Detailed Answer Key For Medical Surgical Exam, A+ Solutions
This premium, high-yield study guide delivers verified Next-Generation
NCLEX (NGN) style multiple-choice questions complete with detailed
answers and professional rationales. Spanning across core clinical
systems—including advanced cardiovascular, renal, and critical care
management—every item is structured to optimize active recall and deep
comprehension. It serves as the ultimate resource for nursing students
aiming for top-tier exam scores and long-term clinical mastery.
Question 1
A client who underwent an abdominal cholecystectomy 4 hours ago
reports sharp abdominal pain. The nurse notes that the patient's
abdominal dressing is saturated with bright red drainage and the heart
rate has increased from 82 bpm to 118 bpm. Which action should the
nurse take first?
A. Administer the prescribed opioid analgesic.
B. Reinforce the dressing and check the client's blood pressure.
C. Apply a warm compress to the abdomen.
D. Facilitate an immediate bedside ultrasound.
,Answer: B. Reinforce the dressing and check the client's blood
pressure.
Rationale: The clinical presentation of saturated bright red drainage
(frank hemorrhage) and tachycardia indicates hypovolemia. The
nurse's priority is to address airway, breathing, and circulation
(ABCs). Reinforcing the dressing helps contain the bleeding, while
checking blood pressure confirms the severity of shock. Opioids (A)
can mask signs of shock. Warm compresses (C) cause vasodilation,
which worsens bleeding. Ultrasound (D) is a secondary action
performed after stabilizing the client.
Question 2
A nurse is preparing to administer regular insulin and NPH insulin in the
same syringe to a client with Type 1 Diabetes Mellitus. Which sequential
action is correct?
A. Draw the NPH insulin first, then draw the regular insulin.
B. Inject air into the regular insulin vial, then inject air into the NPH vial.
C. Inject air into the NPH vial, inject air into the regular vial, and draw the
regular insulin first.
D. Mix the insulins together in a medication cup before drawing them up.
Answer: C. Inject air into the NPH vial, inject air into the regular vial,
and draw the regular insulin first.
Rationale: The correct sequence for mixing insulins prevents
,contamination of the short-acting regular insulin vial with the
longer-acting NPH protein. The standard clinical memory aid is
"Cloudy to Clear (air), Clear to Cloudy (draw)." Air is injected into
NPH (cloudy), then air is injected into regular (clear). Regular
insulin is always drawn into the syringe first.
Question 3
A client with a history of deep vein thrombosis (DVT) is receiving a
continuous intravenous heparin infusion. Which laboratory value requires
an immediate notification to the healthcare provider?
A. Activated partial thromboplastin time (aPTT) of 75 seconds.
B. International Normalized Ratio (INR) of 1.2.
C. Platelet count of 82,000/mm³.
D. Hemoglobin level of 13.5 g/dL.
Answer: C. Platelet count of 82,000/mm³.
Rationale: A platelet count below 150,000/mm³, or a drop of greater
than 50% from baseline, indicates Heparin-Induced
Thrombocytopenia (HIT). This is a life-threatening immunologic
reaction that causes paradoxically high risks of thrombosis and
hemorrhage. Heparin must be stopped immediately. An aPTT of 75
seconds (A) is within the therapeutic range (1.5 to 2.5 times the
normal control). INR (B) monitors warfarin therapy, not heparin.
Hemoglobin (D) is within normal parameters.
, Question 4
An emergency department nurse assesses a client who sustained a crush
injury to the lower right extremity. The client complains of excruciating
pain that is unrelieved by intravenous morphine. Physical assessment
reveals a tense, swollen calf with diminished pedal pulses. Which condition
should the nurse suspect?
A. Acute Compartment Syndrome
B. Superficial Thrombophlebitis
C. Peripheral Artery Disease
D. Peripheral Neuropathy
Answer: A. Acute Compartment Syndrome
Rationale: Acute compartment syndrome is a surgical emergency
characterized by increased pressure within a myofascial
compartment. It typically presents with the "6 Ps", where pain
disproportionate to the injury and unrelieved by narcotics is the
earliest sign. Diminished pulses, paresthesia, and tissue tenseness
confirm ischemia. DVT/thrombophlebitis (B) does not cause this
level of sudden neurovascular compromise. PAD (C) and neuropathy
(D) are chronic conditions.
