RN ADULT MEDICAL SURGICAL
COMPREHENSIVE PRACTICE EXAM
QUESTIONS
1. A nurse is caring for a client who is receiving total
parenteral nutrition (TPN) via a central venous catheter.
The current TPN bag is nearly completed, and the next
bag is unavailable from the pharmacy. Which of the
following actions should the nurse take?
A. Discontinue the infusion and flush the line with heparinized
saline.
B. Infuse 0.9% sodium chloride at the same rate until the new bag
arrives.
C. Administer 10% dextrose in water (D10W) at the same infusion
rate.
D. Decrease the current TPN infusion rate to keep the vein open.
CORRECT ANSWER: C
RATiONAlE: TPN contains high concentrations of dextrose. If
the infusion is abruptly discontinued or interrupted, the client is
at severe risk for rebound hypoglycemia due to continued high
insulin production by the pancreas. Administering D10W at the
same rate maintains blood glucose levels until the next TPN bag
is available.
2. A nurse is assessing a client who is 12 hr postoperative
following a nephrostomy tube placement. Which of the
following findings should the nurse report to the
provider immediately?
,A. Pink-tinged urine output in the drainage bag.
B. Total urine output of 20 mL over the last 2 hours.
C. Report of localized pain at the insertion site rated 4 out of 10.
D. High-pitched bowel sounds heard upon auscultation.
CORRECT ANSWER: B
RATiONAlE: Urine output of less than 30 mL/hr (or 60 mL
over 2 hours) from a nephrostomy tube indicates potential tube
obstruction, displacement, or acute kidney injury, requiring
immediate provider intervention. Pink-tinged urine and
moderate pain are expected early postoperatively.
3. A nurse is caring for a client who was admitted with
acute decompensated heart failure (ADHF) and is
experiencing severe dyspnea, orthopnea, and pink,
frothy sputum. Which of the following actions should the
nurse take first?
A. Administer sublingual nitroglycerin as prescribed.
B. Place the client in an upright position with feet dangling at the
bedside.
C. Administer IV furosemide as prescribed.
D. Draw a stat arterial blood gas (ABG) sample.
CORRECT ANSWER: B
RATiONAlE: Under the priority framework of airway and
breathing, placing the client in a high-Fowler's position with
dependent legs immediately decreases venous return (preload)
to the right side of the heart and improves lung expansion,
making it the fastest action to alleviate acute pulmonary edema.
,4. A nurse is evaluating a client with chronic obstructive
pulmonary disease (COPD) and chronic hypercapnia
who is receiving oxygen therapy. Which of the following
findings indicates that the client is experiencing oxygen-
induced hypoventilation?
A. An oxygen saturation of 92% on a 2 L/min nasal cannula.
B. An increased respiratory rate of 28/min with clear breath
sounds.
C. Progressive lethargy, somnolence, and a respiratory rate of
8/min.
D. An elevated blood pressure of 150/90 mm Hg.
CORRECT ANSWER: C
RATiONAlE: Clients with chronic hypercapnia lose their
hypercapnic respiratory drive and rely on a hypoxic drive (low
oxygen levels) to breathe. Excessive oxygen delivery eliminates
this hypoxic drive, causing hypoventilation, carbon dioxide
narcosis, severe bradypnea, and lethargy.
5. A nurse is caring for a client admitted with diabetic
ketoacidosis (DKA). The client's blood glucose is 420
mg/dL, and arterial blood gas shows pH 7.21, PaCO2 30
mm Hg, and HCO3 14 mEq/L. Which of the following IV
fluids should the nurse expect to initiate first?
A. 0.9% sodium chloride infusion.
B. 0.45% sodium chloride with 5% dextrose.
C. Regular insulin continuous IV infusion without fluid
resuscitation.
D. 5% dextrose in water (D5W).
, CORRECT ANSWER: A
RATiONAlE: Severe dehydration occurs in DKA due to
osmotic diuresis. The immediate priority is to restore
intravascular volume and tissue perfusion using an isotonic
solution like 0.9% sodium chloride. Dextrose is only added later
once blood glucose drops near 250 mg/dL to prevent rapid fluid
shifts and hypoglycemia.
6. A nurse in the emergency department is assessing a
client who experienced an acute ischemic stroke 90
minutes ago. Which of the following findings is a
contraindication for the administration of recombinant
tissue plasminogen activator (rt-PA)?
A. Client age of 68 years old.
B. Blood glucose level of 180 mg/dL.
C. Current blood pressure of 190/115 mm Hg.
D. Informant states symptom onset was exactly 90 minutes ago.
CORRECT ANSWER: C
RATiONAlE: A blood pressure greater than 185/110 mm Hg is
a major exclusion criterion for thrombolytic therapy because it
drastically elevates the risk of hemorrhagic conversion of the
stroke. Blood pressure must be lowered below this threshold
before rt-PA can be safely administered.
7. A nurse is reviewing the laboratory reports of a client
who has end-stage kidney disease (ESKD). Which of the
following laboratory findings should the nurse expect?
