NURS 120 MEDICAL-SURGICAL
NURSING EXAM (2026 UPDATE)
QUESTIONS AND ANSWERS
1. A patient with a history of COPD is admitted with increased dyspnea and productive cough.
The ABG results show: pH 7.30, PaCO2 55 mmHg, and HCO3 28 mEq/L. Which acid-base
imbalance is occurring?
A. Respiratory Acidosis, partially compensated
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis, fully compensated
Answer: A
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory), and the
HCO3 is elevated, indicating the kidneys are attempting to compensate but haven’t
normalized the pH yet.
2. Which assessment finding is the most sensitive indicator of early neurological deterioration
in a patient with a head injury?
A. Change in pupil size and reactivity
,B. Decrease in Level of Consciousness (LOC)
C. Development of Cushing’s Triad
D. Motor weakness on one side of the body
Answer: B
Conceptual Explanation: A change in LOC is the earliest and most sensitive sign of
increased intracranial pressure or neurological decline.
3. A client is diagnosed with hyperkalemia (Potassium 6.2 mEq/L). Which ECG change should
the nurse monitor for most closely?
A. Prominent U waves
B. ST-segment depression
C. Prolonged QT interval
D. Tall, peaked T waves
Answer: D
Conceptual Explanation: Hyperkalemia typically causes tall, peaked T waves, widened
QRS complexes, and potentially cardiac arrest.
4. Following a subtotal thyroidectomy, the nurse notes the patient has developed laryngeal
stridor and tingling in the fingertips. What is the priority intervention?
A. Administer IV Potassium Chloride
B. Encourage the patient to cough and deep breathe
, C. Apply a warm compress to the neck
D. Administer IV Calcium Gluconate
Answer: D
Conceptual Explanation: Tingling (paresthesia) and stridor suggest hypocalcemia
resulting from accidental parathyroid gland removal; IV Calcium Gluconate is the
emergency treatment.
5. A patient is receiving a blood transfusion and develops chills, fever, and low back pain 15
minutes into the infusion. What is the first action the nurse should take?
A. Slow the infusion rate
B. Notify the healthcare provider
C. Stop the infusion immediately
D. Administer diphenhydramine
Answer: C
Conceptual Explanation: These symptoms suggest a hemolytic reaction. The nurse must
stop the transfusion immediately and disconnect the tubing at the hub.
6. Which laboratory value is most important to monitor for a patient receiving Heparin via
continuous IV infusion?
A. Prothrombin Time (PT)
B. International Normalized Ratio (INR)
NURSING EXAM (2026 UPDATE)
QUESTIONS AND ANSWERS
1. A patient with a history of COPD is admitted with increased dyspnea and productive cough.
The ABG results show: pH 7.30, PaCO2 55 mmHg, and HCO3 28 mEq/L. Which acid-base
imbalance is occurring?
A. Respiratory Acidosis, partially compensated
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis, fully compensated
Answer: A
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory), and the
HCO3 is elevated, indicating the kidneys are attempting to compensate but haven’t
normalized the pH yet.
2. Which assessment finding is the most sensitive indicator of early neurological deterioration
in a patient with a head injury?
A. Change in pupil size and reactivity
,B. Decrease in Level of Consciousness (LOC)
C. Development of Cushing’s Triad
D. Motor weakness on one side of the body
Answer: B
Conceptual Explanation: A change in LOC is the earliest and most sensitive sign of
increased intracranial pressure or neurological decline.
3. A client is diagnosed with hyperkalemia (Potassium 6.2 mEq/L). Which ECG change should
the nurse monitor for most closely?
A. Prominent U waves
B. ST-segment depression
C. Prolonged QT interval
D. Tall, peaked T waves
Answer: D
Conceptual Explanation: Hyperkalemia typically causes tall, peaked T waves, widened
QRS complexes, and potentially cardiac arrest.
4. Following a subtotal thyroidectomy, the nurse notes the patient has developed laryngeal
stridor and tingling in the fingertips. What is the priority intervention?
A. Administer IV Potassium Chloride
B. Encourage the patient to cough and deep breathe
, C. Apply a warm compress to the neck
D. Administer IV Calcium Gluconate
Answer: D
Conceptual Explanation: Tingling (paresthesia) and stridor suggest hypocalcemia
resulting from accidental parathyroid gland removal; IV Calcium Gluconate is the
emergency treatment.
5. A patient is receiving a blood transfusion and develops chills, fever, and low back pain 15
minutes into the infusion. What is the first action the nurse should take?
A. Slow the infusion rate
B. Notify the healthcare provider
C. Stop the infusion immediately
D. Administer diphenhydramine
Answer: C
Conceptual Explanation: These symptoms suggest a hemolytic reaction. The nurse must
stop the transfusion immediately and disconnect the tubing at the hub.
6. Which laboratory value is most important to monitor for a patient receiving Heparin via
continuous IV infusion?
A. Prothrombin Time (PT)
B. International Normalized Ratio (INR)
