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MEDICAL-SURGICAL FINAL PRACTICE 200 QUESTIONS EXAM
QUESTIONS AND CORRECT ANSWERS LATEST EDITION 2026
1. A client with heart failure is prescribed furosemide. Which laboratory value should the
nurse monitor most closely?
A) Sodium 140 mEq/L
B) Potassium 3.0 mEq/L
C) Calcium 9.5 mg/dL
D) Magnesium 2.0 mg/dL
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting through increased
excretion in the distal tubule. Hypokalemia (potassium below 3.5 mEq/L) is the most common
and dangerous electrolyte imbalance associated with loop diuretics because it can precipitate
cardiac dysrhythmias. Sodium 140 mEq/L, calcium 9.5 mg/dL, and magnesium 2.0 mg/dL are all
within normal ranges and are not the priority concern when administering furosemide .
2. A client who had a total hip replacement 2 days ago reports sudden shortness of breath
and chest pain. What is the nurse's priority action?
A) Administer prescribed PRN oxygen
B) Call the rapid response team
C) Apply sequential compression devices
D) Elevate the head of the bed
Answer: B
Rationale: Sudden shortness of breath and chest pain in a post-operative orthopedic patient are
classic signs of a pulmonary embolism (PE), which is a life-threatening emergency. The nurse
should immediately call the rapid response team because PE requires urgent medical
intervention including potential thrombolytic therapy or anticoagulation. While administering
oxygen and elevating the head of the bed are supportive measures, the priority is to activate
the emergency response so that definitive treatment can begin without delay. Applying
sequential compression devices is a preventive measure, not an acute intervention .
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3. A client with a history of heart failure is admitted with acute dyspnea. Which assessment
finding is most concerning?
A) Respiratory rate of 22 breaths/min
B) Oxygen saturation of 88% on room air
C) Bilateral crackles in the lung bases
D) Weight gain of 1 kg over 24 hours
Answer: C
Rationale: Bilateral crackles in the lung bases indicate pulmonary congestion, a hallmark of
acute decompensated heart failure requiring immediate intervention. While oxygen saturation
of 88% and weight gain are concerning, crackles indicate fluid in the alveoli that can rapidly
progress to respiratory failure .
4. A client with long-standing uncontrolled hypertension develops left ventricular
hypertrophy. What is the primary mechanism for this change?
A) Increased heart rate
B) Increased cardiac workload due to increased resistance
C) Decreased preload
D) Reduced myocardial contractility
Answer: B
Rationale: Persistent increased resistance to blood flow increases cardiac workload and can
cause thickening of the ventricular muscle (hypertrophy). The heart must work harder to pump
against elevated systemic vascular resistance .
Section 2: Respiratory Disorders
5. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 4 L/min
via nasal cannula. The nurse notes the client appears drowsy and has a respiratory rate of 8
breaths per minute. What is the priority action?
A) Increase the oxygen flow rate
B) Decrease the oxygen flow rate
C) Document the findings and continue monitoring
D) Prepare for endotracheal intubation
Answer: B
Rationale: The client is exhibiting signs of oxygen-induced hypercapnic respiratory failure, also
known as CO2 narcosis. Clients with COPD often rely on hypoxic drive to maintain respirations.
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Administering high concentrations of oxygen eliminates this stimulus, causing decreased
respiratory effort and CO2 retention. The priority action is to decrease the oxygen flow rate to
the lowest level that maintains adequate oxygenation (typically 1-2 L/min). Increasing oxygen
would worsen the condition. While preparing for intubation may eventually be needed, the
immediate nursing action is to reduce oxygen delivery .
6. A client with pneumonia develops impaired gas exchange. What pathophysiological
mechanism most directly contributes to hypoxemia?
A) Hypoventilation
B) Ventilation-perfusion mismatch
C) Diffusion limitation
D) Right-to-left shunt
Answer: B
Rationale: Inflammation and fluid within the alveoli interfere with normal ventilation while
blood continues to flow through affected lung regions, causing V/Q mismatch. This is the
primary mechanism of hypoxemia in pneumonia .
7. A client with a chest tube has continuous bubbling in the water-seal chamber. What does
this indicate?
A) Normal finding
B) Air leak in the system
C) Lung re-expansion
D) Suction is too high
Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak. Intermittent
bubbling is normal with coughing. The nurse should check all connections and the insertion site
for leaks .
