Comprehensive Medical-Surgical Nursing I Final
Examination: 150 Item Advanced Multiple-Choice
Questions Covering Adult Health I, All Perioperative
Care, Cardiovascular, Respiratory, Neurological,
Endocrine, Renal, Gastrointestinal, Musculoskeletal,
Oncologic, and Emergency Nursing with Detailed
Evidence-Based Rationales for Baccalaureate
Nursing Students
Table of Contents
Section Topic Question Numbers
I Perioperative Nursing 1–15
II Cardiovascular Nursing 16–30
III Respiratory Nursing 31–45
IV Neurological Nursing 46–60
V Endocrine Nursing 61–75
VI Renal and Urinary Nursing 76–90
VII Gastrointestinal Nursing 91–105
VIII Musculoskeletal Nursing 106–120
IX Oncologic and Hematologic Nursing 121–135
X Emergency and Critical Care Nursing 136–150
,Section I: Perioperative Nursing
🟢 1. A 72-year-old client is scheduled for an elective total hip arthroplasty. Which preoperative
assessment finding should the nurse report to the surgeon immediately?
A. Hemoglobin 11.2 g/dL
B. Blood pressure 148/86 mm Hg
C. 🔴🔴 Temperature 38.3°C (101°F) and productive cough
D. Fasting blood glucose 142 mg/dL
Rationale: An elevated temperature with productive cough suggests an active infection, which would
necessitate postponing elective surgery to prevent postoperative complications such as prosthetic joint
infection.
🟢 2. A nurse is preparing a client for surgery. The client asks, "Who is responsible for explaining the
procedure and obtaining my informed consent?" What is the nurse's best response?
A. "The nurse explains the procedure and witnesses your signature."
B. 🔴🔴 "The surgeon is responsible for explaining the procedure and obtaining consent."
C. "The anesthesiologist will explain all risks and benefits."
D. "The hospital administrator will review the consent with you."
Rationale: Informed consent is a legal and ethical responsibility of the surgeon performing the
procedure; the nurse's role is to witness the signature and ensure the client understands.
🟢 3. A client is 24 hours postoperative following abdominal surgery. Which assessment finding requires
immediate nursing intervention?
A. Serosanguineous drainage on the dressing
B. 🔴🔴 Respiratory rate 28 breaths/min and oxygen saturation 89% on room air
C. Pain rated 6/10 at the incision site
D. Urine output of 40 mL/hr
Rationale: Tachypnea and hypoxemia suggest atelectasis or pulmonary embolism, which are life-
threatening postoperative complications requiring immediate assessment and intervention.
🟢 4. A nurse is teaching a client about using an incentive spirometer after surgery. Which statement by
the client indicates correct understanding?
A. "I will use it only when I feel short of breath."
B. 🔴🔴 "I will take slow, deep breaths and hold each breath for 3 seconds."
C. "I will exhale forcefully into the device after each breath."
D. "I will use it once every 8 hours while awake."
Rationale: Incentive spirometry prevents atelectasis by encouraging sustained maximal inspiration;
holding the breath for at least 3 seconds promotes alveolar expansion.
🟢 5. A client scheduled for surgery reports taking aspirin daily. The nurse should anticipate which
preoperative instruction?
A. Continue aspirin until the morning of surgery.
B. 🔴🔴 Discontinue aspirin 7 to 10 days before surgery as prescribed.
,C. Double the aspirin dose the day before surgery.
D. Take aspirin with a full glass of water on the day of surgery.
Rationale: Aspirin irreversibly inhibits platelet aggregation and increases bleeding risk; it is typically
discontinued 7–10 days preoperatively.
🟢 6. A postoperative client has a nasogastric tube to low intermittent suction. Which nursing action is
priority?
A. Irrigate the tube with 30 mL of air every 4 hours.
B. 🔴🔴 Assess for signs of fluid and electrolyte imbalance.
C. Clamp the tube for 30 minutes every 2 hours.
D. Position the client flat to facilitate drainage.
Rationale: Nasogastric suction removes gastric fluid rich in hydrogen, chloride, and potassium, leading
to metabolic alkalosis and hypokalemia; monitoring electrolytes is essential.
