Create 10 mcq of medical surgical nursing for Nursing Officer Exams
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I have enough foundational knowledge from the medical library and my training to create high-quality, exam-relevant MCQs. Here are 10 Medical-Surgical Nursing MCQs for Nursing Officer Exams:
Medical-Surgical Nursing - 10 MCQs for Nursing Officer Exam
Q1. A patient returns from the recovery room after an abdominal surgery. Which position is MOST appropriate for this patient in the immediate post-operative period?
- A) Prone position
- B) Trendelenburg position
- C) Lateral (recovery) position with head slightly elevated
- D) Lithotomy position
Answer: C
Rationale: The lateral/semi-prone recovery position with head slightly elevated (15-30°) prevents aspiration of vomitus, maintains airway patency, and promotes drainage of secretions in an unconscious or semiconscious post-operative patient.
Q2. A nurse is caring for a patient with a nasogastric (NG) tube on continuous low suction. Which electrolyte imbalance is MOST likely to develop?
- A) Hyperkalemia
- B) Hypernatremia
- C) Metabolic alkalosis with hypokalemia
- D) Metabolic acidosis with hyperkalemia
Answer: C
Rationale: Continuous gastric suctioning removes hydrochloric acid (HCl) and potassium-rich gastric juice, leading to metabolic alkalosis and hypokalemia. This is a classic complication nurses must monitor.
Q3. A patient with a fresh colostomy asks why the stoma is bright red. What is the BEST nursing response?
- A) "This indicates infection; I will notify the doctor immediately."
- B) "A healthy stoma is moist and bright red or pink due to its rich blood supply."
- C) "The redness will fade to pale pink within 24 hours."
- D) "This is caused by the antiseptic solution used during surgery."
Answer: B
Rationale: A healthy, well-perfused stoma is moist and bright red or beefy pink, similar to the inside of the cheek. A pale, dusky, or dark stoma indicates ischemia and requires immediate reporting.
Q4. A nurse is caring for a patient with a closed chest drainage system (underwater seal drain). The water in the water-seal chamber is fluctuating (tidaling) with respirations. What does this indicate?
- A) An air leak in the system
- B) The drain is functioning properly
- C) The lung has fully re-expanded
- D) The drain is blocked by clots
Answer: B
Rationale: Tidaling (fluctuation of the water level in the water-seal chamber with breathing) indicates the system is patent and functioning. Fluctuation stops when the lung fully re-expands OR if the tubing is kinked/blocked.
Q5. Which nursing intervention takes HIGHEST priority when caring for a patient in hypovolemic shock?
- A) Administer oxygen and establish IV access for fluid resuscitation
- B) Obtain a 12-lead ECG
- C) Insert a urinary catheter to monitor urine output
- D) Obtain blood cultures before starting treatment
Answer: A
Rationale: In hypovolemic shock, the priority is airway/oxygenation and restoring circulating volume via IV fluid resuscitation. Using the ABCs (Airway, Breathing, Circulation) framework, oxygen and IV access are the immediate first steps.
Q6. A patient is post-operative day 1 following a total knee replacement. The nurse notices the patient's calf is swollen, warm, and painful on dorsiflexion of the foot. What is the MOST likely complication and the PRIORITY nursing action?
- A) Wound infection; apply warm compress
- B) Deep vein thrombosis (DVT); keep the leg elevated and notify the physician
- C) Compartment syndrome; release the bandage immediately
- D) Arterial occlusion; begin passive ROM exercises
Answer: B
Rationale: Calf swelling, warmth, pain, and a positive Homans' sign (pain on dorsiflexion) are classic signs of DVT, a common complication after orthopedic surgery. The nurse should elevate the limb, avoid massaging, and immediately notify the physician for diagnostic confirmation (Doppler ultrasound) and anticoagulation therapy.
Q7. When caring for a patient receiving a blood transfusion who develops fever, chills, and lumbar pain 15 minutes after starting the transfusion, the nurse's FIRST action should be:
- A) Slow the transfusion rate and administer antihistamines
- B) Stop the transfusion, keep the IV line open with normal saline, and notify the physician
- C) Continue the transfusion and give paracetamol for fever
- D) Discontinue the IV entirely and send the patient for investigations
Answer: B
Rationale: Fever, chills, and lumbar/back pain indicate a possible hemolytic transfusion reaction (an emergency). The transfusion must be STOPPED IMMEDIATELY. The IV line is kept patent with 0.9% normal saline (do NOT flush blood into the patient). The blood bag and tubing are sent to the blood bank, and the physician is notified urgently.
Q8. A patient has a plaster of Paris (POP) cast applied to the forearm after a Colles' fracture. Four hours later, the patient reports severe pain, and the fingers appear pale and cold. Which complication does the nurse suspect?
- A) Wound infection beneath the cast
- B) Compartment syndrome
- C) Reflex sympathetic dystrophy
- D) Volkmann's ischemic contracture (late stage)
Answer: B
Rationale: Severe pain (especially on passive stretch), pallor, coldness, paresthesia, and absent pulse are the "6 Ps" of compartment syndrome - a surgical emergency. The nurse must notify the physician immediately; a fasciotomy may be required. Volkmann's contracture is the late irreversible complication of an untreated compartment syndrome.
Q9. A nurse is preparing to administer a dose of digoxin 0.25 mg to a patient. Before giving the dose, which assessment is MOST important?
- A) Measure blood pressure
- B) Check the serum potassium level and apical pulse for one full minute
- C) Assess the respiratory rate
- D) Check urine output for the last 8 hours
Answer: B
Rationale: Digoxin toxicity is potentiated by hypokalemia (K+ < 3.5 mEq/L). The nurse must check serum potassium levels before administration. The apical pulse must be counted for a full minute - digoxin should be withheld if the pulse is < 60 bpm (adults) and the physician notified.
Q10. A patient is 2 days post-appendectomy and develops a temperature of 38.8°C, productive cough, and decreased breath sounds at the right base. The MOST likely cause is:
- A) Wound infection
- B) Urinary tract infection
- C) Atelectasis/post-operative pneumonia
- D) Deep vein thrombosis
Answer: C
Rationale: Fever on post-operative day 2 with respiratory signs (cough, decreased breath sounds) strongly suggests atelectasis or pneumonia - the most common early post-operative complication. It results from shallow breathing, immobility, and suppression of the cough reflex. Nursing interventions include deep breathing exercises, incentive spirometry, early ambulation, and positioning.
Quick Reference - Post-Operative Fever Timing Rule ("5 Ws"):
| Day | Cause |
|---|---|
| Day 1-2 | Wind - Atelectasis/pneumonia |
| Day 3-5 | Water - UTI |
| Day 5-7 | Wound - Surgical site infection |
| Day 5+ | Walk - DVT/PE |
| Any time | Wonder drugs - Drug fever |
These 10 questions cover core medical-surgical nursing competencies tested in Nursing Officer Exams: post-operative care, cardiac medications, blood transfusion reactions, chest drain management, orthopedic complications, shock management, ostomy care, and electrolyte imbalances. Each answer includes the clinical rationale to reinforce understanding.
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