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KAPLAN MEDICAL SURGICAL INTEGRATED
FINAL EXAM Questions And Well Graded
Solutions With Rationales Updated 2026-
2027
FUNDAMENTALS OF NURSING CARE (1-50)
1. A nurse is preparing to insert a nasogastric tube. Which action should the nurse take
first?
a) Measure the length of the tube from the nose to the earlobe to the xiphoid
process
b) Lubricate the tip of the tube with water-soluble jelly
c) Place the client in a supine position with head hyperextended
d) Determine the client's ability to swallow and any history of nasal trauma
Correct Answer: d) Determine the client's ability to swallow and any history of
nasal trauma
Rationale: Assessment is the first step of the nursing process. Determining
swallowing ability and history of nasal trauma (deviated septum, epistaxis,
prior surgery) is essential before attempting insertion. Measurement,
lubrication, and positioning occur after this assessment.
2. A client with a urinary catheter reports suprapubic pain and bladder spasms. What is
the nurse's priority action?
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a) Administer prescribed antispasmodic medication
b) Irrigate the catheter with 30 mL of sterile saline
c) Check the catheter for kinks and ensure the drainage bag is below bladder level
d) Notify the healthcare provider immediately
Correct Answer: c) Check the catheter for kinks and ensure the drainage bag is
below bladder level
Rationale: Bladder spasms and suprapubic pain are often caused by catheter
obstruction or improper positioning. The nurse must first check for mechanical
issues (kinks, dependent loops, bag positioning) before considering medication
or notifying the provider. Irrigation requires a provider order.
3. A nurse is providing oral care to an unconscious client. Which position is safest for
this procedure?
a) Supine position with a pillow under the head
b) Side-lying position with the head turned to the side
c) Semi-Fowler's position with head tilted backward
d) Trendelenburg position
Correct Answer: b) Side-lying position with the head turned to the side
Rationale: The side-lying position with head turned to the side allows drainage
of secretions and reduces aspiration risk. Supine position increases aspiration
risk. Trendelenburg would not provide airway protection.
4. A client is on fall precautions. Which action demonstrates the nurse's understanding
of safe patient handling?
a) Placing the bed in the lowest position with all side rails up
b) Keeping the call light within reach and the bed alarm activated
c) Restraining the client to prevent wandering at night
d) Placing a fall risk sign on the door only
Correct Answer: b) Keeping the call light within reach and the bed alarm
activated
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Rationale: Keeping call light within reach empowers the client to call for
assistance, while bed alarms alert staff to unassisted attempts to get up.
Restraints are a last resort and require a provider order. Side rails up can
increase injury risk (climbing over).
5. A nurse is assessing a client's skin. Which finding requires immediate intervention?
a) Dry, flaky skin on the lower extremities
b) A 2 cm x 3 cm stage 2 pressure injury on the sacrum
c) Pallor of the nail beds
d) Ecchymosis on the forearm
Correct Answer: b) A 2 cm x 3 cm stage 2 pressure injury on the sacrum
Rationale: A stage 2 pressure injury involves partial-thickness skin loss with
exposed dermis and requires immediate intervention to prevent progression.
Dry skin, pallor, and ecchymosis require monitoring but are not immediate
priorities.
6. A nurse is preparing to administer an enema to an adult client. In which position
should the nurse place the client?
a) Supine with legs extended
b) Left side-lying with right knee flexed
c) Right side-lying with left knee flexed
d) Prone position
Correct Answer: b) Left side-lying with right knee flexed
Rationale: Left side-lying (Sims' position) with right knee flexed follows the
natural anatomical curve of the sigmoid colon and descending colon, allowing
gravity to facilitate enema flow. This position also reduces the risk of client
discomfort and cramping.
7. A client has a new colostomy. Which stoma assessment finding should the nurse
report to the healthcare provider immediately?
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a) Pink, moist stoma
b) Slight edema of the stoma
c) Dark purple discoloration of the stoma
d) Small amount of bleeding from the stoma surface
Correct Answer: c) Dark purple discoloration of the stoma
Rationale: Dark purple or black discoloration indicates compromised blood
supply and possible necrosis of the stoma tissue. This is an emergency requiring
immediate surgical evaluation. Pink, moist tissue with slight edema and
minimal bleeding are expected findings in the immediate postoperative period.
8. A nurse is teaching a client with a new ileostomy about dietary management. Which
instruction should the nurse include?
a) Eat high-fiber foods to prevent constipation
b) Drink at least 2 liters of fluid daily
c) Avoid all fruits and vegetables
d) Take enteric-coated medications as prescribed
Correct Answer: b) Drink at least 2 liters of fluid daily
Rationale: Clients with an ileostomy have a high risk of fluid and electrolyte
loss due to liquid stool output. Adequate hydration (2-3 liters daily) is essential.
High-fiber foods can cause obstruction, and enteric-coated medications will not
dissolve properly. Fruits and vegetables should be introduced gradually with
caution.
9. A client who is 2 days post-operative from abdominal surgery has a nasogastric tube
to low intermittent suction. The nurse notes that the drainage has become bright red.
