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MEDICAL-SURGICAL RN PROPHECY RELIAS 2026-2027 FINAL
EXAM EXAM PACK | 140 VERIFIED QUESTIONS WITH ANSWERS &
RATIONALES | PASS GUARANTEE
1.
A patient admitted with heart failure presents with dyspnea, 3+ pitting edema, and
orthopnea. The nurse notes crackles in both lung bases.
Which initial nursing action is most appropriate?
A. Increase the IV fluid rate
B. Administer a loop diuretic as prescribed
C. Encourage oral fluid intake
D. Place the patient in a supine position
Correct Answer: B
Rationale: Loop diuretics like furosemide reduce fluid overload and pulmonary
congestion. Increasing fluids or supine positioning would worsen dyspnea.
2.
A 68-year-old with COPD suddenly becomes restless and confused. The nurse
observes shallow respirations and O₂ saturation of 84%.
Which action should the nurse take first?
A. Notify the physician immediately
B. Increase oxygen flow to 6 L/min
C. Encourage pursed-lip breathing
D. Assess airway and apply prescribed oxygen
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Correct Answer: D
Rationale: The priority is to ensure adequate oxygenation. Applying prescribed
oxygen and assessing airway are immediate actions before notifying the provider.
3.
A postoperative patient reports severe abdominal pain and a distended, firm
abdomen. Bowel sounds are absent.
Which complication does the nurse suspect?
A. Paralytic ileus
B. Peritonitis
C. Small bowel obstruction
D. Dehiscence
Correct Answer: A
Rationale: Paralytic ileus results from decreased peristalsis after surgery, causing
pain, distention, and absent bowel sounds.
4.
A patient with type 2 diabetes reports excessive thirst and urination. Lab results
show: glucose 460 mg/dL, pH 7.34, bicarbonate 20 mEq/L.
Which condition does this most likely indicate?
A. Diabetic ketoacidosis
B. Hyperosmolar hyperglycemic state
C. Hypoglycemia
D. Metabolic alkalosis
Correct Answer: B
Rationale: HHS occurs with very high glucose, mild acidosis, and dehydration
without significant ketone production, typical in type 2 diabetes.
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5.
A nurse receives report on four clients. Which patient should be seen first?
A. Post-op appendectomy, complaining of 6/10 pain
B. COPD patient with O₂ saturation of 89% on 2 L nasal cannula
C. New admission with chest pain radiating to the left arm
D. Diabetic with blood glucose 150 mg/dL
Correct Answer: C
Rationale: Chest pain radiating to the arm suggests myocardial ischemia, which
requires immediate evaluation and intervention.
6.
A client receiving IV potassium chloride at 20 mEq/hr complains of burning at the
IV site.
What should the nurse do first?
A. Stop the infusion immediately
B. Dilute the IV solution and restart slowly
C. Apply a warm compress to the site
D. Document and continue the infusion
Correct Answer: A
Rationale: Burning at the IV site indicates potential infiltration or irritation.
Potassium can cause tissue necrosis; stop the infusion to prevent injury.
7.
A patient with pneumonia is receiving IV antibiotics. The nurse notes a red streak
along the vein and tenderness at the IV site.
Which complication is suspected?
A. Phlebitis
B. Infiltration
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C. Extravasation
D. Thrombosis
Correct Answer: A
Rationale: Redness, pain, and warmth along a vein are classic signs of phlebitis.
The IV should be removed and a new site started.
8.
The nurse is caring for a client with a nasogastric (NG) tube connected to suction.
Which lab result requires immediate attention?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Chloride 102 mEq/L
D. Calcium 9.2 mg/dL
Correct Answer: B
Rationale: Hypokalemia (<3.5 mEq/L) is a dangerous complication of NG suction
due to potassium loss, predisposing to arrhythmias.
9.
A client on heparin therapy for DVT has a platelet count of 45,000/mm³.
Which nursing action is appropriate?
A. Continue heparin and monitor closely
B. Notify the provider and stop the heparin
C. Administer aspirin as needed for pain
D. Flush IV lines with heparin solution
Correct Answer: B
Rationale: A platelet count <50,000 with heparin use suggests heparin-induced
thrombocytopenia (HIT). Stop heparin and notify the provider immediately.
