(MEDSURG-BC) 2026
MEDICAL-SURGICAL NURSING MEDSURG-BC
EXAM 2026: The Ultimate 200-Question Practice Test
with Detailed Clinical Rationales, Evidence-Based
Answers, and Comprehensive Success Strategies
Domain 1: Assessment and Diagnosis
QUESTION 1:
A 68-year-old male patient with a history of heart failure is admitted with shortness of breath and
peripheral edema. During the admission assessment, the nurse notes jugular venous distention, a
third heart sound (S3), and crackles auscultated in the bilateral lung bases. The patient's oxygen
saturation is 89% on room air. Which nursing diagnosis should the nurse prioritize for this patient?
A. Excess Fluid Volume related to compromised regulatory mechanism
B. Impaired Gas Exchange related to alveolar-capillary membrane changes
C. Decreased Cardiac Output related to altered myocardial contractility
D. Activity Intolerance related to imbalance between oxygen supply and demand
ANSWER:
B. Impaired Gas Exchange related to alveolar-capillary membrane changes
RATIONALE:
The patient exhibits classic signs of acute decompensated heart failure with pulmonary congestion—
crackles, hypoxemia (SpO2 89%), and an S3 gallop. Impaired Gas Exchange is the priority diagnosis
because it directly addresses the life-threatening oxygenation deficit. While Excess Fluid Volume is a
related problem contributing to the gas exchange impairment, the immediate threat to physiological
stability is the compromised oxygenation . Decreased Cardiac Output is a causative factor but does
not reflect the current priority. Activity Intolerance is appropriate but represents a longer-term
issue .
QUESTION 2:
A nurse is assessing a patient with peripheral arterial disease (PAD). Which finding is most consistent
with this diagnosis?
A. Brownish discoloration of the lower extremities
B. Edema that worsens throughout the day
C. Pallor of the foot when elevated and dependent rubor
D. Thickened, hardened skin with hemosiderin deposits
ANSWER:
C. Pallor of the foot when elevated and dependent rubor
RATIONALE:
Pallor on elevation and dependent rubor are classic findings in peripheral arterial disease, indicating
severe arterial insufficiency. When the leg is elevated, the lack of blood flow results in pallor; when
, (MEDSURG-BC) 2026
dependent, reactive hyperemia causes a reddish-purple discoloration (rubor). Brownish
discoloration, edema worsening throughout the day, and thickened skin with hemosiderin deposits
are characteristic of chronic venous insufficiency . Differentiation between arterial and venous ulcers
is critical in medical-surgical nursing assessment.
QUESTION 3:
A patient with type 2 diabetes mellitus presents with a non-healing ulcer on the plantar surface of
the right foot. The wound is pale, dry, and has well-defined borders with minimal drainage. The
surrounding skin is cool to the touch. Which assessment finding would most help differentiate this as
an arterial ulcer versus a venous stasis ulcer?
A. Presence of infection in the wound
B. Location of the ulcer on the foot
C. History of diabetes mellitus
D. Presence or absence of claudication
ANSWER:
D. Presence or absence of claudication
RATIONALE:
Claudication—pain with ambulation that resolves with rest—is a hallmark symptom of arterial
insufficiency. Arterial ulcers are typically located on the toes, heels, or bony prominences, are pale
and dry with well-defined borders, and are associated with cool skin and diminished or absent
pulses. Venous stasis ulcers occur on the medial malleolus, have irregular borders, are moist with
ruddy granulation tissue, and are associated with edema, hemosiderin staining, and intact pulses.
While location and history provide clues, claudication specifically indicates arterial disease and helps
differentiate the ulcer etiology .
QUESTION 4:
A nurse is performing a focused assessment on a patient who had a coronary artery bypass graft
(CABG) surgery 6 hours ago. The patient's mediastinal chest tube drainage is 150 mL over the past
hour. Which is the most appropriate nursing action?
A. Document the finding as expected in the immediate postoperative period
B. Increase the IV fluid rate to compensate for blood loss
C. Notify the healthcare provider immediately
D. Apply gentle pressure to the chest tube insertion site
ANSWER:
C. Notify the healthcare provider immediately
RATIONALE:
Mediastinal drainage greater than 100-150 mL/hour in the first few hours after CABG surgery
indicates potential hemorrhage and requires immediate notification of the healthcare provider.
While some drainage is expected postoperatively (typically 50-100 mL/hour initially, decreasing over
time), this rate of 150 mL/hour is concerning. Documentation alone is insufficient; this finding
, (MEDSURG-BC) 2026
requires urgent intervention. Increasing IV fluids or applying pressure to the insertion site would not
address the underlying bleeding and could delay necessary surgical intervention .
