MEDICAL-SURGICAL NURSING 2026/2027 |
Comprehensive Board-Style Practice
Questions & Verified Detailed Answers Study
Guide
Section 1: Questions 1–70
1. A nurse is receiving change-of-shift report on four clients. Which client should the
nurse assess first?
A. A client with a dressing that needs reinforcement.
B. A client reporting pain rated 6/10.
C. A client whose urinary output was 100 mL in 12 hours.
D. A client scheduled for discharge in 2 hours.
Rationale: Urinary output of 100 mL over 12 hours equals approximately 8 mL/hour,
significantly below the expected minimum of 30 mL/hour. This finding suggests acute
kidney injury or severe hypovolemia and requires immediate assessment .
2. A charge nurse is assigning rooms for four clients. Which client should be placed in a
private room?
A. A client with pneumonia.
B. A client with Clostridioides difficile infection.
C. A client with cellulitis.
D. A client with a urinary tract infection.
Rationale: C. difficile requires contact precautions and a private room to prevent spore
transmission. Cellulitis and urinary tract infections require only standard precautions .
3. A nurse is delegating tasks to a licensed practical nurse (LPN). Which task is
appropriate to delegate?
A. Performing the initial admission assessment.
B. Inserting a nasogastric tube for decompression.
C. Teaching a client about insulin self-administration.
D. Evaluating the effectiveness of pain medication.
Rationale: LPNs can perform stable, standard procedures such as nasogastric tube
insertion when permitted by facility policy. Initial assessments, client teaching, and
evaluation of medication effectiveness require RN scope of practice .
4. A nurse is caring for a confused client who is attempting to pull out an IV line. The
provider orders restraints. Which action should the nurse take before applying
restraints?
A. Obtain verbal consent from the client.
B. Try less restrictive measures first.
C. Restrain all four extremities for maximum safety.
D. Apply restraints without documentation to save time.
, Rationale: Restraints are a last resort and require the nurse to attempt less restrictive
measures first, such as repositioning, using a sitter, or providing diversions.
Documentation is mandatory .
5. A nurse is caring for a client who is 4 hours postoperative following a transurethral
resection of the prostate (TURP). Which finding is the priority to report to the
provider?
A. Thick, red-colored urine.
B. Complaints of bladder spasms.
C. Continuous bladder irrigation infusing at 40 mL/hour.
D. Urine output of 100 mL in the past 4 hours.
Rationale: Thick, red-colored urine indicates active bleeding, a complication of TURP
requiring immediate provider notification. Pink-tinged urine is expected postoperatively
.
6. A nurse is caring for a client who has a temperature of 39.7°C (103.5°F) and has a
prescription for a hypothermia blanket. The nurse should monitor the client for which
adverse effect?
A. Tachycardia.
B. Shivering.
C. Hypertension.
D. Hyperglycemia.
Rationale: Shivering is a common adverse effect of rapid cooling. Shivering increases
metabolic rate and oxygen demand, which can worsen the client's condition .
7. A client with chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which
medication should the nurse anticipate administering first?
A. Sodium polystyrene sulfonate.
B. IV regular insulin and IV dextrose.
C. Calcium gluconate IV.
D. Furosemide.
Rationale: A potassium level of 6.8 mEq/L is severely elevated and places the client at
high risk for life-threatening cardiac dysrhythmias. IV calcium gluconate is given first
to stabilize the cardiac cell membrane. It does not lower potassium but buys time for
other therapies .
8. A nurse is caring for a client with a chest tube to water seal drainage. The nurse notes
continuous bubbling in the water seal chamber. What is the priority nursing action?
A. Clamp the chest tube immediately.
B. Notify the healthcare provider.
C. Locate the source of the air leak.
D. Document the finding as normal.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. The
nurse should systematically check connections from the patient to the drainage unit to
locate and correct the leak. Clamping is contraindicated due to risk of tension
pneumothorax .
,9. A client is receiving a unit of packed red blood cells. Thirty minutes into the infusion,
the client reports chills and back pain. What is the nurse's priority action?
