MEDICAL-SURGICAL NURSING 6TH EDITION
ACTUAL EXAM [QUESTION 1- 200] AND ANSWERS
UPDATED 2026/2027| ORIGINAL PRACTICE
QUESTIONS|DETAILED RATIONALES |INSTANT
DOWNLOAD
INTRODUCTION
Medical-Surgical Nursing 6th Edition encompasses the assessment and management of adult
patients experiencing acute, chronic, and complex health alterations. Contemporary sixth-edition
medical-surgical nursing resources emphasize clinical reasoning, application of pathophysiology,
evidence-based interventions, pharmacologic management, patient education, and prioritization
of care. The current editions published by Elsevier include comprehensive coverage of adult
medical-surgical conditions and emphasize development of clinical judgment.
This practice bank is intended for nursing students, graduate nurses, practicing nurses reviewing
foundational medical-surgical concepts, and educators seeking advanced application-level
questions. It integrates disease mechanisms with assessment findings, laboratory interpretation,
medication effects, complications, nursing priorities, safety considerations, and patient teaching.
Certification and academic preparation in medical-surgical nursing can strengthen clinical
reasoning and support safe patient care. The material is particularly useful when preparing for
course examinations and NCLEX-style clinical-judgment assessments because the questions
require interpretation of patient data rather than simple memorization.
There is no single standardized certification examination called “Medical-Surgical Nursing 6th
Edition,” so there is no universal official exam duration, question count, or publisher-issued 200-
question blueprint. Accordingly, this 200-question bank uses an original representative
distribution across major medical-surgical nursing domains rather than claiming to reproduce a
proprietary examination or test bank.
CORE DOMAINS TESTED IN MEDICAL-SURGICAL
NURSING 6TH EDITION
Clinical judgment, assessment, prioritization, and nursing process
Fluid, electrolyte, acid-base, and hemodynamic disorders
Cardiovascular and vascular disorders
Respiratory disorders and oxygenation
Neurologic disorders
Gastrointestinal, hepatic, pancreatic, and nutritional disorders
Renal and urinary disorders
Endocrine and metabolic disorders
, Hematologic, immune, infectious, oncologic, and integumentary disorders
Musculoskeletal, perioperative, emergency, and multisystem disorders
CONTENT AREA TABLE
% of Approx. # of
Content Domain Key Topics Covered
Exam Questions
Clinical Judgment & Patient Assessment, prioritization,
8% 16
Safety delegation, deterioration
Sodium, potassium, calcium,
Fluids, Electrolytes & Acid-Base 10% 20
magnesium, ABGs, IV therapy
Heart failure, dysrhythmias, ACS,
Cardiovascular & Vascular 14% 28
hypertension, vascular disease
COPD, asthma, pneumonia, PE,
Respiratory 12% 24
respiratory failure, ventilation
Stroke, seizures, ICP, Parkinson
Neurologic 10% 20
disease, spinal disorders
GI bleeding, liver disease,
Gastrointestinal & Hepatobiliary 10% 20 pancreatitis, inflammatory bowel
disease
AKI, CKD, dialysis, urinary
Renal & Urinary 8% 16 disorders, electrolyte
complications
Diabetes, thyroid, adrenal,
Endocrine & Metabolic 8% 16
pituitary disorders
Hematologic, Immune & Anemia, transfusion, cancer,
8% 16
Oncology immunologic disorders
Musculoskeletal, Integumentary, Fractures, burns, shock, sepsis,
12% 24
Perioperative & Emergencies surgery, trauma
Integrated medical-surgical
Total 100% 200
nursing
QUESTIONS 1-200
Q1: A patient with severe vomiting for 48 hours has a respiratory rate of 10/min, BP 96/58
mmHg, potassium 3.0 mEq/L, chloride 86 mEq/L, and pH 7.51. Which intervention should
the nurse anticipate as the priority?
