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o C. Prepare for emergency

tracheostomy.

o D. Apply humidified oxygen

Medical-Surgical Nursing
therapy.
1. A patient with cirrhosis develops ascites
4. A patient with acute myeloid leukemia
and a serum albumin level of 2.3 g/dL.
develops a fever, mucositis, and
Which intervention would most
neutropenia. What is the nurse’s
effectively reduce the fluid
highest priority?
accumulation in the abdomen?
o A. Administer prescribed
o A. Encourage a low-sodium diet.
antibiotics immediately.
o B. Administer intravenous
o B. Isolate the patient to prevent
furosemide.
infection spread.
o C. Administer intravenous
o C. Provide mouth care with a
albumin and perform
soft toothbrush.
paracentesis.
o D. Monitor for signs of
o D. Restrict fluid intake to 1 liter
thrombocytopenia.
per day.
5. A patient with a history of atrial
2. A patient with acute pancreatitis
fibrillation develops sudden unilateral
presents with severe epigastric pain
leg pain, pallor, and a pulseless
radiating to the back and hypocalcemia.
extremity. What is the priority action?
Which finding requires immediate
intervention? o A. Administer anticoagulants.

o A. Positive Chvostek’s sign. o B. Perform Doppler ultrasound

of the leg.
o B. Cullen’s sign around the
umbilicus. o C. Notify the vascular surgeon
immediately.
o C. Lipase level of 1,200 U/L.
o D. Elevate the affected limb.
o D. Respiratory rate of 24
breaths per minute.

3. After a thyroidectomy, a patient 6. A patient receiving IV fluids at 125

develops stridor, restlessness, and mL/hr suddenly develops crackles in the
difficulty breathing. What is the nurse's lungs and jugular vein distention. What
most immediate action? is the nurse’s initial action?

o A. Administer IV calcium o A. Reduce the IV flow rate.

gluconate.
o B. Notify the physician
o B. Assess for hypocalcemia immediately.
using Trousseau’s sign.
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o C. Administer a loop diuretic as o C. Apply an antiseptic dressing

prescribed. over the site.

o D. Elevate the head of the bed. o D. Flush the catheter with

heparinized saline.
7. During a blood transfusion, a patient
complains of chills and develops a fever 10. While performing wound care, the
of 38.5°C. What is the first nursing nurse observes that the wound bed is
action? pale with minimal granulation tissue.
What does this indicate about the
o A. Stop the transfusion
wound-healing process?
immediately.
o A. The wound is infected.
o B. Administer paracetamol as
prescribed. o B. There is insufficient perfusion
to the wound bed.
o C. Notify the blood bank.
o C. The patient is experiencing
o D. Document the findings in the
poor nutritional intake.
patient’s chart.
o D. The wound is in the
8. A nurse is inserting an indwelling
maturation phase of healing.
urinary catheter in a female patient but
accidentally contaminates the catheter.
What is the best next step?
11. A patient with diabetes mellitus
o A. Continue with the procedure presents with nausea, confusion, and
using sterile gloves. Kussmaul breathing. The arterial blood
gas reveals pH 7.28, HCO₃⁻ 14 mEq/L,
o B. Obtain a new sterile catheter
and PaCO₂ 30 mmHg. Which
kit and restart the procedure.
intervention is most critical?
o C. Clean the catheter with
o A. Administer intravenous
sterile normal saline and
insulin.
proceed.
o B. Start bicarbonate therapy
o D. Inform the physician and
immediately.
document the incident.
o C. Provide oral glucose.
9. A patient with a central venous catheter
(CVC) develops redness, swelling, and o D. Administer oxygen at 2
purulent discharge at the insertion site. L/min.
What is the nurse's most appropriate
12. A patient receiving heparin therapy for
response?
deep vein thrombosis develops a
o A. Remove the catheter platelet count of 80,000/mm³. What is
immediately. the most appropriate action?

