Test Bank for Medical-Surgical Nursing Concepts and Practice 6 th Edition by Holly Stromberg

Clinical competence in medical-surgical nursing isn’t built in a single study session. It’s built question by question, patient by patient, decision by decision.

Med-surg is where the full scope of human illness meets the full depth of nursing knowledge. You need to know cardiovascular pathophysiology as fluently as postoperative wound assessment. You manage a patient in respiratory distress in one room and diabetes education in the next. You recognize early sepsis before the cultures return, defuse a patient’s anxiety before it becomes a safety problem, and delegate safely on a unit where everyone is stretched thin.

It is also a large share of the NCLEX-RN, and the setting that shapes some of the most well-rounded nurses in healthcare.

This test bank accompanies the 6th Edition of Medical-Surgical Nursing: Concepts and Practice by Holly Stromberg, a widely used, concept-driven med-surg text in undergraduate nursing education. It gives you rigorous, systems-based, clinically applied practice for every chapter. Use it for unit exams, course finals, ATI assessments, or NCLEX-RN preparation.

Table of Contents

UNIT I MEDICAL-SURGICAL NURSING SETTINGS

1. Caring for Medical-Surgical Patients
2. Critical Thinking, Clinical Judgment, and the Nursing Process

UNIT II MEDICAL-SURGICAL PATIENT CARE PROBLEMS

3. Fluids, Electrolytes, Acid-Base Balance, and Intravenous Therapy
4. Care of Preoperative and Intraoperative Surgical Patients
5. Care of Postoperative Surgical Patients
6. Infection Prevention and Control
7. Care of Patients With Pain
8. Care of Patients With Cancer
9. Chronic Illness and End-of-Life Care

UNIT III IMMUNE SYSTEM

10. The Immune and Lymphatic Systems
11. Care of Patients With Immune and Lymphatic Disorders

UNIT IV RESPIRATORY SYSTEM

12. The Respiratory System
13. Care of Patients With Disorders of the Upper Respiratory System
14. Care of Patients With Disorders of the Lower Respiratory System

UNIT V HEMATOLOGIC SYSTEM

15. The Hematologic System
16. Care of Patients With Hematologic Disorders

UNIT VI CARDIOVASCULAR SYSTEM

17. The Cardiovascular System
18. Care of Patients With Hypertension and Peripheral Vascular Disease
19. Care of Patients With Cardiac Disorders
20. Care of Patients With Coronary Artery Disease and Cardiac Surgery

UNIT VII NEUROLOGIC SYSTEM

21. The Neurologic System
22. Care of Patients With Head and Spinal Cord Injuries
23. Care of Patients With Brain Disorders
24. Care of Patients With Peripheral Nerve and Degenerative Neurologic Disorders

UNIT VIII SENSORY SYSTEM

25. The Sensory System: Eye
26. The Sensory System: Ear

UNIT IX GASTROINTESTINAL SYSTEM

27. The Gastrointestinal System
28. Care of Patients With Disorders of the Upper Gastrointestinal System
29. Care of Patients With Disorders of the Lower Gastrointestinal System
30. Care of Patients With Disorders of the Gallbladder, Liver, and Pancreas

UNIT X MUSCULOSKELETAL SYSTEM

31. The Musculoskeletal System
32. Care of Patients With Musculoskeletal and Connective Tissue Disorders

UNIT XI URINARY SYSTEM

33. The Urinary System
34. Care of Patients With Disorders of the Urinary System

UNIT XII ENDOCRINE SYSTEM

35. The Endocrine System
36. Care of Patients With Pituitary, Thyroid, Parathyroid, and Adrenal Disorders
37. Care of Patients With Diabetes and Hypoglycemia

UNIT XIII REPRODUCTIVE SYSTEM

38. The Reproductive System
39. Care of Females With Reproductive Disorders
40. Care of Males With Reproductive Disorders
41. Care of Patients With Sexually Transmitted Infections

UNIT XIV INTEGUMENTARY SYSTEM

42. The Integumentary System
43. Care of Patients With Integumentary Disorders and Burns

UNIT XV EMERGENCY AND DISASTER MANAGEMENT

44. Care of Patients in Disasters or Bioterrorism Attacks
45. Care of Patients With Emergent Conditions, Trauma, and Shock

