PN ADULT MEDICAL SURGICAL ONLINE PRACTICE
2026 B 100 VERIFIED Q AND A WITH DETAILED
RATIONALES COMPREHENSIVE MED SURG
TEST
1. A licensed practical nurse (LPN) is caring for a client who is
24 hours postoperative following a total thyroidectomy.
Which of the following assessment findings is the priority for
the nurse to report to the provider?
A. Mild hoarseness when speaking
B. Tonic flexion of the client's wrist when a blood pressure
cuff is inflated
C. Patient report of pain at the incision site rated as 4 on a 0-
to-10 scale
D. Serosanguineous drainage on the dressing measuring 2
cm in diameter
CORRECT ANSWER: B
RATiONAlE: Tonic flexion of the wrist when a blood pressure
cuff is inflated indicates a positive Trousseau's sign, which is a
hallmark sign of hypocalcemia. Hypocalcemia is a potential
complication of a thyroidectomy if the parathyroid glands are
accidentally damaged or removed. This can lead to
laryngospasm and seizures, making it the highest priority
finding. Mild hoarseness is common due to intubation or mild
laryngeal nerve irritation. Incisional pain is expected and can be
managed with analgesics. Small amounts of serosanguineous
drainage are normal postoperatively.
, 2. A nurse is reinforcing discharge teaching with a client who
has a new prescription for sublingual nitroglycerin tablets for
the management of stable angina. Which of the following
instructions should the nurse include?
A. Swallow the tablet with a full glass of water if chest pain
occurs.
B. Store the medication in a clear plastic container on a
sunny windowsill.
C. Take one tablet every 5 minutes for up to three doses if
chest pain persists, then call 911 if pain is unrelieved.
D. Discard the medication bottle 1 year after opening it.
CORRECT ANSWER: C
RATiONAlE: The correct protocol for stable angina is to place
one tablet under the tongue at the onset of chest pain. If the pain
is not relieved after 5 minutes, the client should take a second
tablet and can take a third tablet 5 minutes later. If pain
continues after three doses, emergency services (911) must be
contacted immediately. Sublingual nitroglycerin must not be
swallowed, as it undergoes first-pass metabolism and loses
efficacy. It must be stored in its original dark glass bottle away
from light and heat, and it typically expires 3 to 6 months after
opening.
3. A nurse is collecting data from a client who has a chest tube
connected to a water-seal drainage system. The nurse notes
continuous bubbling in the water-seal chamber. Which of the
following actions should the nurse take first?
A. Increase the suction wall pressure.
B. Clamp the chest tube near the client's insertion site to
check for an air leak.
, C. Document the finding as expected and continue to
monitor.
D. Add sterile water to the suction control chamber.
CORRECT ANSWER: B
RATiONAlE: Continuous bubbling in the water-seal chamber
indicates an air leak within the system or at the insertion site.
Intermittent bubbling is expected with expiration or coughing,
but continuous bubbling is abnormal. The nurse should
temporarily clamp the chest tube near the insertion site to
determine if the leak is originating from the client's thorax or
within the tubing system. Increasing suction or adding water
will not fix an air leak, and documenting it as expected is
inappropriate because it indicates a malfunction or worsening
condition.
4. A nurse is reviewing the laboratory results of a client who is
receiving primary heparin therapy via continuous
intravenous infusion for a deep vein thrombosis (DVT).
Which of the following laboratory values indicates that the
therapy is effective?
A. International Normalized Ratio (INR) of 2.5
B. Activated partial thromboplastin time (aPTT) of 65
seconds
C. Prothrombin time (PT) of 12 seconds
D. Platelet count of 95,000/mm³
CORRECT ANSWER: B
RATiONAlE: Heparin efficacy is monitored using the
activated partial thromboplastin time (aPTT). A therapeutic
, level for a client receiving heparin is typically 1.5 to 2.5 times the
normal reference range (which is around 30 to 40 seconds),
making 65 seconds an effective therapeutic value. INR and PT
are used to monitor warfarin therapy, not heparin. A platelet
count of 95,000/mm³ is low (thrombocytopenia) and could
indicate heparin-induced thrombocytopenia (HIT), which is an
adverse complication rather than a sign of therapeutic
effectiveness.
5. A nurse is preparing to administer morning medications to a
client who has chronic kidney disease (CKD) and a scheduled
hemodialysis treatment in 2 hours. Which of the following
medications should the nurse withhold until after the
procedure?
A. Calcium carbonate
B. Epoetin alfa
C. Lisinopril
D. Famotidine
CORRECT ANSWER: C
RATiONAlE: Antihypertensive medications, such as the ACE
inhibitor lisinopril, are generally withheld prior to hemodialysis.
Hemodialysis shifts fluid rapidly and can cause significant
hypotension; administering an antihypertensive right before
treatment compounds this risk. Additionally, many water-
soluble medications are dialyzed out of the blood during the
procedure, rendering them ineffective. Calcium carbonate acts as
a phosphate binder and is given with meals, epoetin alfa can be
given during or after dialysis, and famotidine does not carry the
same immediate hemodynamic risk as lisinopril.
