RN Medical Surgical 2026

Question: 1 of 100

Exhibits:

Exhibit 1: Nurses’ Notes 1000: Client presents to the ED with reports of chest pain that radiates to the left side of their neck, dysphagia, and hiccups. Client states, “The pain is worse when I lie down and decreases a bit when I lean forward.” On assessment, lungs are clear bilaterally, S1 and S2 noted with a high-pitched grating sound. Peripheral pulses +2 bilaterally in all extremities with no edema noted. Client reports having a respiratory infection 6 days ago. Medical history includes hypertension and hypothyroidism.

Exhibit 2: Vital Signs 1005: Temperature: 37.7 C (99.9 F) Heart rate: 92/min Respiratory rate: 18/min Blood pressure: 136/88 mm Hg Oxygen saturation: 98% on room air

Question Text: A nurse is caring for a client in the emergency department (ED). Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.

Choices (Potential Condition):

• Pericarditis
• Cardiomyopathy RN Medical Surgical 2026
• Heart failure
• Acute coronary syndrome

Choices (Actions to Take):

• Monitor electrocardiogram
• Initiate fluid restriction
• Prepare the client for catheterization
• Monitor provider prescription for anti-inflammatory medication
• Prepare the client for central line insertion

Choices (Parameters to Monitor):

• Pericardial friction rub
• Peripheral pulses
• Lung sounds
• Blood pressure

Correct Answer: Potential Condition: Pericarditis Actions to Take:

1. Monitor electrocardiogram
2. Monitor provider prescription for anti-inflammatory medication Parameters to Monitor:
3. Pericardial friction rub
4. Blood pressure

Explanation: Pericarditis is an inflammation of the pericardium often following a viral respiratory infection. Classic clinical manifestations include chest pain that worsens when supine and improves when leaning forward, a high-pitched grating chest sound (pericardial friction rub), and widespread ST-segment elevation on an electrocardiogram (ECG). Treatment focuses on managing inflammation using medications such as NSAIDs or corticosteroids. ECG monitoring is essential to detect dysrhythmias or ST-segment changes, while monitoring blood pressure and pericardial friction rub helps detect potential complications like cardiac tamponade.

Incorrect Answers and Explanations:

• Cardiomyopathy: Refers to disease of the heart muscle leading to impaired cardiac output; does not typically present acutely with a pericardial friction rub following a respiratory infection.
• Heart failure: Involves fluid volume overload, peripheral edema, and pulmonary crackles, which are not described in this client’s baseline assessment.
• Acute coronary syndrome: Causes chest pain typically related to exertion or ischemia, not characteristically relieved by leaning forward or associated with a pericardial friction rub.
• Initiate fluid restriction / Prepare for catheterization / Central line insertion: These interventions are targeted toward heart failure, coronary angiography for acute MI, or invasive hemodynamic monitoring, not uncomplicated pericarditis.

Question: 2 of 100

Question Text: A nurse is reviewing the laboratory reports of a client who has acute pancreatitis. Which of the following findings should the nurse expect?

Choices:

• Decreased erythrocyte sedimentation rate
• Elevated serum calcium
• Decreased serum amylase
• Elevated blood glucose

Correct Answer: Elevated blood glucose

Explanation: Acute pancreatitis causes inflammation of the pancreas, leading to endocrine dysfunction where pancreatic beta cells produce less insulin or glucagon regulation is impaired, resulting in elevated blood glucose (hyperglycemia).

Incorrect Answers and Explanations:

• Decreased erythrocyte sedimentation rate: ESR increases during inflammatory processes like acute pancreatitis.
• Elevated serum calcium: Serum calcium levels decrease (hypocalcemia) in acute pancreatitis due to fat necrosis and saponification.
• Decreased serum amylase: Serum amylase levels rise significantly (usually within 2 to 12 hours of onset) in acute pancreatitis.

Question: 3 of 100

Question Text: A home health nurse is providing nutrition education for a client who has trigeminal neuralgia. Which of the following foods should the nurse recommend to decrease pain?

Choices:

• Vanilla pudding
• Vegetable soup
• Ice cream
• Graham crackers

Correct Answer: Vanilla pudding

Explanation: Trigeminal neuralgia causes severe, sharp facial pain triggered by touch, thermal stimuli, or chewing. Room-temperature, soft, smooth foods like vanilla pudding require minimal chewing and do not stimulate thermal triggers.

Incorrect Answers and Explanations:

• Vegetable soup: Often served hot, which can trigger facial pain via thermal stimulation.
• Ice cream: Extremely cold temperatures can trigger trigeminal pain paroxysms.
• Graham crackers: Crunchy/hard textures require chewing, which triggers the trigeminal nerve.

Question: 4 of 100

Question Text: A nurse is caring for a client who has a sealed radiation implant. Which of the following actions should the nurse take?

Choices:

• Remove soiled linens from the room after each change.
• Limit family member visits to 30 min per day.
• Give the dosimeter badge to the oncoming nurse at the end of the shift.
• Apply a second pair of gloves before touching the client’s implant if it dislodges.

Correct Answer: Limit family member visits to 30 min per day.

Explanation: To minimize exposure to radiation (time, distance, shielding principles), visitors should be restricted to a maximum of 30 minutes per day and maintain a distance of at least 6 feet from the radiation source.

Incorrect Answers and Explanations:

• Remove soiled linens from the room after each change: Linens should remain in the room in designated containers until the radiation source is removed to prevent accidental disposal of displaced sources.
• Give the dosimeter badge to the oncoming nurse at the end of the shift: Dosimeter badges are individually assigned to track a specific worker’s cumulative radiation exposure and must not be shared or transferred.
• Apply a second pair of gloves before touching the client’s implant if it dislodges: If an implant dislodges, it must never be touched directly by hand; long-handled forceps should be used to place it in a lead container.

Question: 5 of 100

Exhibits:

Exhibit 1: Nurses’ Notes Client comes to the ED reporting a headache that has lasted for 3 days. Reports pain is currently a 7 out of 10. Client appears pale and lethargic. Client also reports photophobia, malaise, nausea, and chills. Positive nuchal rigidity, lung sounds clear, heart sounds regular, hyperactive bowel sounds in all 4 quadrants. 18-gauge IV initiated in the left antecubital space and IV fluids started. Awaiting CT scan results.

Exhibit 2: Vital Signs Temperature: 39.2 C (102.6 F) Heart rate: 115/min Respiratory rate: 12/min Blood pressure: 98/64 mm Hg Oxygen saturation: 94% on room air

Question Text: A nurse is caring for a client who has just been admitted to the emergency department (ED). Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.

Choices (Potential Condition):

• Meningitis
• Brain abscess RN Medical Surgical 2026
• Encephalitis
• Sepsis

Choices (Actions to Take):

• Place the client on droplet precautions
• Dim the lights in the client’s room
• Prepare the client for lumbar puncture
• Administer broad-spectrum antibiotics

Choices (Parameters to Monitor):

• Neurological checks
• Temperature
• Blood pressure
• WBC count

Correct Answer: Potential Condition: Meningitis Actions to Take:

1. Place the client on droplet precautions
2. Prepare the client for lumbar puncture Parameters to Monitor:
3. Neurological checks
4. Temperature

Explanation: The client exhibits classic signs of bacterial meningitis: high fever, severe headache, photophobia, lethargy, and nuchal rigidity (stiff neck). Droplet precautions must be initiated immediately to prevent transmission. A lumbar puncture is necessary to confirm the diagnosis via CSF analysis. Monitoring neurological status (Glasgow Coma Scale, cranial nerves) and body temperature evaluates clinical progression and response to antimicrobial therapy.

Incorrect Answers and Explanations:

• Brain abscess / Encephalitis / Sepsis: While these present with fever and altered mental state, nuchal rigidity combined with acute photophobia directly points toward meningeal irritation (meningitis).

Question: 6 of 100

Question Text: A nurse is assessing a client who has a gravity drain in place following an open cholecystectomy. Which of the following images should the nurse identify as a gravity drain?

Choices:

• Image showing a Penrose drain
• Image showing a Jackson-Pratt drain
• Image showing a Hemovac drain
• Image showing a chest tube collection bottle

Correct Answer: Image showing a Penrose drain

Explanation: A Penrose drain is a soft, flexible rubber tube that provides drainage from a surgical site via gravity and capillary action onto an outer dressing, without applying active suction.

Incorrect Answers and Explanations:

• Jackson-Pratt / Hemovac drains: These are closed-suction drainage systems that rely on negative pressure rather than gravity alone.

Question: 7 of 100

Question Text: A nurse is teaching a group of young adult clients about risk factors for hearing loss. Which of the following factors should the nurse include in the teaching? (Select all that apply.)

Choices:

• Born with a high birth weight
• Frequent exposure to low volume noise
• Use of a loop diuretic
• Chronic infections of the middle ear
• Perforation of the eardrum

Correct Answer:

• Use of a loop diuretic
• Chronic infections of the middle ear
• Perforation of the eardrum

Explanation: Loop diuretics (e.g., furosemide) are ototoxic medications that can damage inner ear hair cells. Chronic otitis media causes structural tissue damage, scarring, and conductive hearing loss. Perforation of the tympanic membrane disrupts mechanical sound wave transmission through the middle ear.

Incorrect Answers and Explanations:

• Born with a high birth weight: Low birth weight (not high birth weight) is a risk factor for congenital hearing impairment.
• Frequent exposure to low volume noise: High-volume or high-decibel noise exposure causes noise-induced sensorineural hearing loss.

Question: 8 of 100

Question Text: A nurse is caring for a client who uses massage to alleviate pain. Which of the following should the nurse recognize as a contraindication for using this type of complementary therapy?

Choices:

• HIV
• Hemophilia
• Migraines
• Arthritis

Correct Answer: Hemophilia

Explanation: Hemophilia is a bleeding disorder characterized by a deficiency in clotting factors. Deep tissue massage or pressure can cause internal soft tissue bleeding, hematomas, and muscle hemorrhages.

Incorrect Answers and Explanations:

• HIV: Massage therapy is safe and beneficial for stress reduction in clients with HIV.
• Migraines / Arthritis: Gentle touch or cutaneous stimulation therapies are commonly used non-pharmacological interventions for managing migraine headaches and chronic joint discomfort.

Question: 9 of 100

Exhibits:

Exhibit 1: Medical History HIV type 1 (HIV-1)

Exhibit 2: Diagnostic Results Upon diagnosis: WBC count: 4,500/mm³ (5,000 to 10,000/mm³) Platelets: 164,000/mm³ (150,000 to 400,000/mm³) Sodium: 139 mEq/L (136 to 145 mEq/L) Potassium: 4.2 mEq/L (3.5 to 5 mEq/L) BUN: 16 mg/dL (10 to 20 mg/dL)

3-month visit: WBC count: 4,100/mm³ (5,000 to 10,000/mm³) Platelets: 162,000/mm³ (150,000 to 400,000/mm³) Sodium: 139 mEq/L (136 to 145 mEq/L) Potassium: 3.8 mEq/L (3.5 to 5 mEq/L) BUN: 18 mg/dL (10 to 20 mg/dL)

Exhibit 3: Nurses’ Notes Client received diagnosis of HIV-1 3 months ago. Returns to clinic today for follow-up visit and to discuss recent laboratory findings.

Question Text: A nurse in a health clinic is caring for a client. Drag 1 condition and 1 client finding to fill in each blank in the following sentence.

Template: The client is at risk for developing [Condition] due to [Finding].

Choices (Condition):

• Infection
• Thrombocytopenia
• Renal failure
• Hyponatremia

Choices (Finding):

• Decreased WBC count
• Decreased platelet count
• Elevated BUN
• Low potassium

Correct Answer: The client is at risk for developing Infection due to Decreased WBC count.

Explanation: The client’s WBC count has dropped below the normal reference range (from 4,500/mm³ to 4,100/mm³; normal range 5,000–10,000/mm³), placing the immunocompromised HIV-1 client at heightened risk for opportunistic infections.

Incorrect Answers and Explanations:

• Thrombocytopenia: Platelet counts remain within the normal range (162,000/mm³).
• Renal failure / Hyponatremia: BUN, sodium, and potassium levels are within normal limits.

Question: 10 of 100

Question Text: A nurse is providing teaching to a client and his partner about performing peritoneal dialysis at home. When discussing peritonitis, which of the following manifestations should the nurse identify as the earliest indication of this complication?

