Test Bank for RN Adult Medical Surgical Exam
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Test Bank 4 for RN Adult Medical Surgical
Nursing: Content Mastery Series Edition 12.0
by Alissa Althoff | All Chapters Questions and
Answers | Latest 2026/2027
Which change in laboratory values indicates to the nurse that a client with rheumatoid arthritis may be
experiencing an adverse effect of methotrexate therapy?
A.Increase in rheumatoid factor
B.Decrease in hemoglobin level
C.Increase in blood glucose level
D.Decrease in erythrocyte sedimentation rate (ESR; sed rate) –
Correct Answer :Correct Answer: B
Rationale:Methotrexate is an immunosuppressant. A common side effect is bone marrow depression,
which would be reflected by a decrease in the hemoglobin level. Option A indicates disease
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progression but is not a side effect of the medication. Option C is not related to methotrexate. Option
D indicates that inflammation associated with the disease has diminished.
A client is diagnosed with an acute small bowel obstruction and suddenly spikes a temperature of
102°F/38.9°C. What other assessments should the nurse include in the client's focused assessment?
(Select all that apply.)
A.Nausea and vomiting
B.Loss of appetite
C.Abdominal cramping
D.Guarding with abdominal palpation
E.Low urine output
F.Cool, clammy skin –
Correct Answer :Correct Answer: A,B,C,D
Rationale:The client is showing signs of peritonitis with the sudden spike in temperature. Low urine
output and cool clammy skin are not seen with peritonitis. Peritonitis is a medical emergency and the
health care provider must be notified immediately.
Which nursing action is necessary for the client with a flail chest?
A.Withhold prescribed analgesic medications.
B.Percuss the fractured rib area with light taps.
C.Avoid implementing pulmonary suctioning.
D.Encourage coughing and deep breathing. –
Answer :Correct Answer: D
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Rationale:Treatment of flail chest is focused on preventing atelectasis and related complications of
compromised ventilation by encouraging coughing and deep breathing. This condition is typically
diagnosed in clients with three or more rib fractures, resulting in paradoxic movement of a segment of
the chest wall. Option C should not be avoided because suctioning is necessary to maintain pulmonary
toilet in clients who require mechanical ventilation. Option A should not be withheld. Option B should
not be applied because the fractures are clearly visible on the chest radiograph.
One day after a Billroth II surgery, the client suddenly grabs his right chest and becomes pale and
diaphoretic. Vital signs are assessed as blood pressure 100/80 mm Hg, pulse 110 beats/min, and
respirations 36 breaths/min. Which action is most important for the nurse to take?
A.Provide a paper bag for his hyperventilation.
B.Administer a prescribed PRN analgesic.
C.Have the client drink a glass of sweetened fruit juice.
D.Apply oxygen at 2 L via nasal cannula. –
Correct Answer :Correct Answer: D
Rationale:Pulmonary embolism and pneumothorax are risks associated with major abdominal surgery.
The nurse should immediately provide oxygen while performing further assessment. A rapid
respiratory rate should not be treated as hyperventilation. Option B should not be administered until
more ominous causes are ruled out or treated. There is no evidence that the client is hypoglycemic.
Which instruction should the nurse teach a female client about the prevention of toxic shock
syndrome?
A."Get immunization against human papillomavirus (HPV)."
B."Change your tampon frequently."
C."Empty your bladder after intercourse."
D."Obtain a yearly flu vaccination." –
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Correct Answer :Correct Answer: B
Rationale:Certain strains of Staphylococcus aureus produce a toxin that can enter the bloodstream
through the vaginal mucosa. Changing the tampon frequently reduces the exposure to these toxins,
which are the primary cause of toxic shock syndrome. Option A helps prevent cervical cancer, not
toxic shock syndrome. Option C can lessen the incidence of urinary tract infection. Option D can help
prevent some individuals from contracting the flu and pneumonia, but no relationship to toxic shock
syndrome has been proven.
The nurse observes the chest tube drainage has exceeded 300 mL of bright red bloody fluid for the
past 30 minutes in the client after a coronary artery bypass graft. What is the nurse's next action?
A.Notify the healthcare provider.
B.Assess for restlessness.
C.Assess for pallor.
D.Tell the charge nurse. –
Correct Answer :Correct Answer: A
Rationale:This client is showing signs of hemorrhage, and must be evaluated by a health care provider.
Pallor and restlessness indicate decreased oxygenation, and support the finding of a possible
hemorrhage. The charge nurse will need to be notified, in the event that this client needs to return to
the operating room
During the shift report, the charge nurse informs a nurse of a reassignment to another unit for the day.
The nurse begins to sigh deeply and tosses about her belongings when preparing to leave. What is the
best immediate action for the charge nurse to take?
A.Continue with the shift report and talk to the nurse about the incident at a later time.
B.Ask the nurse to call the house supervisor to see if she must be reassigned.
C.Stop the shift report and remind the nurse that all staff are floated equally.
