RN Adult Medical Surgical Test Bank 2023

Free preview · Original latest version

Sample questions from RN Adult Medical Surgical Test Bank 2023

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

1. 1.A 68-year-old client in the emergency department has crushing chest pain, diaphoresis, and nausea. Blood pressure is 86/54 mm Hg, heart rate is 112/min, and the ECG shows ST elevation in leads II, III, and aVF. Which action should the nurse take first?

   • A.Administer sublingual nitroglycerin
   • B.Establish IV access and prepare for emergency reperfusion
   • C.Give oral aspirin with water
   • D.Obtain a detailed history of the pain

   Rationale: Inferior ST-elevation myocardial infarction with hypotension requires rapid reperfusion preparation and IV access; nitroglycerin may worsen hypotension, especially with right ventricular involvement. Aspirin is important but should not delay urgent stabilization and reperfusion. A detailed history is lower priority than addressing the time-sensitive threat to cardiac perfusion.

2. 2.A 74-year-old client on a medical unit suddenly develops facial drooping and right arm weakness. The symptoms began 35 minutes ago; blood glucose is 102 mg/dL, blood pressure is 178/96 mm Hg, and oxygen saturation is 97% on room air. What is the nurse's priority action?

   • A.Give aspirin immediately
   • B.Activate the stroke response and prepare for urgent brain imaging
   • C.Lower the blood pressure to below 140/90 mm Hg
   • D.Offer oral fluids to assess swallowing

   Rationale: The client has a possible acute stroke, and urgent imaging is needed to distinguish ischemic from hemorrhagic stroke and determine treatment eligibility. Aspirin is not given until hemorrhage has been excluded, and aggressive blood pressure reduction can impair cerebral perfusion. Oral fluids are unsafe until swallowing has been assessed.

3. 3.A 59-year-old client with sepsis is in the intensive care unit. The temperature is 39.2 C, heart rate is 128/min, blood pressure is 82/46 mm Hg, lactate is 4.6 mmol/L, and urine output is 15 mL/hr. Which action should the nurse take first?

   • A.Obtain blood cultures and administer prescribed broad-spectrum antibiotics promptly
   • B.Wait for culture results before starting antibiotics
   • C.Restrict IV fluids because of the low urine output
   • D.Administer an antipyretic and reassess in 1 hour

   Rationale: The client has septic shock with poor perfusion, so cultures should be obtained promptly if this does not delay broad-spectrum antibiotics. Waiting for culture results delays lifesaving treatment, while fluid restriction can worsen hypoperfusion. An antipyretic does not address the immediate cause of shock.

4. 4.A 63-year-old client with COPD is admitted with increased dyspnea and drowsiness. The client uses accessory muscles, has an oxygen saturation of 82% on room air, and has a prescribed target saturation of 88% to 92%. Which action should the nurse take?

   • A.Apply oxygen at 2 L/min by nasal cannula and reassess the response
   • B.Withhold oxygen because it may suppress respiratory drive
   • C.Apply a nonrebreather mask at 15 L/min and maintain saturation above 98%
   • D.Encourage the client to breathe into a paper bag

   Answer and rationale are in the full material.

5. 5.A 46-year-old client with type 1 diabetes is admitted with vomiting and abdominal pain. The client is lethargic, glucose is 486 mg/dL, potassium is 5.4 mEq/L, bicarbonate is 12 mEq/L, and arterial pH is 7.22. Which prescription should the nurse implement first?

   • A.Begin an IV infusion of isotonic crystalloid
   • B.Administer IV regular insulin before giving fluids
   • C.Give IV sodium bicarbonate
   • D.Administer potassium chloride immediately

   Answer and rationale are in the full material.