[Medical-Surgical Nursing II] COMPLETE EXAM QUESTIONS
AND VERIFIED ANSWERS | 2026–2027 LATEST UPDATE |
GUARANTEED PASS | DETAILED RATIONALES | FULL STUDY
GUIDE | EXAM PREP | PRACTICE TEST | CERTIFICATION
PREPARATION
Section One: Questions 1–100
1. A client with a new diagnosis of type 2 diabetes mellitus is being discharged. Which statement
by the client indicates the need for further teaching regarding their prescribed metformin?
A. "I should take this medication with my evening meal to reduce stomach upset."
B. "I need to report any unusual muscle pain or weakness to my doctor."
C. "I will need to have my kidney function checked regularly while on this medication."
D. "Since this medication can cause low blood sugar, I should always carry a source of sugar."
Correct Answer: D. Since this medication can cause low blood sugar, I should always carry a source
of sugar.
Rationale: Metformin is a biguanide that works primarily by decreasing hepatic glucose production
and increasing insulin sensitivity. It does not typically cause hypoglycemia when used as
monotherapy. The other options are correct statements regarding metformin administration and
safety. Option A is correct because taking it with food reduces gastrointestinal side effects. Option B is
correct as it refers to the rare but serious complication of lactic acidosis, which can present with
muscle pain. Option C is correct because metformin is renally excreted and requires monitoring of
renal function. Thus, the need for carrying a sugar source for hypoglycemia indicates a
misunderstanding, requiring further teaching.
2. A nurse is assessing a client who is 6 hours post-operative following an open cholecystectomy.
Which assessment finding is the most indicative of a potential complication that requires
immediate intervention?
A. Pain score of 5 out of 10 at the incision site.
B. Slight nausea that is relieved by deep breathing.
C. Urinary output of 30 mL over the past 2 hours.
D. Crackles auscultated at the lung bases.
Correct Answer: D. Crackles auscultated at the lung bases.
Rationale: Crackles in the lung bases of a post-operative client are a sign of pulmonary congestion,
which could indicate fluid overload or early pulmonary edema. This requires immediate assessment
and intervention. Incisional pain and mild nausea are expected post-operative findings, although they
need to be managed. A urinary output of 30 mL over 2 hours is less than 30 mL/hr, which is a concern
,and warrants further investigation, but crackles indicate a more immediate, life-threatening
respiratory complication.
3. A client with heart failure is prescribed furosemide and digoxin. Which serum electrolyte
imbalance is the most concerning due to its potential to precipitate digoxin toxicity?
A. Hypercalcemia
B. Hypokalemia
C. Hyponatremia
D. Hypermagnesemia
Correct Answer: B. Hypokalemia
Rationale: Hypokalemia, or low serum potassium, increases the risk of digoxin toxicity by increasing
the binding of digoxin to the sodium-potassium ATPase pump in cardiac cells. Furosemide is a loop
diuretic that can cause significant potassium loss. While the other electrolyte imbalances can occur,
hypokalemia has the most direct and dangerous interaction with digoxin therapy. Option A is
incorrect as hypercalcemia can also predispose to digoxin toxicity, but hypokalemia is the most
common and concerning imbalance in this scenario. Option C and D are less associated with digoxin
toxicity.
4. A nurse is providing discharge teaching to a client who has had a myocardial infarction (MI). The
client is prescribed a beta-blocker. What is the primary purpose of this medication in the post-MI
client?
A. To increase the heart rate and improve cardiac output.
B. To decrease the workload on the heart and prevent remodeling.
C. To dilate coronary arteries and improve oxygen supply.
D. To dissolve any remaining clots in the coronary vessels.
Correct Answer: B. To decrease the workload on the heart and prevent remodeling.
Rationale: Beta-blockers are a cornerstone of post-MI therapy. Their primary benefits are to reduce
sympathetic stimulation, thereby lowering heart rate, blood pressure, and myocardial contractility.
