Medical-Surgical Nursing Certification (MEDSURG-BC) Final Exam – Complete
Test Bank | 250+ NGN-Style Questions with Verified Answers & Detailed
Rationales |
Questions 1–250
1. A 62-year-old male with a history of hypertension presents with acute
onset of crushing substernal chest pain radiating to the left arm, diaphoresis,
and nausea. ECG shows ST-segment elevation in leads V1–V4. Which is the
priority nursing action?
A) Administer sublingual nitroglycerin
B) Activate the cardiac catheterization lab for primary percutaneous coronary
intervention (PCI)
C) Administer IV morphine for pain
D) Obtain a chest X-ray
Answer B: Activate the cardiac catheterization lab for primary percutaneous
coronary intervention (PCI)
,Rationale: STEMI requires immediate reperfusion; primary PCI is preferred if
available within 90 minutes of arrival.
2. A 58-year-old female with COPD is receiving oxygen at 2 L/min via nasal
cannula. Her arterial blood gas (ABG) shows pH 7.32, PaCO2 58 mmHg, PaO2
65 mmHg. Which is the most appropriate nursing intervention?
A) Increase oxygen flow to 4 L/min
B) Prepare for non-invasive positive pressure ventilation (BiPAP)
C) Administer sodium bicarbonate IV
D) Place the patient in Trendelenburg position
Answer B: Prepare for non-invasive positive pressure ventilation (BiPAP)
Rationale: Acute respiratory acidosis (pH <7.35, PaCO2 >45) with COPD
exacerbation is an indication for BiPAP.
3. A 45-year-old male with a history of alcohol use disorder is admitted with
acute pancreatitis. He reports severe epigastric pain radiating to the back,
nausea, and vomiting. Which laboratory finding is most consistent with this
diagnosis?
A) Elevated troponin I
B) Elevated serum lipase and amylase
C) Elevated BUN and creatinine
,D) Elevated liver enzymes
Answer B: Elevated serum lipase and amylase
Rationale: Lipase is more specific than amylase for acute pancreatitis and
remains elevated longer.
4. A 68-year-old female is 2 days post-total knee replacement. She reports
sudden onset of shortness of breath, pleuritic chest pain, and hemoptysis.
Vital signs: HR 110, RR 26, O2 88%. What is the priority nursing action?
A) Administer IV morphine
B) Administer oxygen and prepare for CT pulmonary angiography (CTPA)
C) Administer aspirin
D) Perform a 12-lead ECG
Answer B: Administer oxygen and prepare for CT pulmonary angiography
(CTPA)
Rationale: Suspected pulmonary embolism in a postoperative patient requires
oxygen and diagnostic imaging (CTPA).
5. A 55-year-old male with end-stage renal disease is undergoing
hemodialysis. His blood pressure is 90/60 mmHg, and he reports dizziness.
Which is the most appropriate nursing intervention?
A) Increase the ultrafiltration rate
, B) Decrease the ultrafiltration rate and administer normal saline
C) Administer IV antihypertensive medication
D) Terminate the dialysis session immediately
Answer B: Decrease the ultrafiltration rate and administer normal saline
Rationale: Hypotension during dialysis is managed by slowing fluid removal
and infusing saline.
6. A 72-year-old female with heart failure is receiving furosemide 40 mg IV.
Which assessment finding indicates the medication is effective?
A) Heart rate increases from 80 to 92 bpm
B) Weight decreases by 1.5 kg in 24 hours
C) Blood pressure increases from 110/70 to 140/90 mmHg
D) Urine output decreases to 20 mL/hr
Answer B: Weight decreases by 1.5 kg in 24 hours
Rationale: Weight loss indicates effective diuresis and reduction of fluid
volume overload in heart failure.
7. A 66-year-old male with type 2 diabetes is admitted with a non-healing
ulcer on his right foot. The wound is deep, with exposed tendon and
surrounding erythema. Which is the priority nursing assessment?
