NUR 211 ADULT HEALTH MED SURG I
COMPREHENSIVE FINAL 150 MASTER Q
and AS WITH RATIONALES 2026 2027
1. A nurse on a medical-surgical unit is caring for a
client who is 24 hours post-operative following a total
abdominal hysterectomy. The client sudden reports
sharp chest pain, accompanied by dyspnea and a
respiratory rate of 28 breaths per minute. Which of
the following clinical conditions should the nurse
suspect first, and what immediate action must be
taken?
A. Pulmonary embolism (PE) resulting from a deep
vein thrombosis; the nurse must immediately
administer oxygen via non-rebreather mask, elevate
the head of the bed, assess vital signs, and notify the
health care provider or rapid response team.
B. Atelectasis due to poor use of the incentive spirometer; the
nurse should administer an ordered bronchodilator and
encourage forceful coughing.
C. Severe post-operative pain and panic attack; the nurse
should administer the maximum prescribed dose of an
intravenous opioid analgesic and reassess in one hour.
D. Myocardial infarction due to blood loss anemia; the nurse
must prepare the client for an immediate return to the
operating room for exploratory surgery.
Correct Answer: A
RationalePost-operative clients are at high risk for venous
thromboembolism (VTE) due to immobility and surgical tissue
trauma. Sudden onset of sharp chest pain, tachypnea, and
dyspnea are hallmark signs of a pulmonary embolism.
Immediate actions include oxygenation, positioning for
,optimal lung expansion (high-Fowler's), and urgent medical
notification.
2. A nurse is reviewing the morning laboratory results
for a client who is receiving intravenous furosemide
for the management of severe congestive heart failure.
The laboratory report indicates a serum potassium
level of 2.8 mEq/L. Which of the following continuous
electrocardiogram (ECG) changes should the nurse
monitor for on the telemetry screen?
A. Tall, peaked T waves, a widened QRS complex, and a
prolonged PR interval.
B. Flattened or inverted T waves, ST-segment
depression, and the appearance of prominent U
waves.
C. A shortened QT interval with a sudden lengthening of the ST
segment.
D. High-amplitude R waves accompanied by a shifting baseline
and sinus bradycardia.
Correct Answer: B
RationaleThe client's potassium level is 2.8 mEq/L,
indicating severe hypokalemia (normal range is 3.5 to 5.0
mEq/L). Furosemide is a potassium-wasting loop diuretic.
Electrocardiogram changes associated with hypokalemia
include flattened/inverted T waves, ST depression, and visible
U waves. Peaked T waves indicate hyperkalemia.
3. A nurse is conducting a clinical assessment on a
client who was admitted with a suspected diagnosis of
acute pancreatitis. Which of the following diagnostic
laboratory findings and physical assessment signs
explicitly support this medical diagnosis?
A. Elevated serum alkaline phosphatase, decreased blood urea
nitrogen, and a positive Murphy's sign.
B. Elevated serum bilirubin, elevated hemoglobin, and a
positive Chvostek's sign.
,C. Elevated serum amylase and lipase levels, along
with the presence of Cullen's sign (periumbilical
ecchymosis) or Turner's sign (flank ecchymosis).
D. Decreased serum amylase, elevated serum calcium, and a
positive Trousseau's sign.
Correct Answer: C
RationaleAmylase and lipase are pancreatic enzymes that
rise sharply during acute pancreatitis due to cellular injury.
Cullen's sign (bluish discoloration around the umbilicus) and
Turner's sign (bluish discoloration of the flanks) indicate
retroperitoneal hemorrhage, which occurs in severe
hemorrhagic pancreatitis.
4. A nurse is caring for an older adult client who has
been hospitalized for severe vomiting and diarrhea for
the past three days. The client is confused, has poor
skin turgor, dry mucous membranes, a heart rate of
112 beats per minute, and a blood pressure of 88/52
mm Hg. Which type of intravenous fluid configuration
should the nurse anticipate the provider ordering for
initial volume resuscitation?
A. A hypertonic solution like 3% Sodium Chloride to pull
moisture out of the cellular walls.
B. A hypotonic solution like 0.45% Sodium Chloride to
rehydrate the intracellular spaces rapidly.
