Advanced Med-Surg Practice Exam 2025/2026
1. A patient with acute myocardial infarction develops sudden
shortness of breath, jugular vein distention, and hypotension.
What is the priority nursing action?
Administer oxygen and notify the physician immediately
Rationale: These symptoms indicate possible cardiogenic shock
or acute heart failure. Immediate oxygen therapy and medical
intervention are crucial.
2. A patient with chronic obstructive pulmonary disease (COPD) has
a PaO2 of 55 mmHg and PaCO2 of 60 mmHg. Which intervention
is most appropriate?
Administer low-flow oxygen to maintain SpO2 88–92%
Rationale: Patients with chronic hypercapnia are at risk for
oxygen-induced hypoventilation. Low-flow oxygen maintains
adequate oxygenation without suppressing the respiratory drive.
3. A patient with acute kidney injury has a potassium level of 6.5
mEq/L. Which action should the nurse anticipate?
Prepare to administer IV insulin with glucose
Rationale: Insulin shifts potassium into cells, rapidly lowering
serum potassium and reducing the risk of life-threatening
arrhythmias.
4. A patient with cirrhosis presents with confusion, asterixis, and
elevated ammonia levels. Which treatment is indicated?
Administer lactulose
Rationale: Lactulose decreases ammonia absorption in the gut
and promotes excretion, improving encephalopathy symptoms.
,5. A patient with newly diagnosed type 1 diabetes reports nausea,
vomiting, and rapid breathing. Which action is priority?
Check blood glucose and ketones immediately
Rationale: These symptoms suggest diabetic ketoacidosis (DKA),
a medical emergency requiring rapid assessment and treatment.
6. A post-operative patient develops sudden onset of calf pain,
swelling, and redness. What is the priority nursing intervention?
Notify the physician and prepare for diagnostic testing for DVT
Rationale: These are signs of deep vein thrombosis. Early
diagnosis and treatment prevent pulmonary embolism.
7. A patient with heart failure has 3+ pitting edema in the lower
extremities and crackles in the lungs. Which intervention is most
appropriate?
Administer prescribed diuretics and monitor fluid status
Rationale: Diuretics reduce fluid overload, relieving pulmonary
and peripheral edema.
8. A patient with pneumonia is experiencing hypotension,
tachycardia, and fever. Which condition is most likely?
Septic shock
Rationale: Infection leading to systemic inflammatory response
can cause septic shock, requiring immediate intervention
including fluids and antibiotics.
9. A patient with a history of peptic ulcer disease reports sudden
severe epigastric pain and vomiting blood. Which action is
priority?
Notify the physician immediately and prepare for emergency
endoscopy
Rationale: These are signs of upper GI bleeding, which can be
life-threatening and requires urgent intervention.
, 10. A patient receiving warfarin therapy has an INR of 5.2. What
is the nurse’s priority action?
Hold the next dose and notify the physician
Rationale: INR above therapeutic range increases bleeding risk;
the prescriber may adjust the dose or give vitamin K.
11. A patient with chronic kidney disease presents with fatigue,
pallor, and hemoglobin of 7 g/dL. What intervention should the
nurse anticipate?
Administer prescribed erythropoietin
Rationale: CKD patients often develop anemia due to decreased
erythropoietin production; therapy helps stimulate red blood cell
production.
12. A patient with multiple sclerosis reports sudden blurred
vision and weakness in one leg. What is the priority nursing
action?
Perform a neurological assessment and notify the physician
Rationale: These symptoms may indicate an acute MS
exacerbation, requiring early medical evaluation.
13. A patient with pancreatitis develops hypotension,
tachycardia, and decreased urine output. Which action is most
important?
Initiate aggressive IV fluid resuscitation
Rationale: Hypovolemia is common in acute pancreatitis; fluid
replacement is crucial to maintain perfusion.
14. A patient with COPD has a productive cough with purulent
sputum, fever, and increased dyspnea. Which action is most
appropriate?