o B. Notify the physician and send

a catheter tip for culture.
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o A. Continue the heparin o B. Notify the physician

infusion and monitor the immediately.
platelet count.
o C. Increase the suction
o B. Discontinue heparin and pressure.
notify the physician.
o D. Administer supplemental
o C. Administer vitamin K to oxygen.
reverse the effects of heparin.
16. A patient with a history of COPD
o D. Initiate warfarin therapy to presents with dyspnea, oxygen
replace heparin. saturation of 88%, and pH 7.31. The
nurse notes the patient has been on 4
13. A postoperative patient develops a low-
L/min of oxygen via nasal cannula. What
grade fever, decreased breath sounds,
is the most appropriate intervention?
and inspiratory crackles. Which
complication should the nurse suspect? o A. Increase oxygen flow rate to
6 L/min.
o A. Atelectasis.
o B. Reduce oxygen to 2 L/min
o B. Pulmonary embolism.
and encourage pursed-lip
o C. Pneumonia. breathing.

o D. Pleural effusion. o C. Prepare for intubation and

mechanical ventilation.
14. A patient in the intensive care unit (ICU)
develops agitation, a heart rate of 150 o D. Administer a bronchodilator
bpm, and diaphoresis while on via nebulization.
mechanical ventilation. Which condition
17. A patient with infective endocarditis
is the nurse most concerned about?
develops sudden onset of left-sided
o A. Acute respiratory distress hemiplegia and slurred speech. What
syndrome (ARDS). should the nurse suspect?

o B. Ventilator-associated o A. Septic emboli to the brain.

pneumonia.
o B. Transient ischemic attack
o C. Airway obstruction. (TIA).

o D. Delirium tremens. o C. Hemorrhagic stroke.

15. A nurse observes that a patient’s chest o D. Progressive valvular

tube drainage has abruptly stopped. dysfunction.
The patient appears dyspneic and has
18. A nurse is caring for a patient with acute
diminished breath sounds on the
ischemic stroke who is receiving tissue
affected side. What should the nurse do
plasminogen activator (tPA). Which
first?
finding requires immediate
o A. Assess the chest tube system discontinuation of the infusion?
for kinks or clots.
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o A. Sudden onset of severe o C. Restlessness and Glasgow

headache. Coma Scale (GCS) of 14.

o B. Blood pressure of 160/90 o D. Bilateral brisk pupillary

mmHg. reflexes.

o C. Blood glucose of 60 mg/dL. 22. A patient with a colostomy reports

leakage of stool around the stoma.
o D. Decreased level of
What is the nurse's most appropriate
consciousness.
response?
19. A patient with a history of peptic ulcer
o A. Suggest the patient wear a
disease is admitted with severe
smaller pouching system.
abdominal pain and a rigid, board-like
abdomen. Which complication is most o B. Check the stoma size and
likely? recommend a refitting.

o A. Peritonitis. o C. Increase the frequency of

pouch changes.
o B. Gastrointestinal bleeding.
o D. Clean the stoma area with
o C. Bowel obstruction.
antiseptic and reapply the
o D. Gastric carcinoma. pouch.

20. A patient with newly diagnosed type 1 23. A nurse is teaching a patient with
diabetes is admitted with diabetic asthma how to use a peak flow meter.
ketoacidosis (DKA). Which laboratory What instruction should the nurse
finding would confirm the diagnosis? emphasize?

o A. Serum glucose of 250 mg/dL. o A. Take a deep breath and blow

out as hard as possible into the
o B. Serum bicarbonate of 18 device.
mEq/L.
o B. Perform the measurement
o C. Arterial blood pH of 7.32. before using a bronchodilator.
o D. Presence of ketones in the o C. Average three readings for
urine. the final result.
21. A nurse is conducting a focused o D. Use the meter only when
neurological assessment on a patient asthma symptoms are present.
who had a traumatic brain injury. Which
finding suggests increasing intracranial 24. A patient receiving IV antibiotics
pressure (ICP)? develops sudden itching, facial flushing,
and difficulty breathing. What is the
o A. Decreasing blood pressure priority action?
and tachycardia.
o A. Stop the infusion
o B. Unilateral pupil dilation and immediately.
decerebrate posturing.
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o B. Administer IV hydrocortisone o A. Obtain a 12-lead ECG.

