RN MED SURG Final Exam Newest 2026/2027 Actual Exam Test
Bank Questions And Correct Detailed Answers (Verified
Answers) || Complete A+ Guide - 200 Questions and Answers
Already Graded A+ Premium Exam Tested And Verified
Subject Area Medical-Surgical Nursing
Description This comprehensive final examination assesses mastery of advanced
medical-surgical nursing concepts, including complex pathophysiology,
pharmacology, nursing interventions, and evidence-based practice. The exam
covers cardiology, neurology, endocrinology, renal, gastrointestinal, respiratory,
oncology, and emergency nursing, with emphasis on clinical reasoning,
prioritization, and patient safety.
Expected Grade A+
Total Questions 200
Duration 3 hours
Learning Outcomes 1. Apply advanced pathophysiology to interpret clinical manifestations and
diagnostic data.
2. Prioritize nursing interventions for critically ill patients using clinical judgment.
3. Integrate pharmacological principles with patient-specific factors to ensure safe
medication administration.
4. Synthesize evidence-based guidelines to manage complex medical-surgical
conditions.
5. Demonstrate effective communication and interprofessional collaboration in
high-acuity settings.
Accreditation This exam aligns with AACN Essentials and NCLEX-RN test plan standards,
reflecting current practice guidelines from the American Heart Association,
American Diabetes Association, and other authoritative bodies.
Page 1
,1. A patient with acute decompensated heart failure presents with pulmonary edema,
severe dyspnea, and an oxygen saturation of 84% on room air. The nurse reviews the
electronic health record and notes a recent order for metoprolol succinate 50 mg
orally daily. Which action is most appropriate?
A. Administer the metoprolol as ordered to reduce myocardial oxygen demand.
B. Hold the metoprolol and notify the prescriber immediately.
C. Give the metoprolol with a small amount of water to prevent aspiration.
D. Administer the metoprolol intravenously for faster onset.
Answer: B. Hold the metoprolol and notify the prescriber immediately.
In acute decompensated heart failure with pulmonary edema, beta-blockers like
metoprolol are generally withheld due to negative inotropic effects that can worsen
hemodynamics. The priority is to stabilize the patient with diuretics and vasodilators.
Options A and C are unsafe; option D is not indicated as metoprolol succinate is an oral
formulation.
2. A patient with a history of type 2 diabetes mellitus is admitted with hyperglycemic
hyperosmolar state (HHS). Serum glucose is 680 mg/dL, serum sodium is 132
mEq/L, and serum osmolality is 340 mOsm/kg. The nurse anticipates which initial
intravenous fluid prescription?
A. 0.9% sodium chloride at 15-20 mL/kg per hour
B. 0.45% sodium chloride at 250 mL/hour
C. 5% dextrose in 0.45% sodium chloride at 100 mL/hour
D. Lactated Ringer's solution at 200 mL/hour
Answer: A. 0.9% sodium chloride at 15-20 mL/kg per hour
In HHS, initial fluid resuscitation is with 0.9% sodium chloride (normal saline) to
correct hypovolemia and hyperosmolality. The patient has hyponatremia (132 mEq/L),
which is often due to dilution from hyperglycemia; using 0.45% saline (option B) could
worsen hyponatremia. Options C and D are not appropriate for initial rehydration.
Page 2
,3. A patient admitted with acute pancreatitis develops sudden onset of ecchymosis
around the umbilicus and flank areas. The nurse recognizes this as a sign of which
complication?
A. Retroperitoneal hemorrhage
B. Portal hypertension
C. Disseminated intravascular coagulation
D. Superior mesenteric artery syndrome
Answer: A. Retroperitoneal hemorrhage
Cullen sign (periumbilical ecchymosis) and Grey Turner sign (flank ecchymosis)
indicate retroperitoneal hemorrhage, often due to severe pancreatitis causing
hemorrhage into the retroperitoneal space. This is a life-threatening complication
requiring immediate intervention. Portal hypertension (option B) typically presents
with caput medusae and splenomegaly; DIC (option C) would show bleeding from
multiple sites; SMA syndrome (option D) presents with vomiting and abdominal
distension.
4. A patient with chronic kidney disease stage 5 on hemodialysis has a serum
potassium of 6.8 mEq/L and an ECG showing peaked T waves. The nurse prepares
to administer which of the following as a priority?