🟢 7. A client is in the post-anesthesia care unit (PACU) following general anesthesia. Which assessment
finding indicates the client is ready for discharge from PACU?
A. Heart rate 52 beats/min and drowsy
B. 🔴🔴 Aldrete score of 9 with stable vital signs and purposeful movement
C. Blood pressure 88/50 mm Hg and nausea
D. Respiratory rate 10 breaths/min and unresponsive to verbal stimuli
Rationale: An Aldrete score ≥9 indicates readiness for discharge from PACU, reflecting adequate activity,
respiration, circulation, consciousness, and oxygen saturation.
🟢 8. A client develops malignant hyperthermia during surgery. Which medication should the nurse
anticipate administering?
A. Atropine sulfate
B. 🔴🔴 Dantrolene sodium
C. Epinephrine
D. Sodium bicarbonate
Rationale: Dantrolene sodium is the specific antidote for malignant hyperthermia; it inhibits calcium
release from the sarcoplasmic reticulum.
🟢 9. A nurse is assessing a client's surgical wound on postoperative day 5. Which finding suggests a
wound infection?
A. Serous drainage and mild redness at the edges
B. 🔴🔴 Purulent drainage, warmth, and induration
C. Approximated wound edges with dry intact skin
D. Pain controlled with oral analgesics
Rationale: Purulent drainage, warmth, and induration are classic signs of wound infection requiring
culture and antibiotic therapy.
🟢 10. A client is scheduled for a colon resection. Which preoperative teaching is most important to
include?
, A. "You will be able to eat a regular diet immediately after surgery."
B. 🔴🔴 "You will need to splint your incision when coughing and deep breathing."
C. "You should avoid all movement for the first 24 hours."
D. "You will not need pain medication after surgery."
Rationale: Splinting the incision reduces pain and prevents dehiscence during coughing and deep
breathing, which are essential for preventing pulmonary complications.
🟢 11. A postoperative client reports sudden shortness of breath and chest pain. Vital signs: HR 118, BP
98/60, RR 30, SpO₂ 86%. What is the nurse's priority action?
A. Administer prescribed oral analgesic.
B. 🔴🔴 Apply oxygen and notify the provider immediately.
C. Encourage the client to ambulate.
D. Place the client in a supine position.
Rationale: These findings suggest pulmonary embolism; immediate oxygen and provider notification are
critical while preparing for diagnostic studies such as CT angiography.
🟢 12. A nurse is caring for a client with a Jackson-Pratt drain. Which action is correct?
A. Irrigate the drain with sterile saline daily.
B. 🔴🔴 Compress the bulb to maintain suction and empty when half full.
C. Clamp the drain for 8 hours each shift.
D. Position the drain above the incision site.
Rationale: Jackson-Pratt drains require compression to maintain negative pressure; emptying when half
full prevents reflux and maintains patency.
🟢 13. A client is undergoing preoperative preparation for emergency surgery. The client has a full
stomach. Which intervention is priority?
A. Administer a large-volume enema.
B. 🔴🔴 Prepare for possible rapid-sequence induction and suctioning.
C. Encourage the client to drink clear liquids.
D. Place the client in a supine position for transport.
Rationale: A full stomach increases risk of aspiration during induction; rapid-sequence intubation with
suction available reduces this risk.
🟢 14. A nurse is monitoring a client receiving moderate sedation. Which assessment is most important?
A. Pupil size every 15 minutes
B. 🔴🔴 Continuous pulse oximetry and respiratory rate
C. Blood glucose every 4 hours
D. Urine output every hour
Rationale: Moderate sedation can cause respiratory depression; continuous monitoring of oxygenation
and ventilation is essential for early detection.
🟢 15. A client is postoperative day 2 following open reduction internal fixation (ORIF) of the femur.