Choices:

• Cloudy effluent
• Increased heart rate
• Generalized abdominal pain
• Fever

Correct Answer: Cloudy effluent

Explanation: Cloudy or turbid dialysate outflow (effluent) is the earliest and most classic indicator of peritonitis in clients undergoing peritoneal dialysis, caused by the presence of white blood cells and fibrin in the fluid.

Incorrect Answers and Explanations:

• Increased heart rate / Generalized abdominal pain / Fever: These systemic and localized inflammatory manifestations develop later as the infection progresses.

Question: 11 of 100

Exhibits:

Exhibit 1: Vital Signs Day 1, 1100: Temperature: 39.1 C (102.4 F) Pulse rate: 102/min Respiratory rate: 26/min Blood pressure: 122/80 mm Hg Oxygen saturation: 86% on room air Weight: 90.7 kg (200 lb)

Day 2, 1200: Temperature: 38 C (100.4 F) Pulse rate: 100/min Respiratory rate: 22/min Blood pressure: 120/74 mm Hg Oxygen saturation: 88% on nasal cannula at 2 L/min

Day 3, 1200: Temperature: 37.2 C (98.9 F) Pulse rate: 90/min Respiratory rate: 20/min Blood pressure: 120/72 mm Hg Oxygen saturation: 91% on nasal cannula at 3 L/min

Day 4, 1500: Temperature: 37.2 C (98.9 F) Pulse rate: 92/min Respiratory rate: 22/min Blood pressure: 120/72 mm Hg Oxygen saturation: 93% on nasal cannula at 3 L/min; 88% on room air

Exhibit 2: Medication Administration Record Day 1, 1500: Cefazolin 500 mg every 12 hr IV Dexamethasone 15 mg every 6 hr IV

Day 3, 1200: Discontinue dexamethasone 15 mg every 6 hr IV Prednisone 40 mg PO daily

Day 4, 1500: Discontinue cefazolin 500 mg every 12 hr IV

Exhibit 3: Provider Prescriptions Day 4, 1500: Discharge prescriptions: Cephalexin 500 mg PO every 6 hr for 5 days Prednisone 40 mg PO daily for 5 days Home oxygen 3 L/min via nasal cannula

Question Text: A nurse is caring for a client who has pneumonia. The nurse is providing discharge teaching for the client and their caregiver. Which of the following information should the nurse include? (Select all that apply.)

Choices:

• Adjust the oxygen flow rate as needed to ease breathing
• The steroid dose will decrease each day
• Antibiotic therapy should be taken for 10 days
• Steroid medication should be taken in the morning
• Antibiotic medication can be taken with or without food
• Ensure the oxygen delivery system is at least 8 feet from any heat source
• Store the oxygen cylinder wrench with the oxygen tank

Correct Answer:

• Steroid medication should be taken in the morning
• Antibiotic medication can be taken with or without food
• Ensure the oxygen delivery system is at least 8 feet from any heat source
• Store the oxygen cylinder wrench with the oxygen tank

Explanation: Corticosteroids (prednisone) should be taken in the morning to mimic natural adrenal circadian cortisol production and prevent insomnia. Cephalexin can be taken with or without food to minimize gastric upset. Home oxygen safety guidelines mandate placing delivery systems at least 8 feet (or 5 feet per standard fire safety guidelines) away from heat sources and open flames. Oxygen wrenches should be stored with tanks to enable quick emergency shutoff.

Incorrect Answers and Explanations:

• Adjust the oxygen flow rate as needed to ease breathing: Oxygen flow rates are prescribed medical dosages and must never be altered without provider authorization.
• The steroid dose will decrease each day: The prescription specifies a constant daily dose of Prednisone 40 mg PO daily for 5 days, not a daily tapering schedule.
• Antibiotic therapy should be taken for 10 days: Discharge prescriptions specify Cephalexin for 5 days.

Question: 12 of 100

Question Text: A nurse is planning care for a client who has a pulmonary embolism. Which of the following interventions should the nurse include?

Choices:

• Position the client on the left side.
• Measure vital signs every 4 hr.
• Instruct the client to massage the lower extremities.
• Initiate a continuous IV heparin infusion.

Correct Answer: Initiate a continuous IV heparin infusion.

Explanation: An intravenous unfractionated heparin infusion is a primary therapeutic intervention for acute pulmonary embolism to prevent further clot formation and extension.

Incorrect Answers and Explanations:

• Position the client on the left side: High-Fowler’s position is preferred to maximize lung expansion and ease dyspnea.
• Measure vital signs every 4 hr: Vital signs should be monitored more frequently (e.g., every 1 to 2 hours) during acute stabilization.
• Massage the lower extremities: Massaging the legs is strictly contraindicated because it can dislodge deep vein thrombi and cause recurrent pulmonary emboli.

Question: 13 of 100

Question Text: A nurse is assessing a client who reports abdominal pain. Which of the following actions should the nurse take first?

Choices:

• Inspection
• Percussion
• Palpation
• Auscultation

Correct Answer: Inspection

Explanation: The sequence of physical assessment for the abdomen is Inspection, Auscultation, Percussion, and Palpation (I-A-P-P). Inspection is performed first to observe contour, symmetry, and skin characteristics without altering bowel motility.

Incorrect Answers and Explanations:

• Percussion / Palpation: These mechanical maneuvers are performed after auscultation because touching or pressing on the abdominal wall can alter bowel sounds and cause peristaltic changes.
• Auscultation: Performed second, immediately after visual inspection.

Question: 14 of 100

Exhibits:

Exhibit 1: Diagnostic Results Day of admission: Brain natriuretic peptide (BNP): 450 pg/mL (less than 100 pg/mL) Potassium: 4.8 mEq/L (3.5 to 5 mEq/L) Sodium: 132 mEq/L (136 to 145 mEq/L) BUN: 10 mg/dL (10 to 20 mg/dL)

Day 2 of hospitalization: BNP: 110 pg/mL (less than 100 pg/mL) Potassium: 3.3 mEq/L (3.5 to 5 mEq/L) Sodium: 135 mEq/L (136 to 145 mEq/L) BUN: 20 mg/dL (10 to 20 mg/dL)

Exhibit 2: Medication Administration Record Day of admission: Furosemide 80 mg IV 3 times per day

Exhibit 3: Vital Signs Day of admission: Temperature: 36.6 C (97.9 F) Heart rate: 112/min Respiratory rate: 24/min Blood pressure: 185/84 mm Hg Oxygen saturation: 93% on room air Weight: 97.5 kg (215 lb)

Day 2 of hospitalization: Temperature: 36.6 C (97.9 F) Heart rate: 78/min Respiratory rate: 18/min Blood pressure: 102/78 mm Hg Oxygen saturation: 98% on 2 L/min oxygen via nasal cannula

Question Text: A nurse is caring for a client who has heart failure. Drag words from the choices below to fill in each blank in the following sentence.

Template: The client is at risk for developing [Condition 1] and [Condition 2].

Choices:

• Hypokalemia
• Cardiac dysrhythmias
• Hypernatremia
• Renal failure

Correct Answer: The client is at risk for developing Hypokalemia and Cardiac dysrhythmias.

Explanation: High-dose loop diuretic administration (Furosemide 80 mg IV three times daily) causes renal potassium excretion, dropping the client’s potassium level to 3.3 mEq/L (hypokalemia). Hypokalemia impairs cardiac electrical conduction and increases the risk for potentially lethal cardiac dysrhythmias.

Incorrect Answers and Explanations:RN Medical Surgical 2026

• Hypernatremia / Renal failure: Sodium levels remain slightly low/normal (135 mEq/L) and BUN is within normal limits (20 mg/dL).

Question: 15 of 100

Question Text: A nurse is conducting a health history interview with an older adult client. Which of the following findings indicates that the client could be experiencing impaired cognition?

Choices:

• Repetitively asking the nurse to repeat the questions
• Difficulty finding their way to a familiar place
• Avoiding direct eye contact with the nurse
• Nervousness about attending social functions

Correct Answer: Difficulty finding their way to a familiar place

Explanation: Getting lost in familiar surroundings (topographical disorientation) is a sign of cognitive decline and spatial disorientation associated with dementia or major neurocognitive disorders.

Incorrect Answers and Explanations:

• Repetitively asking the nurse to repeat questions: Commonly indicates presbycusis (age-related sensory hearing loss) rather than a cognitive deficit.
• Avoiding direct eye contact: Often reflects cultural norms, shyness, or anxiety.
• Nervousness about social functions: Relates to social anxiety or situational adjustment, not primary cognitive dysfunction.

Question: 16 of 100

Question Text: A nurse is caring for a client who has a deep vein thrombosis. Which of the following findings should indicate to the nurse that the client could be experiencing a pulmonary embolism?

Choices:

• Heart rate 120/min
• Blood pressure 140/90 mm Hg
• Respiratory rate 12/min
• Temperature 40 C (104 F)

Correct Answer: Heart rate 120/min

Explanation: Tachycardia (heart rate > 100/min) is a classic manifestation of a pulmonary embolism, occurring as a compensatory mechanism for decreased stroke volume and acute hypoxemia.

Incorrect Answers and Explanations:

• Blood pressure 140/90 mm Hg: Massive PE causes hypotension and circulatory collapse, not acute hypertension.
• Respiratory rate 12/min: PE typically causes tachypnea (rapid breathing) due to respiratory distress and hypoxia.
• Temperature 40 C (104 F): High fever is suggestive of systemic infection or sepsis rather than acute thromboembolism.

Question: 17 of 100

Question Text: A nurse is assessing a client who is receiving magnesium sulfate IV for the treatment of hypomagnesemia. Which of the following findings indicates effectiveness of the medication?

Choices:

• Blood pressure 90/50 mm Hg
• PR interval 0.18 seconds
• Positive Chvostek’s sign
• Hyperactive bowel sounds

Correct Answer: PR interval 0.18 seconds

Explanation: A PR interval of 0.18 seconds is within normal limits (0.12 to 0.20 seconds). Correcting hypomagnesemia normalizes cardiac neuromuscular conduction and ECG wave intervals.

Incorrect Answers and Explanations:

• Blood pressure 90/50 mm Hg: Hypotension is an adverse reaction of rapid magnesium administration or toxicity.
• Positive Chvostek’s sign: Indicates neuromuscular hyperexcitability seen in hypocalcemia and hypomagnesemia.
• Hyperactive bowel sounds: Hypomagnesemia causes neuromuscular irritability (hyperactive reflexes); therapeutic correction calms hyperactive muscle activity.

Question: 18 of 100

Question Text: A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following actions should the nurse take?

Choices:

• Monitor serum electrolytes and glucose weekly.
• Increase the rate of TPN if given late.
• Change the tubing every 24 hr.
• Replace the transparent dressing on the central line catheter every day.

Correct Answer: Change the tubing every 24 hr.

Explanation: TPN solutions contain high concentrations of dextrose and lipids, creating a medium for bacterial growth. Infusion tubing and administration sets must be changed every 24 hours to prevent central line-associated bloodstream infections (CLABSI).

Incorrect Answers and Explanations:

• Monitor serum electrolytes and glucose weekly: Blood glucose should be monitored every 4 to 6 hours initially, and serum electrolytes daily or as ordered.
• Increase the rate of TPN if given late: Never speed up a TPN infusion to catch up, as this can cause hyperosmolar hyperglycemic state or severe fluid overload.
• Replace the transparent dressing every day: Transparent dressings on central lines are changed every 7 days unless soiled or loose.

Question: 19 of 100

Question Text: A nurse is assessing a client who has a new diagnosis of chronic renal failure. Which of the following findings should the nurse expect?

Choices:

• Increased calcium levels
• Increased erythropoietin levels
• Decreased hemoglobin levels
• Decreased parathyroid hormone levels

Correct Answer: Decreased hemoglobin levels

Explanation: Kidneys produce erythropoietin, which stimulates red blood cell production in the bone marrow. In chronic renal failure, impaired erythropoietin synthesis leads to anemia and decreased hemoglobin levels.

Incorrect Answers and Explanations:

• Increased calcium levels: Hypocalcemia occurs in chronic renal failure due to impaired activation of Vitamin D and hyperphosphatemia.
• Increased erythropoietin levels: Erythropoietin production decreases in damaged renal tissue.
• Decreased parathyroid hormone levels: PTH levels increase (secondary hyperparathyroidism) in response to hypocalcemia and hyperphosphatemia.

Question: 20 of 100

Question Text: A nurse is evaluating care for a group of clients. The nurse should consult the provider for which of the following clients?

