BARKLEY MEDSURG-BC MEDICAL-SURGICAL CERTIFICATION PRACTICE EXAM] QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains:
Cardiovascular & Peripheral Vascular Systems
Respiratory System
Endocrine & Metabolic Disorders
Gastrointestinal & Renal Systems
Neurological & Sensory Disorders
Musculoskeletal & Integumentary Systems
Hematological, Oncological, & Immunological Disorders
Multisystem & Critical Care Concepts
Perioperative & Pain Management
Gerontology & Palliative/Ethical Considerations
Introduction
This comprehensive practice examination is meticulously designed to evaluate the clinical acumen and critical
thinking skills essential for success in the Medical-Surgical Nursing Certification (MEDSURG-BC) examination. The
assessment focuses on the application of evidence-based practice, pathophysiology, pharmacological interventions,
and nursing management across a spectrum of acute and chronic conditions encountered in the medical-surgical
setting. Structured with both multiple-choice and scenario-based questions, this tool emphasizes clinical decision-
making, prioritization, patient safety, and regulatory compliance. The exam aims to reflect the complexities of
,modern healthcare, challenging the nurse to integrate theoretical knowledge with real-world practice to deliver
safe, competent, and holistic care to a diverse patient population.
SECTION ONE: QUESTIONS 1–100
1. A nurse is assessing a patient with suspected pericarditis. Which finding is most consistent with this
diagnosis?
A. Diminished breath sounds at the lung bases
B. A friction rub heard at the left lower sternal border
C. A holosystolic murmur at the apex
D. Jugular vein distention with clear lung sounds
🟢 B. A friction rub heard at the left lower sternal border
🔴 RATIONALE: A pericardial friction rub is a classic sign of pericarditis, caused by the inflamed pericardial
layers rubbing against each other. It is best heard at the left lower sternal border with the patient leaning
forward. Diminished breath sounds are related to pleural effusions. A holosystolic murmur is characteristic of
mitral regurgitation. Jugular vein distention is a sign of right-sided heart failure.
2. A patient with heart failure is prescribed furosemide. Which laboratory value requires the most immediate
notification of the healthcare provider?
A. Serum sodium of 135 mEq/L
B. Serum potassium of 3.0 mEq/L
,C. Serum creatinine of 1.0 mg/dL
D. Serum magnesium of 1.8 mEq/L
🟢 B. Serum potassium of 3.0 mEq/L
🔴 RATIONALE: Furosemide is a loop diuretic that promotes the excretion of potassium, placing the patient at
risk for hypokalemia. A potassium level of 3.0 mEq/L is critically low and can lead to life-threatening cardiac
dysrhythmias, requiring immediate intervention. The other values are within normal limits.
3. A nurse is preparing to administer a blood transfusion. Which action is the priority to prevent a
transfusion reaction?
A. Verify the patient's identity with two nurses using two identifiers
B. Pre-medicate the patient with diphenhydramine and acetaminophen
C. Check the expiration date of the blood product
D. Ensure the blood is infused within 4 hours of starting
🟢 A. Verify the patient's identity with two nurses using two identifiers
🔴 RATIONALE: The most critical step in preventing a transfusion reaction is accurate patient identification. The
Joint Commission mandates that two nurses verify the patient's identity using two unique identifiers against the
blood product label and the blood bank slip. While all other options are important safety measures, they are
secondary to preventing a mis-transfusion.
4. A patient with chronic kidney disease (CKD) is scheduled for hemodialysis. Which assessment finding is
most important to report to the dialysis team?
, A. Blood pressure of 145/90 mmHg
B. Temperature of 99.0°F (37.2°C)
C. Presence of an arteriovenous (AV) graft thrill
D. Serosanguinous drainage at the AV graft site
🟢 D. Serosanguinous drainage at the AV graft site
🔴 RATIONALE: Serosanguinous drainage at an AV graft site indicates a potential infection or breakdown of the
surgical site, which is a direct contraindication for cannulation and dialysis. This must be reported immediately.
An AV graft thrill is a normal finding. A slightly elevated BP and low-grade fever can occur but are not as
immediately critical to the dialysis procedure as a compromised access site.
5. A nurse is caring for a patient post-thyroidectomy. Which early sign of hypocalcemia should the nurse
prioritize in assessment?
A. Hoarseness of the voice
B. Tingling around the mouth and fingertips
C. Difficulty swallowing
D. Absence of a cough reflex
🟢 B. Tingling around the mouth and fingertips
🔴 RATIONALE: During a thyroidectomy, the parathyroid glands can be inadvertently damaged or removed,
leading to hypocalcemia. Early signs of hypocalcemia include paresthesias (tingling) in the perioral area and
fingertips, which can progress to muscle twitching and tetany. Hoarseness and difficulty swallowing may
indicate laryngeal nerve damage.
