MED-SURG NGN PRACTICE EXAM
QUESTIONS AND DETAILED
SOLUTIONS 2026
▶ You are checking a 75-year-old woman's breast during an annual
gynecologi- cal exam. The left nipple and areola are scaly and reddened.
The patient denies pain and pruritis. She has noticed this scaliness on her
left nipple for the past 8 months. Her dermatologist gave her a potent
topical steroid, which she used twice a day for 1 month. The patient never
went back for the follow-up. She still has the rash and wants an evaluation.
Which of the following is the best intervention for this patient?
A) Prescribe another potent topical steroid and tell the patient to use it
twice a day for 4 weeks
B) Order a mammogram and refer the patient to a breast surgeon
C) Advise her to stop using soap on both breasts when she bathes to avoid
drying
up the skin on her areolae and nipples
D) Order a sonogram and fine-needle biopsy of the breast. Answer: B)
Order a mammogram and refer the patient to a breast surgeon
A scaly, reddened rash on the breast that does not resolve after a few
weeks of medical treatment may indicate breast cancer. She should have a
mammogram performed and see a breast surgeon for evaluation and
treatment.
▶ The following children are considered at higher risk for tuberculosis (TB)
except:
A) A child who has recently been diagnosed with leukemia
B) An infant whose family is homeless
C) A child who was born in Japan
D) A Hispanic child with asthma who is using a steroid inhaler. Answer: C)
A child who was born in Japan
,Risk factors for tuberculosis include compromised immune system, high-
risk populations (minorities, foreign-born people, prisoners, nursing home
residents, indigents, migrant workers and health care providers). Steroid
therapy and blood disorders also increase the risk of TB.
▶ During a sports physical exam of a 14-year-old high school athlete, the
nurse practitioner notices a split of the S2 component of the heart sound
during deep inspiration. She notes that it disappears upon expiration. The
heart rate is regular and no murmurs are auscultated. Which of the
following is correct?
A) This is an abnormal finding and should be evaluated further by a
cardiologist
B) A stress test should be ordered
C) This is a normal finding in some young athletes
D) An echocardiogram should be ordered. Answer: C) This is a normal
finding in some young athletes
It is common to hear a split of the S2 over the pulmonic area of the heart
with inspiration as long as it disappears with expiration, with no other
abnormal symptoms. This is caused by split- ting of the aortic and pulmonic
components.
▶ Mrs. J. L. is a 55-year-old female with a body mass index (BMI) of 24
and a history of asthma. She has hypertension that has been under control
with hydrochlorothiazide 12.5 mg PO daily. Her total cholesterol is 230 g/dl.
How many risk factors for coronary heart disease (CAD) does she have?
A) 1 risk factor
B) 2 risk factors
C) 3 risk factors
D) 4 risk factors. Answer: C) 3 risk factors
Risk factors for coronary heart disease include hypertension,
hypercholesterolemia, and women 55 years of age and older
▶ A common side effect of metformin (Glucophage) therapy is:
A) Weight gain
B) Lactic acidosis
,C) Hypoglycemic episodes
D) Gastrointestinal problems. Answer: D) Gastrointestinal problems
Common side effects of metformin include diarrhea/gastrointestinal
problems.
▶ While doing a cardiac exam on a 45-year-old male, you note an irregular
rhythm with a pulse rate of 110 beats per minute. The patient is alert and is
not in distress. What is the most likely diagnosis?
A) Atrial fibrillation
B) Ventricular fibrillation
C) Cardiac arrhythmia
D) First-degree right bundle branch block. Answer: A) Atrial fibrillation
Atrial fibrillation is chaotic electrical activity of the heart, caused by several
ectopic foci in the atria without any signs of distress.
▶ The following are patients who are at high risk for complications due to
urinary tract infections. Who does not belong in this category?
A) A 38-year-old diabetic patient with a HbA1C of 7.5%
B) A woman with a history of rheumatoid arthritis who is currently being
treated with a regimen of methotrexate and low-dose steroids
C) A 21-year-old woman who is under treatment for 2 sexually transmitted
infections
D) Pregnant women. Answer: C) A 21-year-old woman who is under
treatment for 2 sexually transmitted infections
Risk factors for complications due to urinary tract infection include
pregnancy, diabetes, and steroid therapy.
▶ A 68-year-old woman with hypertension and diabetes is seen by the
nurse practitioner for a dry cough that worsens at night when she lies in
bed. She has shortness of breath, which worsens when she exerts herself.
The patient's pulse rate is 90/min and regular. The patient has gained 6 lbs
over the past 2 months. She is on a nitro- glycerine patch and furosemide
daily. The best explanation for her symptoms is:
, A) Kidney failure
B) Congestive heart failure
C) ACE inhibitor-induced coughing
D) Thyroid disease. Answer: B) Congestive heart failure
Signs and symptoms of congestive heart failure (CHF) include dyspnea on
exertion, edema, fatigue, hemoptysis, cough, orthopnea, hypertension, and
nocturnal dyspnea.
▶ A nurse practitioner is doing a funduscopic exam on a 35-year-old
female during a routine physical exam. He notices that she has sharp disc
margins and a yellowish- orange color in the macular area. The ratio of
veins to arteries is 3:2. What is the next most appropriate action?
A) Advise the patient that she had a normal exam
B) Advise the patient that she had an abnormal exam
C) Refer the patient to the emergency room
D) Refer the patient to an ophthalmologist. Answer: A) Advise the patient
that she had a normal exam
A normal funduscopic exam would include sharp disc margins, with the
macula appearing yellow-orange in color. The ratio comparing the artery to
vein width is 2:3.
▶ During a sports physical, you note that the vision of an 18-year-old male
athlete is 20/30 in both eyes. Which of the following statements is true?
A) The patient can see at 20 ft what a person with normal vision can see at
30 ft
B) The patient can see at 30 ft what a person with normal vision can see at
20 ft
C) The patient cannot engage in contact sports
D) The patient needs to be referred to an ophthalmologist. Answer: A) The
patient can see at 20 ft what a person with normal vision can see at 30 ft
When vision results are 20/30 in both eyes, this means that the patient can
see at 20 ft what a person with normal vision can see at 30 ft.
▶ Carol, a 30-year-old type 2 diabetic, is on regular insulin and lente insulin
in the morning and in the evening. She denies changes in her diet or any
QUESTIONS AND DETAILED
SOLUTIONS 2026
▶ You are checking a 75-year-old woman's breast during an annual
gynecologi- cal exam. The left nipple and areola are scaly and reddened.
The patient denies pain and pruritis. She has noticed this scaliness on her
left nipple for the past 8 months. Her dermatologist gave her a potent
topical steroid, which she used twice a day for 1 month. The patient never
went back for the follow-up. She still has the rash and wants an evaluation.
Which of the following is the best intervention for this patient?
A) Prescribe another potent topical steroid and tell the patient to use it
twice a day for 4 weeks
B) Order a mammogram and refer the patient to a breast surgeon
C) Advise her to stop using soap on both breasts when she bathes to avoid
drying
up the skin on her areolae and nipples
D) Order a sonogram and fine-needle biopsy of the breast. Answer: B)
Order a mammogram and refer the patient to a breast surgeon
A scaly, reddened rash on the breast that does not resolve after a few
weeks of medical treatment may indicate breast cancer. She should have a
mammogram performed and see a breast surgeon for evaluation and
treatment.
▶ The following children are considered at higher risk for tuberculosis (TB)
except:
A) A child who has recently been diagnosed with leukemia
B) An infant whose family is homeless
C) A child who was born in Japan
D) A Hispanic child with asthma who is using a steroid inhaler. Answer: C)
A child who was born in Japan
,Risk factors for tuberculosis include compromised immune system, high-
risk populations (minorities, foreign-born people, prisoners, nursing home
residents, indigents, migrant workers and health care providers). Steroid
therapy and blood disorders also increase the risk of TB.
▶ During a sports physical exam of a 14-year-old high school athlete, the
nurse practitioner notices a split of the S2 component of the heart sound
during deep inspiration. She notes that it disappears upon expiration. The
heart rate is regular and no murmurs are auscultated. Which of the
following is correct?
A) This is an abnormal finding and should be evaluated further by a
cardiologist
B) A stress test should be ordered
C) This is a normal finding in some young athletes
D) An echocardiogram should be ordered. Answer: C) This is a normal
finding in some young athletes
It is common to hear a split of the S2 over the pulmonic area of the heart
with inspiration as long as it disappears with expiration, with no other
abnormal symptoms. This is caused by split- ting of the aortic and pulmonic
components.
▶ Mrs. J. L. is a 55-year-old female with a body mass index (BMI) of 24
and a history of asthma. She has hypertension that has been under control
with hydrochlorothiazide 12.5 mg PO daily. Her total cholesterol is 230 g/dl.
How many risk factors for coronary heart disease (CAD) does she have?
A) 1 risk factor
B) 2 risk factors
C) 3 risk factors
D) 4 risk factors. Answer: C) 3 risk factors
Risk factors for coronary heart disease include hypertension,
hypercholesterolemia, and women 55 years of age and older
▶ A common side effect of metformin (Glucophage) therapy is:
A) Weight gain
B) Lactic acidosis
,C) Hypoglycemic episodes
D) Gastrointestinal problems. Answer: D) Gastrointestinal problems
Common side effects of metformin include diarrhea/gastrointestinal
problems.
▶ While doing a cardiac exam on a 45-year-old male, you note an irregular
rhythm with a pulse rate of 110 beats per minute. The patient is alert and is
not in distress. What is the most likely diagnosis?
A) Atrial fibrillation
B) Ventricular fibrillation
C) Cardiac arrhythmia
D) First-degree right bundle branch block. Answer: A) Atrial fibrillation
Atrial fibrillation is chaotic electrical activity of the heart, caused by several
ectopic foci in the atria without any signs of distress.
▶ The following are patients who are at high risk for complications due to
urinary tract infections. Who does not belong in this category?
A) A 38-year-old diabetic patient with a HbA1C of 7.5%
B) A woman with a history of rheumatoid arthritis who is currently being
treated with a regimen of methotrexate and low-dose steroids
C) A 21-year-old woman who is under treatment for 2 sexually transmitted
infections
D) Pregnant women. Answer: C) A 21-year-old woman who is under
treatment for 2 sexually transmitted infections
Risk factors for complications due to urinary tract infection include
pregnancy, diabetes, and steroid therapy.
▶ A 68-year-old woman with hypertension and diabetes is seen by the
nurse practitioner for a dry cough that worsens at night when she lies in
bed. She has shortness of breath, which worsens when she exerts herself.
The patient's pulse rate is 90/min and regular. The patient has gained 6 lbs
over the past 2 months. She is on a nitro- glycerine patch and furosemide
daily. The best explanation for her symptoms is:
, A) Kidney failure
B) Congestive heart failure
C) ACE inhibitor-induced coughing
D) Thyroid disease. Answer: B) Congestive heart failure
Signs and symptoms of congestive heart failure (CHF) include dyspnea on
exertion, edema, fatigue, hemoptysis, cough, orthopnea, hypertension, and
nocturnal dyspnea.
▶ A nurse practitioner is doing a funduscopic exam on a 35-year-old
female during a routine physical exam. He notices that she has sharp disc
margins and a yellowish- orange color in the macular area. The ratio of
veins to arteries is 3:2. What is the next most appropriate action?
A) Advise the patient that she had a normal exam
B) Advise the patient that she had an abnormal exam
C) Refer the patient to the emergency room
D) Refer the patient to an ophthalmologist. Answer: A) Advise the patient
that she had a normal exam
A normal funduscopic exam would include sharp disc margins, with the
macula appearing yellow-orange in color. The ratio comparing the artery to
vein width is 2:3.
▶ During a sports physical, you note that the vision of an 18-year-old male
athlete is 20/30 in both eyes. Which of the following statements is true?
A) The patient can see at 20 ft what a person with normal vision can see at
30 ft
B) The patient can see at 30 ft what a person with normal vision can see at
20 ft
C) The patient cannot engage in contact sports
D) The patient needs to be referred to an ophthalmologist. Answer: A) The
patient can see at 20 ft what a person with normal vision can see at 30 ft
When vision results are 20/30 in both eyes, this means that the patient can
see at 20 ft what a person with normal vision can see at 30 ft.
▶ Carol, a 30-year-old type 2 diabetic, is on regular insulin and lente insulin
in the morning and in the evening. She denies changes in her diet or any