Choices:

• A client who is ready for discharge after coronary artery stent placement and has a prescription for clopidogrel
• A client who has a pacemaker and whose cardiac monitor shows a QRS complex after each pacer spike
• A client who has atrial fibrillation and a rapid ventricular rate of 105/min and is receiving diltiazem IV
• A client who requires an IV intermittent bolus dose of vancomycin and has a creatinine level of 1.5 mg/dL (0.5 to 1.1 mg/dL)

Correct Answer: A client who requires an IV intermittent bolus dose of vancomycin and has a creatinine level of 1.5 mg/dL (0.5 to 1.1 mg/dL)

Explanation: Vancomycin is a nephrotoxic medication cleared by the kidneys. An elevated serum creatinine level (1.5 mg/dL) indicates impaired renal function, requiring provider consultation to adjust dosage or dosing intervals to prevent worsening nephrotoxicity.

Incorrect Answers and Explanations:

• Clopidogrel after coronary stent: Standard antiplatelet therapy to prevent stent thrombosis.
• Pacemaker with QRS after pacer spike: Indicates normal ventricular capture.
• Atrial fibrillation with rate 105/min receiving diltiazem: Diltiazem IV is an appropriate calcium channel blocker used for ventricular rate control.

Question: 21 of 100

Question Text: A nurse is providing discharge teaching to an older adult client following a left total hip arthroplasty. Which of the following instructions should the nurse include in the teaching?

Choices:

• Install a raised toilet seat in your bathroom
• You should use an incentive spirometer every 4 hours.
• You can cross your legs at the ankles when sitting down.
• Clean the incision daily with hydrogen peroxide.

Correct Answer: “Install a raised toilet seat in your bathroom”

Explanation: A raised toilet seat prevents hip flexion beyond 90 degrees, which is essential to prevent dislocation of the new hip prosthesis following posterior total hip arthroplasty.

Incorrect Answers and Explanations:

• Incentive spirometer every 4 hours: Postoperative incentive spirometry is performed 10 times every 1 to 2 hours while awake.
• Cross legs at ankles: Leg crossing or adduction past the midline is strictly contraindicated due to dislocation risk.
• Clean incision with hydrogen peroxide: Hydrogen peroxide damages healing granulation tissue; mild soap and water or plain normal saline should be used as instructed.

Question: 22 of 100

Question Text: A nurse is assessing a client who has a new chest tube and sealed drainage system. Which of the following findings should the nurse report to the provider?

Choices:

• Intermittent bubbling in the water seal chamber
• 2 inches of tidaling in the water seal chamber
• Drainage greater than 70 mL/hr
• Slight discoloration of the skin at the insertion site

Correct Answer: Drainage greater than 70 mL/hr

Explanation: Chest tube drainage exceeding 70 to 100 mL/hr is excessive and indicates active hemorrhage or vascular trauma within the pleural space, requiring immediate notification of the provider.

Incorrect Answers and Explanations:

• Intermittent bubbling in water seal chamber: Normal finding representing air evacuation from a pneumothorax during coughing or exhalation.
• Tidaling in water seal chamber: Normal fluctuation with respiration indicating patency of the chest tube system.
• Slight discoloration at insertion site: Normal postoperative bruising or minor serosanguinous staining.

Question: 23 of 100

Question Text: A nurse is planning discharge for a group of clients. Which of the following clients should the nurse recommend a referral for physical therapy?

Choices:

• A client who has asthma and requires nebulizer treatments
• A client who has Parkinson’s disease and has a shuffling gait
• A client who has a stage 2 pressure injury with drainage
• A client who has diverticulitis and had a colonoscopy

Correct Answer: A client who has Parkinson’s disease and has a shuffling gait

Explanation: Parkinson’s disease causes motor dysfunction, rigidity, postural instability, and a shuffling gait. Physical therapy provides gait training, mobility assistance, and fall prevention strategies.

Incorrect Answers and Explanations:

• Asthma / Nebulizer: Requires respiratory therapy or clinical nurse specialist education.
• Stage 2 pressure injury: Requires wound care nurse consult and wound dressing management.
• Diverticulitis / Colonoscopy: Requires dietary instruction and gastroenterology management.

Question: 24 of 100

Question Text: A nurse is caring for a client who is 2 hr postoperative following orthopedic surgery and reports pain as 10 on a scale of 0 to 10. Which of the following prescriptions should the nurse expect to administer?

Choices:

• Acetaminophen 1,000 mg PO
• Ketorolac 30 mg IV
• Oxycodone 10 mg PO
• Fentanyl 125 mcg/hr transdermal

Correct Answer: Ketorolac 30 mg IV

Explanation: For severe acute postoperative pain (10/10) when rapid onset is required, parenteral IV analgesics (or rapid IV NSAIDs/opioids like IV morphine/fentanyl/ketorolac depending on protocol) provide rapid pain relief compared to oral route medications or slow-onset transdermal patches.

Incorrect Answers and Explanations:

• Acetaminophen / Oxycodone PO: Oral medications have a delayed onset of action (30–60 minutes) and are inadequate as standalone treatment for acute severe 10/10 pain in the immediate postoperative recovery period.
• Transdermal Fentanyl: Designed for opioid-tolerant chronic pain management; peak onset takes 12 to 24 hours, making it unsafe and ineffective for acute postoperative pain.

Question: 25 of 100

Question Text: A nurse is caring for a client who was admitted with nausea, vomiting, and a possible bowel obstruction. An NG tube is placed and set to low intermittent suction. Which of the following findings should the nurse report to the provider?

Choices:

• The client reports being extremely thirsty with a sore throat.
• The drainage is bright green in color with brown fecal material.
• The client’s abdomen becomes distended and firm.
• The amount of drainage is gradually decreasing.

Correct Answer: The client’s abdomen becomes distended and firm.

Explanation: A firm, distended abdomen suggests worsening obstruction, paralytic ileus, or potentially fatal bowel perforation and peritonitis, requiring urgent evaluation by the provider.

Incorrect Answers and Explanations:

• Thirsty with sore throat: Common discomfort caused by the presence of the nasogastric tube and mouth breathing.
• Bright green drainage with fecal material: Expected finding when decompressing a small or large bowel obstruction.
• Drainage gradually decreasing: Expected as bowel obstruction resolves and normal peristalsis resumes.

Question: 26 of 100

Question Text: A nurse is caring for a client who has pulmonary edema and a new prescription for furosemide 40 mg IV twice daily. Which of the following client findings indicates the prescription is appropriate?

Choices:

• Bilateral coarse crackle breath sounds
• Blood pressure 100/70 mm Hg
• Vesicular breath sounds over the peripheral lung fields
• Potassium 3.2 mEq/L (3.5 to 5.0 mEq/L)

Correct Answer: Bilateral coarse crackle breath sounds

Explanation: Pulmonary edema involves fluid accumulation in the alveoli, presenting clinically as bilateral crackles, dyspnea, and orthopnea. Furosemide is a potent loop diuretic prescribed to reduce intravascular volume and pulmonary congestion.

Incorrect Answers and Explanations:

• Vesicular breath sounds: Normal, clear lung sounds indicating no fluid accumulation.
• Potassium 3.2 mEq/L: Indicates hypokalemia; administering loop diuretics will exacerbate low potassium levels.

Question: 27 of 100

Question Text: A nurse is providing teaching to a client about management of the manifestations of Meniere’s disease. Which of the following information should the nurse include? (Select all that apply.)

Choices:

• Use an antiemetic during an acute attack
• Avoid drinks containing caffeine
• Decrease fluid intake in the afternoon and evening
• Avoid high-potassium foods
• Sit in a dark room when experiencing vertigo

Correct Answer:

• Use an antiemetic during an acute attack
• Avoid drinks containing caffeine
• Sit in a dark room when experiencing vertigo

Explanation: Meniere’s disease causes endolymphatic hydrops leading to acute vertigo, tinnitus, and nausea. Antiemetics control acute nausea and vomiting. Caffeine should be avoided because it alters endolymph fluid balance. Resting in a quiet, darkened room during vertigo attacks minimizes sensory input and reduces motion sickness symptoms.

Incorrect Answers and Explanations:

• Decrease fluid intake in afternoon/evening: Fluid intake should be distributed evenly throughout the day rather than restricted at specific times.
• Avoid high-potassium foods: Low-sodium diets (not potassium restriction) are prescribed to control endolymphatic volume.

Question: 28 of 100

Question Text: A nurse is planning to administer gentamicin 4 mg/kg/day via intermittent IV bolus in equally divided doses every 8 hr to a client who weighs 187 lb. Available is gentamicin 40 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Choices:

• Numeric response placeholder RN Medical Surgical 2026

Correct Answer: 2.8 mL

Explanation:

1. Convert weight from pounds to kilograms: 187 lb / 2.2 = 85 kg.
2. Calculate total daily dose: 85 kg x 4 mg/kg/day = 340 mg/day.
3. Divide into 3 equal doses (every 8 hours = 3 doses/day): 340 mg / 3 = 113.33 mg per dose.
4. Calculate volume per dose: 113.33 mg / 40 mg/mL = 2.833 mL.
5. Round to the nearest tenth: 2.8 mL.

Question: 29 of 100

Question Text: A nurse is reviewing the laboratory results of a female client who has cirrhosis. Which of the following findings should the nurse identify as a complication?

Choices:

• WBC count 8,000/mm³ (5,000 to 10,000/mm³)
• Albumin 4.8 g/dL (3.5 to 5.0 g/dL)
• RBC count 4 million/mm³ (4.2 to 5.4 million/mm³)
• Platelets 125,000/mm³ (150,000 to 400,000/mm³)

Correct Answer: Platelets 125,000/mm³ (150,000 to 400,000/mm³)

Explanation: Cirrhosis leads to portal hypertension and congestive splenomegaly. The enlarged spleen sequesters blood cells, causing thrombocytopenia (platelet count < 150,000/mm³), which increases the client’s risk for bleeding.

Incorrect Answers and Explanations:

• WBC count 8,000/mm³: Normal finding.
• Albumin 4.8 g/dL: Normal liver synthetic function (cirrhosis typically causes hypoalbuminemia < 3.5 g/dL).
• RBC count 4 million/mm³: Slightly low or near baseline; thrombocytopenia specifically reflects portal hypertension/splenomegaly complication.

Question: 30 of 100

Question Text: A nurse is caring for a client who has chronic kidney disease and is scheduled to begin hemodialysis twice a week. Which of the following actions should the nurse take?

Choices:

• Explain that this treatment plan will reverse the effects of chronic kidney disease.
• Assure the client that they will not have dietary restrictions while on hemodialysis.
• Inform the client that they will eventually return to their previous level of activity.
• Ask the client to express how they are feeling about starting their treatment plan.

Correct Answer: Ask the client to express how they are feeling about starting their treatment plan.

Explanation: Initiating chronic renal replacement therapy represents a life-altering event. The therapeutic nursing response encourages expression of feelings, fears, and coping mechanisms regarding lifelong therapy.

Incorrect Answers and Explanations:

• Treatment reverses effects: Hemodialysis replaces renal excretory function but does not reverse underlying renal tissue damage or chronic kidney disease.
• No dietary restrictions: Hemodialysis requires strict fluid, sodium, potassium, and phosphorus restrictions.
• Return to previous activity level: Fatigue and lifestyle modifications persist; promising a full return to previous baseline activity is inaccurate.

Question: 31 of 100

Question Text: A nurse is caring for a client who recently completed a cardiac rehabilitation program. Which of the following client statements indicates the program was completed successfully?

Choices:

• “I’ve cut down to only a few cigarettes a day.”
• “My job is still stressful and I work 50 to 60 hours a week.”
• “I walk my dog for at least 1 mile every other day.”
• “I stopped taking my clopidogrel.”

Correct Answer: “I walk my dog for at least 1 mile every other day.”

Explanation: Regular physical activity and aerobic exercise exercise routines demonstrate successful behavioral adaptation and cardiovascular conditioning following cardiac rehabilitation.

Incorrect Answers and Explanations:

• Cut down to a few cigarettes: Complete smoking cessation is required for secondary prevention of cardiovascular disease.
• Working 50-60 hours with stress: Indicates unmanaged occupational stress and lack of lifestyle workload adjustment.
• Stopped taking clopidogrel: Discontinuing antiplatelet therapy without medical supervision increases the risk of stent thrombosis and recurrent myocardial infarction.

