Test Bank for RN Adult Medical Surgical Exam
Page |1
Test Bank for RN Adult Medical Surgical
Nursing: Content Mastery Series Edition 12.0
by Alissa Althoff | All Chapters Questions and
Answers | Latest 2026/2027
The nurse is discharging home a client at risk for venous thromboembolism (VTE) on low-molecular-
weight heparin. What instruction does the nurse provide to this client?
A) "You must have your aPTT checked every 2 weeks."
B) "Notify your health care provider if your stools appear tarry."
C) "An IV catheter will be placed to administer your heparin."
D) "Massage the injection site after the heparin is injected." –
Correct Answer :B
P a g e 1 | 166
, Test Bank for RN Adult Medical Surgical Exam
Page |2
As with any anticoagulation, low-molecular-weight heparin incurs risk of bleeding. Clients should be
taught to report to their health care provider the presence of tarry stools, bleeding gums, hematuria,
ecchymosis, or petechiae. Low-molecular-weight heparin does not affect activated partial
thromboplastin time (aPTT), as does intravenous heparin. This type of heparin is administered
subcutaneously to deliver a slow sustained response. Massaging the site would hasten absorption and
decrease effects.
Which is the highest priority goal to set for a client with pneumonia?
A) Maintenance of SaO2 of 95%
B) Walking 20 feet three times daily
C) Absence of cyanosis
D) Absence of confusion –
Correct Answer :A
Maintenance of an SaO2 of at least 95% is a clear goal that indicates that the client has adequate
oxygenation. Absence of cyanosis and the presence of confusion are assessment factors that
contribute to evaluation of oxygen; however, they are not absolute measures. Likewise, walking three
times a day does not directly address oxygenation.
The nurse is assessing a client admitted to the cardiac unit. What statement made by the client alerts
the nurse to the possibility of right-sided heart failure?
A) "I sleep with four pillows at night."
B) "I wake up coughing every night."
C) "My shoes fit really tight lately."
D) "I have trouble catching my breath." –
Correct Answer :C
P a g e 2 | 166
, Test Bank for RN Adult Medical Surgical Exam
Page |3
Signs of systemic congestion occur with right-sided heart failure. Fluid is retained, pressure builds in
the venous system, and peripheral edema develops. Left-sided heart failure symptoms include
respiratory symptoms. Orthopnea, coughing, and difficulty breathing all could be results of left-sided
heart failure.
The nurse is caring for a client with Crohn's disease and colonic strictures. Which assessment finding
requires the nurse to consult the health care provider immediately?
A) Traces of blood in the stool
B) Distended abdomen
C) Temperature of 100.0° F (37.8° C)
D) Crampy lower abdominal pain –
Correct Answer :B
The presence of strictures predisposes the client to intestinal obstruction. Abdominal distention may
indicate that the client has developed an obstruction of the large bowel, and the client's provider
should be notified right away. Low-grade fever, bloody diarrhea, and crampy abdominal pain are
common symptoms of Crohn's disease.
What is my favorite football team?
A) I hate football!!
B) the Fightin' Irish
C) GO BUCKS!!!!
D) that team up north –
Correct Answer :C
Seriously, if you don't know the instructor's favorite football by this time, you need to listen to your
recordings from the first lecture. Just sayin'
P a g e 3 | 166
, Test Bank for RN Adult Medical Surgical Exam
Page |4
The nurse is caring for a client who is receiving heparin therapy for a venous thromboembolism (VTE).
The client's activated partial thromboplastin time (aPTT) before heparin therapy was 30 seconds.
Which aPTT result indicates that anticoagulation is adequate at this time?
A) 30 seconds
B) 150 seconds
C) 60 seconds
D) 15 seconds –
Correct Answer :C
Therapeutic aPTT values for clients receiving heparin should range from 1.5 to 2.5 times the control
value.
The nurse is caring for a patient who is being discharged home after a splenectomy. What information
on immune function needs to be included in this patient's discharge planning?
A) Limiting contact with the general population
B) The importance of wearing a face mask in public
C) The mechanisms of the inflammatory response
D) Basic infection control techniques –
Correct Answer :D
The spleen is one of the major organs of the immune system. Without the spleen, the patient is at
higher risk for infection; so, the nurse must be sure that the patient understands basic principles of
infection control. The patient with a splenectomy does not need to understand the mechanisms of
inflammatory response. The patient with a splenectomy does not need to wear a face mask in public
as long as the patient understands and maintains the basic principles of infection control. The patient
P a g e 4 | 166
Page |1
Test Bank for RN Adult Medical Surgical
Nursing: Content Mastery Series Edition 12.0
by Alissa Althoff | All Chapters Questions and
Answers | Latest 2026/2027
The nurse is discharging home a client at risk for venous thromboembolism (VTE) on low-molecular-
weight heparin. What instruction does the nurse provide to this client?
