RN ADULT MEDICAL-SURGICAL NURSING PROCTORED EXAM
UPDATED 2026-2027
COMPREHENSIVE 200-QUESTION EXAM WITH DETAILED
RATIONALES
Question 1
A nurse is assessing a client who has heart failure and is receiving furosemide (Lasix). Which of
the following findings should the nurse identify as an adverse effect of this medication?
A. Bradycardia
B. Hypokalemia
C. Hypernatremia
D. Increased blood pressure
Correct Answer: B
Rationale: Furosemide is a loop diuretic that increases the excretion of sodium, chloride,
potassium, and water by the kidneys. Hypokalemia (low potassium) is a common and
potentially dangerous adverse effect because it can lead to cardiac dysrhythmias. The nurse
should monitor serum potassium levels and assess for signs of hypokalemia such as muscle
weakness, fatigue, and irregular heartbeat. Bradycardia is not expected; furosemide tends to
cause hypovolemia which may actually trigger tachycardia. Hypernatremia would not occur
because furosemide promotes sodium excretion. Blood pressure typically decreases due to
volume depletion.
Question 2
A nurse is caring for a client who requires protective isolation following a hematopoietic stem
cell transplant. Which of the following interventions should the nurse implement to protect the
client from infection?
A. Make sure the client's room has positive-pressure airflow
B. Make sure dietary plates and utensils are disposable
,C. Wear an N95 respirator when providing direct client care
D. Monitor the client's temperature once every 6 hours
Correct Answer: A
Rationale: Positive-pressure airflow is used in protective isolation to prevent outside airborne
particles from entering the room, thus reducing the risk of infection for immunocompromised
clients, such as those undergoing a hematopoietic stem cell transplant. This measure ensures
that air flows out of the room rather than into it, keeping contaminants away. While using
disposable utensils and monitoring temperature are helpful, they do not provide the level of
protection needed for clients in protective isolation. An N95 respirator is used for clients in
negative-pressure rooms (e.g., for those with airborne infections like tuberculosis), not for
protective isolation.
Question 3
A nurse is assessing a client who is postoperative following an open reduction and internal
fixation (ORIF) of the femur. Which of the following assessments should be the nurse's priority?
A. Braden scale
B. Pain assessment
C. Neurovascular assessment
D. Morse Fall Risk scale
Correct Answer: C
Rationale: Following an open reduction and internal fixation (ORIF) of the femur, the priority
assessment is neurovascular status. This is crucial to assess circulation, sensation, and
movement distal to the surgical site, ensuring that there is no compromise in blood flow or
nerve function. While pain assessment and fall risk are important, neurovascular compromise
could lead to permanent damage, making it the priority in this situation. The Braden scale
assesses risk for skin breakdown, which is not the immediate priority in this case.
Question 4
A nurse is caring for a client who has a pneumothorax and a closed-chest drainage system.
Which of the following findings is an indication of lung re-expansion?
A. Increased drainage in the collection chamber
B. Bubbling in the water seal chamber has ceased
,C. Continuous bubbling in the suction control chamber
D. Tidaling in the water seal chamber
Correct Answer: B
Rationale: Cessation of bubbling in the water seal chamber indicates that the air leak has sealed
and the lung is re-expanding. Tidaling (fluctuation) in the water seal chamber is expected with
normal breathing and indicates the system is functioning properly. Continuous bubbling in the
suction control chamber is expected when suction is applied. Increased drainage may indicate
bleeding or other complications.
Question 5
A nurse is reviewing the medical record of a client who is taking warfarin for chronic atrial
fibrillation. Which of the following values should the nurse identify as a desired outcome for this
therapy?
A. Platelet count 150,000/mm³
B. INR 2.5
C. aPTT 60 seconds
D. Hemoglobin 14 g/dL
Correct Answer: B
Rationale: For a client taking warfarin for chronic atrial fibrillation, the desired therapeutic INR
range is typically 2.0 to 3.0. An INR of 2.5 indicates therapeutic anticoagulation. Platelet count,
aPTT, and hemoglobin are important values but do not specifically reflect the therapeutic effect
of warfarin therapy. aPTT is used to monitor unfractionated heparin therapy.
