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2025 Med-Surg 1 Final Test Preparation: In-Depth
Review, Exam-Ready Questions, and Success Tips
1. A client who had surgery has extreme postoperative pain that is worsened when trying to participate in physical therapy. Which intervention for pain management does the nurse include in the client's care plan? A) Round-the-clock analgesia with PRN analgesics (Correct Answer) B) As-needed pain medication after therapy C) Pain medications prior to therapy only D) Patient-controlled analgesia with a basal rate Rationale: Providing scheduled pain relief with PRN options ensures adequate pain control and improves participation in therapy. 2. A new nurse reports to the nurse preceptor that a client requested pain medication, and when the nurse brought it, the client was sound asleep. The nurse states the client cannot possibly sleep with the severe pain the client described. Which response by the experienced nurse is best? A) "Being able to sleep doesn't mean pain doesn't exist." (Correct Answer) B) "You're right; I would put the medication back." C) "Have you ever experienced any type of pain?" D) "The client should be assessed for drug addiction." Rationale: Sleep does not indicate the absence of pain. Clients with severe pain can still fall asleep due to exhaustion, but they may still require pain management. 3. A nurse uses the Checklist of Nonverbal Pain Indicators to assess pain in a nonverbal client with advanced dementia but no other medical history except wellcontrolled hypertension and high cholesterol. The client scores a zero. Which action by the nurse is best? A) Document the findings and continue to monitor. B) Try a small dose of analgesic medication for pain. C) Assess physiologic indicators and vital signs. (Correct Answer) D) Do not give pain medication as no pain is indicated.
Rationale: Physiologic indicators such as heart rate, respiratory rate, and blood pressure changes can help assess pain in nonverbal clients.
4. A nurse on the postoperative inpatient unit receives hand-off report on four clients using patient-controlled analgesia (PCA) pumps. Which client would the nurse see first? A) Client with a respiratory rate of 8 breaths/min. (Correct Answer) B) Client who appears to be sleeping soundly. C) Client with no bolus request in 6 hours. D) Client who is pressing the button every 10 minutes. Rationale: A respiratory rate of 8 breaths/min is dangerously low and may indicate opioidinduced respiratory depression. 5. A registered nurse is caring for a client who is receiving pain medication via PCA. Which action by the nurse indicates the need for further education on pain control with PCA? A) Assesses the client's pain level per agency policy. B) Monitors the client's respiratory rate and sedation. C) Reinforces client teaching about using the PCA pump. D) Presses the button when the client cannot reach it. (Correct Answer) Rationale: The nurse should not press the PCA button for the client, as this can lead to overdosing and respiratory depression. 6. A nurse is preparing to give a client ketorolac intravenously for pain. Which assessment findings would lead the nurse to consult with the primary health care provider? A) Urine output of 20 mL/2 hr (Correct Answer) B) Bilateral lung crackles C) Self-reported pain of 3/ D) Hypoactive bowel sounds Rationale: Ketorolac can cause kidney damage; low urine output may indicate nephrotoxicity.
Rationale: IV insulin and dextrose rapidly shift potassium into the cells, making it the priority intervention for severe hyperkalemia. Here are additional multiple-choice questions with rationales:
1. A new nurse reports to the nurse preceptor that a client requested pain medication, and when the nurse brought it, the client was sound asleep. The nurse states the client cannot possibly sleep with the severe pain the client described. Which response by the experienced nurse is best? A) "Being able to sleep doesn't mean pain doesn't exist." (Correct Answer) B) "You're right; I would put the medication back." C) "Have you ever experienced any type of pain?" D) "The client should be assessed for drug addiction." Rationale: Pain can persist even while a patient is asleep. Sleep is not a reliable indicator of pain absence, and withholding medication based on this assumption is incorrect. 2. A nurse uses the Checklist of Nonverbal Pain Indicators to assess pain in a nonverbal client with advanced dementia but no other medical history except wellcontrolled hypertension and high cholesterol. The client scores a zero. Which action by the nurse is best? A) Document the findings and continue to monitor. B) Try a small dose of analgesic medication for pain. C) Assess physiologic indicators and vital signs. (Correct Answer) D) Do not give pain medication as no pain is indicated. Rationale: Nonverbal clients may not exhibit obvious signs of pain, so additional assessment (e.g., heart rate, blood pressure) is crucial before ruling out pain. 3. A client who had surgery has extreme postoperative pain that is worsened when trying to participate in physical therapy. Which intervention for pain management does the nurse include in the client's care plan? A) Round-the-clock analgesia with PRN analgesics (Correct Answer) B) As-needed pain medication after therapy C) Pain medications prior to therapy only D) Patient-controlled analgesia with a basal rate
Rationale: Scheduled pain medication prevents breakthrough pain and allows for better participation in physical therapy.
