RN Adult Medical Surgical 2026

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Sample questions from RN Adult Medical Surgical 2026

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 62-year-old adult arrives in the emergency department with crushing substernal chest pressure for 40 minutes. The ECG shows ST elevation in leads II, III, and aVF. Blood pressure is 86/54 mm Hg, heart rate is 52/min, respiratory rate is 22/min, and oxygen saturation is 95% on room air. Which prescribed medication should the nurse question before administration?

   • A.Chewable aspirin 324 mg
   • B.Sublingual nitroglycerin 0.4 mg
   • C.Intravenous unfractionated heparin
   • D.Oral atorvastatin 80 mg

   Rationale: Nitroglycerin can further reduce preload and worsen this patient's hypotension, particularly if a right ventricular infarction accompanies the inferior infarction. Aspirin and prescribed anticoagulation support acute coronary syndrome treatment when no contraindication exists. High-intensity atorvastatin is appropriate and does not create the same immediate hemodynamic risk. The exam takeaway is to evaluate blood pressure and contraindications before administering routine chest pain medications.

2. 2.A 74-year-old patient hospitalized with heart failure suddenly develops severe dyspnea and pink, frothy sputum. Blood pressure is 178/96 mm Hg, heart rate is 118/min, respiratory rate is 34/min, and oxygen saturation is 82% on room air. While another nurse activates the rapid response team, which action should the bedside nurse take first?

   • A.Obtain a standing weight
   • B.Insert an indwelling urinary catheter
   • C.Position the patient upright and apply oxygen
   • D.Review the patient's dietary sodium intake

   Rationale: Upright positioning and oxygen immediately address impaired oxygenation from acute pulmonary edema. A standing weight and dietary review may support later heart failure management but delay stabilization. Urinary catheterization may help monitor treatment response if indicated, but it does not correct the immediate respiratory emergency. The exam takeaway is to prioritize breathing before diagnostic measurements or routine monitoring.

3. 3.A 68-year-old patient on a telemetry unit reports dizziness and chest pressure. The monitor shows complete heart block with a ventricular rate of 32/min; blood pressure is 74/42 mm Hg, and the patient is cool and diaphoretic. Emergency assistance has been activated. Which intervention should the nurse prepare for immediately?

   • A.Transcutaneous pacing
   • B.Intravenous adenosine
   • C.Synchronized cardioversion
   • D.An oral beta blocker

   Rationale: Complete heart block with hypotension and ischemic symptoms requires urgent pacing support. Adenosine and beta blockers further suppress conduction and are inappropriate for this bradyarrhythmia. Synchronized cardioversion treats selected unstable tachyarrhythmias, not complete heart block. The exam takeaway is to connect symptomatic high-grade conduction block with immediate pacing readiness.

4. 4.A 65-year-old patient is recovering on a surgical unit 2 days after a total hip arthroplasty. The patient suddenly reports sharp chest pain and shortness of breath; heart rate is 124/min, respiratory rate is 30/min, blood pressure is 92/58 mm Hg, and oxygen saturation is 86% on room air. Which action is the priority?

   • A.Assist the patient to walk to improve ventilation
   • B.Inspect both calves before initiating treatment
   • C.Administer the prescribed oral analgesic and reassess in 30 minutes
   • D.Apply oxygen and activate the rapid response team

   Answer and rationale are in the full material.

5. 5.A 71-year-old patient with a COPD exacerbation is receiving oxygen at 2 L/min by nasal cannula in the emergency department. The patient is increasingly drowsy, with respiratory rate 10/min and oxygen saturation 89%. Arterial blood gases show pH 7.25, PaCO2 72 mm Hg, and HCO3 31 mEq/L. Which action is most appropriate?

   • A.Remove oxygen to restore the patient's respiratory drive
   • B.Notify the emergency clinician and prepare for assisted ventilation
   • C.Coach pursed-lip breathing and reassess in 1 hour
   • D.Increase oxygen until saturation reaches 100% without other intervention

   Answer and rationale are in the full material.