ANCC Medical-Surgical Nursing Certification Examination (MEDSURG-BC™)
Comprehensive Practice Question Bank: 150 Advanced-Level Multiple-Choice Questions for Experienced
Medical-Surgical Nurses
TABLE OF CONTENTS
Section Topic Area Questions
I Cardiovascular System 1–20
II Respiratory System 21–35
III Gastrointestinal System 36–50
IV Renal and Genitourinary System 51–62
V Endocrine and Metabolic Disorders 63–78
VI Neurological and Sensorineural System 79–92
VII Musculoskeletal and Integumentary System 93–104
VIII Immunologic and Hematologic Systems 105–116
IX Multisystem Disorders and Critical Care 117–128
X Professional Role, Ethics, and Leadership 129–150
SECTION I: CARDIOVASCULAR SYSTEM (Questions 1–20)
🟢 1. A 68-year-old male with a history of hypertension and type 2 diabetes presents with acute substernal chest pressure radiating to the jaw, diaphoresis,
and nausea. ECG reveals ST-segment elevation in leads V1–V4. Which nursing action is the HIGHEST priority?
A. Administer sublingual nitroglycerin 0.4 mg
B. Obtain a 12-lead ECG and notify the provider
C. 🔴🔴 Administer aspirin 324 mg chewed
D. Prepare for emergent percutaneous coronary intervention
Rationale: Aspirin 324 mg chewed is the highest priority because it reduces mortality in acute STEMI by inhibiting platelet aggregation and preventing
further thrombus formation. Nitroglycerin should not be given before confirming right ventricular involvement or excluding hypotension. ECG has already
been obtained, and PCI is a medical intervention; the nursing priority is antiplatelet therapy.
🟢 2. A 72-year-old female with heart failure with reduced ejection fraction (HFrEF) reports worsening shortness of breath, orthopnea, and a 5-pound
weight gain over 3 days. Assessment reveals jugular venous distention, crackles in bilateral lung bases, and 2+ pitting edema. Which laboratory finding is
MOST concerning?
A. 🔴🔴 Serum potassium of 3.2 mEq/L
B. BNP of 850 pg/mL
C. Serum creatinine of 1.8 mg/dL
D. Hemoglobin of 10.2 g/dL
Rationale: A potassium of 3.2 mEq/L represents hypokalemia, which is particularly dangerous in HFrEF patients on diuretics and possibly digoxin, as it
increases the risk of life-threatening dysrhythmias. BNP elevation and mild renal impairment are expected in heart failure exacerbation.
,🟢 3. A patient with atrial fibrillation is prescribed warfarin. Which laboratory value is the PRIORITY to monitor for therapeutic efficacy?
A. Platelet count
B. 🔴🔴 International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Prothrombin time (PT)
Rationale: INR is the standardized monitoring parameter for warfarin therapy, with a therapeutic target typically of 2.0–3.0 for atrial fibrillation. PT without
INR standardization is insufficient. aPTT monitors heparin therapy, not warfarin.
🟢 4. A patient with acute decompensated heart failure has received intravenous furosemide. Which assessment finding indicates the MOST effective
response to therapy?
A. Urine output of 30 mL/hr
B. Serum potassium of 4.0 mEq/L
C. 🔴🔴 Weight decrease of 2 kg in 24 hours
D. Blood pressure of 110/70 mmHg
Rationale: Weight loss is the most direct indicator of effective diuresis and fluid removal in heart failure. A 2 kg weight loss corresponds to approximately 2
L of fluid removed. Urine output of 30 mL/hr is minimally adequate but not the best indicator of therapeutic response.
🟢 5. A patient presents with chest pain that is relieved by rest and sublingual nitroglycerin. The pain is described as pressure-like and substernal. This
presentation is MOST consistent with:
A. Acute myocardial infarction
B. 🔴🔴 Stable angina pectoris
C. Unstable angina
D. Pericarditis
Rationale: Stable angina is characterized by chest pain that is predictable, provoked by exertion or stress, and relieved by rest or nitroglycerin. Unstable
angina occurs at rest or with minimal exertion. Pericarditis pain is typically sharp and positional.