What is the priority action?
a) Irrigate the NG tube with sterile water
b) Document the finding as an expected change
c) Assess the client's vital signs and notify the provider
d) Increase the suction pressure
Correct Answer: c) Assess the client's vital signs and notify the provider
KAPLAN MEDICAL SURGICAL INTEGRATED
FINAL EXAM Questions And Well Graded
Solutions With Rationales Updated 2026-
2027
FUNDAMENTALS OF NURSING CARE (1-50)
1. A nurse is preparing to insert a nasogastric tube. Which action should the nurse take
first?
a) Measure the length of the tube from the nose to the earlobe to the xiphoid
process
b) Lubricate the tip of the tube with water-soluble jelly
c) Place the client in a supine position with head hyperextended
d) Determine the client's ability to swallow and any history of nasal trauma
Correct Answer: d) Determine the client's ability to swallow and any history of
nasal trauma
Rationale: Assessment is the first step of the nursing process. Determining
swallowing ability and history of nasal trauma (deviated septum, epistaxis,
prior surgery) is essential before attempting insertion. Measurement,
lubrication, and positioning occur after this assessment.
2. A client with a urinary catheter reports suprapubic pain and bladder spasms. What is
the nurse's priority action?
, 2|Page
a) Administer prescribed antispasmodic medication
b) Irrigate the catheter with 30 mL of sterile saline
c) Check the catheter for kinks and ensure the drainage bag is below bladder level
d) Notify the healthcare provider immediately
Correct Answer: c) Check the catheter for kinks and ensure the drainage bag is
below bladder level
Rationale: Bladder spasms and suprapubic pain are often caused by catheter
obstruction or improper positioning. The nurse must first check for mechanical
issues (kinks, dependent loops, bag positioning) before considering medication
or notifying the provider. Irrigation requires a provider order.
3. A nurse is providing oral care to an unconscious client. Which position is safest for
this procedure?
a) Supine position with a pillow under the head
b) Side-lying position with the head turned to the side
c) Semi-Fowler's position with head tilted backward
d) Trendelenburg position
Correct Answer: b) Side-lying position with the head turned to the side
Rationale: The side-lying position with head turned to the side allows drainage
of secretions and reduces aspiration risk. Supine position increases aspiration
risk. Trendelenburg would not provide airway protection.
4. A client is on fall precautions. Which action demonstrates the nurse's understanding
of safe patient handling?
a) Placing the bed in the lowest position with all side rails up
b) Keeping the call light within reach and the bed alarm activated
c) Restraining the client to prevent wandering at night
d) Placing a fall risk sign on the door only
Correct Answer: b) Keeping the call light within reach and the bed alarm
activated
, 3|Page
Rationale: Keeping call light within reach empowers the client to call for
assistance, while bed alarms alert staff to unassisted attempts to get up.
Restraints are a last resort and require a provider order. Side rails up can
increase injury risk (climbing over).
5. A nurse is assessing a client's skin. Which finding requires immediate intervention?
a) Dry, flaky skin on the lower extremities
b) A 2 cm x 3 cm stage 2 pressure injury on the sacrum
c) Pallor of the nail beds
d) Ecchymosis on the forearm
Correct Answer: b) A 2 cm x 3 cm stage 2 pressure injury on the sacrum
Rationale: A stage 2 pressure injury involves partial-thickness skin loss with
exposed dermis and requires immediate intervention to prevent progression.
Dry skin, pallor, and ecchymosis require monitoring but are not immediate
priorities.
6. A nurse is preparing to administer an enema to an adult client. In which position
should the nurse place the client?
a) Supine with legs extended
b) Left side-lying with right knee flexed
c) Right side-lying with left knee flexed
d) Prone position
Correct Answer: b) Left side-lying with right knee flexed
Rationale: Left side-lying (Sims' position) with right knee flexed follows the
natural anatomical curve of the sigmoid colon and descending colon, allowing
gravity to facilitate enema flow. This position also reduces the risk of client
discomfort and cramping.
7. A client has a new colostomy. Which stoma assessment finding should the nurse
report to the healthcare provider immediately?
, 4|Page
a) Pink, moist stoma
b) Slight edema of the stoma
c) Dark purple discoloration of the stoma
d) Small amount of bleeding from the stoma surface
Correct Answer: c) Dark purple discoloration of the stoma
Rationale: Dark purple or black discoloration indicates compromised blood
supply and possible necrosis of the stoma tissue. This is an emergency requiring
immediate surgical evaluation. Pink, moist tissue with slight edema and
minimal bleeding are expected findings in the immediate postoperative period.
8. A nurse is teaching a client with a new ileostomy about dietary management. Which
instruction should the nurse include?
a) Eat high-fiber foods to prevent constipation
b) Drink at least 2 liters of fluid daily
c) Avoid all fruits and vegetables
d) Take enteric-coated medications as prescribed
Correct Answer: b) Drink at least 2 liters of fluid daily
Rationale: Clients with an ileostomy have a high risk of fluid and electrolyte
loss due to liquid stool output. Adequate hydration (2-3 liters daily) is essential.
High-fiber foods can cause obstruction, and enteric-coated medications will not
dissolve properly. Fruits and vegetables should be introduced gradually with
caution.
9. A client who is 2 days post-operative from abdominal surgery has a nasogastric tube
to low intermittent suction. The nurse notes that the drainage has become bright red.
What is the priority action?
a) Irrigate the NG tube with sterile water
b) Document the finding as an expected change
c) Assess the client's vital signs and notify the provider
d) Increase the suction pressure
Correct Answer: c) Assess the client's vital signs and notify the provider