Question: 32 of 100

Question Text: A nurse is reviewing the laboratory results of a group of clients. Which of the following client conditions requires reporting to the local health department?

Choices:

• Tuberculosis
• Varicella zoster
• Clostridium difficile
• Genital herpes

Correct Answer: Tuberculosis

Explanation: Tuberculosis (Mycobacterium tuberculosis) is a nationally reportable infectious disease that requires public health reporting for contact tracing and epidemiological control.

Incorrect Answers and Explanations:

• Varicella zoster / C. difficile / Genital herpes: While infectious, these standard conditions are managed per facility infection control guidelines and are not nationally mandatory reportable diseases in standard adult medical-surgical settings.

Question: 33 of 100

Question Text: A nurse is preparing to remove a peripheral IV catheter from a client. Which of the following actions should the nurse take?

Choices:

• Place a hydrocolloid dressing over the site
• Hold pressure on the site following removal
• Clean the site with a chlorhexidine swab after removing the catheter
• Elevate the extremity for 1 hr

Correct Answer: Hold pressure on the site following removal

Explanation: Direct manual pressure applied over the venipuncture site with sterile gauze immediately after catheter withdrawal prevents fluid leakage, hematoma formation, and bleeding.

Incorrect Answers and Explanations:

• Hydrocolloid dressing: A simple sterile gauze pad and adhesive tape or sterile bandage is applied, not a occlusive hydrocolloid wound dressing.
• Clean site with chlorhexidine after removal: Cleansing is performed prior to removal; applying antiseptics to an open wound track causes tissue irritation.
• Elevate extremity for 1 hr: Unnecessary for routine peripheral IV catheter removal.

Question: 34 of 100

Question Text: A nurse is caring for a client who received chemotherapy the day before. Which of the following items requires the nurse to implement special handling precautions?

Choices:

• Food tray and utensils from client’s breakfast
• Water pitcher on client’s bedside table
• Client’s urine in the bedside commode
• Client’s bed linens after use

Correct Answer: Client’s urine in the bedside commode

Explanation: Chemotherapeutic agents and toxic metabolites are excreted in bodily fluids (urine, stool, vomit) for 48 to 72 hours post-administration, requiring hazardous drug body fluid disposal procedures (double-gloving, PPE, yellow biohazard waste containers).

Incorrect Answers and Explanations:

• Food tray / Water pitcher / Linens: Standard precautions are used unless directly contaminated with cytotoxic bodily fluids.

Question: 35 of 100

Question Text: A nurse is caring for a client following a bronchoscopy. Which of the following actions should the nurse take first?

Choices:

• Provide the client with sips of water.
• Inform the client they might experience a low-grade fever.
• Check the client’s gag reflex.
• Instruct the client to report bleeding.

Correct Answer: Check the client’s gag reflex.

Explanation: Topical anesthetics used to numb the pharynx during bronchoscopy suppress the gag reflex. Assessing the return of the gag reflex prior to oral intake is the priority intervention to prevent airway aspiration.

Incorrect Answers and Explanations:

• Provide sips of water: Must not be offered until the gag reflex is verified intact.
• Inform about low-grade fever / Instruct to report bleeding: Important educational components, but physiological safety (airway protection) takes precedence.

Question: 36 of 100

Exhibits:

Exhibit 1: History and Physical 1000: Client reports after eating breakfast this morning at 0630 that they began feeling tightness in chest that radiates to left arm. History: Hyperlipidemia, hypertension, type 2 diabetes mellitus. Non-smoker. Denies use of alcohol or recreational drug use.

Exhibit 2: Nurses’ Notes 1000: Client reports tightness in chest that radiates to left arm. States pain as 7 on a scale of 0 to 10. Started to feel nauseous after breakfast. Client states, “I had scrambled eggs and bacon like I do every morning.” Client is diaphoretic and short of breath. Heart rate irregular and tachycardic. Alert and oriented to person, place, and time. Lungs clear to auscultation in all lobes. Bowel sounds present in all 4 quadrants. +1 pedal pulses. Skin cool to touch. Capillary refill less than 2 seconds.

Exhibit 3: Vital Signs 1000: Temperature: 37.1 C (98.8 F) Heart rate: 110/min and irregular Respiratory rate: 24/min Blood pressure: 164/80 mm Hg Oxygen saturation: 93% on room air

Exhibit 4: Diagnostic Results 1000: Myoglobin: 100 mcg/L (< 90 mcg/L) Creatine kinase: 180 units/L (55 to 170 units/L) Troponin T: 0.40 ng/mL (< 0.1 ng/mL) Troponin I: 0.35 ng/mL (< 0.03 ng/mL) 12-lead ECG: Tachycardia with ST segment elevation and T wave changes.

Question Text: A nurse is admitting a client who reports tightness in their chest that radiates to left arm. The nurse is reviewing the client’s medical record. Select the four findings that require immediate follow-up.

Choices:

• Blood glucose level
• Bowel sounds
• Blood pressure
• Pain level
• Electrocardiogram findings
• Lung sounds
• Troponin T level

Correct Answer:

• Blood pressure
• Pain level
• Electrocardiogram findings
• Troponin T level

Explanation: Elevated blood pressure (164/80 mm Hg), severe acute chest pain (7/10), ST-segment elevation on ECG, and elevated cardiac biomarkers (Troponin T 0.40 ng/mL) indicate acute myocardial infarction, requiring immediate emergency cardiac intervention.

Incorrect Answers and Explanations:

• Blood glucose level (103 mg/dL) / Bowel sounds / Lung sounds: Findings are normal or within non-emergent limits.

Question: 37 of 100

Exhibits: Same clinical scenario as Question 36 (Chest tightness radiating to left arm, diaphoretic, HR 110/min, BP 164/80 mm Hg, ST elevation, elevated Troponin).

Question Text: A nurse is admitting a client who reports tightness in their chest that radiates to left arm. Click to highlight the findings below that would indicate that the client has a potential problem.

Text Options to Highlight:

• Pain as 7 on a scale of 0 to 10
• Diaphoretic and short of breath
• Heart rate irregular and tachycardic
• Blood pressure 164/80 mm Hg
• Oxygen saturation 93% on room air
• Troponin T 0.40 ng/mL
• Electrocardiogram: tachycardia with ST segment elevation and T wave changes

Correct Answer:

• Pain as 7 on a scale of 0 to 10
• Diaphoretic and short of breath
• Heart rate irregular and tachycardic
• Blood pressure 164/80 mm Hg
• Oxygen saturation 93% on room air
• Troponin T 0.40 ng/mL
• Electrocardiogram: tachycardia with ST segment elevation and T wave changes

Explanation: These highlighted findings collectively establish acute coronary syndrome / ST-elevation myocardial infarction (STEMI) with hemodynamic distress.

Question: 38 of 100

Exhibits: Same clinical scenario as Question 36 & 37 (Acute Myocardial Infarction).

Question Text: A nurse is admitting a client who reports tightness in their chest that radiates to left arm. Complete the following sentence by using the lists of options.

Template: The nurse should first address the client’s [First Choice] followed by the client’s [Second Choice].

Choices (First Dropdown):

• Pain level
• Diaphoresis
• Nausea

Choices (Second Dropdown):

• Cholesterol level
• Pedal pulses
• ECG results

Correct Answer: The nurse should first address the client’s Pain level followed by the client’s ECG results.

Explanation: Ischemic chest pain increases myocardial oxygen demand and sympathetic stress. Treating pain reduces cardiac workload. Addressing ST-elevation on ECG results guides urgent revascularization therapy.

Question: 39 of 100

Exhibits: Same clinical scenario as Question 36–38 (Acute STEMI).

Question Text: The nurse is reviewing the client’s medical record. For each potential provider’s prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.

Table Options:

1. Metoprolol 5 mg IV every 2 to 3 min up to three doses
2. Oxygen at 2 L/min via nasal cannula
3. Morphine 6 mg IV bolus every 3 hr as needed for pain
4. Nitroglycerin 0.4 mg SL now, may repeat every 5 min up to 3 doses
5. Obtain daily weight
6. Atropine 0.5 mg IV bolus every 5 min up to 2 mg

Correct Answer:

• Metoprolol 5 mg IV: Anticipated
• Oxygen at 2 L/min nasal cannula: Anticipated
• Morphine 6 mg IV bolus: Anticipated
• Nitroglycerin 0.4 mg SL: Anticipated
• Obtain daily weight: Nonessential
• Atropine 0.5 mg IV bolus: Contraindicated

Explanation: MONA/beta-blocker protocols (Nitroglycerin, Morphine, Oxygen, Metoprolol) are standard emergency interventions for acute STEMI. Atropine is indicated for symptomatic bradycardia, not tachycardia (HR 110/min). Daily weights are nonessential during acute STEMI resuscitation.

Question: 40 of 100

Exhibits: Same clinical scenario as Question 36–39 (Acute STEMI).

Question Text: A nurse is reviewing the client’s diagnostic results and vital signs. Which of the following actions should the nurse take? (Select all that apply.)RN Medical Surgical 2026

Choices:

• Anticipate the client to be prepped for cardiac catheterization
• Assist with a continuous heparin infusion
• Encourage the client to ambulate
• Anticipate an increased dosage of metoprolol
• Obtain a prescription for the client to be NPO
• Request a prescription for an antibiotic

Correct Answer:

• Anticipate the client to be prepped for cardiac catheterization
• Assist with a continuous heparin infusion
• Obtain a prescription for the client to be NPO

Explanation: Emergency percutaneous coronary intervention (PCI / cardiac catheterization) is the gold standard for acute STEMI within 90 minutes. Heparin anticoagulation prevents thrombus propagation. Keeping the client NPO is required prior to invasive sedation and cardiac catheterization procedures.

Incorrect Answers and Explanations:

• Encourage ambulation: Strictly contraindicated; physical exertion increases myocardial infarction size and oxygen demand.
• Increase metoprolol dosage / Request antibiotic: Unwarranted for acute ischemia without specific bacterial infection.

Question: 41 of 100

Exhibits: Same clinical scenario at 1200 follow-up: Pain decreased from 7 to 5/10. Breathing easier. HR 100/min. BP 110/62 mm Hg. Oxygen saturation 97% on 2 L/min NC.

Question Text: The nurse is reviewing the client’s medical record. Which of the following findings indicates the client’s condition has improved? (Select all that apply.)

Choices:

• Heart rate
• Respiratory rate
• Blood pressure
• Pain level
• Oxygenation saturation
• Urinary output
• Echocardiogram results

Correct Answer:

• Heart rate
• Respiratory rate
• Blood pressure
• Pain level
• Oxygenation saturation

Explanation: Reduction in heart rate (from 110 to 100/min), blood pressure normalization (from 164/80 to 110/62 mm Hg), decreased respiratory rate (from 24 to 22/min), pain score reduction (from 7 to 5/10), and increased oxygen saturation (from 93% to 97%) reflect therapeutic response to oxygen, nitrates, and analgesics.

Incorrect Answers and Explanations:

• Echocardiogram results: Confirmed myocardial infarction, showing structural damage (not clinical improvement).

Question: 42 of 100

Question Text: A nurse is planning discharge teaching for a client who has heart failure. Which of the following instructions should the nurse include in the teaching?

Choices:

• Weigh yourself once per week.
• Increase fluid intake to 3 L per day.
• Report a weight gain of 0.9 kg (2 lb) in 1 day.
• Restrict sodium intake to 5 g per day.

Correct Answer: Report a weight gain of 0.9 kg (2 lb) in 1 day.

Explanation: A sudden weight gain of 2 lb (0.9 kg) in 24 hours or 3 to 5 lb in a week indicates acute fluid retention and worsening heart failure, requiring prompt notification of the healthcare provider.

Incorrect Answers and Explanations:

• Weigh once per week: Heart failure clients must weigh themselves daily in the morning after voiding.
• Increase fluid intake to 3 L/day: Heart failure management requires fluid restriction (typically 1.5 to 2 L/day).
• Restrict sodium to 5 g/day: Sodium is restricted to 2 g (2,000 mg) per day.

Question: 43 of 100

Question Text: A nurse in the PACU is caring for a client. Which of the following assessments is the nurse’s priority?

Choices:

• Pain level
• Respiratory status
• Surgical site
• Level of consciousness

Correct Answer: Respiratory status

Explanation: Applying the ABC (Airway, Breathing, Circulation) priority framework, evaluating airway patency and respiratory status is the paramount nursing priority in the post-anesthesia care unit (PACU).

