Medical-Surgical Nursing Questions for the Prometric Exam 2026: 20 MCQs with Answers on Cardiac, Respiratory, Neuro, GI, Renal, Endocrine and Perioperative Nursing

Adult medical-surgical nursing is about a third of the Prometric nursing paper, 45 to 52 questions of 150, and it is where most candidates pass or fail. The questions are organised by system and ask for the priority assessment, the expected finding, the nursing intervention or the complication to anticipate. This set of twenty covers the systems and patterns that recur. The full domain map is in the DHA nursing syllabus.

Cardiovascular

Question 1

A patient with chest pain has ST elevation on ECG. While awaiting transfer for primary PCI, the nurse's priorities include:

1. Encouraging the patient to walk to the toilet
2. Continuous cardiac monitoring with a defibrillator nearby, intravenous access, oxygen only if saturations are below 90%, aspirin and other prescribed antiplatelets, analgesia, and keeping the patient on bed rest
3. Giving a large meal
4. Withholding aspirin until the cardiologist arrives

Answer: B. Ventricular fibrillation is the main early killer in STEMI, hence the monitor and defibrillator. Routine oxygen in non-hypoxic patients is no longer recommended.

Question 2

A patient with heart failure gains 2 kg in two days, has new crackles at the lung bases and increasing breathlessness lying flat. The nurse should:

1. Encourage extra fluids
2. Sit the patient upright, give oxygen if hypoxic, report the weight gain and findings promptly, administer prescribed diuretic, monitor urine output and electrolytes, and reinforce daily weights and fluid restriction
3. Lay the patient flat
4. Give a salt-rich diet

Answer: B. A gain of more than 1 to 2 kg in a few days signals fluid overload. Daily weights are the most sensitive bedside monitor.

Question 3

Six hours after a femoral artery cardiac catheterisation, the puncture site is swelling and the foot is cool with a weak pedal pulse. The nurse should:

1. Apply a warm compress
2. Apply firm pressure above the puncture site, keep the leg straight, check and compare distal pulses, and notify the doctor immediately for possible haematoma or arterial occlusion
3. Sit the patient up
4. Remove the dressing and observe

Answer: B. Neurovascular checks of the limb are hourly after arterial access; bleeding and limb ischaemia are the two complications to catch early.

Respiratory

Question 4

A patient has a chest drain for a pneumothorax. Which finding should the nurse report immediately?

1. Gentle bubbling in the water seal during expiration on day one
2. The drainage system disconnecting from the chest tube, or sudden cessation of fluctuation with worsening breathlessness and tracheal deviation
3. Fluctuation of the water seal with breathing
4. Drainage of 50 mL of serous fluid over 8 hours

Answer: B. Fluctuation is normal while the lung is re-expanding; a disconnected system is managed by placing the tube end in sterile water and reconnecting, and a blocked tube with tension signs is an emergency. Tubes are never clamped during transport.

Question 5

A COPD patient's saturations are 86% on room air. The target saturation range and oxygen approach are:

1. 98 to 100% on a non-rebreather mask
2. 88 to 92% using controlled oxygen via a Venturi mask or low-flow nasal cannula, with an arterial blood gas to check for hypercapnia
3. No oxygen at all
4. 15 L/min continuously

Answer: B. Excess oxygen in hypercapnic COPD patients suppresses respiratory drive and worsens acidosis.

Question 6

Which position best improves oxygenation for a patient with acute respiratory distress, if haemodynamically stable?

1. Supine, flat
2. High Fowler's (sitting upright) or, for unilateral lung disease, lying with the good lung down
3. Trendelenburg
4. Prone without assessment

Answer: B. "Good lung down" improves ventilation-perfusion matching; prone positioning is used in ARDS under critical care protocols.

Neurological

Question 7

A patient after a head injury has a GCS that falls from 14 to 11, with a sluggish, dilating right pupil and a rising blood pressure with bradycardia. The nurse should:

1. Document and recheck in an hour
2. Recognise signs of raised intracranial pressure and possible herniation (Cushing's response), notify the doctor immediately, keep the head of bed at 30 degrees with the neck neutral, avoid hypoxia and hypercapnia, and prepare for urgent CT
3. Lay the patient flat
4. Give a sedative

Answer: B. A drop of two or more GCS points is reported immediately. Hypertension with bradycardia and irregular breathing is a late, ominous sign.

