Medical-Surgical Nursing Comprehensive Exam
WITH QUESTIONS AND ANSWERS
2026/2027/ VERIFIED /LATEST UPDATE
Instructions: Choose the best answer for each question. The correct answer and
rationale are provided immediately following each question .
Unit 1: Concepts in Nursing Practice (Chapters 1-17)
A nurse is caring for an older adult patient. Which of the following physiological changes of aging is
most important for the nurse to consider when administering medications?
a) Decreased gastric motility
b) Increased liver function
c) Decreased body fat
d) Increased renal clearance
Answer: a) Decreased gastric motility
Rationale: Decreased gastric motility can delay the absorption of oral medications. Increased liver
function is incorrect; liver function typically decreases. Decreased body fat is incorrect; body fat often
increases, which can affect the distribution of fat-soluble drugs. Increased renal clearance is incorrect;
renal function decreases with age, prolonging the half-life of drugs excreted by the kidneys.
A patient is admitted with fluid volume deficit. Which assessment finding would the nurse expect?
a) Bounding pulse
,b) Distended neck veins
c) Decreased urine specific gravity
d) Postural hypotension
Answer: d) Postural hypotension
Rationale: In fluid volume deficit (hypovolemia), blood volume is decreased, leading to a drop in blood
pressure when changing positions (postural hypotension). A bounding pulse and distended neck veins are
signs of fluid volume excess. Decreased urine specific gravity is also a sign of fluid volume excess; in
deficit, urine specific gravity would be increased as the kidneys try to conserve water.
The nurse is assessing a patient for signs of an allergic reaction. Which of the following is a classic sign
of a Type I hypersensitivity reaction?
a) Hemolytic transfusion reaction
b) Urticaria and pruritus
c) Contact dermatitis
d) Serum sickness
Answer: b) Urticaria and pruritus
Rationale: Type I (immediate) hypersensitivity reactions are IgE-mediated and involve the release of
histamine from mast cells, leading to manifestations like urticaria (hives), pruritus (itching), and
bronchoconstriction. Hemolytic transfusion reactions are Type II. Contact dermatitis is a Type IV
reaction. Serum sickness is a Type III reaction.
A nurse is teaching a patient about a low-sodium diet. Which of the following food choices indicates the
patient understands the teaching?
a) Canned soup
b) Fresh fruit
c) Processed deli meat
d) Frozen dinner
,Answer: b) Fresh fruit
Rationale: Fresh fruits are naturally low in sodium. Canned soups, processed deli meats, and many frozen
dinners are high in sodium and should be avoided on a low-sodium diet.
A patient is scheduled for surgery and asks the nurse why they must stop eating and drinking before the
procedure. What is the nurse's best response?
a) "It helps prevent you from feeling nauseous after surgery."
b) "It reduces the risk of you aspirating stomach contents into your lungs during anesthesia."
c) "It makes the surgery easier for the surgeon to perform."
d) "It prevents you from having a bowel movement during the procedure."
Answer: b) "It reduces the risk of you aspirating stomach contents into your lungs during anesthesia."
Rationale: The primary reason for NPO (nil per os) status before surgery is to prevent aspiration.
Anesthesia can relax the esophageal sphincter, and if the stomach is full, regurgitation and aspiration can
occur, leading to aspiration pneumonia, which can be fatal.
Which of the following is a primary responsibility of the nurse in the immediate postoperative period?
a) Teaching the patient about discharge instructions
b) Assessing the surgical site for signs of infection
c) Maintaining a patent airway
d) Ambulating the patient in the hallway
Answer: c) Maintaining a patent airway
Rationale: The immediate postoperative priority is always ABC (Airway, Breathing, Circulation).
Maintaining a patent airway is the most critical intervention, as the effects of anesthesia can cause the
tongue to fall back and obstruct the airway.
A patient is receiving a blood transfusion and develops a fever, chills, and low back pain. What is the
nurse's first action?
, a) Slow the transfusion rate.
b) Administer acetaminophen as ordered.
c) Stop the transfusion immediately.
d) Obtain a urine sample.
Answer: c) Stop the transfusion immediately.
Rationale: Fever, chills, and low back pain are classic signs of an acute hemolytic transfusion reaction.
The first and most critical action is to stop the transfusion immediately to prevent further infusion of
incompatible blood. The IV line should be kept patent with new tubing and normal saline. The physician
and blood bank must be notified.
The nurse is caring for a patient with a wound that is healing by secondary intention. What would the
nurse expect to see?
a) A clean, straight incision with approximated edges
b) A wound with a large amount of granulation tissue and a wider scar
c) A wound that is sutured closed
d) A wound that heals without any scar formation
Answer: b) A wound with a large amount of granulation tissue and a wider scar
Rationale: Secondary intention healing occurs when the wound edges are not approximated, such as in a
pressure ulcer or a severe laceration. The wound fills with granulation tissue from the bottom up, and the
resulting scar is typically larger and more noticeable.
A patient is at risk for developing a pressure ulcer. Which of the following is the most important nursing
intervention?
a) Massaging bony prominences
b) Repositioning the patient every 2 hours
c) Using a donut-shaped cushion
d) Keeping the head of the bed elevated at 45 degrees
WITH QUESTIONS AND ANSWERS
2026/2027/ VERIFIED /LATEST UPDATE
Instructions: Choose the best answer for each question. The correct answer and
rationale are provided immediately following each question .
