RN Adult Medical-Surgical Nursing Edition 12.0 Actual Exam
2026/2027: Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular & Hematologic Disorders | Q1 – Q10
Section 2 | Respiratory & Acid-Base Disorders | Q11 – Q20
Section 3 | Gastrointestinal, Hepatic & Endocrine Disorders | Q21 – Q30
Section 4 | Renal, Genitourinary & Reproductive Disorders | Q31 – Q40
Section 5 | Neurologic, Musculoskeletal & Integumentary Disorders | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old woman with atrial fibrillation is seen in the anticoagulation clinic. Her INR
is 3.8. She reports no bleeding, bruising, or dark stools. Her warfarin dose has been
stable for 3 months with previous INRs between 2.2 and 2.8.
A. Administer 2.5 mg oral vitamin K immediately
B. Hold the next warfarin dose and contact the provider for dosing guidance ✓
CORRECT
C. Continue the current warfarin dose and recheck the INR in 2 weeks
D. Instruct her to increase her green leafy vegetable intake before the next dose
Correct Answer: B
Rationale: An INR of 3.8 is supratherapeutic for atrial fibrillation management, so
holding the next dose and notifying the provider is the appropriate nursing action to
prevent bleeding complications. Vitamin K is reserved for INRs above 4.5 or active
bleeding, and continuing the current dose increases hemorrhage risk. Most
,anticoagulation protocols specify holding one or more doses and reassessing when the
INR exceeds 3.0 in a stable patient.
Question 2 of 50
A 58-year-old man is admitted with an anterior wall STEMI. Cardiac catheterization
reveals a 90% LAD occlusion, and a drug-eluting stent is placed. Two hours
post-procedure, his blood pressure drops to 82/50 mmHg, heart rate is 110, and a groin
hematoma is expanding.
A. Apply ice to the groin and elevate the head of the bed
B. Administer prescribed metoprolol for tachycardia
C. Prepare the patient for emergency bypass surgery
D. Apply direct pressure to the groin site and activate the rapid response team ✓
CORRECT
Correct Answer: D
Rationale: Hypotension, tachycardia, and an expanding groin hematoma after cardiac
catheterization indicate active bleeding from the arterial access site, requiring
immediate direct pressure and rapid response activation. Metoprolol would worsen
hypotension and mask compensatory tachycardia, and ice application alone is
insufficient for active hemorrhage. Rapid identification and pressure application can
prevent retroperitoneal bleeding and hemodynamic collapse.
Question 3 of 50
A 45-year-old woman with iron deficiency anemia is prescribed ferrous sulfate 325 mg
three times daily. She reports constipation and dark stools since starting therapy 1 week
ago.
A. Reassure her that dark stools are expected and recommend increasing fiber and
fluids ✓ CORRECT
B. Advise her to stop the medication immediately and notify the provider
,C. Suggest switching to enteric-coated iron to eliminate side effects
D. Tell her to take the medication with milk to reduce gastrointestinal irritation
Correct Answer: A
Rationale: Dark tarry stools are a common and expected side effect of iron
supplementation that distinguishes them from melena caused by gastrointestinal
bleeding. Stopping the medication would compromise her hemoglobin recovery, and
milk contains calcium that binds iron and reduces absorption by up to 50%. Increasing
dietary fiber and fluid intake is the standard first-line management for iron-related
constipation.
Question 4 of 50
A 66-year-old man with hypertension and heart failure is receiving intravenous
furosemide 40 mg twice daily for acute pulmonary edema. After the second dose, the
nurse notes a potassium level of 3.1 mEq/L, urine output of 300 mL/hour, and the
patient reports muscle weakness.
