Medical-Surgical Nursing
Certification Review: 150+ Multiple
Choice Questions with Rationales
,CORRECT ANSWERS LATEST EDITION
2026!
DOMAIN 1: ASSESSMENT (25 Questions)
Question 1
A nurse is performing an initial assessment on a patient admitted with pneumonia.
Which finding is most indicative of severe respiratory compromise?
A) Respiratory rate of 22 breaths per minute
B) Oxygen saturation of 91% on room air
C) Use of accessory muscles and nasal flaring
D) Mild crackles at the lung bases
CORRECT ANSWER: C
Rationale: Use of accessory muscles and nasal flaring are late signs of respiratory distress
indicating severe compromise. A respiratory rate of 22 is mildly elevated but not
immediately critical. An SpO2 of 91% is below normal but may be acceptable in some
patients with chronic lung disease. Mild crackles indicate fluid but do not suggest
severe compromise. The nurse should recognize these signs as indicators of impending
respiratory failure requiring immediate intervention .
Question 2
A patient with heart failure reports worsening shortness of breath and a weight gain of 4
pounds in 3 days. What is the nurse's priority action?
,A) Instruct the patient to restrict oral fluids
B) Administer PRN diuretic as ordered
C) Auscultate lung sounds and assess for edema
D) Notify the healthcare provider immediately
CORRECT ANSWER: D
Rationale: A 4-pound weight gain in 3 days indicates significant fluid retention
(approximately 2 liters) and worsening heart failure. The nurse should notify the provider
immediately as this may require medication adjustment or hospitalization. While
assessing lung sounds, administering diuretics, and providing fluid restriction education
are appropriate, the priority is timely communication with the provider to prevent acute
decompensation .
Question 3
Which assessment technique should the nurse use to evaluate a patient for pitting
edema?
A) Measuring the circumference of the affected extremity
B) Applying firm pressure over a bony prominence and assessing indentation
C) Observing skin color and temperature changes
D) Palpating for tenderness along the vascular pathway
CORRECT ANSWER: B
Rationale: Pitting edema is assessed by applying firm pressure with a fingertip over a
bony prominence (such as the tibia or sacrum) for 5-10 seconds and observing for an
indentation that persists after pressure is released. The depth of the pit is graded on a
scale from 1+ (2mm) to 4+ (8mm). Measuring circumference provides objective data
about swelling but does not assess pitting quality. Skin color and temperature changes
indicate vascular compromise, not pitting specifically .
,Question 4
A nurse is assessing a patient's pain level. Which statement by the patient reflects the
most accurate pain assessment data?
A) "My pain is about a 7 on a scale of 0 to 10."
B) "I think the pain is getting worse."
C) "The pain is in my abdomen and it hurts."
D) "It feels like a burning sensation that comes and goes."
CORRECT ANSWER: A
Rationale: The numeric rating scale (0-10) is a valid, reliable tool for quantifying pain
intensity and allows for objective tracking of pain over time. While descriptive
information about location, quality, and timing is also important for comprehensive pain
assessment, a numeric score provides the most measurable and comparable data .
Question 5
A patient with chronic obstructive pulmonary disease (COPD) has the following arterial
blood gas results: pH 7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L. The nurse interprets these
findings as:
A) Acute respiratory acidosis with metabolic compensation
B) Chronic respiratory acidosis with metabolic compensation
C) Acute respiratory alkalosis with metabolic compensation
D) Metabolic acidosis with respiratory compensation
CORRECT ANSWER: B
Rationale: The pH is low (acidosis), PaCO2 is elevated (respiratory acidosis), and HCO3-
is elevated (metabolic compensation). The elevated bicarbonate indicates renal
compensation has occurred over time, suggesting this is a chronic respiratory acidosis,
, commonly seen in COPD patients. In acute respiratory acidosis, bicarbonate would be
normal .
Question 6
Which finding in a patient with cirrhosis is most concerning for progression to hepatic
encephalopathy?
A) Spider angiomas on the chest
B) Asterixis (liver flap)
C) Palmar erythema
D) Caput medusae
CORRECT ANSWER: B
Rationale: Asterixis, or liver flap (involuntary flapping movements of the hands when
wrists are extended), is a characteristic sign of hepatic encephalopathy. Spider
angiomas, palmar erythema, and caput medusae are signs of chronic liver disease and
portal hypertension but do not specifically indicate encephalopathy .
Question 7
A postoperative patient's vital signs show heart rate 118 bpm, blood pressure 88/52
mmHg, respiratory rate 24, temperature 38.6°C (101.5°F). The nurse should first:
A) Administer a bolus of intravenous fluids
B) Obtain a blood culture and administer antibiotics
C) Assess for surgical site infection and bleeding
D) Notify the healthcare provider
CORRECT ANSWER: D
Certification Review: 150+ Multiple
Choice Questions with Rationales
,CORRECT ANSWERS LATEST EDITION
2026!
