COMPREHENSIVE MEDICAL-SURGICAL
NURSING TEST BANK ALL CORE
CLINICAL SYSTEMS COVERED
Master your nursing exams with this comprehensive, high-yield
Medical-Surgical study bank featuring precise answers and
detailed rationales. Every question is meticulously structured to
mirror the exact rigor of standard nursing school curricula and
advanced licensure exams. Perfect for last-minute cramming or
systematic review, this document breaks down complex
pathophysiological mechanisms and prioritizes essential clinical
safety protocols.
Fluid, Electrolytes, and Acid-Base Balance
1. A patient is admitted with a serum sodium
level of 118 mEq/L. Which nursing intervention is
the highest priority?
A. Initiating a continuous infusion of 0.45% normal
saline
B. Implementing strict seizure precautions and
monitoring neurological status
C. Encouraging increased oral water intake
D. Administering scheduled subcutaneous insulin
Correct Answer: B
Rationale: Severe hyponatremia (sodium < 120
mEq/L) places the patient at extreme risk for
cerebral edema, seizures, coma, and death.
Implementing seizure precautions and frequent
,neurological assessments is the highest priority
to ensure patient safety. Infusing hypotonic
fluids like 0.45% NS or increasing oral water
intake would worsen the hyponatremia.
2. A clinician reviews the arterial blood gas
(ABG) results for a patient with acute respiratory
distress: pH 7.28, PaCO2 52 mmHg, HCO3 24
mEq/L. How should the nurse interpret these
findings?
A. Uncompensated metabolic acidosis
B. Compensated respiratory alkalosis
C. Uncompensated respiratory acidosis
D. Fully compensated metabolic alkalosis
Correct Answer: C
Rationale: A pH below 7.35 indicates acidosis.
The PaCO2 is elevated above the normal range
(35–45 mmHg), which accounts for the acidotic
pH, pointing to a respiratory origin. Because the
HCO3 is within the normal range (22–26 mEq/L),
the kidneys have not yet compensated for the
respiratory imbalance, making it
uncompensated.
3. A patient with a history of chronic kidney
disease presents with a serum potassium level
of 6.8 mEq/L. Which provider order should the
,nurse execute first?
A. Administer oral sodium polystyrene sulfonate
(Kayexalate)
B. Obtain a 12-lead electrocardiogram (ECG)
C. Administer intravenous calcium gluconate
D. Initiate a regular insulin and dextrose infusion
Correct Answer: C
Rationale: Hyperkalemia at this severe level
poses an immediate threat of lethal cardiac
dysrhythmias. Intravenous calcium gluconate
does not lower potassium levels, but it
immediately stabilizes the myocardial cell
membrane to prevent dangerous arrhythmias.
This must be given first, followed by therapies
that shift or eliminate potassium
(insulin/dextrose, Kayexalate).
4. A patient is recovering from prolonged
nasogastric (NG) suctioning and frequent
vomiting. Which acid-base imbalance is this
patient at greatest risk for developing?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: B
, Rationale: Nasogastric suction and vomiting
cause a massive loss of gastric secretions,
which are highly acidic (hydrochloric acid). The
loss of hydrogen and chloride ions leaves an
excess of base in the systemic circulation,
resulting in metabolic alkalosis.
5. Which clinical manifestation should the nurse
expect to observe in a patient with a serum
calcium level of 7.2 mg/dL?
A. Negative Chvostek's sign and constipation
B. Hyperreflexia, tetany, and a positive Trousseau's
sign
C. Muscle flaccidity and polyuria
D. Depressed deep tendon reflexes and bradycardia
Correct Answer: B
Rationale: Hypocalcemia (calcium < 8.5 mg/dL)
increases neuromuscular excitability. Classic
signs include hyperreflexia, tetany, muscle
cramping, Chvostek's sign (facial twitching when
the facial nerve is tapped), and Trousseau's sign
(carpal spasm induced by inflating a blood
pressure cuff above systolic pressure).
