Jersey College MedSurg 1 RN Final Exam
2026 – Actual Exam with Verified
Questions & Correct Solutions
Jersey College Med-Surg 1 RN Final Exam 2026 - Practice Q&A
1. A client with a suspected pulmonary embolism is anxious and reports sudden, sharp chest
pain and shortness of breath. Which action should the nurse take first?
A. Administer prescribed morphine sulfate IV.
B. Apply supplemental oxygen via nasal cannula.
C. Obtain a stat electrocardiogram (ECG).
D. Assist the client into a High-Fowler's position.
Answer: B. Apply supplemental oxygen via nasal cannula.
Rationale: The first priority is the ABCs (Airway, Breathing, Circulation). Hypoxia is a primary and
life-threatening concern in a pulmonary embolism. Applying oxygen addresses the impaired gas
exchange immediately. While the other options are important, they come after addressing the
immediate oxygen need.
2. The nurse is caring for a client with a sodium level of 118 mEq/L. Which assessment finding
is the nurse most likely to observe?
A. Polyuria and polydipsia.
B. Bounding peripheral pulses.
C. Muscle twitching and hyperreflexia.
D. Generalized edema.
Answer: C. Muscle twitching and hyperreflexia.
Rationale: A sodium level of 118 mEq/L indicates severe hyponatremia. Neurological symptoms
are prominent due to water shifting into brain cells, causing cerebral edema. This manifests as
muscle twitching, hyperreflexia, confusion, seizures, and can progress to coma. Polyuria is seen
in hypernatremia; bounding pulses and edema are not direct symptoms of hyponatremia.
3. A client with Crohn's disease is receiving total parenteral nutrition (TPN). The nurse notices
a crackle in the lung bases and jugular venous distention. What is the nurse's most
appropriate initial action?
A. Stop the TPN infusion immediately.
B. Slow the TPN infusion and assess vital signs.
,C. Administer a prescribed diuretic.
D. Encourage the client to cough and deep breathe.
Answer: B. Slow the TPN infusion and assess vital signs.
Rationale: The symptoms (crackles, JVD) suggest fluid volume overload, a potential
complication of TPN due to its high solute load. The initial action is to slow the infusion to
prevent further overload and perform a thorough assessment (vital signs, oxygen saturation) to
guide further intervention. Stopping TPN abruptly is not indicated unless the situation is critical.
Diuretics may be prescribed later based on the assessment.
4. When assessing a client with Cushing's syndrome, the nurse expects to find:
A. Weight loss, tremors, and exophthalmos.
B. Hyperpigmentation, hypotension, and hyponatremia.
C. Truncal obesity, moon face, and buffalo hump.
D. Fine hair, cold intolerance, and bradycardia.
Answer: C. Truncal obesity, moon face, and buffalo hump.
Rationale: Cushing's syndrome is characterized by chronic excess cortisol, which causes a
redistribution of fat, leading to truncal obesity, a rounded "moon" face, and a fat pad on the
back of the neck ("buffalo hump"). Weight loss (A) is associated with hyperthyroidism;
hyperpigmentation (B) is seen in Addison's disease; and cold intolerance (D) is seen in
hypothyroidism.
5. A client with a head injury has clear fluid draining from the nose. Which action is most
important for the nurse to take?
A. Test the fluid with a dextrose stick.
B. Suction the nose to maintain airway patency.
C. Place the client in a semi-Fowler's position.
D. Pack the nostrils with sterile gauze.
Answer: A. Test the fluid with a dextrose stick.
Rationale: Clear drainage from the nose or ears after a head injury could be cerebrospinal fluid
(CSF). CSF tests positive for glucose (dextrose) on a test strip, while normal nasal mucus does
not. This is a critical finding indicating a basilar skull fracture. Suctioning (B) is contraindicated as
it could introduce infection; packing the nose (D) is also contraindicated as it can increase
intracranial pressure.
6. The nurse is preparing to administer warfarin (Coumadin) to a client. Which laboratory
value is most critical to review before administration?