Question 6
A home health nurse is providing teaching to a client who has a stage 1 pressure injury on the
greater trochanter of his left hip. Which of the following instructions should the nurse include in
the teaching?
A. Apply a heating pad to the area twice daily
B. Massage the area to promote circulation
C. Change position every hour
D. Keep the area moist with petroleum jelly
Correct Answer: C
, Rationale: For a client with a stage 1 pressure injury, frequent repositioning (every hour) is
essential to relieve pressure on the affected area and prevent progression of the
injury. Massaging the area is contraindicated as it can cause further tissue damage. Heat
application can increase metabolic demand and tissue damage. The area should be kept clean
and dry, not moist with petroleum jelly.
Question 7
A nurse is assessing a client following the completion of hemodialysis. Which of the following
findings is the nurse's priority to report to the provider?
A. Blood pressure 110/70 mm Hg
B. Weight loss of 2 kg
C. Restlessness
D. Mild headache
Correct Answer: C
Rationale: Restlessness following hemodialysis can be an early sign of disequilibrium syndrome
or electrolyte imbalance, which requires immediate medical attention. Mild headache and
expected weight loss (fluid removal) are common after dialysis. A blood pressure of 110/70 mm
Hg is within acceptable range. Restlessness may indicate a serious complication such as cerebral
edema or severe electrolyte shifts.
Question 8
A nurse is caring for a client who is 8 hours postoperative following a total hip arthroplasty. The
client is unable to void on the bedpan. Which of the following actions should the nurse take
first?
A. Insert a Foley catheter
B. Scan the bladder with a portable ultrasound
C. Encourage the client to drink more fluids
D. Notify the provider
Correct Answer: B
Rationale: The nurse should first scan the bladder with a portable ultrasound to assess for
urinary retention. This non-invasive assessment provides objective data about bladder volume.
If significant retention is confirmed, the nurse can then implement appropriate interventions
UPDATED 2026-2027
COMPREHENSIVE 200-QUESTION EXAM WITH DETAILED
RATIONALES
Question 1
A nurse is assessing a client who has heart failure and is receiving furosemide (Lasix). Which of
the following findings should the nurse identify as an adverse effect of this medication?
A. Bradycardia
B. Hypokalemia
C. Hypernatremia
D. Increased blood pressure
Correct Answer: B
Rationale: Furosemide is a loop diuretic that increases the excretion of sodium, chloride,
potassium, and water by the kidneys. Hypokalemia (low potassium) is a common and
potentially dangerous adverse effect because it can lead to cardiac dysrhythmias. The nurse
should monitor serum potassium levels and assess for signs of hypokalemia such as muscle
weakness, fatigue, and irregular heartbeat. Bradycardia is not expected; furosemide tends to
cause hypovolemia which may actually trigger tachycardia. Hypernatremia would not occur
because furosemide promotes sodium excretion. Blood pressure typically decreases due to
volume depletion.
Question 2
A nurse is caring for a client who requires protective isolation following a hematopoietic stem
cell transplant. Which of the following interventions should the nurse implement to protect the
client from infection?
A. Make sure the client's room has positive-pressure airflow
B. Make sure dietary plates and utensils are disposable
,C. Wear an N95 respirator when providing direct client care
D. Monitor the client's temperature once every 6 hours
Correct Answer: A
Rationale: Positive-pressure airflow is used in protective isolation to prevent outside airborne
particles from entering the room, thus reducing the risk of infection for immunocompromised
clients, such as those undergoing a hematopoietic stem cell transplant. This measure ensures
that air flows out of the room rather than into it, keeping contaminants away. While using
disposable utensils and monitoring temperature are helpful, they do not provide the level of
protection needed for clients in protective isolation. An N95 respirator is used for clients in
negative-pressure rooms (e.g., for those with airborne infections like tuberculosis), not for
protective isolation.
