N108 MED SURG TEST 4 PRACTICE EXAM QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026/2027 UPDATED | COMPREHENSIVE REVIEW – EASTWICK
COLLEGE | INSTANT DOWNLOAD PDF.
Core Domains
Endocrine and Metabolic Disorders
Renal and Urinary Disorders
Musculoskeletal and Connective Tissue Disorders
Neurological and Sensory Disorders
Gastrointestinal and Hepatobiliary Disorders
Reproductive and Breast Disorders
Perioperative and Emergency Nursing
Oncology and Hematologic Disorders
Fluid, Electrolyte, and Acid-Base Balance
Infection, Inflammation, and Immunity
Introduction
This comprehensive assessment is designed to evaluate the
medical-surgical nursing knowledge and clinical reasoning of pre-
licensure nursing students preparing for Test 4. It covers critical
domains including endocrine, renal, musculoskeletal, neurological,
gastrointestinal, reproductive, oncologic, and perioperative nursing.
The exam assesses proficiency in patient assessment, prioritization,
medication administration, complication recognition, and evidence-
based interventions. Featuring multiple-choice and scenario-based
questions, it emphasizes real-world clinical decision-making, safety,
and patient-centered care. Candidates must demonstrate sound
nursing judgment and a thorough understanding of complex adult
health concepts to succeed in the classroom and at the bedside.
Section One: Questions 1–72
,1. A patient with type 1 diabetes presents with fruity breath,
Kussmaul respirations, and a blood glucose of 480 mg/dL.
Which action should the nurse take first?
A. Administer subcutaneous insulin glargine.
B. Encourage oral fluids and recheck glucose in 1 hour.
C. Initiate IV fluid resuscitation and prepare an insulin infusion.
D. Place the patient in a supine position and monitor urine output.
🟢 Correct answer: C
🔴 RATIONALE: The patient is in diabetic ketoacidosis (DKA).
Priority management includes IV fluid resuscitation and
continuous IV insulin to correct dehydration, hyperglycemia, and
acidosis. Subcutaneous long-acting insulin is not appropriate for
acute DKA management.
2. A patient with Graves' disease is admitted with fever,
tachycardia, agitation, and confusion. Which medication should
the nurse anticipate administering?
A. Levothyroxine
B. Propylthiouracil and a beta-blocker
C. Radioactive iodine
D. Methimazole only
🟢 Correct answer: B
🔴 RATIONALE: These findings suggest thyroid storm, a life-
threatening complication of hyperthyroidism. Immediate
treatment includes propylthiouracil to block thyroid hormone
synthesis and a beta-blocker to control tachycardia and agitation.
3. A patient with syndrome of inappropriate antidiuretic hormone
(SIADH) has a serum sodium of 118 mEq/L. Which intervention
is most appropriate?
,A. Administer IV 0.9% normal saline at a rapid rate.
B. Encourage a high-sodium diet and free water intake.
C. Administer furosemide and increase oral fluids.
D. Restrict fluids and monitor for neurological changes.
🟢 Correct answer: D
🔴 RATIONALE: SIADH causes dilutional hyponatremia due to
excessive water retention. Fluid restriction is the primary
treatment. Hypertonic saline may be used for severe symptomatic
hyponatremia, but rapid correction can cause osmotic
demyelination.
4. A patient with Addison's disease is admitted with hypotension,
weakness, and hyperkalemia. Which intervention should the
nurse anticipate?
A. Administer IV hydrocortisone and fluids.
B. Administer insulin and glucose.
C. Restrict sodium and administer potassium.
D. Administer levothyroxine.
🟢 Correct answer: A
🔴 RATIONALE: The patient is experiencing Addisonian crisis,
caused by acute adrenal insufficiency. Treatment includes IV
hydrocortisone and fluid resuscitation with normal saline to
restore vascular volume and correct electrolyte imbalances.
5. A patient with Cushing's syndrome is at increased risk for which
complication?
A. Hypoglycemia
B. Infection and hyperglycemia
C. Hypotension
D. Hyperkalemia
, 🟢 Correct answer: B
🔴 RATIONALE: Excess cortisol causes immunosuppression and
increased susceptibility to infection, as well as hyperglycemia due
to increased gluconeogenesis and insulin resistance.
6. A patient with chronic kidney disease has a serum potassium of
6.8 mEq/L. Which intervention should the nurse implement
first?
A. Administer a potassium-sparing diuretic.
B. Encourage a high-potassium diet.
C. Prepare for emergent dialysis or administer calcium gluconate.
D. Restrict fluids and monitor intake and output.
🟢 Correct answer: C
🔴 RATIONALE: Severe hyperkalemia can cause life-threatening
cardiac arrhythmias. Immediate treatment may include IV calcium
gluconate to stabilize the myocardium, followed by insulin and
glucose, sodium bicarbonate, or dialysis.
7. A patient receiving hemodialysis has an arteriovenous fistula in
the left arm. Which action by the nurse is appropriate?
A. Auscultate the fistula for a bruit.
B. Obtain blood pressure in the left arm.
C. Draw blood from the fistula site.
D. Apply pressure over the fistula after cannulation.
🟢 Correct answer: A
🔴 RATIONALE: Assessing the fistula for a thrill or bruit confirms
patency. Blood pressure, venipuncture, and IV access should be
avoided in the fistula arm to prevent thrombosis and infection.