Which finding requires immediate follow-up?
Examination: 150 Item Advanced Multiple-Choice
Questions Covering Adult Health I, All Perioperative
Care, Cardiovascular, Respiratory, Neurological,
Endocrine, Renal, Gastrointestinal, Musculoskeletal,
Oncologic, and Emergency Nursing with Detailed
Evidence-Based Rationales for Baccalaureate
Nursing Students
Table of Contents
Section Topic Question Numbers
I Perioperative Nursing 1–15
II Cardiovascular Nursing 16–30
III Respiratory Nursing 31–45
IV Neurological Nursing 46–60
V Endocrine Nursing 61–75
VI Renal and Urinary Nursing 76–90
VII Gastrointestinal Nursing 91–105
VIII Musculoskeletal Nursing 106–120
IX Oncologic and Hematologic Nursing 121–135
X Emergency and Critical Care Nursing 136–150
,Section I: Perioperative Nursing
🟢 1. A 72-year-old client is scheduled for an elective total hip arthroplasty. Which preoperative
assessment finding should the nurse report to the surgeon immediately?
A. Hemoglobin 11.2 g/dL
B. Blood pressure 148/86 mm Hg
C. 🔴🔴 Temperature 38.3°C (101°F) and productive cough
D. Fasting blood glucose 142 mg/dL
Rationale: An elevated temperature with productive cough suggests an active infection, which would
necessitate postponing elective surgery to prevent postoperative complications such as prosthetic joint
infection.
🟢 2. A nurse is preparing a client for surgery. The client asks, "Who is responsible for explaining the
procedure and obtaining my informed consent?" What is the nurse's best response?
A. "The nurse explains the procedure and witnesses your signature."
B. 🔴🔴 "The surgeon is responsible for explaining the procedure and obtaining consent."
C. "The anesthesiologist will explain all risks and benefits."
D. "The hospital administrator will review the consent with you."
Rationale: Informed consent is a legal and ethical responsibility of the surgeon performing the
procedure; the nurse's role is to witness the signature and ensure the client understands.
🟢 3. A client is 24 hours postoperative following abdominal surgery. Which assessment finding requires
immediate nursing intervention?
A. Serosanguineous drainage on the dressing
B. 🔴🔴 Respiratory rate 28 breaths/min and oxygen saturation 89% on room air
C. Pain rated 6/10 at the incision site
D. Urine output of 40 mL/hr
Rationale: Tachypnea and hypoxemia suggest atelectasis or pulmonary embolism, which are life-
threatening postoperative complications requiring immediate assessment and intervention.
🟢 4. A nurse is teaching a client about using an incentive spirometer after surgery. Which statement by
the client indicates correct understanding?
A. "I will use it only when I feel short of breath."
B. 🔴🔴 "I will take slow, deep breaths and hold each breath for 3 seconds."
C. "I will exhale forcefully into the device after each breath."
D. "I will use it once every 8 hours while awake."
Rationale: Incentive spirometry prevents atelectasis by encouraging sustained maximal inspiration;
holding the breath for at least 3 seconds promotes alveolar expansion.
🟢 5. A client scheduled for surgery reports taking aspirin daily. The nurse should anticipate which
preoperative instruction?
A. Continue aspirin until the morning of surgery.
B. 🔴🔴 Discontinue aspirin 7 to 10 days before surgery as prescribed.
,C. Double the aspirin dose the day before surgery.
D. Take aspirin with a full glass of water on the day of surgery.
Rationale: Aspirin irreversibly inhibits platelet aggregation and increases bleeding risk; it is typically
discontinued 7–10 days preoperatively.
🟢 6. A postoperative client has a nasogastric tube to low intermittent suction. Which nursing action is
priority?
A. Irrigate the tube with 30 mL of air every 4 hours.
B. 🔴🔴 Assess for signs of fluid and electrolyte imbalance.
C. Clamp the tube for 30 minutes every 2 hours.
D. Position the client flat to facilitate drainage.
Rationale: Nasogastric suction removes gastric fluid rich in hydrogen, chloride, and potassium, leading
to metabolic alkalosis and hypokalemia; monitoring electrolytes is essential.