MEDICAL-SURGICAL RN PROPHECY RELIAS 2026-2027 FINAL
EXAM EXAM PACK | 140 VERIFIED QUESTIONS WITH ANSWERS &
RATIONALES | PASS GUARANTEE
1.
A patient admitted with heart failure presents with dyspnea, 3+ pitting edema, and
orthopnea. The nurse notes crackles in both lung bases.
Which initial nursing action is most appropriate?
A. Increase the IV fluid rate
B. Administer a loop diuretic as prescribed
C. Encourage oral fluid intake
D. Place the patient in a supine position
Correct Answer: B
Rationale: Loop diuretics like furosemide reduce fluid overload and pulmonary
congestion. Increasing fluids or supine positioning would worsen dyspnea.
2.
A 68-year-old with COPD suddenly becomes restless and confused. The nurse
observes shallow respirations and O₂ saturation of 84%.
Which action should the nurse take first?
A. Notify the physician immediately
B. Increase oxygen flow to 6 L/min
C. Encourage pursed-lip breathing
D. Assess airway and apply prescribed oxygen
,2 | Page
Correct Answer: D
Rationale: The priority is to ensure adequate oxygenation. Applying prescribed
oxygen and assessing airway are immediate actions before notifying the provider.
3.
A postoperative patient reports severe abdominal pain and a distended, firm
abdomen. Bowel sounds are absent.
Which complication does the nurse suspect?
A. Paralytic ileus
B. Peritonitis
C. Small bowel obstruction
D. Dehiscence
Correct Answer: A
Rationale: Paralytic ileus results from decreased peristalsis after surgery, causing
pain, distention, and absent bowel sounds.
4.
A patient with type 2 diabetes reports excessive thirst and urination. Lab results
show: glucose 460 mg/dL, pH 7.34, bicarbonate 20 mEq/L.
Which condition does this most likely indicate?
A. Diabetic ketoacidosis
B. Hyperosmolar hyperglycemic state
C. Hypoglycemia
D. Metabolic alkalosis
Correct Answer: B
Rationale: HHS occurs with very high glucose, mild acidosis, and dehydration
without significant ketone production, typical in type 2 diabetes.
,3 | Page
5.
A nurse receives report on four clients. Which patient should be seen first?
A. Post-op appendectomy, complaining of 6/10 pain
B. COPD patient with O₂ saturation of 89% on 2 L nasal cannula
C. New admission with chest pain radiating to the left arm
D. Diabetic with blood glucose 150 mg/dL
Correct Answer: C
Rationale: Chest pain radiating to the arm suggests myocardial ischemia, which
requires immediate evaluation and intervention.
6.
A client receiving IV potassium chloride at 20 mEq/hr complains of burning at the
IV site.
What should the nurse do first?
A. Stop the infusion immediately
B. Dilute the IV solution and restart slowly
C. Apply a warm compress to the site
D. Document and continue the infusion
Correct Answer: A
Rationale: Burning at the IV site indicates potential infiltration or irritation.
Potassium can cause tissue necrosis; stop the infusion to prevent injury.
7.
A patient with pneumonia is receiving IV antibiotics. The nurse notes a red streak
along the vein and tenderness at the IV site.
Which complication is suspected?
A. Phlebitis
B. Infiltration
, 4 | Page
C. Extravasation
D. Thrombosis
Correct Answer: A
Rationale: Redness, pain, and warmth along a vein are classic signs of phlebitis.
The IV should be removed and a new site started.
8.
The nurse is caring for a client with a nasogastric (NG) tube connected to suction.
Which lab result requires immediate attention?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Chloride 102 mEq/L
D. Calcium 9.2 mg/dL
Correct Answer: B
Rationale: Hypokalemia (<3.5 mEq/L) is a dangerous complication of NG suction
due to potassium loss, predisposing to arrhythmias.
9.
A client on heparin therapy for DVT has a platelet count of 45,000/mm³.
Which nursing action is appropriate?
A. Continue heparin and monitor closely
B. Notify the provider and stop the heparin
C. Administer aspirin as needed for pain
D. Flush IV lines with heparin solution
Correct Answer: B
Rationale: A platelet count <50,000 with heparin use suggests heparin-induced
thrombocytopenia (HIT). Stop heparin and notify the provider immediately.
