Medical-Surgical Nursing 11th
Edition Ignatavicius: 200 NGN
Exam Prep Questions,
Answers & Detailed
Rationales (Chapters 1-200
Complete Study Guide)
graded by expert
This comprehensive study resource features 200 high-yield multiple-choice questions with explicit
correct answers and detailed rationales covering Chapters 1–69 of the 11th edition Medical-Surgical
Nursing textbook. Designed for Stuvia and Docsity sellers, each question mirrors Next-Generation
NCLEX (NGN) styling to maximize student test-taking strategy, priority assessment, and clinical
judgment capabilities. It serves as an all-in-one exam preparation tool, lecture companion, and
critical care mastery guide for undergraduate nursing students.
A nurse assesses a 74-year-old patient who is 4 hours postoperative after a total hip
arthroplasty. Which assessment finding requires immediate clinical rescue by the nurse?
A) The patient reports a pain level of 6 on a 1-to-10 scale.
B) The patient has 120 mL of serosanguineous drainage in the surgical drain.
C) The patient's left foot is cool to the touch with a weak pedal pulse.
D) The patient has not voided since returning from the recovery room.
Answer: C
, Rationale: A cool extremity with a weak pedal pulse indicates compromised peripheral arterial
perfusion. This is a potential neurovascular complication that requires an immediate critical
rescue intervention (notifying the surgeon). Pain, expected surgical drainage, and temporary
urinary retention are common postoperative findings that do not take priority over immediate
tissue ischemia.
A patient with severe chronic obstructive pulmonary disease (COPD) is admitted with increased
dyspnea and productive cough. The nurse reviews the patient’s arterial blood gas (ABG) results:
pH 7.31, PaCO₂ 52 mm Hg, HCO₃⁻ 28 mEq/L, PaO₂ 68 mm Hg. Which acid-base imbalance is this
patient experiencing?
A) Uncompensated metabolic acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory alkalosis
D) Uncompensated respiratory acidosis
Answer: B
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO₂ is high (>45 mm Hg), which
indicates a respiratory cause. The HCO₃⁻ is elevated (>26 mEq/L), which means the kidneys are
attempting to retain bicarbonate to compensate for the respiratory acidosis. Because the pH has
not returned to the normal range, the compensation is partial.
The nurse is caring for a patient who is receiving an intravenous infusion of 0.9% normal saline
at 125 mL/hr. The patient begins complaining of shortness of breath and has a wet, productive
cough. Upon auscultation, the nurse notes crackles in the bilateral lung bases. Which Action
Alert intervention should the nurse perform first?
A) Notify the healthcare provider immediately.
B) Slow the intravenous infusion rate to a keep-vein-open status.
C) Administer a prescribed dose of intravenous furosemide.
D) Elevate the head of the patient's bed to a high-Fowler's position.
Answer: D
Rationale: The patient is showing signs of circulatory overload (fluid volume excess). Elevating
the head of the bed to a high-Fowler's position is the priority immediate nursing action to
maximize chest expansion, ease breathing, and improve oxygenation. Slowing the IV rate and
notifying the provider are also necessary but follow positioning.
A nurse is reviewing laboratory results for a patient with acute kidney injury. The patient’s
serum potassium level is 6.3 mEq/L. Which Drug Alert medication should the nurse anticipate
administering to quickly shift potassium from the extracellular fluid into the intracellular fluid?
A) Sodium polystyrene sulfonate orally
B) Regular insulin intravenously along with 50% dextrose
C) Calcium gluconate intravenously
D) Spironolactone orally
Answer: B
, Rationale: Intravenous regular insulin drives potassium into the cells, lowering serum levels
rapidly. Dextrose is given concurrently to prevent hypoglycemia. Sodium polystyrene sulfonate
eliminates potassium via the GI tract but takes hours to work. Calcium gluconate protects the
myocardium but does not lower serum potassium levels.
A patient with Type 1 diabetes mellitus is admitted to the emergency department in a state of
Diabetic Ketoacidosis (DKA). The nurse notes rapid, deep, sighing respirations. How should the
nurse document this specific respiratory pattern?
