Med Surg Certification Practice Exam V4 | 200
Exam Questions with Verified Answers | Medical
Surgical Nursing Certification Study Guide 2026
• This is a 200-question Med-Surg Certification Practice Exam covering all core
medical-surgical nursing topics, designed to mirror the style, depth, and rigor of the
actual certification exam — use it by attempting each question independently
before reviewing the correct answer and EXPERT RATIONALE.
• Each question includes five answer options (A–E), a clearly highlighted correct
answer, and a detailed EXPERT RATIONALE to reinforce clinical reasoning and help
you retain key concepts for exam day.
MED-SURG CERTIFICATION PRACTICE EXAM V4
200 Questions with Verified Answers | Medical-Surgical Nursing Certification
Study Guide 2026
1. A patient is admitted with acute myocardial infarction (MI). Which ECG
finding is most indicative of an acute STEMI?
A) Prolonged PR interval
B) Widened QRS complex
C) Shortened QT interval
D) T-wave inversion only
E) ST-segment elevation in two or more contiguous leads
Correct Answer: E) ST-segment elevation in two or more contiguous leads
EXPERT RATIONALE: STEMI is defined by ST-segment elevation of ≥1 mm in two
or more contiguous leads, indicating transmural myocardial ischemia requiring
immediate reperfusion therapy.
2. A nurse is caring for a patient with heart failure. Which assessment finding
indicates worsening fluid overload?
,A) Weight loss of 2 lbs overnight
B) Decreased jugular venous distension
C) Urine output of 60 mL/hour
D) Clear lung sounds bilaterally
E) Sudden weight gain of 3 lbs in 24 hours
Correct Answer: E) Sudden weight gain of 3 lbs in 24 hours
EXPERT RATIONALE: Sudden weight gain of 2–3 lbs in 24 hours or 5 lbs in a
week indicates fluid retention, a hallmark of worsening heart failure requiring
prompt intervention.
3. A patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen therapy. What is the recommended oxygen flow rate to avoid
suppressing the hypoxic drive?
A) 6–8 L/min via nasal cannula
B) 10–12 L/min via non-rebreather mask
C) 100% FiO2 via mechanical ventilator
D) 5 L/min via simple face mask
E) 1–2 L/min via nasal cannula
Correct Answer: E) 1–2 L/min via nasal cannula
EXPERT RATIONALE: COPD patients rely on hypoxic drive to breathe. Excessive
oxygen suppresses this drive and can cause respiratory depression. Low-flow
oxygen at 1–2 L/min maintains SpO2 at 88–92%.
4. A patient post-total hip replacement is at highest risk for which
complication?
A) Pulmonary fibrosis
,B) Stress ulcer
C) Acute kidney injury
D) Corneal abrasion
E) Deep vein thrombosis (DVT)
Correct Answer: E) Deep vein thrombosis (DVT)
EXPERT RATIONALE: Post-orthopedic surgery patients are at high risk for DVT
due to venous stasis, vessel wall injury, and hypercoagulability (Virchow's triad).
Prophylactic anticoagulation and early ambulation are essential.
5. The nurse is teaching a patient newly diagnosed with type 2 diabetes about
foot care. Which instruction is most important?
A) Soak feet in hot water daily
B) Walk barefoot indoors only
C) Apply lotion between the toes
D) Trim toenails in a rounded shape
E) Inspect feet daily for cuts, blisters, or sores
Correct Answer: E) Inspect feet daily for cuts, blisters, or sores
EXPERT RATIONALE: Diabetic neuropathy reduces sensation, making early
detection of foot injuries critical to prevent infection, ulceration, and potential
amputation.
6. A patient with peptic ulcer disease asks what medications to avoid. The
nurse correctly identifies which drug class as contraindicated?
A) Proton pump inhibitors
B) H2 receptor blockers
C) Antacids
, D) Sucralfate
E) NSAIDs
Correct Answer: E) NSAIDs
EXPERT RATIONALE: NSAIDs inhibit prostaglandin synthesis, reducing the
protective mucous layer of the stomach, worsening ulcer disease and increasing
risk of GI bleeding.
7. Which electrolyte imbalance is most commonly associated with prolonged
nasogastric (NG) tube suctioning?
A) Hyperkalemia
B) Hypernatremia
C) Hypercalcemia
D) Hypermagnesemia
E) Hypokalemia
Correct Answer: E) Hypokalemia
EXPERT RATIONALE: Prolonged NG suctioning removes gastric secretions rich
in hydrochloric acid and potassium, leading to hypokalemia and metabolic
alkalosis.
8. A patient with acute pancreatitis is in severe pain. What is the priority
nursing intervention?