Question 8

A stroke patient has a right hemiparesis and failed a bedside swallow screen. The nurse should:

1. Give thin fluids with a straw
2. Keep the patient nil by mouth, including oral medication, until formal swallow assessment, maintain hydration by the prescribed route, and position upright for any oral intake once cleared
3. Give a normal diet
4. Feed the patient lying flat

Answer: B. Aspiration pneumonia is a leading cause of death after stroke. Swallow screening precedes any oral intake.

Question 9

During a tonic-clonic seizure on the ward, the nurse should:

1. Restrain the limbs and put a spatula in the mouth
2. Protect the head, move hazards away, note the time, turn the patient to the side as soon as possible, give prescribed rescue benzodiazepine if the seizure exceeds 5 minutes, and call for help; afterwards check airway, glucose and injuries
3. Leave the patient to find a doctor
4. Give oral medication during the seizure

Answer: B. Nothing is put in the mouth. Timing the seizure determines when status epilepticus treatment begins.

Gastrointestinal and renal

Question 10

A patient vomits bright red blood and has a pulse of 120 and blood pressure of 90/60 mmHg. The nurse's immediate actions include:

1. Giving oral fluids
2. Calling for help, two large-bore IV cannulae, bloods including crossmatch, oxygen, keeping nil by mouth, monitoring vital signs frequently and preparing for urgent endoscopy, with blood products as prescribed
3. Sitting the patient in a chair
4. Giving antacids

Answer: B. Upper GI bleeding with shock is resuscitated before endoscopy; a Glasgow-Blatchford score guides urgency.

Question 11

Two days after formation of a new ileostomy, the stoma is dusky purple and dry. The nurse should:

1. Document as normal
2. Report immediately, because a dusky or black stoma indicates ischaemia; a healthy stoma is pink, red and moist
3. Apply ice
4. Irrigate the stoma

Answer: B. Ileostomy output is liquid and high volume, so dehydration and potassium loss are monitored; the appliance is cut to fit to protect peristomal skin.

Question 12

A patient has a serum potassium of 6.5 mmol/L and peaked T waves. The nurse should expect to administer first:

1. Oral potassium
2. Intravenous calcium gluconate to protect the heart, then insulin with dextrose and nebulised salbutamol to shift potassium into cells, with continuous cardiac monitoring and preparation for dialysis if indicated
3. Furosemide alone
4. Sodium chloride 0.9% bolus

Answer: B. Potassium-containing fluids and drugs are stopped; a repeat level is sent to exclude haemolysis if the result is unexpected.

Question 13

A patient returning from haemodialysis has an arteriovenous fistula in the left arm. Which nursing action is correct?

1. Take blood pressure in the left arm
2. Never use the fistula arm for blood pressure, venepuncture or cannulation; check for a thrill and bruit each shift, and report bleeding, absent thrill or signs of infection
3. Apply a tight dressing over the fistula
4. Elevate the arm with a sling

Answer: B. A fistula is the patient's lifeline; limb-alert signage and patient education protect it.

Endocrine

Question 14

A patient with type 1 diabetes has a blood glucose of 25 mmol/L, Kussmaul breathing, abdominal pain and ketones of 4 mmol/L. The nurse anticipates:

1. Subcutaneous insulin and discharge
2. Diabetic ketoacidosis management: intravenous fluids, fixed-rate intravenous insulin, hourly glucose and ketones, potassium replacement guided by levels, cardiac monitoring, and glucose added to fluids when blood glucose falls below 14 mmol/L
3. Oral hypoglycaemics
4. Fluid restriction

Answer: B. Potassium falls as insulin acts; replacement starts once the level is below about 5.5 mmol/L and urine output is adequate.