as prescribed.
o B. Administer oxygen at 2
o C. Maintain airway and call for L/min.
emergency assistance.
o C. Administer aspirin 325 mg
o D. Prepare to administer orally.
epinephrine.
o D. Start nitroglycerin infusion.
25. A nurse is administering enteral feeding
28. A postoperative patient reports severe
to a patient with a nasogastric tube.
pain despite receiving prescribed
Before starting the feeding, what is the
opioids. The nurse notes redness,
most critical action?
warmth, and swelling at the surgical
o A. Flush the tube with sterile site. What is the nurse's best action?
water.
o A. Reassess the pain after 30
o B. Verify tube placement with minutes.
pH testing.
o B. Notify the physician about
o C. Check for residual gastric possible wound infection.
volume.
o C. Administer an additional
o D. Ensure the patient is dose of opioid.
positioned at a 45-degree angle.
o D. Apply a warm compress to
26. A patient receiving chemotherapy the area.
develops oral mucositis. Which
29. A patient with Parkinson’s disease is
intervention should the nurse prioritize
prescribed levodopa-carbidopa. Which
to promote comfort?
statement by the patient indicates a
o A. Encourage the use of an need for further teaching?
alcohol-based mouthwash.
o A. “I will take the medication on
o B. Administer viscous lidocaine an empty stomach.”
before meals.
o B. “I may experience dizziness
o C. Offer acidic juices to cleanse when standing up.”
the oral cavity.
o C. “This medication will cure my
o D. Use a hard-bristled disease.”
toothbrush to maintain oral
o D. “I should avoid high-protein
hygiene.
meals when taking this drug.”
27. A patient in the emergency department
30. A patient develops a sudden onset of
presents with severe chest pain,
high fever, tachycardia, and confusion
diaphoresis, and ST elevation in the
12 hours after surgery. What should the
anterior leads. Which is the nurse's first
nurse suspect?
priority?
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o A. Systemic inflammatory o D. Sensation in the distal

response syndrome (SIRS). extremities.

o B. Malignant hyperthermia. 34. A patient admitted for severe burns

develops dark brown urine. What is the
o C. Postoperative infection.
nurse’s priority?
o D. Pulmonary embolism.
o A. Administer IV fluids to
31. A patient with advanced liver failure maintain urine output.
presents with asterixis, confusion, and
o B. Monitor for signs of infection.
lethargy. Which intervention is most
appropriate? o C. Obtain a urine sample for
culture and sensitivity.
o A. Administer lactulose as
prescribed. o D. Notify the physician to
initiate dialysis.
o B. Restrict dietary protein
intake. 35. A patient with a history of myocardial
infarction is prescribed beta-blockers.
o C. Provide IV vitamin K
Which finding indicates the need for
supplementation.
immediate intervention?
o D. Start paracentesis for ascites.
o A. Heart rate of 50 bpm.
32. During a blood transfusion, the patient
o B. Blood pressure of 130/80
develops back pain, hypotension, and
mmHg.
hemoglobinuria. What complication
should the nurse suspect? o C. Occasional premature
ventricular contractions.
o A. Febrile non-hemolytic
reaction. o D. Fatigue and weakness after
activity.
o B. Acute hemolytic reaction.
36. nurse is caring for a patient with
o C. Anaphylactic shock.
nephrotic syndrome who develops
o D. Transfusion-associated generalized edema. Which laboratory
circulatory overload. value would most likely correlate with
this finding?
33. A nurse is caring for a patient with
Guillain-Barré syndrome experiencing o A. Decreased serum albumin.
ascending paralysis. What is the priority
o B. Increased blood urea
assessment?
nitrogen (BUN).
o A. Motor strength in the upper
o C. Elevated serum sodium.
extremities.
o D. Decreased serum creatinine.
o B. Reflexes in the lower
extremities. 37. A patient with a history of atrial
fibrillation presents with sudden-onset
o C. Respiratory rate and effort.
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left lower leg pain, pallor, and o C. Immobilize the chest wall.
pulselessness. What should the nurse
o D. Call for immediate
suspect?
intubation.
o A. Arterial embolism.
41. A nurse finds a patient unconscious and
o B. Deep vein thrombosis. pulseless. The defibrillator shows a
rhythm consistent with ventricular
o C. Acute compartment
fibrillation. What is the nurse’s
syndrome.
immediate action?
o D. Peripheral neuropathy.
o A. Start chest compressions.
38. A nurse is preparing to administer a
o B. Administer epinephrine.
second dose of chemotherapy to a
patient. Which assessment finding o C. Deliver a defibrillation shock.
would warrant delaying the infusion?
o D. Secure the patient’s airway.
o A. Platelet count of
42. A nurse is caring for a patient who is
75,000/mm³.
NPO and receiving continuous enteral
o B. Hemoglobin of 12 g/dL. feeding via a nasogastric tube. The
patient starts vomiting. What is the
o C. Neutrophil count of
nurse’s priority action?
1,500/mm³.
o A. Stop the feeding
o D. Total bilirubin of 1 mg/dL.
immediately.
39. A patient with septic shock is receiving
o B. Check tube placement with
norepinephrine. Which assessment
an X-ray.
finding indicates the drug is having its
intended effect? o C. Elevate the head of the bed.

