Med Surg Final Exam Latest Questions and
Verified Answers Plus Rationales Latest
2026/27 Academic Year
SECTION 1: CARDIOVASCULAR & HEMATOLOGICAL (Questions 1-
15)
QUESTION 1
A nurse is caring for a client with heart failure who has jugular vein
distention, 3+ pitting edema, and crackles in the lung bases. 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) Limit carbohydrates to 50 g/day
Answer: B) Restrict sodium to 2 g/day
Rationale: Sodium restriction reduces fluid retention, a key factor in
heart failure exacerbation. The client is showing signs of fluid
overload (JVD, edema, crackles). Fluid intake is typically restricted,
not increased. While potassium-rich foods may be encouraged if the
client is on diuretics, sodium restriction is the priority intervention.
,QUESTION 2
A client with heart failure has a prescription for digoxin. The nurse is
aware that sufficient potassium should be included in the diet because
hypokalemia in combination with this medication:
A) Can predispose to dysrhythmias
B) May lead to oliguria
C) May cause irritability and anxiety
D) Sometimes alters consciousness
Answer: A) Can predispose to dysrhythmias
Rationale: Hypokalemia increases the risk of digoxin toxicity and
cardiac dysrhythmias. Digoxin and potassium compete for the same
binding sites on the sodium-potassium pump; low potassium levels
enhance digoxin's effects. This is a critical safety consideration for
clients on digoxin therapy.
QUESTION 3
A nurse is caring for a client in an intensive care unit with hypertensive
crisis. The priority assessment in the first hour of care is:
A) Heart rate
B) Blood pressure
C) Respiratory rate
D) Level of consciousness
Answer: B) Blood pressure
Rationale: In hypertensive crisis, blood pressure monitoring is the
priority to prevent target organ damage. The immediate goal is to
reduce mean arterial pressure by no more than 25% within the first
hour. While other assessments are important, blood pressure is the
most critical parameter to monitor.
,QUESTION 4
While caring for a client admitted with a myocardial infarction 2 days
ago, the nurse notes today's temperature is 101.1°F (38.4°C). The
appropriate nursing intervention is:
A) Call the healthcare provider immediately
B) Administer acetaminophen as ordered as this is normal at this time
C) Send blood, urine, and sputum for culture
D) Increase the client's fluid intake
Answer: B) Administer acetaminophen as ordered as this is normal
at this time
Rationale: Low-grade fever (up to 101°F/38.3°C) is common 24-48
hours after an MI due to the inflammatory response to myocardial
necrosis. This is an expected finding and should be managed with
antipyretics. It does not require immediate provider notification,
cultures, or increased fluid intake as a primary intervention.
QUESTION 5
A nurse is administering sevelamer (RenaGel) during lunch to a client
with end-stage renal disease. The client asks why the medication must
be taken with meals. The nurse should explain that RenaGel:
A) Prevents indigestion associated with spicy foods
B) Binds with phosphorus in foods and prevents absorption
C) Promotes stomach emptying and prevents gastric reflux
D) Enhances calcium absorption from foods
Answer: B) Binds with phosphorus in foods and prevents absorption
Rationale: Sevelamer is a phosphate binder that works by binding
dietary phosphorus in the gastrointestinal tract, preventing its
, absorption. It must be taken with meals to bind phosphorus from
food. This is a key medication education point for clients with ESRD.
QUESTION 6
A client has an arteriovenous (AV) fistula for hemodialysis. Which finding
should the nurse report immediately?
A) Thrill upon palpation
B) Absence of a bruit
C) Distended blood vessels
D) Swishing sound upon auscultation
Answer: B) Absence of a bruit
Rationale: A bruit (swishing sound) and thrill indicate patency of the
AV fistula. The absence of a bruit suggests occlusion or clotting,
requiring immediate notification. Distended blood vessels are an
expected finding. This is a critical assessment for clients with AV
fistulas.