QUESTION 5:
A patient with heart failure is prescribed digoxin and furosemide. The nurse should monitor closely
for which adverse effect that may occur with this medication combination?
A. Hyperkalemia
B. Digitalis toxicity related to hypokalemia
C. Pulmonary edema
D. Hypertensive crisis
ANSWER:
B. Digitalis toxicity related to hypokalemia
RATIONALE:
Furosemide, a loop diuretic, causes potassium wasting, which can lead to hypokalemia. Hypokalemia
increases the risk of digoxin toxicity because digoxin competes with potassium for binding sites on
the Na⁺/K⁺-ATPase pump in cardiac cells. Signs of digoxin toxicity include nausea, vomiting, visual
disturbances (yellow-green halos), and cardiac dysrhythmias. The nurse should monitor serum
potassium levels and report any decreases. The combination does not typically cause hyperkalemia,
and these medications are used to manage pulmonary edema and hypertension, not precipitate
them .
QUESTION 6:
A patient is scheduled for a stress test at 1100. Which statement by the patient requires the nurse to
contact the provider for possible rescheduling?
A. "I'm still hungry after the bowl of cereal I ate at 7 AM."
B. "I didn't take my heart pills this morning because the doctor told me not to."
C. "I have had chest pain a couple of times since I saw my doctor last week."
D. "I smoked a cigarette this morning to calm my nerves."
ANSWER:
D. "I smoked a cigarette this morning to calm my nerves."
RATIONALE:
Smoking before a stress test is contraindicated because nicotine causes vasoconstriction and can
affect test results. Patients should be instructed to avoid smoking, caffeine, and alcohol for at least
4-6 hours before the test. While a light breakfast is typically not allowed (NPO status may be
required), the cereal might be acceptable depending on the provider's orders. The patient
appropriately followed the instruction not to take heart medications. Recent chest pain is important
to report but does not necessarily require rescheduling unless it represents a change in status. The
smoking is a modifiable behavior that can alter test outcomes .
, (MEDSURG-BC) 2026
QUESTION 7:
A patient with end-stage renal disease (ESRD) is admitted with confusion, muscle twitching, and
nausea. Laboratory results reveal BUN 85 mg/dL, creatinine 8.2 mg/dL, and potassium 6.8 mEq/L.
Which finding should the nurse report to the provider immediately?
A. BUN 85 mg/dL
B. Creatinine 8.2 mg/dL
C. Potassium 6.8 mEq/L
D. Presence of confusion
ANSWER:
C. Potassium 6.8 mEq/L
RATIONALE:
A potassium level of 6.8 mEq/L represents severe hyperkalemia, which poses an immediate risk of
life-threatening cardiac dysrhythmias. While all findings are abnormal and concerning, hyperkalemia
at this level requires emergent intervention—typically IV calcium gluconate for cardiac stabilization,
insulin and glucose to shift potassium intracellularly, and possibly dialysis. BUN 85 mg/dL and
creatinine 8.2 mg/dL indicate severe renal impairment but are consistent with the patient's ESRD
diagnosis. Confusion may be related to uremia but is less immediately life-threatening than severe
hyperkalemia.
QUESTION 8:
A nurse is evaluating the laboratory results of a patient at risk for coronary artery disease. Which
lipid panel result indicates the highest risk requiring dietary teaching intervention?
A. Total cholesterol 180 mg/dL, HDL 70 mg/dL, LDL 90 mg/dL
B. Total cholesterol 185 mg/dL, HDL 50 mg/dL, LDL 120 mg/dL
C. Total cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL
D. Total cholesterol 195 mg/dL, HDL 55 mg/dL, LDL 125 mg/dL
ANSWER:
C. Total cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL
RATIONALE:
This lipid panel reveals multiple risk factors: elevated LDL (≥160 mg/dL is high), low HDL (<40 mg/dL
is a risk factor in males; <50 mg/dL in females), and total cholesterol >190 mg/dL. The combination
represents significantly increased cardiovascular risk and warrants aggressive dietary and
pharmacologic intervention. The other options show progressively better lipid profiles, with Option
A representing an ideal pattern (low total cholesterol, high HDL, low LDL). The patient with these
results would require the most intensive dietary teaching .
QUESTION 9:
A patient with left-sided heart failure reports increasing difficulty completing daily 1-mile walks.
Which finding does this symptom most likely indicate?