A) Cheyne-Stokes respirations
B) Biot's respirations
C) Kussmaul respirations
D) Hypoventilation
Answer: C
Rationale: Kussmaul respirations are deep, rapid, and regular breaths. They represent a
compensatory mechanism by the respiratory system to blow off carbon dioxide and eliminate
excess acids in metabolic acidosis conditions such as DKA.
The nurse is monitoring a patient who returned from a thyroidectomy 2 hours ago. The patient
reports a tingling sensation around the mouth and muscles twitching in the hand when a blood
pressure cuff is inflated. Which electrolyte imbalance should the nurse suspect?
A) Hypercalcemia
B) Hypocalcemia
C) Hyperkalemia
D) Hypomagnesemia
Answer: B
Rationale: Injury to or accidental removal of the parathyroid glands during a thyroidectomy can
cause a precipitous drop in serum calcium. Perioral numbness and a positive Trousseau's sign
(hand spasm with BP cuff inflation) are classic signs of neuromuscular hyperexcitablity
secondary to hypocalcemia.
A patient with a history of deep vein thrombosis (DVT) is prescribed continuous intravenous
heparin therapy. The nurse reviews the laboratory results and notes an activated partial
thromboplastin time (aPTT) of 110 seconds. What is the nurse's priority action?
A) Increase the heparin infusion rate based on the standard protocol.
B) Stop the heparin infusion and prepare the antidote protamine sulfate.
C) Maintain the current infusion rate and recheck the aPTT in 4 hours.
D) Document the finding as an expected therapeutic response to heparin.
Answer: B
Rationale: A normal aPTT is 30–40 seconds, and the therapeutic range for heparin therapy is
typically 1.5 to 2.5 times the normal value (approx. 60–80 seconds). An aPTT of 110 seconds
indicates critical over-anticoagulation, putting the patient at extreme risk for hemorrhage. The
infusion must be stopped immediately.
, While assessing an older adult patient who is confused and has been experiencing severe
vomiting for 3 days, the nurse notes poor skin turgor, dry mucous membranes, and a heart rate
of 112 beats per minute. Which IV fluid selection should the nurse expect the provider to
prescribe for initial volume resuscitation?
A) 0.45% Normal Saline (half-normal saline)
B) 5% Dextrose in Water (D5W)
C) 0.9% Sodium Chloride (Normal Saline)
D) 5% Dextrose in 0.45% Normal Saline
Answer: C
Rationale: The patient exhibits clinical signs of hypovolemia (dehydration and tachycardia). An
isotonic fluid such as 0.9% Sodium Chloride or Lactated Ringer's is required to expand the
extracellular fluid volume and restore intravascular pressure. Hypotonic fluids (0.45% NS) would
cause fluid to shift into cells, which does not address acute intravascular volume loss effectively.
The nurse is caring for a patient who has been diagnosed with a spinal cord injury at the level of
T4. The patient suddenly complains of a severe, throbbing headache, and the nurse measures
the blood pressure at 198/104 mm Hg. What is the first action the nurse must take?
A) Check the patient's urinary drainage catheter for kinks or obstruction.
B) Administer an emergency dose of intravenous hydralazine.
C) Raise the head of the bed to a fully upright, 90-degree position.
D) Notify the rapid response team and the primary provider.
Answer: C
Rationale: This patient is presenting with signs of autonomic dysreflexia, an emergency life-
threatening condition in patients with spinal cord injuries above T6. The immediate first nursing
action is to sit the patient upright to induce orthostatic pressure drops and help lower the
intracranial blood pressure. Finding the noxious stimulus (like a blocked catheter) is the second
step.
A nurse evaluates a patient who is receiving a blood transfusion. Within 15 minutes of initiating
the transfusion, the patient develops a fever, chills, low back pain, and tachycardia. Which type
of transfusion reaction should the nurse immediately manage?
A) Febrile non-hemolytic reaction
B) Circulatory overload reaction
C) Acute hemolytic transfusion reaction
D) Mild allergic reaction
Answer: C
Rationale: Low back pain, fever, chills, and tachycardia are classic signs of an acute hemolytic
transfusion reaction, which is caused by an ABO incompatibility. This is a critical rescue scenario.
The nurse must stop the transfusion immediately, disconnect the blood tubing, and infuse
normal saline through new tubing.