C. An isotonic crystalloid solution, such as 0.9%
Sodium Chloride (Normal Saline) or Lactated
Ringer's, to expand the intravascular extracellular
fluid volume.
D. A high-density colloid solution like 25% Albumin to expand
the interstitial spaces.
Correct Answer: C
RationaleThe client exhibits signs of severe fluid volume
deficit and hypovolemic shock. Initial volume resuscitation
requires an isotonic crystalloid solution (such as 0.9% NaCl or
, Lactated Ringer's) because it remains in the intravascular
space, expanding circulating volume and stabilizing blood
pressure without shifting fluids between compartments.
5. A nurse is monitoring a client who is receiving a
primary blood transfusion of packed red blood cells
(PRBCs). Fifteen minutes after the transfusion begins,
the client develops chills, lower back pain, fever, and
tachypnea. Which of the following types of transfusion
reactions is occurring, and what is the nurse's priority
action?
A. Circulatory overload; the nurse must slow the infusion rate
down to a keep-vein-open speed and place the client in a supine
position.
B. An acute hemolytic transfusion reaction; the nurse
must immediately stop the transfusion, disconnect the
blood tubing from the IV access hub, flush the line or
hang a new bag of 0.9% Normal Saline with completely
new tubing, and notify the provider and blood bank.
C. An allergic reaction; the nurse should administer a
prescribed antipyretic and continue to monitor the current rate.
D. A febrile non-hemolytic reaction; the nurse must accelerate
the current infusion rate to finish the blood bag quickly.
Correct Answer: B
RationaleChills, lower back pain (lumbar pain due to
hemoglobin clearing through the kidneys), fever, and
tachypnea indicate an acute hemolytic transfusion reaction,
an incompatibility issue. The priority action is to immediately
stop the infusion to prevent further antibody-antigen
interaction, disconnect the tainted line, and run fresh saline
using new tubing to maintain vascular access.
6. A nurse is providing discharge teaching to a client
newly diagnosed with type 1 diabetes mellitus
regarding the management of hypoglycemic episodes
at home. Which of the following statements by the
COMPREHENSIVE FINAL 150 MASTER Q
and AS WITH RATIONALES 2026 2027
1. A nurse on a medical-surgical unit is caring for a
client who is 24 hours post-operative following a total
abdominal hysterectomy. The client sudden reports
sharp chest pain, accompanied by dyspnea and a
respiratory rate of 28 breaths per minute. Which of
the following clinical conditions should the nurse
suspect first, and what immediate action must be
taken?
A. Pulmonary embolism (PE) resulting from a deep
vein thrombosis; the nurse must immediately
administer oxygen via non-rebreather mask, elevate
the head of the bed, assess vital signs, and notify the
health care provider or rapid response team.
B. Atelectasis due to poor use of the incentive spirometer; the
nurse should administer an ordered bronchodilator and
encourage forceful coughing.
C. Severe post-operative pain and panic attack; the nurse
should administer the maximum prescribed dose of an
intravenous opioid analgesic and reassess in one hour.
D. Myocardial infarction due to blood loss anemia; the nurse
must prepare the client for an immediate return to the
operating room for exploratory surgery.
Correct Answer: A
RationalePost-operative clients are at high risk for venous
thromboembolism (VTE) due to immobility and surgical tissue
trauma. Sudden onset of sharp chest pain, tachypnea, and
dyspnea are hallmark signs of a pulmonary embolism.
Immediate actions include oxygenation, positioning for
,optimal lung expansion (high-Fowler's), and urgent medical
notification.
2. A nurse is reviewing the morning laboratory results
for a client who is receiving intravenous furosemide
for the management of severe congestive heart failure.
The laboratory report indicates a serum potassium
level of 2.8 mEq/L. Which of the following continuous
electrocardiogram (ECG) changes should the nurse
monitor for on the telemetry screen?
A. Tall, peaked T waves, a widened QRS complex, and a
prolonged PR interval.
B. Flattened or inverted T waves, ST-segment
depression, and the appearance of prominent U
waves.
C. A shortened QT interval with a sudden lengthening of the ST
segment.
