MED-SURG NURSING 2026 FULL REVIEW
COMPANION | COMPLETE CHAPTER
STUDY GUIDE WITH KEY CLINICAL
CONCEPTS || UPDATED EDITION
<RECENT VERSION>
Section 1: Cardiovascular & Hematology
1. A client with atrial fibrillation is prescribed apixaban. The nurse's education should
emphasize which critical point?
a) "Have your blood drawn for INR levels weekly."
b) "This medication requires a subcutaneous injection."
c) "Report any signs of unusual bleeding or bruising immediately."
d) "Take this medication on a strictly empty stomach."
2. The hallmark symptom the nurse expects to find in a client with left-sided heart failure is:
a) Jugular venous distention
b) Hepatomegaly
c) Sacral edema
d) Crackles in the lung fields (pulmonary congestion)
3. During blood administration, a client develops chills, fever, and low back pain. The
nurse's priority action is to:
a) Slow the infusion rate and monitor vital signs.
b) Stop the transfusion, keep the IV line open with normal saline, and notify the provider.
c) Administer PRN acetaminophen and continue the transfusion.
d) Check for a hemoglobin and hematocrit reaction.
4. A client with a DVT is on a heparin infusion. The therapeutic goal for the activated partial
thromboplastin time (aPTT) is typically:
a) 1.5 to 2.5 times the control value.
,b) 2.0 to 3.0 times the control value.
c) Equal to the client's baseline.
d) 3.0 to 4.0 times the control value.
5. The most specific lab test to diagnose an acute myocardial infarction (MI) is:
a) Creatine kinase (CK)
b) Myoglobin
c) Troponin I or T
d) Lactate dehydrogenase (LDH)
Section 2: Respiratory
6. A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is
receiving oxygen at 4 L/min via nasal cannula. The client becomes somnolent. The nurse
suspects:
a) Hypoxemia
b) Oxygen-induced hypoventilation (CO2 narcosis)
c) Pneumothorax
d) Respiratory infection
7. The primary diagnostic test for pulmonary embolism (PE) is:
a) Chest X-ray
b) Arterial Blood Gas (ABG)
c) CT pulmonary angiography (CTPA)
d) D-dimer
8. When preparing a client for a thoracentesis, the nurse should position the client:
a) Lying flat on the affected side.
b) Sitting on the edge of the bed, leaning forward over a bedside table.
c) In a Trendelenburg position.
d) In a high-Fowler's position, leaning to the unaffected side.
9. A client with asthma is prescribed a fluticasone (inhaled corticosteroid) and albuterol
(SABA). The nurse teaches that the correct order for administration is:
a) Albuterol first, then fluticasone.
b) Fluticasone first, then albuterol.
c) Only use albuterol during an attack.
d) Mix both medications in the same nebulizer.
,10. Which finding in a client with a chest tube to water seal drainage is indicative of an air
leak?
a) Continuous bubbling in the water seal chamber
b) Tidaling in the water seal chamber with respiration.
c) Absence of drainage in the collection chamber.
d) Bloody drainage in the collection chamber.
Section 3: Endocrine & Diabetes
11. A client with Type 1 diabetes has polyuria, polydipsia, and Kussmaul respirations. Their
blood glucose is 650 mg/dL. The nurse anticipates which primary electrolyte imbalance?
a) Hyperkalemia
b) Hypocalcemia
c) Hyponatremia
d) Hypomagnesemia
12. The nurse is teaching a client about sick day rules for diabetes management. Which
instruction is correct?
a) "Stop taking your insulin or oral agents if you can't eat."
b) "Monitor your blood glucose at least every 4 hours and continue taking your medications."
c) "Only drink clear liquids until your blood sugar is normal."
d) "Exercise more to lower your elevated blood glucose."
