MED SURG 201 MEDICAL-SURGICAL
NURSING FINAL EXAM 2026/2027:
150 PRACTICE QUESTIONS WITH
BOLDED ANSWERS AND DETAILED
RATIONALES
Question 1
A 68-year-old male with heart failure presents with weight gain, jugular venous
distension, and bilateral lower extremity edema. Which dietary instruction is most
important?
A. Increase fluid intake to 3 L/day
B. Restrict sodium to < 2 g/day
C. Increase potassium-rich foods
D. Restrict protein intake
Correct answer: B
Rationale: Sodium restriction reduces fluid retention (B). Increased fluid (A) worsens
edema. Potassium (C) is not primary. Protein restriction (D) is not indicated in heart
failure.
Question 2
A patient with COPD has an SpO₂ of 88% on room air and a PaCO₂ of 58 mmHg.
Which oxygen delivery method is safest?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 2 L/min (24% FiO₂)
C. Nasal cannula at 6 L/min
D. Simple face mask at 10 L/min
Correct answer: B
Rationale: COPD with hypercapnia needs controlled O₂ (Venturi) to avoid suppressing
respiratory drive (B). High flow (A, C, D) can worsen hypercapnia.
Question 3
A client with chronic kidney disease has a potassium level of 6.8 mEq/L. Which
electrocardiogram change should the nurse expect?
,A. Flattened T waves
B. Prominent U waves
C. Tall, peaked T waves
D. Prolonged PR interval
Correct answer: C
Rationale: Hyperkalemia (K+ > 5.5) causes tall, peaked T waves, widened QRS, and
possible cardiac arrest. Flattened T waves (A) and prominent U waves (B) occur with
hypokalemia. Prolonged PR interval (D) is seen in first-degree heart block, not
specifically hyperkalemia.
Question 4
A nurse is caring for a client with heart failure who presents with shortness of breath,
jugular vein distention, and peripheral edema. Which intervention should the nurse
implement first?
A. Administer furosemide as prescribed
B. Place the client in a high-Fowler's position
C. Restrict daily fluid intake to 1.5 liters
D. Apply sequential compression devices
Correct answer: B
Rationale: High-Fowler's position promotes lung expansion and reduces venous return,
easing dyspnea. While furosemide (A) and fluid restriction (C) are important,
positioning is the immediate priority to improve oxygenation. Sequential compression
devices (D) are for DVT prevention, not acute heart failure.
Question 6
A patient post-MI develops a new harsh holosystolic murmur at the left lower sternal
border. Which complication is most likely?
A. Papillary muscle rupture
B. Ventricular septal rupture
C. Free wall rupture
D. Pericarditis
Correct Answer: B
Rationale: A new holosystolic murmur at the left lower sternal border after MI suggests
ventricular septal rupture (VSD), which creates a left-to-right shunt. Papillary muscle
rupture (A) causes acute mitral regurgitation with a systolic murmur at the apex. Free
wall rupture (C) leads to tamponade and pulseless electrical activity. Pericarditis (D)
causes a friction rub, not a holosystolic murmur.
,Question 7
A patient with chronic kidney disease (stage 4) has a potassium of 6.2 mEq/L. Which
ECG finding is most concerning?
A. Flattened T waves
B. Prominent U waves
C. Peaked T waves
D. Prolonged PR interval
Correct Answer: C
Rationale: Hyperkalemia (K⁺ > 5.5 mEq/L) causes tall, peaked T waves, widened QRS,
and possible cardiac arrest. Flattened T waves (A) and prominent U waves (B) occur
with hypokalemia. Prolonged PR interval (D) is seen in first-degree heart block, not
specifically hyperkalemia.
Question 8
The nurse is teaching a client with type 1 diabetes about sick-day management.
Which statement indicates correct understanding?
A. "I will stop my insulin until my fever goes away."
B. "I will check my blood glucose every 4 hours."
C. "I will drink sugar-free liquids to avoid hyperglycemia."
D. "I will only take my metformin if I eat something."
Correct Answer: B
Rationale: During illness, blood glucose should be checked every 4 hours due to stress-
induced hyperglycemia. Insulin should never be stopped (A); it may be increased.
