___________________________________________________________________
Medical-Surgical Nursing Certification
Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A Instant Download Pdf
___________________________________________________________________
1. A patient with acute decompensated heart failure develops severe
dyspnea, crackles throughout both lung fields, pink frothy sputum, and an
oxygen saturation of 82%. Which intervention should the nurse implement
first?
A. Administer IV furosemide
B. Place the patient in high-Fowler position and administer oxygen
C. Obtain a stat chest radiograph
D. Restrict oral fluids
Answer: Place the patient in high-Fowler position and administer oxygen
Rationale: Acute pulmonary edema causes profound hypoxemia and respiratory
distress. Airway and breathing take priority. High-Fowler positioning improves
lung expansion, while supplemental oxygen addresses hypoxemia. Diuretics are
important but should follow immediate stabilization.
2. A patient with diabetic ketoacidosis has a serum potassium of 2.9 mEq/L
and a blood glucose of 540 mg/dL. Which prescribed intervention should
the nurse question?
A. IV regular insulin infusion
B. IV isotonic fluid replacement
,C. Continuous cardiac monitoring
D. Potassium replacement
Answer: IV regular insulin infusion
Rationale: Insulin drives potassium intracellularly and can precipitate life-
threatening hypokalemia. When potassium is below approximately 3.3 mEq/L,
potassium replacement is generally initiated before insulin therapy.
3. A patient with SIADH has a sodium level of 118 mEq/L and develops
confusion and a seizure. Which intervention is the priority?
A. Encourage oral fluids
B. Administer prescribed hypertonic saline
C. Administer hypotonic IV fluids
D. Encourage a low-sodium diet
Answer: Administer prescribed hypertonic saline
Rationale: Severe symptomatic hyponatremia can cause cerebral edema and
seizures. Carefully administered hypertonic saline may be required to increase
serum sodium while avoiding overly rapid correction.
4. A patient receiving a continuous heparin infusion has a platelet count that
decreases from 240,000/mm³ to 96,000/mm³. Which action is most
appropriate?
A. Increase the heparin infusion
B. Administer vitamin K
C. Stop heparin and notify the provider
D. Give aspirin
Answer: Stop heparin and notify the provider
Rationale: A major platelet decline during heparin therapy raises concern for
heparin-induced thrombocytopenia. Heparin should be discontinued and an
alternative non-heparin anticoagulant considered.
, 5. A patient with chronic obstructive pulmonary disease is receiving oxygen at
2 L/min by nasal cannula. The patient becomes increasingly somnolent.
Which assessment is most important?
A. Serum sodium
B. Arterial blood gas
C. Urine specific gravity
D. Hemoglobin concentration
Answer: Arterial blood gas
Rationale: Increasing somnolence in a patient with COPD receiving oxygen may
indicate worsening hypercapnia and CO₂ retention. ABG analysis evaluates
oxygenation, ventilation, and acid-base status.
6. A patient with cirrhosis suddenly develops hematemesis, hypotension,
tachycardia, and altered mental status. Which complication is most likely
responsible?
A. Acute pancreatitis
B. Esophageal variceal hemorrhage
C. Acute cholecystitis
D. Hepatorenal syndrome
Answer: Esophageal variceal hemorrhage
Rationale: Portal hypertension can produce esophageal varices that rupture and
cause massive upper gastrointestinal bleeding. Hemodynamic stabilization and
urgent control of hemorrhage are priorities.
7. A patient with chronic kidney disease has a potassium level of 6.8 mEq/L
and peaked T waves on ECG. Which medication should the nurse anticipate
administering immediately to stabilize the myocardium?
A. Sodium polystyrene sulfonate
B. IV calcium gluconate
, C. Oral furosemide
D. Sodium bicarbonate only
Answer: IV calcium gluconate
Rationale: IV calcium does not lower serum potassium but rapidly stabilizes the
cardiac membrane and reduces the risk of fatal dysrhythmias. Additional
therapies are required to shift or remove potassium.
8. A patient with acute ischemic stroke suddenly develops difficulty
swallowing. What is the nurse's priority action before giving oral
medications?
A. Give water to assess swallowing
B. Perform or obtain a formal swallow assessment
C. Place the patient supine
D. Encourage rapid oral intake
Answer: Perform or obtain a formal swallow assessment
Rationale: Dysphagia is common after stroke and significantly increases
aspiration risk. Oral intake should be withheld until swallowing safety has been
assessed.
9. A patient with adrenal insufficiency presents with hypotension, weakness,
vomiting, hyponatremia, and hyperkalemia. Which treatment should the
nurse anticipate?
A. IV hydrocortisone and isotonic fluids
B. Fluid restriction and insulin
C. IV levothyroxine only
D. Oral potassium supplementation
Answer: IV hydrocortisone and isotonic fluids
Rationale: Addisonian crisis causes cortisol deficiency, volume depletion,
hypotension, hyponatremia, and hyperkalemia. Immediate glucocorticoid
replacement and aggressive fluid resuscitation are essential.