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains:
Cardiovascular & Peripheral Vascular Systems
Respiratory System
Endocrine & Metabolic Disorders
Gastrointestinal & Renal Systems
Neurological & Sensory Disorders
Musculoskeletal & Integumentary Systems
Hematological, Oncological, & Immunological Disorders
Multisystem & Critical Care Concepts
Perioperative & Pain Management
Gerontology & Palliative/Ethical Considerations
Introduction
This comprehensive practice examination is meticulously designed to evaluate the clinical acumen and critical
thinking skills essential for success in the Medical-Surgical Nursing Certification (MEDSURG-BC) examination. The
assessment focuses on the application of evidence-based practice, pathophysiology, pharmacological interventions,
and nursing management across a spectrum of acute and chronic conditions encountered in the medical-surgical
setting. Structured with both multiple-choice and scenario-based questions, this tool emphasizes clinical decision-
making, prioritization, patient safety, and regulatory compliance. The exam aims to reflect the complexities of
,modern healthcare, challenging the nurse to integrate theoretical knowledge with real-world practice to deliver
safe, competent, and holistic care to a diverse patient population.
SECTION ONE: QUESTIONS 1–100
1. A nurse is assessing a patient with suspected pericarditis. Which finding is most consistent with this
diagnosis?
A. Diminished breath sounds at the lung bases
B. A friction rub heard at the left lower sternal border
C. A holosystolic murmur at the apex
D. Jugular vein distention with clear lung sounds
🟢 B. A friction rub heard at the left lower sternal border
🔴 RATIONALE: A pericardial friction rub is a classic sign of pericarditis, caused by the inflamed pericardial
layers rubbing against each other. It is best heard at the left lower sternal border with the patient leaning
forward. Diminished breath sounds are related to pleural effusions. A holosystolic murmur is characteristic of
mitral regurgitation. Jugular vein distention is a sign of right-sided heart failure.
2. A patient with heart failure is prescribed furosemide. Which laboratory value requires the most immediate
notification of the healthcare provider?
A. Serum sodium of 135 mEq/L
B. Serum potassium of 3.0 mEq/L
,C. Serum creatinine of 1.0 mg/dL
D. Serum magnesium of 1.8 mEq/L
🟢 B. Serum potassium of 3.0 mEq/L
🔴 RATIONALE: Furosemide is a loop diuretic that promotes the excretion of potassium, placing the patient at
risk for hypokalemia. A potassium level of 3.0 mEq/L is critically low and can lead to life-threatening cardiac
dysrhythmias, requiring immediate intervention. The other values are within normal limits.
3. A nurse is preparing to administer a blood transfusion. Which action is the priority to prevent a
transfusion reaction?
A. Verify the patient's identity with two nurses using two identifiers
B. Pre-medicate the patient with diphenhydramine and acetaminophen
C. Check the expiration date of the blood product
D. Ensure the blood is infused within 4 hours of starting
🟢 A. Verify the patient's identity with two nurses using two identifiers
🔴 RATIONALE: The most critical step in preventing a transfusion reaction is accurate patient identification. The
Joint Commission mandates that two nurses verify the patient's identity using two unique identifiers against the
blood product label and the blood bank slip. While all other options are important safety measures, they are
secondary to preventing a mis-transfusion.
4. A patient with chronic kidney disease (CKD) is scheduled for hemodialysis. Which assessment finding is
most important to report to the dialysis team?
, A. Blood pressure of 145/90 mmHg
B. Temperature of 99.0°F (37.2°C)
C. Presence of an arteriovenous (AV) graft thrill
D. Serosanguinous drainage at the AV graft site
🟢 D. Serosanguinous drainage at the AV graft site
🔴 RATIONALE: Serosanguinous drainage at an AV graft site indicates a potential infection or breakdown of the
surgical site, which is a direct contraindication for cannulation and dialysis. This must be reported immediately.
An AV graft thrill is a normal finding. A slightly elevated BP and low-grade fever can occur but are not as
immediately critical to the dialysis procedure as a compromised access site.
5. A nurse is caring for a patient post-thyroidectomy. Which early sign of hypocalcemia should the nurse
prioritize in assessment?
A. Hoarseness of the voice
B. Tingling around the mouth and fingertips
C. Difficulty swallowing
D. Absence of a cough reflex
🟢 B. Tingling around the mouth and fingertips
🔴 RATIONALE: During a thyroidectomy, the parathyroid glands can be inadvertently damaged or removed,
leading to hypocalcemia. Early signs of hypocalcemia include paresthesias (tingling) in the perioral area and
fingertips, which can progress to muscle twitching and tetany. Hoarseness and difficulty swallowing may
indicate laryngeal nerve damage.