QUESTION 7
A nurse is caring for a client with peripheral vascular disease. The
outcome, "The client will have decreased venous congestion," would be
met when the client:
A) Avoids prolonged sitting or standing
B) Avoids trauma and irritation to skin
C) Wears protective shoes
D) Quits smoking
Answer: A) Avoids prolonged sitting or standing
Verified Answers Plus Rationales Latest
2026/27 Academic Year
SECTION 1: CARDIOVASCULAR & HEMATOLOGICAL (Questions 1-
15)
QUESTION 1
A nurse is caring for a client with heart failure who has jugular vein
distention, 3+ pitting edema, and crackles in the lung bases. 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) Limit carbohydrates to 50 g/day
Answer: B) Restrict sodium to 2 g/day
Rationale: Sodium restriction reduces fluid retention, a key factor in
heart failure exacerbation. The client is showing signs of fluid
overload (JVD, edema, crackles). Fluid intake is typically restricted,
not increased. While potassium-rich foods may be encouraged if the
client is on diuretics, sodium restriction is the priority intervention.
,QUESTION 2
A client with heart failure has a prescription for digoxin. The nurse is
aware that sufficient potassium should be included in the diet because
hypokalemia in combination with this medication:
A) Can predispose to dysrhythmias
B) May lead to oliguria
C) May cause irritability and anxiety
D) Sometimes alters consciousness
Answer: A) Can predispose to dysrhythmias
Rationale: Hypokalemia increases the risk of digoxin toxicity and
cardiac dysrhythmias. Digoxin and potassium compete for the same
binding sites on the sodium-potassium pump; low potassium levels
enhance digoxin's effects. This is a critical safety consideration for
clients on digoxin therapy.
QUESTION 3
A nurse is caring for a client in an intensive care unit with hypertensive
crisis. The priority assessment in the first hour of care is:
A) Heart rate
B) Blood pressure
C) Respiratory rate
D) Level of consciousness
Answer: B) Blood pressure
Rationale: In hypertensive crisis, blood pressure monitoring is the
priority to prevent target organ damage. The immediate goal is to
reduce mean arterial pressure by no more than 25% within the first
hour. While other assessments are important, blood pressure is the
most critical parameter to monitor.
,QUESTION 4
While caring for a client admitted with a myocardial infarction 2 days
ago, the nurse notes today's temperature is 101.1°F (38.4°C). The
appropriate nursing intervention is:
A) Call the healthcare provider immediately
B) Administer acetaminophen as ordered as this is normal at this time
C) Send blood, urine, and sputum for culture
D) Increase the client's fluid intake
Answer: B) Administer acetaminophen as ordered as this is normal
at this time
Rationale: Low-grade fever (up to 101°F/38.3°C) is common 24-48
hours after an MI due to the inflammatory response to myocardial
necrosis. This is an expected finding and should be managed with
antipyretics. It does not require immediate provider notification,
cultures, or increased fluid intake as a primary intervention.
QUESTION 5
A nurse is administering sevelamer (RenaGel) during lunch to a client
with end-stage renal disease. The client asks why the medication must
be taken with meals. The nurse should explain that RenaGel:
A) Prevents indigestion associated with spicy foods
B) Binds with phosphorus in foods and prevents absorption
C) Promotes stomach emptying and prevents gastric reflux
D) Enhances calcium absorption from foods
Answer: B) Binds with phosphorus in foods and prevents absorption
Rationale: Sevelamer is a phosphate binder that works by binding
dietary phosphorus in the gastrointestinal tract, preventing its
, absorption. It must be taken with meals to bind phosphorus from
food. This is a key medication education point for clients with ESRD.
QUESTION 6
A client has an arteriovenous (AV) fistula for hemodialysis. Which finding
should the nurse report immediately?
A) Thrill upon palpation
B) Absence of a bruit
C) Distended blood vessels
D) Swishing sound upon auscultation
Answer: B) Absence of a bruit
Rationale: A bruit (swishing sound) and thrill indicate patency of the
AV fistula. The absence of a bruit suggests occlusion or clotting,
requiring immediate notification. Distended blood vessels are an
expected finding. This is a critical assessment for clients with AV
fistulas.
QUESTION 7
A nurse is caring for a client with peripheral vascular disease. The
outcome, "The client will have decreased venous congestion," would be
met when the client:
A) Avoids prolonged sitting or standing
B) Avoids trauma and irritation to skin
C) Wears protective shoes
D) Quits smoking
Answer: A) Avoids prolonged sitting or standing