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Page |1
Test Bank 4 for RN Adult Medical Surgical
Nursing: Content Mastery Series Edition 12.0
by Alissa Althoff | All Chapters Questions and
Answers | Latest 2026/2027
Which change in laboratory values indicates to the nurse that a client with rheumatoid arthritis may be
experiencing an adverse effect of methotrexate therapy?
A.Increase in rheumatoid factor
B.Decrease in hemoglobin level
C.Increase in blood glucose level
D.Decrease in erythrocyte sedimentation rate (ESR; sed rate) –
Correct Answer :Correct Answer: B
Rationale:Methotrexate is an immunosuppressant. A common side effect is bone marrow depression,
which would be reflected by a decrease in the hemoglobin level. Option A indicates disease
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, Test Bank for RN Adult Medical Surgical Exam
Page |2
progression but is not a side effect of the medication. Option C is not related to methotrexate. Option
D indicates that inflammation associated with the disease has diminished.
A client is diagnosed with an acute small bowel obstruction and suddenly spikes a temperature of
102°F/38.9°C. What other assessments should the nurse include in the client's focused assessment?
(Select all that apply.)
A.Nausea and vomiting
B.Loss of appetite
C.Abdominal cramping
D.Guarding with abdominal palpation
E.Low urine output
F.Cool, clammy skin –
Correct Answer :Correct Answer: A,B,C,D
Rationale:The client is showing signs of peritonitis with the sudden spike in temperature. Low urine
output and cool clammy skin are not seen with peritonitis. Peritonitis is a medical emergency and the
health care provider must be notified immediately.
Which nursing action is necessary for the client with a flail chest?
A.Withhold prescribed analgesic medications.
B.Percuss the fractured rib area with light taps.
C.Avoid implementing pulmonary suctioning.
D.Encourage coughing and deep breathing. –
Answer :Correct Answer: D
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Rationale:Treatment of flail chest is focused on preventing atelectasis and related complications of
compromised ventilation by encouraging coughing and deep breathing. This condition is typically
diagnosed in clients with three or more rib fractures, resulting in paradoxic movement of a segment of
the chest wall. Option C should not be avoided because suctioning is necessary to maintain pulmonary
toilet in clients who require mechanical ventilation. Option A should not be withheld. Option B should
not be applied because the fractures are clearly visible on the chest radiograph.
One day after a Billroth II surgery, the client suddenly grabs his right chest and becomes pale and
diaphoretic. Vital signs are assessed as blood pressure 100/80 mm Hg, pulse 110 beats/min, and
respirations 36 breaths/min. Which action is most important for the nurse to take?
A.Provide a paper bag for his hyperventilation.
B.Administer a prescribed PRN analgesic.
C.Have the client drink a glass of sweetened fruit juice.
D.Apply oxygen at 2 L via nasal cannula. –
Correct Answer :Correct Answer: D
Rationale:Pulmonary embolism and pneumothorax are risks associated with major abdominal surgery.
The nurse should immediately provide oxygen while performing further assessment. A rapid
respiratory rate should not be treated as hyperventilation. Option B should not be administered until
more ominous causes are ruled out or treated. There is no evidence that the client is hypoglycemic.
Which instruction should the nurse teach a female client about the prevention of toxic shock
syndrome?
A."Get immunization against human papillomavirus (HPV)."
B."Change your tampon frequently."
C."Empty your bladder after intercourse."
D."Obtain a yearly flu vaccination." –
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Page |4
Correct Answer :Correct Answer: B
Rationale:Certain strains of Staphylococcus aureus produce a toxin that can enter the bloodstream
through the vaginal mucosa. Changing the tampon frequently reduces the exposure to these toxins,
which are the primary cause of toxic shock syndrome. Option A helps prevent cervical cancer, not
toxic shock syndrome. Option C can lessen the incidence of urinary tract infection. Option D can help
prevent some individuals from contracting the flu and pneumonia, but no relationship to toxic shock
syndrome has been proven.
The nurse observes the chest tube drainage has exceeded 300 mL of bright red bloody fluid for the
past 30 minutes in the client after a coronary artery bypass graft. What is the nurse's next action?
A.Notify the healthcare provider.
B.Assess for restlessness.
C.Assess for pallor.
D.Tell the charge nurse. –
Correct Answer :Correct Answer: A
Rationale:This client is showing signs of hemorrhage, and must be evaluated by a health care provider.
Pallor and restlessness indicate decreased oxygenation, and support the finding of a possible
hemorrhage. The charge nurse will need to be notified, in the event that this client needs to return to
the operating room
During the shift report, the charge nurse informs a nurse of a reassignment to another unit for the day.
The nurse begins to sigh deeply and tosses about her belongings when preparing to leave. What is the
best immediate action for the charge nurse to take?
A.Continue with the shift report and talk to the nurse about the incident at a later time.
B.Ask the nurse to call the house supervisor to see if she must be reassigned.
C.Stop the shift report and remind the nurse that all staff are floated equally.
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