NSG523 Medical Surgical Nursing

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Sample questions from NSG523 Medical Surgical Nursing

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

1. 1.A client with acute chest pressure is prescribed sublingual nitroglycerin. Which assessment finding should the nurse report before administering the medication?

   • A.The client took sildenafil 4 hours ago
   • B.The client reports pain rated 8/10
   • C.The client's heart rate is 92/min
   • D.The client has a history of stable angina

   Rationale: Nitroglycerin combined with sildenafil can cause profound hypotension, so the recent dose must be reported before administration. Severe pain is a reason to treat promptly, not withhold nitroglycerin by itself. A heart rate of 92/min is not a contraindication. Stable angina is an indication for prescribed nitroglycerin, although the nurse should still assess blood pressure.

2. 2.A client with heart failure receiving furosemide reports weakness. The cardiac monitor shows new premature ventricular contractions, and the potassium level is 2.8 mEq/L. What is the nurse's priority action?

   • A.Notify the provider and anticipate potassium replacement
   • B.Administer the next furosemide dose with food
   • C.Encourage the client to restrict dietary potassium
   • D.Document the findings as an expected diuretic effect

   Rationale: Severe hypokalemia can trigger dangerous dysrhythmias, so the nurse should promptly notify the provider and anticipate replacement and monitoring. Giving more furosemide may worsen potassium loss. Potassium restriction is inappropriate when the level is low. Weakness may occur with hypokalemia, but ventricular ectopy makes this more than a finding to simply document.

3. 3.A client with suspected septic shock has a blood pressure of 82/48 mm Hg, a heart rate of 124/min, and cool extremities. Which prescription should the nurse implement first?

   • A.Begin rapid infusion of isotonic crystalloid
   • B.Administer an oral antipyretic
   • C.Obtain a urine specimen before any treatment
   • D.Place the client in a chair to improve ventilation

   Rationale: Rapid isotonic crystalloid resuscitation is an immediate priority for hypotension from suspected septic shock, while the team continues time-sensitive sepsis interventions. An antipyretic does not correct impaired perfusion. Cultures and urine specimens are important but should not delay initial resuscitation when the client is unstable. Sitting the client upright does not address shock and may worsen hypotension.

4. 4.A client with COPD exacerbation is receiving oxygen. The client is drowsy, and arterial blood gas results are pH 7.28, PaCO2 68 mm Hg, and HCO3 31 mEq/L. How should the nurse interpret these findings?

   • A.Acute-on-chronic respiratory acidosis with inadequate ventilation
   • B.Metabolic alkalosis with appropriate compensation
   • C.Respiratory alkalosis from excessive ventilation
   • D.Fully compensated chronic respiratory acidosis

   Answer and rationale are in the full material.

5. 5.A client with asthma develops severe dyspnea. Which finding is most concerning and requires immediate escalation of care?

   • A.A nearly silent chest with increasing fatigue
   • B.Expiratory wheezing throughout both lungs
   • C.A productive cough with clear sputum
   • D.A respiratory rate of 24/min while speaking in full sentences

   Answer and rationale are in the full material.