A) "You must have your aPTT checked every 2 weeks."
B) "Notify your health care provider if your stools appear tarry."
C) "An IV catheter will be placed to administer your heparin."
D) "Massage the injection site after the heparin is injected." –
Correct Answer :B
P a g e 1 | 166
, Test Bank for RN Adult Medical Surgical Exam
Page |2
As with any anticoagulation, low-molecular-weight heparin incurs risk of bleeding. Clients should be
taught to report to their health care provider the presence of tarry stools, bleeding gums, hematuria,
ecchymosis, or petechiae. Low-molecular-weight heparin does not affect activated partial
thromboplastin time (aPTT), as does intravenous heparin. This type of heparin is administered
subcutaneously to deliver a slow sustained response. Massaging the site would hasten absorption and
decrease effects.
Which is the highest priority goal to set for a client with pneumonia?
A) Maintenance of SaO2 of 95%
B) Walking 20 feet three times daily
C) Absence of cyanosis
D) Absence of confusion –
Correct Answer :A
Maintenance of an SaO2 of at least 95% is a clear goal that indicates that the client has adequate
oxygenation. Absence of cyanosis and the presence of confusion are assessment factors that
contribute to evaluation of oxygen; however, they are not absolute measures. Likewise, walking three
times a day does not directly address oxygenation.
The nurse is assessing a client admitted to the cardiac unit. What statement made by the client alerts
the nurse to the possibility of right-sided heart failure?
A) "I sleep with four pillows at night."
B) "I wake up coughing every night."
C) "My shoes fit really tight lately."
D) "I have trouble catching my breath." –
Correct Answer :C
P a g e 2 | 166
, Test Bank for RN Adult Medical Surgical Exam
Page |3
Signs of systemic congestion occur with right-sided heart failure. Fluid is retained, pressure builds in
the venous system, and peripheral edema develops. Left-sided heart failure symptoms include
respiratory symptoms. Orthopnea, coughing, and difficulty breathing all could be results of left-sided
heart failure.
The nurse is caring for a client with Crohn's disease and colonic strictures. Which assessment finding
requires the nurse to consult the health care provider immediately?
A) Traces of blood in the stool
B) Distended abdomen
C) Temperature of 100.0° F (37.8° C)
D) Crampy lower abdominal pain –
Correct Answer :B
The presence of strictures predisposes the client to intestinal obstruction. Abdominal distention may
indicate that the client has developed an obstruction of the large bowel, and the client's provider
should be notified right away. Low-grade fever, bloody diarrhea, and crampy abdominal pain are
common symptoms of Crohn's disease.
What is my favorite football team?
A) I hate football!!
B) the Fightin' Irish
C) GO BUCKS!!!!
D) that team up north –
Correct Answer :C
Seriously, if you don't know the instructor's favorite football by this time, you need to listen to your
recordings from the first lecture. Just sayin'
P a g e 3 | 166
, Test Bank for RN Adult Medical Surgical Exam
Page |4
The nurse is caring for a client who is receiving heparin therapy for a venous thromboembolism (VTE).
The client's activated partial thromboplastin time (aPTT) before heparin therapy was 30 seconds.
Which aPTT result indicates that anticoagulation is adequate at this time?
A) 30 seconds
B) 150 seconds
C) 60 seconds
D) 15 seconds –
Correct Answer :C
Therapeutic aPTT values for clients receiving heparin should range from 1.5 to 2.5 times the control
value.
The nurse is caring for a patient who is being discharged home after a splenectomy. What information
on immune function needs to be included in this patient's discharge planning?
A) Limiting contact with the general population
B) The importance of wearing a face mask in public
C) The mechanisms of the inflammatory response
D) Basic infection control techniques –
Correct Answer :D
The spleen is one of the major organs of the immune system. Without the spleen, the patient is at
higher risk for infection; so, the nurse must be sure that the patient understands basic principles of
infection control. The patient with a splenectomy does not need to understand the mechanisms of
inflammatory response. The patient with a splenectomy does not need to wear a face mask in public
as long as the patient understands and maintains the basic principles of infection control. The patient
P a g e 4 | 166