A. Slow the infusion rate.
B. Administer prescribed acetaminophen.
C. Stop the transfusion immediately.
D. Notify the blood bank.
Rationale: Chills and back pain are classic signs of an acute hemolytic transfusion
reaction, which is life-threatening. The priority is to stop the transfusion immediately .
10. A client with cirrhosis is experiencing confusion and asterixis. The nurse should
anticipate which medication order?
A. Lactulose PO or via NG tube.
B. Neomycin IV.
C. Furosemide IV.
D. Vitamin K IM.
Rationale: The client is demonstrating signs of hepatic encephalopathy caused by
accumulation of ammonia. Lactulose acidifies the colon, converting ammonia to
ammonium, which is trapped and excreted in stool .
11. A client is admitted with a diagnosis of infective endocarditis. Which assessment
finding is most specific to this condition?
A. Chest pain radiating to the left arm.
B. Osler's nodes and Janeway lesions.
C. Bilateral crackles.
D. Jugular venous distention.
Rationale: Osler's nodes (painful, red lesions on fingertips) and Janeway lesions
(painless, red lesions on palms and soles) are classic manifestations of infective
endocarditis .
12. A nurse is caring for a client who is 2 days postoperative following a total hip
arthroplasty. Which finding should the nurse report to the provider immediately?
A. Pain rating of 5 on a 0-to-10 scale.
B. Serosanguinous drainage on the surgical dressing.
C. Calf swelling and redness on the operative leg.
D. Temperature of 37.5°C (99.5°F).
Rationale: Calf swelling, redness, and warmth are classic signs of deep vein thrombosis,
a serious complication following hip surgery that requires immediate intervention to
prevent pulmonary embolism .
13. A client with heart failure is prescribed furosemide. Which laboratory value should
the nurse monitor most closely?
A. Serum sodium.
B. Serum potassium.
C. Serum calcium.
D. Serum magnesium.
Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to
, hypokalemia. Hypokalemia increases the risk of cardiac dysrhythmias and digoxin
toxicity .
14. A client with type 2 diabetes mellitus is being discharged. Which statement indicates
understanding of disease management?
A. "I will check my feet weekly for any sores or cuts."
B. "I will need to have my eyes examined by an ophthalmologist every year."
C. "I can stop my medication once my blood glucose levels are normal."
D. "I will only check my blood sugar when I feel sick."
Rationale: Annual dilated eye examinations are recommended for clients with diabetes
to detect retinopathy. Foot checks should be daily, medications should not be stopped
without provider guidance, and blood glucose should be monitored regularly .
15. A nurse is assessing a client who has a new prescription for enoxaparin. Which action
should the nurse take?
A. Administer the medication via the IM route.
B. Expel the air bubble from the prefilled syringe.
C. Inject the medication into the abdomen.
D. Aspirate for blood return before injection.
Rationale: Enoxaparin is a low-molecular-weight heparin administered subcutaneously
into the abdomen. The air bubble should not be expelled, and aspiration is unnecessary
.
16. A nurse is caring for a client who has a new prescription for captopril. The nurse
should instruct the client to monitor for and report which adverse effect?
A. Angioedema.
B. Insomnia.
C. Constipation.
D. Bradycardia.
Rationale: Angioedema is a serious and potentially life-threatening adverse effect of
ACE inhibitors. Clients must seek immediate medical attention if swelling of the face,
lips, tongue, or throat occurs.
17. A nurse is providing teaching to a client who has a new prescription for warfarin.
Which statement indicates the client needs further instruction?
A. "I will use a soft toothbrush to prevent bleeding gums."
B. "I will avoid eating large amounts of leafy green vegetables."
C. "I will take aspirin for headaches without checking with my provider."
D. "I will wear a medical alert bracelet."
Rationale: Aspirin and other NSAIDs increase the risk of bleeding when taken with
warfarin. Clients should consult their provider before taking any over-the-counter
medications.
18. A nurse is caring for a client who has been diagnosed with active tuberculosis. Which
type of isolation precautions should the nurse implement?