4. A nurse on the postoperative inpatient unit receives hand-off report on four clients using patient-controlled analgesia (PCA) pumps. Which client would the nurse see first? A) Client with a respiratory rate of 8 breaths/min. (Correct Answer) B) Client who appears to be sleeping soundly. C) Client with no bolus request in 6 hours. D) Client who is pressing the button every 10 minutes. Rationale: A respiratory rate of 8 breaths per minute suggests opioid-induced respiratory depression, requiring immediate intervention. 5. A registered nurse is caring for a client who is receiving pain medication via patientcontrolled analgesia (PCA). Which action by the nurse indicates the need for further education on pain control with PCA? A) Assesses the client's pain level per agency policy. B) Monitors the client's respiratory rate and sedation. C) Reinforces client teaching about using the PCA pump. D) Presses the button when the client cannot reach it. (Correct Answer) Rationale: Only the client should press the PCA button to prevent overdose. The nurse pressing it violates patient safety guidelines. 6. A nurse is preparing to give a client ketorolac intravenously for pain. Which assessment findings would lead the nurse to consult with the primary health care provider? A) Urine output of 20 mL/2 hr (Correct Answer) B) Bilateral lung crackles C) Self-reported pain of 3/ D) Hypoactive bowel sounds Rationale: Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that can cause kidney damage. Oliguria (low urine output) may indicate renal impairment.
A) Prepare to administer dextrose 50% and 10 units of regular insulin IV push. (Correct Answer) B) Prepare the client for hemodialysis treatment. C) Provide a heart-healthy, low-potassium diet. D) Prepare to administer patiromer by mouth. Rationale: Insulin and dextrose shift potassium into cells, rapidly reducing serum potassium levels in life-threatening hyperkalemia. A registered nurse is caring for a client who is receiving pain medication via patientcontrolled analgesia (PCA). Which action by the nurse indicates the need for further education on pain control with PCA? Assesses the client's pain level per agency policy. Monitors the client's respiratory rate and sedation. Reinforces client teaching about using the PCA pump. Presses the button when the client cannot reach it. - - correct ans- - Presses the button when the client cannot reach it. A nurse is preparing to give a client ketorolac intravenously for pain. Which assessment findings would lead the nurse to consult with the primary health care provider? Urine output of 20 mL/2 hr Bilateral lung crackles Self-reported pain of 3/ Hypoactive bowel sounds - - correct ans- - Urine output 20ml/2hr A nurse assesses clients at a family practice clinic for risk factors that could lead to dehydration. Which client is at greatest risk for dehydration? A 76 year old who is cognitively impaired. An 83 year old with congestive heart failure. A 55 year old who recently received intravenous fluids.
A 36 year old who is prescribed long-term steroid therapy. - - correct ans- - A 76 year old who is cognitively impaired A nurse is assessing clients on a medical-surgical unit. Which adult client does the nurse identify as being at greatest risk for insensible water loss? Client taking furosemide. Client who is on fluid restrictions. Client who is constipated with abdominal pain. Anxious client who has tachypnea. - - correct ans- - Anxious client who has tachypnea After teaching a client who is prescribed a restricted sodium diet, a nurse assesses the client's understanding. Which food choice for lunch indicates that the client correctly understood the teaching? Grilled chicken breast with glazed carrots Salami and cheese on whole-wheat crackers Slices of smoked ham with potato salad Bowl of tomato soup with a grilled cheese sandwich - - correct ans- - Grilled chicken breast with glazed carrots A nurse cares for a client who has a serum potassium of 6.5 mEq/L (6.5 mmol/L) and is exhibiting cardiovascular changes. Which intervention will the nurse implement first? Prepare to administer dextrose 50% and 10 units of regular insulin IV push. Prepare the client for hemodialysis treatment. Provide a heart-healthy, low-potassium diet. Prepare to administer patiromer by mouth. - - correct ans- - Prepare to administer dextrose 50% and 10 units of regular insulin IV push A new nurse is preparing to administer IV potassium to a client with hypokalemia. What action indicates the nurse needs to review this procedure?