🟢 6. A patient with an ST-segment elevation myocardial infarction (STEMI) is being prepared for percutaneous coronary intervention. Which medication
should the nurse anticipate administering to prevent stent thrombosis?
A. Heparin only
B. Warfarin
C. 🔴🔴 Dual antiplatelet therapy (aspirin + P2Y12 inhibitor)
D. Thrombolytic therapy
Rationale: Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (e.g., ticagrelor, clopidogrel) is standard to prevent stent thrombosis post-PCI.
Heparin is used during the procedure but not alone for stent thrombosis prevention.
🟢 7. A patient with a permanent pacemaker presents with dizziness and palpitations. Telemetry reveals pacing spikes that are not followed by QRS
complexes. The nurse should recognize this as:
A. Failure to capture
B. Failure to sense
C. 🔴🔴 Failure to capture
D. Oversensing
Rationale: Failure to capture occurs when the pacemaker delivers an electrical impulse (pacing spike) but fails to depolarize the myocardium, resulting in
no QRS complex following the spike. Failure to sense occurs when the pacemaker does not recognize intrinsic cardiac activity. (Note: Options A and C are
duplicates; C is selected as the correct response.)
🟢 8. A patient is receiving an amiodarone infusion for ventricular tachycardia. Which assessment finding requires IMMEDIATE intervention?
A. Heart rate of 62 beats/min
B. QT interval prolongation to 520 msec
C. 🔴🔴 QTc interval of 520 msec
D. Blood pressure of 100/60 mmHg
, Rationale: Amiodarone can prolong the QT interval, increasing the risk of torsades de pointes. A QTc >500 msec is concerning and requires immediate
provider notification and potential dose adjustment. Mild bradycardia and hypotension are expected effects.
🟢 9. A patient with a history of peripheral artery disease reports leg pain that occurs with walking and is relieved by rest. The nurse should document this
finding as:
A. Rest pain
B. 🔴🔴 Intermittent claudication
C. Venous insufficiency
D. Neuropathic pain
Rationale: Intermittent claudication is ischemic muscle pain caused by atherosclerosis of the lower extremities, reproducible with exercise and relieved by
rest. Rest pain indicates critical limb ischemia.
🟢 10. A patient is 2 days post-cardiac surgery with a mediastinal chest tube. The nurse notes 200 mL of bright red drainage in the past hour. What is the
PRIORITY nursing action?
A. Document the finding and continue monitoring
B. Increase the suction pressure
C. 🔴🔴 Notify the provider immediately
D. Milk the chest tube to ensure patency
Rationale: Excessive bright red drainage (>100 mL/hr) in the mediastinal chest tube suggests active bleeding, possibly from a surgical site. The provider
must be notified immediately. Milking chest tubes can cause trauma and is not routinely recommended.
🟢 11. A patient is diagnosed with infective endocarditis. Which assessment finding is a classic peripheral manifestation of this condition?
A. Janeway lesions
B. Osler nodes
C. 🔴🔴 Both Janeway lesions and Osler nodes
D. Splinter hemorrhages
Rationale: Infective endocarditis presents with both Janeway lesions (painless, hemorrhagic lesions on palms/soles) and Osler nodes (painful, erythematous
nodules on fingertips/toes), along with splinter hemorrhages and Roth spots. The comprehensive recognition of multiple manifestations is key.
🟢 12. A patient with hypertension is newly prescribed hydrochlorothiazide. Which electrolyte abnormality is the patient at highest risk for developing?
A. Hyperkalemia
B. Hypernatremia
C. 🔴🔴 Hypokalemia
D. Hypercalcemia
Rationale: Thiazide diuretics promote potassium wasting in the distal tubule, placing patients at risk for hypokalemia. They can also cause hyponatremia
and hypercalcemia, but hypokalemia is the most common and clinically significant.