A) Blood glucose monitoring
Test Bank | 250+ NGN-Style Questions with Verified Answers & Detailed
Rationales |
Questions 1–250
1. A 62-year-old male with a history of hypertension presents with acute
onset of crushing substernal chest pain radiating to the left arm, diaphoresis,
and nausea. ECG shows ST-segment elevation in leads V1–V4. Which is the
priority nursing action?
A) Administer sublingual nitroglycerin
B) Activate the cardiac catheterization lab for primary percutaneous coronary
intervention (PCI)
C) Administer IV morphine for pain
D) Obtain a chest X-ray
Answer B: Activate the cardiac catheterization lab for primary percutaneous
coronary intervention (PCI)
,Rationale: STEMI requires immediate reperfusion; primary PCI is preferred if
available within 90 minutes of arrival.
2. A 58-year-old female with COPD is receiving oxygen at 2 L/min via nasal
cannula. Her arterial blood gas (ABG) shows pH 7.32, PaCO2 58 mmHg, PaO2
65 mmHg. Which is the most appropriate nursing intervention?
A) Increase oxygen flow to 4 L/min
B) Prepare for non-invasive positive pressure ventilation (BiPAP)
C) Administer sodium bicarbonate IV
D) Place the patient in Trendelenburg position
Answer B: Prepare for non-invasive positive pressure ventilation (BiPAP)
Rationale: Acute respiratory acidosis (pH <7.35, PaCO2 >45) with COPD
exacerbation is an indication for BiPAP.
3. A 45-year-old male with a history of alcohol use disorder is admitted with
acute pancreatitis. He reports severe epigastric pain radiating to the back,
nausea, and vomiting. Which laboratory finding is most consistent with this
diagnosis?
A) Elevated troponin I
B) Elevated serum lipase and amylase
C) Elevated BUN and creatinine
,D) Elevated liver enzymes
Answer B: Elevated serum lipase and amylase
Rationale: Lipase is more specific than amylase for acute pancreatitis and
remains elevated longer.
4. A 68-year-old female is 2 days post-total knee replacement. She reports
sudden onset of shortness of breath, pleuritic chest pain, and hemoptysis.
Vital signs: HR 110, RR 26, O2 88%. What is the priority nursing action?
A) Administer IV morphine
B) Administer oxygen and prepare for CT pulmonary angiography (CTPA)
C) Administer aspirin
D) Perform a 12-lead ECG
Answer B: Administer oxygen and prepare for CT pulmonary angiography
(CTPA)
Rationale: Suspected pulmonary embolism in a postoperative patient requires
oxygen and diagnostic imaging (CTPA).
5. A 55-year-old male with end-stage renal disease is undergoing
hemodialysis. His blood pressure is 90/60 mmHg, and he reports dizziness.
Which is the most appropriate nursing intervention?
A) Increase the ultrafiltration rate
, B) Decrease the ultrafiltration rate and administer normal saline
C) Administer IV antihypertensive medication
D) Terminate the dialysis session immediately
Answer B: Decrease the ultrafiltration rate and administer normal saline
Rationale: Hypotension during dialysis is managed by slowing fluid removal
and infusing saline.
6. A 72-year-old female with heart failure is receiving furosemide 40 mg IV.
Which assessment finding indicates the medication is effective?
A) Heart rate increases from 80 to 92 bpm
B) Weight decreases by 1.5 kg in 24 hours
C) Blood pressure increases from 110/70 to 140/90 mmHg
D) Urine output decreases to 20 mL/hr
Answer B: Weight decreases by 1.5 kg in 24 hours
Rationale: Weight loss indicates effective diuresis and reduction of fluid
volume overload in heart failure.
7. A 66-year-old male with type 2 diabetes is admitted with a non-healing
ulcer on his right foot. The wound is deep, with exposed tendon and
surrounding erythema. Which is the priority nursing assessment?
A) Blood glucose monitoring