13. A client with Addison's disease is at risk for adrenal crisis. Which finding requires
immediate intervention?
a) Blood pressure 88/50 mmHg and nausea
b) Weight gain of 2 lbs.
c) Mild hyperglycemia.
d) Skin hyperpigmentation.
14. For a client with hyperthyroidism (Graves' disease), the nurse should assess for which
cardinal sign?
a) Bradycardia and weight gain
b) Exophthalmos (protruding eyes)
c) Cold intolerance
d) Coarse, dry skin
, 15. The priority nursing action for a client with Syndrome of Inappropriate Antidiuretic
Hormone (SIADH) is:
a) Encouraging oral fluid intake.
b) Restricting fluid intake as prescribed.
c) Administering IV boluses of normal saline.
d) Monitoring for signs of dehydration.
Section 4: Renal & GU
16. A client with End-Stage Renal Disease (ESRD) on hemodialysis has a temporary femoral
vein catheter. The nurse should:
a) Use the catheter to draw routine blood work.
b) Keep the head of the bed elevated at least 30 degrees and keep the leg straight.
c) Use the catheter to administer IV fluids if needed.
d) Change the dressing daily using clean technique.
17. The most common early sign of acute kidney injury (AKI) is:
a) Oliguria
b) Hypertension
c) Uremic frost
d) Hyperkalemia
18. A client with a history of recurrent calcium oxalate kidney stones should be encouraged
to:
a) Limit calcium intake.
b) Increase dietary oxalate (spinach, nuts).
c) Increase fluid intake to 2.5-3L/day and limit sodium/protein.
d) Take vitamin C supplements.
19. After a transurethral resection of the prostate (TURP), continuous bladder irrigation (CBI)
is ordered. The nurse's goal is to:
a) Maintain urine output of at least 30 mL/hr.
b) Keep the drainage a clear, light pink color.
c) Irrigate with antibiotic solution.
d) Clamp the catheter for 30 minutes every 2 hours.
20. Peritoneal dialysis is preferred over hemodialysis for some clients because it:
a) Is faster and more efficient.
b) Provides more dietary freedom.
COMPANION | COMPLETE CHAPTER
STUDY GUIDE WITH KEY CLINICAL
CONCEPTS || UPDATED EDITION
<RECENT VERSION>
Section 1: Cardiovascular & Hematology
1. A client with atrial fibrillation is prescribed apixaban. The nurse's education should
emphasize which critical point?
a) "Have your blood drawn for INR levels weekly."
b) "This medication requires a subcutaneous injection."
c) "Report any signs of unusual bleeding or bruising immediately."
d) "Take this medication on a strictly empty stomach."
2. The hallmark symptom the nurse expects to find in a client with left-sided heart failure is:
a) Jugular venous distention
b) Hepatomegaly
c) Sacral edema
d) Crackles in the lung fields (pulmonary congestion)
3. During blood administration, a client develops chills, fever, and low back pain. The
nurse's priority action is to:
a) Slow the infusion rate and monitor vital signs.
b) Stop the transfusion, keep the IV line open with normal saline, and notify the provider.
c) Administer PRN acetaminophen and continue the transfusion.
d) Check for a hemoglobin and hematocrit reaction.
4. A client with a DVT is on a heparin infusion. The therapeutic goal for the activated partial
thromboplastin time (aPTT) is typically:
a) 1.5 to 2.5 times the control value.
,b) 2.0 to 3.0 times the control value.
c) Equal to the client's baseline.
d) 3.0 to 4.0 times the control value.
5. The most specific lab test to diagnose an acute myocardial infarction (MI) is:
a) Creatine kinase (CK)
b) Myoglobin
c) Troponin I or T
d) Lactate dehydrogenase (LDH)
Section 2: Respiratory
6. A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is
receiving oxygen at 4 L/min via nasal cannula. The client becomes somnolent. The nurse
suspects:
a) Hypoxemia
b) Oxygen-induced hypoventilation (CO2 narcosis)
c) Pneumothorax
d) Respiratory infection
7. The primary diagnostic test for pulmonary embolism (PE) is:
a) Chest X-ray
b) Arterial Blood Gas (ABG)
c) CT pulmonary angiography (CTPA)
d) D-dimer
8. When preparing a client for a thoracentesis, the nurse should position the client:
a) Lying flat on the affected side.
b) Sitting on the edge of the bed, leaning forward over a bedside table.
c) In a Trendelenburg position.
d) In a high-Fowler's position, leaning to the unaffected side.
