MED-SURG NGN ACTUAL EXAM
QUESTIONS AND COMPLETE STUDY
GUIDE 2026
▶ 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
illness, but recently started attending aerobic classes in the afternoon.
Because of her work- outs, her blood sugars have dipped below 50 mg/ dL
very early in the morning.
Her fasting blood sugar before breakfast is now elevated and higher than
normal. Which of the following is best described?
A) Somogyi phenomenon
B) Dawn phenomenon
,C) Raynaud's phenomenon
D) Insulin resistance. Answer: A) Somogi phenomenon
The Somogi phenomenon is when nocturnal hypoglycemia (2 a.m to 3
a.m.) stimulates the liver to produce glucagon to raise the blood sugar. The
fasting blood glucose levels will be elevated from this glucagon production.
▶ A 40-year-old female is positive for anti-hepatitis C virus (HCV). Which
test is appropriate for follow-up?
A) HCV RNA
B) HCV antibodies
C) HCV core antigen
D) Hepatitis C surface antigen. Answer: A) HCV RNA
HCV RNA is performed following a positive anti-hepatitis C virus test.
▶ When the nurse practitioner is evaluating a patient for intermittent
claudication, he/she would first:
A) Order a venogram
B) Order T.E.D. anti-embolism stockings
C) Check the ankle and brachial blood pressure before and after exercise
D) Check the pedal and posterior tibial pulses. Answer: C) Check the ankle
and brachial blood pressure before and after excercise
Initial evaluation for intermittent claudication would include checking the
ankle and brachial blood pressure before and after exercise.
▶ All of the following drugs can interact with theophylline (Theo-24) except:
A) Erythromycin
B) Montelukast (Singulair)
C) Phenytoin sodium (Dilantin)
D) Cimetidine (Tagamet). Answer: B)Montelukast(Singulair)
Medications that are contraindicated with theophylline include
erythromycin, phenytoin sodium, and cimetidine.
, ▶ You note a high-pitched and blowing pansystolic murmur in a 70-year-
old male. It is Grade II/VI and is best heard at the apical area. Which of the
following is most likely?
A) Ventricular septal defect
B) Tricuspid regurgitation
C) Mitral regurgitation
D) Mitral stenosis. Answer: C) Mitral regurgitation
Mitral regurgitation is best heard at the apical area, and manifests as a
high-pitched, blowing pansystolic murmur.
▶ The cover/uncover test is a screening tool for:
A) Color blindness
B) Strabismus
C) Visual acuity
D) Cataracts. Answer: B) Strabismus
The cover/uncover test screens for strabismus. Color blindness is
evaluated by using the Ishihara tool. Visual acuity is evaluated using the
Snellen chart. Cataracts are screened by using the ophthalmoscope and
shining a light into the eyes at an angle, approximately 15 inches away. If
the red reflex is not elicited, then cataracts are present
▶ The mother of a 4-week-old infant is concerned that her infant's eyes are
crossed for a few seconds occasionally. The nurse practitioner would:
A) Recommend referral to a pediatric ophthalmologist
B) Advise the mother that this is a normal finding in infants up to 2 months
of age
C) Recommend that multivitamin supplements be given to the infant daily
D) Educate her on how to patch the infant's eye every 4 hours. Answer: B)
Advise the mother that this is a normal finding in infants up to 2 months of
age
Infants' eyes commonly cross over at times, and this is a normal finding up
to 2 months of age.
QUESTIONS AND COMPLETE STUDY
GUIDE 2026
▶ 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
illness, but recently started attending aerobic classes in the afternoon.
Because of her work- outs, her blood sugars have dipped below 50 mg/ dL
very early in the morning.
Her fasting blood sugar before breakfast is now elevated and higher than
normal. Which of the following is best described?
A) Somogyi phenomenon
B) Dawn phenomenon
,C) Raynaud's phenomenon
D) Insulin resistance. Answer: A) Somogi phenomenon
The Somogi phenomenon is when nocturnal hypoglycemia (2 a.m to 3
a.m.) stimulates the liver to produce glucagon to raise the blood sugar. The
fasting blood glucose levels will be elevated from this glucagon production.
▶ A 40-year-old female is positive for anti-hepatitis C virus (HCV). Which
test is appropriate for follow-up?
A) HCV RNA
B) HCV antibodies
C) HCV core antigen
D) Hepatitis C surface antigen. Answer: A) HCV RNA
HCV RNA is performed following a positive anti-hepatitis C virus test.
▶ When the nurse practitioner is evaluating a patient for intermittent
claudication, he/she would first:
A) Order a venogram
B) Order T.E.D. anti-embolism stockings
C) Check the ankle and brachial blood pressure before and after exercise
D) Check the pedal and posterior tibial pulses. Answer: C) Check the ankle
and brachial blood pressure before and after excercise
Initial evaluation for intermittent claudication would include checking the
ankle and brachial blood pressure before and after exercise.
▶ All of the following drugs can interact with theophylline (Theo-24) except:
A) Erythromycin
B) Montelukast (Singulair)
C) Phenytoin sodium (Dilantin)
D) Cimetidine (Tagamet). Answer: B)Montelukast(Singulair)
Medications that are contraindicated with theophylline include
erythromycin, phenytoin sodium, and cimetidine.
, ▶ You note a high-pitched and blowing pansystolic murmur in a 70-year-
old male. It is Grade II/VI and is best heard at the apical area. Which of the
following is most likely?
A) Ventricular septal defect
B) Tricuspid regurgitation
C) Mitral regurgitation
D) Mitral stenosis. Answer: C) Mitral regurgitation
Mitral regurgitation is best heard at the apical area, and manifests as a
high-pitched, blowing pansystolic murmur.
▶ The cover/uncover test is a screening tool for:
A) Color blindness
B) Strabismus
C) Visual acuity
D) Cataracts. Answer: B) Strabismus
The cover/uncover test screens for strabismus. Color blindness is
evaluated by using the Ishihara tool. Visual acuity is evaluated using the
Snellen chart. Cataracts are screened by using the ophthalmoscope and
shining a light into the eyes at an angle, approximately 15 inches away. If
the red reflex is not elicited, then cataracts are present
▶ The mother of a 4-week-old infant is concerned that her infant's eyes are
crossed for a few seconds occasionally. The nurse practitioner would:
A) Recommend referral to a pediatric ophthalmologist
B) Advise the mother that this is a normal finding in infants up to 2 months
of age
C) Recommend that multivitamin supplements be given to the infant daily
D) Educate her on how to patch the infant's eye every 4 hours. Answer: B)
Advise the mother that this is a normal finding in infants up to 2 months of
age
Infants' eyes commonly cross over at times, and this is a normal finding up
to 2 months of age.
