NUR 1211 MEDICAL SURGICAL FINAL EXAM (2026/2027) | ACTUAL EXAM QUESTIONS
AND CORRECT DETAILED VERIFIED ANSWERS
NUR 1211: Medical-Surgical Nursing Comprehensive Final Examination | Core Domains: Nursing
Process in Adult Health, Fluid & Electrolyte Balance, Perioperative Care, Cardiovascular Disorders,
Respiratory Disorders, Gastrointestinal & Hepatobiliary Disorders, Renal & Urological Disorders,
Endocrine & Metabolic Disorders, Neurological Disorders, Musculoskeletal Disorders, Hematology &
Oncology, and Multisystem Complexities | Nursing Program Focus | Comprehensive Medical-Surgical
Final Exam Format
Exam Structure
The NUR 1211 Medical Surgical Final Exam for the 2026/2027 academic cycle is a 125-question,
multiple-choice question (MCQ) examination.
Introduction
This NUR 1211 Medical Surgical Final Exam guide for the 2026/2027 cycle prepares nursing students for
the summative assessment of adult medical-surgical nursing knowledge. The content integrates
pathophysiology, pharmacology, and nursing management for patients with complex health conditions
across body systems, emphasizing clinical judgment, priority-setting, and evidence-based interventions in
diverse healthcare settings.
Answer Format
All correct answers and nursing interventions must be presented in bold and green, followed by
detailed rationales that connect disease pathophysiology to clinical manifestations, justify
pharmacological and non-pharmacological management, apply priority-setting frameworks (e.g., ABCs,
Maslow's), and incorporate patient safety principles.
Full 125-Question NUR 1211 Medical-Surgical Final Exam
1. A client with heart failure is prescribed furosemide 40 mg IV daily. Which laboratory value should the
nurse monitor most closely?
A. Calcium
B. Potassium
C. Sodium
D. Magnesium
Furosemide is a loop diuretic that causes significant potassium loss through the kidneys. Hypokalemia
can lead to life-threatening dysrhythmias, especially in clients with heart failure who may also be on
,digoxin. Therefore, the nurse must monitor potassium levels closely and anticipate potassium
supplementation or use of potassium-sparing diuretics.
2. A postoperative client on the second day after abdominal surgery has absent bowel sounds, abdominal
distension, and nausea. What condition does the nurse suspect?
A. Paralytic ileus
B. Paralytic ileus
C. Small bowel obstruction
D. Peritonitis
After abdominal surgery, decreased peristalsis due to anesthesia, opioids, and handling of the bowel
commonly leads to paralytic ileus, characterized by absent bowel sounds, distension, nausea, and no
passage of flatus or stool. It is a functional obstruction, not mechanical, and typically resolves within
2–3 days with supportive care.
3. A client with chronic kidney disease (CKD) has a serum potassium level of 6.2 mEq/L. Which ECG
change should the nurse expect?
A. Prolonged PR interval
B. Peaked T waves
C. U waves
D. ST-segment depression
Hyperkalemia causes characteristic ECG changes that progress with severity: peaked T waves are the
earliest sign, followed by widened QRS, loss of P waves, and eventually sine wave pattern and
ventricular fibrillation. Immediate intervention (e.g., calcium gluconate, insulin/glucose, sodium
bicarbonate) is required to stabilize cardiac membranes.
4. Which assessment finding in a client 24 hours after a total hip arthroplasty requires immediate
intervention?
A. Pain rated 5/10
B. Shortening and external rotation of the affected leg
C. Incisional drainage of 50 mL serosanguinous fluid
,D. Temperature of 100.4°F (38°C)
Shortening and external rotation of the affected leg are classic signs of hip dislocation, a serious
postoperative complication requiring immediate reduction. Other options are expected findings: pain is
common, moderate drainage is normal, and low-grade fever may occur due to inflammatory response.
5. A client with type 1 diabetes mellitus presents with Kussmaul respirations, fruity breath odor, and
blood glucose of 480 mg/dL. What is the priority nursing action?
A. Administer subcutaneous insulin
B. Initiate IV fluid resuscitation with 0.9% NaCl
C. Provide oral fluids
D. Check urine for ketones
This client is in diabetic ketoacidosis (DKA). The priority is initiate IV fluid resuscitation with
0.9% NaCl to restore intravascular volume, improve perfusion, and lower blood glucose via dilution
and renal excretion. Insulin is given after fluid resuscitation begins to prevent shock from rapid fluid
shifts.
6. A client with a history of atrial fibrillation is prescribed warfarin. Which statement by the client
indicates understanding of the medication?