A. Activated Partial Thromboplastin Time (aPTT).
B. International Normalized Ratio (INR).
,C. Prothrombin Time (PT).
D. Platelet count.
Answer: B. International Normalized Ratio (INR).
Rationale: Warfarin is a vitamin K antagonist anticoagulant. The INR is the standardized test
used to monitor its effectiveness and ensure the client is within the therapeutic range (usually
2.0-3.0 for most indications). While the PT is also elevated, the INR is the preferred and most
reliable value.
7. A client with a history of heart failure is prescribed furosemide (Lasix) 40 mg IV. One hour
after administration, which finding best indicates the medication is effective?
A. A decrease in blood pressure.
B. A weight loss of 1 kg.
C. An increase in urine output.
D. Relief from peripheral edema.
Answer: C. An increase in urine output.
Rationale: Furosemide is a loop diuretic with a rapid onset. The most immediate and direct
indicator of its effectiveness is a significant increase in urine output (diuresis) within the first
hour. Weight loss and relief of edema are longer-term outcomes.
8. A client with type 1 diabetes has a blood glucose level of 55 mg/dL. The client is alert and
oriented. What is the most appropriate initial nursing action?
A. Administer 1 mg of glucagon IM.
B. Provide 4 oz of fruit juice.
C. Give the client a complex carbohydrate and protein.
D. Notify the healthcare provider immediately.
Answer: B. Provide 4 oz of fruit juice.
Rationale: For a conscious client with hypoglycemia, the rule of "15-15" applies: administer 15
grams of a fast-acting carbohydrate (like 4 oz of juice or regular soda) and recheck blood sugar
in 15 minutes. Glucagon (A) is for unconscious clients. A complex carb (C) is given after the
blood sugar stabilizes to prevent recurrence.
9. The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) about
breathing techniques. Which instruction is correct?
A. "Use diaphragmatic breathing, inhaling through your nose and exhaling slowly through
pursed lips."
B. "Take rapid, shallow breaths to improve carbon dioxide elimination."
C. "Breathe in quickly through your mouth and exhale normally."
D. "Avoid using pursed-lip breathing as it can increase the work of breathing."
, Answer: A. "Use diaphragmatic breathing, inhaling through your nose and exhaling slowly
through pursed lips."
Rationale: Pursed-lip breathing prolongs exhalation, keeps the airways open longer, and
prevents air trapping, which is a key problem in COPD. Diaphragmatic breathing improves
ventilation efficiency.
10. A client with a new ileostomy is concerned about the odor from the drainage. Which
suggestion by the nurse is most helpful?
A. "Limit your fluid intake to thicken the output."
B. "Avoid eating green leafy vegetables and beans."
C. "Place a deodorizer tablet in the ostomy pouch."
D. "Irrigate the ileostomy daily to regulate output."
Answer: C. "Place a deodorizer tablet in the ostomy pouch."
Rationale: Ostomy deodorizer tablets are safe and effective for controlling odor. Limiting fluids
(A) is dangerous and can lead to dehydration. While some foods can cause gas, blanket
avoidance (B) is not necessary. Ileostomies cannot be irrigated (D); this is a procedure for some
colostomies.
11. A client with pancreatitis has severe abdominal pain. Which position should the nurse
encourage to provide comfort?
A. Supine with legs extended.
B. Lying on the side with the head elevated.
C. Knee-chest position.
D. Sitting upright, leaning forward.
Answer: D. Sitting upright, leaning forward.
Rationale: This position takes pressure off the inflamed pancreas and the surrounding nerves,
which can help alleviate pain. The supine position often exacerbates the pain.
12. The nurse is assessing a client with a cast on the lower leg. Which finding is a priority and
should be reported immediately?
A. The client reports itching under the cast.
B. Capillary refill is 4 seconds in the toes.
C. Petechiae are noted on the chest.
D. The client can only wiggle toes with significant effort.
Answer: B. Capillary refill is 4 seconds in the toes.
