Medical Surgical Nursing Certification
Comprehensive Final Test (Qns & Ans)
2025
1. Scenario: A 66‑year‑old male presents with crushing chest
pain, diaphoresis, and shortness of breath. His ECG shows ST‐
segment elevations in the lateral leads, and his serum troponin is
elevated. Which of the following is the most time‑sensitive
intervention?
A) Administer sublingual nitroglycerin
B) Initiate thrombolytic therapy after a non‑contrast CT scan
C) Activate the cardiac catheterization lab for emergent
percutaneous coronary intervention (PCI)
D) Begin IV beta‑blockers immediately
ANS: C) Activate the cardiac catheterization lab for
emergent percutaneous coronary intervention (PCI)
©2025
, Rationale: In the setting of ST‑elevation myocardial
infarction (STEMI), rapid reperfusion via PCI is the gold standard
to restore coronary blood flow and limit myocardial damage.
2. Scenario: A 72‑year‑old postoperative patient following
abdominal surgery develops hypotension, tachycardia, and
decreased urine output. Laboratory tests show lactic acidosis.
What is the best acute management strategy?
A) Administer intravenous fluids rapidly
B) Begin vasopressor support immediately
C) Request an urgent CT scan of the abdomen
D) Increase analgesic medications
ANS: A) Administer intravenous fluids rapidly
Rationale: In the setting of septic shock or hypovolemia
evidenced by lactic acidosis, aggressive fluid resuscitation is the
initial management step to restore perfusion before vasopressors
are considered.
3. Scenario: An older patient with multiple comorbidities is on
several medications. He presents with an episode of confusion and
hypotension. Which strategy is essential to identify potential
medication-related problems?
A) Initiate a new medication for memory support
©2025
, B) Perform a comprehensive medication reconciliation with
multidisciplinary input
C) Advise the patient to skip medications on the day of
symptoms
D) Increase the dosage of his antihypertensive drugs
ANS: B) Perform a comprehensive medication reconciliation
with multidisciplinary input
Rationale: Reviewing all medications—prescription, OTC,
and supplements—with input from a pharmacist and the care team
is vital to detect potential interactions and adverse effects that
may be contributing to the patient’s presentation.
4. Scenario: A hospital is implementing a new Electronic
Health Record (EHR) system in the Medical-Surgical unit. Staff
report challenges with navigation and delays in documentation.
What is the best next step to address these user concerns?
A) Mandate continued use until the end-of-year evaluation
B) Conduct usability testing and solicit feedback for iterative
improvements
C) Revert to paper-based records temporarily
D) Limit system use to managerial staff only
©2025
, ANS: B) Conduct usability testing and solicit feedback for
iterative improvements
Rationale: User-centered iterative testing ensures the system
meets clinician needs and improves workflow, reducing
documentation delays and errors.
5. Scenario: A 59‑year‑old patient undergoing colon surgery
develops a surgical site infection postoperatively. Which
evidence‑based measure is most critical in preventing such
infections?
A) Routine prophylactic antibiotics based solely on patient
age
B) Preoperative skin antisepsis and appropriate antibiotic
prophylaxis
C) Delaying surgery until culture results are available
D) Using only postoperative antibiotics without preoperative
measures
ANS: B) Preoperative skin antisepsis and appropriate
antibiotic prophylaxis
Rationale: Strict adherence to infection control protocols—
including antisepsis and timely prophylactic antibiotics—has been
proven to reduce surgical site infections.
©2025
Comprehensive Final Test (Qns & Ans)
2025
1. Scenario: A 66‑year‑old male presents with crushing chest
pain, diaphoresis, and shortness of breath. His ECG shows ST‐
segment elevations in the lateral leads, and his serum troponin is
elevated. Which of the following is the most time‑sensitive
intervention?
A) Administer sublingual nitroglycerin
B) Initiate thrombolytic therapy after a non‑contrast CT scan
C) Activate the cardiac catheterization lab for emergent
percutaneous coronary intervention (PCI)
D) Begin IV beta‑blockers immediately
ANS: C) Activate the cardiac catheterization lab for
emergent percutaneous coronary intervention (PCI)
©2025
, Rationale: In the setting of ST‑elevation myocardial
infarction (STEMI), rapid reperfusion via PCI is the gold standard
to restore coronary blood flow and limit myocardial damage.
2. Scenario: A 72‑year‑old postoperative patient following
abdominal surgery develops hypotension, tachycardia, and
decreased urine output. Laboratory tests show lactic acidosis.
What is the best acute management strategy?
A) Administer intravenous fluids rapidly
B) Begin vasopressor support immediately
C) Request an urgent CT scan of the abdomen
D) Increase analgesic medications
ANS: A) Administer intravenous fluids rapidly
Rationale: In the setting of septic shock or hypovolemia
evidenced by lactic acidosis, aggressive fluid resuscitation is the
initial management step to restore perfusion before vasopressors
are considered.
3. Scenario: An older patient with multiple comorbidities is on
several medications. He presents with an episode of confusion and
hypotension. Which strategy is essential to identify potential
medication-related problems?
A) Initiate a new medication for memory support
©2025
, B) Perform a comprehensive medication reconciliation with
multidisciplinary input
C) Advise the patient to skip medications on the day of
symptoms
D) Increase the dosage of his antihypertensive drugs
ANS: B) Perform a comprehensive medication reconciliation
with multidisciplinary input
Rationale: Reviewing all medications—prescription, OTC,
and supplements—with input from a pharmacist and the care team
is vital to detect potential interactions and adverse effects that
may be contributing to the patient’s presentation.
4. Scenario: A hospital is implementing a new Electronic
Health Record (EHR) system in the Medical-Surgical unit. Staff
report challenges with navigation and delays in documentation.
What is the best next step to address these user concerns?
A) Mandate continued use until the end-of-year evaluation
B) Conduct usability testing and solicit feedback for iterative
improvements
C) Revert to paper-based records temporarily
D) Limit system use to managerial staff only
©2025
, ANS: B) Conduct usability testing and solicit feedback for
iterative improvements
Rationale: User-centered iterative testing ensures the system
meets clinician needs and improves workflow, reducing
documentation delays and errors.
5. Scenario: A 59‑year‑old patient undergoing colon surgery
develops a surgical site infection postoperatively. Which
evidence‑based measure is most critical in preventing such
infections?
A) Routine prophylactic antibiotics based solely on patient
age
B) Preoperative skin antisepsis and appropriate antibiotic
prophylaxis
C) Delaying surgery until culture results are available
D) Using only postoperative antibiotics without preoperative
measures
ANS: B) Preoperative skin antisepsis and appropriate
antibiotic prophylaxis
Rationale: Strict adherence to infection control protocols—
including antisepsis and timely prophylactic antibiotics—has been
proven to reduce surgical site infections.
©2025