A. Slow the IV furosemide infusion rate to reduce diuresis
B. Administer the next dose as scheduled and recheck potassium in the morning
C. Hold the next furosemide dose and notify the provider to request potassium
replacement ✓ CORRECT
D. Encourage the patient to eat bananas and orange juice until the next lab draw
Correct Answer: C
Rationale: A potassium of 3.1 mEq/L with symptoms of hypokalemia in a patient
receiving loop diuretics requires holding the diuretic and notifying the provider for
replacement therapy, as cardiac arrhythmias can occur at this level. Relying on dietary
potassium alone is insufficient for acute symptomatic hypokalemia, and administering
the next dose could worsen the deficit. Loop diuretics cause significant potassium
wasting that must be actively replaced in heart failure patients.
Question 5 of 50
, A 54-year-old man with peripheral arterial disease is scheduled for a femoral-popliteal
bypass graft. During preoperative teaching, he asks why he must stop smoking before
surgery.
A. Smoking increases the risk of anesthesia awareness during the procedure
B. Nicotine causes vasoconstriction that reduces blood flow to the graft and impairs
wound healing ✓ CORRECT
C. Tobacco smoke contains carbon monoxide that interacts with general anesthetic
agents
D. Smoking cessation is primarily required to reduce postoperative nausea and vomiting
Correct Answer: B
Rationale: Nicotine is a potent vasoconstrictor that compromises perfusion to the distal
extremity and the surgical graft site, significantly increasing the risk of graft failure and
poor wound healing in vascular surgery patients. Carbon monoxide does reduce
oxygen-carrying capacity but does not directly interact with anesthetic agents, and while
smoking cessation has systemic benefits, graft patency is the primary surgical concern.
Patients with PAD who continue smoking have a 30-40% graft failure rate within the first
year.
Question 6 of 50
A 38-year-old woman with a history of rheumatic heart disease presents to the
emergency department with sudden onset dyspnea, orthopnea, and a diastolic murmur
at the apex. An echocardiogram reveals severe mitral stenosis with a valve area of 0.9
cm².
A. Give all medications with food to prevent gastric irritation
B. Administer intravenous fluids aggressively to maintain preload
C. Avoid anticoagulants due to the risk of bleeding with valve disease
D. Monitor for atrial fibrillation and ensure anticoagulation therapy is maintained ✓
CORRECT
2026/2027: Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular & Hematologic Disorders | Q1 – Q10
Section 2 | Respiratory & Acid-Base Disorders | Q11 – Q20
Section 3 | Gastrointestinal, Hepatic & Endocrine Disorders | Q21 – Q30
Section 4 | Renal, Genitourinary & Reproductive Disorders | Q31 – Q40
Section 5 | Neurologic, Musculoskeletal & Integumentary Disorders | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old woman with atrial fibrillation is seen in the anticoagulation clinic. Her INR
is 3.8. She reports no bleeding, bruising, or dark stools. Her warfarin dose has been
stable for 3 months with previous INRs between 2.2 and 2.8.
A. Administer 2.5 mg oral vitamin K immediately
B. Hold the next warfarin dose and contact the provider for dosing guidance ✓
CORRECT
C. Continue the current warfarin dose and recheck the INR in 2 weeks
D. Instruct her to increase her green leafy vegetable intake before the next dose
Correct Answer: B
Rationale: An INR of 3.8 is supratherapeutic for atrial fibrillation management, so
holding the next dose and notifying the provider is the appropriate nursing action to
prevent bleeding complications. Vitamin K is reserved for INRs above 4.5 or active
bleeding, and continuing the current dose increases hemorrhage risk. Most
,anticoagulation protocols specify holding one or more doses and reassessing when the
INR exceeds 3.0 in a stable patient.
Question 2 of 50
A 58-year-old man is admitted with an anterior wall STEMI. Cardiac catheterization
reveals a 90% LAD occlusion, and a drug-eluting stent is placed. Two hours
post-procedure, his blood pressure drops to 82/50 mmHg, heart rate is 110, and a groin
hematoma is expanding.