9. A client with asthma is prescribed a fluticasone (inhaled corticosteroid) and albuterol
(SABA). The nurse teaches that the correct order for administration is:
a) Albuterol first, then fluticasone.
b) Fluticasone first, then albuterol.
c) Only use albuterol during an attack.
d) Mix both medications in the same nebulizer.
,10. Which finding in a client with a chest tube to water seal drainage is indicative of an air
leak?
a) Continuous bubbling in the water seal chamber
b) Tidaling in the water seal chamber with respiration.
c) Absence of drainage in the collection chamber.
d) Bloody drainage in the collection chamber.
Section 3: Endocrine & Diabetes
11. A client with Type 1 diabetes has polyuria, polydipsia, and Kussmaul respirations. Their
blood glucose is 650 mg/dL. The nurse anticipates which primary electrolyte imbalance?
a) Hyperkalemia
b) Hypocalcemia
c) Hyponatremia
d) Hypomagnesemia
12. The nurse is teaching a client about sick day rules for diabetes management. Which
instruction is correct?
a) "Stop taking your insulin or oral agents if you can't eat."
b) "Monitor your blood glucose at least every 4 hours and continue taking your medications."
c) "Only drink clear liquids until your blood sugar is normal."
d) "Exercise more to lower your elevated blood glucose."
13. A client with Addison's disease is at risk for adrenal crisis. Which finding requires
immediate intervention?
a) Blood pressure 88/50 mmHg and nausea
b) Weight gain of 2 lbs.
c) Mild hyperglycemia.
d) Skin hyperpigmentation.
14. For a client with hyperthyroidism (Graves' disease), the nurse should assess for which
cardinal sign?
a) Bradycardia and weight gain
b) Exophthalmos (protruding eyes)
c) Cold intolerance
d) Coarse, dry skin
, 15. The priority nursing action for a client with Syndrome of Inappropriate Antidiuretic
Hormone (SIADH) is:
a) Encouraging oral fluid intake.
b) Restricting fluid intake as prescribed.
c) Administering IV boluses of normal saline.
d) Monitoring for signs of dehydration.
Section 4: Renal & GU
16. A client with End-Stage Renal Disease (ESRD) on hemodialysis has a temporary femoral
vein catheter. The nurse should:
a) Use the catheter to draw routine blood work.
b) Keep the head of the bed elevated at least 30 degrees and keep the leg straight.
c) Use the catheter to administer IV fluids if needed.
d) Change the dressing daily using clean technique.
17. The most common early sign of acute kidney injury (AKI) is:
a) Oliguria
b) Hypertension
c) Uremic frost
d) Hyperkalemia
18. A client with a history of recurrent calcium oxalate kidney stones should be encouraged
to:
a) Limit calcium intake.
b) Increase dietary oxalate (spinach, nuts).
c) Increase fluid intake to 2.5-3L/day and limit sodium/protein.
d) Take vitamin C supplements.
19. After a transurethral resection of the prostate (TURP), continuous bladder irrigation (CBI)
is ordered. The nurse's goal is to:
a) Maintain urine output of at least 30 mL/hr.
b) Keep the drainage a clear, light pink color.
c) Irrigate with antibiotic solution.
d) Clamp the catheter for 30 minutes every 2 hours.
20. Peritoneal dialysis is preferred over hemodialysis for some clients because it:
a) Is faster and more efficient.
b) Provides more dietary freedom.