This decrease in workload reduces myocardial oxygen demand and helps prevent adverse cardiac
remodeling, which can lead to heart failure. Option A is the opposite of the drug's action. Option C
describes the action of nitrates. Option D describes the action of thrombolytics or antiplatelet agents.
5. An older adult client with a history of chronic obstructive pulmonary disease (COPD) is admitted
with confusion and respiratory distress. Which blood gas finding is most consistent with
uncompensated respiratory acidosis?
A. pH 7.32, PaCO2 55 mm Hg, HCO3- 24 mEq/L
B. pH 7.48, PaCO2 30 mm Hg, HCO3- 22 mEq/L
C. pH 7.36, PaCO2 48 mm Hg, HCO3- 28 mEq/L
D. pH 7.45, PaCO2 42 mm Hg, HCO3- 25 mEq/L
Correct Answer: A. pH 7.32, PaCO2 55 mm Hg, HCO3- 24 mEq/L
,Rationale: The arterial blood gas (ABG) results in Option A show a low pH (acidemia) and an elevated
PaCO2 (respiratory acidosis). The HCO3- is within normal limits, indicating that the kidneys have not
yet had time to compensate. This is an uncompensated respiratory acidosis, a common finding in a
COPD exacerbation. Option B shows a respiratory alkalosis. Option C shows a partially compensated
respiratory acidosis. Option D shows normal ABGs.
6. A client is receiving a blood transfusion. Fifteen minutes after the infusion begins, the client
reports a headache, chills, and low back pain. What is the priority nursing action?
A. Slow the infusion rate and monitor the client's vital signs closely.
B. Stop the transfusion and disconnect the blood tubing from the IV site.
C. Notify the healthcare provider and prepare to administer an antihistamine.
D. Stop the infusion, maintain IV access with normal saline, and notify the blood bank.
Correct Answer: D. Stop the infusion, maintain IV access with normal saline, and notify the blood
bank.
Rationale: The client is exhibiting signs of a possible acute hemolytic transfusion reaction, indicated
by fever, chills, and low back pain. The priority actions are to stop the transfusion, keep the IV line
open with normal saline to maintain venous access, and notify the blood bank and the healthcare
provider immediately. Option A is incorrect because the transfusion should be stopped, not slowed.
Option B is incorrect because the blood tubing should not be disconnected as it may need to be sent
to the blood bank for analysis. Option C is not the immediate priority; while antihistamines may be
given for an allergic reaction, this presentation is more consistent with a hemolytic reaction.
7. The nurse is caring for a client with an acute exacerbation of ulcerative colitis. Which clinical
manifestation would the nurse expect to observe?
A. Constipation and abdominal distention.
B. Steatorrhea and weight gain.
C. Severe abdominal cramping and bloody diarrhea.
D. Fistula formation and perianal abscesses.
Correct Answer: C. Severe abdominal cramping and bloody diarrhea.
Rationale: The hallmark of an acute exacerbation of ulcerative colitis is severe, bloody diarrhea
accompanied by abdominal cramping and pain. Ulcerative colitis is a chronic inflammatory bowel
disease that affects the mucosa of the colon, leading to ulcerations that bleed. Option A is more
typical of a bowel obstruction. Option B is associated with malabsorption disorders like Crohn's
disease affecting the small intestine, or pancreatic insufficiency. Option D is a complication more
commonly seen in Crohn's disease, which is transmural and can lead to fistulas and abscesses.
8. A client with cirrhosis is being assessed for ascites. Which nursing assessment technique is most
reliable for detecting the presence of ascites?
A. Palpating the abdomen for a firm, enlarged liver.
B. Measuring the abdominal girth daily at the umbilicus.
, C. Auscultating the abdomen for hyperactive bowel sounds.
D. Assessing for shifting dullness and a fluid wave.
Correct Answer: D. Assessing for shifting dullness and a fluid wave.
Rationale: Shifting dullness and a fluid wave are specific physical examination maneuvers used to
detect the presence of ascites, or free fluid in the peritoneal cavity. Option B, measuring abdominal
girth, is useful for monitoring changes in ascites, but it is not the most reliable initial detection
method. Option A is a finding that may be present in cirrhosis but does not specifically indicate
ascites. Option C is not relevant to the detection of ascites.
