(2025/2026 Updated) Davis Advantage for Medical-
Surgical Nursing: Making Connections to Practice 3rd
Edition | Hoffman & Sullivan | Complete Test Bank &
Exam Prep (Graded A+)
Section I: Professional Foundations & Clinical Principles
1. A nurse is caring for a patient with a new colostomy. Which statement indicates a need for
further teaching?
A. "I should empty the pouch when it is one-third full."
B. "I can use a pouch with a filter to reduce odor."
C. "I should change the pouch every day regardless of leakage."
D. "I need to cleanse the skin around the stoma gently with warm water."
Correct Answer: C
Rationale: Ostomy pouches typically require changing every 3 to 7 days, not daily, unless
leakage or skin irritation occurs. Daily changes can damage the peristomal skin. Emptying at
one-third full, using filtered pouches, and gentle skin cleansing with warm water are all
appropriate practices .
2. A nurse is assessing a patient for fluid volume deficit. Which finding is most consistent with
this condition?
A. Orthostatic hypotension and tachycardia
B. Crackles in lung bases
C. Jugular vein distension
D. Bounding pulse
Correct Answer: A
Rationale: Orthostatic hypotension and tachycardia are classic signs of hypovolemia (fluid
volume deficit). Crackles, jugular vein distension, and bounding pulse indicate fluid volume
excess, not deficit .
3. A patient has a serum sodium level of 118 mEq/L. Which assessment finding is most
concerning?
,A. Muscle cramps
B. Nausea and vomiting
C. Altered mental status (confusion, seizures)
D. Dry mucous membranes
Correct Answer: C
Rationale: Severe hyponatremia (Na+ <120 mEq/L) can cause cerebral edema leading to
altered mental status, seizures, and coma. Neurological changes are the most concerning
manifestation because they indicate brain involvement .
4. The nurse is teaching a patient about foods high in potassium. Which food should the
patient include?
A. Apples
B. Bananas, oranges, potatoes
C. White bread
D. Green beans
Correct Answer: B
Rationale: Bananas, oranges, potatoes (with skin), tomatoes, avocado, spinach, and beans
are high in potassium. Apples and white bread are low in potassium .
5. A patient with chronic diarrhea develops metabolic acidosis. Which finding supports this
diagnosis?
A. pH 7.50, HCO3 32
B. pH 7.32, HCO3 16
C. pH 7.48, PaCO2 32
D. pH 7.38, PaCO2 48
Correct Answer: B
Rationale: Metabolic acidosis (bicarbonate loss from diarrhea) presents with low pH (<7.35)
and low HCO3 (<22). Respiratory rate increases as compensation .
6. A patient has a serum albumin level of 2.0 g/dL. The nurse understands this may lead to:
, A. Increased risk of drug toxicity
B. Increased serum calcium level
C. Increased clotting time
D. Decreased risk of edema
Correct Answer: A
Rationale: Low albumin decreases protein-binding sites, increasing free (active)
concentrations of highly protein-bound drugs such as phenytoin and warfarin, increasing risk of
toxicity .
7. Which competency best demonstrates effective medical-surgical nursing practice?
A. Completing assigned tasks according to the unit routine
B. Integrating assessment findings, clinical judgment, evidence, and patient preferences into
nursing care
C. Following provider prescriptions without questioning unexpected findings
D. Prioritizing completion of documentation over changes in patient condition
Correct Answer: B
Rationale: Medical-surgical nursing requires integrating clinical knowledge, assessment
findings, evidence-based practice, patient preferences, safety principles, and clinical judgment.
Nurses must also recognize and communicate concerns about potentially unsafe prescriptions .
8. A nurse is caring for four patients. Which action best demonstrates clinical judgment?
A. Administering medications at the scheduled time without reassessing
B. Using the same assessment sequence for every patient
C. Comparing current findings with baseline data and determining which change requires
immediate intervention
D. Asking another nurse to make decisions whenever the patient's condition changes
Correct Answer: C
Rationale: Clinical judgment involves recognizing meaningful cues, analyzing their
significance, determining priorities, taking appropriate action, and evaluating outcomes.
Comparing current findings with baseline data helps identify clinically significant deterioration .
, 9. A patient newly diagnosed with heart failure tells the nurse, "I don't want to follow the diet
the provider recommended." Which response best demonstrates patient-centered care?
A. "You need to follow the prescribed diet if you want to avoid complications."
B. "The diet is standard for patients with your diagnosis, so you should follow it."
C. "Tell me what concerns you have about the recommended diet so we can discuss options
that fit your preferences."
D. "Your family should help you make sure that you follow the diet after discharge."
Correct Answer: C
Rationale: Patient-centered care respects the patient's values, preferences, concerns, and
ability to participate in decisions. Exploring the patient's concerns allows collaboration on
realistic strategies rather than issuing directives .
10. A patient with heart failure reports waking up at night gasping for air. The nurse
documents this finding as:
A. Dyspnea on exertion
B. Orthopnea
C. Paroxysmal nocturnal dyspnea
D. Kussmaul breathing
Correct Answer: C
Rationale: Paroxysmal nocturnal dyspnea occurs when fluid shifts from the legs to the lungs
while lying flat, causing sudden awakening with shortness of breath. This is a classic finding in
heart failure .
11. Which assessment finding in a patient with pneumonia requires the nurse to intervene
immediately?
