NUR 115 MS MEDICAL-SURGICAL NURSING I
EXAM GUIDE 2026 EDITION Q&A
1. A 65-year-old patient with chronic obstructive pulmonary
disease (COPD) presents with increasing shortness of breath,
cyanosis, and bulging neck veins. Which condition should
the nurse suspect first?
A. Pneumothorax
B. Cor pulmonale
C. Pulmonary embolism
D. Pneumonia
Correct Answer: B
Explanation: Cor pulmonale is right-sided heart failure
caused by long-standing lung disease like COPD. The
symptoms of cyanosis, dyspnea, and jugular vein distension
(bulging neck veins) are classic signs. Pneumothorax would
present with sudden chest pain and decreased breath
sounds, pulmonary embolism with sudden onset dyspnea
and chest pain, and pneumonia with fever and productive
cough.
2. A patient with diabetes mellitus type 2 is prescribed
metformin. Which nursing instruction is most important to
prevent a serious complication?
A. Take the medication with food to reduce gastrointestinal
upset
B. Discontinue the medication 48 hours before contrast
imaging studies
C. Monitor blood glucose levels twice daily
D. Increase fiber intake to prevent constipation
Correct Answer: B
, Explanation: Metformin must be discontinued 48 hours
before contrast imaging studies to prevent lactic acidosis, a
rare but serious complication. While taking with food
reduces GI upset (A), it's not the most critical safety
instruction. Blood glucose monitoring (C) and fiber intake
(D) are important but not as critical as preventing lactic
acidosis.
3. A postoperative patient on day 2 after abdominal surgery
develops sudden onset tachycardia, tachypnea, and oxygen
saturation of 88%. What is the nurse's priority action?
A. Administer prescribed antibiotics
B. Apply oxygen and notify the healthcare provider
immediately
C. Encourage deep breathing and coughing exercises
D. Elevate the head of the bed to 30 degrees
Correct Answer: B
Explanation: These symptoms suggest pulmonary
embolism, a medical emergency. The priority is to apply
oxygen to improve oxygenation and immediately notify the
healthcare provider for further intervention. While
elevation (D) and deep breathing (C) are helpful, they don't
address the emergency. Antibiotics (A) are not indicated
unless infection is confirmed.
4. Which laboratory value requires immediate intervention in a
patient with acute kidney injury?
A. Creatinine 2.5 mg/dL
B. Potassium 6.2 mEq/L
, C. BUN 45 mg/dL
D. Sodium 132 mEq/L
Correct Answer: B
Explanation: Potassium of 6.2 mEq/L indicates
hyperkalemia, which can cause life-threatening cardiac
arrhythmias and requires immediate intervention. While
elevated creatinine (A) and BUN (C) indicate kidney
dysfunction, and hyponatremia (D) is concerning,
hyperkalemia poses the most immediate threat to life.
5. A patient with heart failure is prescribed furosemide. Which
assessment finding indicates the medication is effective?
A. Weight gain of 2 kg in 24 hours
B. Decreased edema and improved breath sounds
C. Increased urine output with decreased blood pressure
D. Elevated serum potassium levels
Correct Answer: B
Explanation: Effective furosemide therapy in heart failure
results in decreased edema and improved breath sounds as
fluid is removed from the lungs and tissues. Weight gain (A)
indicates fluid retention, not improvement. While increased
urine output (C) is expected, decreased blood pressure may
indicate over-diuresis. Furosemide causes potassium loss,
not elevation (D).
6. A patient with suspected myocardial infarction presents with
chest pain. Which ECG finding is most specific for acute
myocardial injury?
A. ST-segment elevation
, B. T-wave inversion
C. Prolonged PR interval
D.QT interval prolongation
Correct Answer: A
Explanation: ST-segment elevation is the most specific ECG
finding for acute myocardial injury and indicates STEMI
(ST-elevation myocardial infarction), requiring immediate
intervention. T-wave inversion (B) can indicate ischemia
but is less specific. Prolonged PR interval (C) indicates heart
block, and QT prolongation (D) increases arrhythmia risk
but doesn't indicate acute MI.
7. Which nursing intervention is most effective in preventing
ventilator-associated pneumonia (VAP)?
A. Administering prophylactic antibiotics
B. Maintaining the head of bed at 30-45 degrees
C. Changing ventilator circuits every 24 hours
D. Suctioning the endotracheal tube every 2 hours
Correct Answer: B
Explanation: Maintaining the head of bed at 30-45 degrees
is the most effective evidence-based intervention for
preventing VAP by reducing aspiration risk. Prophylactic
antibiotics (A) are not recommended and can lead to
resistance. Changing circuits daily (C) is unnecessary and
increases contamination risk. Routine suctioning (D) can
introduce bacteria and should be done only when needed.
8. A patient with cirrhosis develops hepatic encephalopathy.
Which medication should the nurse expect to be prescribed?