Unit 1: Concepts in Nursing Practice (Chapters 1-17)
A nurse is caring for an older adult patient. Which of the following physiological changes of aging is
most important for the nurse to consider when administering medications?
a) Decreased gastric motility
b) Increased liver function
c) Decreased body fat
d) Increased renal clearance
Answer: a) Decreased gastric motility
Rationale: Decreased gastric motility can delay the absorption of oral medications. Increased liver
function is incorrect; liver function typically decreases. Decreased body fat is incorrect; body fat often
increases, which can affect the distribution of fat-soluble drugs. Increased renal clearance is incorrect;
renal function decreases with age, prolonging the half-life of drugs excreted by the kidneys.
A patient is admitted with fluid volume deficit. Which assessment finding would the nurse expect?
a) Bounding pulse
,b) Distended neck veins
c) Decreased urine specific gravity
d) Postural hypotension
Answer: d) Postural hypotension
Rationale: In fluid volume deficit (hypovolemia), blood volume is decreased, leading to a drop in blood
pressure when changing positions (postural hypotension). A bounding pulse and distended neck veins are
signs of fluid volume excess. Decreased urine specific gravity is also a sign of fluid volume excess; in
deficit, urine specific gravity would be increased as the kidneys try to conserve water.
The nurse is assessing a patient for signs of an allergic reaction. Which of the following is a classic sign
of a Type I hypersensitivity reaction?
a) Hemolytic transfusion reaction
b) Urticaria and pruritus
c) Contact dermatitis
d) Serum sickness
Answer: b) Urticaria and pruritus
Rationale: Type I (immediate) hypersensitivity reactions are IgE-mediated and involve the release of
histamine from mast cells, leading to manifestations like urticaria (hives), pruritus (itching), and
bronchoconstriction. Hemolytic transfusion reactions are Type II. Contact dermatitis is a Type IV
reaction. Serum sickness is a Type III reaction.
A nurse is teaching a patient about a low-sodium diet. Which of the following food choices indicates the
patient understands the teaching?
a) Canned soup
b) Fresh fruit
c) Processed deli meat
d) Frozen dinner
,Answer: b) Fresh fruit
Rationale: Fresh fruits are naturally low in sodium. Canned soups, processed deli meats, and many frozen
dinners are high in sodium and should be avoided on a low-sodium diet.
A patient is scheduled for surgery and asks the nurse why they must stop eating and drinking before the
procedure. What is the nurse's best response?
a) "It helps prevent you from feeling nauseous after surgery."
b) "It reduces the risk of you aspirating stomach contents into your lungs during anesthesia."
c) "It makes the surgery easier for the surgeon to perform."
d) "It prevents you from having a bowel movement during the procedure."
Answer: b) "It reduces the risk of you aspirating stomach contents into your lungs during anesthesia."
Rationale: The primary reason for NPO (nil per os) status before surgery is to prevent aspiration.
Anesthesia can relax the esophageal sphincter, and if the stomach is full, regurgitation and aspiration can
occur, leading to aspiration pneumonia, which can be fatal.
Which of the following is a primary responsibility of the nurse in the immediate postoperative period?
a) Teaching the patient about discharge instructions
b) Assessing the surgical site for signs of infection
c) Maintaining a patent airway
d) Ambulating the patient in the hallway
Answer: c) Maintaining a patent airway
Rationale: The immediate postoperative priority is always ABC (Airway, Breathing, Circulation).
Maintaining a patent airway is the most critical intervention, as the effects of anesthesia can cause the
tongue to fall back and obstruct the airway.
A patient is receiving a blood transfusion and develops a fever, chills, and low back pain. What is the
nurse's first action?
, a) Slow the transfusion rate.
b) Administer acetaminophen as ordered.
c) Stop the transfusion immediately.
d) Obtain a urine sample.
Answer: c) Stop the transfusion immediately.
Rationale: Fever, chills, and low back pain are classic signs of an acute hemolytic transfusion reaction.
The first and most critical action is to stop the transfusion immediately to prevent further infusion of
incompatible blood. The IV line should be kept patent with new tubing and normal saline. The physician
and blood bank must be notified.
The nurse is caring for a patient with a wound that is healing by secondary intention. What would the
nurse expect to see?
a) A clean, straight incision with approximated edges
b) A wound with a large amount of granulation tissue and a wider scar
c) A wound that is sutured closed
d) A wound that heals without any scar formation
Answer: b) A wound with a large amount of granulation tissue and a wider scar
Rationale: Secondary intention healing occurs when the wound edges are not approximated, such as in a
pressure ulcer or a severe laceration. The wound fills with granulation tissue from the bottom up, and the
resulting scar is typically larger and more noticeable.
A patient is at risk for developing a pressure ulcer. Which of the following is the most important nursing
intervention?
a) Massaging bony prominences
b) Repositioning the patient every 2 hours
c) Using a donut-shaped cushion
d) Keeping the head of the bed elevated at 45 degrees