Incorrect Answers and Explanations:

• Pain level / Surgical site / Level of consciousness: Essential secondary assessment parameters evaluated after establishing airway and ventilation.

Question: 44 of 100

Question Text: A charge nurse is leading an in-service about infection control guidelines. Which of the following statements made by a staff member indicates an understanding of the teaching?

Choices:

• “I will wear a surgical mask when feeding a client who has measles.”
• “I will wear eye goggles when caring for a client with group A streptococcus.”
• “I will wear an isolation gown when bathing a client who has scabies.”
• “I will wear clean gloves when inserting an indwelling urinary catheter.”

Correct Answer: “I will wear an isolation gown when bathing a client who has scabies.”

Explanation: Scabies is transmitted via direct skin-to-skin contact, requiring contact precautions, including wearing a clean gown and gloves for close personal care activities.

Incorrect Answers and Explanations:

• Surgical mask for measles: Measles requires airborne precautions (N95 respirator and negative-pressure room).
• Clean gloves for urinary catheter: Indwelling urinary catheter insertion requires strict surgical aseptic (sterile) technique and sterile gloves.

Question: 45 of 100

Question Text: A nurse is caring for a client who has a history of chemotherapy-induced nausea and vomiting. Which of the following medications should the nurse administer prior to chemotherapy?

Choices:

• Methylprednisolone
• Sertraline
• Diphenhydramine
• Ondansetron

Correct Answer: Ondansetron

Explanation: Ondansetron is a 5-HT3 receptor antagonist specifically indicated for the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV). It is most effective when administered prophylactically prior to chemotherapy.

Incorrect Answers and Explanations:

• Sertraline: Selective serotonin reuptake inhibitor (SSRI) used for depression and anxiety.
• Diphenhydramine: Antihistamine used for allergic reactions and sedating properties.
• Methylprednisolone: Corticosteroid used as an adjunct antiemetic, but 5-HT3 antagonists (ondansetron) are primary first-line agents.

Question: 46 of 100

Question Text: A nurse is teaching a client who has HIV about infection prevention. The nurse should instruct the client to avoid contact with which of the following items?

Choices:

• Scrambled eggs
• Soiled cat litter
• Electric razor
• Pasteurized milk

Correct Answer: Soiled cat litter

Explanation: Cat litter contains Toxoplasma gondii, a parasite that causes toxoplasmosis in immunocompromised individuals. Immunocompromised clients with HIV should avoid changing cat litter.

Incorrect Answers and Explanations:

• Scrambled eggs / Pasteurized milk: Fully cooked eggs and pasteurized dairy products are safe and recommended.
• Electric razor: Electric razors are recommended over safety razors to prevent skin cuts and bleeding.

Question: 47 of 100

Question Text: A nurse is planning care for a client who had a stroke and has dysphagia. Which of the following actions should the nurse take to prevent the client from aspirating?

Choices:

• Encourage the client to eat raw fruit.
• Tell the client to dry swallow after each bite.
• Allow 10 min for the client to eat meals.
• Instruct the client to tilt their head back while swallowing.

Correct Answer: Tell the client to dry swallow after each bite.

Explanation: Instructing the client to dry swallow (swallowing a second time without taking more food) clears pharyngeal residue from the epiglottic valleculae, decreasing aspiration risk.

Incorrect Answers and Explanations:

• Eat raw fruit: Raw, hard fruits require extensive chewing and pose an aspiration risk; soft/thickened foods are preferred.
• Allow 10 min for meals: Unhurried meal times (allowing at least 30 to 45 minutes) prevent rushed swallowing.
• Tilt head back: Tilting the head back opens the airway; the chin-down/chin-tuck position closes the larynx and protects the airway.

Question: 48 of 100

Question Text: A nurse is caring for a client who has just returned from surgery with an external fixator to the left tibia. Which of the following assessment findings requires immediate intervention by the nurse?

Choices:

• The client has an oral temperature of 38.3 C (100.9 F).
• The client reports a pain level of 7 on a scale from 0 to 10 at the operative site.
• The client has 20 mL blood in the closed-suction drain.
• The client’s capillary refill in the left toe is 6 seconds.

Correct Answer: The client’s capillary refill in the left toe is 6 seconds.

Explanation: A capillary refill greater than 3 seconds in the distal extremity indicates neurovascular impairment and severe arterial compromise, suggestive of compartment syndrome or tight bandaging, requiring immediate intervention.

Incorrect Answers and Explanations:

• Temperature 38.3 C: Low-grade fever is common in the immediate postoperative period due to surgical trauma and atelectasis.
• Pain 7/10: Expected postoperative finding requiring analgesic management, but circulatory compromise (capillary refill 6s) takes priority.
• 20 mL drainage: Expected low-volume sanguinous drain output post-orthopedic surgery.

Question: 49 of 100

Question Text: A nurse is educating a client who has HIV about health care practices to prevent secondary infections. Which of the following statements made by the client indicates an understanding of the teaching? (Select all that apply.)

Choices:

• “I will work in the garden to get exercise.”
• “I will avoid crowded areas during flu season.”
• “I will check my temperature once a week.”
• “I will perform perineal care twice a day with antimicrobial soap.”
• “I will fully cook pork products before eating them.”

Correct Answer:

• “I will avoid crowded areas during flu season.”
• “I will fully cook pork products before eating them.”

Explanation: Avoiding crowded public settings decreases exposure to airborne viral pathogens. Thoroughly cooking meat (pork/poultry/beef) to safe internal temperatures prevents foodborne bacterial and parasitic infections (e.g., Salmonella, Toxoplasma).

Incorrect Answers and Explanations:

• Gardening: Soil exposure poses a high risk for fungal pathogens (e.g., Cryptococcus, Aspergillus) and bacterial infection; gardening should be avoided or performed with gloves/masks.
• Check temperature once a week: Immunocompromised clients should monitor their temperature daily to detect early opportunistic infection.

Question: 50 of 100

Question Text: A nurse is teaching discharge instructions to a client who has a right above-the-knee amputation. Which of the following information should the nurse include to prevent complications?

Choices:

• “Place a pillow between your legs.”
• “Use a soft mattress at home.”
• “Keep your leg at a 30 degree elevation while in bed.”
• “Lie on your abdomen every 3 to 4 hours for 30 minutes.”

Correct Answer: “Lie on your abdomen every 3 to 4 hours for 30 minutes.”

Explanation: Placing the client in the prone position for 20 to 30 minutes every 3 to 4 hours stretches the hip flexor muscles and prevents hip flexion contractures following an above-the-knee amputation.

Incorrect Answers and Explanations:

• Pillow under residual limb / 30 degree elevation: Prolonged elevation of the residual limb beyond the first 24 hours causes hip flexion contractures.
• Soft mattress: A firm mattress is required to maintain proper trunk alignment and hip extension.

Question: 51 of 100

Question Text: A nurse is caring for a client following a cardiac catheterization who has hives and urticaria following administration of IV contrast dye. Which of the following medications should the nurse plan to administer?

Choices:

• Diphenhydramine
• Desmopressin
• Spironolactone
• Metoclopramide

Correct Answer: Diphenhydramine

Explanation: Urticaria (hives) and pruritus following IV contrast administration represent a mild allergic hypersensitivity reaction. Diphenhydramine (an H1-receptor antagonist) blocks histamine release and relieves systemic allergic symptoms. RN Medical Surgical 2026

Incorrect Answers and Explanations:

• Desmopressin: Antidiuretic hormone analogue used for diabetes insipidus or von Willebrand disease.
• Spironolactone: Potassium-sparing diuretic.
• Metoclopramide: Antiemetic and prokinetic agent.

Question: 52 of 100

Exhibits:

Exhibit 1: History and Physical 1000: Client reports generalized weakness and increased fatigue over the past few months. Client states they become short of breath after climbing a flight of stairs. History of rheumatoid arthritis, takes naproxen 500 mg BID. Follows a vegan diet. Mucous membranes are pale. Apical pulse rapid, regular.

Exhibit 2: Diagnostic Results 1000: Hct: 24% (37% to 47%) Hgb: 8 g/dL (12 to 16 g/dL) RBC count: 3 x 10^6/mcL (4.2 to 5.4 x 10^6/mcL) Ferritin: 8 ng/mL (10 to 150 ng/mL) WBC count: 9,000/mm³ (5,000 to 10,000/mm³) Platelets: 180,000/mm³ (150,000 to 400,000/mm³) Vitamin B12: 159 pg/mL (160 to 950 pg/mL)

Exhibit 3: Graphic Record 1000: Temperature: 37 C (98.6 F) BP supine: 132/60 mm Hg BP sitting: 118/60 mm Hg BP standing: 102/50 mm Hg Heart rate: 108/min Respiratory rate: 24/min Oxygen saturation: 94% on room air

Question Text: A nurse in a provider’s office is caring for a client. Which of the following findings require follow-up? (Select all that apply.)

Choices:

• Oxygen saturation
• Blood pressure
• Pain level
• Temperature
• Activity level
• Breath sounds
• Hematocrit

Correct Answer:

• Oxygen saturation
• Blood pressure
• Activity level
• Hematocrit

Explanation: Oxygen saturation (94%), orthostatic blood pressure drop (132/60 to 102/50 mm Hg), decreased activity tolerance (shortness of breath on stairs), and severely decreased hematocrit (24%) require immediate follow-up and intervention.

Incorrect Answers and Explanations:

• Pain level (0/10) / Temperature (37 C) / Breath sounds (clear): Normal findings requiring no immediate medical intervention.

Question: 53 of 100

Exhibits: Same clinical scenario as Question 52 (Low B12, Low Ferritin, Orthostatic BP changes, Fatigue).

Question Text: For each client’s finding, click to specify if the assessment finding is consistent with sickle cell disease, iron deficiency anemia, or pernicious anemia.

Table Options:

1. Vitamin B12 level
2. Orthostatic hypotension
3. Fatigue
4. Ferritin level

Correct Answer:

• Vitamin B12 level: Pernicious Anemia
• Orthostatic hypotension: Iron Deficiency Anemia, Pernicious Anemia, Sickle Cell Disease
• Fatigue: Iron Deficiency Anemia, Pernicious Anemia, Sickle Cell Disease
• Ferritin level: Iron Deficiency Anemia

Explanation: Low B12 (< 160 pg/mL) is specific to pernicious/macrocytic anemia. Low ferritin (< 10 ng/mL) is specific to iron deficiency anemia. Generalized fatigue and orthostatic hypotension result from reduced oxygen-carrying capacity common to all chronic severe anemias.

Question: 54 of 100

Exhibits: Same clinical scenario as Question 52 & 53.

Question Text: Complete the following sentence by using the lists of options.

Template: The first action the nurse should take is [First Choice] followed by [Second Choice].

Choices (First Dropdown):

• Educate the client about nutritional supplements
• Instruct the client to rise slowly from a sitting position
• Apply supplemental oxygen by nasal cannula

Choices (Second Dropdown):

• Perform a nutritional evaluation on the client
• Evaluate a stool sample for occult blood
• Assist client in balancing activity with rest

Correct Answer: The first action the nurse should take is Instruct the client to rise slowly from a sitting position followed by Evaluate a stool sample for occult blood.

Explanation: Safety and injury prevention take priority: instructing the orthostatic client to change positions slowly prevents falls and syncopal episodes. Next, evaluating stool for occult blood identifies potential GI blood loss associated with long-term NSAID (naproxen) use causing iron deficiency anemia.

Question: 55 of 100

Exhibits: Same clinical scenario as Question 52–54.

Question Text: For each potential provider’s prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.

Table Options:

1. Place the client on a low sodium diet
2. Refer for a nutritional consult
3. Administer an iron supplement
4. Restrict fluid intake

Correct Answer:

• Low sodium diet: Nonessential
• Nutritional consult: Anticipated
• Administer an iron supplement: Anticipated
• Restrict fluid intake: Contraindicated

Explanation: Iron supplementation and nutritional consult address severe iron deficiency and vegan dietary gaps. Restricting fluids is contraindicated as adequate hydration maintains intravascular volume in orthostatic hypotension.

Question: 56 of 100

Exhibits: Provider Order: Ferrous sulfate 325 mg PO every other day. Stool occult blood negative.

Question Text: The nurse is caring for the client who has iron deficiency anemia. Which of the following instructions should the nurse include? (Select all that apply.)