A) Administer IV sodium bicarbonate
B) Administer prescribed isotonic fluid with potassium replacement
C) Restrict oral and IV fluids
D) Administer a loop diuretic
,Correct Answer: B
Rationale: Persistent vomiting causes loss of gastric hydrochloric acid, producing metabolic
alkalosis, chloride depletion, volume depletion, and potassium loss. Isotonic fluid restores
circulating volume, while potassium replacement corrects the clinically important hypokalemia.
Sodium bicarbonate would worsen alkalosis. Fluid restriction and loop diuretics would further
reduce intravascular volume and potassium.
Q2: A patient receiving IV potassium chloride reports burning at the peripheral IV site.
The infusion pump is alarming for increased resistance. What should the nurse do first?
A) Increase the infusion rate
B) Apply a warm compress and continue the infusion
C) Stop the infusion and assess the IV site
D) Flush the catheter rapidly with saline
Correct Answer: C
Rationale: IV potassium is irritating and can cause serious tissue injury if infiltration or
extravasation occurs. The infusion should be stopped while the site is assessed. Increasing the
rate or forcefully flushing the catheter could worsen tissue injury. Potassium must never be
rapidly administered IV because of the risk for life-threatening dysrhythmias.
Q3: A patient with SIADH has a serum sodium of 118 mEq/L and becomes confused.
Which finding requires the most immediate intervention?
A) Urine specific gravity of 1.030
B) Weight gain of 1 kg
C) Mild nausea
D) New generalized seizure activity
Correct Answer: D
Rationale: Severe hyponatremia can cause cerebral edema and neurologic deterioration. A new
seizure indicates severe neurologic involvement and is an emergency. Concentrated urine and
weight gain are consistent with SIADH, while nausea is less immediately threatening. Airway
protection and treatment of severe symptomatic hyponatremia take priority.
Q4: A patient with hyperkalemia has peaked T waves on the ECG. Which medication
should the nurse expect to administer first to stabilize the myocardium?
A) Regular insulin alone
B) IV calcium gluconate
C) Sodium polystyrene sulfonate
D) Oral furosemide
Correct Answer: B
, Rationale: IV calcium does not lower serum potassium, but it rapidly stabilizes the cardiac
membrane and reduces the risk of lethal dysrhythmias in severe hyperkalemia with ECG
changes. Insulin with glucose shifts potassium intracellularly but does not immediately stabilize
the myocardium. Potassium-removal therapies act more slowly.
Q5: A patient with COPD receiving oxygen becomes increasingly somnolent. The
respiratory rate decreases from 20 to 9/min. Which action is most appropriate?
A) Increase oxygen to the maximum flow rate
B) Encourage oral fluids
C) Assess ventilation and obtain an arterial blood gas
D) Place the patient flat in bed
Correct Answer: C
Rationale: Increasing somnolence and bradypnea suggest hypoventilation and possible acute
hypercapnia. The nurse should immediately assess airway and ventilation and obtain an ABG as
prescribed or indicated. Simply increasing oxygen does not correct hypoventilation and may
worsen CO2 retention in susceptible patients. Supine positioning can impair ventilation.
Q6: A patient with acute heart failure suddenly develops severe dyspnea, pink frothy
sputum, crackles, and oxygen saturation of 78%. Which prescription should the nurse
implement first?
A) Encourage oral fluids
B) Place the patient supine
C) Apply oxygen and position the patient upright
D) Administer a sedative
Correct Answer: C
Rationale: The findings indicate acute pulmonary edema. The immediate priorities are
improving oxygenation and reducing venous return by positioning the patient upright. Fluid
intake should not be encouraged, and supine positioning worsens pulmonary congestion.
Sedatives may depress respiratory function and are not the first priority.
Q7: A patient receiving digoxin for heart failure reports anorexia, nausea, and yellow-
green visual halos. The apical pulse is 52/min. What should the nurse do?