COMPREHENSIVE PRACTICE EXAM
QUESTIONS
1. A nurse is caring for a client who is receiving total
parenteral nutrition (TPN) via a central venous catheter.
The current TPN bag is nearly completed, and the next
bag is unavailable from the pharmacy. Which of the
following actions should the nurse take?
A. Discontinue the infusion and flush the line with heparinized
saline.
B. Infuse 0.9% sodium chloride at the same rate until the new bag
arrives.
C. Administer 10% dextrose in water (D10W) at the same infusion
rate.
D. Decrease the current TPN infusion rate to keep the vein open.
CORRECT ANSWER: C
RATiONAlE: TPN contains high concentrations of dextrose. If
the infusion is abruptly discontinued or interrupted, the client is
at severe risk for rebound hypoglycemia due to continued high
insulin production by the pancreas. Administering D10W at the
same rate maintains blood glucose levels until the next TPN bag
is available.
2. A nurse is assessing a client who is 12 hr postoperative
following a nephrostomy tube placement. Which of the
following findings should the nurse report to the
provider immediately?
,A. Pink-tinged urine output in the drainage bag.
B. Total urine output of 20 mL over the last 2 hours.
C. Report of localized pain at the insertion site rated 4 out of 10.
D. High-pitched bowel sounds heard upon auscultation.
CORRECT ANSWER: B
RATiONAlE: Urine output of less than 30 mL/hr (or 60 mL
over 2 hours) from a nephrostomy tube indicates potential tube
obstruction, displacement, or acute kidney injury, requiring
immediate provider intervention. Pink-tinged urine and
moderate pain are expected early postoperatively.
3. A nurse is caring for a client who was admitted with
acute decompensated heart failure (ADHF) and is
experiencing severe dyspnea, orthopnea, and pink,
frothy sputum. Which of the following actions should the
nurse take first?
A. Administer sublingual nitroglycerin as prescribed.
B. Place the client in an upright position with feet dangling at the
bedside.
C. Administer IV furosemide as prescribed.
D. Draw a stat arterial blood gas (ABG) sample.
CORRECT ANSWER: B
RATiONAlE: Under the priority framework of airway and
breathing, placing the client in a high-Fowler's position with
dependent legs immediately decreases venous return (preload)
to the right side of the heart and improves lung expansion,
making it the fastest action to alleviate acute pulmonary edema.
,4. A nurse is evaluating a client with chronic obstructive
pulmonary disease (COPD) and chronic hypercapnia
who is receiving oxygen therapy. Which of the following
findings indicates that the client is experiencing oxygen-
induced hypoventilation?
A. An oxygen saturation of 92% on a 2 L/min nasal cannula.
B. An increased respiratory rate of 28/min with clear breath
sounds.
C. Progressive lethargy, somnolence, and a respiratory rate of
8/min.
D. An elevated blood pressure of 150/90 mm Hg.
CORRECT ANSWER: C
RATiONAlE: Clients with chronic hypercapnia lose their
hypercapnic respiratory drive and rely on a hypoxic drive (low
oxygen levels) to breathe. Excessive oxygen delivery eliminates
this hypoxic drive, causing hypoventilation, carbon dioxide
narcosis, severe bradypnea, and lethargy.
5. A nurse is caring for a client admitted with diabetic
ketoacidosis (DKA). The client's blood glucose is 420
mg/dL, and arterial blood gas shows pH 7.21, PaCO2 30
mm Hg, and HCO3 14 mEq/L. Which of the following IV
fluids should the nurse expect to initiate first?
A. 0.9% sodium chloride infusion.
B. 0.45% sodium chloride with 5% dextrose.
C. Regular insulin continuous IV infusion without fluid
resuscitation.
D. 5% dextrose in water (D5W).
, CORRECT ANSWER: A
RATiONAlE: Severe dehydration occurs in DKA due to
osmotic diuresis. The immediate priority is to restore
intravascular volume and tissue perfusion using an isotonic
solution like 0.9% sodium chloride. Dextrose is only added later
once blood glucose drops near 250 mg/dL to prevent rapid fluid
shifts and hypoglycemia.
6. A nurse in the emergency department is assessing a
client who experienced an acute ischemic stroke 90
minutes ago. Which of the following findings is a
contraindication for the administration of recombinant
tissue plasminogen activator (rt-PA)?
A. Client age of 68 years old.
B. Blood glucose level of 180 mg/dL.
C. Current blood pressure of 190/115 mm Hg.
D. Informant states symptom onset was exactly 90 minutes ago.
CORRECT ANSWER: C
RATiONAlE: A blood pressure greater than 185/110 mm Hg is
a major exclusion criterion for thrombolytic therapy because it
drastically elevates the risk of hemorrhagic conversion of the
stroke. Blood pressure must be lowered below this threshold
before rt-PA can be safely administered.
7. A nurse is reviewing the laboratory reports of a client
who has end-stage kidney disease (ESKD). Which of the
following laboratory findings should the nurse expect?