Sugary liquids are needed if glucose is low (C). Metformin (D) is not used in type 1
diabetes; sick-day management focuses on insulin.
Question 9
A client with cirrhosis develops ascites and hepatic encephalopathy. Which dietary
restriction should the nurse anticipate?
A. High-protein diet
B. Low-sodium diet
C. Increased fat intake
D. Fluid restriction to 1 L/day
, Correct Answer: B
Rationale: Ascites management requires sodium restriction to reduce fluid retention.
Protein should be adequate but not necessarily high (A) due to encephalopathy risk.
Increased fat (C) is not indicated. Fluid restriction (D) may be used in severe cases but is
not the primary dietary restriction for ascites.
Question 10
A nurse is assessing a client one hour after an abdominal hysterectomy. The client's
dressing has a small amount of serosanguineous drainage, and vital signs are stable.
Which action should the nurse take first?
A. Reinforce the dressing and document the finding
B. Notify the surgeon immediately
C. Mark the drainage border and reassess in one hour
D. Apply a pressure dressing to the site
Correct Answer: C
Rationale: A small amount of serosanguineous drainage is expected after surgery.
Marking the border allows objective evaluation of whether bleeding is increasing, which
is the priority nursing action before escalating care. Reinforcing the dressing (A) is
appropriate but does not provide objective data. Notifying the surgeon (B) is
premature. A pressure dressing (D) is not indicated for expected drainage.
Question 11
A patient with pneumonia has RR 32/min, O₂ sat 88% on room air, and crackles in
both lower lobes. What is the nurse's priority?
A. Encourage fluids
B. Obtain sputum culture
C. Apply oxygen
D. Administer ordered azithromycin
Correct Answer: C. Apply oxygen
Rationale: Hypoxemia is the immediate risk; oxygenation always comes before
diagnostics or medications.
Question 12
A patient with COPD is receiving 2 L/min O₂ via nasal cannula. Which finding requires
immediate action?
NURSING FINAL EXAM 2026/2027:
150 PRACTICE QUESTIONS WITH
BOLDED ANSWERS AND DETAILED
RATIONALES
Question 1
A 68-year-old male with heart failure presents with weight gain, jugular venous
distension, and bilateral lower extremity edema. Which dietary instruction is most
important?
A. Increase fluid intake to 3 L/day
B. Restrict sodium to < 2 g/day
C. Increase potassium-rich foods
D. Restrict protein intake
Correct answer: B
Rationale: Sodium restriction reduces fluid retention (B). Increased fluid (A) worsens
edema. Potassium (C) is not primary. Protein restriction (D) is not indicated in heart
failure.
Question 2
A patient with COPD has an SpO₂ of 88% on room air and a PaCO₂ of 58 mmHg.
Which oxygen delivery method is safest?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 2 L/min (24% FiO₂)
C. Nasal cannula at 6 L/min
D. Simple face mask at 10 L/min
Correct answer: B
Rationale: COPD with hypercapnia needs controlled O₂ (Venturi) to avoid suppressing
respiratory drive (B). High flow (A, C, D) can worsen hypercapnia.
Question 3
A client with chronic kidney disease has a potassium level of 6.8 mEq/L. Which
electrocardiogram change should the nurse expect?
,A. Flattened T waves
B. Prominent U waves
C. Tall, peaked T waves
D. Prolonged PR interval
Correct answer: C
Rationale: Hyperkalemia (K+ > 5.5) causes tall, peaked T waves, widened QRS, and
possible cardiac arrest. Flattened T waves (A) and prominent U waves (B) occur with
hypokalemia. Prolonged PR interval (D) is seen in first-degree heart block, not
specifically hyperkalemia.
Question 4
A nurse is caring for a client with heart failure who presents with shortness of breath,
jugular vein distention, and peripheral edema. Which intervention should the nurse
implement first?