A) Administer the medication with food
B) Recheck the pulse after administration
C) Hold digoxin and notify the provider
D) Give an additional dose of potassium without an order
Correct Answer: C
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are classic warning
signs of digoxin toxicity. The medication should be withheld and the provider notified. Digoxin
ACTUAL EXAM [QUESTION 1- 200] AND ANSWERS
UPDATED 2026/2027| ORIGINAL PRACTICE
QUESTIONS|DETAILED RATIONALES |INSTANT
DOWNLOAD
INTRODUCTION
Medical-Surgical Nursing 6th Edition encompasses the assessment and management of adult
patients experiencing acute, chronic, and complex health alterations. Contemporary sixth-edition
medical-surgical nursing resources emphasize clinical reasoning, application of pathophysiology,
evidence-based interventions, pharmacologic management, patient education, and prioritization
of care. The current editions published by Elsevier include comprehensive coverage of adult
medical-surgical conditions and emphasize development of clinical judgment.
This practice bank is intended for nursing students, graduate nurses, practicing nurses reviewing
foundational medical-surgical concepts, and educators seeking advanced application-level
questions. It integrates disease mechanisms with assessment findings, laboratory interpretation,
medication effects, complications, nursing priorities, safety considerations, and patient teaching.
Certification and academic preparation in medical-surgical nursing can strengthen clinical
reasoning and support safe patient care. The material is particularly useful when preparing for
course examinations and NCLEX-style clinical-judgment assessments because the questions
require interpretation of patient data rather than simple memorization.
There is no single standardized certification examination called “Medical-Surgical Nursing 6th
Edition,” so there is no universal official exam duration, question count, or publisher-issued 200-
question blueprint. Accordingly, this 200-question bank uses an original representative
distribution across major medical-surgical nursing domains rather than claiming to reproduce a
proprietary examination or test bank.
CORE DOMAINS TESTED IN MEDICAL-SURGICAL
NURSING 6TH EDITION
Clinical judgment, assessment, prioritization, and nursing process
Fluid, electrolyte, acid-base, and hemodynamic disorders
Cardiovascular and vascular disorders
Respiratory disorders and oxygenation
Neurologic disorders
Gastrointestinal, hepatic, pancreatic, and nutritional disorders
Renal and urinary disorders
Endocrine and metabolic disorders
, Hematologic, immune, infectious, oncologic, and integumentary disorders
Musculoskeletal, perioperative, emergency, and multisystem disorders
CONTENT AREA TABLE
% of Approx. # of
Content Domain Key Topics Covered
Exam Questions
Clinical Judgment & Patient Assessment, prioritization,
8% 16
Safety delegation, deterioration
Sodium, potassium, calcium,
Fluids, Electrolytes & Acid-Base 10% 20
magnesium, ABGs, IV therapy
Heart failure, dysrhythmias, ACS,
Cardiovascular & Vascular 14% 28
hypertension, vascular disease
COPD, asthma, pneumonia, PE,
Respiratory 12% 24
respiratory failure, ventilation
Stroke, seizures, ICP, Parkinson
Neurologic 10% 20
disease, spinal disorders
GI bleeding, liver disease,
Gastrointestinal & Hepatobiliary 10% 20 pancreatitis, inflammatory bowel
disease
AKI, CKD, dialysis, urinary
Renal & Urinary 8% 16 disorders, electrolyte
complications
Diabetes, thyroid, adrenal,
Endocrine & Metabolic 8% 16
pituitary disorders
Hematologic, Immune & Anemia, transfusion, cancer,
8% 16
Oncology immunologic disorders
Musculoskeletal, Integumentary, Fractures, burns, shock, sepsis,
12% 24
Perioperative & Emergencies surgery, trauma
Integrated medical-surgical
Total 100% 200
nursing
QUESTIONS 1-200
Q1: A patient with severe vomiting for 48 hours has a respiratory rate of 10/min, BP 96/58
mmHg, potassium 3.0 mEq/L, chloride 86 mEq/L, and pH 7.51. Which intervention should
the nurse anticipate as the priority?
