RN Adult Medical Surgical Midterm Proctored Exam 2026

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Sample questions from RN Adult Medical Surgical Midterm Proctored Exam 2026

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

1. 1.A client with heart failure reports worsening dyspnea and has crackles, an oxygen saturation of 88%, and pink frothy sputum. Which action should the nurse take first?

   • A.Place the client in high-Fowler position and apply prescribed oxygen
   • B.Obtain a daily weight
   • C.Restrict oral fluids
   • D.Administer the scheduled oral diuretic

   Rationale: High-Fowler positioning and oxygen support ventilation and oxygenation during acute pulmonary edema. A daily weight and fluid restriction are useful for ongoing heart failure management but do not address the immediate breathing problem. An oral diuretic may be part of treatment, but it is not the first priority when the client is hypoxemic and in respiratory distress.

2. 2.A client taking digoxin reports nausea and yellow-green halos around lights. The apical pulse is 52/min. What should the nurse do?

   • A.Hold the dose and notify the health care provider
   • B.Give the dose with food
   • C.Administer the dose and recheck the pulse in 1 hour
   • D.Encourage the client to increase dietary potassium

   Rationale: Nausea, visual disturbances, and bradycardia suggest digoxin toxicity, so the dose should be held and the prescriber notified. Giving the dose or waiting to recheck risks worsening toxicity. Potassium intake is not a substitute for evaluation; low potassium can increase digoxin toxicity, but these symptoms require prompt assessment and likely serum drug and electrolyte testing.

3. 3.A client with COPD has an oxygen saturation of 86% on room air and is dyspneic. Which initial oxygen approach is most appropriate?

   • A.Apply low-flow oxygen by nasal cannula and titrate to the prescribed target
   • B.Withhold oxygen because it may suppress the client's respiratory drive
   • C.Apply a nonrebreather mask at 15 L/min and leave it in place regardless of response
   • D.Ask the client to breathe into a paper bag

   Rationale: Hypoxemia should be treated with carefully titrated oxygen, often with a prescribed target such as 88% to 92% for clients at risk of hypercapnia. Withholding oxygen is unsafe, and the concern about respiratory drive does not justify leaving hypoxemia untreated. A nonrebreather at a fixed high flow may be excessive without assessment, while paper-bag breathing is unsafe and does not treat hypoxemia.

4. 4.A client with pneumonia is receiving antibiotics and oxygen. Which finding best indicates that the treatment is effective?

   • A.The client is more alert and oxygen saturation has improved
   • B.The client has a new productive cough
   • C.The temperature remains elevated
   • D.The respiratory rate has increased from 22 to 30/min

   Answer and rationale are in the full material.

5. 5.A client with a suspected ischemic stroke arrived 1 hour ago. Which assessment is most important before possible thrombolytic therapy?

   • A.Obtain a noncontrast head CT to exclude intracranial hemorrhage
   • B.Give aspirin immediately
   • C.Lower the blood pressure to below 120/80 mm Hg
   • D.Begin oral fluids to prevent dehydration

   Answer and rationale are in the full material.