A. Sodium polystyrene sulfonate (Kayexalate) orally
B. Calcium gluconate intravenously
C. Regular insulin 10 units intravenously with 50 mL of 50% dextrose
D. Albuterol 10 mg via nebulization
Answer: B. Calcium gluconate intravenously
In life-threatening hyperkalemia with ECG changes, the priority is to stabilize the
cardiac membrane by administering intravenous calcium gluconate or calcium
chloride. This reduces the risk of ventricular fibrillation. Options A, C, and D help shift
potassium into cells or remove it, but they act more slowly; calcium should be given
first.
Page 3
, 5. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 28
mm Hg and a cerebral perfusion pressure (CPP) of 50 mm Hg. The mean arterial
pressure (MAP) is 78 mm Hg. Which intervention should the nurse question?
A. Administer mannitol 0.5 g/kg intravenously
B. Elevate the head of bed to 30 degrees
C. Administer fentanyl 50 mcg intravenously for pain
D. Administer 500 mL of 0.9% sodium chloride bolus
Answer: D. Administer 500 mL of 0.9% sodium chloride bolus
CPP = MAP - ICP. Current CPP is 50 mm Hg (normal 60-70). Administering a fluid
bolus with 0.9% sodium chloride (isotonic) may increase MAP but also potentially
increase ICP, and is not the preferred intervention. Mannitol (option A) is an osmotic
diuretic that reduces ICP; head elevation (option B) promotes venous drainage;
fentanyl (option C) can reduce pain and agitation, lowering ICP.
6. A patient with cirrhosis and ascites is being treated with spironolactone and
furosemide. The nurse notes a serum sodium of 128 mEq/L, potassium of 3.2 mEq/L,
and creatinine of 1.8 mg/dL. Which action is most appropriate?
A. Continue both diuretics and restrict fluid intake to 1 L/day
B. Hold spironolactone and continue furosemide
C. Hold furosemide and continue spironolactone
D. Discontinue both diuretics and administer hypertonic saline
Answer: C. Hold furosemide and continue spironolactone
The patient has hyponatremia and hypokalemia. Spironolactone is a potassium-sparing
diuretic; furosemide causes potassium and sodium loss. Holding furosemide and
continuing spironolactone can help correct hypokalemia and avoid worsening
hyponatremia. Fluid restriction (option A) is appropriate but does not address the
electrolyte abnormalities. Hypertonic saline (option D) is reserved for severe
symptomatic hyponatremia.
Page 4
Bank Questions And Correct Detailed Answers (Verified
Answers) || Complete A+ Guide - 200 Questions and Answers
Already Graded A+ Premium Exam Tested And Verified
Subject Area Medical-Surgical Nursing
Description This comprehensive final examination assesses mastery of advanced
medical-surgical nursing concepts, including complex pathophysiology,
pharmacology, nursing interventions, and evidence-based practice. The exam
covers cardiology, neurology, endocrinology, renal, gastrointestinal, respiratory,
oncology, and emergency nursing, with emphasis on clinical reasoning,
prioritization, and patient safety.
Expected Grade A+
Total Questions 200
Duration 3 hours
Learning Outcomes 1. Apply advanced pathophysiology to interpret clinical manifestations and
diagnostic data.
2. Prioritize nursing interventions for critically ill patients using clinical judgment.
3. Integrate pharmacological principles with patient-specific factors to ensure safe
medication administration.
4. Synthesize evidence-based guidelines to manage complex medical-surgical
conditions.
5. Demonstrate effective communication and interprofessional collaboration in
high-acuity settings.
Accreditation This exam aligns with AACN Essentials and NCLEX-RN test plan standards,
reflecting current practice guidelines from the American Heart Association,
American Diabetes Association, and other authoritative bodies.
Page 1
,1. A patient with acute decompensated heart failure presents with pulmonary edema,
severe dyspnea, and an oxygen saturation of 84% on room air. The nurse reviews the
electronic health record and notes a recent order for metoprolol succinate 50 mg
orally daily. Which action is most appropriate?
A. Administer the metoprolol as ordered to reduce myocardial oxygen demand.
B. Hold the metoprolol and notify the prescriber immediately.
C. Give the metoprolol with a small amount of water to prevent aspiration.
D. Administer the metoprolol intravenously for faster onset.
Answer: B. Hold the metoprolol and notify the prescriber immediately.
In acute decompensated heart failure with pulmonary edema, beta-blockers like
metoprolol are generally withheld due to negative inotropic effects that can worsen
hemodynamics. The priority is to stabilize the patient with diuretics and vasodilators.
Options A and C are unsafe; option D is not indicated as metoprolol succinate is an oral
formulation.