A. Temperature of 38.3°C (101°F)
B. Oxygen saturation of 86% on room air
C. Respiratory rate of 24 breaths per minute
D. Productive cough with green sputum
Correct Answer: B
Rationale: An oxygen saturation below 88% indicates severe hypoxemia requiring
Surgical Nursing: Making Connections to Practice 3rd
Edition | Hoffman & Sullivan | Complete Test Bank &
Exam Prep (Graded A+)
Section I: Professional Foundations & Clinical Principles
1. A nurse is caring for a patient with a new colostomy. Which statement indicates a need for
further teaching?
A. "I should empty the pouch when it is one-third full."
B. "I can use a pouch with a filter to reduce odor."
C. "I should change the pouch every day regardless of leakage."
D. "I need to cleanse the skin around the stoma gently with warm water."
Correct Answer: C
Rationale: Ostomy pouches typically require changing every 3 to 7 days, not daily, unless
leakage or skin irritation occurs. Daily changes can damage the peristomal skin. Emptying at
one-third full, using filtered pouches, and gentle skin cleansing with warm water are all
appropriate practices .
2. A nurse is assessing a patient for fluid volume deficit. Which finding is most consistent with
this condition?
A. Orthostatic hypotension and tachycardia
B. Crackles in lung bases
C. Jugular vein distension
D. Bounding pulse
Correct Answer: A
Rationale: Orthostatic hypotension and tachycardia are classic signs of hypovolemia (fluid
volume deficit). Crackles, jugular vein distension, and bounding pulse indicate fluid volume
excess, not deficit .
3. A patient has a serum sodium level of 118 mEq/L. Which assessment finding is most
concerning?
,A. Muscle cramps
B. Nausea and vomiting
C. Altered mental status (confusion, seizures)
D. Dry mucous membranes
Correct Answer: C
Rationale: Severe hyponatremia (Na+ <120 mEq/L) can cause cerebral edema leading to
altered mental status, seizures, and coma. Neurological changes are the most concerning
manifestation because they indicate brain involvement .
4. The nurse is teaching a patient about foods high in potassium. Which food should the
patient include?
A. Apples
B. Bananas, oranges, potatoes
C. White bread
D. Green beans
Correct Answer: B
Rationale: Bananas, oranges, potatoes (with skin), tomatoes, avocado, spinach, and beans
are high in potassium. Apples and white bread are low in potassium .
5. A patient with chronic diarrhea develops metabolic acidosis. Which finding supports this
diagnosis?
A. pH 7.50, HCO3 32
B. pH 7.32, HCO3 16
C. pH 7.48, PaCO2 32
D. pH 7.38, PaCO2 48
Correct Answer: B
Rationale: Metabolic acidosis (bicarbonate loss from diarrhea) presents with low pH (<7.35)
and low HCO3 (<22). Respiratory rate increases as compensation .
6. A patient has a serum albumin level of 2.0 g/dL. The nurse understands this may lead to:
, A. Increased risk of drug toxicity
B. Increased serum calcium level
C. Increased clotting time
D. Decreased risk of edema
Correct Answer: A
Rationale: Low albumin decreases protein-binding sites, increasing free (active)
concentrations of highly protein-bound drugs such as phenytoin and warfarin, increasing risk of
toxicity .
7. Which competency best demonstrates effective medical-surgical nursing practice?
A. Completing assigned tasks according to the unit routine
B. Integrating assessment findings, clinical judgment, evidence, and patient preferences into
nursing care
C. Following provider prescriptions without questioning unexpected findings
D. Prioritizing completion of documentation over changes in patient condition
Correct Answer: B
Rationale: Medical-surgical nursing requires integrating clinical knowledge, assessment
findings, evidence-based practice, patient preferences, safety principles, and clinical judgment.
Nurses must also recognize and communicate concerns about potentially unsafe prescriptions .
8. A nurse is caring for four patients. Which action best demonstrates clinical judgment?
A. Administering medications at the scheduled time without reassessing
B. Using the same assessment sequence for every patient
C. Comparing current findings with baseline data and determining which change requires
immediate intervention
D. Asking another nurse to make decisions whenever the patient's condition changes
Correct Answer: C
Rationale: Clinical judgment involves recognizing meaningful cues, analyzing their
significance, determining priorities, taking appropriate action, and evaluating outcomes.
Comparing current findings with baseline data helps identify clinically significant deterioration .
, 9. A patient newly diagnosed with heart failure tells the nurse, "I don't want to follow the diet
the provider recommended." Which response best demonstrates patient-centered care?
A. "You need to follow the prescribed diet if you want to avoid complications."
B. "The diet is standard for patients with your diagnosis, so you should follow it."
C. "Tell me what concerns you have about the recommended diet so we can discuss options
that fit your preferences."
D. "Your family should help you make sure that you follow the diet after discharge."
Correct Answer: C
Rationale: Patient-centered care respects the patient's values, preferences, concerns, and
ability to participate in decisions. Exploring the patient's concerns allows collaboration on
realistic strategies rather than issuing directives .
10. A patient with heart failure reports waking up at night gasping for air. The nurse
documents this finding as:
A. Dyspnea on exertion
B. Orthopnea
C. Paroxysmal nocturnal dyspnea
D. Kussmaul breathing
Correct Answer: C
Rationale: Paroxysmal nocturnal dyspnea occurs when fluid shifts from the legs to the lungs
while lying flat, causing sudden awakening with shortness of breath. This is a classic finding in
heart failure .
11. Which assessment finding in a patient with pneumonia requires the nurse to intervene
immediately?
A. Temperature of 38.3°C (101°F)
B. Oxygen saturation of 86% on room air
C. Respiratory rate of 24 breaths per minute
D. Productive cough with green sputum
Correct Answer: B
Rationale: An oxygen saturation below 88% indicates severe hypoxemia requiring
