Prophecy Relias Rn Medical Surgical Form A
Actual Exam Questions And Correct
Answers Latest Update 2026/2027 .
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
150 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses entry-level registered nurse competency in medical-surgical nursing across
cardiovascular, respiratory, neurological, gastrointestinal, endocrine, renal, musculoskeletal, perioperative,
oncologic, and fluid/electrolyte domains. Items require clinical judgment, prioritization, and application of
current evidence-based standards.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 75% (minimum 38/50 correct).
HIGHP - Page 1 of 48
,1. Which finding best differentiates ARDS from cardiogenic pulmonary edema?
[ ] A. Bilateral crackles on auscultation
[ ] B. Elevated BNP and jugular venous distention
[ ] C. PaO2/FiO2 ratio <300 with normal PCWP
[ ] D. Improved oxygenation with diuresis
CORRECT: C. PaO2/FiO2 ratio <300 with normal PCWP
ARDS is defined by acute onset, bilateral infiltrates, PaO2/FiO2 300, and a pulmonary capillary wedge
pressure (PCWP) 18 mmHg indicating non-cardiogenic edema. Cardiogenic edema typically has elevated
BNP, JVD, and responds to diuretics, while crackles are nonspecific.
2. A patient with acute decompensated heart failure is prescribed IV furosemide. Which
assessment best evaluates therapeutic response?
[ ] A. Serum potassium level
[ ] B. Daily weight and urine output
[ ] C. Blood urea nitrogen
[ ] D. Heart rate variability
CORRECT: B. Daily weight and urine output
Daily weight and urine output directly reflect fluid removal and are the most reliable indicators of diuretic
efficacy in heart failure. Electrolytes and BUN monitor safety, not therapeutic response; heart rate variability is
unrelated.
3. Which ECG change is most indicative of hyperkalemia?
[ ] A. Prolonged QT interval
[ ] B. Prominent U waves
[ ] C. Peaked T waves and widened QRS
[ ] D. ST segment elevation
CORRECT: C. Peaked T waves and widened QRS
Hyperkalemia classically produces tall, peaked T waves, shortened QT, and widened QRS that can progress
to sine wave. U waves suggest hypokalemia; prolonged QT is seen with hypocalcemia or hypomagnesemia;
ST elevation indicates ischemia.
4. Which intervention is priority for a patient with a new tracheostomy and copious
secretions?
[ ] A. Suction the airway using sterile technique
[ ] B. Deflate the cuff to allow clearance
[ ] C. Administer a nebulized bronchodilator
[ ] D. Increase humidification of oxygen
HIGHP - Page 2 of 48
, CORRECT: A. Suction the airway using sterile technique
Suctioning clears secretions and maintains airway patency; sterile technique prevents infection. Deflating the
cuff risks aspiration; bronchodilators and humidification are adjuncts, not immediate priorities for copious
secretions.
5. Which finding in a patient with a new colostomy requires immediate intervention?
[ ] A. Stoma is beefy red and moist
[ ] B. Stoma is dusky and cool to touch
[ ] C. Small amount of bleeding at stoma edge
[ ] D. Mild peristomal irritation
CORRECT: B. Stoma is dusky and cool to touch
A dusky, cool stoma indicates ischemia and requires immediate notification of the provider. A beefy red, moist
stoma is normal; minor bleeding and mild irritation are common and not emergent.
6. Which assessment finding is most concerning in a patient receiving IV insulin for DKA?
[ ] A. Blood glucose 250 mg/dL
[ ] B. Serum potassium 3.2 mEq/L
[ ] C. Urine output 50 mL/hr
[ ] D. Serum bicarbonate 18 mEq/L
CORRECT: B. Serum potassium 3.2 mEq/L
Insulin drives potassium intracellularly, causing hypokalemia, which can precipitate fatal arrhythmias. Glucose
of 250 is expected during treatment; urine output and bicarbonate are not immediate red flags.
7. Which finding best indicates effective fluid resuscitation in a patient with hypovolemic
shock?
[ ] A. Urine output 0.5 mL/kg/hr
[ ] B. Heart rate 120 bpm
[ ] C. Mean arterial pressure 65 mm Hg
[ ] D. Central venous pressure 2 mm Hg
CORRECT: A. Urine output 0.5 mL/kg/hr
Urine output of at least 0.5 mL/kg/hr indicates adequate renal perfusion and is a key endpoint of
resuscitation. Tachycardia, MAP of 65 (borderline), and low CVP suggest ongoing hypoperfusion.