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026/2027 UPDATED | COMPREHENSIVE REVIEW – EASTWICK
COLLEGE | INSTANT DOWNLOAD PDF.
Core Domains
Endocrine and Metabolic Disorders
Renal and Urinary Disorders
Musculoskeletal and Connective Tissue Disorders
Neurological and Sensory Disorders
Gastrointestinal and Hepatobiliary Disorders
Reproductive and Breast Disorders
Perioperative and Emergency Nursing
Oncology and Hematologic Disorders
Fluid, Electrolyte, and Acid-Base Balance
Infection, Inflammation, and Immunity
Introduction
This comprehensive assessment is designed to evaluate the
medical-surgical nursing knowledge and clinical reasoning of pre-
licensure nursing students preparing for Test 4. It covers critical
domains including endocrine, renal, musculoskeletal, neurological,
gastrointestinal, reproductive, oncologic, and perioperative nursing.
The exam assesses proficiency in patient assessment, prioritization,
medication administration, complication recognition, and evidence-
based interventions. Featuring multiple-choice and scenario-based
questions, it emphasizes real-world clinical decision-making, safety,
and patient-centered care. Candidates must demonstrate sound
nursing judgment and a thorough understanding of complex adult
health concepts to succeed in the classroom and at the bedside.
Section One: Questions 1–72
,1. A patient with type 1 diabetes presents with fruity breath,
Kussmaul respirations, and a blood glucose of 480 mg/dL.
Which action should the nurse take first?
A. Administer subcutaneous insulin glargine.
B. Encourage oral fluids and recheck glucose in 1 hour.
C. Initiate IV fluid resuscitation and prepare an insulin infusion.
D. Place the patient in a supine position and monitor urine output.
🟢 Correct answer: C
🔴 RATIONALE: The patient is in diabetic ketoacidosis (DKA).
Priority management includes IV fluid resuscitation and
continuous IV insulin to correct dehydration, hyperglycemia, and
acidosis. Subcutaneous long-acting insulin is not appropriate for
acute DKA management.
2. A patient with Graves' disease is admitted with fever,
tachycardia, agitation, and confusion. Which medication should
the nurse anticipate administering?
A. Levothyroxine
B. Propylthiouracil and a beta-blocker
C. Radioactive iodine
D. Methimazole only
🟢 Correct answer: B
🔴 RATIONALE: These findings suggest thyroid storm, a life-
threatening complication of hyperthyroidism. Immediate
treatment includes propylthiouracil to block thyroid hormone
synthesis and a beta-blocker to control tachycardia and agitation.
3. A patient with syndrome of inappropriate antidiuretic hormone
(SIADH) has a serum sodium of 118 mEq/L. Which intervention
is most appropriate?
,A. Administer IV 0.9% normal saline at a rapid rate.
B. Encourage a high-sodium diet and free water intake.
C. Administer furosemide and increase oral fluids.
D. Restrict fluids and monitor for neurological changes.
🟢 Correct answer: D
🔴 RATIONALE: SIADH causes dilutional hyponatremia due to
excessive water retention. Fluid restriction is the primary
treatment. Hypertonic saline may be used for severe symptomatic
hyponatremia, but rapid correction can cause osmotic
demyelination.
4. A patient with Addison's disease is admitted with hypotension,
weakness, and hyperkalemia. Which intervention should the
nurse anticipate?
A. Administer IV hydrocortisone and fluids.
B. Administer insulin and glucose.
C. Restrict sodium and administer potassium.
D. Administer levothyroxine.
🟢 Correct answer: A
🔴 RATIONALE: The patient is experiencing Addisonian crisis,
caused by acute adrenal insufficiency. Treatment includes IV
hydrocortisone and fluid resuscitation with normal saline to
restore vascular volume and correct electrolyte imbalances.
5. A patient with Cushing's syndrome is at increased risk for which
complication?
A. Hypoglycemia
B. Infection and hyperglycemia
C. Hypotension
D. Hyperkalemia
, 🟢 Correct answer: B
🔴 RATIONALE: Excess cortisol causes immunosuppression and
increased susceptibility to infection, as well as hyperglycemia due
to increased gluconeogenesis and insulin resistance.
6. A patient with chronic kidney disease has a serum potassium of
6.8 mEq/L. Which intervention should the nurse implement
first?
A. Administer a potassium-sparing diuretic.
B. Encourage a high-potassium diet.
C. Prepare for emergent dialysis or administer calcium gluconate.
D. Restrict fluids and monitor intake and output.
🟢 Correct answer: C
🔴 RATIONALE: Severe hyperkalemia can cause life-threatening
cardiac arrhythmias. Immediate treatment may include IV calcium
gluconate to stabilize the myocardium, followed by insulin and
glucose, sodium bicarbonate, or dialysis.
7. A patient receiving hemodialysis has an arteriovenous fistula in
the left arm. Which action by the nurse is appropriate?
A. Auscultate the fistula for a bruit.
B. Obtain blood pressure in the left arm.
C. Draw blood from the fistula site.
D. Apply pressure over the fistula after cannulation.
🟢 Correct answer: A
🔴 RATIONALE: Assessing the fistula for a thrill or bruit confirms
patency. Blood pressure, venipuncture, and IV access should be
avoided in the fistula arm to prevent thrombosis and infection.