Edition Ignatavicius: 200 NGN
Exam Prep Questions,
Answers & Detailed
Rationales (Chapters 1-200
Complete Study Guide)
graded by expert
This comprehensive study resource features 200 high-yield multiple-choice questions with explicit
correct answers and detailed rationales covering Chapters 1–69 of the 11th edition Medical-Surgical
Nursing textbook. Designed for Stuvia and Docsity sellers, each question mirrors Next-Generation
NCLEX (NGN) styling to maximize student test-taking strategy, priority assessment, and clinical
judgment capabilities. It serves as an all-in-one exam preparation tool, lecture companion, and
critical care mastery guide for undergraduate nursing students.
A nurse assesses a 74-year-old patient who is 4 hours postoperative after a total hip
arthroplasty. Which assessment finding requires immediate clinical rescue by the nurse?
A) The patient reports a pain level of 6 on a 1-to-10 scale.
B) The patient has 120 mL of serosanguineous drainage in the surgical drain.
C) The patient's left foot is cool to the touch with a weak pedal pulse.
D) The patient has not voided since returning from the recovery room.
Answer: C
, Rationale: A cool extremity with a weak pedal pulse indicates compromised peripheral arterial
perfusion. This is a potential neurovascular complication that requires an immediate critical
rescue intervention (notifying the surgeon). Pain, expected surgical drainage, and temporary
urinary retention are common postoperative findings that do not take priority over immediate
tissue ischemia.
A patient with severe chronic obstructive pulmonary disease (COPD) is admitted with increased
dyspnea and productive cough. The nurse reviews the patient’s arterial blood gas (ABG) results:
pH 7.31, PaCO₂ 52 mm Hg, HCO₃⁻ 28 mEq/L, PaO₂ 68 mm Hg. Which acid-base imbalance is this
patient experiencing?
A) Uncompensated metabolic acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory alkalosis
D) Uncompensated respiratory acidosis
Answer: B
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO₂ is high (>45 mm Hg), which
indicates a respiratory cause. The HCO₃⁻ is elevated (>26 mEq/L), which means the kidneys are
attempting to retain bicarbonate to compensate for the respiratory acidosis. Because the pH has
not returned to the normal range, the compensation is partial.
The nurse is caring for a patient who is receiving an intravenous infusion of 0.9% normal saline
at 125 mL/hr. The patient begins complaining of shortness of breath and has a wet, productive
cough. Upon auscultation, the nurse notes crackles in the bilateral lung bases. Which Action
Alert intervention should the nurse perform first?
A) Notify the healthcare provider immediately.
B) Slow the intravenous infusion rate to a keep-vein-open status.
C) Administer a prescribed dose of intravenous furosemide.
D) Elevate the head of the patient's bed to a high-Fowler's position.
Answer: D
Rationale: The patient is showing signs of circulatory overload (fluid volume excess). Elevating
the head of the bed to a high-Fowler's position is the priority immediate nursing action to
maximize chest expansion, ease breathing, and improve oxygenation. Slowing the IV rate and
notifying the provider are also necessary but follow positioning.
A nurse is reviewing laboratory results for a patient with acute kidney injury. The patient’s
serum potassium level is 6.3 mEq/L. Which Drug Alert medication should the nurse anticipate
administering to quickly shift potassium from the extracellular fluid into the intracellular fluid?
A) Sodium polystyrene sulfonate orally
B) Regular insulin intravenously along with 50% dextrose
C) Calcium gluconate intravenously
D) Spironolactone orally
Answer: B
, Rationale: Intravenous regular insulin drives potassium into the cells, lowering serum levels
rapidly. Dextrose is given concurrently to prevent hypoglycemia. Sodium polystyrene sulfonate
eliminates potassium via the GI tract but takes hours to work. Calcium gluconate protects the
myocardium but does not lower serum potassium levels.
A patient with Type 1 diabetes mellitus is admitted to the emergency department in a state of
Diabetic Ketoacidosis (DKA). The nurse notes rapid, deep, sighing respirations. How should the
nurse document this specific respiratory pattern?
