Medical-Surgical Nursing,
Pharmacology, and Clinical
Judgment 2026/2027
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**Target Question Count: 75**
---
### Question 1
The nurse is caring for a patient who is 12 hours post-operative following a right colectomy. The
patient's vital signs are: temperature 99.2°F, heart rate 98 beats per minute, respiratory rate 22 breaths
per minute, blood pressure 142/88 mmHg, and oxygen saturation 94% on 2 L nasal cannula. The patient
reports incisional pain rated 7 on a 0-10 scale. Which intervention should the nurse implement first?
A. Administer prescribed intravenous morphine sulfate
B. Encourage the patient to use the incentive spirometer
C. Notify the healthcare provider of the vital signs
,D. Assess the surgical incision for signs of infection
💫RATIONALE✔️✔️: The patient's vital signs indicate potential hypoventilation and ineffective gas
exchange related to pain and anesthesia effects. Encouraging incentive spirometry use is the priority
intervention to prevent atelectasis and pneumonia, which are common post-operative complications.
Pain management should follow to facilitate effective deep breathing.
💫ANSWER✔️✔️: B. Encourage the patient to use the incentive spirometer
---
### Question 2
A patient with chronic kidney disease stage 4 has the following laboratory results: serum creatinine 4.2
mg/dL, blood urea nitrogen 58 mg/dL, potassium 5.8 mEq/L, and hemoglobin 9.8 g/dL. Which finding
requires the nurse's immediate action?
A. Serum creatinine of 4.2 mg/dL
B. Blood urea nitrogen of 58 mg/dL
C. Potassium level of 5.8 mEq/L
D. Hemoglobin of 9.8 g/dL
💫RATIONALE✔️✔️: A potassium level of 5.8 mEq/L is significantly elevated and places the patient at
risk for life-threatening cardiac dysrhythmias. This requires immediate intervention, including notifying
the healthcare provider, administering potassium-binding medications, and preparing for possible
dialysis.
💫ANSWER✔️✔️: C. Potassium level of 5.8 mEq/L
,---
### Question 3
The nurse is administering digoxin to a patient with heart failure. Which assessment finding should
prompt the nurse to withhold the medication and notify the healthcare provider?
A. Heart rate of 58 beats per minute
B. Serum potassium of 4.2 mEq/L
C. Blood pressure of 128/76 mmHg
D. Respiratory rate of 16 breaths per minute
💫RATIONALE✔️✔️: Digoxin should be withheld if the apical heart rate is less than 60 beats per
minute in adults, as bradycardia is a sign of digoxin toxicity. The nurse should assess the patient further
and notify the healthcare provider before administering the dose.
💫ANSWER✔️✔️: A. Heart rate of 58 beats per minute
---
### Question 4
A patient with type 1 diabetes mellitus is experiencing nausea, vomiting, and abdominal pain. The
patient's blood glucose is 420 mg/dL, and urine ketones are positive. Which acid-base imbalance does
the nurse anticipate?
, A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
💫RATIONALE✔️✔️: Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis due to the
accumulation of ketone bodies from fatty acid breakdown. The patient's presentation of hyperglycemia,
ketonuria, and gastrointestinal symptoms is classic for DKA.
💫ANSWER✔️✔️: A. Metabolic acidosis
---
### Question 5
The nurse is preparing to insert a nasogastric tube for gastric decompression. Which position should the
nurse place the patient in to facilitate tube insertion?
A. Supine with the head of bed flat
B. High Fowler's position with the head tilted forward
C. Left lateral position with the head elevated
D. Trendelenburg position with the head lowered
💫RATIONALE✔️✔️: High Fowler's position with the head tilted forward allows the tube to follow the
natural curvature of the nasopharynx and facilitates passage into the esophagus. This position also
reduces the risk of aspiration.
Pharmacology, and Clinical
Judgment 2026/2027
---
**Target Question Count: 75**
---
### Question 1
The nurse is caring for a patient who is 12 hours post-operative following a right colectomy. The
patient's vital signs are: temperature 99.2°F, heart rate 98 beats per minute, respiratory rate 22 breaths
per minute, blood pressure 142/88 mmHg, and oxygen saturation 94% on 2 L nasal cannula. The patient
reports incisional pain rated 7 on a 0-10 scale. Which intervention should the nurse implement first?
A. Administer prescribed intravenous morphine sulfate
B. Encourage the patient to use the incentive spirometer
C. Notify the healthcare provider of the vital signs
,D. Assess the surgical incision for signs of infection
💫RATIONALE✔️✔️: The patient's vital signs indicate potential hypoventilation and ineffective gas
exchange related to pain and anesthesia effects. Encouraging incentive spirometry use is the priority
intervention to prevent atelectasis and pneumonia, which are common post-operative complications.
Pain management should follow to facilitate effective deep breathing.
💫ANSWER✔️✔️: B. Encourage the patient to use the incentive spirometer
---
### Question 2
A patient with chronic kidney disease stage 4 has the following laboratory results: serum creatinine 4.2
mg/dL, blood urea nitrogen 58 mg/dL, potassium 5.8 mEq/L, and hemoglobin 9.8 g/dL. Which finding
requires the nurse's immediate action?
A. Serum creatinine of 4.2 mg/dL
B. Blood urea nitrogen of 58 mg/dL
C. Potassium level of 5.8 mEq/L
D. Hemoglobin of 9.8 g/dL
💫RATIONALE✔️✔️: A potassium level of 5.8 mEq/L is significantly elevated and places the patient at
risk for life-threatening cardiac dysrhythmias. This requires immediate intervention, including notifying
the healthcare provider, administering potassium-binding medications, and preparing for possible
dialysis.
💫ANSWER✔️✔️: C. Potassium level of 5.8 mEq/L
,---
### Question 3
The nurse is administering digoxin to a patient with heart failure. Which assessment finding should
prompt the nurse to withhold the medication and notify the healthcare provider?
A. Heart rate of 58 beats per minute
B. Serum potassium of 4.2 mEq/L
C. Blood pressure of 128/76 mmHg
D. Respiratory rate of 16 breaths per minute
💫RATIONALE✔️✔️: Digoxin should be withheld if the apical heart rate is less than 60 beats per
minute in adults, as bradycardia is a sign of digoxin toxicity. The nurse should assess the patient further
and notify the healthcare provider before administering the dose.
💫ANSWER✔️✔️: A. Heart rate of 58 beats per minute
---
### Question 4
A patient with type 1 diabetes mellitus is experiencing nausea, vomiting, and abdominal pain. The
patient's blood glucose is 420 mg/dL, and urine ketones are positive. Which acid-base imbalance does
the nurse anticipate?
, A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
💫RATIONALE✔️✔️: Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis due to the
accumulation of ketone bodies from fatty acid breakdown. The patient's presentation of hyperglycemia,
ketonuria, and gastrointestinal symptoms is classic for DKA.
💫ANSWER✔️✔️: A. Metabolic acidosis
---
### Question 5
The nurse is preparing to insert a nasogastric tube for gastric decompression. Which position should the
nurse place the patient in to facilitate tube insertion?
A. Supine with the head of bed flat
B. High Fowler's position with the head tilted forward
C. Left lateral position with the head elevated
D. Trendelenburg position with the head lowered
💫RATIONALE✔️✔️: High Fowler's position with the head tilted forward allows the tube to follow the
natural curvature of the nasopharynx and facilitates passage into the esophagus. This position also
reduces the risk of aspiration.
