Medical-Surgical Nursing Certification Exam: 150
Advanced Practice Questions with Detailed Answer
Key, A+ Solutions, and Comprehensive Rationales
for Clinical Mastery exam made by best examiners
in the world
Table of Contents
1. Cardiovascular System (Questions 1-20)
2. Respiratory System (Questions 21-35)
3. Endocrine System (Questions 36-50)
4. Neurological System (Questions 51-65)
5. Renal & Genitourinary System (Questions 66-80)
6. Gastrointestinal & Hepatobiliary System (Questions 81-95)
7. Musculoskeletal & Integumentary Systems (Questions 96-110)
8. Hematologic & Oncologic Systems (Questions 111-125)
9. Perioperative & Emergency Care (Questions 126-140)
10. Multisystem & Critical Care Concepts (Questions 141-150)
Exam Questions
1. Cardiovascular System
🟢 1. A patient with chronic heart failure is prescribed spironolactone. Which assessment finding is
most critical for the nurse to monitor?
A. Heart rate
B. Serum potassium
C. Serum sodium
D. Urine output
🔴🔴 Correct Answer: B. Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic. Its primary risk is hyperkalemia, especially in
patients with heart failure who may also be on ACE inhibitors or ARBs. Monitoring serum potassium is
crucial to prevent life-threatening cardiac dysrhythmias.
, 🟢 2. A patient is admitted with an acute myocardial infarction (MI). The physician orders a fibrinolytic
agent. Which finding is an absolute contraindication for this therapy?
A. Blood pressure of 150/90 mm Hg
B. A history of peptic ulcer disease
C. Recent ischemic stroke within the last 3 months
D. Age of 70 years
🔴🔴 Correct Answer: C. Recent ischemic stroke within the last 3 months
Rationale: Any history of intracranial hemorrhage, ischemic stroke within 3 months, or known structural
cerebral vascular lesion are absolute contraindications to fibrinolytic therapy due to the high risk of
intracranial bleeding.
🟢 3. A patient is scheduled for a cardiac catheterization. Which pre-procedure instruction is most
important for the nurse to provide?
A. "You will need to be NPO for 12 hours before the procedure."
B. "You will feel a warm, flushing sensation when the contrast dye is injected."
C. "You can take your metformin as usual the morning of the procedure."
D. "You will be under general anesthesia for the procedure."
🔴🔴 Correct Answer: B. "You will feel a warm, flushing sensation when the contrast dye is injected."
Rationale: Informing the patient about the expected sensation of warmth or flushing from the contrast
dye helps reduce anxiety and prepares them for the experience. Metformin is typically held 48 hours
before and after the procedure due to the risk of contrast-induced nephropathy and lactic acidosis.
🟢 4. A patient is 12 hours post-coronary artery bypass graft (CABG) surgery. The nurse notes 250 mL of
bright red blood in the chest tube drainage system over the last hour. What is the nurse's priority
action?
A. Increase the IV fluid rate.
B. Milk the chest tube.
C. Notify the surgeon immediately.
D. Administer a prescribed analgesic.
🔴🔴 Correct Answer: C. Notify the surgeon immediately.
Rationale: Chest tube drainage greater than 100-150 mL/hr for more than 2 consecutive hours, or a
sudden gush of bright red blood, indicates potential hemorrhage and possible cardiac tamponade. This
is a surgical emergency requiring immediate notification of the surgeon.
🟢 5. Which assessment finding is most characteristic of cardiac tamponade following cardiac surgery?
A. Hypertension and bradycardia
B. Muffled heart sounds and jugular venous distension
C. Increased urine output and peripheral edema
D. Crackles in the lungs and frothy sputum
🔴🔴 Correct Answer: B. Muffled heart sounds and jugular venous distension
Rationale: Cardiac tamponade is characterized by Beck's triad: hypotension, muffled heart sounds, and
jugular venous distension (JVD). This occurs due to fluid accumulation in the pericardial sac, which
impedes ventricular filling.
