Medical-Surgical Nursing II Midterm
Examination: Advanced Adult Health
Nursing A 150-Question Comprehensive
Multiple-Choice Examination with
Correct Answers and Detailed
Rationales for Baccalaureate Nursing
Students
Table of Contents
Section Topic Questions
I Perioperative Nursing Care 1–15
II Fluid, Electrolyte, and Acid–Base Imbalances 16–30
III Cardiovascular System Disorders 31–50
IV Respiratory System Disorders 51–70
V Neurological System Disorders 71–85
VI Endocrine System Disorders 86–100
VII Gastrointestinal and Hepatic Disorders 101–115
VIII Renal and Urinary System Disorders 116–130
,Section Topic Questions
IX Musculoskeletal and Integumentary Disorders 131–140
X Hematologic, Oncologic, and Immune Disorders 141–150
Section I: Perioperative Nursing Care (Questions 1–15)
🟢 1. A nurse is caring for a patient who is 48 hours post-operative following abdominal surgery. The
nurse notes the wound has dehisced and a loop of bowel is protruding. Which action should the nurse
take first?
A. Attempt to gently reinsert the protruding organ into the abdominal cavity.
B. Apply a sterile dressing moistened with sterile normal saline.
C. Place the patient in a High-Fowler's position to reduce abdominal pressure.
D. Notify the surgeon immediately before performing any other interventions.
🔴🔴 Correct Answer: B
Rationale: Evisceration is a medical emergency. The nurse should first cover the protruding organs with
sterile dressings moistened with sterile normal saline to prevent drying and infection, then notify the
surgeon.
🟢 2. A nurse is preparing a patient for surgery. Which of the following is the primary responsibility of the
nurse regarding informed consent?
A. Explaining the surgical procedure and its risks to the patient
B. Obtaining the patient's signature on the consent form
C. Witnessing the patient's signature and verifying understanding
D. Determining the patient's mental capacity to give consent
🔴🔴 Correct Answer: C
Rationale: The surgeon is responsible for explaining the procedure and obtaining consent; the nurse's
role is to witness the signature and verify that the patient understands the procedure.
🟢 3. A nurse is caring for a client who is 24 hours postoperative following a thyroidectomy. Which of the
following findings should the nurse report immediately?
A. Pain at the surgical site
B. Tingling in the fingers and circumferential area
C. Hoarseness when speaking
D. Serosanguineous drainage on the dressing
🔴🔴 Correct Answer: B
,Rationale: Tingling around the mouth (circumoral paresthesia) and in the fingers are classic early signs
of hypocalcemia, a potential complication of a thyroidectomy if the parathyroid glands are inadvertently
damaged.
🟢 4. A nurse is caring for a client who is postoperative following a total hip arthroplasty. Which of the
following actions should the nurse take to prevent dislocation of the hip prosthesis?
A. Place a pillow between the client's legs when turning.
B. Flex the client's hip beyond 90 degrees during repositioning.
C. Encourage the client to cross the legs when sitting.
D. Position the client in a side-lying position without support.
🔴🔴 Correct Answer: A
Rationale: Placing a pillow between the legs (abduction pillow) prevents adduction and flexion beyond
90 degrees, which are the primary mechanisms of hip prosthesis dislocation.
🟢 5. A patient is admitted with a diagnosis of Acute Pancreatitis. Which laboratory result should the
nurse expect to find elevated?
A. Hematocrit
B. Serum Calcium
C. Serum Potassium
D. Serum Amylase
🔴🔴 Correct Answer: D
Rationale: Serum amylase and lipase are significantly elevated in acute pancreatitis due to the
inflammation of the pancreas and the leakage of enzymes into the bloodstream.
🟢 6. A nurse is assessing a patient who is at risk for malignant hyperthermia during surgery. Which of the
following findings is an early sign of this condition?
A. Decreased heart rate
B. Muscle rigidity and tachycardia
C. Hypothermia and bradycardia
D. Decreased end-tidal CO₂
🔴🔴 Correct Answer: B
Rationale: Malignant hyperthermia is characterized by muscle rigidity, tachycardia, hyperthermia, and
elevated end-tidal CO₂. It is a life-threatening reaction to certain anesthetic agents.
🟢 7. A nurse is providing preoperative teaching to a patient scheduled for a colon resection. Which of the
following statements by the patient indicates a need for further teaching?
