Med-Surg Nursing Exam Prep 2026–2027 Adult Health
ADULT HEALTH CONCEPTS
& CLINICAL APPLICATION
EXAM PREP
2026–2027
Med-Surg Nursing Exam Prep 2026–2027 Adult Health | Practice Resource • Page 1
, Med-Surg Nursing Exam Prep 2026–2027 Adult Health
Med-Surg Nursing Exam Prep 2026–2027 Adult Health
Concepts & Clinical Application
Question 1: Fluid & Electrolyte Balance
**A client with heart failure is prescribed furosemide
(Lasix) 40 mg IV push. Which assessment finding requires immediate
intervention?**
A) Serum potassium 3.1 mEq/L
B) Urine output of 60 mL/hr
C) Blood pressure 118/72 mm Hg
D) Weight loss of 1 kg since admission
Correct Answer: A) Serum potassium 3.1 mEq/L
Detailed Rationale
Furosemide is a loop diuretic that causes significant potassium excretion. A
serum potassium of 3.1 mEq/L indicates hypokalemia (normal 3.5–5.0 mEq/L).
Hypokalemia predisposes the client to life-threatening dysrhythmias,
particularly ventricular tachycardia and torsades de pointes, especially in a
client with heart failure who may already have cardiac irritability. This
requires immediate intervention including potassium replacement and cardiac
monitoring.
Why the Other Options Are Incorrect
• B) Urine output of 60 mL/hr indicates adequate renal perfusion and expected diuretic response. This is
therapeutic, not concerning.
• C) BP 118/72 mm Hg is within normal limits and actually desirable in heart failure management. No immediate
action needed.
• D) Weight loss of 1 kg (2.2 lb) is consistent with fluid loss from diuresis and represents approximately 1 liter of
fluid. This is an expected therapeutic effect.
Question 2: Respiratory System
**A nurse is caring for a client with a chest tube
following a thoracotomy. Which finding indicates a need for immediate
intervention?**
A) Continuous bubbling in the water seal chamber
B) Serosanguineous drainage of 50 mL in the first hour
Med-Surg Nursing Exam Prep 2026–2027 Adult Health | Practice Resource • Page 2
, Med-Surg Nursing Exam Prep 2026–2027 Adult Health
C) Tidaling in the water seal chamber during respiration
D) Chest tube secured with tape at the insertion site
**Correct Answer: A) Continuous bubbling in the water seal
chamber**
Detailed Rationale
Continuous bubbling in the water seal chamber indicates an air leak in the
system. The water seal chamber should have intermittent (tidaling) bubbling
only during respiration if there is a pleural air leak, but continuous bubbling
suggests a system leak (loose connections, cracked tubing, or dislodgement).
This must be investigated immediately because it compromises the negative
pressure needed for lung re-expansion. The nurse should check all connections,
the insertion site, and the tubing for leaks.
Why the Other Options Are Incorrect
• B) Serosanguineous drainage of 50 mL/hr is within normal limits post-thoracotomy (typically concern if >100–
200 mL/hr). This is expected.
• C) Tidaling (fluctuation of fluid with respiration) is a normal and expected finding that indicates the chest tube
is patent and functioning properly.
• D) Securing the chest tube with tape is appropriate practice to prevent accidental dislodgement. This is a
correct nursing action, not a concern.
Question 3: Cardiovascular System
**A client is admitted with an acute myocardial infarction
(MI). The nurse notes the client has developed new-onset atrial fibrillation
with a heart rate of 148 beats per minute. Which assessment finding is most
concerning?**
A) Blood pressure 106/68 mm Hg
B) Client reports palpitations
C) New confusion and restlessness
D) Irregular radial pulse
Correct Answer: C) New confusion and restlessness
Detailed Rationale
New confusion and restlessness in a client with atrial fibrillation and rapid
ventricular rate (148 bpm) indicates decreased cerebral perfusion. The rapid
heart rate shortens diastolic filling time, reducing stroke volume and cardiac
output. This leads to inadequate perfusion to vital organs, including the
brain. New neurological changes are the most concerning finding because they
indicate hemodynamic compromise and possible cardiogenic shock. This requires
immediate intervention, possibly synchronized cardioversion.
Why the Other Options Are Incorrect
• A) BP 106/68 mm Hg is low-normal. While it should be monitored closely, it is not immediately life-threatening
in isolation.
• B) Palpitations are a common and expected symptom of atrial fibrillation. While uncomfortable, they do not
indicate immediate danger.