o A. Increased urine output. o D. Administer an antiemetic.

o B. Warm, flushed skin. 43. A patient receiving IV fluids develops

crackles in the lungs and jugular vein
o C. Decreased heart rate.
distension. What is the nurse’s next
o D. Reduced respiratory rate. step?

40. A nurse observes paradoxical chest o A. Decrease the IV fluid infusion

movement in a patient with chest rate.
trauma. What is the priority nursing
o B. Administer diuretics as
intervention?
prescribed.
o A. Administer supplemental
o C. Elevate the head of the bed
oxygen.
to 90 degrees.
o B. Prepare for chest tube
o D. Notify the healthcare
insertion.
provider immediately.
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44. A patient with a tracheostomy has thick Which intervention should the nurse
secretions and reports difficulty prioritize?
breathing. What is the most appropriate
o A. Administer a proton pump
intervention?
inhibitor.
o A. Perform tracheostomy
o B. Prepare for endoscopic
suctioning.
variceal ligation.
o B. Increase the flow rate of
o C. Insert a nasogastric tube for
humidified oxygen.
decompression.
o C. Encourage the patient to
o D. Start IV fluids to maintain
cough forcefully.
hemodynamic stability.
o D. Replace the tracheostomy
48. A patient with a chest tube for
tube.
hemothorax drainage has 200 mL of
45. A nurse is assessing a patient who is 4 bright red output in 1 hour. What is the
hours postoperative from abdominal nurse's priority action?
surgery. Which finding requires
o A. Assess the patient for signs of
immediate intervention?
hypovolemia.
o A. Urine output of 20 mL/hr.
o B. Reposition the chest tube to
o B. Temperature of 37.8°C improve drainage.
(100°F).
o C. Notify the healthcare
o C. Blood pressure of 110/70 provider immediately.
mmHg.
o D. Increase the suction level of
o D. Pain level of 8/10 on a the drainage system.
numeric scale.
49. A nurse is caring for a patient receiving
46. A patient with an external fixator for a total parenteral nutrition (TPN). Which
fractured femur reports severe pain finding would require immediate
unrelieved by analgesics. The nurse action?
notes swelling, pallor, and decreased
o A. Blood glucose of 250 mg/dL.
capillary refill. What should the nurse
suspect? o B. Serum potassium of 3.5
mEq/L.
o A. Compartment syndrome.
o C. Temperature of 38.5°C
o B. Osteomyelitis.
(101.3°F).
o C. Venous thromboembolism.
o D. Slightly cloudy TPN solution.
o D. Displacement of the fracture.
50. A patient with a diagnosis of acute
47. A patient with a history of liver cirrhosis pancreatitis has a serum calcium level of
presents with hematemesis and is 7.8 mg/dL. Which clinical manifestation
diagnosed with esophageal varices. should the nurse monitor for?
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o A. Tetany and positive

Chvostek’s sign.

o B. Polyuria and polydipsia.

o C. Generalized edema and

ascites.

o D. Hyperreflexia and
tachycardia.