Adult Medical-Surgical Nursing
150-Item Practice Examination
Multiple Choice with Answers & Rationales
,1. A client with heart failure is prescribed furosemide. Which laboratory
value should the nurse monitor most closely?
A. Serum potassium
B. Serum calcium
C. White blood cell count
D. Platelet count
Answer: A
Rationale: Furosemide is a loop diuretic that promotes potassium wasting,
increasing the risk of hypokalemia, which can cause dangerous dysrhythmias.
Calcium, WBC, and platelet counts are not directly affected by loop diuretics.
2. The nurse auscultates an S3 heart sound in a client with heart failure.
What does this finding indicate?
A. Normal finding in all adults
B. Fluid volume overload/ventricular filling problem
C. Mitral valve stenosis only
D. Pericardial friction rub
Answer: B
Rationale: An S3 (ventricular gallop) occurs from rapid ventricular filling and
is a classic sign of fluid overload/heart failure in adults. It is normal in children
and young adults but abnormal in older adults. It is not a friction rub or
specific to mitral stenosis.
3. A client is admitted with an acute MI and reports crushing chest pain.
Which nursing action takes priority?
A. Obtain a 12-lead ECG
B. Administer oral analgesics
C. Notify the family
D. Ambulate the client to reduce anxiety
Answer: A
,Rationale: A 12-lead ECG rapidly identifies ST-elevation changes and guides
emergent treatment (MONA, reperfusion). Oral analgesics are not first-line,
notifying family is not urgent, and ambulation increases myocardial oxygen
demand and is contraindicated.
4. Which finding indicates digoxin toxicity in a client taking digoxin for heart
failure?
A. Increased appetite
B. Visual disturbances (halos, yellow-green vision)
C. Hypertension
D. Tachycardia
Answer: B
Rationale: Classic signs of digoxin toxicity include visual disturbances such as
halos and yellow-green vision, along with anorexia, nausea, and
dysrhythmias (often bradycardia, not tachycardia). Hypertension is not a
typical toxicity sign.
5. A client post-cardiac catheterization via the femoral approach must
maintain which position?
A. High Fowler's with leg flexed
B. Supine with affected leg straight for several hours
C. Left lateral with knees bent
D. Ambulate immediately
Answer: B
Rationale: The client must lie flat with the affected leg straight and
immobilized to prevent bleeding or hematoma at the femoral puncture site.
Flexing the hip or ambulating early risks arterial bleeding.
6. Which teaching point is most important for a client newly prescribed
warfarin?
A. Increase intake of green leafy vegetables
, B. Report unusual bruising or bleeding and maintain consistent vitamin K
intake
C. Take with antacids for stomach upset
D. Stop the medication if a dose is missed
Answer: B
Rationale: Warfarin efficacy is affected by vitamin K intake, so consistency
(not elimination) is key; clients must also report bleeding/bruising to the
provider. Antacids can alter absorption, and doses should never be doubled or
stopped without guidance.
7. A client with atrial fibrillation is at greatest risk for which complication?
A. Pulmonary embolism
B. Embolic stroke
C. Pneumothorax
D. Deep vein thrombosis of the arm
Answer: B
Rationale: In atrial fibrillation, blood pools in the atria due to ineffective
contraction, forming thrombi that can embolize to the brain, causing an
embolic stroke. This is why anticoagulation is central to management.
8. The nurse notes pulsus paradoxus in a client with pericardial effusion.
This finding suggests:
A. Normal respiratory variation
B. Cardiac tamponade
C. Hypertensive crisis
D. Aortic aneurysm
Answer: B
Rationale: Pulsus paradoxus (an exaggerated drop in systolic BP >10 mmHg
during inspiration) is a hallmark sign of cardiac tamponade, where fluid
accumulation compresses the heart and impairs filling.
9. A client with peripheral arterial disease should be taught to:
150-Item Practice Examination
Multiple Choice with Answers & Rationales
,1. A client with heart failure is prescribed furosemide. Which laboratory
value should the nurse monitor most closely?
A. Serum potassium
B. Serum calcium
C. White blood cell count
D. Platelet count
Answer: A
Rationale: Furosemide is a loop diuretic that promotes potassium wasting,
increasing the risk of hypokalemia, which can cause dangerous dysrhythmias.
Calcium, WBC, and platelet counts are not directly affected by loop diuretics.
2. The nurse auscultates an S3 heart sound in a client with heart failure.
What does this finding indicate?
A. Normal finding in all adults
B. Fluid volume overload/ventricular filling problem
C. Mitral valve stenosis only
D. Pericardial friction rub
Answer: B
Rationale: An S3 (ventricular gallop) occurs from rapid ventricular filling and
is a classic sign of fluid overload/heart failure in adults. It is normal in children
and young adults but abnormal in older adults. It is not a friction rub or
specific to mitral stenosis.
3. A client is admitted with an acute MI and reports crushing chest pain.
Which nursing action takes priority?
A. Obtain a 12-lead ECG
B. Administer oral analgesics
C. Notify the family
D. Ambulate the client to reduce anxiety
Answer: A
,Rationale: A 12-lead ECG rapidly identifies ST-elevation changes and guides
emergent treatment (MONA, reperfusion). Oral analgesics are not first-line,
notifying family is not urgent, and ambulation increases myocardial oxygen
demand and is contraindicated.
4. Which finding indicates digoxin toxicity in a client taking digoxin for heart
failure?
A. Increased appetite
B. Visual disturbances (halos, yellow-green vision)
C. Hypertension
D. Tachycardia
Answer: B
Rationale: Classic signs of digoxin toxicity include visual disturbances such as
halos and yellow-green vision, along with anorexia, nausea, and
dysrhythmias (often bradycardia, not tachycardia). Hypertension is not a
typical toxicity sign.
5. A client post-cardiac catheterization via the femoral approach must
maintain which position?
A. High Fowler's with leg flexed
B. Supine with affected leg straight for several hours
C. Left lateral with knees bent
D. Ambulate immediately
Answer: B
Rationale: The client must lie flat with the affected leg straight and
immobilized to prevent bleeding or hematoma at the femoral puncture site.
Flexing the hip or ambulating early risks arterial bleeding.
6. Which teaching point is most important for a client newly prescribed
warfarin?
A. Increase intake of green leafy vegetables
, B. Report unusual bruising or bleeding and maintain consistent vitamin K
intake
C. Take with antacids for stomach upset
D. Stop the medication if a dose is missed
Answer: B
Rationale: Warfarin efficacy is affected by vitamin K intake, so consistency
(not elimination) is key; clients must also report bleeding/bruising to the
provider. Antacids can alter absorption, and doses should never be doubled or
stopped without guidance.
7. A client with atrial fibrillation is at greatest risk for which complication?
A. Pulmonary embolism
B. Embolic stroke
C. Pneumothorax
D. Deep vein thrombosis of the arm
Answer: B
Rationale: In atrial fibrillation, blood pools in the atria due to ineffective
contraction, forming thrombi that can embolize to the brain, causing an
embolic stroke. This is why anticoagulation is central to management.
8. The nurse notes pulsus paradoxus in a client with pericardial effusion.
This finding suggests:
A. Normal respiratory variation
B. Cardiac tamponade
C. Hypertensive crisis
D. Aortic aneurysm
Answer: B
Rationale: Pulsus paradoxus (an exaggerated drop in systolic BP >10 mmHg
during inspiration) is a hallmark sign of cardiac tamponade, where fluid
accumulation compresses the heart and impairs filling.
9. A client with peripheral arterial disease should be taught to:
