Original DHA nursing questions on medical-surgical & chronic disease, with explanations.
Short answer: 10 original multiple-choice practice questions on medical-surgical & chronic disease for nurses preparing for the DHA licensing exam, each with the correct answer and a full explanation. This is a Meddex topic, not a DHA heading. They are original and are not real exam items.
About these questions
Every question here is original. Meddex wrote it for exam preparation. None is a real, recalled or leaked exam item, and none comes from DHA, Prometric, UAE University or the NIHS.
Meddex is independent and is not affiliated with DHA, Prometric, UAE University or the NIHS.
Clinical review of the question bank is not complete yet. Treat the explanations as study aids and check official guidance before you rely on a fact.
This is a sample, not the whole bank, and doing well on it does not predict an exam result.
What medical-surgical covers
Endocrine, renal, GI, musculoskeletal and peri-operative care.
Look for the unstable patient first, then ask what the body is doing: a fluid, electrolyte, glucose or perfusion problem. Monitor, report and act in that order unless the stem says the patient is getting worse.
Where it fits in the exam
DHA lists four coverage headings for Registered Nurse and publishes no weights. Medical-Surgical & Chronic Disease is one of ten Meddex domains, so it is a Meddex grouping and not a DHA heading. Its questions can appear under more than one DHA heading.
DHA does not state how many answer options its questions have or whether each has one best answer. Meddex practice items use four options with one best answer, as a practice format.
How to use these questions
Decide your answer before you press Show answer. Then read the reason for every option, including the ones you rejected. Note the idea you missed and come back to it in a few days.
Practice questions
Question 1
Medical-Surgical & Chronic DiseaseEasy
A woman takes levothyroxine for hypothyroidism and has just been started on ferrous sulfate tablets. Which instruction should the nurse give?
AOption A: Take levothyroxine on an empty stomach before breakfast, with iron 4 hours apart
BOption B: Take both tablets together with breakfast so that she does not forget either of them
COption C: Take levothyroxine together with the iron tablet because iron helps it to be absorbed
DOption D: Take levothyroxine with a strong coffee in the morning so that it works faster and she is alert
Show answer for question 1
Correct answer: A. Take levothyroxine on an empty stomach before breakfast, with iron 4 hours apart
Levothyroxine is best absorbed on an empty stomach, and its absorption is reduced by food, iron, calcium and antacids. It is taken 30 to 60 minutes before breakfast, with iron, calcium and antacids kept at least 4 hours apart. Her thyroid function is rechecked after the new medicine starts, because the dose may need to change.
Why B is wrong. Food and iron both reduce the absorption of levothyroxine.
Why C is wrong. Iron binds levothyroxine in the gut and lowers its absorption.
Why D is wrong. Coffee reduces the absorption of levothyroxine, so it is kept apart from the dose.
Topic: Hypothyroidism: levothyroxine teaching with an iron supplement. Reference: Levothyroxine sodium tablets: summary of product characteristics (electronic medicines compendium)
Question 2
Medical-Surgical & Chronic DiseaseMedium
A patient on continuous ambulatory peritoneal dialysis reports abdominal pain. The nurse notes that the drained dialysate is cloudy. What is the best action?
AOption A: Reassure the patient that cloudy fluid is expected after a long dwell
BOption B: Give paracetamol and review the effluent at the next routine exchange
COption C: Discard the bag and start a fresh exchange to see whether the next fluid is clear or cloudy
DOption D: Send effluent for cell count and culture and inform the renal team promptly
Show answer for question 2
Correct answer: D. Send effluent for cell count and culture and inform the renal team promptly
Cloudy effluent with abdominal pain suggests peritonitis, the main infective complication of peritoneal dialysis. A sample is sent for cell count and culture before antibiotics are started, the bag is retained for inspection, and the renal team is informed so that treatment is given quickly.
Why A is wrong. Cloudy fluid is not expected and needs investigation as possible infection.
Why B is wrong. Analgesia without investigation treats the symptom while a serious infection is missed.
Why C is wrong. Discarding the effluent destroys the diagnostic sample and delays treatment.
Topic: Chronic kidney disease - cloudy effluent in peritoneal dialysis. Reference: International Society for Peritoneal Dialysis: Peritoneal dialysis-related infections recommendations; Lewis Medical-Surgical Nursing: Chronic kidney disease
Question 3
Medical-Surgical & Chronic DiseaseMedium
An intensive care unit uses an insulin infusion with a target of up to 10 mmol/L, not 4.5 to 6.0 mmol/L. A new nurse asks why the tighter target is avoided. What is the best answer?
AOption A: Hypoglycaemia is easy to detect in sedated patients, so lower targets are safe
BOption B: A high glucose is harmless in critical illness, so no target needs to be set at all
COption C: NICE-SUGAR found more severe hypoglycaemia and higher mortality with tight control
DOption D: Insulin does not lower glucose in critical illness, so a tight target cannot be reached
Show answer for question 3
Correct answer: C. NICE-SUGAR found more severe hypoglycaemia and higher mortality with tight control
The NICE-SUGAR trial of over 6,000 critically ill adults compared a target of 4.5 to 6.0 mmol/L with a target of 10 mmol/L or less. Tight control raised severe hypoglycaemia (6.8% against 0.5%) and 90-day mortality. Most units therefore aim for about 7.8 to 10 mmol/L. Insulin does work, a target is still needed because marked hyperglycaemia is harmful, and hypoglycaemia is hard to detect in sedated patients.
Why A is wrong. Sedation hides the symptoms of hypoglycaemia, so detection is harder, and not easier.
Why B is wrong. Marked hyperglycaemia is linked to harm, so a target is set.
Why D is wrong. Insulin does lower glucose in critical illness, although the dose needs are variable.
Topic: Diabetes: glucose targets in critical illness. Reference: NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009;360:1283-1297
Question 4
Medical-Surgical & Chronic DiseaseMedium
A man with a history of heavy NSAID use vomits coffee-ground material twice. His pulse is 118 and his blood pressure is 92/58. What should the nurse do first?
AOption A: Take a full dietary and drug history before alerting the medical team about the bleeding
BOption B: Insert two large-bore cannulas, send a crossmatch and escalate urgently
COption C: Give him a large drink of water to dilute and wash out the stomach contents
DOption D: Give an oral antacid and observe for any further vomiting over the next hour or so
Show answer for question 4
Correct answer: B. Insert two large-bore cannulas, send a crossmatch and escalate urgently
Upper gastrointestinal bleeding with tachycardia and hypotension signals haemodynamic compromise. The nurse secures large-bore access, takes bloods including a crossmatch, keeps him nil by mouth for possible endoscopy and calls for urgent medical help, while monitoring airway, observations and urine output.
Why A is wrong. History is useful but must not delay resuscitation of an unstable patient.
Why C is wrong. Oral fluids may provoke vomiting and are inappropriate before endoscopy.
Why D is wrong. An antacid does not treat or monitor a significant bleed and waiting delays resuscitation.
Topic: Gastrointestinal bleeding - initial nursing response to haematemesis. Reference: NICE CG141 Acute upper gastrointestinal bleeding in over 16s: management; Lewis Medical-Surgical Nursing: Gastrointestinal bleeding
Question 5
Medical-Surgical & Chronic DiseaseMedium
A 62-year-old woman with breast cancer and bone metastases has had three days of thirst, polyuria, constipation and increasing confusion. Her corrected calcium is 3.4 mmol/L. Which treatment should the nurse expect to be started first?
AOption A: Oral calcium and vitamin D supplements
BOption B: Fluid restriction to ease the polyuria
COption C: Intravenous furosemide to increase calcium excretion
Correct answer: D. Intravenous 0.9% sodium chloride rehydration
Severe hypercalcaemia causes an osmotic diuresis and volume depletion, which further reduces calcium excretion. Intravenous 0.9% sodium chloride rehydration is the first step, followed by an intravenous bisphosphonate such as zoledronic acid. Loop diuretics are reserved for fluid overload after rehydration.
Why A is wrong. Calcium supplements would raise an already dangerous calcium level.
Why B is wrong. Restriction worsens dehydration and further raises calcium.
Why C is wrong. Diuretics before rehydration deepen volume depletion; they are used only if overload develops.
Topic: Electrolyte disturbance - hypercalcaemia of malignancy. Reference: Society for Endocrinology Emergency Guidance: Emergency management of acute hypercalcaemia in adult patients; Royal Marsden Manual of Clinical Nursing Procedures
Question 6
Medical-Surgical & Chronic DiseaseMedium
A 67-year-old man with small cell lung cancer feels tired but is alert and has had no seizures. He looks euvolaemic. His sodium is 126 mmol/L, serum osmolality is low, urine osmolality is 520 mOsm/kg and urine sodium is 48 mmol/L. Which nursing action fits the likely diagnosis?
AOption A: Encourage at least 3 litres of oral fluid a day, because extra water helps the kidneys to flush out the excess sodium
BOption B: Restrict oral fluid as prescribed, keep a fluid balance chart and monitor sodium and neurological status
COption C: Give desmopressin to concentrate his urine further and so correct the sodium
DOption D: Give a litre of sodium chloride 0.9% over 30 minutes to raise the sodium level quickly
Show answer for question 6
Correct answer: B. Restrict oral fluid as prescribed, keep a fluid balance chart and monitor sodium and neurological status
A low serum osmolality with concentrated urine (osmolality above 100 mOsm/kg and urine sodium above 30 mmol/L) in a euvolaemic patient with a lung tumour points to the syndrome of inappropriate antidiuretic hormone secretion. Water is retained and dilutes the sodium. With mild symptoms, fluid restriction is first-line, along with treating the cause, and sodium and neurological state are monitored. Extra fluid worsens the dilution, and saline can worsen it further because the excess water is retained while the sodium load is excreted.
Why A is wrong. Extra fluid would be retained and lower the sodium further.
Why C is wrong. Desmopressin acts like antidiuretic hormone and would worsen water retention.
Why D is wrong. In this condition the urine is already concentrated, so a saline load is passed out as concentrated urine and the water is kept, which can lower the sodium further.
Topic: Hyponatraemia: syndrome of inappropriate antidiuretic hormone secretion. Reference: Spasovski G et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 2014;170:G1-G47
Question 7
Medical-Surgical & Chronic DiseaseEasy
A nurse teaches a woman who is starting alendronate 70 mg once a week for osteoporosis. Which instruction is correct?
AOption A: Chew it with a little orange juice so that it dissolves and is absorbed more quickly
BOption B: Take it with breakfast and a glass of milk, because food protects the stomach lining from irritation by the tablet
COption C: Take it at bedtime with a snack so that it is absorbed slowly while you sleep through the night
DOption D: Swallow it whole with plain water soon after waking and stay upright for 30 minutes before food or drink
Show answer for question 7
Correct answer: D. Swallow it whole with plain water soon after waking and stay upright for 30 minutes before food or drink
Alendronate is poorly absorbed, and food, milk, juice and other drinks reduce this further. It can also injure the oesophagus if it lodges there. The tablet is swallowed whole with plain water on an empty stomach on waking, and the patient stays sitting or standing for at least 30 minutes, until after the first food or drink of the day. It is not taken at bedtime. Calcium and vitamin D are taken at another time.
Why A is wrong. Chewing and juice both raise the risk of oesophageal irritation and lower absorption.
Why B is wrong. Milk and food reduce absorption of the drug.
Why C is wrong. Lying down soon after the tablet raises the risk of oesophageal injury, and food reduces absorption.
Topic: Osteoporosis: teaching about oral bisphosphonate. Reference: Alendronic acid 70 mg tablets: summary of product characteristics (electronic medicines compendium)
Question 8
Medical-Surgical & Chronic DiseaseMedium
A nurse is giving a vesicant chemotherapy drug through a peripheral cannula. The patient reports burning at the site, the area is swollen, and there is no blood return. What should the nurse do first?
AOption A: Flush the cannula with sodium chloride 0.9% to wash the drug on into the vein quickly
BOption B: Stop the infusion, leave the cannula in, try to aspirate residual drug and follow the extravasation policy
COption C: Remove the cannula at once and apply firm pressure to the site without trying to aspirate
DOption D: Slow the infusion rate and reassess the site again in 15 minutes before taking any action
Show answer for question 8
Correct answer: B. Stop the infusion, leave the cannula in, try to aspirate residual drug and follow the extravasation policy
Suspected extravasation of a vesicant is an emergency, because tissue damage can progress to necrosis. The infusion is stopped at once, the cannula is left in place and the nurse tries to aspirate residual drug through it. Help is called and the local extravasation protocol is followed, including drug-specific compresses or antidotes. Flushing pushes more drug into the tissue, and carrying on delays treatment.
Why A is wrong. A flush would push more of the drug into the surrounding tissue.
Why C is wrong. Removing the cannula loses the route for aspirating residual drug and for any antidote.
Why D is wrong. Continuing at any rate delivers more drug into the tissue.
Topic: Oncology nursing: suspected extravasation of a vesicant drug. Reference: Pérez Fidalgo JA et al. Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. Ann Oncol 2012;23(Suppl 7):vii167-vii173
Question 9
Medical-Surgical & Chronic DiseaseEasy
A woman is 4 days after a partial gastrectomy. She has palpitations, sweating and abdominal cramps about 20 minutes after meals. The nurse teaches her about dumping syndrome. Which statement shows she understands?
AOption A: I will have sweet drinks with my meals to keep up my energy
BOption B: I will eat two large meals a day so that my stomach is irritated less often
COption C: I will drink plenty of fluid with each meal to help the food pass through
DOption D: I will eat six small meals and take my drinks between meals, not with them
Show answer for question 9
Correct answer: D. I will eat six small meals and take my drinks between meals, not with them
After gastric surgery, food and fluid move into the small bowel too quickly, drawing fluid in and causing early symptoms. Eating small frequent meals, drinking between meals (about 30 minutes before or after) and limiting simple sugars slows this. A dietitian reviews her intake, because she must still keep her weight up.
Why A is wrong. Concentrated sugars draw fluid into the bowel and make the symptoms worse.
Why B is wrong. Large meals make dumping worse.
Why C is wrong. Fluid taken with a meal speeds emptying and can make the symptoms worse.
Topic: Gastrointestinal disease: dumping syndrome teaching after gastrectomy. Reference: Scarpellini E et al. International consensus on the diagnosis and management of dumping syndrome. Nat Rev Endocrinol 2020;16:448-466
Question 10
Medical-Surgical & Chronic DiseaseEasy
A conscious diabetic patient is sweaty and shaky with a glucose of 3.0 mmol/L. What should the nurse do FIRST?
AOption A: Withhold all food and recheck the glucose in 2 hours
BOption B: Administer the next dose of long-acting insulin
COption C: Give a high-protein meal only and observe
DOption D: Give 15–20 g of fast-acting carbohydrate orally
Show answer for question 10
Correct answer: D. Give 15–20 g of fast-acting carbohydrate orally
Treat conscious hypoglycaemia with 15–20 g rapidly absorbed carbohydrate (e.g., glucose tablets or juice), recheck after about 15 minutes, then follow with a longer-acting carbohydrate.
Why A is wrong. Delay risks neuroglycopenia and loss of consciousness.
Why B is wrong. Insulin would worsen hypoglycaemia.
Why C is wrong. Protein is absorbed too slowly to correct a low glucose quickly.
Topic: Hypoglycaemia. Reference: Joint British Diabetes Societies Hypoglycaemia guideline
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Frequently asked questions
DHA does not publish how many questions come from each topic. It lists four coverage headings for Registered Nurse with no weights. Meddex groups its questions into ten domains of its own.
No. They are original practice questions written by Meddex for exam preparation. DHA does not publish sample questions, and its Assessment Manual says sharing assessment questions is not allowed, so we do not use or claim real or recalled items.
The Meddex app has the full bank, which you can practise by topic with a free account. These pages are a short sample, and the questions on them do not change.
No. Each question has a Show answer button. The answer, the explanation and the reason each wrong option is wrong are part of the page text, so they are there when you press it.