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Medical-Surgical Nursing & ICU (Nursing & Patient Care) Solved Questions & Notes (2026) - Apex Rankers

Medical & Health Sciences > Nursing & Patient Care > Medical-Surgical Nursing & ICU

38 Total Solved Questions
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Medical-Surgical Nursing & ICU

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Q. 1 Nursing
Difficulty: Medium (1 Mark)
A patient with a water-seal chest drainage system has continuous vigorous bubbling in the water-seal chamber. What does this finding indicate to the nurse?
A
Normal expected function during deep inspiration
B
An air leak in the chest tube system or patient's pleural space
✓ Correct
C
The lung has fully expanded
D
The suction pressure is too low
💡 Step-by-Step Explanation & Concept Rationale
Intermittent tidaling/bubbling with coughing is normal, but continuous bubbling in the water-seal chamber indicates a leak in the drainage apparatus or persistent pneumothorax.
Q. 2 Nursing
Difficulty: Easy (1 Mark)
During a blood transfusion, the patient complains of chills, back pain, fever, and shortness of breath 10 minutes into the infusion. What is the immediate priority nursing action?
A
Slow the transfusion rate and check vital signs
B
Stop the transfusion immediately and keep the IV line open with normal saline
✓ Correct
C
Administer oral paracetamol and continue
D
Call the blood bank to check crossmatch
💡 Step-by-Step Explanation & Concept Rationale
At the first sign of an acute hemolytic or severe transfusion reaction, the transfusion must be stopped immediately to minimize foreign antigen exposure while maintaining IV access with fresh tubing and 0.9% saline.
Q. 3 Nursing
Difficulty: Easy (1 Mark)
Which clinical sign elicited by tapping the facial nerve anterior to the earlobe produces facial twitching, indicating hypocalcemia in a post-thyroidectomy patient?
A
Trousseau sign
B
Chvostek sign
✓ Correct
C
Romberg sign
D
Homan sign
💡 Step-by-Step Explanation & Concept Rationale
Chvostek's sign is unprovoked or percussion-induced twitching of the circumoral and facial muscles caused by neuromuscular hyperexcitability from hypocalcemia.
Q. 4 Nursing
Difficulty: Easy (1 Mark)
The Glasgow Coma Scale (GCS) evaluates neurological responsiveness across which three behavioral domains?
A
Pupillary response, deep tendon reflexes, cranial nerves
B
Eye opening, verbal response, and motor response
✓ Correct
C
Blood pressure, heart rate, respiratory rate
D
Orientation, memory, abstract thinking
💡 Step-by-Step Explanation & Concept Rationale
The Glasgow Coma Scale assesses Eye Opening (1-4), Verbal Response (1-5), and Motor Response (1-6) for a score ranging from 3 (deep coma) to 15 (fully alert).
Q. 5 Nursing
Difficulty: Easy (1 Mark)
In a patient with deep vein thrombosis (DVT) in the left calf, which nursing intervention is STRICTLY contraindicated?
A
Bed rest with leg elevation
B
Massaging or rubbing the affected calf muscle
✓ Correct
C
Monitoring coagulation parameters
D
Administering prescribed anticoagulation
💡 Step-by-Step Explanation & Concept Rationale
Vigorously massaging or rubbing the affected extremity can dislodge the thrombus, precipitating potentially fatal pulmonary embolism.
Q. 6 Nursing
Difficulty: Easy (1 Mark)
What is the primary post-operative nursing rationale for encouraging early ambulation and deep breathing exercises following major abdominal surgery?
A
To increase urinary output
B
To prevent atelectasis, pneumonia, and deep vein thrombosis
✓ Correct
C
To decrease wound healing time
D
To replace intravenous fluids
💡 Step-by-Step Explanation & Concept Rationale
Early ambulation promotes venous return to prevent DVT and stimulates diaphragmatic movement to reverse alveolar collapse (atelectasis) and prevent hypostatic pneumonia.
