MEDSURG-BC Board certification
recognizing advanced expertise in medical-
surgical nursing, patient management, care
coordination, and professional practice.
Question 1
A 72-year-old patient presents with confusion, urinary incontinence, and unsteady
gait. The nurse suspects which of the following conditions?
A. Delirium
B. Dementia
C. Normal aging changes
D. Urinary tract infection
Answer: D. Urinary tract infection
Rationale: The classic triad of confusion, urinary incontinence, and unsteady gait
in an elderly patient is highly suggestive of a urinary tract infection (UTI). UTIs in
older adults often present with atypical symptoms, including acute confusion, falls,
and incontinence. While delirium and dementia can present similarly, the sudden
onset and presence of incontinence make UTI the most likely diagnosis. A
urinalysis should be obtained promptly.
Question 2
A patient with a history of heart failure is admitted with shortness of breath and
peripheral edema. Which of the following assessment findings is MOST indicative
of worsening heart failure?
A. Jugular venous distension
B. Blood pressure of 140/90 mmHg
C. Heart rate of 88 beats/min
D. Respiratory rate of 18 breaths/min
Answer: A. Jugular venous distension
,Rationale: Jugular venous distension (JVD) is a direct indicator of elevated central
venous pressure and right-sided heart failure. It is a reliable sign of fluid volume
overload. While hypertension and tachycardia may be present, JVD is more
specific for worsening heart failure. The normal respiratory rate may be falsely
reassuring. Peripheral edema can occur in heart failure but is less specific than
JVD.
Question 3
A patient is 24 hours post-operative following a total hip replacement. Which of
the following findings requires IMMEDIATE intervention?
A. Pain rated 5/10 at the surgical site
B. Temperature of 100.2°F (37.9°C)
C. Calf swelling and warmth on the operative side
D. Heart rate of 82 beats/min
Answer: C. Calf swelling and warmth on the operative side
Rationale: Calf swelling and warmth on the operative side are classic signs of a
deep vein thrombosis (DVT), which is a life-threatening complication following
hip replacement surgery. DVT can lead to pulmonary embolism. This finding
requires immediate notification of the healthcare provider and diagnostic testing
(Doppler ultrasound). Mild pain, low-grade fever, and tachycardia are expected
post-operative findings.
Question 4
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen
at 2 L/min via nasal cannula. Which of the following assessment findings indicates
the need to adjust oxygen therapy?
A. Respiratory rate of 22 breaths/min
B. SpO₂ of 89%
C. Patient reports feeling short of breath
D. Arterial blood gas shows PaCO₂ of 55 mmHg
Answer: B. SpO₂ of 89%
,Rationale: For patients with COPD, oxygen should be titrated to maintain SpO₂
between 88-92%. An SpO₂ of 89% is at the lower end of the target range but may
still be acceptable. However, if the patient is symptomatic or the SpO₂ drops below
88%, oxygen should be increased. A PaCO₂ of 55 mmHg is elevated but may be
baseline for some COPD patients. The key is to maintain adequate oxygenation
without inducing hypercapnia.
Question 5
A patient with diabetes mellitus presents with nausea, vomiting, and abdominal
pain. The nurse notes a fruity odor on the patient's breath. Which of the following
is the PRIORITY action?
A. Administer insulin
B. Check blood glucose
C. Administer antiemetics
D. Obtain a serum potassium level
Answer: B. Check blood glucose
Rationale: The fruity breath odor suggests diabetic ketoacidosis (DKA). The
priority action is to check the blood glucose level to confirm hyperglycemia. While
insulin administration, antiemetics, and electrolyte monitoring are important, the
immediate priority is assessment. DKA is a medical emergency requiring prompt
treatment with insulin and fluid resuscitation.
Question 6
A patient is admitted with chest pain and shortness of breath. An electrocardiogram
(ECG) shows ST-segment elevation in leads V1-V4. The nurse should prepare for
which of the following interventions?
A. Administration of thrombolytics
B. Administration of nitroglycerin
C. Administration of morphine
D. Preparation for percutaneous coronary intervention (PCI)
Answer: D. Preparation for percutaneous coronary intervention (PCI)
, Rationale: ST-segment elevation in leads V1-V4 indicates an anteroseptal
myocardial infarction. PCI is the preferred treatment for STEMI and should be
performed within 90 minutes of presentation. Thrombolytics are an alternative if
PCI is not available within 120 minutes. Nitroglycerin and morphine are adjunctive
therapies but not the definitive treatment.
Question 7
A patient with a history of liver cirrhosis presents with confusion, asterixis, and
jaundice. The nurse suspects which of the following?
A. Hepatic encephalopathy
B. Hepatorenal syndrome
C. Spontaneous bacterial peritonitis
D. Variceal bleeding
Answer: A. Hepatic encephalopathy
Rationale: Confusion and asterixis (liver flap) are classic signs of hepatic
encephalopathy, a complication of liver cirrhosis caused by the accumulation of
ammonia and other toxins in the blood. Jaundice is a sign of liver dysfunction.
Hepatorenal syndrome presents with renal failure. Spontaneous bacterial peritonitis
presents with abdominal pain and fever. Variceal bleeding presents with
hematemesis or melena.
Question 8
A patient with a history of chronic kidney disease is admitted with weakness and
palpitations. The ECG shows peaked T waves. Which of the following electrolyte
imbalances is MOST likely?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypercalcemia
Answer: B. Hyperkalemia
Rationale: Peaked (tented) T waves are the earliest ECG sign of hyperkalemia.