Rationale: A capillary refill time greater than 3 seconds indicates impaired circulation and is a
sign of compartment syndrome, a medical emergency. Itching (A) is common. Petechiae (C) are
2026 – Actual Exam with Verified
Questions & Correct Solutions
Jersey College Med-Surg 1 RN Final Exam 2026 - Practice Q&A
1. A client with a suspected pulmonary embolism is anxious and reports sudden, sharp chest
pain and shortness of breath. Which action should the nurse take first?
A. Administer prescribed morphine sulfate IV.
B. Apply supplemental oxygen via nasal cannula.
C. Obtain a stat electrocardiogram (ECG).
D. Assist the client into a High-Fowler's position.
Answer: B. Apply supplemental oxygen via nasal cannula.
Rationale: The first priority is the ABCs (Airway, Breathing, Circulation). Hypoxia is a primary and
life-threatening concern in a pulmonary embolism. Applying oxygen addresses the impaired gas
exchange immediately. While the other options are important, they come after addressing the
immediate oxygen need.
2. The nurse is caring for a client with a sodium level of 118 mEq/L. Which assessment finding
is the nurse most likely to observe?
A. Polyuria and polydipsia.
B. Bounding peripheral pulses.
C. Muscle twitching and hyperreflexia.
D. Generalized edema.
Answer: C. Muscle twitching and hyperreflexia.
Rationale: A sodium level of 118 mEq/L indicates severe hyponatremia. Neurological symptoms
are prominent due to water shifting into brain cells, causing cerebral edema. This manifests as
muscle twitching, hyperreflexia, confusion, seizures, and can progress to coma. Polyuria is seen
in hypernatremia; bounding pulses and edema are not direct symptoms of hyponatremia.
3. A client with Crohn's disease is receiving total parenteral nutrition (TPN). The nurse notices
a crackle in the lung bases and jugular venous distention. What is the nurse's most
appropriate initial action?
A. Stop the TPN infusion immediately.
B. Slow the TPN infusion and assess vital signs.
,C. Administer a prescribed diuretic.
D. Encourage the client to cough and deep breathe.
Answer: B. Slow the TPN infusion and assess vital signs.
Rationale: The symptoms (crackles, JVD) suggest fluid volume overload, a potential
complication of TPN due to its high solute load. The initial action is to slow the infusion to
prevent further overload and perform a thorough assessment (vital signs, oxygen saturation) to
guide further intervention. Stopping TPN abruptly is not indicated unless the situation is critical.
Diuretics may be prescribed later based on the assessment.
4. When assessing a client with Cushing's syndrome, the nurse expects to find:
A. Weight loss, tremors, and exophthalmos.
B. Hyperpigmentation, hypotension, and hyponatremia.
C. Truncal obesity, moon face, and buffalo hump.
D. Fine hair, cold intolerance, and bradycardia.
Answer: C. Truncal obesity, moon face, and buffalo hump.
Rationale: Cushing's syndrome is characterized by chronic excess cortisol, which causes a
redistribution of fat, leading to truncal obesity, a rounded "moon" face, and a fat pad on the
back of the neck ("buffalo hump"). Weight loss (A) is associated with hyperthyroidism;
hyperpigmentation (B) is seen in Addison's disease; and cold intolerance (D) is seen in
hypothyroidism.
5. A client with a head injury has clear fluid draining from the nose. Which action is most
important for the nurse to take?
A. Test the fluid with a dextrose stick.
B. Suction the nose to maintain airway patency.
C. Place the client in a semi-Fowler's position.
D. Pack the nostrils with sterile gauze.
Answer: A. Test the fluid with a dextrose stick.
Rationale: Clear drainage from the nose or ears after a head injury could be cerebrospinal fluid
(CSF). CSF tests positive for glucose (dextrose) on a test strip, while normal nasal mucus does
not. This is a critical finding indicating a basilar skull fracture. Suctioning (B) is contraindicated as
it could introduce infection; packing the nose (D) is also contraindicated as it can increase
intracranial pressure.
6. The nurse is preparing to administer warfarin (Coumadin) to a client. Which laboratory
value is most critical to review before administration?
A. Activated Partial Thromboplastin Time (aPTT).
B. International Normalized Ratio (INR).
,C. Prothrombin Time (PT).