8. Which intervention is contraindicated for a patient with suspected increased intracranial
pressure?
HIGHP - Page 3 of 48
, [ ] A. Elevate head of bed 30 degrees
[ ] B. Perform frequent oral suctioning
[ ] C. Administer mannitol as prescribed
[ ] D. Maintain normothermia
CORRECT: B. Perform frequent oral suctioning
Suctioning increases intrathoracic pressure and ICP; it should be limited to when necessary and preceded by
hyperoxygenation. HOB elevation, mannitol, and normothermia are appropriate ICP management strategies.
9. Which laboratory value requires immediate action before administering IV contrast?
[ ] A. Serum creatinine 2.8 mg/dL
[ ] B. Hemoglobin 11 g/dL
[ ] C. Platelet count 150,000/mm3
[ ] D. INR 1.2
CORRECT: A. Serum creatinine 2.8 mg/dL
Elevated creatinine indicates renal impairment, increasing risk of contrast-induced nephropathy; the provider
should be notified. Hemoglobin, platelets, and INR within normal limits do not preclude contrast
administration.
10. Which statement by a patient with a new below-knee amputation indicates need for
further teaching?
[ ] A. I will wrap my stump with elastic bandage.
[ ] B. I will elevate my stump on a pillow constantly.
[ ] C. I will perform range-of-motion exercises.
[ ] D. I will inspect my stump daily.
CORRECT: B. I will elevate my stump on a pillow constantly.
Constant elevation can cause hip flexion contracture; the stump should be elevated intermittently, not
continuously. Wrapping, ROM exercises, and daily inspection are appropriate self-care measures.
11. A client with acute decompensated heart failure becomes dyspneic and hypotensive
two hours after a 500 mL bolus. Which finding most specifically indicates cardiogenic
pulmonary edema rather than ARDS?
[ ] A. Bilateral crackles with an S3 gallop and elevated BNP
[ ] B. Diffuse bilateral infiltrates with normal pulmonary capillary wedge pressure
[ ] C. Refractory hypoxemia with a PaO2/FiO2 ratio below 200
[ ] D. Frothy sputum with a normal chest radiograph
HIGHP - Page 4 of 48
Actual Exam Questions And Correct
Answers Latest Update 2026/2027 .
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
150 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses entry-level registered nurse competency in medical-surgical nursing across
cardiovascular, respiratory, neurological, gastrointestinal, endocrine, renal, musculoskeletal, perioperative,
oncologic, and fluid/electrolyte domains. Items require clinical judgment, prioritization, and application of
current evidence-based standards.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 75% (minimum 38/50 correct).
HIGHP - Page 1 of 48
,1. Which finding best differentiates ARDS from cardiogenic pulmonary edema?
[ ] A. Bilateral crackles on auscultation
[ ] B. Elevated BNP and jugular venous distention
[ ] C. PaO2/FiO2 ratio <300 with normal PCWP
[ ] D. Improved oxygenation with diuresis
CORRECT: C. PaO2/FiO2 ratio <300 with normal PCWP
ARDS is defined by acute onset, bilateral infiltrates, PaO2/FiO2 300, and a pulmonary capillary wedge
pressure (PCWP) 18 mmHg indicating non-cardiogenic edema. Cardiogenic edema typically has elevated
BNP, JVD, and responds to diuretics, while crackles are nonspecific.
2. A patient with acute decompensated heart failure is prescribed IV furosemide. Which
assessment best evaluates therapeutic response?
[ ] A. Serum potassium level
[ ] B. Daily weight and urine output
[ ] C. Blood urea nitrogen
[ ] D. Heart rate variability
CORRECT: B. Daily weight and urine output
Daily weight and urine output directly reflect fluid removal and are the most reliable indicators of diuretic
efficacy in heart failure. Electrolytes and BUN monitor safety, not therapeutic response; heart rate variability is
unrelated.
3. Which ECG change is most indicative of hyperkalemia?
[ ] A. Prolonged QT interval
[ ] B. Prominent U waves
[ ] C. Peaked T waves and widened QRS
[ ] D. ST segment elevation
CORRECT: C. Peaked T waves and widened QRS
Hyperkalemia classically produces tall, peaked T waves, shortened QT, and widened QRS that can progress
to sine wave. U waves suggest hypokalemia; prolonged QT is seen with hypocalcemia or hypomagnesemia;
ST elevation indicates ischemia.
