Medsurg-Bc Certification Exam Prep 2026
— Comprehensive Practice Examination
**1. A nurse is assessing a client with heart failure who reports
increasing shortness of breath, orthopnea, and a 5-pound
weight gain over 3 days. Which assessment finding indicates
acute decompensated heart failure?**
A. Blood pressure 138/82 mmHg
B. Bibasilar crackles and jugular venous distention
C. Heart rate 72 beats/min
D. Oxygen saturation 96% on room air
**Correct answer:** B. Bibasilar crackles and jugular venous
distention
**Rationale:** Bibasilar crackles and jugular venous distention
are classic signs of fluid overload and acute decompensated
heart failure. The weight gain of 5 pounds in 3 days reflects
fluid retention. The other findings are within normal limits and
do not indicate decompensation.
---
**2. A client complains of crushing chest pain that radiates to
the left arm. Which action should the nurse take FIRST?**
,A. Administer nitroglycerin sublingually
B. Obtain a 12-lead ECG
C. Administer aspirin 325 mg chewed
D. Assess vital signs and oxygen saturation
**Correct answer:** B. Obtain a 12-lead ECG
**Rationale:** Obtaining a 12-lead ECG is the priority for a
client with suspected acute coronary syndrome. The ECG
should be obtained within 10 minutes of arrival to identify ST-
elevation myocardial infarction (STEMI) and guide reperfusion
therapy. While oxygen, nitroglycerin, and aspirin are important,
the ECG provides critical diagnostic information that guides
immediate treatment.
---
**3. A nurse is assessing a client who has right-sided heart
failure. Which finding should the nurse expect?**
A. Crackles in the lung bases
B. Jugular vein distension
C. Dry, nonproductive cough
D. Low oxygen saturation levels
,**Correct answer:** B. Jugular vein distension
**Rationale:** Right-sided heart failure causes systemic venous
congestion because the right ventricle is unable to pump blood
effectively into the pulmonary circulation. This leads to jugular
vein distention, dependent peripheral edema, hepatomegaly,
and ascites. Crackles and a dry cough are classical
manifestations of left-sided heart failure.
---
**4. A client with new-onset atrial fibrillation has a ventricular
rate of 156/min and is hemodynamically stable with blood
pressure 128/78 mm Hg. The client reports lightheadedness
and palpitations. Which intervention should the nurse
anticipate?**
A. Immediate synchronized cardioversion
B. Administration of intravenous amiodarone
C. Administration of intravenous diltiazem
D. Insertion of a temporary pacemaker
**Correct answer:** C. Administration of intravenous diltiazem
**Rationale:** In hemodynamically stable atrial fibrillation with
rapid ventricular response, rate control with a calcium channel
blocker (diltiazem) or beta-blocker is indicated. Immediate
, synchronized cardioversion is reserved for hemodynamically
unstable patients.
---
**5. A 68-year-old patient with a history of chronic obstructive
pulmonary disease (COPD) is admitted with increasing
dyspnea, productive cough, and fatigue. The patient is
receiving oxygen at 2 L/min by nasal cannula. The nurse notes
a respiratory rate of 28/min, oxygen saturation of 86%,
diminished breath sounds bilaterally, and increasing
somnolence. Which nursing action is the priority?**
A. Increase oxygen flow to 6 L/min immediately
B. Place the patient in a high-Fowler position and assess
ventilation status
C. Administer a sedative to decrease anxiety and oxygen
consumption
D. Encourage the patient to ambulate to mobilize pulmonary
secretions
**Correct answer:** B. Place the patient in a high-Fowler
position and assess ventilation status
**Rationale:** A patient with COPD and worsening hypoxemia,
tachypnea, and somnolence requires immediate assessment of
airway and ventilation. High-Fowler positioning promotes
maximal diaphragmatic expansion and can improve ventilation.
— Comprehensive Practice Examination
**1. A nurse is assessing a client with heart failure who reports
increasing shortness of breath, orthopnea, and a 5-pound
weight gain over 3 days. Which assessment finding indicates
acute decompensated heart failure?**
A. Blood pressure 138/82 mmHg
B. Bibasilar crackles and jugular venous distention
C. Heart rate 72 beats/min
D. Oxygen saturation 96% on room air
**Correct answer:** B. Bibasilar crackles and jugular venous
distention
**Rationale:** Bibasilar crackles and jugular venous distention
are classic signs of fluid overload and acute decompensated
heart failure. The weight gain of 5 pounds in 3 days reflects
fluid retention. The other findings are within normal limits and
do not indicate decompensation.
---
**2. A client complains of crushing chest pain that radiates to
the left arm. Which action should the nurse take FIRST?**
,A. Administer nitroglycerin sublingually
B. Obtain a 12-lead ECG
C. Administer aspirin 325 mg chewed
D. Assess vital signs and oxygen saturation
**Correct answer:** B. Obtain a 12-lead ECG
**Rationale:** Obtaining a 12-lead ECG is the priority for a
client with suspected acute coronary syndrome. The ECG
should be obtained within 10 minutes of arrival to identify ST-
elevation myocardial infarction (STEMI) and guide reperfusion
therapy. While oxygen, nitroglycerin, and aspirin are important,
the ECG provides critical diagnostic information that guides
immediate treatment.
---
**3. A nurse is assessing a client who has right-sided heart
failure. Which finding should the nurse expect?**
A. Crackles in the lung bases
B. Jugular vein distension
C. Dry, nonproductive cough
D. Low oxygen saturation levels
,**Correct answer:** B. Jugular vein distension
**Rationale:** Right-sided heart failure causes systemic venous
congestion because the right ventricle is unable to pump blood
effectively into the pulmonary circulation. This leads to jugular
vein distention, dependent peripheral edema, hepatomegaly,
and ascites. Crackles and a dry cough are classical
manifestations of left-sided heart failure.
---
**4. A client with new-onset atrial fibrillation has a ventricular
rate of 156/min and is hemodynamically stable with blood
pressure 128/78 mm Hg. The client reports lightheadedness
and palpitations. Which intervention should the nurse
anticipate?**
A. Immediate synchronized cardioversion
B. Administration of intravenous amiodarone
C. Administration of intravenous diltiazem
D. Insertion of a temporary pacemaker
**Correct answer:** C. Administration of intravenous diltiazem
**Rationale:** In hemodynamically stable atrial fibrillation with
rapid ventricular response, rate control with a calcium channel
blocker (diltiazem) or beta-blocker is indicated. Immediate
, synchronized cardioversion is reserved for hemodynamically
unstable patients.
---
**5. A 68-year-old patient with a history of chronic obstructive
pulmonary disease (COPD) is admitted with increasing
dyspnea, productive cough, and fatigue. The patient is
receiving oxygen at 2 L/min by nasal cannula. The nurse notes
a respiratory rate of 28/min, oxygen saturation of 86%,
diminished breath sounds bilaterally, and increasing
somnolence. Which nursing action is the priority?**
A. Increase oxygen flow to 6 L/min immediately
B. Place the patient in a high-Fowler position and assess
ventilation status
C. Administer a sedative to decrease anxiety and oxygen
consumption
D. Encourage the patient to ambulate to mobilize pulmonary
secretions
**Correct answer:** B. Place the patient in a high-Fowler
position and assess ventilation status
**Rationale:** A patient with COPD and worsening hypoxemia,
tachypnea, and somnolence requires immediate assessment of
airway and ventilation. High-Fowler positioning promotes
maximal diaphragmatic expansion and can improve ventilation.