A. "I will need to stop eating and drinking after midnight."
B. "I should remove my jewelry and nail polish before surgery."
C. "I can take my aspirin as usual the morning of surgery."
D. "I will practice deep breathing and coughing exercises."
, 🔴🔴 Correct Answer: C
Rationale: Aspirin and other anticoagulants increase the risk of bleeding during and after surgery and
are typically discontinued several days before the procedure. The patient requires further teaching.
🟢 8. A nurse is caring for a postoperative patient who has a Jackson-Pratt drain in place. Which of the
following actions should the nurse take?
A. Empty the drain every 8 hours.
B. Maintain compression on the drain bulb.
C. Irrigate the drain with sterile saline daily.
D. Position the drain above the insertion site.
🔴🔴 Correct Answer: B
Rationale: A Jackson-Pratt drain is a serum-collection device that uses gentle suction created by
compressing the bulb. Maintaining compression on the bulb ensures continued drainage and prevents
fluid accumulation.
🟢 9. A patient is scheduled for surgery and asks the nurse about advance directives. Which of the
following responses by the nurse is appropriate?
A. "Advance directives are only for elderly patients."
B. "You will need to discuss advance directives with your surgeon."
C. "Advance directives allow you to specify your wishes for care if you become unable to communicate."
D. "Advance directives must be completed before you can have surgery."
🔴🔴 Correct Answer: C
Rationale: Advance directives are legal documents that allow patients to communicate their healthcare
wishes in advance, including the appointment of a healthcare proxy and specific treatment preferences.
🟢 10. A nurse is monitoring a patient in the PACU following general anesthesia. Which of the following
findings should the nurse report immediately?
A. Blood pressure of 110/70 mmHg
B. Respiratory rate of 8 breaths per minute
C. Temperature of 36.5°C (97.7°F)
D. Urine output of 50 mL in the past hour
🔴🔴 Correct Answer: B
Rationale: A respiratory rate of 8 breaths per minute indicates respiratory depression, a common
complication of general anesthesia and opioid administration. This requires immediate intervention.
🟢 11. A patient is undergoing a bone marrow biopsy. The client expresses fear about the procedure and
asks the nurse if the biopsy will hurt. Which of the following responses should the nurse make?
A. "You must be very worried about what the biopsy will show."
B. "You'll be asleep for the whole biopsy procedure and won't be aware of what's happening."
C. "Your provider scheduled this, so she will want to know you still have questions about the
Examination: Advanced Adult Health
Nursing A 150-Question Comprehensive
Multiple-Choice Examination with
Correct Answers and Detailed
Rationales for Baccalaureate Nursing
Students
Table of Contents
Section Topic Questions
I Perioperative Nursing Care 1–15
II Fluid, Electrolyte, and Acid–Base Imbalances 16–30
III Cardiovascular System Disorders 31–50
IV Respiratory System Disorders 51–70
V Neurological System Disorders 71–85
VI Endocrine System Disorders 86–100
VII Gastrointestinal and Hepatic Disorders 101–115
VIII Renal and Urinary System Disorders 116–130
,Section Topic Questions
IX Musculoskeletal and Integumentary Disorders 131–140
X Hematologic, Oncologic, and Immune Disorders 141–150
Section I: Perioperative Nursing Care (Questions 1–15)
🟢 1. A nurse is caring for a patient who is 48 hours post-operative following abdominal surgery. The
nurse notes the wound has dehisced and a loop of bowel is protruding. Which action should the nurse
take first?
A. Attempt to gently reinsert the protruding organ into the abdominal cavity.
B. Apply a sterile dressing moistened with sterile normal saline.
C. Place the patient in a High-Fowler's position to reduce abdominal pressure.
D. Notify the surgeon immediately before performing any other interventions.
🔴🔴 Correct Answer: B
Rationale: Evisceration is a medical emergency. The nurse should first cover the protruding organs with
sterile dressings moistened with sterile normal saline to prevent drying and infection, then notify the
surgeon.
🟢 2. A nurse is preparing a patient for surgery. Which of the following is the primary responsibility of the
nurse regarding informed consent?
A. Explaining the surgical procedure and its risks to the patient
B. Obtaining the patient's signature on the consent form
C. Witnessing the patient's signature and verifying understanding
D. Determining the patient's mental capacity to give consent
🔴🔴 Correct Answer: C
Rationale: The surgeon is responsible for explaining the procedure and obtaining consent; the nurse's
role is to witness the signature and verify that the patient understands the procedure.
🟢 3. A nurse is caring for a client who is 24 hours postoperative following a thyroidectomy. Which of the
following findings should the nurse report immediately?
