BKAT Med-Surg Exam (2026/2027) | QUESTIONS
WITH VERIFIED ANSWERS
Basic Knowledge Assessment Tool (BKAT) for Medical-Surgical Nursing Examination | Core Domains:
Nursing Process & Critical Thinking in Med-Surg, Fluid & Electrolyte Balance, Acid-Base Balance,
Cardiovascular Disorders, Respiratory Disorders, Gastrointestinal Disorders, Renal & Urological
Disorders, Endocrine Disorders, Neurological Disorders, Musculoskeletal Disorders, and Pharmacology
in Medical-Surgical Nursing | Registered Nurse Competency Assessment Focus | Knowledge Validation
Exam Format
Exam Structure
The BKAT for Medical-Surgical Nursing is a standardized 100-question, multiple-choice
examination used to assess the foundational knowledge of practicing RNs or nursing graduates
in the adult medical-surgical domain.
Introduction
This BKAT Med-Surg Exam guide for the 2026/2027 cycle prepares nurses for this validated competency
assessment tool. The content tests essential knowledge of pathophysiology, nursing management, and
pharmacological principles for common adult health conditions, serving as a benchmark for competency,
orientation readiness, or identification of knowledge gaps in the medical-surgical setting.
Answer Format
All correct answers and core med-surg principles are presented in bold and green, followed by detailed,
verified rationales that reference evidence-based practice, standard nursing interventions, and the
underlying physiological principles for adult medical-surgical patient care.
1. A nurse is caring for a patient with heart failure who has 3+ pitting edema in the
lower extremities. Which nursing diagnosis is the priority?
A. A. Activity intolerance
B. B. Excess fluid volume
C. C. Impaired skin integrity
D. D. Ineffective tissue perfusion
B. Excess fluid volume
Excess fluid volume is the root cause of edema, crackles, and weight gain in heart failure.
Addressing fluid overload takes precedence over secondary issues like skin breakdown or
activity intolerance. Diuretics, fluid restriction, and daily weights are key interventions.
,2. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.2
mEq/L. Which ECG change is expected?
A. A. Prolonged PR interval
B. B. Peaked T waves
C. C. U waves
D. D. ST-segment depression
B. Peaked T waves
Hyperkalemia causes tall, peaked T waves on ECG, which can progress to widened QRS, sine
wave pattern, and ventricular fibrillation. Hypokalemia causes U waves and ST depression.
Immediate treatment includes calcium gluconate to stabilize the myocardium.
3. A patient is admitted with diabetic ketoacidosis (DKA). Which finding is most
concerning?
A. A. Blood glucose 350 mg/dL
B. B. Bicarbonate 14 mEq/L
C. C. Potassium 5.8 mEq/L
D. D. pH 7.25
C. Potassium 5.8 mEq/L
Although hyperkalemia is present initially in DKA due to acidosis, potassium shifts
intracellularly once insulin therapy begins, leading to life-threatening hypokalemia. The nurse
must monitor ECG and prepare for potassium replacement once levels drop below 5.3 mEq/L.
4. A patient with COPD is prescribed oxygen at 2 L/min via nasal cannula. Why is a
low flow rate used?
A. A. To prevent oxygen toxicity
B. B. To avoid suppressing the hypoxic drive
C. C. To reduce fire risk
D. D. To prevent mucosal drying
B. To avoid suppressing the hypoxic drive
In chronic CO₂ retainers, the primary respiratory drive is hypoxia, not hypercapnia. High
oxygen levels can remove this drive, leading to respiratory arrest. Low-flow oxygen (1–2
L/min) maintains hypoxic stimulation while improving oxygenation.
,5. A patient is 1 day post–total hip arthroplasty. Which instruction is essential?
A. A. “Cross your legs when sitting.”
B. B. “Bend at the waist to tie your shoes.”
C. C. “Keep your legs abducted with a pillow between them.”
D. D. “Sleep on your operative side.”
C. “Keep your legs abducted with a pillow between them.”
Hip precautions after total hip replacement include avoiding hip flexion >90°, adduction, and
internal rotation. An abduction pillow prevents adduction and dislocation. Crossing legs (A),
bending at the waist (B), and sleeping on the operative side (D) increase dislocation risk.
6. A patient with a history of alcoholism is admitted with confusion and ataxia.
Which vitamin should be administered first?