8. A client with a pulmonary embolism is prescribed heparin. Which laboratory value should
the nurse monitor?
A) INR
B) aPTT
C) Platelet count
D) Hemoglobin
Answer: B
Rationale: aPTT monitors heparin therapy. Therapeutic range is 1.5-2.5 times the control value.
INR monitors warfarin therapy .
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Section 3: Renal & Urinary Disorders
9. A client with chronic kidney disease (CKD) has a serum creatinine of 3.2 mg/dL. Which
medication adjustment is most appropriate for a drug that is primarily renally eliminated?
A) Increase the dose to achieve therapeutic levels despite reduced clearance
B) Maintain the standard dose but monitor renal function weekly
C) Reduce the dose or extend the dosing interval based on creatinine clearance
D) Discontinue the drug entirely because of contraindication in renal impairment
Answer: C
Rationale: In CKD stage 4, creatinine clearance is severely reduced (15-29 mL/min). For renally
eliminated drugs, dose reduction or interval extension prevents accumulation and toxicity.
Option A could cause toxicity. Option B is insufficient. Option D is overly aggressive unless the
drug is specifically contraindicated .
10. A client develops acute kidney injury after severe dehydration. What is the primary
pathophysiological cause?
A) Tubular obstruction
B) Decreased renal perfusion
C) Immune complex deposition
D) Direct toxin injury
Answer: B
Rationale: Significant volume loss reduces blood flow to the kidneys and can decrease
glomerular filtration. This is pre-renal acute kidney injury, which is reversible if caught early .
11. A client with chronic kidney disease develops metabolic acidosis. What is the primary
reason?
A) Increased hydrogen ion excretion
B) Reduced ability of the kidneys to excrete hydrogen ions and regenerate bicarbonate
C) Increased bicarbonate production
D) Hyperventilation
Answer: B
Rationale: Renal dysfunction impairs normal acid-base regulation and can result in acid
accumulation due to decreased hydrogen ion excretion and bicarbonate regeneration .
12. A client with a urinary tract infection presents with dysuria, frequency, and urgency.
Which finding would indicate upper urinary tract involvement?
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MEDICAL-SURGICAL FINAL PRACTICE 200 QUESTIONS EXAM
QUESTIONS AND CORRECT ANSWERS LATEST EDITION 2026
1. A client with heart failure is prescribed furosemide. Which laboratory value should the
nurse monitor most closely?
A) Sodium 140 mEq/L
B) Potassium 3.0 mEq/L
C) Calcium 9.5 mg/dL
D) Magnesium 2.0 mg/dL
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting through increased
excretion in the distal tubule. Hypokalemia (potassium below 3.5 mEq/L) is the most common
and dangerous electrolyte imbalance associated with loop diuretics because it can precipitate
cardiac dysrhythmias. Sodium 140 mEq/L, calcium 9.5 mg/dL, and magnesium 2.0 mg/dL are all
within normal ranges and are not the priority concern when administering furosemide .
2. A client who had a total hip replacement 2 days ago reports sudden shortness of breath
and chest pain. What is the nurse's priority action?
A) Administer prescribed PRN oxygen
B) Call the rapid response team
C) Apply sequential compression devices
D) Elevate the head of the bed
Answer: B
Rationale: Sudden shortness of breath and chest pain in a post-operative orthopedic patient are
classic signs of a pulmonary embolism (PE), which is a life-threatening emergency. The nurse
should immediately call the rapid response team because PE requires urgent medical
intervention including potential thrombolytic therapy or anticoagulation. While administering
oxygen and elevating the head of the bed are supportive measures, the priority is to activate
the emergency response so that definitive treatment can begin without delay. Applying
sequential compression devices is a preventive measure, not an acute intervention .
1|Page
,2
3. A client with a history of heart failure is admitted with acute dyspnea. Which assessment
finding is most concerning?
A) Respiratory rate of 22 breaths/min
B) Oxygen saturation of 88% on room air
C) Bilateral crackles in the lung bases
D) Weight gain of 1 kg over 24 hours
Answer: C
Rationale: Bilateral crackles in the lung bases indicate pulmonary congestion, a hallmark of
acute decompensated heart failure requiring immediate intervention. While oxygen saturation
of 88% and weight gain are concerning, crackles indicate fluid in the alveoli that can rapidly
progress to respiratory failure .