A) Cheyne-Stokes respirations
B) Biot's respirations
C) Kussmaul respirations
D) Hypoventilation
Answer: C
Rationale: Kussmaul respirations are deep, rapid, and regular breaths. They represent a
compensatory mechanism by the respiratory system to blow off carbon dioxide and eliminate
excess acids in metabolic acidosis conditions such as DKA.
The nurse is monitoring a patient who returned from a thyroidectomy 2 hours ago. The patient
reports a tingling sensation around the mouth and muscles twitching in the hand when a blood
pressure cuff is inflated. Which electrolyte imbalance should the nurse suspect?
A) Hypercalcemia
B) Hypocalcemia
C) Hyperkalemia
D) Hypomagnesemia
Answer: B
Rationale: Injury to or accidental removal of the parathyroid glands during a thyroidectomy can
cause a precipitous drop in serum calcium. Perioral numbness and a positive Trousseau's sign
(hand spasm with BP cuff inflation) are classic signs of neuromuscular hyperexcitablity
secondary to hypocalcemia.
A patient with a history of deep vein thrombosis (DVT) is prescribed continuous intravenous
heparin therapy. The nurse reviews the laboratory results and notes an activated partial
thromboplastin time (aPTT) of 110 seconds. What is the nurse's priority action?
A) Increase the heparin infusion rate based on the standard protocol.
B) Stop the heparin infusion and prepare the antidote protamine sulfate.
C) Maintain the current infusion rate and recheck the aPTT in 4 hours.
D) Document the finding as an expected therapeutic response to heparin.
Answer: B
Rationale: A normal aPTT is 30–40 seconds, and the therapeutic range for heparin therapy is
typically 1.5 to 2.5 times the normal value (approx. 60–80 seconds). An aPTT of 110 seconds
indicates critical over-anticoagulation, putting the patient at extreme risk for hemorrhage. The
infusion must be stopped immediately.
, While assessing an older adult patient who is confused and has been experiencing severe
vomiting for 3 days, the nurse notes poor skin turgor, dry mucous membranes, and a heart rate
of 112 beats per minute. Which IV fluid selection should the nurse expect the provider to
prescribe for initial volume resuscitation?
A) 0.45% Normal Saline (half-normal saline)
B) 5% Dextrose in Water (D5W)
C) 0.9% Sodium Chloride (Normal Saline)
D) 5% Dextrose in 0.45% Normal Saline
Answer: C
Rationale: The patient exhibits clinical signs of hypovolemia (dehydration and tachycardia). An
isotonic fluid such as 0.9% Sodium Chloride or Lactated Ringer's is required to expand the
extracellular fluid volume and restore intravascular pressure. Hypotonic fluids (0.45% NS) would
cause fluid to shift into cells, which does not address acute intravascular volume loss effectively.
The nurse is caring for a patient who has been diagnosed with a spinal cord injury at the level of
T4. The patient suddenly complains of a severe, throbbing headache, and the nurse measures
the blood pressure at 198/104 mm Hg. What is the first action the nurse must take?
A) Check the patient's urinary drainage catheter for kinks or obstruction.
B) Administer an emergency dose of intravenous hydralazine.
C) Raise the head of the bed to a fully upright, 90-degree position.
D) Notify the rapid response team and the primary provider.
Answer: C
Rationale: This patient is presenting with signs of autonomic dysreflexia, an emergency life-
threatening condition in patients with spinal cord injuries above T6. The immediate first nursing
action is to sit the patient upright to induce orthostatic pressure drops and help lower the
intracranial blood pressure. Finding the noxious stimulus (like a blocked catheter) is the second
step.
A nurse evaluates a patient who is receiving a blood transfusion. Within 15 minutes of initiating
the transfusion, the patient develops a fever, chills, low back pain, and tachycardia. Which type
of transfusion reaction should the nurse immediately manage?
A) Febrile non-hemolytic reaction
B) Circulatory overload reaction
C) Acute hemolytic transfusion reaction
D) Mild allergic reaction
Answer: C
Rationale: Low back pain, fever, chills, and tachycardia are classic signs of an acute hemolytic
transfusion reaction, which is caused by an ABO incompatibility. This is a critical rescue scenario.
The nurse must stop the transfusion immediately, disconnect the blood tubing, and infuse
normal saline through new tubing.