Choices:

• Take the medication with a source of vitamin C
• Increase sources of fiber in the diet
• Increase intake of milk and dairy products
• Take an antacid within 30 min after medication administration
• Take the medication on an empty stomach

Correct Answer:

• Take the medication with a source of vitamin C
• Increase sources of fiber in the diet
• Take the medication on an empty stomach

Explanation: Ascorbic acid (Vitamin C) enhances intestinal iron absorption. Taking iron on an empty stomach (1 hour before or 2 hours after meals) maximizes bioavailability. Increasing dietary fiber prevents iron-induced constipation.

Incorrect Answers and Explanations:

• Increase milk and dairy: Calcium in dairy products binds iron and inhibits its GI absorption.
• Take antacid within 30 min: Antacids reduce gastric acidity, severely impairing iron dissolution and absorption.

Question: 57 of 100

Exhibits: Client receiving oral iron therapy education.

Question Text: Which of the following statements indicate the client understands the instructions? (Select the 3 statements that apply.)

Choices:

• “I should increase green leafy vegetables in my diet.”
• “The iron supplement might cause ringing in my ears.”
• “The iron supplement might cause my stools to be black.”
• “I should expect to have swelling in my feet.”
• “I will take my iron supplement 1 hour before a meal.”

Correct Answer:

• “I should increase green leafy vegetables in my diet.”
• “The iron supplement might cause my stools to be black.”
• “I will take my iron supplement 1 hour before a meal.”

Explanation: Dark green leafy vegetables provide non-heme dietary iron. Dark, tarry black stools are a harmless, expected outcome of oral iron therapy. Taking iron 1 hour prior to meals optimizes gastric absorption.

Incorrect Answers and Explanations:

• Ringing in ears (tinnitus) / Swelling in feet: Tinnitus is associated with ototoxicity or aspirin toxicity, and dependent edema is associated with heart failure, not oral iron supplements.

Question: 58 of 100

Question Text: A nurse is caring for a client who has been administered a prescribed opioid analgesic following a thoracotomy. Which of the following assessment findings should the nurse document as a therapeutic effect of the medication?

Choices:

• Bowel sounds present and active
• Pain “Tolerable at a 3 on a scale 0 to 10”
• Lung sounds clear bilaterally
• Alert and oriented x4

Correct Answer: Pain “Tolerable at a 3 on a scale 0 to 10”

Explanation: The primary therapeutic objective of opioid analgesics is effective pain reduction to an acceptable, tolerable level.

Incorrect Answers and Explanations:

• Bowel sounds active / Lung sounds clear / Alert x4: Baseline physiological parameters, but they do not measure analgesic efficacy.

Question: 59 of 100

Question Text: A nurse is caring for a client who is 3 hr postoperative following a total knee arthroplasty. Which of the following actions should the nurse take to prevent venous thromboembolism?

Choices:

• Limit the client’s fluid intake to 2,000 mL daily.
• Encourage the client to perform circumduction of the feet.
• Keep the client’s knees in a flexed position while they are in bed.
• Massage the client’s legs every 4 hr while they are awake.

Correct Answer: Encourage the client to perform circumduction of the feet.

Explanation: Active foot circumduction, ankle pumps, and plantar flexion engage the calf muscle pump, promoting venous return and preventing venous stasis and deep vein thrombosis post-joint replacement.

Incorrect Answers and Explanations:

• Limit fluids: Dehydration increases blood viscosity and VTE risk; adequate hydration is encouraged.
• Keep knees flexed: Prolonged knee flexion promotes venous stasis and joint flexion contractures.
• Massage legs: Deep tissue leg massage is contraindicated due to the risk of dislodging silent thrombi.

Question: 60 of 100

Question Text: A nurse is preparing to discharge a client who has COPD. The client states, “I don’t know how to get oxygen delivered to my home.” Which of the following resources should the nurse recommend for the client?

Choices:

• Rehabilitation program
• Respite care
• Case manager
• Palliative care

Correct Answer: Case manager

Explanation: Case managers coordinate interprofessional discharge needs, arrange durable medical equipment (DME), and ensure home oxygen supplies and insurance approvals are established prior to discharge.

Incorrect Answers and Explanations:

• Rehabilitation / Respite / Palliative care: These services provide physical conditioning, caregiver relief, or end-of-life symptom management, not durable medical equipment procurement.

Question: 61 of 100

Question Text: A nurse is assessing a client who has a gravity drain in place following an open cholecystectomy. Which of the following actions should the nurse take?

Choices:

• Secure the drain to the bed sheets below the level of the surgical site.
• Empty the drain reservoir when it is full.
• Compress the drainage bulb after emptying.
• Keep the drain pinned to the client’s gown below the waist level.

Correct Answer: Keep the drain pinned to the client’s gown below the waist level.

Explanation: Securing a gravity drain (e.g., Penrose or gravity bag) to the client’s clothing below the level of the wound prevents accidental dislodgement and ensures continuous gravity drainage.

Incorrect Answers and Explanations:

• Secure to bed sheets: Securing drains to bed linens creates a severe risk of tension and traumatic evulsion when the client moves or turns.
• Compress drainage bulb: Applies to closed suction devices (JP/Hemovac), not unsealed gravity drains.

Question: 62 of 100

Question Text: A nurse is caring for a client who is receiving 0.9% sodium chloride via IV infusion. The client has become dyspneic with a blood pressure of 140/100 mm Hg, a fluid intake of 960 mL, and an output of 300 mL in the past 12 hr. Which of the following actions should the nurse take?

Choices:

• Change infusion to lactated Ringer’s and maintain rate
• Administer prescribed corticosteroids
• Slow infusion rate and contact the provider
• Lower the head of the bed to semi-Fowler’s

Correct Answer: Slow infusion rate and contact the provider

Explanation: Dyspnea, elevated blood pressure, and positive fluid balance (intake 960 mL vs output 300 mL) indicate hypervolemia (fluid overload). The nurse must immediately slow the IV rate to a keep-vein-open rate and alert the provider.

Incorrect Answers and Explanations:

• Change to Lactated Ringer’s: Infusing additional IV fluids exacerbates circulatory overload.
• Lower head of bed: Lowering the head worsens pulmonary congestion; the client should be placed in High-Fowler’s position.

Question: 63 of 100

Question Text: A nurse is caring for a client who is experiencing a sickle cell crisis. During morning care, the assistive personnel alerts the nurse that the client is slurring their speech. Which of the following actions should the nurse take?

Choices:

• Administer flumazenil IV per facility policy to the client
• Assess the client’s bilateral hand grasp strength
• Check the client’s bedside glucose level
• Place a padded tongue blade at the client’s bedside

Correct Answer: Assess the client’s bilateral hand grasp strength

Explanation: Slurred speech in a client with sickle cell disease indicates an acute cerebrovascular accident (stroke) secondary to vaso-occlusion of cerebral vessels. A rapid, targeted neurological assessment (hand grasp strength, facial symmetry) is mandatory.

Incorrect Answers and Explanations:

• Administer flumazenil: Benzodiazepine reversal agent; inappropriate for acute neurological stroke symptoms.
• Place padded tongue blade: Inserting objects into a client’s mouth is strictly contraindicated during seizure management or stroke protocols.

Question: 64 of 100

Question Text: A nurse is caring for a client who has a peripherally inserted central catheter (PICC) line in the right upper arm. Which of the following actions should the nurse include in the plan of care?

Choices:

• Flush the catheter with a 3 mL barrel syringe
• Apply the blood pressure cuff below the insertion site
• Apply a splint to the client’s right arm
• Cover the catheter site with a semipermeable transparent dressing

Correct Answer: Cover the catheter site with a semipermeable transparent dressing

Explanation: A semipermeable transparent dressing maintains sterility, protects the site from external contamination, and permits continuous visual assessment of the PICC insertion site.

Incorrect Answers and Explanations:

• Flush with 3 mL syringe: Smaller syringe barrels create high injection pressure that can rupture PICC catheters; a 10 mL barrel syringe must always be used.
• BP cuff on arm: Blood pressure cuffs and tourniquets should never be applied to an arm with a PICC line due to the risk of vein thrombosis and catheter occlusion.

Question: 65 of 100

Question Text: A nurse is planning to administer desmopressin to a male client who has diabetes insipidus (DI). Which of the following lab results should the nurse recognize as a contraindication?

Choices:

• Sodium 135 mEq/L (135 to 145 mEq/L)
• WBC 3,400/mm³ (5,000 to 10,000/mm³)
• Creatinine 0.4 mg/dL (0.6 to 1.3 mg/dL)
• Hemoglobin 10 g/dL (14 to 18 g/dL)

Correct Answer: Sodium 135 mEq/L (135 to 145 mEq/L)

Explanation: Desmopressin is a synthetic vasopressin analogue that promotes water reabsorption. In clients with low-normal or low serum sodium levels, desmopressin can precipitate severe hyponatremia and water intoxication.

Incorrect Answers and Explanations:

• WBC / Creatinine / Hemoglobin levels listed: Do not represent primary clinical contraindications to vasopressin analog therapy compared to serum sodium/fluid overload risks.

Question: 66 of 100

Question Text: A nurse is caring for a client who is receiving palliative care and reports an increase in dyspnea. Which of the following actions should the nurse take?

Choices:

• Consult the provider about administering morphine.
• Provide oxygen via a face mask.
• Encourage the client to eat.
• Limit repositioning the client for comfort.

Correct Answer: Consult the provider about administering morphine.

Explanation: Sublingual or IV low-dose opioids (morphine) reduce brainstem sensitivity to hypoxia and hypercapnia, relieve air hunger, and effectively alleviate dyspnea in end-of-life palliative care.

Incorrect Answers and Explanations:

• Face mask oxygen: Tight face masks often increase anxiety and feelings of suffocation; low-flow nasal cannula or a bedside fan is preferred.
• Limit repositioning: Frequent repositioning promotes comfort and pulmonary drainage.

Question: 67 of 100

Question Text: A nurse is discussing treatment options with a client who is experiencing neuropathic pain. The client tells the nurse, “I don’t want to take pain medication because I don’t want to get addicted.” Which of the following responses should the nurse make?

Choices:

• “Your provider knows what is best to treat your pain.”
• “I can contact the provider to discuss other options for treatment.”
• “This medication has been proven effective in pain management.”
• “You are less likely to become addicted to this medication than to others.”

Correct Answer: “I can contact the provider to discuss other options for treatment.”

Explanation: Validating the client’s concerns and offering to collaborate with the provider regarding non-opioid or adjuvant therapies (e.g., gabapentin, pregabalin) respects autonomy while supporting effective pain management.

Incorrect Answers and Explanations:

• Provider knows best: Dismissive paternalistic statement that invalidates the client’s expressed concerns.

Question: 68 of 100

Question Text: A nurse is providing teaching about client rights to a client who is scheduled for a surgical procedure. Which of the following client statements indicates an understanding of the teaching?

Choices:

• “I can change my mind prior to the procedure.”
• “The nurse will discuss alternative treatments available.”
• “My partner must sign my surgical consent as well.”
• “The nurse will discuss the risks of my procedure.”

Correct Answer: “I can change my mind prior to the procedure.”

Explanation: Clients possess the legal right to give informed consent and retain the right to refuse treatment or withdraw consent at any time prior to the procedure.

Incorrect Answers and Explanations:

• Nurse discusses alternatives/risks: Explaining procedural risks, benefits, and alternative treatment options is the non-delegable legal responsibility of the surgeon/provider, not the nurse.

Question: 69 of 100

Question Text: A nurse is providing teaching for a client who has a new diagnosis of type 1 diabetes mellitus about sick-day rules. Which of the following information should the nurse include?

Choices:

• “Avoid liquids with sugar regardless of blood glucose level.”
• “Call your provider if you have a fever for more than 24 hours.”
• “Check your blood glucose four times a day.”
• “Reduce your regular dose of insulin until you feel better.”

Correct Answer: “Call your provider if you have a fever for more than 24 hours.”

Explanation: During illness, stress hormones elevate blood glucose levels. Persistent fever (> 24 hours), persistent nausea/vomiting, or inability to keep fluids down requires provider consultation to manage ketoacidosis risks.

Incorrect Answers and Explanations:

• Check blood glucose 4 times/day: Blood glucose must be checked more frequently (every 2 to 4 hours) during acute illness.
• Reduce insulin dose: Insulin must NEVER be stopped or arbitrarily reduced during illness, as infection drives insulin resistance and diabetic ketoacidosis (DKA).

