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Medical-Surgical Nursing · Medical-Surgical Nursing Mock Exam

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Showing all 15 practice questions with expert explanatory rationales.

Question 1 of 15

Case excerpt

During care in a specialty care unit at 18:15, a patient with suspected acute stroke develops facial droop and unilateral weakness; the family identifies the last-known-well time.

Which nursing action is the priority?

A. The patient's preferred pharmacy
B. The date of the last dental visit
C. The name of the family physician
D. The exact last-known-well time
E. The usual bedtime

Expert Explanatory Rationale

Correct Answer: D. The exact last-known-well time

Last-known-well time is essential for time-sensitive stroke decisions. Activate the stroke response without delay.

Question 2 of 15

Case excerpt

During care in a medical unit at 21:05, a patient with heart failure reports sudden worsening dyspnea and is unable to lie flat; crackles are heard bilaterally.

What is the safest response by the nurse?

A. Position upright, assess oxygenation, and activate urgent clinical support
B. Place the patient flat
C. Encourage ambulation
D. Encourage oral fluids
E. Delay assessment until the next medication round

Expert Explanatory Rationale

Correct Answer: A. Position upright, assess oxygenation, and activate urgent clinical support

Acute pulmonary congestion can impair gas exchange. Support breathing, assess promptly, and escalate care.

Question 3 of 15

Case excerpt

During care in an outpatient clinic at 07:20, a patient with diabetes is confused, diaphoretic, and has a blood glucose of 48 mg/dL; the patient is unable to swallow safely.

Which intervention should the nurse implement first?

A. Wait for the next meal
B. Give orange juice by mouth
C. Administer glucagon or IV dextrose according to protocol and access
D. Encourage walking
E. Administer rapid-acting insulin

Expert Explanatory Rationale

Correct Answer: C. Administer glucagon or IV dextrose according to protocol and access

Severe hypoglycemia with unsafe swallowing requires a nonoral treatment such as IV dextrose or glucagon per protocol.

Question 4 of 15

Case excerpt

During care in a community health setting at 09:45, a patient with a chest tube has sudden respiratory distress and the drainage system becomes disconnected.

How should the nurse respond to this finding?

A. Strip the tubing forcefully
B. Remove the chest tube
C. Leave the patient to find supplies
D. Clamp the tube for an extended period without an order
E. Restore the system according to emergency chest-drainage policy and urgently assess the patient

Expert Explanatory Rationale

Correct Answer: E. Restore the system according to emergency chest-drainage policy and urgently assess the patient

A disconnection can compromise the drainage system. Follow emergency policy, assess respiratory status, and obtain immediate assistance.

Question 5 of 15

Case excerpt

During care in an acute-care unit at 11:10, a patient with chronic kidney disease has a potassium level of 6.3 mEq/L and peaked T waves.

Which action best protects the patient?

A. Encourage exercise
B. Notify the provider or rapid response team immediately and prepare for emergency treatment
C. Administer a potassium supplement
D. Offer a potassium-rich snack
E. Repeat the laboratory test next week

Expert Explanatory Rationale

Correct Answer: B. Notify the provider or rapid response team immediately and prepare for emergency treatment

Hyperkalemia with ECG changes can cause life-threatening dysrhythmias and requires urgent treatment.

Question 6 of 15

Case excerpt

During care in a rehabilitation unit at 13:35, a patient with a new lower-leg cast reports severe pain unrelieved by analgesia and pain with passive toe movement.

Which nursing action is the priority?

A. Expected cast discomfort
B. Contact dermatitis
C. Mild dependent edema only
D. Simple muscle fatigue
E. Compartment syndrome

Expert Explanatory Rationale

Correct Answer: E. Compartment syndrome

Severe escalating pain and pain with passive stretch are warning signs of compartment syndrome requiring urgent evaluation.

Question 7 of 15

Case excerpt

During care in a specialty care unit at 15:50, a patient with COPD has increasing somnolence and shallow respirations after receiving an opioid.

What is the safest response by the nurse?

A. Remove oxygen without assessment
B. Assess airway and respiratory status and initiate urgent escalation
C. Encourage the patient to sleep
D. Administer another opioid dose
E. Offer a sedative

Expert Explanatory Rationale

Correct Answer: B. Assess airway and respiratory status and initiate urgent escalation

Opioids can depress ventilation. Assess respiratory status immediately and follow emergency reversal/escalation protocols.

Question 8 of 15

Case excerpt

During care in a medical unit at 18:15, a patient with suspected gastrointestinal bleeding has coffee-ground emesis, tachycardia, and falling blood pressure.

Which intervention should the nurse implement first?

A. Administer a laxative
B. Delay notification until the next hemoglobin result
C. Assist the patient to walk
D. Offer oral fluids
E. Activate urgent support, assess circulation, and maintain prescribed IV access

Expert Explanatory Rationale

Correct Answer: E. Activate urgent support, assess circulation, and maintain prescribed IV access

Signs of hemodynamic instability with GI bleeding require immediate escalation and circulatory support.

Question 9 of 15

Case excerpt

During care in an outpatient clinic at 21:05, a patient receiving a blood transfusion develops chills, back pain, and dyspnea shortly after initiation.