Question 5
A nurse is caring for a client diagnosed with acute pancreatitis. Which
dietary prescription should the nurse anticipate during the initial acute
This premium, high-yield study guide delivers verified Next-Generation
NCLEX (NGN) style multiple-choice questions complete with detailed
answers and professional rationales. Spanning across core clinical
systems—including advanced cardiovascular, renal, and critical care
management—every item is structured to optimize active recall and deep
comprehension. It serves as the ultimate resource for nursing students
aiming for top-tier exam scores and long-term clinical mastery.
Question 1
A client who underwent an abdominal cholecystectomy 4 hours ago
reports sharp abdominal pain. The nurse notes that the patient's
abdominal dressing is saturated with bright red drainage and the heart
rate has increased from 82 bpm to 118 bpm. Which action should the
nurse take first?
A. Administer the prescribed opioid analgesic.
B. Reinforce the dressing and check the client's blood pressure.
C. Apply a warm compress to the abdomen.
D. Facilitate an immediate bedside ultrasound.
,Answer: B. Reinforce the dressing and check the client's blood
pressure.
Rationale: The clinical presentation of saturated bright red drainage
(frank hemorrhage) and tachycardia indicates hypovolemia. The
nurse's priority is to address airway, breathing, and circulation
(ABCs). Reinforcing the dressing helps contain the bleeding, while
checking blood pressure confirms the severity of shock. Opioids (A)
can mask signs of shock. Warm compresses (C) cause vasodilation,
which worsens bleeding. Ultrasound (D) is a secondary action
performed after stabilizing the client.
Question 2
A nurse is preparing to administer regular insulin and NPH insulin in the
same syringe to a client with Type 1 Diabetes Mellitus. Which sequential
action is correct?
A. Draw the NPH insulin first, then draw the regular insulin.
B. Inject air into the regular insulin vial, then inject air into the NPH vial.
C. Inject air into the NPH vial, inject air into the regular vial, and draw the
regular insulin first.
D. Mix the insulins together in a medication cup before drawing them up.
Answer: C. Inject air into the NPH vial, inject air into the regular vial,
and draw the regular insulin first.
Rationale: The correct sequence for mixing insulins prevents
,contamination of the short-acting regular insulin vial with the
longer-acting NPH protein. The standard clinical memory aid is
"Cloudy to Clear (air), Clear to Cloudy (draw)." Air is injected into
NPH (cloudy), then air is injected into regular (clear). Regular
insulin is always drawn into the syringe first.
Question 3
A client with a history of deep vein thrombosis (DVT) is receiving a
continuous intravenous heparin infusion. Which laboratory value requires
an immediate notification to the healthcare provider?
A. Activated partial thromboplastin time (aPTT) of 75 seconds.
B. International Normalized Ratio (INR) of 1.2.
C. Platelet count of 82,000/mm³.
D. Hemoglobin level of 13.5 g/dL.
Answer: C. Platelet count of 82,000/mm³.
Rationale: A platelet count below 150,000/mm³, or a drop of greater
than 50% from baseline, indicates Heparin-Induced
Thrombocytopenia (HIT). This is a life-threatening immunologic
reaction that causes paradoxically high risks of thrombosis and
hemorrhage. Heparin must be stopped immediately. An aPTT of 75
seconds (A) is within the therapeutic range (1.5 to 2.5 times the
normal control). INR (B) monitors warfarin therapy, not heparin.
Hemoglobin (D) is within normal parameters.
, Question 4
An emergency department nurse assesses a client who sustained a crush
injury to the lower right extremity. The client complains of excruciating
pain that is unrelieved by intravenous morphine. Physical assessment
reveals a tense, swollen calf with diminished pedal pulses. Which condition
should the nurse suspect?
A. Acute Compartment Syndrome
B. Superficial Thrombophlebitis
C. Peripheral Artery Disease
D. Peripheral Neuropathy
Answer: A. Acute Compartment Syndrome
Rationale: Acute compartment syndrome is a surgical emergency
characterized by increased pressure within a myofascial
compartment. It typically presents with the "6 Ps", where pain
disproportionate to the injury and unrelieved by narcotics is the
earliest sign. Diminished pulses, paresthesia, and tissue tenseness
confirm ischemia. DVT/thrombophlebitis (B) does not cause this
level of sudden neurovascular compromise. PAD (C) and neuropathy
(D) are chronic conditions.
Question 5
A nurse is caring for a client diagnosed with acute pancreatitis. Which
dietary prescription should the nurse anticipate during the initial acute