The nurse is assessing a client diagnosed with trigeminal neuralgia affecting cranial nerve V. What assessment findings will the nurse expect for this client? Severe facial pain Ptosis (eyelid drooping) Slurred speech Expressive aphasia - - correct ans- - Severe facial pain The nurse is performing an assessment of cranial nerve III. Which testing is appropriate? Deep tendon reflexes Pupil constriction Upper muscle strength Speech and language - - correct ans- - Pupil constriction A nurse is teaching a client with cerebellar function impairment. Which statement would the nurse include in this client's discharge teaching? "Connect a light to flash when your door bell rings." "Use a natural gas detector with an audible alarm." "Ask a friend to drive you to your follow-up appointments."
"Label your faucet knobs with hot and cold signs." - correct ans- - Ask a friend to drive you to your follow up appointments A nurse assesses a client and notes the client's position as indicated in the illustration below: "Pt with arms pulled in towards body" How would the nurse document this finding? Spinal cord degeneration Decorticate posturing Atypical hyperreflexia Decerebrate posturing - - correct ans- - Decorticate posturing A client is in the emergency department reporting a brief episode during which he was dizzy, unable to speak, and felt numbness in his left leg. Currently the client's neurologic examination is normal. About what drug would the nurse plan to teach the patient? Mannitol Clopidogrel Heparin sodium Alteplase - - correct ans- - Clopidogrel A client with a stroke is being evaluated for fibrinolytic therapy. What information from the client or family is most important for the nurse to obtain? Time of symptom onset
A client with a family history of glaucoma asks the nurse how to prevent glaucoma? What statement by the nurse is appropriate? "You should check with your primary health care provider about eye examination." "You should have your intraocular pressure measured once or twice a year." "You should check with your primary health care provider about preventive drug therapy." "You should have genetic testing to determine your risk for glaucoma." - - correct ans- - You should have your intraocular pressure measured once or twice a year The nurse assesses a client for factors that place the client at risk for cataracts. Which factor places the client at the highest risk for cataract development? Glaucoma Advanced age Diabetes mellitus Heart disease - - correct ans- - Advanced age A client who is nearly blind is admitted to the hospital. What action by the nurse is most important? Orient the client to the room using a focal point. Speak loudly and slowing when talking to the client. Let the client arrange objects on the bedside table. Allow the client to feel his or her way around. - - correct ans- - Orient the client to the room using a focal point A client is taking timolol eyedrops. The nurse assesses the client's pulse at 48 beats/min. What action by the nurse is the priority? Give the drops using punctal occlusion. Take the client's blood pressure and temperature. Ask the client about excessive salivation.
Hold the eyedrops and notify the primary health care provider. - - correct ans- - Hold the eye drops and notify the primary health care provider The client's electronic health record indicates a sensorineural hearing loss. What assessment question does the nurse ask to determine the possible cause? "Have you been told your ear bones don't move?" "Do you feel like something is in your ear?" "Have you been exposed to loud noises?" "Do you have frequent ear infections?" - - correct ans- - Have you been exposed to loud noises? A client is scheduled for a colonoscopy and the nurse has provided instructions on the bowel cleansing regimen. What statement by the client indicates a need for further teaching? "It's a good thing I love orange and cherry gelatin." "I'll avoid ibuprofen for several days before the test." "My spouse will be here to drive me home." "I'll buy a case of clear Gatorade before the prep." - - correct ans- - It's a good thing i love orange and cherry gelatin The nurse is caring for a client who has frequent gastric pain and dyspepsia. Which procedure would the nurse expect for the client to make an accurate diagnosis? Abdominal arteriogram Nuclear medicine scan Magnetic resonance imaging (MRI) Esophagogastroduodenoscopy (EGD) - - correct ans - EGD The nurse is caring for a client who has been diagnosed with peptic ulcer disease. For which complication would the nurse monitor? Gastric cancer