A. Left ventricular failure
B. Peripheral vasodilation
MEDICAL-SURGICAL NURSING MEDSURG-BC
EXAM 2026: The Ultimate 200-Question Practice Test
with Detailed Clinical Rationales, Evidence-Based
Answers, and Comprehensive Success Strategies
Domain 1: Assessment and Diagnosis
QUESTION 1:
A 68-year-old male patient with a history of heart failure is admitted with shortness of breath and
peripheral edema. During the admission assessment, the nurse notes jugular venous distention, a
third heart sound (S3), and crackles auscultated in the bilateral lung bases. The patient's oxygen
saturation is 89% on room air. Which nursing diagnosis should the nurse prioritize for this patient?
A. Excess Fluid Volume related to compromised regulatory mechanism
B. Impaired Gas Exchange related to alveolar-capillary membrane changes
C. Decreased Cardiac Output related to altered myocardial contractility
D. Activity Intolerance related to imbalance between oxygen supply and demand
ANSWER:
B. Impaired Gas Exchange related to alveolar-capillary membrane changes
RATIONALE:
The patient exhibits classic signs of acute decompensated heart failure with pulmonary congestion—
crackles, hypoxemia (SpO2 89%), and an S3 gallop. Impaired Gas Exchange is the priority diagnosis
because it directly addresses the life-threatening oxygenation deficit. While Excess Fluid Volume is a
related problem contributing to the gas exchange impairment, the immediate threat to physiological
stability is the compromised oxygenation . Decreased Cardiac Output is a causative factor but does
not reflect the current priority. Activity Intolerance is appropriate but represents a longer-term
issue .
QUESTION 2:
A nurse is assessing a patient with peripheral arterial disease (PAD). Which finding is most consistent
with this diagnosis?
A. Brownish discoloration of the lower extremities
B. Edema that worsens throughout the day
C. Pallor of the foot when elevated and dependent rubor
D. Thickened, hardened skin with hemosiderin deposits
ANSWER:
C. Pallor of the foot when elevated and dependent rubor
RATIONALE:
Pallor on elevation and dependent rubor are classic findings in peripheral arterial disease, indicating
severe arterial insufficiency. When the leg is elevated, the lack of blood flow results in pallor; when
, (MEDSURG-BC) 2026
dependent, reactive hyperemia causes a reddish-purple discoloration (rubor). Brownish
discoloration, edema worsening throughout the day, and thickened skin with hemosiderin deposits
are characteristic of chronic venous insufficiency . Differentiation between arterial and venous ulcers
is critical in medical-surgical nursing assessment.
QUESTION 3:
A patient with type 2 diabetes mellitus presents with a non-healing ulcer on the plantar surface of
the right foot. The wound is pale, dry, and has well-defined borders with minimal drainage. The
surrounding skin is cool to the touch. Which assessment finding would most help differentiate this as
an arterial ulcer versus a venous stasis ulcer?
A. Presence of infection in the wound
B. Location of the ulcer on the foot
C. History of diabetes mellitus
D. Presence or absence of claudication
ANSWER:
D. Presence or absence of claudication
RATIONALE:
Claudication—pain with ambulation that resolves with rest—is a hallmark symptom of arterial
insufficiency. Arterial ulcers are typically located on the toes, heels, or bony prominences, are pale
and dry with well-defined borders, and are associated with cool skin and diminished or absent
pulses. Venous stasis ulcers occur on the medial malleolus, have irregular borders, are moist with
ruddy granulation tissue, and are associated with edema, hemosiderin staining, and intact pulses.
While location and history provide clues, claudication specifically indicates arterial disease and helps
differentiate the ulcer etiology .
QUESTION 4:
A nurse is performing a focused assessment on a patient who had a coronary artery bypass graft
(CABG) surgery 6 hours ago. The patient's mediastinal chest tube drainage is 150 mL over the past
hour. Which is the most appropriate nursing action?
A. Document the finding as expected in the immediate postoperative period
B. Increase the IV fluid rate to compensate for blood loss
C. Notify the healthcare provider immediately
D. Apply gentle pressure to the chest tube insertion site
ANSWER:
C. Notify the healthcare provider immediately
RATIONALE:
Mediastinal drainage greater than 100-150 mL/hour in the first few hours after CABG surgery
indicates potential hemorrhage and requires immediate notification of the healthcare provider.
While some drainage is expected postoperatively (typically 50-100 mL/hour initially, decreasing over
time), this rate of 150 mL/hour is concerning. Documentation alone is insufficient; this finding
, (MEDSURG-BC) 2026
requires urgent intervention. Increasing IV fluids or applying pressure to the insertion site would not
address the underlying bleeding and could delay necessary surgical intervention .