9. A client is admitted with suspected acute pancreatitis. Which laboratory finding would be most
specific for this diagnosis?
A. Elevated serum amylase and lipase.
B. Elevated serum bilirubin and alkaline phosphatase.
C. Elevated liver transaminases (ALT, AST).
D. Elevated serum glucose and white blood cell count.
Correct Answer: A. Elevated serum amylase and lipase.
Rationale: In acute pancreatitis, the digestive enzymes trypsin, amylase, and lipase are released into
the bloodstream. Serum lipase is considered more specific to the pancreas and has a longer half-life
than amylase. Elevated bilirubin and alkaline phosphatase are more indicative of biliary obstruction.
Elevated liver transaminases can be seen in many conditions, including hepatitis. Elevated glucose
and WBCs are nonspecific signs of inflammation and stress.
10. A client with chronic kidney disease (CKD) is scheduled for hemodialysis. The nurse knows that
which of the following is a key component of the pre-dialysis assessment?
A. Checking for a bruit and thrill over the arteriovenous (AV) fistula.
B. Assessing the client's blood glucose level to prevent hypoglycemia.
C. Weighing the client to determine the amount of fluid to be removed.
D. Evaluating the client's level of consciousness for signs of uremic encephalopathy.
Correct Answer: C. Weighing the client to determine the amount of fluid to be removed.
Rationale: Accurate pre-dialysis weight is essential to calculate the ultrafiltration rate, which is the
amount of fluid to be removed during the hemodialysis session. While assessing the AV fistula for a
bruit and thrill is crucial for assessing patency (Option A), it is a vascular access assessment, not the
primary determinant of fluid removal. Option B is more relevant for clients with diabetes. Option D is
a general assessment for uremia, but it is not specifically used to calculate the fluid removal goal.
11. A client is diagnosed with a pulmonary embolism (PE). The nurse anticipates the healthcare
provider will prescribe which class of medication as the primary treatment?
A. Thrombolytics
B. Anticoagulants
AND VERIFIED ANSWERS | 2026–2027 LATEST UPDATE |
GUARANTEED PASS | DETAILED RATIONALES | FULL STUDY
GUIDE | EXAM PREP | PRACTICE TEST | CERTIFICATION
PREPARATION
Section One: Questions 1–100
1. A client with a new diagnosis of type 2 diabetes mellitus is being discharged. Which statement
by the client indicates the need for further teaching regarding their prescribed metformin?
A. "I should take this medication with my evening meal to reduce stomach upset."
B. "I need to report any unusual muscle pain or weakness to my doctor."
C. "I will need to have my kidney function checked regularly while on this medication."
D. "Since this medication can cause low blood sugar, I should always carry a source of sugar."
Correct Answer: D. Since this medication can cause low blood sugar, I should always carry a source
of sugar.
Rationale: Metformin is a biguanide that works primarily by decreasing hepatic glucose production
and increasing insulin sensitivity. It does not typically cause hypoglycemia when used as
monotherapy. The other options are correct statements regarding metformin administration and
safety. Option A is correct because taking it with food reduces gastrointestinal side effects. Option B is
correct as it refers to the rare but serious complication of lactic acidosis, which can present with
muscle pain. Option C is correct because metformin is renally excreted and requires monitoring of
renal function. Thus, the need for carrying a sugar source for hypoglycemia indicates a
misunderstanding, requiring further teaching.
2. A nurse is assessing a client who is 6 hours post-operative following an open cholecystectomy.
Which assessment finding is the most indicative of a potential complication that requires
immediate intervention?
A. Pain score of 5 out of 10 at the incision site.
B. Slight nausea that is relieved by deep breathing.
C. Urinary output of 30 mL over the past 2 hours.
D. Crackles auscultated at the lung bases.
Correct Answer: D. Crackles auscultated at the lung bases.
