.
Correct Answer: A. Administer high-flow oxygen via non-rebreather mask and position the
client upright with legs dangling.
Rationale: Pink, frothy sputum combined with severe dyspnea indicates acute pulmonary
edema, a life-threatening medical emergency. Placing the client in an upright position with legs
dependent reduces venous return (preload) to the heart, while high-flow oxygen addresses
immediate hypoxemia.
Question 2
A nurse is monitoring a client who has a temporary transvenous pacemaker inserted following a
complete heart block. Which finding indicates failure to capture?
A. Pacing spikes on the electrocardiogram that are not followed by P waves or QRS
complexes.
B. Pacing spikes occurring at regular intervals directly preceding wide QRS complexes.
C. The absence of pacing spikes when the intrinsic heart rate drops below the set limit.
D. A resting heart rate that remains stable at seventy-two beats per minute.
,Correct Answer: A. Pacing spikes on the electrocardiogram that are not followed by P
waves or QRS complexes.
Rationale: Failure to capture occurs when the pacemaker generates an electrical impulse
(indicated by a spike), but the myocardium fails to respond, meaning no depolarization (no P
wave or QRS complex) follows the spike. This requires immediate clinical intervention and
adjustment of output settings.
Question 3
A nurse is assessing a client with a suspected abdominal aortic aneurysm. Which of the
following physical assessment findings is most characteristic of this condition?
A. A pulsating mass in the periumbilical area accompanied by a bruit upon auscultation.
B. Severe, dull aching pain radiating outward to both lower extremities with palpable pedal
pulses.
C. Unilateral pitting edema in the lower calf accompanied by a positive Homans sign.
D. Absent bowel sounds throughout all four abdominal quadrants with rebound tenderness.
Correct Answer: A. A pulsating mass in the periumbilical area accompanied by a bruit
upon auscultation.
Rationale: The classic clinical manifestations of an abdominal aortic aneurysm include a
prominent, pulsating mass felt in the periumbilical region, often accompanied by a systolic bruit
heard over the aorta. Palpating the area deeply should be avoided to prevent rupture.
Question 4
A nurse is caring for a client who sustained an acute anterior wall myocardial infarction. Which
complication should the nurse monitor for most closely during the first twenty-four to forty-eight
hours post-infarction?
A. Ventricular arrhythmias, such as ventricular tachycardia or ventricular fibrillation.
B. Chronic peripheral venous insufficiency and lower extremity stasis ulcers.
C. Hyperactive bowel sounds and intractable chronic diarrhea.
D. Progressive bilateral hearing loss and tinnitus.
Correct Answer: A. Ventricular arrhythmias, such as ventricular tachycardia or
ventricular fibrillation.
,Rationale: Electrical instability of the ischemic myocardium during the first forty-eight hours
following a myocardial infarction frequently triggers lethal ventricular arrhythmias, making
continuous cardiac monitoring essential.
Question 5
A nurse is providing discharge teaching to a client who has chronic stable angina and a new
prescription for sublingual nitroglycerin tablets. Which instruction should the nurse emphasize
regarding proper storage and usage?
A. Keep the tablets in their original dark, airtight glass container and replace them every six
months.
B. Store the medication bottle in the kitchen refrigerator to prolong its active shelf life.
C. Take up to five tablets spaced two minutes apart before calling emergency services.
D. Swallow the sublingual tablet whole with a full glass of cold water.
Correct Answer: A. Keep the tablets in their original dark, airtight glass container and
replace them every six months.
Rationale: Nitroglycerin is unstable and loses potency when exposed to light, heat, moisture, or
air. It must be stored in its original amber glass bottle with a tight cap and replaced every six
months to ensure efficacy during acute angina attacks.
Section 2: Respiratory Disorders & Mechanical Ventilation
Question 6
A nurse is caring for a client with a chest tube connected to a water-seal drainage system
following a lobectomy. The nurse notes continuous, vigorous bubbling in the water-seal
chamber. How should the nurse interpret this finding?
A. There is an active air leak somewhere in the drainage system or thoracic cavity.
B. The client's lung has fully re-expanded and the chest tube is ready for removal.
C. This is a normal, expected finding during continuous suctioning.
D. The suction control chamber pressure is set too low.
Correct Answer: A. There is an active air leak somewhere in the drainage system or
thoracic cavity.