Q. 7 Nursing
Difficulty: Easy (1 Mark)
Which of the following is the most characteristic early clinical indicator of developing hypovolemic shock?
A
Severe bradycardia
B
Tachycardia and mild tachypnea with cool, clammy skin
✓ Correct
C
Profound hypertension
D
Flushed warm extremities
💡 Step-by-Step Explanation & Concept Rationale
Compensatory tachycardia and peripheral vasoconstriction (cool, clammy skin) occur early in hypovolemia as sympathetic activation attempts to maintain cardiac output before blood pressure falls.
Q. 8 Nursing
Difficulty: Medium (1 Mark)
For an unconscious patient with a tracheostomy, what is the maximum recommended duration for a single endotracheal suctioning pass to prevent severe hypoxia?
A
5 to 10 seconds
B
10 to 15 seconds
✓ Correct
C
25 to 30 seconds
D
45 seconds
💡 Step-by-Step Explanation & Concept Rationale
Suction passes should not exceed 10 to 15 seconds to prevent suction-induced hypoxia, bradycardia, and mucosal trauma; hyperoxygenation before and after is essential.
Q. 9 Nursing
Difficulty: Easy (1 Mark)
In a diabetic patient who becomes confused, diaphoresis, shaky, and tachycardia with a capillary blood glucose of 45 mg/dL, what is the immediate nursing intervention if conscious?
A
Administer 10 units of regular insulin subcutaneous
B
Administer 15-20 grams of fast-acting oral carbohydrates (e.g., fruit juice or glucose tablets)
✓ Correct
C
Place the patient in Trendelenburg position
D
Encourage the patient to sleep
💡 Step-by-Step Explanation & Concept Rationale
The 'Rule of 15' dictates giving 15-20 g of simple fast-acting carbohydrate (half cup fruit juice or 3-4 glucose tablets) for mild-to-moderate hypoglycemia, rechecking glucose after 15 minutes.
Q. 10 Nursing
Difficulty: Medium (1 Mark)
Which clinical observation is the earliest and most sensitive sign of increasing intracranial pressure (ICP)?
A
Fixed, dilated pupils
B
Change in the level of consciousness (restlessness, lethargy, confusion)
✓ Correct
C
Cushing's triad (bradycardia, hypertension, irregular breathing)
D
Decerebrate posturing
💡 Step-by-Step Explanation & Concept Rationale
Altered level of consciousness is the most sensitive early indicator of rising ICP; pupillary changes and Cushing's triad are late signs indicating imminent brainstem herniation.
Q. 11 Nursing
Difficulty: Easy (1 Mark)
A patient who underwent a total thyroidectomy 24 hours ago reports numbness and tingling around the mouth and fingers. The nurse suspects:
A
Thyroid storm
B
Hypocalcemia due to accidental parathyroid injury or excision
✓ Correct
C
Laryngeal edema
D
Hyperglycemia
💡 Step-by-Step Explanation & Concept Rationale
Perioral paresthesias and carpopedal spasm are classic early manifestations of hypocalcemia following thyroidectomy.
Q. 12 Nursing
Difficulty: Medium (1 Mark)
In a patient with chronic obstructive pulmonary disease (COPD), why should high-flow oxygen (>4-5 L/min) generally be avoided unless critically indicated?
A
It triggers severe pulmonary fibrosis
B
It blunts the hypoxic respiratory drive in chronically hypercapnic patients
✓ Correct
C
It increases risk of pneumothorax
D
It promotes hypothermia
💡 Step-by-Step Explanation & Concept Rationale
Patients with severe chronic hypercapnia may rely on hypoxemia to drive respiration; excessive oxygen can eliminate this hypoxic drive and worsen CO2 retention.
Q. 13 Nursing
Difficulty: Medium (1 Mark)
Which electrocardiographic (ECG) change is typically observed in severe hyperkalemia (serum potassium > 6.5 mEq/L)?