2. A patient with a history of type 2 diabetes mellitus is admitted with hyperglycemic
hyperosmolar state (HHS). Serum glucose is 680 mg/dL, serum sodium is 132
mEq/L, and serum osmolality is 340 mOsm/kg. The nurse anticipates which initial
intravenous fluid prescription?
A. 0.9% sodium chloride at 15-20 mL/kg per hour
B. 0.45% sodium chloride at 250 mL/hour
C. 5% dextrose in 0.45% sodium chloride at 100 mL/hour
D. Lactated Ringer's solution at 200 mL/hour
Answer: A. 0.9% sodium chloride at 15-20 mL/kg per hour
In HHS, initial fluid resuscitation is with 0.9% sodium chloride (normal saline) to
correct hypovolemia and hyperosmolality. The patient has hyponatremia (132 mEq/L),
which is often due to dilution from hyperglycemia; using 0.45% saline (option B) could
worsen hyponatremia. Options C and D are not appropriate for initial rehydration.
Page 2
,3. A patient admitted with acute pancreatitis develops sudden onset of ecchymosis
around the umbilicus and flank areas. The nurse recognizes this as a sign of which
complication?
A. Retroperitoneal hemorrhage
B. Portal hypertension
C. Disseminated intravascular coagulation
D. Superior mesenteric artery syndrome
Answer: A. Retroperitoneal hemorrhage
Cullen sign (periumbilical ecchymosis) and Grey Turner sign (flank ecchymosis)
indicate retroperitoneal hemorrhage, often due to severe pancreatitis causing
hemorrhage into the retroperitoneal space. This is a life-threatening complication
requiring immediate intervention. Portal hypertension (option B) typically presents
with caput medusae and splenomegaly; DIC (option C) would show bleeding from
multiple sites; SMA syndrome (option D) presents with vomiting and abdominal
distension.
4. A patient with chronic kidney disease stage 5 on hemodialysis has a serum
potassium of 6.8 mEq/L and an ECG showing peaked T waves. The nurse prepares
to administer which of the following as a priority?
A. Sodium polystyrene sulfonate (Kayexalate) orally
B. Calcium gluconate intravenously
C. Regular insulin 10 units intravenously with 50 mL of 50% dextrose
D. Albuterol 10 mg via nebulization
Answer: B. Calcium gluconate intravenously
In life-threatening hyperkalemia with ECG changes, the priority is to stabilize the
cardiac membrane by administering intravenous calcium gluconate or calcium
chloride. This reduces the risk of ventricular fibrillation. Options A, C, and D help shift
potassium into cells or remove it, but they act more slowly; calcium should be given
first.
Page 3
, 5. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 28
mm Hg and a cerebral perfusion pressure (CPP) of 50 mm Hg. The mean arterial
pressure (MAP) is 78 mm Hg. Which intervention should the nurse question?
A. Administer mannitol 0.5 g/kg intravenously
B. Elevate the head of bed to 30 degrees
C. Administer fentanyl 50 mcg intravenously for pain
D. Administer 500 mL of 0.9% sodium chloride bolus
Answer: D. Administer 500 mL of 0.9% sodium chloride bolus
CPP = MAP - ICP. Current CPP is 50 mm Hg (normal 60-70). Administering a fluid
bolus with 0.9% sodium chloride (isotonic) may increase MAP but also potentially
increase ICP, and is not the preferred intervention. Mannitol (option A) is an osmotic
diuretic that reduces ICP; head elevation (option B) promotes venous drainage;
fentanyl (option C) can reduce pain and agitation, lowering ICP.
6. A patient with cirrhosis and ascites is being treated with spironolactone and
furosemide. The nurse notes a serum sodium of 128 mEq/L, potassium of 3.2 mEq/L,
and creatinine of 1.8 mg/dL. Which action is most appropriate?
A. Continue both diuretics and restrict fluid intake to 1 L/day
B. Hold spironolactone and continue furosemide
C. Hold furosemide and continue spironolactone
D. Discontinue both diuretics and administer hypertonic saline
Answer: C. Hold furosemide and continue spironolactone
The patient has hyponatremia and hypokalemia. Spironolactone is a potassium-sparing
diuretic; furosemide causes potassium and sodium loss. Holding furosemide and
continuing spironolactone can help correct hypokalemia and avoid worsening
hyponatremia. Fluid restriction (option A) is appropriate but does not address the
electrolyte abnormalities. Hypertonic saline (option D) is reserved for severe
symptomatic hyponatremia.
Page 4