A. “I will take aspirin if I have a headache.”
B. “I will maintain a consistent intake of green leafy vegetables.”
C. “I can stop the medication once my INR is normal.”
D. “I don’t need regular blood tests.”
Warfarin antagonizes vitamin K, which is abundant in green leafy vegetables. Sudden increases or
decreases in vitamin K intake alter INR. Therefore, the client should maintain a consistent intake
of green leafy vegetables rather than avoid them. Regular INR monitoring is essential, and
warfarin is usually long-term for atrial fibrillation.
7. A client with COPD is receiving oxygen therapy at 2 L/min via nasal cannula. The nurse notes increased
drowsiness and a respiratory rate of 8 breaths/min. What is the priority action?
A. Increase oxygen flow to 4 L/min
B. Reduce oxygen flow and assess ABGs
, C. Administer naloxone
D. Prepare for intubation
In COPD clients with chronic CO₂ retention, high oxygen levels can suppress the hypoxic drive to
breathe, leading to CO₂ narcosis. The nurse should reduce oxygen flow and assess ABGs to confirm
hypercapnia. Oxygen should be titrated to maintain SpO₂ 88–92%, not higher.
8. Which electrolyte imbalance is most likely to cause tetany and Chvostek’s sign?
A. Hypernatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypermagnesemia
Hypocalcemia increases neuromuscular excitability, leading to muscle spasms, tetany, and positive
Chvostek’s (facial twitch when tapping facial nerve) and Trousseau’s signs (carpopedal spasm with BP
cuff inflation). Causes include hypoparathyroidism, vitamin D deficiency, and acute pancreatitis.
9. A client is scheduled for a colonoscopy. Which statement by the client indicates effective teaching about
bowel preparation?
A. “I can drink coffee with cream the morning before.”
B. “I will drink only clear liquids starting 24 hours before the procedure.”
C. “I can eat a light breakfast the day of the test.”
D. “I’ll stop my antihypertensive medications.”
Bowel prep requires clear liquid diet for 24 hours prior and complete evacuation to visualize the colon.
“I will drink only clear liquids starting 24 hours before the procedure” demonstrates
understanding. Cream makes coffee opaque; food is prohibited; most antihypertensives are continued
with sips of water.
10. A client with suspected pulmonary embolism has sudden onset of dyspnea, chest pain, and
tachycardia. Which diagnostic test is most definitive?
A. Chest X-ray
B. D-dimer
AND CORRECT DETAILED VERIFIED ANSWERS
NUR 1211: Medical-Surgical Nursing Comprehensive Final Examination | Core Domains: Nursing
Process in Adult Health, Fluid & Electrolyte Balance, Perioperative Care, Cardiovascular Disorders,
Respiratory Disorders, Gastrointestinal & Hepatobiliary Disorders, Renal & Urological Disorders,
Endocrine & Metabolic Disorders, Neurological Disorders, Musculoskeletal Disorders, Hematology &
Oncology, and Multisystem Complexities | Nursing Program Focus | Comprehensive Medical-Surgical
Final Exam Format
Exam Structure
The NUR 1211 Medical Surgical Final Exam for the 2026/2027 academic cycle is a 125-question,
multiple-choice question (MCQ) examination.
Introduction
This NUR 1211 Medical Surgical Final Exam guide for the 2026/2027 cycle prepares nursing students for
the summative assessment of adult medical-surgical nursing knowledge. The content integrates
pathophysiology, pharmacology, and nursing management for patients with complex health conditions
across body systems, emphasizing clinical judgment, priority-setting, and evidence-based interventions in
diverse healthcare settings.
Answer Format
All correct answers and nursing interventions must be presented in bold and green, followed by
detailed rationales that connect disease pathophysiology to clinical manifestations, justify
pharmacological and non-pharmacological management, apply priority-setting frameworks (e.g., ABCs,
Maslow's), and incorporate patient safety principles.
Full 125-Question NUR 1211 Medical-Surgical Final Exam
1. A client with heart failure is prescribed furosemide 40 mg IV daily. Which laboratory value should the
nurse monitor most closely?
A. Calcium
B. Potassium
C. Sodium
D. Magnesium
Furosemide is a loop diuretic that causes significant potassium loss through the kidneys. Hypokalemia
can lead to life-threatening dysrhythmias, especially in clients with heart failure who may also be on
,digoxin. Therefore, the nurse must monitor potassium levels closely and anticipate potassium
supplementation or use of potassium-sparing diuretics.
2. A postoperative client on the second day after abdominal surgery has absent bowel sounds, abdominal
distension, and nausea. What condition does the nurse suspect?