A) Administer oral enzymes
B) Encourage oral fluids
C) Apply a warm compress to the abdomen
D) Prepare the patient for immediate surgery
E) Administer IV opioid analgesics as ordered and maintain NPO status
Exam Questions with Verified Answers | Medical
Surgical Nursing Certification Study Guide 2026
• This is a 200-question Med-Surg Certification Practice Exam covering all core
medical-surgical nursing topics, designed to mirror the style, depth, and rigor of the
actual certification exam — use it by attempting each question independently
before reviewing the correct answer and EXPERT RATIONALE.
• Each question includes five answer options (A–E), a clearly highlighted correct
answer, and a detailed EXPERT RATIONALE to reinforce clinical reasoning and help
you retain key concepts for exam day.
MED-SURG CERTIFICATION PRACTICE EXAM V4
200 Questions with Verified Answers | Medical-Surgical Nursing Certification
Study Guide 2026
1. A patient is admitted with acute myocardial infarction (MI). Which ECG
finding is most indicative of an acute STEMI?
A) Prolonged PR interval
B) Widened QRS complex
C) Shortened QT interval
D) T-wave inversion only
E) ST-segment elevation in two or more contiguous leads
Correct Answer: E) ST-segment elevation in two or more contiguous leads
EXPERT RATIONALE: STEMI is defined by ST-segment elevation of ≥1 mm in two
or more contiguous leads, indicating transmural myocardial ischemia requiring
immediate reperfusion therapy.
2. A nurse is caring for a patient with heart failure. Which assessment finding
indicates worsening fluid overload?
,A) Weight loss of 2 lbs overnight
B) Decreased jugular venous distension
C) Urine output of 60 mL/hour
D) Clear lung sounds bilaterally
E) Sudden weight gain of 3 lbs in 24 hours
Correct Answer: E) Sudden weight gain of 3 lbs in 24 hours
EXPERT RATIONALE: Sudden weight gain of 2–3 lbs in 24 hours or 5 lbs in a
week indicates fluid retention, a hallmark of worsening heart failure requiring
prompt intervention.
3. A patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen therapy. What is the recommended oxygen flow rate to avoid
suppressing the hypoxic drive?
A) 6–8 L/min via nasal cannula
B) 10–12 L/min via non-rebreather mask
C) 100% FiO2 via mechanical ventilator
D) 5 L/min via simple face mask
E) 1–2 L/min via nasal cannula
Correct Answer: E) 1–2 L/min via nasal cannula
EXPERT RATIONALE: COPD patients rely on hypoxic drive to breathe. Excessive
oxygen suppresses this drive and can cause respiratory depression. Low-flow
oxygen at 1–2 L/min maintains SpO2 at 88–92%.
4. A patient post-total hip replacement is at highest risk for which
complication?
A) Pulmonary fibrosis
,B) Stress ulcer
C) Acute kidney injury
D) Corneal abrasion
E) Deep vein thrombosis (DVT)
Correct Answer: E) Deep vein thrombosis (DVT)
EXPERT RATIONALE: Post-orthopedic surgery patients are at high risk for DVT
due to venous stasis, vessel wall injury, and hypercoagulability (Virchow's triad).
Prophylactic anticoagulation and early ambulation are essential.
5. The nurse is teaching a patient newly diagnosed with type 2 diabetes about
foot care. Which instruction is most important?
A) Soak feet in hot water daily
B) Walk barefoot indoors only
C) Apply lotion between the toes
D) Trim toenails in a rounded shape
E) Inspect feet daily for cuts, blisters, or sores
Correct Answer: E) Inspect feet daily for cuts, blisters, or sores
EXPERT RATIONALE: Diabetic neuropathy reduces sensation, making early
detection of foot injuries critical to prevent infection, ulceration, and potential
amputation.
6. A patient with peptic ulcer disease asks what medications to avoid. The
nurse correctly identifies which drug class as contraindicated?
A) Proton pump inhibitors
B) H2 receptor blockers
C) Antacids
, D) Sucralfate
E) NSAIDs
Correct Answer: E) NSAIDs
EXPERT RATIONALE: NSAIDs inhibit prostaglandin synthesis, reducing the
protective mucous layer of the stomach, worsening ulcer disease and increasing
risk of GI bleeding.
7. Which electrolyte imbalance is most commonly associated with prolonged
nasogastric (NG) tube suctioning?
A) Hyperkalemia
B) Hypernatremia
C) Hypercalcemia
D) Hypermagnesemia
E) Hypokalemia
Correct Answer: E) Hypokalemia
EXPERT RATIONALE: Prolonged NG suctioning removes gastric secretions rich
in hydrochloric acid and potassium, leading to hypokalemia and metabolic
alkalosis.
8. A patient with acute pancreatitis is in severe pain. What is the priority
nursing intervention?
A) Administer oral enzymes
B) Encourage oral fluids
C) Apply a warm compress to the abdomen
D) Prepare the patient for immediate surgery
E) Administer IV opioid analgesics as ordered and maintain NPO status