UNIT XVI MENTAL HEALTH NURSING OF THE ADULT

46. Care of Patients With Cognitive Function Disorders
47. Care of Patients With Anxiety, Mood, and Eating Disorders
48. Care of Patients With Substance-Related and Addictive Disorders
49. Care of Patients With Thought and Personality Disorders

What’s Inside

• Hundreds of practice questions mapped to every chapter
• Multiple-choice, select-all-that-apply, priority, delegation, and Next Generation NCLEX-style scenario questions
• Complete answer keys with pathophysiologically grounded rationales
• Alignment with current NCLEX-RN and Next Generation NCLEX standards
• Coverage of all major body systems, surgical nursing concepts, and evidence-based med-surg practice, aligned with the 6th Edition

Who It’s For

• Undergraduate RN students in med-surg courses using Stromberg’s 6th Edition
• NCLEX-RN candidates reviewing med-surg content
• LPN-to-RN bridge students
• Nursing faculty writing 6th Edition-aligned exams and unit assessments
• Accelerated BSN and second-degree students
• New graduate nurses consolidating med-surg skills
• Students preparing for ATI med-surg assessments

Topics Covered

• Foundations of medical-surgical nursing and evidence-based practice
• Fluid, electrolyte, and acid-base balance and clinical imbalances
• Perioperative nursing: preoperative, intraoperative, and postoperative care
• Pain: acute and chronic assessment and evidence-based management
• Oncology nursing and cancer care management
• Immune disorders: HIV/AIDS, autoimmune, and allergy conditions
• Integumentary disorders and wound management
• Sensory disorders: ophthalmic and auditory conditions
• Musculoskeletal disorders and orthopedic nursing care
• Neurological disorders: stroke, TBI, seizures, and neurodegenerative conditions
• Cardiovascular disorders: heart failure, ACS, dysrhythmias, and vascular conditions
• Hematological disorders: anemia, clotting disorders, and blood dyscrasias
• Respiratory disorders: pneumonia, COPD, asthma, and acute respiratory failure
• Gastrointestinal disorders and hepatobiliary conditions
• Endocrine disorders: diabetes mellitus, thyroid disease, and adrenal conditions
• Renal and urological disorders and chronic kidney disease
• Reproductive system disorders and sexually transmitted infections
• Mental health considerations in the medical-surgical setting

Why This Test Bank Delivers Results

Stromberg’s text is built on the idea that students learn best when clinical concepts are made concrete, when pathophysiology is tied directly to nursing assessment and intervention, and when the volume of med-surg content is organized to support understanding rather than rote memorization. This test bank extends that approach with applied clinical thinking.

Its questions go beyond recall. You’ll be asked to:

• Identify the earliest sign of increased intracranial pressure before herniation and name the assessment parameter that warns of it.
• Decide which of four assigned patients to assess first, based on the clinical data given rather than which diagnosis sounds most serious.
• Distinguish expected postoperative findings from early warning signs of complications after abdominal surgery.
• Make a safe delegation decision when scope-of-practice boundaries are tested.

These are the judgments the NCLEX tests and the decisions that protect patients. The test bank builds them body system by body system and scenario by scenario.

The 6th Edition reflects current evidence-based med-surg practice, including updated guidelines across body systems, current pharmacological management, and the NCLEX-RN test plan with NGN clinical judgment integration. Rationales explain the pathophysiology, nursing priorities, management standards, and clinical reasoning behind each answer. Questions are organized chapter by chapter for targeted study.

Sample Questions

Question 1
A nurse is caring for a patient admitted with SIADH. Labs show serum sodium 119 mEq/L, serum osmolality 254 mOsm/kg, and urine osmolality 680 mOsm/kg. The patient is alert but reports a severe headache and is becoming more confused. Which nursing action is the priority?