Rationale: Crackles in the lung bases of a post-operative client are a sign of pulmonary congestion,
which could indicate fluid overload or early pulmonary edema. This requires immediate assessment
and intervention. Incisional pain and mild nausea are expected post-operative findings, although they
need to be managed. A urinary output of 30 mL over 2 hours is less than 30 mL/hr, which is a concern
,and warrants further investigation, but crackles indicate a more immediate, life-threatening
respiratory complication.
3. A client with heart failure is prescribed furosemide and digoxin. Which serum electrolyte
imbalance is the most concerning due to its potential to precipitate digoxin toxicity?
A. Hypercalcemia
B. Hypokalemia
C. Hyponatremia
D. Hypermagnesemia
Correct Answer: B. Hypokalemia
Rationale: Hypokalemia, or low serum potassium, increases the risk of digoxin toxicity by increasing
the binding of digoxin to the sodium-potassium ATPase pump in cardiac cells. Furosemide is a loop
diuretic that can cause significant potassium loss. While the other electrolyte imbalances can occur,
hypokalemia has the most direct and dangerous interaction with digoxin therapy. Option A is
incorrect as hypercalcemia can also predispose to digoxin toxicity, but hypokalemia is the most
common and concerning imbalance in this scenario. Option C and D are less associated with digoxin
toxicity.
4. A nurse is providing discharge teaching to a client who has had a myocardial infarction (MI). The
client is prescribed a beta-blocker. What is the primary purpose of this medication in the post-MI
client?
A. To increase the heart rate and improve cardiac output.
B. To decrease the workload on the heart and prevent remodeling.
C. To dilate coronary arteries and improve oxygen supply.
D. To dissolve any remaining clots in the coronary vessels.
Correct Answer: B. To decrease the workload on the heart and prevent remodeling.
Rationale: Beta-blockers are a cornerstone of post-MI therapy. Their primary benefits are to reduce
sympathetic stimulation, thereby lowering heart rate, blood pressure, and myocardial contractility.
This decrease in workload reduces myocardial oxygen demand and helps prevent adverse cardiac
remodeling, which can lead to heart failure. Option A is the opposite of the drug's action. Option C
describes the action of nitrates. Option D describes the action of thrombolytics or antiplatelet agents.
5. An older adult client with a history of chronic obstructive pulmonary disease (COPD) is admitted
with confusion and respiratory distress. Which blood gas finding is most consistent with
uncompensated respiratory acidosis?
A. pH 7.32, PaCO2 55 mm Hg, HCO3- 24 mEq/L
B. pH 7.48, PaCO2 30 mm Hg, HCO3- 22 mEq/L
C. pH 7.36, PaCO2 48 mm Hg, HCO3- 28 mEq/L
D. pH 7.45, PaCO2 42 mm Hg, HCO3- 25 mEq/L
Correct Answer: A. pH 7.32, PaCO2 55 mm Hg, HCO3- 24 mEq/L
,Rationale: The arterial blood gas (ABG) results in Option A show a low pH (acidemia) and an elevated
PaCO2 (respiratory acidosis). The HCO3- is within normal limits, indicating that the kidneys have not
yet had time to compensate. This is an uncompensated respiratory acidosis, a common finding in a
COPD exacerbation. Option B shows a respiratory alkalosis. Option C shows a partially compensated
respiratory acidosis. Option D shows normal ABGs.
6. A client is receiving a blood transfusion. Fifteen minutes after the infusion begins, the client
reports a headache, chills, and low back pain. What is the priority nursing action?
A. Slow the infusion rate and monitor the client's vital signs closely.
B. Stop the transfusion and disconnect the blood tubing from the IV site.
C. Notify the healthcare provider and prepare to administer an antihistamine.
D. Stop the infusion, maintain IV access with normal saline, and notify the blood bank.
Correct Answer: D. Stop the infusion, maintain IV access with normal saline, and notify the blood
bank.
Rationale: The client is exhibiting signs of a possible acute hemolytic transfusion reaction, indicated
by fever, chills, and low back pain. The priority actions are to stop the transfusion, keep the IV line
open with normal saline to maintain venous access, and notify the blood bank and the healthcare
provider immediately. Option A is incorrect because the transfusion should be stopped, not slowed.