A. A. Vitamin B12
B. B. Folic acid
C. C. Thiamine (B1)
D. D. Vitamin C
C. Thiamine (B1)
Thiamine deficiency causes Wernicke’s encephalopathy (confusion, ataxia, ophthalmoplegia).
Glucose administration without thiamine can worsen symptoms by depleting remaining
stores. Thiamine must be given before glucose in at-risk patients.
7. A patient with cirrhosis develops asterixis and fetor hepaticus. What is the
priority intervention?
A. A. Restrict protein intake
B. B. Administer lactulose
C. C. Administer neomycin
D. D. Increase fluid intake
B. Administer lactulose
Asterixis and fetor hepaticus indicate hepatic encephalopathy. Lactulose acidifies the colon,
trapping ammonia as ammonium for excretion. Protein restriction is no longer recommended
as it worsens malnutrition; current guidelines support adequate protein with vegetable
sources.
, 8. A patient with suspected pulmonary embolism has sudden dyspnea and
tachycardia. Which diagnostic test is most definitive?
A. A. D-dimer
B. B. Chest X-ray
C. C. CT pulmonary angiography
D. D. Arterial blood gas
C. CT pulmonary angiography
CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism,
showing filling defects in pulmonary arteries. D-dimer is sensitive but not specific; chest X-ray
and ABG are nondiagnostic but may show hypoxia or respiratory alkalosis.
9. A patient with Addison’s disease has hyponatremia and hyperkalemia. What is
the priority action?
A. A. Administer hydrocortisone
B. B. Give sodium bicarbonate
C. C. Restrict fluids
D. D. Administer insulin
A. Administer hydrocortisone
Addison’s disease is adrenal insufficiency. Glucocorticoid replacement (hydrocortisone)
corrects the underlying cause of electrolyte imbalances. Without cortisol, the patient cannot
maintain vascular tone or sodium balance, leading to shock.
10. A patient with heart failure is prescribed furosemide 40 mg IV twice daily.
Which laboratory value should be monitored most closely?
A. A. Calcium
B. B. Sodium
C. C. Potassium
D. D. Phosphorus
C. Potassium
Furosemide is a loop diuretic that causes significant potassium excretion in the urine, leading
to hypokalemia. Hypokalemia increases the risk of cardiac dysrhythmias, especially in
patients on digoxin. Serum potassium must be monitored regularly.
WITH VERIFIED ANSWERS
Basic Knowledge Assessment Tool (BKAT) for Medical-Surgical Nursing Examination | Core Domains:
Nursing Process & Critical Thinking in Med-Surg, Fluid & Electrolyte Balance, Acid-Base Balance,
Cardiovascular Disorders, Respiratory Disorders, Gastrointestinal Disorders, Renal & Urological
Disorders, Endocrine Disorders, Neurological Disorders, Musculoskeletal Disorders, and Pharmacology
in Medical-Surgical Nursing | Registered Nurse Competency Assessment Focus | Knowledge Validation
Exam Format
Exam Structure
The BKAT for Medical-Surgical Nursing is a standardized 100-question, multiple-choice
examination used to assess the foundational knowledge of practicing RNs or nursing graduates
in the adult medical-surgical domain.
Introduction
This BKAT Med-Surg Exam guide for the 2026/2027 cycle prepares nurses for this validated competency
assessment tool. The content tests essential knowledge of pathophysiology, nursing management, and
pharmacological principles for common adult health conditions, serving as a benchmark for competency,
orientation readiness, or identification of knowledge gaps in the medical-surgical setting.
Answer Format
All correct answers and core med-surg principles are presented in bold and green, followed by detailed,
verified rationales that reference evidence-based practice, standard nursing interventions, and the
underlying physiological principles for adult medical-surgical patient care.
1. A nurse is caring for a patient with heart failure who has 3+ pitting edema in the
lower extremities. Which nursing diagnosis is the priority?
A. A. Activity intolerance
B. B. Excess fluid volume
C. C. Impaired skin integrity
D. D. Ineffective tissue perfusion
B. Excess fluid volume
Excess fluid volume is the root cause of edema, crackles, and weight gain in heart failure.
Addressing fluid overload takes precedence over secondary issues like skin breakdown or
activity intolerance. Diuretics, fluid restriction, and daily weights are key interventions.
,2. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.2
mEq/L. Which ECG change is expected?
A. A. Prolonged PR interval
B. B. Peaked T waves
C. C. U waves
D. D. ST-segment depression
B. Peaked T waves
Hyperkalemia causes tall, peaked T waves on ECG, which can progress to widened QRS, sine
wave pattern, and ventricular fibrillation. Hypokalemia causes U waves and ST depression.
