Test Bank - Medical-Surgical Nursing (11th
Edition) Ignatavicius | All Chapters 1-74
Included | Verified Q&As with Rationales for
NCLEX & HESI Readiness (2025/2026)
Ace your exams with the complete Test Bank for Medical-Surgical Nursing (11th Edition) by
Ignatavicius. Features verified Q&As for all 74 chapters, mapped to the latest NCLEX-RN & HESI
blueprints. Includes Next-Gen (NGN) exemplars, in-depth rationales, and a focus on the NCSBN
Clinical Judgment Model to secure your path to passing grade A+. Master your nursing curriculum
today!
1. A 45-year-old patient with an acute exacerbation of asthma is admitted to the
medical-surgical unit. The nurse hears high-pitched wheezing on expiration. An hour
later, the nurse notes that the patient's respiratory rate has increased to 32
breaths/minute, they are using accessory muscles, and breath sounds are now
completely absent in the bilateral lower lobes. Which action should the nurse take
first?
A. Administer a prescribed PRN dose of an oral corticosteroid.
B. Assist the patient to perform incentive spirometry.
C. Activate the Rapid Response Team and prepare for immediate endotracheal
intubation.
D. Obtain a portable chest X-ray to evaluate for a pneumothorax.
Rationale: The disappearance of wheezing in a patient with severe respiratory
distress is a critical indicator of "silent chest syndrome," which signifies a complete
lack of air movement due to severe bronchoconstriction. This is a life-threatening
medical emergency indicating impending respiratory failure. The nurse must
immediately call for emergency assistance (Rapid Response Team) and prepare for
airway management. Corticosteroids take hours to work and are insufficient for acute
airway closure. Incentive spirometry requires air movement and cannot be performed
by a patient in acute failure. A chest X-ray is diagnostic but delays necessary life-
saving airway intervention.
2. The nurse is caring for a 72-year-old patient who underwent a total knee
arthroplasty 24 hours ago. The patient has a history of type 2 diabetes mellitus and
chronic kidney disease. During the morning assessment, the patient reports new-
onset localized calf pain and swelling in the left leg. Which intervention should the
nurse implement first?
,A. Massage the affected calf to alleviate muscle spasms and pain.
B. Instruct the patient to remain on bed rest and notify the orthopedic surgeon
immediately.
C. Place a warm, moist heating pad directly over the painful area of the calf.
D. Elevate the left leg on two pillows above the level of the heart.
Rationale: Unilateral calf pain, swelling, and warmth post-major orthopedic surgery
are classic signs of a deep vein thrombosis (DVT). The immediate priority is to
prevent the thrombus from dislodging and causing a pulmonary embolism (PE). The
patient must be placed on bed rest to restrict movement of the extremity, and the
surgeon must be notified to obtain diagnostic imaging (e.g., venous duplex
ultrasound). Massaging the calf is strictly contraindicated because it can directly
dislodge the clot. While elevation can reduce edema, the primary immediate action is
immobilization and provider notification. Applying heat requires a specific provider
order due to the risk of burns and vasodilation potentially destabilizing a clot.
3. A nurse is reviewing morning laboratory results for a patient with acute
decompensated heart failure who is receiving scheduled twice-daily intravenous
furosemide. The laboratory report indicates a serum potassium level of 2.8 mEq/L
(2.8 mmol/L). Which assessment finding requires the nurse's immediate
intervention?
A. Hyperactive bowel sounds in all four abdominal quadrants.
B. The presence of premature ventricular contractions (PVCs) on the cardiac
monitor.
C. Occasional muscle cramping in the bilateral lower extremities.
D. A blood pressure reading of 118/74 mmHg.
Rationale: A serum potassium level of 2.8 mEq/L indicates severe hypokalemia, a
well-known complication of loop diuretics like furosemide. Severe hypokalemia
destabilizes the myocardial cell membrane, leading to lethal ventricular
dysrhythmias, such as PVCs, ventricular tachycardia, or ventricular fibrillation.
Monitoring and addressing cardiac irritability is the absolute priority to prevent
cardiac arrest. Hypokalemia causes hypoactive (not hyperactive) bowel sounds due
to decreased smooth muscle motility. While muscle cramping is a valid sign of
hypokalemia, it is not life-threatening compared to cardiac ectopy. A blood pressure
of 118/74 mmHg is a normal finding and does not require immediate intervention.
4. A nurse on a medical-surgical unit receives a change-of-shift report for four
patients. Which patient should the nurse assess first?
A. A 55-year-old patient with acute pancreatitis who reports constant abdominal pain
rated as 7/10.
,B. A 68-year-old patient with chronic kidney disease whose morning serum
creatinine is 3.2 mg/dL.