Patients with chronic kidney disease are at high risk for hyperkalemia due to
recognizing advanced expertise in medical-
surgical nursing, patient management, care
coordination, and professional practice.
Question 1
A 72-year-old patient presents with confusion, urinary incontinence, and unsteady
gait. The nurse suspects which of the following conditions?
A. Delirium
B. Dementia
C. Normal aging changes
D. Urinary tract infection
Answer: D. Urinary tract infection
Rationale: The classic triad of confusion, urinary incontinence, and unsteady gait
in an elderly patient is highly suggestive of a urinary tract infection (UTI). UTIs in
older adults often present with atypical symptoms, including acute confusion, falls,
and incontinence. While delirium and dementia can present similarly, the sudden
onset and presence of incontinence make UTI the most likely diagnosis. A
urinalysis should be obtained promptly.
Question 2
A patient with a history of heart failure is admitted with shortness of breath and
peripheral edema. Which of the following assessment findings is MOST indicative
of worsening heart failure?
A. Jugular venous distension
B. Blood pressure of 140/90 mmHg
C. Heart rate of 88 beats/min
D. Respiratory rate of 18 breaths/min
Answer: A. Jugular venous distension
,Rationale: Jugular venous distension (JVD) is a direct indicator of elevated central
venous pressure and right-sided heart failure. It is a reliable sign of fluid volume
overload. While hypertension and tachycardia may be present, JVD is more
specific for worsening heart failure. The normal respiratory rate may be falsely
reassuring. Peripheral edema can occur in heart failure but is less specific than
JVD.
Question 3
A patient is 24 hours post-operative following a total hip replacement. Which of
the following findings requires IMMEDIATE intervention?
A. Pain rated 5/10 at the surgical site
B. Temperature of 100.2°F (37.9°C)
C. Calf swelling and warmth on the operative side
D. Heart rate of 82 beats/min
Answer: C. Calf swelling and warmth on the operative side
Rationale: Calf swelling and warmth on the operative side are classic signs of a
deep vein thrombosis (DVT), which is a life-threatening complication following
hip replacement surgery. DVT can lead to pulmonary embolism. This finding
requires immediate notification of the healthcare provider and diagnostic testing
(Doppler ultrasound). Mild pain, low-grade fever, and tachycardia are expected
post-operative findings.
Question 4
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen
at 2 L/min via nasal cannula. Which of the following assessment findings indicates
the need to adjust oxygen therapy?
A. Respiratory rate of 22 breaths/min
B. SpO₂ of 89%
C. Patient reports feeling short of breath
D. Arterial blood gas shows PaCO₂ of 55 mmHg
Answer: B. SpO₂ of 89%
,Rationale: For patients with COPD, oxygen should be titrated to maintain SpO₂
between 88-92%. An SpO₂ of 89% is at the lower end of the target range but may
still be acceptable. However, if the patient is symptomatic or the SpO₂ drops below
88%, oxygen should be increased. A PaCO₂ of 55 mmHg is elevated but may be
baseline for some COPD patients. The key is to maintain adequate oxygenation
without inducing hypercapnia.
Question 5
A patient with diabetes mellitus presents with nausea, vomiting, and abdominal
pain. The nurse notes a fruity odor on the patient's breath. Which of the following
is the PRIORITY action?
A. Administer insulin
B. Check blood glucose
C. Administer antiemetics
D. Obtain a serum potassium level
Answer: B. Check blood glucose
Rationale: The fruity breath odor suggests diabetic ketoacidosis (DKA). The
priority action is to check the blood glucose level to confirm hyperglycemia. While
insulin administration, antiemetics, and electrolyte monitoring are important, the
immediate priority is assessment. DKA is a medical emergency requiring prompt
treatment with insulin and fluid resuscitation.
Question 6
A patient is admitted with chest pain and shortness of breath. An electrocardiogram
(ECG) shows ST-segment elevation in leads V1-V4. The nurse should prepare for
which of the following interventions?
A. Administration of thrombolytics
B. Administration of nitroglycerin
C. Administration of morphine
D. Preparation for percutaneous coronary intervention (PCI)
Answer: D. Preparation for percutaneous coronary intervention (PCI)
, Rationale: ST-segment elevation in leads V1-V4 indicates an anteroseptal
myocardial infarction. PCI is the preferred treatment for STEMI and should be
performed within 90 minutes of presentation. Thrombolytics are an alternative if
PCI is not available within 120 minutes. Nitroglycerin and morphine are adjunctive
therapies but not the definitive treatment.
Question 7
A patient with a history of liver cirrhosis presents with confusion, asterixis, and
jaundice. The nurse suspects which of the following?
A. Hepatic encephalopathy
B. Hepatorenal syndrome
C. Spontaneous bacterial peritonitis
D. Variceal bleeding
Answer: A. Hepatic encephalopathy
Rationale: Confusion and asterixis (liver flap) are classic signs of hepatic
encephalopathy, a complication of liver cirrhosis caused by the accumulation of
ammonia and other toxins in the blood. Jaundice is a sign of liver dysfunction.
Hepatorenal syndrome presents with renal failure. Spontaneous bacterial peritonitis
presents with abdominal pain and fever. Variceal bleeding presents with
hematemesis or melena.
Question 8
A patient with a history of chronic kidney disease is admitted with weakness and
palpitations. The ECG shows peaked T waves. Which of the following electrolyte
imbalances is MOST likely?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypercalcemia
Answer: B. Hyperkalemia
Rationale: Peaked (tented) T waves are the earliest ECG sign of hyperkalemia.
Patients with chronic kidney disease are at high risk for hyperkalemia due to