A. Contact precautions.
B. Droplet precautions.
C. Airborne precautions.
Comprehensive Board-Style Practice
Questions & Verified Detailed Answers Study
Guide
Section 1: Questions 1–70
1. A nurse is receiving change-of-shift report on four clients. Which client should the
nurse assess first?
A. A client with a dressing that needs reinforcement.
B. A client reporting pain rated 6/10.
C. A client whose urinary output was 100 mL in 12 hours.
D. A client scheduled for discharge in 2 hours.
Rationale: Urinary output of 100 mL over 12 hours equals approximately 8 mL/hour,
significantly below the expected minimum of 30 mL/hour. This finding suggests acute
kidney injury or severe hypovolemia and requires immediate assessment .
2. A charge nurse is assigning rooms for four clients. Which client should be placed in a
private room?
A. A client with pneumonia.
B. A client with Clostridioides difficile infection.
C. A client with cellulitis.
D. A client with a urinary tract infection.
Rationale: C. difficile requires contact precautions and a private room to prevent spore
transmission. Cellulitis and urinary tract infections require only standard precautions .
3. A nurse is delegating tasks to a licensed practical nurse (LPN). Which task is
appropriate to delegate?
A. Performing the initial admission assessment.
B. Inserting a nasogastric tube for decompression.
C. Teaching a client about insulin self-administration.
D. Evaluating the effectiveness of pain medication.
Rationale: LPNs can perform stable, standard procedures such as nasogastric tube
insertion when permitted by facility policy. Initial assessments, client teaching, and
evaluation of medication effectiveness require RN scope of practice .
4. A nurse is caring for a confused client who is attempting to pull out an IV line. The
provider orders restraints. Which action should the nurse take before applying
restraints?
A. Obtain verbal consent from the client.
B. Try less restrictive measures first.
C. Restrain all four extremities for maximum safety.
D. Apply restraints without documentation to save time.
, Rationale: Restraints are a last resort and require the nurse to attempt less restrictive
measures first, such as repositioning, using a sitter, or providing diversions.
Documentation is mandatory .
5. A nurse is caring for a client who is 4 hours postoperative following a transurethral
resection of the prostate (TURP). Which finding is the priority to report to the
provider?
A. Thick, red-colored urine.
B. Complaints of bladder spasms.
C. Continuous bladder irrigation infusing at 40 mL/hour.
D. Urine output of 100 mL in the past 4 hours.
Rationale: Thick, red-colored urine indicates active bleeding, a complication of TURP
requiring immediate provider notification. Pink-tinged urine is expected postoperatively
.
6. A nurse is caring for a client who has a temperature of 39.7°C (103.5°F) and has a
prescription for a hypothermia blanket. The nurse should monitor the client for which
adverse effect?
A. Tachycardia.
B. Shivering.
C. Hypertension.
D. Hyperglycemia.
Rationale: Shivering is a common adverse effect of rapid cooling. Shivering increases
metabolic rate and oxygen demand, which can worsen the client's condition .
7. A client with chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which
medication should the nurse anticipate administering first?
A. Sodium polystyrene sulfonate.
B. IV regular insulin and IV dextrose.
C. Calcium gluconate IV.
D. Furosemide.
Rationale: A potassium level of 6.8 mEq/L is severely elevated and places the client at
high risk for life-threatening cardiac dysrhythmias. IV calcium gluconate is given first
to stabilize the cardiac cell membrane. It does not lower potassium but buys time for
other therapies .
8. A nurse is caring for a client with a chest tube to water seal drainage. The nurse notes
continuous bubbling in the water seal chamber. What is the priority nursing action?
A. Clamp the chest tube immediately.
B. Notify the healthcare provider.
C. Locate the source of the air leak.
D. Document the finding as normal.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. The
nurse should systematically check connections from the patient to the drainage unit to
locate and correct the leak. Clamping is contraindicated due to risk of tension
pneumothorax .
,9. A client is receiving a unit of packed red blood cells. Thirty minutes into the infusion,
the client reports chills and back pain. What is the nurse's priority action?