Obtain a sputum culture and administer prescribed antibiotics
1. A patient with acute myocardial infarction develops sudden
shortness of breath, jugular vein distention, and hypotension.
What is the priority nursing action?
Administer oxygen and notify the physician immediately
Rationale: These symptoms indicate possible cardiogenic shock
or acute heart failure. Immediate oxygen therapy and medical
intervention are crucial.
2. A patient with chronic obstructive pulmonary disease (COPD) has
a PaO2 of 55 mmHg and PaCO2 of 60 mmHg. Which intervention
is most appropriate?
Administer low-flow oxygen to maintain SpO2 88–92%
Rationale: Patients with chronic hypercapnia are at risk for
oxygen-induced hypoventilation. Low-flow oxygen maintains
adequate oxygenation without suppressing the respiratory drive.
3. A patient with acute kidney injury has a potassium level of 6.5
mEq/L. Which action should the nurse anticipate?
Prepare to administer IV insulin with glucose
Rationale: Insulin shifts potassium into cells, rapidly lowering
serum potassium and reducing the risk of life-threatening
arrhythmias.
4. A patient with cirrhosis presents with confusion, asterixis, and
elevated ammonia levels. Which treatment is indicated?
Administer lactulose
Rationale: Lactulose decreases ammonia absorption in the gut
and promotes excretion, improving encephalopathy symptoms.
,5. A patient with newly diagnosed type 1 diabetes reports nausea,
vomiting, and rapid breathing. Which action is priority?
Check blood glucose and ketones immediately
Rationale: These symptoms suggest diabetic ketoacidosis (DKA),
a medical emergency requiring rapid assessment and treatment.
6. A post-operative patient develops sudden onset of calf pain,
swelling, and redness. What is the priority nursing intervention?
Notify the physician and prepare for diagnostic testing for DVT
Rationale: These are signs of deep vein thrombosis. Early
diagnosis and treatment prevent pulmonary embolism.
7. A patient with heart failure has 3+ pitting edema in the lower
extremities and crackles in the lungs. Which intervention is most
appropriate?
Administer prescribed diuretics and monitor fluid status
Rationale: Diuretics reduce fluid overload, relieving pulmonary
and peripheral edema.
8. A patient with pneumonia is experiencing hypotension,
tachycardia, and fever. Which condition is most likely?
Septic shock
Rationale: Infection leading to systemic inflammatory response
can cause septic shock, requiring immediate intervention
including fluids and antibiotics.
9. A patient with a history of peptic ulcer disease reports sudden
severe epigastric pain and vomiting blood. Which action is
priority?
Notify the physician immediately and prepare for emergency
endoscopy
Rationale: These are signs of upper GI bleeding, which can be
life-threatening and requires urgent intervention.
, 10. A patient receiving warfarin therapy has an INR of 5.2. What
is the nurse’s priority action?
Hold the next dose and notify the physician
Rationale: INR above therapeutic range increases bleeding risk;
the prescriber may adjust the dose or give vitamin K.
11. A patient with chronic kidney disease presents with fatigue,
pallor, and hemoglobin of 7 g/dL. What intervention should the
nurse anticipate?
Administer prescribed erythropoietin
Rationale: CKD patients often develop anemia due to decreased
erythropoietin production; therapy helps stimulate red blood cell
production.
12. A patient with multiple sclerosis reports sudden blurred
vision and weakness in one leg. What is the priority nursing
action?
Perform a neurological assessment and notify the physician
Rationale: These symptoms may indicate an acute MS
exacerbation, requiring early medical evaluation.
13. A patient with pancreatitis develops hypotension,
tachycardia, and decreased urine output. Which action is most
important?
Initiate aggressive IV fluid resuscitation
Rationale: Hypovolemia is common in acute pancreatitis; fluid
replacement is crucial to maintain perfusion.
14. A patient with COPD has a productive cough with purulent
sputum, fever, and increased dyspnea. Which action is most
appropriate?
Obtain a sputum culture and administer prescribed antibiotics