4. Which intervention is priority for a patient with a new tracheostomy and copious
secretions?
[ ] A. Suction the airway using sterile technique
[ ] B. Deflate the cuff to allow clearance
[ ] C. Administer a nebulized bronchodilator
[ ] D. Increase humidification of oxygen
HIGHP - Page 2 of 48
, CORRECT: A. Suction the airway using sterile technique
Suctioning clears secretions and maintains airway patency; sterile technique prevents infection. Deflating the
cuff risks aspiration; bronchodilators and humidification are adjuncts, not immediate priorities for copious
secretions.
5. Which finding in a patient with a new colostomy requires immediate intervention?
[ ] A. Stoma is beefy red and moist
[ ] B. Stoma is dusky and cool to touch
[ ] C. Small amount of bleeding at stoma edge
[ ] D. Mild peristomal irritation
CORRECT: B. Stoma is dusky and cool to touch
A dusky, cool stoma indicates ischemia and requires immediate notification of the provider. A beefy red, moist
stoma is normal; minor bleeding and mild irritation are common and not emergent.
6. Which assessment finding is most concerning in a patient receiving IV insulin for DKA?
[ ] A. Blood glucose 250 mg/dL
[ ] B. Serum potassium 3.2 mEq/L
[ ] C. Urine output 50 mL/hr
[ ] D. Serum bicarbonate 18 mEq/L
CORRECT: B. Serum potassium 3.2 mEq/L
Insulin drives potassium intracellularly, causing hypokalemia, which can precipitate fatal arrhythmias. Glucose
of 250 is expected during treatment; urine output and bicarbonate are not immediate red flags.
7. Which finding best indicates effective fluid resuscitation in a patient with hypovolemic
shock?
[ ] A. Urine output 0.5 mL/kg/hr
[ ] B. Heart rate 120 bpm
[ ] C. Mean arterial pressure 65 mm Hg
[ ] D. Central venous pressure 2 mm Hg
CORRECT: A. Urine output 0.5 mL/kg/hr
Urine output of at least 0.5 mL/kg/hr indicates adequate renal perfusion and is a key endpoint of
resuscitation. Tachycardia, MAP of 65 (borderline), and low CVP suggest ongoing hypoperfusion.
8. Which intervention is contraindicated for a patient with suspected increased intracranial
pressure?
HIGHP - Page 3 of 48
, [ ] A. Elevate head of bed 30 degrees
[ ] B. Perform frequent oral suctioning
[ ] C. Administer mannitol as prescribed
[ ] D. Maintain normothermia
CORRECT: B. Perform frequent oral suctioning
Suctioning increases intrathoracic pressure and ICP; it should be limited to when necessary and preceded by
hyperoxygenation. HOB elevation, mannitol, and normothermia are appropriate ICP management strategies.
9. Which laboratory value requires immediate action before administering IV contrast?
[ ] A. Serum creatinine 2.8 mg/dL
[ ] B. Hemoglobin 11 g/dL
[ ] C. Platelet count 150,000/mm3
[ ] D. INR 1.2
CORRECT: A. Serum creatinine 2.8 mg/dL
Elevated creatinine indicates renal impairment, increasing risk of contrast-induced nephropathy; the provider
should be notified. Hemoglobin, platelets, and INR within normal limits do not preclude contrast
administration.
10. Which statement by a patient with a new below-knee amputation indicates need for
further teaching?
[ ] A. I will wrap my stump with elastic bandage.
[ ] B. I will elevate my stump on a pillow constantly.
[ ] C. I will perform range-of-motion exercises.
[ ] D. I will inspect my stump daily.
CORRECT: B. I will elevate my stump on a pillow constantly.
Constant elevation can cause hip flexion contracture; the stump should be elevated intermittently, not
continuously. Wrapping, ROM exercises, and daily inspection are appropriate self-care measures.
11. A client with acute decompensated heart failure becomes dyspneic and hypotensive
two hours after a 500 mL bolus. Which finding most specifically indicates cardiogenic
pulmonary edema rather than ARDS?
[ ] A. Bilateral crackles with an S3 gallop and elevated BNP
[ ] B. Diffuse bilateral infiltrates with normal pulmonary capillary wedge pressure
[ ] C. Refractory hypoxemia with a PaO2/FiO2 ratio below 200
[ ] D. Frothy sputum with a normal chest radiograph
HIGHP - Page 4 of 48