A. Slow the infusion rate.
B. Administer prescribed acetaminophen.
C. Stop the transfusion immediately.
D. Notify the blood bank.
Rationale: Chills and back pain are classic signs of an acute hemolytic transfusion
reaction, which is life-threatening. The priority is to stop the transfusion immediately .
10. A client with cirrhosis is experiencing confusion and asterixis. The nurse should
anticipate which medication order?
A. Lactulose PO or via NG tube.
B. Neomycin IV.
C. Furosemide IV.
D. Vitamin K IM.
Rationale: The client is demonstrating signs of hepatic encephalopathy caused by
accumulation of ammonia. Lactulose acidifies the colon, converting ammonia to
ammonium, which is trapped and excreted in stool .
11. A client is admitted with a diagnosis of infective endocarditis. Which assessment
finding is most specific to this condition?
A. Chest pain radiating to the left arm.
B. Osler's nodes and Janeway lesions.
C. Bilateral crackles.
D. Jugular venous distention.
Rationale: Osler's nodes (painful, red lesions on fingertips) and Janeway lesions
(painless, red lesions on palms and soles) are classic manifestations of infective
endocarditis .
12. A nurse is caring for a client who is 2 days postoperative following a total hip
arthroplasty. Which finding should the nurse report to the provider immediately?
A. Pain rating of 5 on a 0-to-10 scale.
B. Serosanguinous drainage on the surgical dressing.
C. Calf swelling and redness on the operative leg.
D. Temperature of 37.5°C (99.5°F).
Rationale: Calf swelling, redness, and warmth are classic signs of deep vein thrombosis,
a serious complication following hip surgery that requires immediate intervention to
prevent pulmonary embolism .
13. A client with heart failure is prescribed furosemide. Which laboratory value should
the nurse monitor most closely?
A. Serum sodium.
B. Serum potassium.
C. Serum calcium.
D. Serum magnesium.
Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to
, hypokalemia. Hypokalemia increases the risk of cardiac dysrhythmias and digoxin
toxicity .
14. A client with type 2 diabetes mellitus is being discharged. Which statement indicates
understanding of disease management?
A. "I will check my feet weekly for any sores or cuts."
B. "I will need to have my eyes examined by an ophthalmologist every year."
C. "I can stop my medication once my blood glucose levels are normal."
D. "I will only check my blood sugar when I feel sick."
Rationale: Annual dilated eye examinations are recommended for clients with diabetes
to detect retinopathy. Foot checks should be daily, medications should not be stopped
without provider guidance, and blood glucose should be monitored regularly .
15. A nurse is assessing a client who has a new prescription for enoxaparin. Which action
should the nurse take?
A. Administer the medication via the IM route.
B. Expel the air bubble from the prefilled syringe.
C. Inject the medication into the abdomen.
D. Aspirate for blood return before injection.
Rationale: Enoxaparin is a low-molecular-weight heparin administered subcutaneously
into the abdomen. The air bubble should not be expelled, and aspiration is unnecessary
.
16. A nurse is caring for a client who has a new prescription for captopril. The nurse
should instruct the client to monitor for and report which adverse effect?
A. Angioedema.
B. Insomnia.
C. Constipation.
D. Bradycardia.
Rationale: Angioedema is a serious and potentially life-threatening adverse effect of
ACE inhibitors. Clients must seek immediate medical attention if swelling of the face,
lips, tongue, or throat occurs.
17. A nurse is providing teaching to a client who has a new prescription for warfarin.
Which statement indicates the client needs further instruction?
A. "I will use a soft toothbrush to prevent bleeding gums."
B. "I will avoid eating large amounts of leafy green vegetables."
C. "I will take aspirin for headaches without checking with my provider."
D. "I will wear a medical alert bracelet."
Rationale: Aspirin and other NSAIDs increase the risk of bleeding when taken with
warfarin. Clients should consult their provider before taking any over-the-counter
medications.
18. A nurse is caring for a client who has been diagnosed with active tuberculosis. Which
type of isolation precautions should the nurse implement?
A. Contact precautions.
B. Droplet precautions.
C. Airborne precautions.