, Rationale: Intermittent bubbling in the water-seal chamber during exhalation or coughing is
normal when an air leak is resolving. However, continuous, vigorous bubbling indicates an air
leak within the system connections or from the client's lung.
Question 7
A nurse is managing a client with acute respiratory distress syndrome who is intubated and
mechanically ventilated. Which ventilator setting adjustment is standard in protective lung
ventilation strategies?
A. Using low tidal volumes (six milliliters per kilogram of ideal body weight) to prevent
volutrauma.
B. Maintaining high tidal volumes (twelve to fifteen milliliters per kilogram) to maximize
alveolar recruitment.
C. Setting the fraction of inspired oxygen at one hundred percent indefinitely to ensure tissue
oxygenation.
D. Eliminating positive end-expiratory pressure entirely to lower intrathoracic pressure.
Correct Answer: A. Using low tidal volumes (six milliliters per kilogram of ideal body
weight) to prevent volutrauma.
Rationale: Low tidal volume ventilation prevents overdistention of fragile alveoli (volutrauma
and barotrauma) in acute respiratory distress syndrome clients, significantly reducing mortality
rates.
Question 8
A nurse is assessing a client who has a tension pneumothorax. Which clinical manifestation is
uniquely characteristic of a tension pneumothorax compared to a simple pneumothorax?
A. Tracheal deviation away from the affected side, absent breath sounds on the injured side,
and hemodynamic instability.
B. Bilateral equal breath sounds with mild expiratory wheezing throughout all lung fields.
C. Hypertension, bradycardia, and bradypnea (Cushing triad).
D. Productive cough with thick rust-colored sputum and pleuritic chest pain.
Correct Answer: A. Tracheal deviation away from the affected side, absent breath sounds
on the injured side, and hemodynamic instability.
Review with Questions, Answers and Rationales
2026/2027 Update
Section 1: Cardiovascular Disorders & Hemodynamic Monitoring
Question 1
A nurse is caring for a client admitted with acute decompensated heart failure who presents with
severe dyspnea, orthopnea, and pink, frothy sputum. Which of the following is the nurse's
immediate priority intervention?
A. Administer high-flow oxygen via non-rebreather mask and position the client upright with
legs dangling.
B. Obtain a twelve-lead electrocardiogram and draw a baseline complete metabolic panel.
C. Insert an indwelling urinary catheter to accurately measure hourly urine output.
D. Encourage the client to perform pursed-lip breathing exercises and ambulate in the
hallway.
Correct Answer: A. Administer high-flow oxygen via non-rebreather mask and position the
client upright with legs dangling.
Rationale: Pink, frothy sputum combined with severe dyspnea indicates acute pulmonary
edema, a life-threatening medical emergency. Placing the client in an upright position with legs
dependent reduces venous return (preload) to the heart, while high-flow oxygen addresses
immediate hypoxemia.
Question 2
A nurse is monitoring a client who has a temporary transvenous pacemaker inserted following a
complete heart block. Which finding indicates failure to capture?
A. Pacing spikes on the electrocardiogram that are not followed by P waves or QRS
complexes.
B. Pacing spikes occurring at regular intervals directly preceding wide QRS complexes.
C. The absence of pacing spikes when the intrinsic heart rate drops below the set limit.
D. A resting heart rate that remains stable at seventy-two beats per minute.
,Correct Answer: A. Pacing spikes on the electrocardiogram that are not followed by P
waves or QRS complexes.
Rationale: Failure to capture occurs when the pacemaker generates an electrical impulse
(indicated by a spike), but the myocardium fails to respond, meaning no depolarization (no P
wave or QRS complex) follows the spike. This requires immediate clinical intervention and
adjustment of output settings.
Question 3
A nurse is assessing a client with a suspected abdominal aortic aneurysm. Which of the
following physical assessment findings is most characteristic of this condition?
A. A pulsating mass in the periumbilical area accompanied by a bruit upon auscultation.
B. Severe, dull aching pain radiating outward to both lower extremities with palpable pedal
pulses.
C. Unilateral pitting edema in the lower calf accompanied by a positive Homans sign.
D. Absent bowel sounds throughout all four abdominal quadrants with rebound tenderness.
Correct Answer: A. A pulsating mass in the periumbilical area accompanied by a bruit
upon auscultation.