🟢 6. A patient with atrial fibrillation is prescribed warfarin. The nurse should reinforce that the
international normalized ratio (INR) should be maintained within which therapeutic range for this
Advanced Practice Questions with Detailed Answer
Key, A+ Solutions, and Comprehensive Rationales
for Clinical Mastery exam made by best examiners
in the world
Table of Contents
1. Cardiovascular System (Questions 1-20)
2. Respiratory System (Questions 21-35)
3. Endocrine System (Questions 36-50)
4. Neurological System (Questions 51-65)
5. Renal & Genitourinary System (Questions 66-80)
6. Gastrointestinal & Hepatobiliary System (Questions 81-95)
7. Musculoskeletal & Integumentary Systems (Questions 96-110)
8. Hematologic & Oncologic Systems (Questions 111-125)
9. Perioperative & Emergency Care (Questions 126-140)
10. Multisystem & Critical Care Concepts (Questions 141-150)
Exam Questions
1. Cardiovascular System
🟢 1. A patient with chronic heart failure is prescribed spironolactone. Which assessment finding is
most critical for the nurse to monitor?
A. Heart rate
B. Serum potassium
C. Serum sodium
D. Urine output
🔴🔴 Correct Answer: B. Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic. Its primary risk is hyperkalemia, especially in
patients with heart failure who may also be on ACE inhibitors or ARBs. Monitoring serum potassium is
crucial to prevent life-threatening cardiac dysrhythmias.
, 🟢 2. A patient is admitted with an acute myocardial infarction (MI). The physician orders a fibrinolytic
agent. Which finding is an absolute contraindication for this therapy?
A. Blood pressure of 150/90 mm Hg
B. A history of peptic ulcer disease
C. Recent ischemic stroke within the last 3 months
D. Age of 70 years
🔴🔴 Correct Answer: C. Recent ischemic stroke within the last 3 months
Rationale: Any history of intracranial hemorrhage, ischemic stroke within 3 months, or known structural
cerebral vascular lesion are absolute contraindications to fibrinolytic therapy due to the high risk of
intracranial bleeding.
🟢 3. A patient is scheduled for a cardiac catheterization. Which pre-procedure instruction is most
important for the nurse to provide?
A. "You will need to be NPO for 12 hours before the procedure."
B. "You will feel a warm, flushing sensation when the contrast dye is injected."
C. "You can take your metformin as usual the morning of the procedure."
D. "You will be under general anesthesia for the procedure."
🔴🔴 Correct Answer: B. "You will feel a warm, flushing sensation when the contrast dye is injected."
Rationale: Informing the patient about the expected sensation of warmth or flushing from the contrast
dye helps reduce anxiety and prepares them for the experience. Metformin is typically held 48 hours
before and after the procedure due to the risk of contrast-induced nephropathy and lactic acidosis.
🟢 4. A patient is 12 hours post-coronary artery bypass graft (CABG) surgery. The nurse notes 250 mL of
bright red blood in the chest tube drainage system over the last hour. What is the nurse's priority
action?
A. Increase the IV fluid rate.
B. Milk the chest tube.
C. Notify the surgeon immediately.
D. Administer a prescribed analgesic.
🔴🔴 Correct Answer: C. Notify the surgeon immediately.
Rationale: Chest tube drainage greater than 100-150 mL/hr for more than 2 consecutive hours, or a
sudden gush of bright red blood, indicates potential hemorrhage and possible cardiac tamponade. This
is a surgical emergency requiring immediate notification of the surgeon.
🟢 5. Which assessment finding is most characteristic of cardiac tamponade following cardiac surgery?
A. Hypertension and bradycardia
B. Muffled heart sounds and jugular venous distension
C. Increased urine output and peripheral edema
D. Crackles in the lungs and frothy sputum
🔴🔴 Correct Answer: B. Muffled heart sounds and jugular venous distension
Rationale: Cardiac tamponade is characterized by Beck's triad: hypotension, muffled heart sounds, and
jugular venous distension (JVD). This occurs due to fluid accumulation in the pericardial sac, which
impedes ventricular filling.
🟢 6. A patient with atrial fibrillation is prescribed warfarin. The nurse should reinforce that the
international normalized ratio (INR) should be maintained within which therapeutic range for this