C. A 42-year-old patient who underwent a thyroidectomy 6 hours ago and has
developed a hoarse voice and audible stridor.
D. A 74-year-old patient with a history of heart failure who has 2+ pitting edema in
both lower extremities.
Rationale: Following thyroid surgery, swelling or hematoma formation can compress
the trachea, leading to sudden airway obstruction. Stridor indicates a critically
narrowed airway and represents an immediate life-threatening emergency. The
nurse must assess this patient first, ensure emergency tracheostomy equipment is at
the bedside, and notify the surgeon. Abdominal pain is expected with acute
pancreatitis. A creatinine of 3.2 mg/dL is elevated but expected in chronic kidney
disease. Dependent edema is a chronic, expected finding in stable heart failure.
5. A nurse is caring for a patient who is 12 hours postoperative following an
abdominal hysterectomy. The patient's vital signs are: temperature 37.2°C (99.0°F),
pulse 112 beats/minute, respirations 22 breaths/minute, and blood pressure 88/52
mmHg. The patient is pale and reports feeling dizzy. Which action should the nurse
take first?
A. Administer the scheduled postoperative intravenous antibiotic infusion.
B. Increase the rate of the patient's incentive spirometry exercises.
C. Check the patient's surgical dressing and perineal pads for excessive
bleeding.
D. Request an prescription for an oral iron supplement from the provider.
Rationale: Tachycardia, hypotension, tachypnea, pallor, and dizziness in an early
postoperative patient are classic, warning signs of hypovolaemic shock due to
internal or external hemorrhage. The priority is to assess the surgical site and pads
for bleeding while preparing for fluid resuscitation. Tachycardia and hypotension
require immediate physical assessment before executing routine tasks like antibiotic
administration. Incentive spirometry prevents atelectasis but does not address
hemodynamic instability. Iron supplements are for chronic anemia and are not an
acute intervention for active hypovolaemic shock.
6. A patient with a history of severe cirrhosis is admitted with suspected hepatic
encephalopathy. The patient is confused and fluctuates between lethargy and
agitation. Which laboratory value should the nurse review to confirm the underlying
cause of the patient's altered mental status?
A. Serum alanine aminotransferase (ALT).
B. Conjugated (direct) bilirubin.
, C. Blood ammonia level.
D. Serum albumin level.
Rationale: Hepatic encephalopathy is caused by the liver's inability to metabolize and
detoxify protein byproducts, primarily ammonia. Elevated systemic blood ammonia
levels cross the blood-brain barrier, causing neurotoxicity, confusion, altered mental
status, and asterixis. ALT is an enzyme reflecting liver cell injury but does not directly
cause neurological changes. Bilirubin levels reflect jaundice and biliary clearance.
Low albumin levels cause fluid shifts (ascites and edema) due to decreased oncotic
pressure, not acute cognitive impairment.
7. A patient with type 1 diabetes mellitus is admitted to the emergency
department in diabetic ketoacidosis (DKA). The nurse notes a blood glucose level of
520 mg/dL, a regular insulin infusion is running, and the patient is currently receiving
0.9% normal saline. The patient's repeat blood glucose level is now 245 mg/dL.
Which prescription should the nurse anticipate executing next?
A. Discontinue the insulin infusion and switch to subcutaneous sliding-scale insulin.
B. Change the intravenous fluid to a solution containing 5% dextrose (e.g., 5%
dextrose in 0.45% normal saline).
C. Increase the regular insulin infusion rate to lower the glucose faster.
D. Administer an intravenous bolus of 50% dextrose (D50) immediately.
Rationale: When treating DKA, blood glucose levels typically drop faster than the
underlying ketoacidosis resolves. Once blood glucose falls to approximately 250–
300 mg/dL, dextrose must be added to the intravenous fluids. This prevents sudden
hypoglycemia and cerebral edema, while allowing the continuous insulin infusion to
remain running safely until the anion gap closes and ketones disappear.
Discontinuing the insulin too early will cause a relapse into ketosis. Increasing the
insulin infusion would worsen the risk of rapid glucose drops. D50 is used for severe
hypoglycemia, which is not present.
8. A patient with severe dynamic burns covering 40% of their total body surface
area arrives in the emergency department. The injury occurred 2 hours ago. Which
laboratory value should the nurse expect to find during this acute fluid shift phase?