A) Encourage oral fluids to correct the dilutional hyponatremia by increasing urinary solute excretion
B) Implement the prescribed fluid restriction, notify the provider of the worsening neurological symptoms, and prepare for hypertonic saline for severe symptomatic hyponatremia
C) Give a loop diuretic to increase free water excretion and correct the high urine osmolality
D) Position the patient supine with legs elevated and reassess neurological status in two hours

Correct answer: B
Rationale: A sodium of 119 mEq/L with headache and progressive confusion is severe symptomatic hyponatremia, a neurological emergency. Water moves from hypotonic serum into brain cells, causing cerebral edema. The urine osmolality of 680 with a serum osmolality of 254 shows the kidneys concentrating urine despite dilute serum, consistent with autonomous ADH secretion. Fluid restriction is the cornerstone of SIADH management, but when neurological symptoms appear, the provider needs to be notified at once, because 3% saline is typically ordered to raise the sodium and reduce cerebral edema. Sodium must be corrected slowly, generally no more than about 8–10 mEq/L in 24 hours, to avoid osmotic demyelination, so serum sodium needs frequent monitoring and seizure precautions are appropriate. Extra oral fluids would worsen the dilution. Loop diuretics are sometimes used alongside hypertonic saline but don’t address the emergency alone. Supine positioning and a two-hour delay do nothing for the underlying problem.

Question 2
A nurse is caring for a patient four hours after a right total hip arthroplasty. The right foot is pale and cool compared with the left, capillary refill in the right great toe is four seconds, the right pedal pulse is diminished compared with the left, and the patient rates right leg pain 9/10. Pulses were equal one hour ago. Which action is the priority?

A) Elevate the right leg on two pillows to improve venous return and reduce edema
B) Give the prescribed PRN opioid and reassess in one hour
C) Notify the surgeon immediately of the acute neurovascular change suggesting possible arterial compromise and prepare for urgent surgical evaluation
D) Apply ice to the right leg and reassess pulses in 30 minutes

Correct answer: C
Rationale: Acute pallor, coolness, prolonged capillary refill, severe pain, and a diminished pulse, all new within an hour, suggest acute arterial compromise, possibly from vascular injury during surgery or thrombus. Hematoma compression, nerve injury, and compartment syndrome are also possible, and all need urgent surgical evaluation. The change from baseline is the key finding. The six Ps of acute arterial occlusion (pain, pallor, pulselessness, poikilothermia, paresthesia, paralysis) are beginning to appear, and ischemia can progress to irreversible muscle and nerve damage within hours. Elevation can further reduce arterial perfusion pressure and worsen ischemia. Giving analgesia first delays the emergency, and ice causes vasoconstriction that reduces blood flow. Waiting 30 minutes risks permanent limb damage.

Question 3
A nurse is reviewing morning labs for a patient with chronic liver failure from alcoholic cirrhosis: INR 3.8, platelets 62,000/mm³, albumin 1.9 g/dL, total bilirubin 8.4 mg/dL, and ammonia 98 mcmol/L. The patient is increasingly lethargic, and asterixis is present. Which condition is most likely, and which intervention is the priority?

A) Wernicke’s encephalopathy from thiamine deficiency; give IV thiamine immediately
B) Hepatic encephalopathy from ammonia accumulation; notify the provider, give lactulose as prescribed, and monitor neurological status frequently
C) Alcohol withdrawal delirium; start the CIWA protocol and give a benzodiazepine
D) Opioid toxicity from analgesic accumulation; hold scheduled analgesics and give naloxone

Correct answer: B
Rationale: Increasing lethargy and asterixis (the flapping tremor of outstretched hands) in a patient with advanced liver failure suggest hepatic encephalopathy. The failing liver can’t convert ammonia from protein catabolism and gut bacteria into urea, so ammonia crosses the blood-brain barrier and astrocytes take it up, disrupting cerebral function. Diagnosis is mainly clinical, since ammonia levels correlate imperfectly with severity. The labs confirm severe synthetic failure: the INR reflects reduced clotting factor production, the albumin reflects reduced albumin synthesis, the platelet count reflects portal hypertension with splenic sequestration, and the bilirubin reflects impaired hepatic processing and excretion. Lactulose is first-line treatment. It acidifies the colon to trap ammonia as non-absorbable ammonium, reduces ammonia-producing bacteria, and acts as a cathartic, with a goal of about two to three soft stools daily. Rifaximin is often added, and protein restriction is no longer recommended because malnutrition worsens outcomes. Wernicke’s is a concern in alcohol-dependent patients but doesn’t explain asterixis with high ammonia. Withdrawal is not suggested by this picture, and nothing here points to opioid toxicity.

