RELIAS PROPHECY MEDICAL-SURGICAL RN
FORM A EXAM PREP QUESTIONS & DETAILED
RATIONALES 2026-2027
Master your nursing competency exam with this
comprehensive study guide featuring premium multiple-
choice questions, verified answers, and detailed rationales.
Tailored exactly to the layout used by top-tier sellers, this
resource breaks down core medical-surgical concepts
including prioritization, pharmacology, and emergency
interventions. It is designed to maximize your retention and
boost your test scores, serving as the ultimate tool to
guarantee an A+ grade.
1. Priority Assessment and Triage
A nurse on a busy medical-surgical unit receives the shift report
on four patients. Which patient should the nurse assess first?
A) A 45-year-old patient who is 2 days post-operative and
requesting a PRN stool softener.
B) A 68-year-old patient with chronic heart failure who has 2+
pitting edema in both lower extremities.
C) A 52-year-old patient admitted with acute cholecystitis who is
complaining of 8/10 pain.
D) A 71-year-old patient with a history of atrial fibrillation who
suddenly develops a new onset of slurred speech.
,Answer: D
Rationale: Using the ABCs (Airway, Breathing, Circulation) and
neurological safety frameworks, a sudden change in neurological
status, such as new-onset slurred speech, is a classic sign of an
acute stroke (CVA). This represents an immediate, life-
threatening emergency requiring rapid evaluation and potentially
time-sensitive interventions like thrombolytic therapy. Chronic
heart failure edema is expected, cholecystitis pain can be
managed with scheduled/PRN analgesics after checking the
priority patient, and a stool softener is non-urgent.
2. Tracheostomy Care Safety
The nurse is preparing to suction an adult patient who has a
temporary tracheostomy tube. Which action should the nurse take
first?
A) Insert the catheter 4 to 5 inches into the tracheostomy tube.
B) Set the wall suction pressure to 160 mm Hg.
C) Hyperoxygenate the patient with 100% oxygen for 30 to 60
seconds.
D) Apply intermittent suction while rotating and withdrawing the
catheter.
Answer: C
Rationale: Suctioning can cause sudden hypoxemia, vagal
stimulation, and arrhythmias. Hyperoxygenating the patient with
100% oxygen prior to inserting the catheter mitigates the risk of
hypoxia during the procedure. Safe suction pressure for an adult
should typically be set between 100 and 120 mm Hg; 160 mm Hg
is too high and can cause mucosal damage. Suction should never
be applied during insertion.
,3. Urinary Catheterization Complications
While inflating the 10 mL balloon of an indwelling urinary catheter
in a male patient, the patient grimaces and complains of severe
pain. What is the most appropriate action by the nurse?
A) Instruct the patient to take deep breaths while continuing to
inflate the balloon.
B) Aspirate the fluid to deflate the balloon, advance the catheter
further, and attempt reinflation.
C) Pull back gently on the catheter to ensure it is seated against
the bladder neck.
D) Remove the catheter immediately and notify the healthcare
provider.
Answer: B
Rationale: If a patient experiences severe discomfort during
balloon inflation, it indicates the balloon is likely located in the
sensitive urethra rather than fully inside the urinary bladder. The
nurse must immediately stop inflating, withdraw the fluid to deflate
the balloon completely, advance the catheter an additional 1 to 2
inches (or until resistance is met/urine flow is confirmed), and
then attempt to gently reinflate. Forcing inflation can cause
urethral trauma or rupture.
4. Closed Chest Drainage Systems
The nurse notes that a patient’s Jackson-Pratt (JP) abdominal
drain is half full of serosanguineous fluid. After emptying the drain
into a graduated cylinder, which action must the nurse take to
ensure the device functions correctly?
, A) Leave the bulb fully expanded to allow gravity drainage.
B) Compress the bulb fully before re-inserting the drainage plug.
C) Rinse the inside of the bulb with sterile normal saline.
D) Tape the bulb securely above the level of the patient's
abdomen.
Answer: B
Rationale: A Jackson-Pratt (JP) drain operates on negative
pressure suction. In order to establish this vacuum, the nurse
must compress the bulb entirely before securing the plug cap. If
the bulb remains uncompressed or fully expanded, gravity alone
will not provide sufficient suction to pull deep wound drainage out.
JP drains should always be kept below the level of the wound to
facilitate proper drainage.
5. Early Indicators of Neurological Decline
A patient is admitted following a closed head injury for overnight
observation. Which clinical finding is the most sensitive and
earliest indicator of an increase in intracranial pressure (ICP) or
neurological worsening?
A) Symmetrical, sluggish pupillary response to light.
B) Decerebrate posturing when painful stimuli are applied.
C) A subtle change in the patient's level of consciousness (LOC).
D) A widening pulse pressure accompanied by bradycardia.