Option B is incorrect because the blood tubing should not be disconnected as it may need to be sent
to the blood bank for analysis. Option C is not the immediate priority; while antihistamines may be
given for an allergic reaction, this presentation is more consistent with a hemolytic reaction.
7. The nurse is caring for a client with an acute exacerbation of ulcerative colitis. Which clinical
manifestation would the nurse expect to observe?
A. Constipation and abdominal distention.
B. Steatorrhea and weight gain.
C. Severe abdominal cramping and bloody diarrhea.
D. Fistula formation and perianal abscesses.
Correct Answer: C. Severe abdominal cramping and bloody diarrhea.
Rationale: The hallmark of an acute exacerbation of ulcerative colitis is severe, bloody diarrhea
accompanied by abdominal cramping and pain. Ulcerative colitis is a chronic inflammatory bowel
disease that affects the mucosa of the colon, leading to ulcerations that bleed. Option A is more
typical of a bowel obstruction. Option B is associated with malabsorption disorders like Crohn's
disease affecting the small intestine, or pancreatic insufficiency. Option D is a complication more
commonly seen in Crohn's disease, which is transmural and can lead to fistulas and abscesses.
8. A client with cirrhosis is being assessed for ascites. Which nursing assessment technique is most
reliable for detecting the presence of ascites?
A. Palpating the abdomen for a firm, enlarged liver.
B. Measuring the abdominal girth daily at the umbilicus.
, C. Auscultating the abdomen for hyperactive bowel sounds.
D. Assessing for shifting dullness and a fluid wave.
Correct Answer: D. Assessing for shifting dullness and a fluid wave.
Rationale: Shifting dullness and a fluid wave are specific physical examination maneuvers used to
detect the presence of ascites, or free fluid in the peritoneal cavity. Option B, measuring abdominal
girth, is useful for monitoring changes in ascites, but it is not the most reliable initial detection
method. Option A is a finding that may be present in cirrhosis but does not specifically indicate
ascites. Option C is not relevant to the detection of ascites.
9. A client is admitted with suspected acute pancreatitis. Which laboratory finding would be most
specific for this diagnosis?
A. Elevated serum amylase and lipase.
B. Elevated serum bilirubin and alkaline phosphatase.
C. Elevated liver transaminases (ALT, AST).
D. Elevated serum glucose and white blood cell count.
Correct Answer: A. Elevated serum amylase and lipase.
Rationale: In acute pancreatitis, the digestive enzymes trypsin, amylase, and lipase are released into
the bloodstream. Serum lipase is considered more specific to the pancreas and has a longer half-life
than amylase. Elevated bilirubin and alkaline phosphatase are more indicative of biliary obstruction.
Elevated liver transaminases can be seen in many conditions, including hepatitis. Elevated glucose
and WBCs are nonspecific signs of inflammation and stress.
10. A client with chronic kidney disease (CKD) is scheduled for hemodialysis. The nurse knows that
which of the following is a key component of the pre-dialysis assessment?
A. Checking for a bruit and thrill over the arteriovenous (AV) fistula.
B. Assessing the client's blood glucose level to prevent hypoglycemia.
C. Weighing the client to determine the amount of fluid to be removed.
D. Evaluating the client's level of consciousness for signs of uremic encephalopathy.
Correct Answer: C. Weighing the client to determine the amount of fluid to be removed.
Rationale: Accurate pre-dialysis weight is essential to calculate the ultrafiltration rate, which is the
amount of fluid to be removed during the hemodialysis session. While assessing the AV fistula for a
bruit and thrill is crucial for assessing patency (Option A), it is a vascular access assessment, not the
primary determinant of fluid removal. Option B is more relevant for clients with diabetes. Option D is
a general assessment for uremia, but it is not specifically used to calculate the fluid removal goal.
11. A client is diagnosed with a pulmonary embolism (PE). The nurse anticipates the healthcare
provider will prescribe which class of medication as the primary treatment?
A. Thrombolytics
B. Anticoagulants
