MEDSURG-BC sample questions

Question 1

A patient admitted with severe traumatic brain injury develops cerebral edema. The provider orders intravenous maintenance fluids. Why is the administration of 0.45% sodium chloride strictly contraindicated in this clinical scenario?

```mermaid
flowchart TD
A[0.45% NaCl Infusion] --> B[Decreased Plasma Osmolality]
B --> C[Water Shifts Down Osmotic Gradient]
C --> D[Intracellular Swelling of Astrocytes]
D --> E[Elevated Intracranial Pressure]
```

Accepted Answer

It is hypotonic and shifts fluid into the intracellular compartment, worsening cerebral edema.

Answer

It rapidly binds ionized calcium, precipitating severe metabolic alkalosis and tetany.

Answer

It is hypertonic and draws free water out of brain tissue, inducing central pontine myelinolysis.

Answer

It causes rapid vascular expansion, provoking acute left ventricular failure.

Question 2

A 68-year-old patient with small cell lung cancer is admitted to the medical-surgical unit after experiencing two days of worsening lethargy, headache, and confusion. The patient has a medical history of hypertension treated with hydrochlorothiazide. On examination, the patient is disoriented to time and place, mucous membranes appear moist, and there is no peripheral edema or jugular venous distention.

Initial laboratory investigations reveal a serum sodium level of 118 mEq/L (reference range: 135–145 mEq/L), serum potassium of 3.8 mEq/L, serum osmolality of 245 mOsm/kg, and elevated urine sodium and osmolality. The provider diagnoses the syndrome of inappropriate antidiuretic hormone secretion (SIADH).

The primary nurse notes that the patient begins twitching and exhibits coarse tremors. Which complication is this patient at highest immediate risk of developing if the sodium level is not corrected cautiously?

Accepted Answer

Generalized tonic-clonic seizures and cerebral herniation

Answer

Severe metabolic alkalosis with hypocalcemic tetany

Answer

Hyperkalemic cardiac arrest and ventricular fibrillation

Answer

Acute hypovolemic shock and profound circulatory collapse

Question 3

When conducting a standard bedside physical examination of a medical-surgical patient, the nurse assesses the head, eyes, ears, nose, and throat (HEENT). Which finding documented as 'PERRLA' confirms normal ocular physiological function?

Accepted Answer

Pupils equal, round, and reactive to light and accommodation

Answer

Pupils evenly raised, round, and responsive to light application

Answer

Palpebral fissures equal, round, and reactive to light and acuity

Answer

Peripheral eye reflexes responsive to light and alignment

Question 4

A 52-year-old patient presents to the medical-surgical unit complaining of severe, sharp right lower quadrant abdominal pain accompanied by nausea and fever. In applying clinical assessment principles, how should the nurse sequence the physical examination?

Accepted Answer

Perform a focused examination directed at the chief complaint and abdomen before conducting the full review of systems.

Answer

Complete a comprehensive head-to-toe assessment before inspecting the abdomen to maintain routine standardization.

Answer

Palpate the right lower quadrant first to establish baseline pain intensity before assessing other quadrants.

Answer

Avoid any physical assessment until complete diagnostic ultrasound imaging is completed.

Question 5

An adult patient admitted for acute gastroenteritis with protracted vomiting undergoes orthostatic vital sign evaluation. The recorded vital signs across positions are shown in the figure. What physiological alteration do these assessment findings indicate?

Accepted Answer

Intravascular volume depletion

Answer

Cushing's triad

Answer

Increased intracranial pressure

Answer

Autonomic hyperreflexia

Question 6

During an admission psychosocial evaluation on an adult medical-surgical unit, the nurse screens the patient for suicide risk using a bio-psycho-social framework. Which documented finding represents an internal protective factor that decreases suicide risk?

Accepted Answer

Strong personal cultural or spiritual beliefs that discourage suicide

Answer

Access to lethal household prescription medications

Answer

Presence of acute major depression with severe psychic agitation

Answer

Recent prescription of a second sedative-hypnotic agent

Free MEDSURG-BC sample questions

When conducting a standard bedside physical examination of a medical-surgical patient, the nurse assesses the head, eyes, ears, nose, and throat (HEENT). Which finding documented as 'PERRLA' confirms normal ocular physiological function?

A 52-year-old patient presents to the medical-surgical unit complaining of severe, sharp right lower quadrant abdominal pain accompanied by nausea and fever. In applying clinical assessment principles, how should the nurse sequence the physical examination?

An adult patient admitted for acute gastroenteritis with protracted vomiting undergoes orthostatic vital sign evaluation. The recorded vital signs across positions are shown in the figure. What physiological alteration do these assessment findings indicate?

During an admission psychosocial evaluation on an adult medical-surgical unit, the nurse screens the patient for suicide risk using a bio-psycho-social framework. Which documented finding represents an internal protective factor that decreases suicide risk?

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