Med-Surg

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Sample questions from Med-Surg

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

1. 1.A 64-year-old client arrives in the emergency department with crushing substernal chest pain that began 30 minutes ago. Blood pressure is 138/82 mm Hg, heart rate is 96/min, and oxygen saturation is 96% on room air. The ECG shows ST elevation in leads II, III, and aVF. Which action should the nurse take first?

   • A.Administer chewable aspirin as prescribed while activating the reperfusion pathway.
   • B.Apply oxygen at 4 L/min before initiating other treatments.
   • C.Wait for the troponin result before notifying the cardiac team.
   • D.Administer an oral beta blocker before arranging further evaluation.

   Rationale: ST elevation with ischemic symptoms requires immediate reperfusion activation and aspirin unless contraindicated. Routine oxygen is not indicated at this oxygen saturation. Waiting for troponin delays treatment, and an oral beta blocker is not the initial priority. The exam takeaway is to act on a diagnostic STEMI ECG without waiting for biomarker confirmation.

2. 2.A 72-year-old client on a medical unit develops severe dyspnea and pink, frothy sputum. The client has heart failure, a respiratory rate of 32/min, oxygen saturation of 84% on room air, and blood pressure of 178/96 mm Hg. Which action should the nurse take first?

   • A.Place the client supine and elevate the legs.
   • B.Sit the client upright and initiate oxygen while summoning urgent assistance.
   • C.Obtain a daily weight before administering prescribed medications.
   • D.Encourage oral fluids to thin respiratory secretions.

   Rationale: Upright positioning and oxygen immediately address impaired gas exchange from acute pulmonary edema. Supine positioning with leg elevation can worsen pulmonary congestion. Daily weight is useful for ongoing management but delays stabilization, and oral fluids increase the fluid burden. Prioritize breathing before routine monitoring or longer-term treatment.

3. 3.A 69-year-old client with a COPD exacerbation is receiving oxygen at 2 L/min in the emergency department. Oxygen saturation is 88%, respiratory rate is 10/min, and the client is increasingly drowsy. Arterial blood gases show pH 7.25, PaCO2 72 mm Hg, and HCO3 30 mEq/L. Which action is most appropriate?

   • A.Remove oxygen to restore the client's respiratory drive.
   • B.Encourage coughing and reassess in 1 hour.
   • C.Escalate care immediately and prepare for ventilatory support.
   • D.Administer a prescribed sedative to reduce respiratory effort.

   Rationale: Acidemia, marked hypercapnia, and worsening consciousness indicate acute ventilatory failure requiring immediate escalation. Removing oxygen worsens hypoxemia and does not treat inadequate ventilation. Coughing alone delays definitive support, and sedation can further depress breathing. In COPD, evaluate ventilation and mental status rather than relying only on the oxygen saturation.

4. 4.A 58-year-old client develops sudden dyspnea and pleuritic chest pain 2 days after hip replacement. Heart rate is 124/min, respiratory rate is 30/min, blood pressure is 104/68 mm Hg, and oxygen saturation is 86% on room air. Which action should the nurse take first?

   • A.Ambulate the client to determine whether symptoms improve.
   • B.Massage the affected leg to reduce venous stasis.
   • C.Obtain a sputum specimen before contacting the provider.
   • D.Apply oxygen and activate the rapid response system.

   Answer and rationale are in the full material.

5. 5.A 47-year-old client with a chest tube for traumatic pneumothorax is recovering on a surgical unit. During repositioning, the tube is pulled completely out of the chest. The client becomes dyspneic, with oxygen saturation falling from 96% to 89%. Which action should the nurse take first?

   • A.Attempt to reinsert the tube through the existing opening.
   • B.Apply a sterile occlusive dressing according to emergency protocol and summon immediate assistance.
   • C.Clamp the disconnected tube near the drainage chamber.
   • D.Leave the insertion site uncovered until the provider arrives.

   Answer and rationale are in the full material.