A. Serum potassium 3.2 mEq/L.
B. Hematocrit 32%.
C. Serum potassium 6.1 mEq/L.
D. Serum sodium 152 mEq/L.
Rationale: During the resuscitation (emergent) phase of a burn injury, massive
cellular destruction releases large amounts of intracellular potassium into the
extracellular fluid, resulting in hyperkalemia. Concurrently, fluid shifts from the
Edition) Ignatavicius | All Chapters 1-74
Included | Verified Q&As with Rationales for
NCLEX & HESI Readiness (2025/2026)
Ace your exams with the complete Test Bank for Medical-Surgical Nursing (11th Edition) by
Ignatavicius. Features verified Q&As for all 74 chapters, mapped to the latest NCLEX-RN & HESI
blueprints. Includes Next-Gen (NGN) exemplars, in-depth rationales, and a focus on the NCSBN
Clinical Judgment Model to secure your path to passing grade A+. Master your nursing curriculum
today!
1. A 45-year-old patient with an acute exacerbation of asthma is admitted to the
medical-surgical unit. The nurse hears high-pitched wheezing on expiration. An hour
later, the nurse notes that the patient's respiratory rate has increased to 32
breaths/minute, they are using accessory muscles, and breath sounds are now
completely absent in the bilateral lower lobes. Which action should the nurse take
first?
A. Administer a prescribed PRN dose of an oral corticosteroid.
B. Assist the patient to perform incentive spirometry.
C. Activate the Rapid Response Team and prepare for immediate endotracheal
intubation.
D. Obtain a portable chest X-ray to evaluate for a pneumothorax.
Rationale: The disappearance of wheezing in a patient with severe respiratory
distress is a critical indicator of "silent chest syndrome," which signifies a complete
lack of air movement due to severe bronchoconstriction. This is a life-threatening
medical emergency indicating impending respiratory failure. The nurse must
immediately call for emergency assistance (Rapid Response Team) and prepare for
airway management. Corticosteroids take hours to work and are insufficient for acute
airway closure. Incentive spirometry requires air movement and cannot be performed
by a patient in acute failure. A chest X-ray is diagnostic but delays necessary life-
saving airway intervention.
2. The nurse is caring for a 72-year-old patient who underwent a total knee
arthroplasty 24 hours ago. The patient has a history of type 2 diabetes mellitus and
chronic kidney disease. During the morning assessment, the patient reports new-
onset localized calf pain and swelling in the left leg. Which intervention should the
nurse implement first?
,A. Massage the affected calf to alleviate muscle spasms and pain.
B. Instruct the patient to remain on bed rest and notify the orthopedic surgeon
immediately.
C. Place a warm, moist heating pad directly over the painful area of the calf.
D. Elevate the left leg on two pillows above the level of the heart.
Rationale: Unilateral calf pain, swelling, and warmth post-major orthopedic surgery
are classic signs of a deep vein thrombosis (DVT). The immediate priority is to
prevent the thrombus from dislodging and causing a pulmonary embolism (PE). The
patient must be placed on bed rest to restrict movement of the extremity, and the
surgeon must be notified to obtain diagnostic imaging (e.g., venous duplex
ultrasound). Massaging the calf is strictly contraindicated because it can directly
dislodge the clot. While elevation can reduce edema, the primary immediate action is
immobilization and provider notification. Applying heat requires a specific provider
order due to the risk of burns and vasodilation potentially destabilizing a clot.
3. A nurse is reviewing morning laboratory results for a patient with acute
decompensated heart failure who is receiving scheduled twice-daily intravenous
furosemide. The laboratory report indicates a serum potassium level of 2.8 mEq/L
(2.8 mmol/L). Which assessment finding requires the nurse's immediate
intervention?
A. Hyperactive bowel sounds in all four abdominal quadrants.
B. The presence of premature ventricular contractions (PVCs) on the cardiac
monitor.
C. Occasional muscle cramping in the bilateral lower extremities.
D. A blood pressure reading of 118/74 mmHg.
Rationale: A serum potassium level of 2.8 mEq/L indicates severe hypokalemia, a
well-known complication of loop diuretics like furosemide. Severe hypokalemia
destabilizes the myocardial cell membrane, leading to lethal ventricular
dysrhythmias, such as PVCs, ventricular tachycardia, or ventricular fibrillation.
Monitoring and addressing cardiac irritability is the absolute priority to prevent
cardiac arrest. Hypokalemia causes hypoactive (not hyperactive) bowel sounds due
to decreased smooth muscle motility. While muscle cramping is a valid sign of
hypokalemia, it is not life-threatening compared to cardiac ectopy. A blood pressure
of 118/74 mmHg is a normal finding and does not require immediate intervention.
4. A nurse on a medical-surgical unit receives a change-of-shift report for four
patients. Which patient should the nurse assess first?
A. A 55-year-old patient with acute pancreatitis who reports constant abdominal pain
rated as 7/10.
,B. A 68-year-old patient with chronic kidney disease whose morning serum
creatinine is 3.2 mg/dL.