Question 15

A conscious patient on insulin is sweating, shaking and confused with a glucose of 2.8 mmol/L. The nurse should:

1. Give insulin
2. Give 15 to 20 g of fast-acting carbohydrate (glucose tablets, gel or juice), recheck in 15 minutes and repeat if needed, then a longer-acting carbohydrate; use IM glucagon or IV dextrose if the patient cannot swallow
3. Give a large meal only
4. Wait for the doctor

Answer: B. Hypoglycaemia below 4 mmol/L is treated immediately; the cause (missed meal, excess insulin, exercise) is reviewed afterwards.

Question 16

After a total thyroidectomy, which finding should the nurse report urgently?

1. Mild throat discomfort
2. Tingling around the mouth and fingers, muscle cramps or a positive Chvostek sign, indicating hypocalcaemia, or any neck swelling, stridor or voice change
3. A temperature of 37.2 °C
4. Thirst

Answer: B. Parathyroid injury causes hypocalcaemia within 24 to 72 hours; calcium gluconate is kept available. A neck haematoma is an airway emergency.

Musculoskeletal, perioperative and oncology

Question 17

After a posterior-approach total hip replacement, the nurse teaches the patient to avoid:

1. Walking with a frame
2. Hip flexion beyond 90 degrees, crossing the legs (adduction) and internal rotation, using a raised toilet seat and an abduction pillow in bed
3. Ankle pumping exercises
4. Sleeping on the back

Answer: B. Dislocation precautions depend on the approach; always check the surgeon's protocol. Pharmacological VTE prophylaxis continues for about five weeks.

Question 18

A patient in a plaster cast for a tibial fracture reports increasing pain unrelieved by analgesia, with pain on passive toe stretch and tightness. The nurse should:

1. Elevate the leg above the heart and give more analgesia
2. Suspect compartment syndrome, keep the limb at heart level, notify the doctor immediately so the cast can be split to skin, and prepare for possible fasciotomy; do not wait for pulse loss
3. Apply ice over the cast
4. Reassure that pain is normal

Answer: B. Pain out of proportion is the earliest sign; pulses are lost late. Elevation above the heart reduces perfusion.

Question 19

On the first postoperative day after abdominal surgery, which intervention most reduces the risk of atelectasis and pneumonia?

1. Strict bed rest
2. Adequate analgesia, deep breathing and coughing exercises with wound support, incentive spirometry, and early mobilisation
3. Oxygen 15 L/min for 24 hours
4. Nil by mouth for three days

Answer: B. Pain control enables breathing exercises and mobilisation, which also reduce VTE and ileus.

Question 20

A patient on chemotherapy has a neutrophil count of 0.4 × 10⁹/L and a temperature of 38.3 °C. The nurse should:

1. Give paracetamol and recheck in four hours
2. Treat as neutropenic sepsis: notify the doctor immediately, obtain blood cultures and start intravenous broad-spectrum antibiotics within one hour, monitor vital signs closely and apply protective isolation measures
3. Encourage visitors with flowers
4. Give a rectal temperature check

Answer: B. Neutropenic sepsis kills within hours; rectal procedures are avoided because of the risk of bacteraemia.

How to practise

• Work the systems in blueprint order, cardiac and respiratory first, with 40 to 50 questions a day and an error log.
• For every condition learn four things: priority assessment, expected finding, nursing action, complication to report.
• Know the numbers: target saturations, GCS thresholds, potassium and glucose cut-offs, weight gain limits.

The Registered Nurse bank has medical-surgical chapters by system with explanations; related sets are the nursing sample questions, pharmacology questions and high-yield topics. The plan is in DHA nursing exam preparation online.

Frequently asked questions

How many medical-surgical questions are in the Prometric nursing exam?

About 45 to 52 of 150, the largest domain on the paper.

Which systems come up most?

Cardiovascular, respiratory and endocrine, followed by neurological, GI and renal, with perioperative care across all of them.

Are the questions scenario-based?

Yes. Most describe a patient and ask for the priority action, the finding to report or the correct intervention.

Is the medical-surgical content the same for DHA and SCFHS?

Yes. The blueprint is shared across the Gulf authorities, so one preparation covers all.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.