A. Paralytic ileus
B. Paralytic ileus
C. Small bowel obstruction
D. Peritonitis
After abdominal surgery, decreased peristalsis due to anesthesia, opioids, and handling of the bowel
commonly leads to paralytic ileus, characterized by absent bowel sounds, distension, nausea, and no
passage of flatus or stool. It is a functional obstruction, not mechanical, and typically resolves within
2–3 days with supportive care.
3. A client with chronic kidney disease (CKD) has a serum potassium level of 6.2 mEq/L. Which ECG
change should the nurse expect?
A. Prolonged PR interval
B. Peaked T waves
C. U waves
D. ST-segment depression
Hyperkalemia causes characteristic ECG changes that progress with severity: peaked T waves are the
earliest sign, followed by widened QRS, loss of P waves, and eventually sine wave pattern and
ventricular fibrillation. Immediate intervention (e.g., calcium gluconate, insulin/glucose, sodium
bicarbonate) is required to stabilize cardiac membranes.
4. Which assessment finding in a client 24 hours after a total hip arthroplasty requires immediate
intervention?
A. Pain rated 5/10
B. Shortening and external rotation of the affected leg
C. Incisional drainage of 50 mL serosanguinous fluid
,D. Temperature of 100.4°F (38°C)
Shortening and external rotation of the affected leg are classic signs of hip dislocation, a serious
postoperative complication requiring immediate reduction. Other options are expected findings: pain is
common, moderate drainage is normal, and low-grade fever may occur due to inflammatory response.
5. A client with type 1 diabetes mellitus presents with Kussmaul respirations, fruity breath odor, and
blood glucose of 480 mg/dL. What is the priority nursing action?
A. Administer subcutaneous insulin
B. Initiate IV fluid resuscitation with 0.9% NaCl
C. Provide oral fluids
D. Check urine for ketones
This client is in diabetic ketoacidosis (DKA). The priority is initiate IV fluid resuscitation with
0.9% NaCl to restore intravascular volume, improve perfusion, and lower blood glucose via dilution
and renal excretion. Insulin is given after fluid resuscitation begins to prevent shock from rapid fluid
shifts.
6. A client with a history of atrial fibrillation is prescribed warfarin. Which statement by the client
indicates understanding of the medication?
A. “I will take aspirin if I have a headache.”
B. “I will maintain a consistent intake of green leafy vegetables.”
C. “I can stop the medication once my INR is normal.”
D. “I don’t need regular blood tests.”
Warfarin antagonizes vitamin K, which is abundant in green leafy vegetables. Sudden increases or
decreases in vitamin K intake alter INR. Therefore, the client should maintain a consistent intake
of green leafy vegetables rather than avoid them. Regular INR monitoring is essential, and
warfarin is usually long-term for atrial fibrillation.
7. A client with COPD is receiving oxygen therapy at 2 L/min via nasal cannula. The nurse notes increased
drowsiness and a respiratory rate of 8 breaths/min. What is the priority action?
A. Increase oxygen flow to 4 L/min
B. Reduce oxygen flow and assess ABGs
, C. Administer naloxone
D. Prepare for intubation
In COPD clients with chronic CO₂ retention, high oxygen levels can suppress the hypoxic drive to
breathe, leading to CO₂ narcosis. The nurse should reduce oxygen flow and assess ABGs to confirm
hypercapnia. Oxygen should be titrated to maintain SpO₂ 88–92%, not higher.
8. Which electrolyte imbalance is most likely to cause tetany and Chvostek’s sign?
A. Hypernatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypermagnesemia
Hypocalcemia increases neuromuscular excitability, leading to muscle spasms, tetany, and positive
Chvostek’s (facial twitch when tapping facial nerve) and Trousseau’s signs (carpopedal spasm with BP
cuff inflation). Causes include hypoparathyroidism, vitamin D deficiency, and acute pancreatitis.
9. A client is scheduled for a colonoscopy. Which statement by the client indicates effective teaching about
bowel preparation?
A. “I can drink coffee with cream the morning before.”
B. “I will drink only clear liquids starting 24 hours before the procedure.”
C. “I can eat a light breakfast the day of the test.”
D. “I’ll stop my antihypertensive medications.”
Bowel prep requires clear liquid diet for 24 hours prior and complete evacuation to visualize the colon.
“I will drink only clear liquids starting 24 hours before the procedure” demonstrates
understanding. Cream makes coffee opaque; food is prohibited; most antihypertensives are continued
with sips of water.
10. A client with suspected pulmonary embolism has sudden onset of dyspnea, chest pain, and
tachycardia. Which diagnostic test is most definitive?
A. Chest X-ray
B. D-dimer