Med-Surg Nursing Exam Prep 2026–2027 Adult Health | Practice Resource • Page 3
, Med-Surg Nursing Exam Prep 2026–2027 Adult Health
• D) Irregular radial pulse is the expected rhythm for atrial fibrillation. This is a characteristic finding, not a
complication.
Question 4: Neurological System
**A nurse is caring for a client who had a craniotomy 24
hours ago. Which assessment finding should the nurse report to the provider
immediately?**
A) Urine output of 200 mL/hr for the past 2 hours
B) Temperature of 37.8°C (100.0°F)
C) Complaint of a mild headache
D) Glasgow Coma Scale score of 15
**Correct Answer: A) Urine output of 200 mL/hr for the past
2 hours**
Detailed Rationale
Excessive urine output (polyuria) following craniotomy may indicate diabetes
insipidus (DI), which can occur due to decreased antidiuretic hormone (ADH)
secretion after pituitary or hypothalamic manipulation. Output of 200 mL/hr for
2 consecutive hours (400 mL total) is significantly elevated and could lead to
severe dehydration, hypernatremia, and hypovolemic shock. This requires
immediate reporting and likely treatment with desmopressin (DDAVP) and fluid
replacement.
Why the Other Options Are Incorrect
• B) Temperature of 37.8°C (100.0°F) is a low-grade elevation. While monitoring for infection is important, this
alone does not require immediate provider notification.
• C) A mild headache is common post-craniotomy and can be managed with prescribed analgesics. It does not
indicate a complication unless it is severe or sudden.
• D) GCS of 15 indicates full consciousness and is the best possible score. This is a reassuring finding.
Question 5: Endocrine System
**A client with type 1 diabetes mellitus is admitted with
diabetic ketoacidosis (DKA). The nurse is reviewing laboratory results. Which
finding requires immediate intervention?**
A) Serum glucose 320 mg/dL
B) Serum potassium 2.9 mEq/L
C) Arterial pH 7.28
D) Serum bicarbonate 16 mEq/L
Correct Answer: B) Serum potassium 2.9 mEq/L
Detailed Rationale
In DKA, total body potassium is depleted due to osmotic diuresis, even though
serum potassium may initially appear normal or elevated due to acidosis and
insulin deficiency. Once treatment begins with insulin, potassium shifts back
into cells, causing serum potassium to drop rapidly. A serum potassium of 2.9
Med-Surg Nursing Exam Prep 2026–2027 Adult Health | Practice Resource • Page 4
ADULT HEALTH CONCEPTS
& CLINICAL APPLICATION
EXAM PREP
2026–2027
Med-Surg Nursing Exam Prep 2026–2027 Adult Health | Practice Resource • Page 1
, Med-Surg Nursing Exam Prep 2026–2027 Adult Health
Med-Surg Nursing Exam Prep 2026–2027 Adult Health
Concepts & Clinical Application
Question 1: Fluid & Electrolyte Balance
**A client with heart failure is prescribed furosemide
(Lasix) 40 mg IV push. Which assessment finding requires immediate
intervention?**
A) Serum potassium 3.1 mEq/L
B) Urine output of 60 mL/hr
C) Blood pressure 118/72 mm Hg
D) Weight loss of 1 kg since admission
Correct Answer: A) Serum potassium 3.1 mEq/L
Detailed Rationale
Furosemide is a loop diuretic that causes significant potassium excretion. A
serum potassium of 3.1 mEq/L indicates hypokalemia (normal 3.5–5.0 mEq/L).
Hypokalemia predisposes the client to life-threatening dysrhythmias,
particularly ventricular tachycardia and torsades de pointes, especially in a
client with heart failure who may already have cardiac irritability. This
requires immediate intervention including potassium replacement and cardiac
monitoring.
Why the Other Options Are Incorrect
• B) Urine output of 60 mL/hr indicates adequate renal perfusion and expected diuretic response. This is
therapeutic, not concerning.
• C) BP 118/72 mm Hg is within normal limits and actually desirable in heart failure management. No immediate
action needed.
• D) Weight loss of 1 kg (2.2 lb) is consistent with fluid loss from diuresis and represents approximately 1 liter of
fluid. This is an expected therapeutic effect.
Question 2: Respiratory System
**A nurse is caring for a client with a chest tube
following a thoracotomy. Which finding indicates a need for immediate
intervention?**
A) Continuous bubbling in the water seal chamber
B) Serosanguineous drainage of 50 mL in the first hour
Med-Surg Nursing Exam Prep 2026–2027 Adult Health | Practice Resource • Page 2
, Med-Surg Nursing Exam Prep 2026–2027 Adult Health
C) Tidaling in the water seal chamber during respiration
D) Chest tube secured with tape at the insertion site
**Correct Answer: A) Continuous bubbling in the water seal
chamber**
Detailed Rationale
Continuous bubbling in the water seal chamber indicates an air leak in the
system. The water seal chamber should have intermittent (tidaling) bubbling
only during respiration if there is a pleural air leak, but continuous bubbling
suggests a system leak (loose connections, cracked tubing, or dislodgement).