Respiratory System Disorders
NURSING TEST BANK ALL CORE
CLINICAL SYSTEMS COVERED
Master your nursing exams with this comprehensive, high-yield
Medical-Surgical study bank featuring precise answers and
detailed rationales. Every question is meticulously structured to
mirror the exact rigor of standard nursing school curricula and
advanced licensure exams. Perfect for last-minute cramming or
systematic review, this document breaks down complex
pathophysiological mechanisms and prioritizes essential clinical
safety protocols.
Fluid, Electrolytes, and Acid-Base Balance
1. A patient is admitted with a serum sodium
level of 118 mEq/L. Which nursing intervention is
the highest priority?
A. Initiating a continuous infusion of 0.45% normal
saline
B. Implementing strict seizure precautions and
monitoring neurological status
C. Encouraging increased oral water intake
D. Administering scheduled subcutaneous insulin
Correct Answer: B
Rationale: Severe hyponatremia (sodium < 120
mEq/L) places the patient at extreme risk for
cerebral edema, seizures, coma, and death.
Implementing seizure precautions and frequent
,neurological assessments is the highest priority
to ensure patient safety. Infusing hypotonic
fluids like 0.45% NS or increasing oral water
intake would worsen the hyponatremia.
2. A clinician reviews the arterial blood gas
(ABG) results for a patient with acute respiratory
distress: pH 7.28, PaCO2 52 mmHg, HCO3 24
mEq/L. How should the nurse interpret these
findings?
A. Uncompensated metabolic acidosis
B. Compensated respiratory alkalosis
C. Uncompensated respiratory acidosis
D. Fully compensated metabolic alkalosis
Correct Answer: C
Rationale: A pH below 7.35 indicates acidosis.
The PaCO2 is elevated above the normal range
(35–45 mmHg), which accounts for the acidotic
pH, pointing to a respiratory origin. Because the
HCO3 is within the normal range (22–26 mEq/L),
the kidneys have not yet compensated for the
respiratory imbalance, making it
uncompensated.
3. A patient with a history of chronic kidney
disease presents with a serum potassium level
of 6.8 mEq/L. Which provider order should the
,nurse execute first?
A. Administer oral sodium polystyrene sulfonate
(Kayexalate)
B. Obtain a 12-lead electrocardiogram (ECG)
C. Administer intravenous calcium gluconate
D. Initiate a regular insulin and dextrose infusion
Correct Answer: C
Rationale: Hyperkalemia at this severe level
poses an immediate threat of lethal cardiac
dysrhythmias. Intravenous calcium gluconate
does not lower potassium levels, but it
immediately stabilizes the myocardial cell
membrane to prevent dangerous arrhythmias.
This must be given first, followed by therapies
that shift or eliminate potassium
(insulin/dextrose, Kayexalate).
4. A patient is recovering from prolonged
nasogastric (NG) suctioning and frequent
vomiting. Which acid-base imbalance is this
patient at greatest risk for developing?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: B
, Rationale: Nasogastric suction and vomiting
cause a massive loss of gastric secretions,
which are highly acidic (hydrochloric acid). The
loss of hydrogen and chloride ions leaves an
excess of base in the systemic circulation,
resulting in metabolic alkalosis.
5. Which clinical manifestation should the nurse
expect to observe in a patient with a serum
calcium level of 7.2 mg/dL?
A. Negative Chvostek's sign and constipation
B. Hyperreflexia, tetany, and a positive Trousseau's
sign
C. Muscle flaccidity and polyuria
D. Depressed deep tendon reflexes and bradycardia
Correct Answer: B
Rationale: Hypocalcemia (calcium < 8.5 mg/dL)
increases neuromuscular excitability. Classic
signs include hyperreflexia, tetany, muscle
cramping, Chvostek's sign (facial twitching when
the facial nerve is tapped), and Trousseau's sign
(carpal spasm induced by inflating a blood
pressure cuff above systolic pressure).
Respiratory System Disorders