A. Pain at the surgical site
B. Tingling in the fingers and circumferential area
C. Hoarseness when speaking
D. Serosanguineous drainage on the dressing
🔴🔴 Correct Answer: B
,Rationale: Tingling around the mouth (circumoral paresthesia) and in the fingers are classic early signs
of hypocalcemia, a potential complication of a thyroidectomy if the parathyroid glands are inadvertently
damaged.
🟢 4. A nurse is caring for a client who is postoperative following a total hip arthroplasty. Which of the
following actions should the nurse take to prevent dislocation of the hip prosthesis?
A. Place a pillow between the client's legs when turning.
B. Flex the client's hip beyond 90 degrees during repositioning.
C. Encourage the client to cross the legs when sitting.
D. Position the client in a side-lying position without support.
🔴🔴 Correct Answer: A
Rationale: Placing a pillow between the legs (abduction pillow) prevents adduction and flexion beyond
90 degrees, which are the primary mechanisms of hip prosthesis dislocation.
🟢 5. A patient is admitted with a diagnosis of Acute Pancreatitis. Which laboratory result should the
nurse expect to find elevated?
A. Hematocrit
B. Serum Calcium
C. Serum Potassium
D. Serum Amylase
🔴🔴 Correct Answer: D
Rationale: Serum amylase and lipase are significantly elevated in acute pancreatitis due to the
inflammation of the pancreas and the leakage of enzymes into the bloodstream.
🟢 6. A nurse is assessing a patient who is at risk for malignant hyperthermia during surgery. Which of the
following findings is an early sign of this condition?
A. Decreased heart rate
B. Muscle rigidity and tachycardia
C. Hypothermia and bradycardia
D. Decreased end-tidal CO₂
🔴🔴 Correct Answer: B
Rationale: Malignant hyperthermia is characterized by muscle rigidity, tachycardia, hyperthermia, and
elevated end-tidal CO₂. It is a life-threatening reaction to certain anesthetic agents.
🟢 7. A nurse is providing preoperative teaching to a patient scheduled for a colon resection. Which of the
following statements by the patient indicates a need for further teaching?
A. "I will need to stop eating and drinking after midnight."
B. "I should remove my jewelry and nail polish before surgery."
C. "I can take my aspirin as usual the morning of surgery."
D. "I will practice deep breathing and coughing exercises."
, 🔴🔴 Correct Answer: C
Rationale: Aspirin and other anticoagulants increase the risk of bleeding during and after surgery and
are typically discontinued several days before the procedure. The patient requires further teaching.
🟢 8. A nurse is caring for a postoperative patient who has a Jackson-Pratt drain in place. Which of the
following actions should the nurse take?
A. Empty the drain every 8 hours.
B. Maintain compression on the drain bulb.
C. Irrigate the drain with sterile saline daily.
D. Position the drain above the insertion site.
🔴🔴 Correct Answer: B
Rationale: A Jackson-Pratt drain is a serum-collection device that uses gentle suction created by
compressing the bulb. Maintaining compression on the bulb ensures continued drainage and prevents
fluid accumulation.
🟢 9. A patient is scheduled for surgery and asks the nurse about advance directives. Which of the
following responses by the nurse is appropriate?
A. "Advance directives are only for elderly patients."
B. "You will need to discuss advance directives with your surgeon."
C. "Advance directives allow you to specify your wishes for care if you become unable to communicate."
D. "Advance directives must be completed before you can have surgery."
🔴🔴 Correct Answer: C
Rationale: Advance directives are legal documents that allow patients to communicate their healthcare
wishes in advance, including the appointment of a healthcare proxy and specific treatment preferences.
🟢 10. A nurse is monitoring a patient in the PACU following general anesthesia. Which of the following
findings should the nurse report immediately?
A. Blood pressure of 110/70 mmHg
B. Respiratory rate of 8 breaths per minute
C. Temperature of 36.5°C (97.7°F)
D. Urine output of 50 mL in the past hour
🔴🔴 Correct Answer: B
Rationale: A respiratory rate of 8 breaths per minute indicates respiratory depression, a common
complication of general anesthesia and opioid administration. This requires immediate intervention.
🟢 11. A patient is undergoing a bone marrow biopsy. The client expresses fear about the procedure and
asks the nurse if the biopsy will hurt. Which of the following responses should the nurse make?
A. "You must be very worried about what the biopsy will show."
B. "You'll be asleep for the whole biopsy procedure and won't be aware of what's happening."
C. "Your provider scheduled this, so she will want to know you still have questions about the