This must be investigated immediately because it compromises the negative
pressure needed for lung re-expansion. The nurse should check all connections,
the insertion site, and the tubing for leaks.
Why the Other Options Are Incorrect
• B) Serosanguineous drainage of 50 mL/hr is within normal limits post-thoracotomy (typically concern if >100–
200 mL/hr). This is expected.
• C) Tidaling (fluctuation of fluid with respiration) is a normal and expected finding that indicates the chest tube
is patent and functioning properly.
• D) Securing the chest tube with tape is appropriate practice to prevent accidental dislodgement. This is a
correct nursing action, not a concern.
Question 3: Cardiovascular System
**A client is admitted with an acute myocardial infarction
(MI). The nurse notes the client has developed new-onset atrial fibrillation
with a heart rate of 148 beats per minute. Which assessment finding is most
concerning?**
A) Blood pressure 106/68 mm Hg
B) Client reports palpitations
C) New confusion and restlessness
D) Irregular radial pulse
Correct Answer: C) New confusion and restlessness
Detailed Rationale
New confusion and restlessness in a client with atrial fibrillation and rapid
ventricular rate (148 bpm) indicates decreased cerebral perfusion. The rapid
heart rate shortens diastolic filling time, reducing stroke volume and cardiac
output. This leads to inadequate perfusion to vital organs, including the
brain. New neurological changes are the most concerning finding because they
indicate hemodynamic compromise and possible cardiogenic shock. This requires
immediate intervention, possibly synchronized cardioversion.
Why the Other Options Are Incorrect
• A) BP 106/68 mm Hg is low-normal. While it should be monitored closely, it is not immediately life-threatening
in isolation.
• B) Palpitations are a common and expected symptom of atrial fibrillation. While uncomfortable, they do not
indicate immediate danger.
Med-Surg Nursing Exam Prep 2026–2027 Adult Health | Practice Resource • Page 3
, Med-Surg Nursing Exam Prep 2026–2027 Adult Health
• D) Irregular radial pulse is the expected rhythm for atrial fibrillation. This is a characteristic finding, not a
complication.
Question 4: Neurological System
**A nurse is caring for a client who had a craniotomy 24
hours ago. Which assessment finding should the nurse report to the provider
immediately?**
A) Urine output of 200 mL/hr for the past 2 hours
B) Temperature of 37.8°C (100.0°F)
C) Complaint of a mild headache
D) Glasgow Coma Scale score of 15
**Correct Answer: A) Urine output of 200 mL/hr for the past
2 hours**
Detailed Rationale
Excessive urine output (polyuria) following craniotomy may indicate diabetes
insipidus (DI), which can occur due to decreased antidiuretic hormone (ADH)
secretion after pituitary or hypothalamic manipulation. Output of 200 mL/hr for
2 consecutive hours (400 mL total) is significantly elevated and could lead to
severe dehydration, hypernatremia, and hypovolemic shock. This requires
immediate reporting and likely treatment with desmopressin (DDAVP) and fluid
replacement.
Why the Other Options Are Incorrect
• B) Temperature of 37.8°C (100.0°F) is a low-grade elevation. While monitoring for infection is important, this
alone does not require immediate provider notification.
• C) A mild headache is common post-craniotomy and can be managed with prescribed analgesics. It does not
indicate a complication unless it is severe or sudden.
• D) GCS of 15 indicates full consciousness and is the best possible score. This is a reassuring finding.
Question 5: Endocrine System
**A client with type 1 diabetes mellitus is admitted with
diabetic ketoacidosis (DKA). The nurse is reviewing laboratory results. Which
finding requires immediate intervention?**
A) Serum glucose 320 mg/dL
B) Serum potassium 2.9 mEq/L
C) Arterial pH 7.28
D) Serum bicarbonate 16 mEq/L
Correct Answer: B) Serum potassium 2.9 mEq/L
Detailed Rationale
In DKA, total body potassium is depleted due to osmotic diuresis, even though
serum potassium may initially appear normal or elevated due to acidosis and
insulin deficiency. Once treatment begins with insulin, potassium shifts back
into cells, causing serum potassium to drop rapidly. A serum potassium of 2.9
Med-Surg Nursing Exam Prep 2026–2027 Adult Health | Practice Resource • Page 4