D. Platelet count.
Answer: B. International Normalized Ratio (INR).
Rationale: Warfarin is a vitamin K antagonist anticoagulant. The INR is the standardized test
used to monitor its effectiveness and ensure the client is within the therapeutic range (usually
2.0-3.0 for most indications). While the PT is also elevated, the INR is the preferred and most
reliable value.
7. A client with a history of heart failure is prescribed furosemide (Lasix) 40 mg IV. One hour
after administration, which finding best indicates the medication is effective?
A. A decrease in blood pressure.
B. A weight loss of 1 kg.
C. An increase in urine output.
D. Relief from peripheral edema.
Answer: C. An increase in urine output.
Rationale: Furosemide is a loop diuretic with a rapid onset. The most immediate and direct
indicator of its effectiveness is a significant increase in urine output (diuresis) within the first
hour. Weight loss and relief of edema are longer-term outcomes.
8. A client with type 1 diabetes has a blood glucose level of 55 mg/dL. The client is alert and
oriented. What is the most appropriate initial nursing action?
A. Administer 1 mg of glucagon IM.
B. Provide 4 oz of fruit juice.
C. Give the client a complex carbohydrate and protein.
D. Notify the healthcare provider immediately.
Answer: B. Provide 4 oz of fruit juice.
Rationale: For a conscious client with hypoglycemia, the rule of "15-15" applies: administer 15
grams of a fast-acting carbohydrate (like 4 oz of juice or regular soda) and recheck blood sugar
in 15 minutes. Glucagon (A) is for unconscious clients. A complex carb (C) is given after the
blood sugar stabilizes to prevent recurrence.
9. The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) about
breathing techniques. Which instruction is correct?
A. "Use diaphragmatic breathing, inhaling through your nose and exhaling slowly through
pursed lips."
B. "Take rapid, shallow breaths to improve carbon dioxide elimination."
C. "Breathe in quickly through your mouth and exhale normally."
D. "Avoid using pursed-lip breathing as it can increase the work of breathing."
, Answer: A. "Use diaphragmatic breathing, inhaling through your nose and exhaling slowly
through pursed lips."
Rationale: Pursed-lip breathing prolongs exhalation, keeps the airways open longer, and
prevents air trapping, which is a key problem in COPD. Diaphragmatic breathing improves
ventilation efficiency.
10. A client with a new ileostomy is concerned about the odor from the drainage. Which
suggestion by the nurse is most helpful?
A. "Limit your fluid intake to thicken the output."
B. "Avoid eating green leafy vegetables and beans."
C. "Place a deodorizer tablet in the ostomy pouch."
D. "Irrigate the ileostomy daily to regulate output."
Answer: C. "Place a deodorizer tablet in the ostomy pouch."
Rationale: Ostomy deodorizer tablets are safe and effective for controlling odor. Limiting fluids
(A) is dangerous and can lead to dehydration. While some foods can cause gas, blanket
avoidance (B) is not necessary. Ileostomies cannot be irrigated (D); this is a procedure for some
colostomies.
11. A client with pancreatitis has severe abdominal pain. Which position should the nurse
encourage to provide comfort?
A. Supine with legs extended.
B. Lying on the side with the head elevated.
C. Knee-chest position.
D. Sitting upright, leaning forward.
Answer: D. Sitting upright, leaning forward.
Rationale: This position takes pressure off the inflamed pancreas and the surrounding nerves,
which can help alleviate pain. The supine position often exacerbates the pain.
12. The nurse is assessing a client with a cast on the lower leg. Which finding is a priority and
should be reported immediately?
A. The client reports itching under the cast.
B. Capillary refill is 4 seconds in the toes.
C. Petechiae are noted on the chest.
D. The client can only wiggle toes with significant effort.
Answer: B. Capillary refill is 4 seconds in the toes.
Rationale: A capillary refill time greater than 3 seconds indicates impaired circulation and is a
sign of compartment syndrome, a medical emergency. Itching (A) is common. Petechiae (C) are