Which nursing actions are appropriate? (Select all that apply)

A. Discard the blood bag before reporting
B. Reassess the patient after the intervention and compare findings with the baseline
C. Document objective findings, actions taken, and the patient's response
D. Slow the transfusion and observe
E. Stop the transfusion and keep IV access open with normal saline using new tubing
F. Escalate promptly if the patient's condition worsens or remains outside the expected range
G. Delay follow-up until the end of the shift even if the condition is worsening

Expert Explanatory Rationale

Correct Answer: B. Reassess the patient after the intervention and compare findings with the baseline; C. Document objective findings, actions taken, and the patient's response; E. Stop the transfusion and keep IV access open with normal saline using new tubing; F. Escalate promptly if the patient's condition worsens or remains outside the expected range

These findings may indicate a transfusion reaction. Stop the transfusion, maintain access with saline and new tubing, and follow reaction protocol. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 10 of 15

Case excerpt

During care in a community health setting at 07:20, a patient with pneumonia has an oxygen saturation that falls from 95% to 86% and increasing work of breathing.

Which nursing actions are appropriate? (Select all that apply)

A. Document objective findings, actions taken, and the patient's response
B. Document the value and return later
C. Escalate promptly if the patient's condition worsens or remains outside the expected range
D. Promptly assess respiratory status, support oxygenation per order, and escalate care
E. Reassess the patient after the intervention and compare findings with the baseline
F. Encourage the patient to lie flat
G. Delay follow-up until the end of the shift even if the condition is worsening

Expert Explanatory Rationale

Correct Answer: A. Document objective findings, actions taken, and the patient's response; C. Escalate promptly if the patient's condition worsens or remains outside the expected range; D. Promptly assess respiratory status, support oxygenation per order, and escalate care; E. Reassess the patient after the intervention and compare findings with the baseline

A significant oxygenation decline and increased work of breathing require immediate assessment and escalation. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 11 of 15

Case excerpt

During care in an acute-care unit at 09:45, a patient with cirrhosis becomes increasingly confused and has asterixis.

Which nursing actions are appropriate? (Select all that apply)

A. Document objective findings, actions taken, and the patient's response
B. Escalate promptly if the patient's condition worsens or remains outside the expected range
C. Delay follow-up until the end of the shift even if the condition is worsening
D. Otitis media
E. Reassess the patient after the intervention and compare findings with the baseline
F. Hypoglycemia as the only possible cause
G. Hepatic encephalopathy

Expert Explanatory Rationale

Correct Answer: A. Document objective findings, actions taken, and the patient's response; B. Escalate promptly if the patient's condition worsens or remains outside the expected range; E. Reassess the patient after the intervention and compare findings with the baseline; G. Hepatic encephalopathy

Confusion and asterixis in cirrhosis suggest hepatic encephalopathy; assess for triggers and implement prescribed treatment. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 12 of 15

Case excerpt

During care in a rehabilitation unit at 11:10, a patient after thyroidectomy develops stridor and difficulty breathing.

Which nursing actions are appropriate? (Select all that apply)

A. Delay follow-up until the end of the shift even if the condition is worsening
B. Reassess the patient after the intervention and compare findings with the baseline
C. Document objective findings, actions taken, and the patient's response
D. Escalate promptly if the patient's condition worsens or remains outside the expected range
E. Offer sips of water
F. Activate emergency airway support and prepare for immediate intervention
G. Place a pillow over the neck

Expert Explanatory Rationale

Correct Answer: B. Reassess the patient after the intervention and compare findings with the baseline; C. Document objective findings, actions taken, and the patient's response; D. Escalate promptly if the patient's condition worsens or remains outside the expected range; F. Activate emergency airway support and prepare for immediate intervention

Stridor after thyroid surgery may indicate airway obstruction from edema or hematoma and is an emergency. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 13 of 15

Case excerpt

During care in a specialty care unit at 13:35, a patient with a suspected pulmonary embolism suddenly develops pleuritic chest pain, tachycardia, and hypoxemia.

Which nursing actions are appropriate? (Select all that apply)

A. Escalate promptly if the patient's condition worsens or remains outside the expected range
B. Massage the affected leg
C. Reassess the patient after the intervention and compare findings with the baseline
D. Document objective findings, actions taken, and the patient's response
E. Delay follow-up until the end of the shift even if the condition is worsening
F. Initiate emergency assessment and escalation while supporting oxygenation
G. Encourage unassisted ambulation

Expert Explanatory Rationale

Correct Answer: A. Escalate promptly if the patient's condition worsens or remains outside the expected range; C. Reassess the patient after the intervention and compare findings with the baseline; D. Document objective findings, actions taken, and the patient's response; F. Initiate emergency assessment and escalation while supporting oxygenation

Sudden chest pain, tachycardia, and hypoxemia may indicate pulmonary embolism and require emergency response. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 14 of 15

Case excerpt

A prescribed IV infusion contains 420 mL and must run evenly over 6 hours. The patient is receiving care related to medical-surgical nursing.

What rate should the nurse program in mL/hr? Enter the number only.

Expert Explanatory Rationale

Correct Answer: 70

Calculate volume divided by time: 420 mL ÷ 6 hr = 70 mL/hr. Verify the prescription, pump settings, and patient response.

Question 15 of 15

Case excerpt

The nurse is completing a safe nursing care sequence for a patient receiving medical-surgical nursing care.

Place the nursing actions in the safest order.

A. Verify the patient's identity, explain the planned care, and assess current status
B. Gather the required equipment and confirm that it is functioning
C. Perform the intervention using the prescribed procedure and appropriate safety measures
D. Reassess the patient and evaluate the response
E. Document the findings, intervention, and outcome

Expert Explanatory Rationale

Correct Answer: A. Verify the patient's identity, explain the planned care, and assess current status; B. Gather the required equipment and confirm that it is functioning; C. Perform the intervention using the prescribed procedure and appropriate safety measures; D. Reassess the patient and evaluate the response; E. Document the findings, intervention, and outcome

The nurse first verifies identity and assesses the patient, prepares equipment, performs the intervention safely, reassesses the response, and documents the care.

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