D. High-amplitude R waves accompanied by a shifting baseline
and sinus bradycardia.
Correct Answer: B
RationaleThe client's potassium level is 2.8 mEq/L,
indicating severe hypokalemia (normal range is 3.5 to 5.0
mEq/L). Furosemide is a potassium-wasting loop diuretic.
Electrocardiogram changes associated with hypokalemia
include flattened/inverted T waves, ST depression, and visible
U waves. Peaked T waves indicate hyperkalemia.
3. A nurse is conducting a clinical assessment on a
client who was admitted with a suspected diagnosis of
acute pancreatitis. Which of the following diagnostic
laboratory findings and physical assessment signs
explicitly support this medical diagnosis?
A. Elevated serum alkaline phosphatase, decreased blood urea
nitrogen, and a positive Murphy's sign.
B. Elevated serum bilirubin, elevated hemoglobin, and a
positive Chvostek's sign.
,C. Elevated serum amylase and lipase levels, along
with the presence of Cullen's sign (periumbilical
ecchymosis) or Turner's sign (flank ecchymosis).
D. Decreased serum amylase, elevated serum calcium, and a
positive Trousseau's sign.
Correct Answer: C
RationaleAmylase and lipase are pancreatic enzymes that
rise sharply during acute pancreatitis due to cellular injury.
Cullen's sign (bluish discoloration around the umbilicus) and
Turner's sign (bluish discoloration of the flanks) indicate
retroperitoneal hemorrhage, which occurs in severe
hemorrhagic pancreatitis.
4. A nurse is caring for an older adult client who has
been hospitalized for severe vomiting and diarrhea for
the past three days. The client is confused, has poor
skin turgor, dry mucous membranes, a heart rate of
112 beats per minute, and a blood pressure of 88/52
mm Hg. Which type of intravenous fluid configuration
should the nurse anticipate the provider ordering for
initial volume resuscitation?
A. A hypertonic solution like 3% Sodium Chloride to pull
moisture out of the cellular walls.
B. A hypotonic solution like 0.45% Sodium Chloride to
rehydrate the intracellular spaces rapidly.
C. An isotonic crystalloid solution, such as 0.9%
Sodium Chloride (Normal Saline) or Lactated
Ringer's, to expand the intravascular extracellular
fluid volume.
D. A high-density colloid solution like 25% Albumin to expand
the interstitial spaces.
Correct Answer: C
RationaleThe client exhibits signs of severe fluid volume
deficit and hypovolemic shock. Initial volume resuscitation
requires an isotonic crystalloid solution (such as 0.9% NaCl or
, Lactated Ringer's) because it remains in the intravascular
space, expanding circulating volume and stabilizing blood
pressure without shifting fluids between compartments.
5. A nurse is monitoring a client who is receiving a
primary blood transfusion of packed red blood cells
(PRBCs). Fifteen minutes after the transfusion begins,
the client develops chills, lower back pain, fever, and
tachypnea. Which of the following types of transfusion
reactions is occurring, and what is the nurse's priority
action?
A. Circulatory overload; the nurse must slow the infusion rate
down to a keep-vein-open speed and place the client in a supine
position.
B. An acute hemolytic transfusion reaction; the nurse
must immediately stop the transfusion, disconnect the
blood tubing from the IV access hub, flush the line or
hang a new bag of 0.9% Normal Saline with completely
new tubing, and notify the provider and blood bank.
C. An allergic reaction; the nurse should administer a
prescribed antipyretic and continue to monitor the current rate.
D. A febrile non-hemolytic reaction; the nurse must accelerate
the current infusion rate to finish the blood bag quickly.
Correct Answer: B
RationaleChills, lower back pain (lumbar pain due to
hemoglobin clearing through the kidneys), fever, and
tachypnea indicate an acute hemolytic transfusion reaction,
an incompatibility issue. The priority action is to immediately
stop the infusion to prevent further antibody-antigen
interaction, disconnect the tainted line, and run fresh saline
using new tubing to maintain vascular access.
6. A nurse is providing discharge teaching to a client
newly diagnosed with type 1 diabetes mellitus
regarding the management of hypoglycemic episodes
at home. Which of the following statements by the