Question 3
A nurse is assessing a client who is postoperative following an open reduction and internal
fixation (ORIF) of the femur. Which of the following assessments should be the nurse's priority?
A. Braden scale
B. Pain assessment
C. Neurovascular assessment
D. Morse Fall Risk scale
Correct Answer: C
Rationale: Following an open reduction and internal fixation (ORIF) of the femur, the priority
assessment is neurovascular status. This is crucial to assess circulation, sensation, and
movement distal to the surgical site, ensuring that there is no compromise in blood flow or
nerve function. While pain assessment and fall risk are important, neurovascular compromise
could lead to permanent damage, making it the priority in this situation. The Braden scale
assesses risk for skin breakdown, which is not the immediate priority in this case.
Question 4
A nurse is caring for a client who has a pneumothorax and a closed-chest drainage system.
Which of the following findings is an indication of lung re-expansion?
A. Increased drainage in the collection chamber
B. Bubbling in the water seal chamber has ceased
,C. Continuous bubbling in the suction control chamber
D. Tidaling in the water seal chamber
Correct Answer: B
Rationale: Cessation of bubbling in the water seal chamber indicates that the air leak has sealed
and the lung is re-expanding. Tidaling (fluctuation) in the water seal chamber is expected with
normal breathing and indicates the system is functioning properly. Continuous bubbling in the
suction control chamber is expected when suction is applied. Increased drainage may indicate
bleeding or other complications.
Question 5
A nurse is reviewing the medical record of a client who is taking warfarin for chronic atrial
fibrillation. Which of the following values should the nurse identify as a desired outcome for this
therapy?
A. Platelet count 150,000/mm³
B. INR 2.5
C. aPTT 60 seconds
D. Hemoglobin 14 g/dL
Correct Answer: B
Rationale: For a client taking warfarin for chronic atrial fibrillation, the desired therapeutic INR
range is typically 2.0 to 3.0. An INR of 2.5 indicates therapeutic anticoagulation. Platelet count,
aPTT, and hemoglobin are important values but do not specifically reflect the therapeutic effect
of warfarin therapy. aPTT is used to monitor unfractionated heparin therapy.
Question 6
A home health nurse is providing teaching to a client who has a stage 1 pressure injury on the
greater trochanter of his left hip. Which of the following instructions should the nurse include in
the teaching?
A. Apply a heating pad to the area twice daily
B. Massage the area to promote circulation
C. Change position every hour
D. Keep the area moist with petroleum jelly
Correct Answer: C
, Rationale: For a client with a stage 1 pressure injury, frequent repositioning (every hour) is
essential to relieve pressure on the affected area and prevent progression of the
injury. Massaging the area is contraindicated as it can cause further tissue damage. Heat
application can increase metabolic demand and tissue damage. The area should be kept clean
and dry, not moist with petroleum jelly.
Question 7
A nurse is assessing a client following the completion of hemodialysis. Which of the following
findings is the nurse's priority to report to the provider?
A. Blood pressure 110/70 mm Hg
B. Weight loss of 2 kg
C. Restlessness
D. Mild headache
Correct Answer: C
Rationale: Restlessness following hemodialysis can be an early sign of disequilibrium syndrome
or electrolyte imbalance, which requires immediate medical attention. Mild headache and
expected weight loss (fluid removal) are common after dialysis. A blood pressure of 110/70 mm
Hg is within acceptable range. Restlessness may indicate a serious complication such as cerebral
edema or severe electrolyte shifts.
Question 8
A nurse is caring for a client who is 8 hours postoperative following a total hip arthroplasty. The
client is unable to void on the bedpan. Which of the following actions should the nurse take
first?
A. Insert a Foley catheter
B. Scan the bladder with a portable ultrasound
C. Encourage the client to drink more fluids
D. Notify the provider
Correct Answer: B
Rationale: The nurse should first scan the bladder with a portable ultrasound to assess for
urinary retention. This non-invasive assessment provides objective data about bladder volume.
If significant retention is confirmed, the nurse can then implement appropriate interventions