EXAM GUIDE 2026 EDITION Q&A
1. A 65-year-old patient with chronic obstructive pulmonary
disease (COPD) presents with increasing shortness of breath,
cyanosis, and bulging neck veins. Which condition should
the nurse suspect first?
A. Pneumothorax
B. Cor pulmonale
C. Pulmonary embolism
D. Pneumonia
Correct Answer: B
Explanation: Cor pulmonale is right-sided heart failure
caused by long-standing lung disease like COPD. The
symptoms of cyanosis, dyspnea, and jugular vein distension
(bulging neck veins) are classic signs. Pneumothorax would
present with sudden chest pain and decreased breath
sounds, pulmonary embolism with sudden onset dyspnea
and chest pain, and pneumonia with fever and productive
cough.
2. A patient with diabetes mellitus type 2 is prescribed
metformin. Which nursing instruction is most important to
prevent a serious complication?
A. Take the medication with food to reduce gastrointestinal
upset
B. Discontinue the medication 48 hours before contrast
imaging studies
C. Monitor blood glucose levels twice daily
D. Increase fiber intake to prevent constipation
Correct Answer: B
, Explanation: Metformin must be discontinued 48 hours
before contrast imaging studies to prevent lactic acidosis, a
rare but serious complication. While taking with food
reduces GI upset (A), it's not the most critical safety
instruction. Blood glucose monitoring (C) and fiber intake
(D) are important but not as critical as preventing lactic
acidosis.
3. A postoperative patient on day 2 after abdominal surgery
develops sudden onset tachycardia, tachypnea, and oxygen
saturation of 88%. What is the nurse's priority action?
A. Administer prescribed antibiotics
B. Apply oxygen and notify the healthcare provider
immediately
C. Encourage deep breathing and coughing exercises
D. Elevate the head of the bed to 30 degrees
Correct Answer: B
Explanation: These symptoms suggest pulmonary
embolism, a medical emergency. The priority is to apply
oxygen to improve oxygenation and immediately notify the
healthcare provider for further intervention. While
elevation (D) and deep breathing (C) are helpful, they don't
address the emergency. Antibiotics (A) are not indicated
unless infection is confirmed.
4. Which laboratory value requires immediate intervention in a
patient with acute kidney injury?
A. Creatinine 2.5 mg/dL
B. Potassium 6.2 mEq/L
, C. BUN 45 mg/dL
D. Sodium 132 mEq/L
Correct Answer: B
Explanation: Potassium of 6.2 mEq/L indicates
hyperkalemia, which can cause life-threatening cardiac
arrhythmias and requires immediate intervention. While
elevated creatinine (A) and BUN (C) indicate kidney
dysfunction, and hyponatremia (D) is concerning,
hyperkalemia poses the most immediate threat to life.
5. A patient with heart failure is prescribed furosemide. Which
assessment finding indicates the medication is effective?
A. Weight gain of 2 kg in 24 hours
B. Decreased edema and improved breath sounds
C. Increased urine output with decreased blood pressure
D. Elevated serum potassium levels
Correct Answer: B
Explanation: Effective furosemide therapy in heart failure
results in decreased edema and improved breath sounds as
fluid is removed from the lungs and tissues. Weight gain (A)
indicates fluid retention, not improvement. While increased
urine output (C) is expected, decreased blood pressure may
indicate over-diuresis. Furosemide causes potassium loss,
not elevation (D).
6. A patient with suspected myocardial infarction presents with
chest pain. Which ECG finding is most specific for acute
myocardial injury?
A. ST-segment elevation
, B. T-wave inversion
C. Prolonged PR interval
D.QT interval prolongation
Correct Answer: A
Explanation: ST-segment elevation is the most specific ECG
finding for acute myocardial injury and indicates STEMI
(ST-elevation myocardial infarction), requiring immediate
intervention. T-wave inversion (B) can indicate ischemia
but is less specific. Prolonged PR interval (C) indicates heart
block, and QT prolongation (D) increases arrhythmia risk
but doesn't indicate acute MI.
7. Which nursing intervention is most effective in preventing
ventilator-associated pneumonia (VAP)?
A. Administering prophylactic antibiotics
B. Maintaining the head of bed at 30-45 degrees
C. Changing ventilator circuits every 24 hours
D. Suctioning the endotracheal tube every 2 hours
Correct Answer: B
Explanation: Maintaining the head of bed at 30-45 degrees
is the most effective evidence-based intervention for
preventing VAP by reducing aspiration risk. Prophylactic
antibiotics (A) are not recommended and can lead to
resistance. Changing circuits daily (C) is unnecessary and
increases contamination risk. Routine suctioning (D) can
introduce bacteria and should be done only when needed.
8. A patient with cirrhosis develops hepatic encephalopathy.
Which medication should the nurse expect to be prescribed?