2026 B 100 VERIFIED Q AND A WITH DETAILED
RATIONALES COMPREHENSIVE MED SURG
TEST
1. A licensed practical nurse (LPN) is caring for a client who is
24 hours postoperative following a total thyroidectomy.
Which of the following assessment findings is the priority for
the nurse to report to the provider?
A. Mild hoarseness when speaking
B. Tonic flexion of the client's wrist when a blood pressure
cuff is inflated
C. Patient report of pain at the incision site rated as 4 on a 0-
to-10 scale
D. Serosanguineous drainage on the dressing measuring 2
cm in diameter
CORRECT ANSWER: B
RATiONAlE: Tonic flexion of the wrist when a blood pressure
cuff is inflated indicates a positive Trousseau's sign, which is a
hallmark sign of hypocalcemia. Hypocalcemia is a potential
complication of a thyroidectomy if the parathyroid glands are
accidentally damaged or removed. This can lead to
laryngospasm and seizures, making it the highest priority
finding. Mild hoarseness is common due to intubation or mild
laryngeal nerve irritation. Incisional pain is expected and can be
managed with analgesics. Small amounts of serosanguineous
drainage are normal postoperatively.
, 2. A nurse is reinforcing discharge teaching with a client who
has a new prescription for sublingual nitroglycerin tablets for
the management of stable angina. Which of the following
instructions should the nurse include?
A. Swallow the tablet with a full glass of water if chest pain
occurs.
B. Store the medication in a clear plastic container on a
sunny windowsill.
C. Take one tablet every 5 minutes for up to three doses if
chest pain persists, then call 911 if pain is unrelieved.
D. Discard the medication bottle 1 year after opening it.
CORRECT ANSWER: C
RATiONAlE: The correct protocol for stable angina is to place
one tablet under the tongue at the onset of chest pain. If the pain
is not relieved after 5 minutes, the client should take a second
tablet and can take a third tablet 5 minutes later. If pain
continues after three doses, emergency services (911) must be
contacted immediately. Sublingual nitroglycerin must not be
swallowed, as it undergoes first-pass metabolism and loses
efficacy. It must be stored in its original dark glass bottle away
from light and heat, and it typically expires 3 to 6 months after
opening.
3. A nurse is collecting data from a client who has a chest tube
connected to a water-seal drainage system. The nurse notes
continuous bubbling in the water-seal chamber. Which of the
following actions should the nurse take first?
A. Increase the suction wall pressure.
B. Clamp the chest tube near the client's insertion site to
check for an air leak.
, C. Document the finding as expected and continue to
monitor.
D. Add sterile water to the suction control chamber.
CORRECT ANSWER: B
RATiONAlE: Continuous bubbling in the water-seal chamber
indicates an air leak within the system or at the insertion site.
Intermittent bubbling is expected with expiration or coughing,
but continuous bubbling is abnormal. The nurse should
temporarily clamp the chest tube near the insertion site to
determine if the leak is originating from the client's thorax or
within the tubing system. Increasing suction or adding water
will not fix an air leak, and documenting it as expected is
inappropriate because it indicates a malfunction or worsening
condition.
4. A nurse is reviewing the laboratory results of a client who is
receiving primary heparin therapy via continuous
intravenous infusion for a deep vein thrombosis (DVT).
Which of the following laboratory values indicates that the
therapy is effective?
A. International Normalized Ratio (INR) of 2.5
B. Activated partial thromboplastin time (aPTT) of 65
seconds
C. Prothrombin time (PT) of 12 seconds
D. Platelet count of 95,000/mm³
CORRECT ANSWER: B
RATiONAlE: Heparin efficacy is monitored using the
activated partial thromboplastin time (aPTT). A therapeutic
, level for a client receiving heparin is typically 1.5 to 2.5 times the
normal reference range (which is around 30 to 40 seconds),
making 65 seconds an effective therapeutic value. INR and PT
are used to monitor warfarin therapy, not heparin. A platelet
count of 95,000/mm³ is low (thrombocytopenia) and could
indicate heparin-induced thrombocytopenia (HIT), which is an
adverse complication rather than a sign of therapeutic
effectiveness.
5. A nurse is preparing to administer morning medications to a
client who has chronic kidney disease (CKD) and a scheduled
hemodialysis treatment in 2 hours. Which of the following
medications should the nurse withhold until after the
procedure?
A. Calcium carbonate
B. Epoetin alfa
C. Lisinopril
D. Famotidine
CORRECT ANSWER: C
RATiONAlE: Antihypertensive medications, such as the ACE
inhibitor lisinopril, are generally withheld prior to hemodialysis.
Hemodialysis shifts fluid rapidly and can cause significant
hypotension; administering an antihypertensive right before
treatment compounds this risk. Additionally, many water-
soluble medications are dialyzed out of the blood during the
procedure, rendering them ineffective. Calcium carbonate acts as
a phosphate binder and is given with meals, epoetin alfa can be
given during or after dialysis, and famotidine does not carry the
same immediate hemodynamic risk as lisinopril.