4. A client with long-standing uncontrolled hypertension develops left ventricular
hypertrophy. What is the primary mechanism for this change?
A) Increased heart rate
B) Increased cardiac workload due to increased resistance
C) Decreased preload
D) Reduced myocardial contractility
Answer: B
Rationale: Persistent increased resistance to blood flow increases cardiac workload and can
cause thickening of the ventricular muscle (hypertrophy). The heart must work harder to pump
against elevated systemic vascular resistance .
Section 2: Respiratory Disorders
5. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 4 L/min
via nasal cannula. The nurse notes the client appears drowsy and has a respiratory rate of 8
breaths per minute. What is the priority action?
A) Increase the oxygen flow rate
B) Decrease the oxygen flow rate
C) Document the findings and continue monitoring
D) Prepare for endotracheal intubation
Answer: B
Rationale: The client is exhibiting signs of oxygen-induced hypercapnic respiratory failure, also
known as CO2 narcosis. Clients with COPD often rely on hypoxic drive to maintain respirations.
2|Page
,3
Administering high concentrations of oxygen eliminates this stimulus, causing decreased
respiratory effort and CO2 retention. The priority action is to decrease the oxygen flow rate to
the lowest level that maintains adequate oxygenation (typically 1-2 L/min). Increasing oxygen
would worsen the condition. While preparing for intubation may eventually be needed, the
immediate nursing action is to reduce oxygen delivery .
6. A client with pneumonia develops impaired gas exchange. What pathophysiological
mechanism most directly contributes to hypoxemia?
A) Hypoventilation
B) Ventilation-perfusion mismatch
C) Diffusion limitation
D) Right-to-left shunt
Answer: B
Rationale: Inflammation and fluid within the alveoli interfere with normal ventilation while
blood continues to flow through affected lung regions, causing V/Q mismatch. This is the
primary mechanism of hypoxemia in pneumonia .
7. A client with a chest tube has continuous bubbling in the water-seal chamber. What does
this indicate?
A) Normal finding
B) Air leak in the system
C) Lung re-expansion
D) Suction is too high
Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak. Intermittent
bubbling is normal with coughing. The nurse should check all connections and the insertion site
for leaks .
8. A client with a pulmonary embolism is prescribed heparin. Which laboratory value should
the nurse monitor?
A) INR
B) aPTT
C) Platelet count
D) Hemoglobin
Answer: B
Rationale: aPTT monitors heparin therapy. Therapeutic range is 1.5-2.5 times the control value.
INR monitors warfarin therapy .
3|Page
, 4
Section 3: Renal & Urinary Disorders
9. A client with chronic kidney disease (CKD) has a serum creatinine of 3.2 mg/dL. Which
medication adjustment is most appropriate for a drug that is primarily renally eliminated?
A) Increase the dose to achieve therapeutic levels despite reduced clearance
B) Maintain the standard dose but monitor renal function weekly
C) Reduce the dose or extend the dosing interval based on creatinine clearance
D) Discontinue the drug entirely because of contraindication in renal impairment
Answer: C
Rationale: In CKD stage 4, creatinine clearance is severely reduced (15-29 mL/min). For renally
eliminated drugs, dose reduction or interval extension prevents accumulation and toxicity.
Option A could cause toxicity. Option B is insufficient. Option D is overly aggressive unless the
drug is specifically contraindicated .
10. A client develops acute kidney injury after severe dehydration. What is the primary
pathophysiological cause?
A) Tubular obstruction
B) Decreased renal perfusion
C) Immune complex deposition
D) Direct toxin injury
Answer: B
Rationale: Significant volume loss reduces blood flow to the kidneys and can decrease
glomerular filtration. This is pre-renal acute kidney injury, which is reversible if caught early .
11. A client with chronic kidney disease develops metabolic acidosis. What is the primary
reason?
A) Increased hydrogen ion excretion
B) Reduced ability of the kidneys to excrete hydrogen ions and regenerate bicarbonate
C) Increased bicarbonate production
D) Hyperventilation
Answer: B
Rationale: Renal dysfunction impairs normal acid-base regulation and can result in acid
accumulation due to decreased hydrogen ion excretion and bicarbonate regeneration .
12. A client with a urinary tract infection presents with dysuria, frequency, and urgency.
Which finding would indicate upper urinary tract involvement?
4|Page