QUESTION 5:
A patient with heart failure is prescribed digoxin and furosemide. The nurse should monitor closely
for which adverse effect that may occur with this medication combination?
A. Hyperkalemia
B. Digitalis toxicity related to hypokalemia
C. Pulmonary edema
D. Hypertensive crisis
ANSWER:
B. Digitalis toxicity related to hypokalemia
RATIONALE:
Furosemide, a loop diuretic, causes potassium wasting, which can lead to hypokalemia. Hypokalemia
increases the risk of digoxin toxicity because digoxin competes with potassium for binding sites on
the Na⁺/K⁺-ATPase pump in cardiac cells. Signs of digoxin toxicity include nausea, vomiting, visual
disturbances (yellow-green halos), and cardiac dysrhythmias. The nurse should monitor serum
potassium levels and report any decreases. The combination does not typically cause hyperkalemia,
and these medications are used to manage pulmonary edema and hypertension, not precipitate
them .
QUESTION 6:
A patient is scheduled for a stress test at 1100. Which statement by the patient requires the nurse to
contact the provider for possible rescheduling?
A. "I'm still hungry after the bowl of cereal I ate at 7 AM."
B. "I didn't take my heart pills this morning because the doctor told me not to."
C. "I have had chest pain a couple of times since I saw my doctor last week."
D. "I smoked a cigarette this morning to calm my nerves."
ANSWER:
D. "I smoked a cigarette this morning to calm my nerves."
RATIONALE:
Smoking before a stress test is contraindicated because nicotine causes vasoconstriction and can
affect test results. Patients should be instructed to avoid smoking, caffeine, and alcohol for at least
4-6 hours before the test. While a light breakfast is typically not allowed (NPO status may be
required), the cereal might be acceptable depending on the provider's orders. The patient
appropriately followed the instruction not to take heart medications. Recent chest pain is important
to report but does not necessarily require rescheduling unless it represents a change in status. The
smoking is a modifiable behavior that can alter test outcomes .
, (MEDSURG-BC) 2026
QUESTION 7:
A patient with end-stage renal disease (ESRD) is admitted with confusion, muscle twitching, and
nausea. Laboratory results reveal BUN 85 mg/dL, creatinine 8.2 mg/dL, and potassium 6.8 mEq/L.
Which finding should the nurse report to the provider immediately?
A. BUN 85 mg/dL
B. Creatinine 8.2 mg/dL
C. Potassium 6.8 mEq/L
D. Presence of confusion
ANSWER:
C. Potassium 6.8 mEq/L
RATIONALE:
A potassium level of 6.8 mEq/L represents severe hyperkalemia, which poses an immediate risk of
life-threatening cardiac dysrhythmias. While all findings are abnormal and concerning, hyperkalemia
at this level requires emergent intervention—typically IV calcium gluconate for cardiac stabilization,
insulin and glucose to shift potassium intracellularly, and possibly dialysis. BUN 85 mg/dL and
creatinine 8.2 mg/dL indicate severe renal impairment but are consistent with the patient's ESRD
diagnosis. Confusion may be related to uremia but is less immediately life-threatening than severe
hyperkalemia.
QUESTION 8:
A nurse is evaluating the laboratory results of a patient at risk for coronary artery disease. Which
lipid panel result indicates the highest risk requiring dietary teaching intervention?
A. Total cholesterol 180 mg/dL, HDL 70 mg/dL, LDL 90 mg/dL
B. Total cholesterol 185 mg/dL, HDL 50 mg/dL, LDL 120 mg/dL
C. Total cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL
D. Total cholesterol 195 mg/dL, HDL 55 mg/dL, LDL 125 mg/dL
ANSWER:
C. Total cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL
RATIONALE:
This lipid panel reveals multiple risk factors: elevated LDL (≥160 mg/dL is high), low HDL (<40 mg/dL
is a risk factor in males; <50 mg/dL in females), and total cholesterol >190 mg/dL. The combination
represents significantly increased cardiovascular risk and warrants aggressive dietary and
pharmacologic intervention. The other options show progressively better lipid profiles, with Option
A representing an ideal pattern (low total cholesterol, high HDL, low LDL). The patient with these
results would require the most intensive dietary teaching .
QUESTION 9:
A patient with left-sided heart failure reports increasing difficulty completing daily 1-mile walks.
Which finding does this symptom most likely indicate?
A. Left ventricular failure
B. Peripheral vasodilation