A. Apply ice to the groin and elevate the head of the bed
B. Administer prescribed metoprolol for tachycardia
C. Prepare the patient for emergency bypass surgery
D. Apply direct pressure to the groin site and activate the rapid response team ✓
CORRECT
Correct Answer: D
Rationale: Hypotension, tachycardia, and an expanding groin hematoma after cardiac
catheterization indicate active bleeding from the arterial access site, requiring
immediate direct pressure and rapid response activation. Metoprolol would worsen
hypotension and mask compensatory tachycardia, and ice application alone is
insufficient for active hemorrhage. Rapid identification and pressure application can
prevent retroperitoneal bleeding and hemodynamic collapse.
Question 3 of 50
A 45-year-old woman with iron deficiency anemia is prescribed ferrous sulfate 325 mg
three times daily. She reports constipation and dark stools since starting therapy 1 week
ago.
A. Reassure her that dark stools are expected and recommend increasing fiber and
fluids ✓ CORRECT
B. Advise her to stop the medication immediately and notify the provider
,C. Suggest switching to enteric-coated iron to eliminate side effects
D. Tell her to take the medication with milk to reduce gastrointestinal irritation
Correct Answer: A
Rationale: Dark tarry stools are a common and expected side effect of iron
supplementation that distinguishes them from melena caused by gastrointestinal
bleeding. Stopping the medication would compromise her hemoglobin recovery, and
milk contains calcium that binds iron and reduces absorption by up to 50%. Increasing
dietary fiber and fluid intake is the standard first-line management for iron-related
constipation.
Question 4 of 50
A 66-year-old man with hypertension and heart failure is receiving intravenous
furosemide 40 mg twice daily for acute pulmonary edema. After the second dose, the
nurse notes a potassium level of 3.1 mEq/L, urine output of 300 mL/hour, and the
patient reports muscle weakness.
A. Slow the IV furosemide infusion rate to reduce diuresis
B. Administer the next dose as scheduled and recheck potassium in the morning
C. Hold the next furosemide dose and notify the provider to request potassium
replacement ✓ CORRECT
D. Encourage the patient to eat bananas and orange juice until the next lab draw
Correct Answer: C
Rationale: A potassium of 3.1 mEq/L with symptoms of hypokalemia in a patient
receiving loop diuretics requires holding the diuretic and notifying the provider for
replacement therapy, as cardiac arrhythmias can occur at this level. Relying on dietary
potassium alone is insufficient for acute symptomatic hypokalemia, and administering
the next dose could worsen the deficit. Loop diuretics cause significant potassium
wasting that must be actively replaced in heart failure patients.
Question 5 of 50
, A 54-year-old man with peripheral arterial disease is scheduled for a femoral-popliteal
bypass graft. During preoperative teaching, he asks why he must stop smoking before
surgery.
A. Smoking increases the risk of anesthesia awareness during the procedure
B. Nicotine causes vasoconstriction that reduces blood flow to the graft and impairs
wound healing ✓ CORRECT
C. Tobacco smoke contains carbon monoxide that interacts with general anesthetic
agents
D. Smoking cessation is primarily required to reduce postoperative nausea and vomiting
Correct Answer: B
Rationale: Nicotine is a potent vasoconstrictor that compromises perfusion to the distal
extremity and the surgical graft site, significantly increasing the risk of graft failure and
poor wound healing in vascular surgery patients. Carbon monoxide does reduce
oxygen-carrying capacity but does not directly interact with anesthetic agents, and while
smoking cessation has systemic benefits, graft patency is the primary surgical concern.
Patients with PAD who continue smoking have a 30-40% graft failure rate within the first
year.
Question 6 of 50
A 38-year-old woman with a history of rheumatic heart disease presents to the
emergency department with sudden onset dyspnea, orthopnea, and a diastolic murmur
at the apex. An echocardiogram reveals severe mitral stenosis with a valve area of 0.9
cm².
A. Give all medications with food to prevent gastric irritation
B. Administer intravenous fluids aggressively to maintain preload
C. Avoid anticoagulants due to the risk of bleeding with valve disease
D. Monitor for atrial fibrillation and ensure anticoagulation therapy is maintained ✓
CORRECT