Rationale: The classic clinical manifestations of an abdominal aortic aneurysm include a
prominent, pulsating mass felt in the periumbilical region, often accompanied by a systolic bruit
heard over the aorta. Palpating the area deeply should be avoided to prevent rupture.
Question 4
A nurse is caring for a client who sustained an acute anterior wall myocardial infarction. Which
complication should the nurse monitor for most closely during the first twenty-four to forty-eight
hours post-infarction?
A. Ventricular arrhythmias, such as ventricular tachycardia or ventricular fibrillation.
B. Chronic peripheral venous insufficiency and lower extremity stasis ulcers.
C. Hyperactive bowel sounds and intractable chronic diarrhea.
D. Progressive bilateral hearing loss and tinnitus.
Correct Answer: A. Ventricular arrhythmias, such as ventricular tachycardia or
ventricular fibrillation.
,Rationale: Electrical instability of the ischemic myocardium during the first forty-eight hours
following a myocardial infarction frequently triggers lethal ventricular arrhythmias, making
continuous cardiac monitoring essential.
Question 5
A nurse is providing discharge teaching to a client who has chronic stable angina and a new
prescription for sublingual nitroglycerin tablets. Which instruction should the nurse emphasize
regarding proper storage and usage?
A. Keep the tablets in their original dark, airtight glass container and replace them every six
months.
B. Store the medication bottle in the kitchen refrigerator to prolong its active shelf life.
C. Take up to five tablets spaced two minutes apart before calling emergency services.
D. Swallow the sublingual tablet whole with a full glass of cold water.
Correct Answer: A. Keep the tablets in their original dark, airtight glass container and
replace them every six months.
Rationale: Nitroglycerin is unstable and loses potency when exposed to light, heat, moisture, or
air. It must be stored in its original amber glass bottle with a tight cap and replaced every six
months to ensure efficacy during acute angina attacks.
Section 2: Respiratory Disorders & Mechanical Ventilation
Question 6
A nurse is caring for a client with a chest tube connected to a water-seal drainage system
following a lobectomy. The nurse notes continuous, vigorous bubbling in the water-seal
chamber. How should the nurse interpret this finding?
A. There is an active air leak somewhere in the drainage system or thoracic cavity.
B. The client's lung has fully re-expanded and the chest tube is ready for removal.
C. This is a normal, expected finding during continuous suctioning.
D. The suction control chamber pressure is set too low.
Correct Answer: A. There is an active air leak somewhere in the drainage system or
thoracic cavity.
, Rationale: Intermittent bubbling in the water-seal chamber during exhalation or coughing is
normal when an air leak is resolving. However, continuous, vigorous bubbling indicates an air
leak within the system connections or from the client's lung.
Question 7
A nurse is managing a client with acute respiratory distress syndrome who is intubated and
mechanically ventilated. Which ventilator setting adjustment is standard in protective lung
ventilation strategies?
A. Using low tidal volumes (six milliliters per kilogram of ideal body weight) to prevent
volutrauma.
B. Maintaining high tidal volumes (twelve to fifteen milliliters per kilogram) to maximize
alveolar recruitment.
C. Setting the fraction of inspired oxygen at one hundred percent indefinitely to ensure tissue
oxygenation.
D. Eliminating positive end-expiratory pressure entirely to lower intrathoracic pressure.
Correct Answer: A. Using low tidal volumes (six milliliters per kilogram of ideal body
weight) to prevent volutrauma.
Rationale: Low tidal volume ventilation prevents overdistention of fragile alveoli (volutrauma
and barotrauma) in acute respiratory distress syndrome clients, significantly reducing mortality
rates.
Question 8
A nurse is assessing a client who has a tension pneumothorax. Which clinical manifestation is
uniquely characteristic of a tension pneumothorax compared to a simple pneumothorax?
A. Tracheal deviation away from the affected side, absent breath sounds on the injured side,
and hemodynamic instability.
B. Bilateral equal breath sounds with mild expiratory wheezing throughout all lung fields.
C. Hypertension, bradycardia, and bradypnea (Cushing triad).
D. Productive cough with thick rust-colored sputum and pleuritic chest pain.
Correct Answer: A. Tracheal deviation away from the affected side, absent breath sounds
on the injured side, and hemodynamic instability.