A
Prominent U waves
B
Tall, peaked, symmetric T waves and widened QRS complexes
✓ Correct
C
ST segment depression
D
Shortened PR interval
💡 Step-by-Step Explanation & Concept Rationale
Hyperkalemia accelerates repolarization, causing narrow peaked 'tent-like' T waves, followed by PR prolongation, QRS widening, and sinusoidal arrest.
Q. 14 Nursing
Difficulty: Easy (1 Mark)
When caring for a patient following a lumbar puncture, which nursing instruction is most critical to prevent post-dural puncture headache?
A
Encourage the patient to walk immediately
B
Maintain flat supine bed rest for 4 to 6 hours and encourage oral hydration
✓ Correct
C
Administer high-dose opioids
D
Apply warm compresses to neck
💡 Step-by-Step Explanation & Concept Rationale
Lying flat minimizes CSF leakage through the dural puncture site, decreasing intracranial hypotension and spinal headache.
Q. 15 Nursing
Difficulty: Easy (1 Mark)
What is the primary nursing consideration when administering intravenous Potassium Chloride (KCl)?
A
It can be given as a rapid IV push in emergencies
B
It must NEVER be administered as an IV push or bolus (must be diluted and infused slowly via infusion pump)
✓ Correct
C
It should be given intramuscularly
D
It is infused with blood products
💡 Step-by-Step Explanation & Concept Rationale
Direct IV push of potassium chloride causes immediate fatal ventricular fibrillation and cardiac arrest; it must always be thoroughly diluted and infused at a controlled rate.
Q. 16 Nursing
Difficulty: Easy (1 Mark)
In an adult patient experiencing a generalized tonic-clonic seizure, what is the primary nursing safety action?
A
Force an airway or bite block between the teeth
B
Protect the patient's head from trauma and turn the patient into lateral recovery position to prevent aspiration
✓ Correct
C
Restrain the patient's limbs firmly
D
Administer oral water immediately
💡 Step-by-Step Explanation & Concept Rationale
During a seizure, the nurse must never restrain the patient or insert objects into the mouth; turning the patient on their side maintains an open airway and drains oral secretions.
Q. 17 Nursing
Difficulty: Medium (1 Mark)
A postoperative patient with a cast on the right forearm reports severe, unrelieved, burning pain out of proportion to injury, with pallor and paresthesia. The nurse suspects:
A
Normal postoperative swelling
B
Acute compartment syndrome
✓ Correct
C
Cast loosening
D
Phantom limb pain
💡 Step-by-Step Explanation & Concept Rationale
The '6 Ps' (Pain out of proportion, Paresthesia, Pallor, Poikilothermia, Pulselessness, Paralysis) indicate acute compartment syndrome, requiring immediate cast bivalving or fasciotomy.
Q. 18 Nursing
Difficulty: Medium (1 Mark)
What is the priority nursing assessment in a patient receiving intravenous magnesium sulfate for pre-eclampsia to detect toxicity?
A
Serum albumin level
B
Presence of deep tendon reflexes (patellar reflex), respiratory rate (>12 bpm), and urine output (>30 mL/hr)
✓ Correct
C
Blood glucose level
D
Body temperature
💡 Step-by-Step Explanation & Concept Rationale
Loss of deep tendon reflexes is the earliest sign of magnesium toxicity, followed by respiratory depression and cardiac arrest; Calcium Gluconate must be available.
Q. 19 Nursing
Difficulty: Easy (1 Mark)
In a patient diagnosed with acute pancreatitis, which body position is typically most comfortable in relieving severe epigastric pain?
A
Flat supine
B
Fetal position (leaning forward with knees drawn up)
✓ Correct
C
Trendelenburg
D
Prone position
💡 Step-by-Step Explanation & Concept Rationale
Sitting up and leaning forward or lying in the fetal position decreases tension on the retroperitoneum and relieves pancreatic pain.
Q. 20 Nursing
Difficulty: Medium (1 Mark)
Which clinical finding in a patient with a closed head injury indicates Cushing's triad, signaling dangerously high intracranial pressure?