🟢 7. A client is in the post-anesthesia care unit (PACU) following general anesthesia. Which assessment
finding indicates the client is ready for discharge from PACU?
A. Heart rate 52 beats/min and drowsy
B. 🔴🔴 Aldrete score of 9 with stable vital signs and purposeful movement
C. Blood pressure 88/50 mm Hg and nausea
D. Respiratory rate 10 breaths/min and unresponsive to verbal stimuli
Rationale: An Aldrete score ≥9 indicates readiness for discharge from PACU, reflecting adequate activity,
respiration, circulation, consciousness, and oxygen saturation.
🟢 8. A client develops malignant hyperthermia during surgery. Which medication should the nurse
anticipate administering?
A. Atropine sulfate
B. 🔴🔴 Dantrolene sodium
C. Epinephrine
D. Sodium bicarbonate
Rationale: Dantrolene sodium is the specific antidote for malignant hyperthermia; it inhibits calcium
release from the sarcoplasmic reticulum.
🟢 9. A nurse is assessing a client's surgical wound on postoperative day 5. Which finding suggests a
wound infection?
A. Serous drainage and mild redness at the edges
B. 🔴🔴 Purulent drainage, warmth, and induration
C. Approximated wound edges with dry intact skin
D. Pain controlled with oral analgesics
Rationale: Purulent drainage, warmth, and induration are classic signs of wound infection requiring
culture and antibiotic therapy.
🟢 10. A client is scheduled for a colon resection. Which preoperative teaching is most important to
include?
, A. "You will be able to eat a regular diet immediately after surgery."
B. 🔴🔴 "You will need to splint your incision when coughing and deep breathing."
C. "You should avoid all movement for the first 24 hours."
D. "You will not need pain medication after surgery."
Rationale: Splinting the incision reduces pain and prevents dehiscence during coughing and deep
breathing, which are essential for preventing pulmonary complications.
🟢 11. A postoperative client reports sudden shortness of breath and chest pain. Vital signs: HR 118, BP
98/60, RR 30, SpO₂ 86%. What is the nurse's priority action?
A. Administer prescribed oral analgesic.
B. 🔴🔴 Apply oxygen and notify the provider immediately.
C. Encourage the client to ambulate.
D. Place the client in a supine position.
Rationale: These findings suggest pulmonary embolism; immediate oxygen and provider notification are
critical while preparing for diagnostic studies such as CT angiography.
🟢 12. A nurse is caring for a client with a Jackson-Pratt drain. Which action is correct?
A. Irrigate the drain with sterile saline daily.
B. 🔴🔴 Compress the bulb to maintain suction and empty when half full.
C. Clamp the drain for 8 hours each shift.
D. Position the drain above the incision site.
Rationale: Jackson-Pratt drains require compression to maintain negative pressure; emptying when half
full prevents reflux and maintains patency.
🟢 13. A client is undergoing preoperative preparation for emergency surgery. The client has a full
stomach. Which intervention is priority?
A. Administer a large-volume enema.
B. 🔴🔴 Prepare for possible rapid-sequence induction and suctioning.
C. Encourage the client to drink clear liquids.
D. Place the client in a supine position for transport.
Rationale: A full stomach increases risk of aspiration during induction; rapid-sequence intubation with
suction available reduces this risk.
🟢 14. A nurse is monitoring a client receiving moderate sedation. Which assessment is most important?
A. Pupil size every 15 minutes
B. 🔴🔴 Continuous pulse oximetry and respiratory rate
C. Blood glucose every 4 hours
D. Urine output every hour
Rationale: Moderate sedation can cause respiratory depression; continuous monitoring of oxygenation
and ventilation is essential for early detection.
🟢 15. A client is postoperative day 2 following open reduction internal fixation (ORIF) of the femur.
Which finding requires immediate follow-up?