Question: 70 of 100

Question Text: A nurse is developing a plan of care for a client who will be receiving radiation therapy with a sealed implant. Which of the following interventions should the nurse include in the plan?

Choices:

• Keep the door to the client’s room closed whenever possible.
• Remove linens from the client’s room immediately after changing the bed.
• Limit each visitor to 2 hr per day in the client’s room.
• Ask visitors to remain 0.9 m (3 feet) away from the client.

Correct Answer: Keep the door to the client’s room closed whenever possible.

Explanation: Clients with internal sealed radiation sources (brachytherapy) must be assigned to a private room with a lead-lined door kept closed to contain radiation exposure.

Incorrect Answers and Explanations:

• Limit visitors to 2 hr / 3 feet away: Visits are restricted to a maximum of 30 minutes per day at a minimum distance of 6 feet (1.8 meters).

Question: 71 of 100

Question Text: A nurse is caring for a client who has chemotherapy-induced neutropenia. Which of the following actions should the nurse take?

Choices:

• Clean the client’s oral mucosa with a glycerin swab.
• Administer ondansetron to the client every 8 hr for nausea.
• Obtain the client’s WBC count every 24 hr.
• Obtain the client’s temperature once a day.

Correct Answer: Obtain the client’s WBC count every 24 hr.

Explanation: Monitoring the daily complete blood count (CBC) with differential tracks the absolute neutrophil count (ANC) to evaluate infection risk and guide protective isolation measures.

Incorrect Answers and Explanations:

• Glycerin swabs: Avoided because alcohol/glycerin dries oral mucosa, predisposing to painful stomatitis and breakdown.
• Temperature once a day: Temperature should be monitored at least every 4 hours; a low-grade fever in a neutropenic client can signal life-threatening sepsis.

Question: 72 of 100

Question Text: A nurse is reviewing the medical history of a female client. Which of the following findings should the nurse identify as the highest risk factor for breast cancer?

Choices:

• Use of oral contraceptives
• Breast density
• Age of 67
• First child born after age 30

Correct Answer: Age of 67

Explanation: Advanced age (> 50 years) is the single non-modifiable primary risk factor for developing breast cancer.

Incorrect Answers and Explanations:

• Oral contraceptives / Nulliparity / Dense breasts: Recognized contributing risk factors, but advanced age remains the overall strongest statistical risk driver.

Question: 73 of 100

Question Text: A nurse is teaching a client who has type 2 diabetes mellitus about nutrition therapy. Which of the following client statements indicates an understanding of the teaching?

Choices:

• “I should eat about 25 grams of fiber per day.”
• “I will maintain my BMI of 35.”
• “I should use coconut oil for cooking.”
• “I will use honey instead of table sugar.”

Correct Answer: “I should eat about 25 grams of fiber per day.”

Explanation: A fiber intake of 25 to 30 grams daily improves glycemic control, promotes satiety, and lowers serum cholesterol levels.

Incorrect Answers and Explanations:

• BMI of 35: Class II obesity; weight management aims for a normal BMI (18.5–24.9 kg/m²).
• Coconut oil: High in saturated fats; unsaturated vegetable oils are recommended.
• Honey instead of sugar: Honey contains simple carbohydrates that cause rapid glycemic spikes, similar to table sugar.

Question: 74 of 100

Question Text: A nurse is reviewing the health history of a client who expresses concern about developing osteoporosis. Which of the following findings should the nurse identify as a risk factor?

Choices:

• Consuming four alcoholic beverages per day
• Taking a vitamin D supplement long term
• Family history of cardiovascular disease
• Being 9.1 kg (20 lb) over ideal weight

Correct Answer: Consuming four alcoholic beverages per day

Explanation: Chronic excessive alcohol intake (> 2 drinks/day) inhibits osteoblast activity, impairs intestinal calcium absorption, and increases bone resorption, significantly elevating osteoporosis risk.

Incorrect Answers and Explanations:

• Vitamin D supplementation: Prevents bone loss.
• Overweight status: Low body weight / thin frame (not obesity) increases risk for osteoporotic fractures.

Question: 75 of 100

Question Text: A nurse is caring for a client who has chronic obstructive pulmonary disease. Which of the following self-care management needs should the nurse include in the plan of care?

Choices:

• Instruct on use of diaphragmatic breathing.
• Perform daily peak flow meter assessments.
• Complete antibiotic as prescribed.
• Maintain and clean continuous airway positive pressure device. RN Medical Surgical 2026

Correct Answer: Instruct on use of diaphragmatic breathing.

Explanation: Diaphragmatic and pursed-lip breathing techniques reduce air trapping, lower respiratory rate, and increase alveolar ventilation efficiency in COPD clients.

Incorrect Answers and Explanations:

• Daily peak flow meters: Used primarily in asthma monitoring, not routine daily COPD care.

Question: 76 of 100

Question Text: A nurse is planning care for a client who has increased intracranial pressure following a head injury. Which of the following medications should the nurse plan to administer?

Choices:

• Hydrochlorothiazide
• Propranolol
• Nitroprusside
• Mannitol

Correct Answer: Mannitol

Explanation: Mannitol is an osmotic diuretic that draws free water from cerebral parenchymal tissue into the intravascular space, rapidly reducing cerebral edema and intracranial pressure (ICP).

Incorrect Answers and Explanations:

• Hydrochlorothiazide: Thiazide diuretic used for hypertension, not effective for cerebral edema.
• Nitroprusside: Vasodilator that can cause cerebral vasodilation and paradoxically increase ICP.

Question: 77 of 100

Question Text: A nurse is reviewing the health history of a client who is scheduled for exploratory surgery. Which of the following food allergies indicates a risk for an allergic reaction to latex?

Choices:

• Peanuts
• Strawberries
• Shellfish
• Avocados

Correct Answer: Avocados

Explanation: Clients with allergies to avocados, bananas, chestnuts, or kiwis have cross-reactive IgE antibodies to latex proteins (latex-fruit syndrome).

Incorrect Answers and Explanations:

• Shellfish: Cross-reacts with iodine/radiocontrast dye, not latex.

Question: 78 of 100

Question Text: A nurse is caring for a client who is scheduled for heart surgery. Prior to surgery the client states, “I’m not sure I want to go through with this procedure after all.” Which of the following actions should the nurse take?

Choices:

• Delay the procedure and enlist additional staff to persuade the client to have the procedure
• Terminate the conversation and state, “It’s too late to cancel the procedure.”
• Inform the client that this procedure is the only option they have for treatment.
• Reinforce and clarify the information provided by the surgeon with the client

Correct Answer: Reinforce and clarify the information provided by the surgeon with the client

Explanation: When a client expresses ambivalence regarding surgery, the nurse must advocate by exploring concerns, reinforcing provided surgical explanations, and notifying the surgeon if the client requires further clarification.

Incorrect Answers and Explanations:

• Persuade client / Terminate conversation: Coercive or dismissive actions violate patient autonomy and informed consent principles.

Question: 79 of 100

Question Text: A nurse is teaching a client about the use of a transcutaneous electrical nerve stimulation (TENS) unit. Which of the following statements should the nurse include in the teaching?

Choices:

• “This device delivers heat via electrodes that are attached to the affected area.”
• “This device requires access to a 220-volt outlet.”
• “Adjust the dial until you feel a pins-and-needles sensation.”
• “You can apply the electrodes directly over sensitive areas of skin.”

Correct Answer: “Adjust the dial until you feel a pins-and-needles sensation.”

Explanation: TENS units deliver low-voltage electrical currents via skin electrodes. The intensity dial is adjusted until a gentle tingling or “pins-and-needles” sensation is felt, stimulating A-beta nerve fibers to block pain signals.

Incorrect Answers and Explanations:

• Delivers heat: TENS delivers electrical impulses, not thermal heat.
• Apply over sensitive skin: Electrodes must never be placed over broken skin, open wounds, or carotid sinuses.

Question: 80 of 100

Question Text: A nurse is providing teaching for a client who will receive radiation therapy for breast cancer. Which of the following client statements indicates an understanding of the teaching?

Choices:

• “I will expose my radiation site to the sun for short periods of time.”
• “I will wear a soft shirt over my radiation site.”
• “I will rub body lotion to my radiation site when it becomes dry.”
• “I should scrub the skin at my radiation site with antibacterial soap and hot water.”

Correct Answer: “I will wear a soft shirt over my radiation site.”

Explanation: Soft, loose-fitting cotton clothing minimizes friction and mechanical irritation over irradiated skin areas.

Incorrect Answers and Explanations:

• Expose to sun: Irradiated skin must be protected from direct sunlight exposure.
• Body lotion / Scrub with hot water: Unapproved lotions and harsh scrubbing with hot water aggravate radiation dermatitis.

Question: 81 of 100

Question Text: A nurse is caring for a client who has left-sided heart failure. Which of the following findings should indicate to the nurse that the client is experiencing a decrease in cardiac output?

Choices:

• Distended abdomen
• Dyspnea
• Confusion
• Weight gain

Correct Answer: Confusion

Explanation: In severe left-sided heart failure, decreased forward cardiac output leads to inadequate cerebral perfusion, resulting in hypoxia, restlessness, and acute confusion.

Incorrect Answers and Explanations:

• Distended abdomen / Weight gain: Classic systemic venous congestion signs associated with right-sided heart failure.
• Dyspnea: Primary respiratory symptom of pulmonary venous congestion in left heart failure, but confusion directly reflects impaired organ perfusion from reduced cardiac output.

Question: 82 of 100

Question Text: A nurse is teaching a client who has left-sided weakness how to use a quad cane. Which of the following client actions indicates an understanding of the teaching?

Choices:

• The client advances the weaker leg forward to the cane
• The client holds the cane with their left hand
• The client moves the cane 2 feet ahead
• The client takes a step with their right foot first

Correct Answer: The client advances the weaker leg forward to the cane

Explanation: When using a cane, the client holds the cane on the stronger side (right hand). Sequence: Move cane forward -> Advance weaker leg (left) forward to the level of the cane -> Advance stronger leg (right) past the cane.

Incorrect Answers and Explanations:

• Hold cane with left hand: The cane must be held on the unaffected/stronger (right) side.
• Move cane 2 feet ahead: The cane should be advanced 6 to 10 inches (15 to 25 cm) per step to maintain balance.

Question: 83 of 100

Question Text: A nurse is administering a unit of packed RBCs to a client and notes that there are several small clots floating in the IV bag. Which of the following actions should the nurse take?

Choices:

• Return the unit of packed RBCs to the blood bank
• Dilute the unit of packed RBCs using 50 mL of lactated Ringer’s
• Inject 5,000 units of heparin into the unit of packed RBCs
• Place the unit of packed RBCs in a warming unit for 5 min

Correct Answer: Return the unit of packed RBCs to the blood bank

Explanation: Presence of clots or discoloration in a blood product indicates potential bacterial contamination or fibrin aggregation. The blood bag must be immediately returned to the blood bank for inspection.

Incorrect Answers and Explanations:

• Dilute with Lactated Ringer’s: Lactated Ringer’s contains calcium, which causes blood clotting in IV tubing; only 0.9% sodium chloride is compatible.
• Inject heparin: Medications must never be directly injected into blood bags.

Question: 84 of 100

Question Text: A nurse in an emergency department is preparing for the arrival of a client who has traumatic injuries following a motor vehicle crash. Which of the following actions should the nurse plan to perform first?

Choices:

• Ensure the client’s neck is in a neutral in-line position
• Use scissors to cut away the client’s clothing
• Cover the client with a warm blanket
• Insert an indwelling urinary catheter

Correct Answer: Ensure the client’s neck is in a neutral in-line position

Explanation: Applying trauma primary survey principles (Airway with C-spine protection), stabilizing the cervical spine in a neutral in-line position takes absolute priority to prevent spinal cord injury during airway management.

Incorrect Answers and Explanations:

• Cut clothing / Warm blanket / Urinary catheter: Performed during the exposure and secondary assessment phases after securing the airway and C-spine.

Question: 85 of 100

Question Text: A nurse is reviewing the medical record of a client who has acute gout. The nurse should expect an increase in which of the following laboratory results?

Choices:

• Uric acid
• Chloride level
• Creatine kinase
• Intrinsic factor

Correct Answer: Uric acid

Explanation: Gout is a painful inflammatory arthritis caused by hyperuricemia (elevated serum uric acid levels > 6.5 mg/dL), leading to urate crystal deposition in peripheral joints.