A. Administer furosemide as prescribed
B. Place the client in a high-Fowler's position
C. Restrict daily fluid intake to 1.5 liters
D. Apply sequential compression devices
Correct answer: B
Rationale: High-Fowler's position promotes lung expansion and reduces venous return,
easing dyspnea. While furosemide (A) and fluid restriction (C) are important,
positioning is the immediate priority to improve oxygenation. Sequential compression
devices (D) are for DVT prevention, not acute heart failure.
Question 6
A patient post-MI develops a new harsh holosystolic murmur at the left lower sternal
border. Which complication is most likely?
A. Papillary muscle rupture
B. Ventricular septal rupture
C. Free wall rupture
D. Pericarditis
Correct Answer: B
Rationale: A new holosystolic murmur at the left lower sternal border after MI suggests
ventricular septal rupture (VSD), which creates a left-to-right shunt. Papillary muscle
rupture (A) causes acute mitral regurgitation with a systolic murmur at the apex. Free
wall rupture (C) leads to tamponade and pulseless electrical activity. Pericarditis (D)
causes a friction rub, not a holosystolic murmur.
,Question 7
A patient with chronic kidney disease (stage 4) has a potassium of 6.2 mEq/L. Which
ECG finding is most concerning?
A. Flattened T waves
B. Prominent U waves
C. Peaked T waves
D. Prolonged PR interval
Correct Answer: C
Rationale: Hyperkalemia (K⁺ > 5.5 mEq/L) causes tall, peaked T waves, widened QRS,
and possible cardiac arrest. Flattened T waves (A) and prominent U waves (B) occur
with hypokalemia. Prolonged PR interval (D) is seen in first-degree heart block, not
specifically hyperkalemia.
Question 8
The nurse is teaching a client with type 1 diabetes about sick-day management.
Which statement indicates correct understanding?
A. "I will stop my insulin until my fever goes away."
B. "I will check my blood glucose every 4 hours."
C. "I will drink sugar-free liquids to avoid hyperglycemia."
D. "I will only take my metformin if I eat something."
Correct Answer: B
Rationale: During illness, blood glucose should be checked every 4 hours due to stress-
induced hyperglycemia. Insulin should never be stopped (A); it may be increased.
Sugary liquids are needed if glucose is low (C). Metformin (D) is not used in type 1
diabetes; sick-day management focuses on insulin.
Question 9
A client with cirrhosis develops ascites and hepatic encephalopathy. Which dietary
restriction should the nurse anticipate?
A. High-protein diet
B. Low-sodium diet
C. Increased fat intake
D. Fluid restriction to 1 L/day
, Correct Answer: B
Rationale: Ascites management requires sodium restriction to reduce fluid retention.
Protein should be adequate but not necessarily high (A) due to encephalopathy risk.
Increased fat (C) is not indicated. Fluid restriction (D) may be used in severe cases but is
not the primary dietary restriction for ascites.
Question 10
A nurse is assessing a client one hour after an abdominal hysterectomy. The client's
dressing has a small amount of serosanguineous drainage, and vital signs are stable.
Which action should the nurse take first?
A. Reinforce the dressing and document the finding
B. Notify the surgeon immediately
C. Mark the drainage border and reassess in one hour
D. Apply a pressure dressing to the site
Correct Answer: C
Rationale: A small amount of serosanguineous drainage is expected after surgery.
Marking the border allows objective evaluation of whether bleeding is increasing, which
is the priority nursing action before escalating care. Reinforcing the dressing (A) is
appropriate but does not provide objective data. Notifying the surgeon (B) is
premature. A pressure dressing (D) is not indicated for expected drainage.
Question 11
A patient with pneumonia has RR 32/min, O₂ sat 88% on room air, and crackles in
both lower lobes. What is the nurse's priority?
A. Encourage fluids
B. Obtain sputum culture
C. Apply oxygen
D. Administer ordered azithromycin
Correct Answer: C. Apply oxygen
Rationale: Hypoxemia is the immediate risk; oxygenation always comes before
diagnostics or medications.
Question 12
A patient with COPD is receiving 2 L/min O₂ via nasal cannula. Which finding requires
immediate action?