Immediate treatment includes calcium gluconate to stabilize the myocardium.
3. A patient is admitted with diabetic ketoacidosis (DKA). Which finding is most
concerning?
A. A. Blood glucose 350 mg/dL
B. B. Bicarbonate 14 mEq/L
C. C. Potassium 5.8 mEq/L
D. D. pH 7.25
C. Potassium 5.8 mEq/L
Although hyperkalemia is present initially in DKA due to acidosis, potassium shifts
intracellularly once insulin therapy begins, leading to life-threatening hypokalemia. The nurse
must monitor ECG and prepare for potassium replacement once levels drop below 5.3 mEq/L.
4. A patient with COPD is prescribed oxygen at 2 L/min via nasal cannula. Why is a
low flow rate used?
A. A. To prevent oxygen toxicity
B. B. To avoid suppressing the hypoxic drive
C. C. To reduce fire risk
D. D. To prevent mucosal drying
B. To avoid suppressing the hypoxic drive
In chronic CO₂ retainers, the primary respiratory drive is hypoxia, not hypercapnia. High
oxygen levels can remove this drive, leading to respiratory arrest. Low-flow oxygen (1–2
L/min) maintains hypoxic stimulation while improving oxygenation.
,5. A patient is 1 day post–total hip arthroplasty. Which instruction is essential?
A. A. “Cross your legs when sitting.”
B. B. “Bend at the waist to tie your shoes.”
C. C. “Keep your legs abducted with a pillow between them.”
D. D. “Sleep on your operative side.”
C. “Keep your legs abducted with a pillow between them.”
Hip precautions after total hip replacement include avoiding hip flexion >90°, adduction, and
internal rotation. An abduction pillow prevents adduction and dislocation. Crossing legs (A),
bending at the waist (B), and sleeping on the operative side (D) increase dislocation risk.
6. A patient with a history of alcoholism is admitted with confusion and ataxia.
Which vitamin should be administered first?
A. A. Vitamin B12
B. B. Folic acid
C. C. Thiamine (B1)
D. D. Vitamin C
C. Thiamine (B1)
Thiamine deficiency causes Wernicke’s encephalopathy (confusion, ataxia, ophthalmoplegia).
Glucose administration without thiamine can worsen symptoms by depleting remaining
stores. Thiamine must be given before glucose in at-risk patients.
7. A patient with cirrhosis develops asterixis and fetor hepaticus. What is the
priority intervention?
A. A. Restrict protein intake
B. B. Administer lactulose
C. C. Administer neomycin
D. D. Increase fluid intake
B. Administer lactulose
Asterixis and fetor hepaticus indicate hepatic encephalopathy. Lactulose acidifies the colon,
trapping ammonia as ammonium for excretion. Protein restriction is no longer recommended
as it worsens malnutrition; current guidelines support adequate protein with vegetable
sources.
, 8. A patient with suspected pulmonary embolism has sudden dyspnea and
tachycardia. Which diagnostic test is most definitive?
A. A. D-dimer
B. B. Chest X-ray
C. C. CT pulmonary angiography
D. D. Arterial blood gas
C. CT pulmonary angiography
CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism,
showing filling defects in pulmonary arteries. D-dimer is sensitive but not specific; chest X-ray
and ABG are nondiagnostic but may show hypoxia or respiratory alkalosis.
9. A patient with Addison’s disease has hyponatremia and hyperkalemia. What is
the priority action?
A. A. Administer hydrocortisone
B. B. Give sodium bicarbonate
C. C. Restrict fluids
D. D. Administer insulin
A. Administer hydrocortisone
Addison’s disease is adrenal insufficiency. Glucocorticoid replacement (hydrocortisone)
corrects the underlying cause of electrolyte imbalances. Without cortisol, the patient cannot
maintain vascular tone or sodium balance, leading to shock.
10. A patient with heart failure is prescribed furosemide 40 mg IV twice daily.
Which laboratory value should be monitored most closely?
A. A. Calcium
B. B. Sodium
C. C. Potassium
D. D. Phosphorus
C. Potassium
Furosemide is a loop diuretic that causes significant potassium excretion in the urine, leading
to hypokalemia. Hypokalemia increases the risk of cardiac dysrhythmias, especially in
patients on digoxin. Serum potassium must be monitored regularly.