Question 4
A charge nurse is starting the night shift and must decide which patient to see first. Which patient takes priority?

A) A 54-year-old with stable angina, three hours after a scheduled nitroglycerin patch, watching television comfortably
B) A 67-year-old two days after a sigmoid colectomy who says the incision is “feeling tighter,” with temperature 38.8°C, heart rate 102 bpm, and respiratory rate 20
C) A 45-year-old with type 2 diabetes whose evening glucose is 218 mg/dL and who is asking for an evening snack
D) A 71-year-old with chronic heart failure sleeping comfortably with SpO₂ 94% on 2 L/min, which is baseline

Correct answer: B
Rationale: The priority is the patient with the most acute, potentially life-threatening change from expected recovery. A fever of 38.8°C with tachycardia and a new feeling of wound tightness two days after bowel surgery needs prompt assessment for anastomotic leak, bleeding or hematoma, or infection. Fever this early is often from atelectasis, but the combination of tachycardia and abdominal or wound changes can’t be assumed benign. Anastomotic leaks usually appear between days three and seven but can begin earlier, and an unrecognized leak can progress to peritonitis and septic shock. The angina patient is comfortable with no acute change, a glucose of 218 mg/dL needs attention but isn’t an immediate threat, and the heart failure patient is at documented baseline.

Question 5
A nurse is giving discharge teaching to a patient going home on warfarin after treatment for a pulmonary embolism. Which patient statement shows the teaching was effective?

A) “I should eat extra spinach and kale every day, because green vegetables will help thin my blood along with the warfarin.”
B) “I’ll keep my vitamin K intake consistent instead of cutting out leafy greens, because sudden changes in how much I eat will affect my INR.”
C) “I can stop taking warfarin once I feel completely better, since I’m only on it temporarily.”
D) “I should take ibuprofen for aches and pains, since it’s aspirin that interacts with warfarin.”

Correct answer: B
Rationale: Warfarin reduces the synthesis of functional vitamin K-dependent clotting factors II, VII, IX, and X, and vitamin K opposes its effect. Large swings in vitamin K intake cause swings in INR: a sudden increase lowers the INR and reduces protection, and a sudden decrease raises the INR and the bleeding risk. The recommendation is consistency, not elimination. Eating extra greens would antagonize warfarin. Stopping when feeling better is dangerous, because PE treatment generally requires at least three months of anticoagulation and stopping early risks recurrence. Ibuprofen and other NSAIDs, like aspirin, should be avoided unless prescribed, because they impair platelet function and irritate the GI mucosa, raising bleeding risk. Acetaminophen is the usual choice for mild to moderate pain, though regular high doses can raise the INR.

Frequently Asked Questions

Which edition does this test bank cover?
The 6th Edition of Medical-Surgical Nursing: Concepts and Practice by Holly Stromberg. Questions follow that edition’s chapter organization, updated clinical content, evidence-based practice standards, and current NCLEX-RN and NGN frameworks.

How are the questions organized?
Chapter by chapter. You can study through every body system or target areas such as cardiovascular, neurological, or endocrine nursing based on your exam priorities and knowledge gaps.

Is it aligned with the NCLEX-RN and Next Generation NCLEX?
Yes. Questions reflect current NCLEX-RN standards and the clinical judgment emphasis of the NGN. Priority, delegation, clinical deterioration, and complex scenario questions appear throughout.

Is it useful for NCLEX-RN candidates reviewing med-surg?
Yes. Med-surg makes up a large share of the NCLEX-RN, and this test bank pairs chapter-by-chapter coverage with application-level clinical reasoning questions.

How soon can I access it?
Immediately. You get instant digital access after purchase and can study on any device, on your own schedule.

Are the rationales detailed enough for real clinical learning?
Yes. Each rationale explains the pathophysiology, nursing priorities, and clinical reasoning behind the correct answer, in keeping with Stromberg’s concept-based approach.

Can faculty use it for course assessments?
Yes. The chapter-by-chapter organization, varied formats, and scenario emphasis suit unit exams, comprehensive finals, and NCLEX-preparatory assessments in undergraduate med-surg courses aligned with the 6th Edition.