C. A 42-year-old patient who underwent a thyroidectomy 6 hours ago and has
developed a hoarse voice and audible stridor.
D. A 74-year-old patient with a history of heart failure who has 2+ pitting edema in
both lower extremities.
Rationale: Following thyroid surgery, swelling or hematoma formation can compress
the trachea, leading to sudden airway obstruction. Stridor indicates a critically
narrowed airway and represents an immediate life-threatening emergency. The
nurse must assess this patient first, ensure emergency tracheostomy equipment is at
the bedside, and notify the surgeon. Abdominal pain is expected with acute
pancreatitis. A creatinine of 3.2 mg/dL is elevated but expected in chronic kidney
disease. Dependent edema is a chronic, expected finding in stable heart failure.
5. A nurse is caring for a patient who is 12 hours postoperative following an
abdominal hysterectomy. The patient's vital signs are: temperature 37.2°C (99.0°F),
pulse 112 beats/minute, respirations 22 breaths/minute, and blood pressure 88/52
mmHg. The patient is pale and reports feeling dizzy. Which action should the nurse
take first?
A. Administer the scheduled postoperative intravenous antibiotic infusion.
B. Increase the rate of the patient's incentive spirometry exercises.
C. Check the patient's surgical dressing and perineal pads for excessive
bleeding.
D. Request an prescription for an oral iron supplement from the provider.
Rationale: Tachycardia, hypotension, tachypnea, pallor, and dizziness in an early
postoperative patient are classic, warning signs of hypovolaemic shock due to
internal or external hemorrhage. The priority is to assess the surgical site and pads
for bleeding while preparing for fluid resuscitation. Tachycardia and hypotension
require immediate physical assessment before executing routine tasks like antibiotic
administration. Incentive spirometry prevents atelectasis but does not address
hemodynamic instability. Iron supplements are for chronic anemia and are not an
acute intervention for active hypovolaemic shock.
6. A patient with a history of severe cirrhosis is admitted with suspected hepatic
encephalopathy. The patient is confused and fluctuates between lethargy and
agitation. Which laboratory value should the nurse review to confirm the underlying
cause of the patient's altered mental status?
A. Serum alanine aminotransferase (ALT).
B. Conjugated (direct) bilirubin.
, C. Blood ammonia level.
D. Serum albumin level.
Rationale: Hepatic encephalopathy is caused by the liver's inability to metabolize and
detoxify protein byproducts, primarily ammonia. Elevated systemic blood ammonia
levels cross the blood-brain barrier, causing neurotoxicity, confusion, altered mental
status, and asterixis. ALT is an enzyme reflecting liver cell injury but does not directly
cause neurological changes. Bilirubin levels reflect jaundice and biliary clearance.
Low albumin levels cause fluid shifts (ascites and edema) due to decreased oncotic
pressure, not acute cognitive impairment.
7. A patient with type 1 diabetes mellitus is admitted to the emergency
department in diabetic ketoacidosis (DKA). The nurse notes a blood glucose level of
520 mg/dL, a regular insulin infusion is running, and the patient is currently receiving
0.9% normal saline. The patient's repeat blood glucose level is now 245 mg/dL.
Which prescription should the nurse anticipate executing next?
A. Discontinue the insulin infusion and switch to subcutaneous sliding-scale insulin.
B. Change the intravenous fluid to a solution containing 5% dextrose (e.g., 5%
dextrose in 0.45% normal saline).
C. Increase the regular insulin infusion rate to lower the glucose faster.
D. Administer an intravenous bolus of 50% dextrose (D50) immediately.
Rationale: When treating DKA, blood glucose levels typically drop faster than the
underlying ketoacidosis resolves. Once blood glucose falls to approximately 250–
300 mg/dL, dextrose must be added to the intravenous fluids. This prevents sudden
hypoglycemia and cerebral edema, while allowing the continuous insulin infusion to
remain running safely until the anion gap closes and ketones disappear.
Discontinuing the insulin too early will cause a relapse into ketosis. Increasing the
insulin infusion would worsen the risk of rapid glucose drops. D50 is used for severe
hypoglycemia, which is not present.
8. A patient with severe dynamic burns covering 40% of their total body surface
area arrives in the emergency department. The injury occurred 2 hours ago. Which
laboratory value should the nurse expect to find during this acute fluid shift phase?
A. Serum potassium 3.2 mEq/L.
B. Hematocrit 32%.
C. Serum potassium 6.1 mEq/L.
D. Serum sodium 152 mEq/L.
Rationale: During the resuscitation (emergent) phase of a burn injury, massive
cellular destruction releases large amounts of intracellular potassium into the
extracellular fluid, resulting in hyperkalemia. Concurrently, fluid shifts from the