Medical-Surgical Nursing Certification
Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A Instant Download Pdf
___________________________________________________________________
1. A patient with acute decompensated heart failure develops severe
dyspnea, crackles throughout both lung fields, pink frothy sputum, and an
oxygen saturation of 82%. Which intervention should the nurse implement
first?
A. Administer IV furosemide
B. Place the patient in high-Fowler position and administer oxygen
C. Obtain a stat chest radiograph
D. Restrict oral fluids
Answer: Place the patient in high-Fowler position and administer oxygen
Rationale: Acute pulmonary edema causes profound hypoxemia and respiratory
distress. Airway and breathing take priority. High-Fowler positioning improves
lung expansion, while supplemental oxygen addresses hypoxemia. Diuretics are
important but should follow immediate stabilization.
2. A patient with diabetic ketoacidosis has a serum potassium of 2.9 mEq/L
and a blood glucose of 540 mg/dL. Which prescribed intervention should
the nurse question?
A. IV regular insulin infusion
B. IV isotonic fluid replacement
,C. Continuous cardiac monitoring
D. Potassium replacement
Answer: IV regular insulin infusion
Rationale: Insulin drives potassium intracellularly and can precipitate life-
threatening hypokalemia. When potassium is below approximately 3.3 mEq/L,
potassium replacement is generally initiated before insulin therapy.
3. A patient with SIADH has a sodium level of 118 mEq/L and develops
confusion and a seizure. Which intervention is the priority?
A. Encourage oral fluids
B. Administer prescribed hypertonic saline
C. Administer hypotonic IV fluids
D. Encourage a low-sodium diet
Answer: Administer prescribed hypertonic saline
Rationale: Severe symptomatic hyponatremia can cause cerebral edema and
seizures. Carefully administered hypertonic saline may be required to increase
serum sodium while avoiding overly rapid correction.
4. A patient receiving a continuous heparin infusion has a platelet count that
decreases from 240,000/mm³ to 96,000/mm³. Which action is most
appropriate?
A. Increase the heparin infusion
B. Administer vitamin K
C. Stop heparin and notify the provider
D. Give aspirin
Answer: Stop heparin and notify the provider
Rationale: A major platelet decline during heparin therapy raises concern for
heparin-induced thrombocytopenia. Heparin should be discontinued and an
alternative non-heparin anticoagulant considered.
, 5. A patient with chronic obstructive pulmonary disease is receiving oxygen at
2 L/min by nasal cannula. The patient becomes increasingly somnolent.
Which assessment is most important?
A. Serum sodium
B. Arterial blood gas
C. Urine specific gravity
D. Hemoglobin concentration
Answer: Arterial blood gas
Rationale: Increasing somnolence in a patient with COPD receiving oxygen may
indicate worsening hypercapnia and CO₂ retention. ABG analysis evaluates
oxygenation, ventilation, and acid-base status.
6. A patient with cirrhosis suddenly develops hematemesis, hypotension,
tachycardia, and altered mental status. Which complication is most likely
responsible?
A. Acute pancreatitis
B. Esophageal variceal hemorrhage
C. Acute cholecystitis
D. Hepatorenal syndrome
Answer: Esophageal variceal hemorrhage
Rationale: Portal hypertension can produce esophageal varices that rupture and
cause massive upper gastrointestinal bleeding. Hemodynamic stabilization and
urgent control of hemorrhage are priorities.
7. A patient with chronic kidney disease has a potassium level of 6.8 mEq/L
and peaked T waves on ECG. Which medication should the nurse anticipate
administering immediately to stabilize the myocardium?
A. Sodium polystyrene sulfonate
B. IV calcium gluconate
, C. Oral furosemide
D. Sodium bicarbonate only
Answer: IV calcium gluconate
Rationale: IV calcium does not lower serum potassium but rapidly stabilizes the
cardiac membrane and reduces the risk of fatal dysrhythmias. Additional
therapies are required to shift or remove potassium.
8. A patient with acute ischemic stroke suddenly develops difficulty
swallowing. What is the nurse's priority action before giving oral
medications?
A. Give water to assess swallowing
B. Perform or obtain a formal swallow assessment
C. Place the patient supine
D. Encourage rapid oral intake
Answer: Perform or obtain a formal swallow assessment
Rationale: Dysphagia is common after stroke and significantly increases
aspiration risk. Oral intake should be withheld until swallowing safety has been
assessed.
9. A patient with adrenal insufficiency presents with hypotension, weakness,
vomiting, hyponatremia, and hyperkalemia. Which treatment should the
nurse anticipate?
A. IV hydrocortisone and isotonic fluids
B. Fluid restriction and insulin
C. IV levothyroxine only
D. Oral potassium supplementation
Answer: IV hydrocortisone and isotonic fluids
Rationale: Addisonian crisis causes cortisol deficiency, volume depletion,
hypotension, hyponatremia, and hyperkalemia. Immediate glucocorticoid
replacement and aggressive fluid resuscitation are essential.