A nurse reviews the electronic health record of a client who has Crohn disease and a draining fistula. Which documentation would alert the nurse to urgently contact the primary health care provider for additional prescriptions? White blood cell count of 8200/mm3 (8.2 ´ 109/L) Client ate 20% of breakfast meal Client's weight decreased by 3 lb (1.4 kg) Serum potassium of 2.6 mEq/L (2.6 mmol/L) - - correct ans- - Serum potassium of 2.6 mEq/L The fluid shift that occurs in peritonitis may result in which of the following? Significant increase in circulatory volume Increased bowel motility caused by increased fluid volume Intracellular fluid moving into the GI tract Decreased circulatory volume and hypovolemic shock - - correct ans- - Decreased circulatory volume and hypovolemic shock The nurse is caring for the patient with acute appendicitis. Which interventions will the nurse perform? (Select all that apply) Administer laxatives Administer IV fluids as prescribed Maintain the patient on NPO status Apply warm compress to the right lower abdominal quadrant
Maintain the patient in the supine position - - correct ans- - Administer IV fluids as prescribed Maintain the NPO status An assistive personnel (AP) was feeding a client with a tracheostomy. Later that evening, the UAP reports that the client had a coughing spell during the meal. What action by the nurse is best? Assess the client's lung sounds. Assign a different AP to the client. Report the AP to the manager. Request thicker liquids for meals. - - correct ans- - Assess the clients lung sounds A nurse is caring for four clients. Which one would the nurse see first? Client who needs a beta blocker, and has a blood pressure of 98/58 mm Hg. Client who had a first dose of captopril and needs to use the bathroom. Hypertensive client with a blood pressure of 153/85 mm Hg. Client who needs pain medication prior to a dressing change of a surgical wound. - - correct ans- - Client who had a first dose of captopril and needs to use the bathroom The patient is scheduled for surgery in the morning and ordered NPO after midnight. You are the patient's nurse working night shift. The patient complained of chest pain (sharp, 7/ nonradiating) at 2am. There is an order for nitroglycerin sublingual 0.4mg PRN for chest pain every 5 minutes (maximum of 3 doses). What will you do? The nurse will give the medication (nitroglycerin 0.4mg sublingual) and monitor the chest pain. The nurse will hold the medication. The nurse will call the doctor and get an order for nitroglycerin patch. The nurse will give morphine instead. - - correct ans- - The nurse will give the medication and monitor the chest pain
The nurse is trying to assess the level of consciousness of a patient. Which of the following questions should the nurse ask? Can you please repeat these three words? Pencil, paper, eraser. Do you have any pain? What brought you to the hospital? How many kids do you have? - - correct ans- - What brought you to the hospital The nurse is developing a plan of care for the client scheduled for cataract surgery. The nurse documents which most appropriate nursing diagnosis in the plan of care? Anxiety Self-care deficit Nutrition, imbalanced Sensory perception, disturbed - - correct ans- - Sensory perception, disturbed Patient overdosed with morphine, an opioid medication. What will the nurse plan to administer? Narcan Protamine sulfate fluid bolus of NS 0.9% Flumazenil - - correct ans- - Narcan The nurse is performing an abdominal assessment and inspects the skin on the abdomen. The nurse performs which assessment technique next? Palpates the abdomen. Percuss the right lower abdominal quadrant. Listens to bowel sounds in all four quadrants.
Palpates the liver at the right rib margin. - - correct ans- - Listens to bowel sounds in all four quadrants The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? Numbness in the legs Bradycardia Nausea and vomiting. Rigid, board-like abdomen. - - correct ans- - Rigid, board like abdomen The nurse touches the corner of the mouth or cheek of the patient to look for twitches when the facial nerve is touched over the parotid. You know that the nurse is checking for hypocalcemia by using which method? Trousseau's sign Murphy's sign Mcburney's sign Chvostek's sign - - correct ans- - Chvosteks sign The client with glaucoma asks the nurse if complete vision will return. The most appropriate response is: "Although some vision has been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan." "Your vision will return to normal as soon as the medications begin to work." "Your vision will never return to normal." "Your vision loss is temporary and will return in about 3-4 weeks." - - correct ans- - Although some vision has been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan The patient has been having Ventricular tachycardia and frequent PVCs (premature ventricular contractions). Which electrolyte should the nurse assess first?