A) Administer IV sodium bicarbonate
B) Administer prescribed isotonic fluid with potassium replacement
C) Restrict oral and IV fluids
D) Administer a loop diuretic
,Correct Answer: B
Rationale: Persistent vomiting causes loss of gastric hydrochloric acid, producing metabolic
alkalosis, chloride depletion, volume depletion, and potassium loss. Isotonic fluid restores
circulating volume, while potassium replacement corrects the clinically important hypokalemia.
Sodium bicarbonate would worsen alkalosis. Fluid restriction and loop diuretics would further
reduce intravascular volume and potassium.
Q2: A patient receiving IV potassium chloride reports burning at the peripheral IV site.
The infusion pump is alarming for increased resistance. What should the nurse do first?
A) Increase the infusion rate
B) Apply a warm compress and continue the infusion
C) Stop the infusion and assess the IV site
D) Flush the catheter rapidly with saline
Correct Answer: C
Rationale: IV potassium is irritating and can cause serious tissue injury if infiltration or
extravasation occurs. The infusion should be stopped while the site is assessed. Increasing the
rate or forcefully flushing the catheter could worsen tissue injury. Potassium must never be
rapidly administered IV because of the risk for life-threatening dysrhythmias.
Q3: A patient with SIADH has a serum sodium of 118 mEq/L and becomes confused.
Which finding requires the most immediate intervention?
A) Urine specific gravity of 1.030
B) Weight gain of 1 kg
C) Mild nausea
D) New generalized seizure activity
Correct Answer: D
Rationale: Severe hyponatremia can cause cerebral edema and neurologic deterioration. A new
seizure indicates severe neurologic involvement and is an emergency. Concentrated urine and
weight gain are consistent with SIADH, while nausea is less immediately threatening. Airway
protection and treatment of severe symptomatic hyponatremia take priority.
Q4: A patient with hyperkalemia has peaked T waves on the ECG. Which medication
should the nurse expect to administer first to stabilize the myocardium?
A) Regular insulin alone
B) IV calcium gluconate
C) Sodium polystyrene sulfonate
D) Oral furosemide
Correct Answer: B
, Rationale: IV calcium does not lower serum potassium, but it rapidly stabilizes the cardiac
membrane and reduces the risk of lethal dysrhythmias in severe hyperkalemia with ECG
changes. Insulin with glucose shifts potassium intracellularly but does not immediately stabilize
the myocardium. Potassium-removal therapies act more slowly.
Q5: A patient with COPD receiving oxygen becomes increasingly somnolent. The
respiratory rate decreases from 20 to 9/min. Which action is most appropriate?
A) Increase oxygen to the maximum flow rate
B) Encourage oral fluids
C) Assess ventilation and obtain an arterial blood gas
D) Place the patient flat in bed
Correct Answer: C
Rationale: Increasing somnolence and bradypnea suggest hypoventilation and possible acute
hypercapnia. The nurse should immediately assess airway and ventilation and obtain an ABG as
prescribed or indicated. Simply increasing oxygen does not correct hypoventilation and may
worsen CO2 retention in susceptible patients. Supine positioning can impair ventilation.
Q6: A patient with acute heart failure suddenly develops severe dyspnea, pink frothy
sputum, crackles, and oxygen saturation of 78%. Which prescription should the nurse
implement first?
A) Encourage oral fluids
B) Place the patient supine
C) Apply oxygen and position the patient upright
D) Administer a sedative
Correct Answer: C
Rationale: The findings indicate acute pulmonary edema. The immediate priorities are
improving oxygenation and reducing venous return by positioning the patient upright. Fluid
intake should not be encouraged, and supine positioning worsens pulmonary congestion.
Sedatives may depress respiratory function and are not the first priority.
Q7: A patient receiving digoxin for heart failure reports anorexia, nausea, and yellow-
green visual halos. The apical pulse is 52/min. What should the nurse do?
A) Administer the medication with food
B) Recheck the pulse after administration
C) Hold digoxin and notify the provider
D) Give an additional dose of potassium without an order
Correct Answer: C
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are classic warning
signs of digoxin toxicity. The medication should be withheld and the provider notified. Digoxin