Answer: C
Rationale: A change in the level of consciousness (such as
increased drowsiness, restlessness, confusion, or difficulty
arousing) is the earliest and most sensitive clinical indicator of
neurological deterioration or rising ICP. Structural changes like
FORM A EXAM PREP QUESTIONS & DETAILED
RATIONALES 2026-2027
Master your nursing competency exam with this
comprehensive study guide featuring premium multiple-
choice questions, verified answers, and detailed rationales.
Tailored exactly to the layout used by top-tier sellers, this
resource breaks down core medical-surgical concepts
including prioritization, pharmacology, and emergency
interventions. It is designed to maximize your retention and
boost your test scores, serving as the ultimate tool to
guarantee an A+ grade.
1. Priority Assessment and Triage
A nurse on a busy medical-surgical unit receives the shift report
on four patients. Which patient should the nurse assess first?
A) A 45-year-old patient who is 2 days post-operative and
requesting a PRN stool softener.
B) A 68-year-old patient with chronic heart failure who has 2+
pitting edema in both lower extremities.
C) A 52-year-old patient admitted with acute cholecystitis who is
complaining of 8/10 pain.
D) A 71-year-old patient with a history of atrial fibrillation who
suddenly develops a new onset of slurred speech.
,Answer: D
Rationale: Using the ABCs (Airway, Breathing, Circulation) and
neurological safety frameworks, a sudden change in neurological
status, such as new-onset slurred speech, is a classic sign of an
acute stroke (CVA). This represents an immediate, life-
threatening emergency requiring rapid evaluation and potentially
time-sensitive interventions like thrombolytic therapy. Chronic
heart failure edema is expected, cholecystitis pain can be
managed with scheduled/PRN analgesics after checking the
priority patient, and a stool softener is non-urgent.
2. Tracheostomy Care Safety
The nurse is preparing to suction an adult patient who has a
temporary tracheostomy tube. Which action should the nurse take
first?
A) Insert the catheter 4 to 5 inches into the tracheostomy tube.
B) Set the wall suction pressure to 160 mm Hg.
C) Hyperoxygenate the patient with 100% oxygen for 30 to 60
seconds.
D) Apply intermittent suction while rotating and withdrawing the
catheter.
Answer: C
Rationale: Suctioning can cause sudden hypoxemia, vagal
stimulation, and arrhythmias. Hyperoxygenating the patient with
100% oxygen prior to inserting the catheter mitigates the risk of
hypoxia during the procedure. Safe suction pressure for an adult
should typically be set between 100 and 120 mm Hg; 160 mm Hg
is too high and can cause mucosal damage. Suction should never
be applied during insertion.
,3. Urinary Catheterization Complications
While inflating the 10 mL balloon of an indwelling urinary catheter
in a male patient, the patient grimaces and complains of severe
pain. What is the most appropriate action by the nurse?
A) Instruct the patient to take deep breaths while continuing to
inflate the balloon.
B) Aspirate the fluid to deflate the balloon, advance the catheter
further, and attempt reinflation.
C) Pull back gently on the catheter to ensure it is seated against
the bladder neck.
D) Remove the catheter immediately and notify the healthcare
provider.
Answer: B
Rationale: If a patient experiences severe discomfort during
balloon inflation, it indicates the balloon is likely located in the
sensitive urethra rather than fully inside the urinary bladder. The
nurse must immediately stop inflating, withdraw the fluid to deflate
the balloon completely, advance the catheter an additional 1 to 2
inches (or until resistance is met/urine flow is confirmed), and
then attempt to gently reinflate. Forcing inflation can cause
urethral trauma or rupture.
4. Closed Chest Drainage Systems
The nurse notes that a patient’s Jackson-Pratt (JP) abdominal
drain is half full of serosanguineous fluid. After emptying the drain
into a graduated cylinder, which action must the nurse take to
ensure the device functions correctly?
, A) Leave the bulb fully expanded to allow gravity drainage.
B) Compress the bulb fully before re-inserting the drainage plug.
C) Rinse the inside of the bulb with sterile normal saline.
D) Tape the bulb securely above the level of the patient's
abdomen.
Answer: B
Rationale: A Jackson-Pratt (JP) drain operates on negative
pressure suction. In order to establish this vacuum, the nurse
must compress the bulb entirely before securing the plug cap. If
the bulb remains uncompressed or fully expanded, gravity alone
will not provide sufficient suction to pull deep wound drainage out.
JP drains should always be kept below the level of the wound to
facilitate proper drainage.
5. Early Indicators of Neurological Decline
A patient is admitted following a closed head injury for overnight
observation. Which clinical finding is the most sensitive and
earliest indicator of an increase in intracranial pressure (ICP) or
neurological worsening?
A) Symmetrical, sluggish pupillary response to light.
B) Decerebrate posturing when painful stimuli are applied.
C) A subtle change in the patient's level of consciousness (LOC).
D) A widening pulse pressure accompanied by bradycardia.
Answer: C
Rationale: A change in the level of consciousness (such as
increased drowsiness, restlessness, confusion, or difficulty
arousing) is the earliest and most sensitive clinical indicator of
neurological deterioration or rising ICP. Structural changes like