DOMAIN 1: ASSESSMENT (25 Questions)
Question 1
A nurse is performing an initial assessment on a patient admitted with pneumonia.
Which finding is most indicative of severe respiratory compromise?
A) Respiratory rate of 22 breaths per minute
B) Oxygen saturation of 91% on room air
C) Use of accessory muscles and nasal flaring
D) Mild crackles at the lung bases
CORRECT ANSWER: C
Rationale: Use of accessory muscles and nasal flaring are late signs of respiratory distress
indicating severe compromise. A respiratory rate of 22 is mildly elevated but not
immediately critical. An SpO2 of 91% is below normal but may be acceptable in some
patients with chronic lung disease. Mild crackles indicate fluid but do not suggest
severe compromise. The nurse should recognize these signs as indicators of impending
respiratory failure requiring immediate intervention .
Question 2
A patient with heart failure reports worsening shortness of breath and a weight gain of 4
pounds in 3 days. What is the nurse's priority action?
,A) Instruct the patient to restrict oral fluids
B) Administer PRN diuretic as ordered
C) Auscultate lung sounds and assess for edema
D) Notify the healthcare provider immediately
CORRECT ANSWER: D
Rationale: A 4-pound weight gain in 3 days indicates significant fluid retention
(approximately 2 liters) and worsening heart failure. The nurse should notify the provider
immediately as this may require medication adjustment or hospitalization. While
assessing lung sounds, administering diuretics, and providing fluid restriction education
are appropriate, the priority is timely communication with the provider to prevent acute
decompensation .
Question 3
Which assessment technique should the nurse use to evaluate a patient for pitting
edema?
A) Measuring the circumference of the affected extremity
B) Applying firm pressure over a bony prominence and assessing indentation
C) Observing skin color and temperature changes
D) Palpating for tenderness along the vascular pathway
CORRECT ANSWER: B
Rationale: Pitting edema is assessed by applying firm pressure with a fingertip over a
bony prominence (such as the tibia or sacrum) for 5-10 seconds and observing for an
indentation that persists after pressure is released. The depth of the pit is graded on a
scale from 1+ (2mm) to 4+ (8mm). Measuring circumference provides objective data
about swelling but does not assess pitting quality. Skin color and temperature changes
indicate vascular compromise, not pitting specifically .
,Question 4
A nurse is assessing a patient's pain level. Which statement by the patient reflects the
most accurate pain assessment data?
A) "My pain is about a 7 on a scale of 0 to 10."
B) "I think the pain is getting worse."
C) "The pain is in my abdomen and it hurts."
D) "It feels like a burning sensation that comes and goes."
CORRECT ANSWER: A
Rationale: The numeric rating scale (0-10) is a valid, reliable tool for quantifying pain
intensity and allows for objective tracking of pain over time. While descriptive
information about location, quality, and timing is also important for comprehensive pain
assessment, a numeric score provides the most measurable and comparable data .
Question 5
A patient with chronic obstructive pulmonary disease (COPD) has the following arterial
blood gas results: pH 7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L. The nurse interprets these
findings as:
A) Acute respiratory acidosis with metabolic compensation
B) Chronic respiratory acidosis with metabolic compensation
C) Acute respiratory alkalosis with metabolic compensation
D) Metabolic acidosis with respiratory compensation
CORRECT ANSWER: B
Rationale: The pH is low (acidosis), PaCO2 is elevated (respiratory acidosis), and HCO3-
is elevated (metabolic compensation). The elevated bicarbonate indicates renal
compensation has occurred over time, suggesting this is a chronic respiratory acidosis,
, commonly seen in COPD patients. In acute respiratory acidosis, bicarbonate would be
normal .
Question 6
Which finding in a patient with cirrhosis is most concerning for progression to hepatic
encephalopathy?
A) Spider angiomas on the chest
B) Asterixis (liver flap)
C) Palmar erythema
D) Caput medusae
CORRECT ANSWER: B
Rationale: Asterixis, or liver flap (involuntary flapping movements of the hands when
wrists are extended), is a characteristic sign of hepatic encephalopathy. Spider
angiomas, palmar erythema, and caput medusae are signs of chronic liver disease and
portal hypertension but do not specifically indicate encephalopathy .
Question 7
A postoperative patient's vital signs show heart rate 118 bpm, blood pressure 88/52
mmHg, respiratory rate 24, temperature 38.6°C (101.5°F). The nurse should first:
A) Administer a bolus of intravenous fluids
B) Obtain a blood culture and administer antibiotics
C) Assess for surgical site infection and bleeding
D) Notify the healthcare provider
CORRECT ANSWER: D