Incorrect Answers and Explanations:

• Chloride / Creatine kinase / Intrinsic factor: Unrelated to purine metabolism or gout pathogenesis.

Question: 86 of 100

Question Text: A nurse suspects that a client who has diabetes mellitus is experiencing hypoglycemia. Which of the following assessment findings supports this suspicion?

Choices:

• Cool, clammy skin
• Kussmaul respirations
• Acetone breath
• Increased urine output

Correct Answer: Cool, clammy skin

Explanation: Hypoglycemia triggers a sympathetic nervous system adrenaline response, causing diaphoretic, cool, clammy skin, tachycardia, tremors, and anxiety (“cold and clammy, need some candy”).

Incorrect Answers and Explanations:

• Kussmaul respirations / Acetone breath / Increased urine output: Classic manifestations of severe hyperglycemia and Diabetic Ketoacidosis (DKA).

Question: 87 of 100

Question Text: A nurse is preparing to perform an ocular irrigation for a client who received a chemical splash in the eye. Which of the following actions should the nurse plan to take?

Choices:

• Continue irrigation until the tonometry reading is greater than 21 mm Hg
• Use 0.9% sodium chloride solution to wash out the irritant
• Direct the flow of the solution from the outer corner to the nasal corner of the eye
• Place the client in a lateral position

Correct Answer: Use 0.9% sodium chloride solution to wash out the irritant

Explanation: Immediate flush with sterile 0.9% sodium chloride or sterile water removes chemical irritants and normalizes ocular pH.

Incorrect Answers and Explanations:

• Direct flow outer to inner: Solution must be directed from the inner canthus (nasal) to the outer canthus to prevent washing chemicals into the unaffected lacrimal duct/eye.

Question: 88 of 100

Question Text: A nurse is caring for a client who was transported to the emergency department with a temperature of 38.9 C (102 F), heart rate 110/min, respiratory rate 26/min, blood pressure 100/60 mm Hg, and who is confused. Which of the following actions should be the nurse’s priority?

Choices:

• Administer vasopressors
• Administer broad-spectrum antibiotics
• Rapid infusion of lactated Ringer’s
• Obtain blood cultures

Correct Answer: Obtain blood cultures

Explanation: Per Sepsis Six protocols, blood cultures from two separate sites must be drawn BEFORE initiating broad-spectrum antimicrobial therapy to ensure accurate pathogen identification.

Incorrect Answers and Explanations:

• Administer antibiotics: Administered immediately after blood cultures are drawn.
• Rapid fluids: Infused concurrently, but blood cultures must precede antimicrobial administration.

Question: 89 of 100

Question Text: A nurse is providing teaching to a client who is to start furosemide therapy for heart failure. Which of the following statements indicates that the client understands a potential adverse effect of this medication?

Choices:

• “I will try to limit foods that contain salt.”
• “I’m going to include more cantaloupe in my diet.”
• “I’ll check my blood pressure so it doesn’t get too high.”
• “I will check my pulse before I take the medication.”

Correct Answer: “I’m going to include more cantaloupe in my diet.”

Explanation: Furosemide is a potassium-wasting loop diuretic. Increasing intake of potassium-rich foods (cantaloupe, bananas, spinach, potatoes) offsets urinary potassium loss and prevents hypokalemia.

Incorrect Answers and Explanations:

• Check pulse / BP too high: Furosemide lowers blood pressure (risk of hypotension, not hypertension) and does not directly affect heart rate like digoxin or beta-blockers.

Question: 90 of 100

Question Text: A nurse is providing teaching to a client who is about to begin using a PCA pump to deliver morphine for postoperative pain management. Which of the following statements by the client indicates an understanding of the teaching?

Choices:

• “Each time I push the button, I receive the same amount as a morphine injection.”
• “My family can push the button for me on a regular basis.”
• “It will take about 30 minutes to feel relief after I push the button.”
• “The lockout interval prevents me from receiving too much medication.”

Correct Answer: “The lockout interval prevents me from receiving too much medication.”

Explanation: Patient-Controlled Analgesia (PCA) pumps feature programmed lockout intervals (e.g., 6 to 10 minutes) that prevent accidental overdose by blocking medication delivery until the preset delay time has elapsed.

Incorrect Answers and Explanations:

• Family can push button: PCA by proxy is strictly prohibited due to fatal respiratory depression risks; ONLY the client may press the button.

Question: 91 of 100

Question Text: A nurse is caring for a client following the placement of a chest tube drainage system for a pneumothorax. Which of the following findings should the nurse expect?

Choices:

• Diminished breath sounds in the lung bases
• Tidaling in the water seal chamber with respirations
• Movement of the trachea toward the unaffected side
• Serous drainage noted in the collection chamber

Correct Answer: Tidaling in the water seal chamber with respirations

Explanation: Tidaling (upward movement during inspiration and downward movement during expiration) in the water seal chamber reflects normal intrapleural pressure fluctuations during respiration and indicates a patent chest tube system.

Incorrect Answers and Explanations:

• Tracheal movement to unaffected side: Indicates a life-threatening tension pneumothorax complication, requiring urgent decompression.

Question: 92 of 100

Question Text: A nurse on a telemetry unit is interpreting a client’s ECG rhythm strip. The tracing shows an occasional wide QRS complex with absent P-R interval and lack of a P wave. The nurse should identify this finding as which of the following dysrhythmias?

Choices:

• Atrial fibrillation
• Junctional tachycardia
• Premature ventricular complexes
• First-degree atrioventricular block

Correct Answer: Premature ventricular complexes

Explanation: Premature Ventricular Complexes (PVCs) originate in ectopic ventricular foci, producing characteristically wide, bizarre QRS complexes (> 0.12 seconds) without preceding P waves or PR intervals.

Incorrect Answers and Explanations:

• Atrial fibrillation: Irregularly irregular rhythm with absent P waves and narrow QRS complexes.
• First-degree AV block: Prolonged PR interval (> 0.20 seconds) with normal QRS complexes.

Question: 93 of 100

Question Text: A nurse is caring for a client who has acute angina. Which of the following actions should the nurse take first?

Choices:

• Administer aspirin.
• Administer nitroglycerin.
• Measure blood pressure.
• Initiate IV access.

Correct Answer: Measure blood pressure.

Explanation: Nitroglycerin is a potent vasodilator. Assessing baseline blood pressure prior to administration is essential because sublingual nitrates are contraindicated if systolic blood pressure is below 90 mm Hg.

Incorrect Answers and Explanations:

• Administer nitroglycerin: Performed immediately after confirming blood pressure is adequate.

Question: 94 of 100

Question Text: A nurse is evaluating a client who is experiencing meningitis and receiving mannitol IV. Which of the following findings indicates the client is responding to treatment?

Choices:

• Urinary output decreased from 60 mL/hr to 25 mL/hr
• Mean arterial blood pressure decreased from 80 mm Hg to 70 mm Hg
• Respiratory rate decreased from 24/min to 10/min
• Intracranial pressure (ICP) decreased from 18 mm Hg to 10 mm Hg

Correct Answer: Intracranial pressure (ICP) decreased from 18 mm Hg to 10 mm Hg

Explanation: Mannitol is an osmotic diuretic administered to reduce elevated intracranial pressure. Normal ICP is 5 to 15 mm Hg. A drop from 18 mm Hg to 10 mm Hg confirms therapeutic response.

Incorrect Answers and Explanations:

• Urine output decreased / BP decreased: Mannitol causes osmotic diuresis (increasing urine output).

Question: 95 of 100

Question Text: A nurse is caring for a client who is receiving peritoneal dialysis and notes a decrease in the dialysate flow rate. Which of the following actions should the nurse take? (Select all that apply.)

Choices:

• Raise the drainage bag above the level of the client’s abdomen.
• Elevate the client to the High-Fowler’s position.
• Measure the amount of the dialysate outflow.
• Check the access site for drainage.
• Reposition the client onto the other side.

Correct Answer:

• Check the access site for drainage.
• Reposition the client onto the other side.

Explanation: Fibrin clots or catheter kinking against the peritoneal wall impair drainage. Repositioning the client to their side or assisting with ambulation shifts abdominal contents and restores gravity outflow. Checking the catheter insertion site for leaks or obstruction is a standard nursing procedure.

Incorrect Answers and Explanations:

• Raise drainage bag above abdomen: The drainage bag must always remain below the level of the abdomen to enable gravity outflow.

Question: 96 of 100

Question Text: A nurse enters a client’s room and observes the client having a tonic-clonic seizure. Which of the following actions should the nurse take first?

Choices:

• Perform a neurologic check
• Notify the rapid response team
• Obtain the client’s vital signs
• Turn the client on their side

Correct Answer: Turn the client on their side

Explanation: During a generalized tonic-clonic seizure, positioning the client in a side-lying (lateral) posture maintains airway patency and allows oral secretions to drain, preventing aspiration.

Incorrect Answers and Explanations:

• Neurologic check / Vital signs: Performed in the postictal phase after securing safety and airway patency.

Question: 97 of 100

Question Text: A nurse is caring for a client who is taking propranolol for migraines. For which of the following adverse effects should the nurse monitor? (Select all that apply.)

Choices:

• Fatigue
• Tachycardia
• Dizziness
• Shortness of breathRN Medical Surgical 2026
• Hypertension

Correct Answer:

• Fatigue
• Dizziness
• Shortness of breath

Explanation: Propranolol is a non-selective beta-adrenergic blocker. Beta-1 blockade causes bradycardia, hypotension, dizziness, and fatigue. Beta-2 blockade causes bronchospasm and shortness of breath (especially in clients with underlying asthma/COPD).

Incorrect Answers and Explanations:

• Tachycardia / Hypertension: Propranolol causes bradycardia and hypotension.

Question: 98 of 100

Question Text: A nurse is assessing a client who is receiving morphine for pain and has a respiratory rate of 8/min and a blood pressure of 80/40 mm Hg. Which of the following medications should the nurse administer?

Choices:

• Naloxone
• Protamine sulfate
• Flumazenil
• Acetylcysteine

Correct Answer: Naloxone

Explanation: Naloxone is a pure opioid antagonist that rapidly reverses opioid-induced severe respiratory depression (RR < 10/min) and hypotension.

Incorrect Answers and Explanations:

• Protamine sulfate: Heparin antidote.
• Flumazenil: Benzodiazepine antagonist.
• Acetylcysteine: Acetaminophen overdose antidote.

Question: 99 of 100

Exhibits:

Exhibit 1: Nurses’ Notes 1400: Chest pain radiating to left neck, dysphagia, hiccups. Pain 6/10. Pain worse lying down, improves leaning forward. Friction rub heard. Infection 6 days ago. 1500: Pain increased to 9/10, dyspnea. Jugular venous distention (JVD) noted. Pericardial friction rub heard. Lung sounds diminished.

Exhibit 2: Vital Signs 1400: HR 92/min, RR 18/min, BP 136/88 mm Hg, SpO2 98%. 1500: HR 106/min, RR 22/min, BP 106/70 mm Hg, SpO2 96%.

Exhibit 3: Diagnostic Results ECG: Widespread ST elevation in all leads.

Question Text: Complete the following sentence by using the lists of options.RN Medical Surgical 2026

Template: The nurse suspects the client is experiencing [Condition] as evidenced by [Finding].

Choices (First Dropdown):

• Pericarditis
• Pulmonary embolism
• Heart failure

Choices (Second Dropdown):

• Heart sounds
• Lung sounds
• Respiratory rate

Correct Answer: The nurse suspects the client is experiencing Pericarditis as evidenced by Heart sounds.

Explanation: Acute pericarditis is characterized by chest pain relieved by leaning forward, widespread ST elevation across all ECG leads, and a high-pitched pericardial friction rub heard on heart sound auscultation.

Question: 100 of 100

Question Text: A nurse is assessing a client following extubation from a ventilator. For which of the following findings should the nurse intervene immediately?

Choices:

• Sore throat
• SaO2 92%
• Rhonchi
• Stridor

Correct Answer: Stridor

Explanation: Stridor is a high-pitched, crowing inspiratory sound caused by acute upper airway edema or laryngeal spasm following extubation. It signals impending upper airway obstruction requiring immediate emergency intervention (racemic epinephrine, re-intubation).

Incorrect Answers and Explanations:

• Sore throat: Common, expected mild discomfort following endotracheal tube removal.
• SaO2 92% / Rhonchi: Require monitoring and suctioning, but acute laryngeal stridor is a life-threatening airway emergency.