A
Hypotension, tachycardia, and tachypnea
B
Severe hypertension with widening pulse pressure, bradycardia, and irregular respirations
✓ Correct
C
Fever, chills, and diarrhea
D
Hypotension and bradycardia
💡 Step-by-Step Explanation & Concept Rationale
Cushing's triad is a life-threatening late sign of brainstem herniation characterized by systolic hypertension, bradycardia, and bradypnea/Cheyne-Stokes breathing.
Q. 21 Nursing
Difficulty: Medium (1 Mark)
Clinical Scenario 2: In managing a specialized nursing procedure for Medical-Surgical Nursing & ICU, which clinical standard ensures optimal patient safety and outcome?
A
Adhere strictly to aseptic technique, continuous vital signs monitoring, and documentation of patient tolerance
✓ Correct
B
Bypass safety checklists to expedite bedside care
C
Delegate patient assessment to non-clinical orderlies
D
Administer medication without checking physician orders
💡 Step-by-Step Explanation & Concept Rationale
Adherence to institutional aseptic guidelines, rigorous monitoring of patient physiological responses, and precise charting constitute the gold standard of professional nursing accountability.
Q. 22 Nursing
Difficulty: Medium (1 Mark)
Clinical Scenario 6: In managing a specialized nursing procedure for Medical-Surgical Nursing & ICU, which clinical standard ensures optimal patient safety and outcome?
A
Adhere strictly to aseptic technique, continuous vital signs monitoring, and documentation of patient tolerance
✓ Correct
B
Bypass safety checklists to expedite bedside care
C
Delegate patient assessment to non-clinical orderlies
D
Administer medication without checking physician orders
💡 Step-by-Step Explanation & Concept Rationale
Adherence to institutional aseptic guidelines, rigorous monitoring of patient physiological responses, and precise charting constitute the gold standard of professional nursing accountability.
Q. 23 Nursing
Difficulty: Medium (1 Mark)
Clinical Scenario 10: In managing a specialized nursing procedure for Medical-Surgical Nursing & ICU, which clinical standard ensures optimal patient safety and outcome?
A
Adhere strictly to aseptic technique, continuous vital signs monitoring, and documentation of patient tolerance
✓ Correct
B
Bypass safety checklists to expedite bedside care
C
Delegate patient assessment to non-clinical orderlies
D
Administer medication without checking physician orders
💡 Step-by-Step Explanation & Concept Rationale
Adherence to institutional aseptic guidelines, rigorous monitoring of patient physiological responses, and precise charting constitute the gold standard of professional nursing accountability.
Q. 24 Nursing
Difficulty: Medium (1 Mark)
Clinical Scenario 14: In managing a specialized nursing procedure for Medical-Surgical Nursing & ICU, which clinical standard ensures optimal patient safety and outcome?
A
Adhere strictly to aseptic technique, continuous vital signs monitoring, and documentation of patient tolerance
✓ Correct
B
Bypass safety checklists to expedite bedside care
C
Delegate patient assessment to non-clinical orderlies
D
Administer medication without checking physician orders
💡 Step-by-Step Explanation & Concept Rationale
Adherence to institutional aseptic guidelines, rigorous monitoring of patient physiological responses, and precise charting constitute the gold standard of professional nursing accountability.
Q. 25 Nursing
Difficulty: Medium (1 Mark)
Clinical Scenario 18: In managing a specialized nursing procedure for Medical-Surgical Nursing & ICU, which clinical standard ensures optimal patient safety and outcome?
A
Adhere strictly to aseptic technique, continuous vital signs monitoring, and documentation of patient tolerance
✓ Correct
B
Bypass safety checklists to expedite bedside care
C
Delegate patient assessment to non-clinical orderlies
D
Administer medication without checking physician orders
💡 Step-by-Step Explanation & Concept Rationale
Adherence to institutional aseptic guidelines, rigorous monitoring of patient physiological responses, and precise charting constitute the gold standard of professional nursing accountability.
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