ADVANCED MEDICAL-SURGICAL
NURSING PRACTICE EXAM QUESTIONS
AND ANSWERS
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via a
nasal cannula at 2 L/min. The nurse notes the patient’s respiratory rate has decreased to 10
breaths/min and the patient is becoming lethargic. Which action should the nurse take first?
A. Increase the oxygen flow rate to 4 L/min.
B. Prepare for immediate intubation.
C. Perform a rapid neurological assessment.
D. Notify the healthcare provider and decrease the oxygen flow.
Answer: D
Conceptual Explanation: In COPD patients, excessive oxygen can suppress the hypoxic
drive to breathe, leading to CO2 retention and respiratory depression. The priority is to
adjust the oxygen and notify the provider.
2. Which clinical manifestation should a nurse prioritize when assessing a patient suspected
of having an evolving tension pneumothorax?
A. Tracheal deviation toward the unaffected side.
,B. Muffled heart sounds and jugular vein distension.
C. Increased breath sounds on the affected side.
D. Productive cough with blood-tinged sputum.
Answer: A
Conceptual Explanation: Tracheal deviation is a late and critical sign of tension
pneumothorax, indicating significant mediastinal shift that can compromise cardiac output.
3. A patient with acute renal failure has a serum potassium level of 6.8 mEq/L. The nurse
should be most concerned about which electrocardiogram (ECG) change?
A. Prominent U waves.
B. Shortened PR interval.
C. Tall, peaked T waves.
D. ST-segment depression.
Answer: C
Conceptual Explanation: Hyperkalemia causes peaked T waves, widening of the QRS
complex, and loss of P waves, which can progress to ventricular fibrillation.
4. When caring for a patient following a thyroidectomy, which assessment finding requires
the most immediate intervention?
A. Laryngeal stridor.
B. Hoarseness when speaking.
, C. Positive Chvostek’s sign.
D. Complaints of pain at the incision site.
Answer: A
Conceptual Explanation: Stridor indicates airway obstruction, which is an immediate life-
threatening emergency following neck surgery.
5. A patient is admitted with a diagnosis of rule-out myocardial infarction (MI). Which cardiac
biomarker is most specific for myocardial injury and remains elevated for up to 14 days?
A. Myoglobin
B. Troponin T
C. CK-MB
D. C-reactive protein
Answer: B
Conceptual Explanation: Troponin T is highly specific to cardiac muscle and stays
elevated longer than CK-MB or Myoglobin, making it ideal for diagnosing delayed MI
presentations.
6. A nurse is assessing a patient with Cushing’s syndrome. Which of the following findings is
most characteristic of this condition?
A. Trunkal obesity and a ‘buffalo hump’.
B. Weight loss and hypotension.
NURSING PRACTICE EXAM QUESTIONS
AND ANSWERS
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via a
nasal cannula at 2 L/min. The nurse notes the patient’s respiratory rate has decreased to 10
breaths/min and the patient is becoming lethargic. Which action should the nurse take first?
A. Increase the oxygen flow rate to 4 L/min.
B. Prepare for immediate intubation.
C. Perform a rapid neurological assessment.
D. Notify the healthcare provider and decrease the oxygen flow.
Answer: D
Conceptual Explanation: In COPD patients, excessive oxygen can suppress the hypoxic
drive to breathe, leading to CO2 retention and respiratory depression. The priority is to
adjust the oxygen and notify the provider.
2. Which clinical manifestation should a nurse prioritize when assessing a patient suspected
of having an evolving tension pneumothorax?
A. Tracheal deviation toward the unaffected side.
,B. Muffled heart sounds and jugular vein distension.
C. Increased breath sounds on the affected side.
D. Productive cough with blood-tinged sputum.
Answer: A
Conceptual Explanation: Tracheal deviation is a late and critical sign of tension
pneumothorax, indicating significant mediastinal shift that can compromise cardiac output.
3. A patient with acute renal failure has a serum potassium level of 6.8 mEq/L. The nurse
should be most concerned about which electrocardiogram (ECG) change?
A. Prominent U waves.
B. Shortened PR interval.
C. Tall, peaked T waves.
D. ST-segment depression.
Answer: C
Conceptual Explanation: Hyperkalemia causes peaked T waves, widening of the QRS
complex, and loss of P waves, which can progress to ventricular fibrillation.
4. When caring for a patient following a thyroidectomy, which assessment finding requires
the most immediate intervention?
A. Laryngeal stridor.
B. Hoarseness when speaking.
, C. Positive Chvostek’s sign.
D. Complaints of pain at the incision site.
Answer: A
Conceptual Explanation: Stridor indicates airway obstruction, which is an immediate life-
threatening emergency following neck surgery.
5. A patient is admitted with a diagnosis of rule-out myocardial infarction (MI). Which cardiac
biomarker is most specific for myocardial injury and remains elevated for up to 14 days?
A. Myoglobin
B. Troponin T
C. CK-MB
D. C-reactive protein
Answer: B
Conceptual Explanation: Troponin T is highly specific to cardiac muscle and stays
elevated longer than CK-MB or Myoglobin, making it ideal for diagnosing delayed MI
presentations.
6. A nurse is assessing a patient with Cushing’s syndrome. Which of the following findings is
most characteristic of this condition?
A. Trunkal obesity and a ‘buffalo hump’.
B. Weight loss and hypotension.