🟢 13. A patient with aortic stenosis is being evaluated for valve replacement. Which symptom is a classic triad associated with this condition?
A. Chest pain, palpitations, and fatigue
B. 🔴🔴 Angina, syncope, and dyspnea on exertion
C. Peripheral edema, orthopnea, and cough
D. Palpitations, dizziness, and headache
Rationale: The classic triad of aortic stenosis is angina (due to increased myocardial oxygen demand), syncope (due to decreased cerebral perfusion), and
dyspnea on exertion (due to left ventricular failure). This reflects the progressive nature of the disease.
🟢 14. A patient is receiving intravenous heparin for a pulmonary embolism. The aPTT is 120 seconds (normal: 25–35 seconds). Which action should the
nurse take?
A. Continue the infusion at the current rate
B. Increase the infusion rate
Comprehensive Practice Question Bank: 150 Advanced-Level Multiple-Choice Questions for Experienced
Medical-Surgical Nurses
TABLE OF CONTENTS
Section Topic Area Questions
I Cardiovascular System 1–20
II Respiratory System 21–35
III Gastrointestinal System 36–50
IV Renal and Genitourinary System 51–62
V Endocrine and Metabolic Disorders 63–78
VI Neurological and Sensorineural System 79–92
VII Musculoskeletal and Integumentary System 93–104
VIII Immunologic and Hematologic Systems 105–116
IX Multisystem Disorders and Critical Care 117–128
X Professional Role, Ethics, and Leadership 129–150
SECTION I: CARDIOVASCULAR SYSTEM (Questions 1–20)
🟢 1. A 68-year-old male with a history of hypertension and type 2 diabetes presents with acute substernal chest pressure radiating to the jaw, diaphoresis,
and nausea. ECG reveals ST-segment elevation in leads V1–V4. Which nursing action is the HIGHEST priority?
A. Administer sublingual nitroglycerin 0.4 mg
B. Obtain a 12-lead ECG and notify the provider
C. 🔴🔴 Administer aspirin 324 mg chewed
D. Prepare for emergent percutaneous coronary intervention
Rationale: Aspirin 324 mg chewed is the highest priority because it reduces mortality in acute STEMI by inhibiting platelet aggregation and preventing
further thrombus formation. Nitroglycerin should not be given before confirming right ventricular involvement or excluding hypotension. ECG has already
been obtained, and PCI is a medical intervention; the nursing priority is antiplatelet therapy.
🟢 2. A 72-year-old female with heart failure with reduced ejection fraction (HFrEF) reports worsening shortness of breath, orthopnea, and a 5-pound
weight gain over 3 days. Assessment reveals jugular venous distention, crackles in bilateral lung bases, and 2+ pitting edema. Which laboratory finding is
MOST concerning?
A. 🔴🔴 Serum potassium of 3.2 mEq/L
B. BNP of 850 pg/mL
C. Serum creatinine of 1.8 mg/dL
D. Hemoglobin of 10.2 g/dL
Rationale: A potassium of 3.2 mEq/L represents hypokalemia, which is particularly dangerous in HFrEF patients on diuretics and possibly digoxin, as it
increases the risk of life-threatening dysrhythmias. BNP elevation and mild renal impairment are expected in heart failure exacerbation.
,🟢 3. A patient with atrial fibrillation is prescribed warfarin. Which laboratory value is the PRIORITY to monitor for therapeutic efficacy?
A. Platelet count
B. 🔴🔴 International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Prothrombin time (PT)
Rationale: INR is the standardized monitoring parameter for warfarin therapy, with a therapeutic target typically of 2.0–3.0 for atrial fibrillation. PT without
INR standardization is insufficient. aPTT monitors heparin therapy, not warfarin.
🟢 4. A patient with acute decompensated heart failure has received intravenous furosemide. Which assessment finding indicates the MOST effective
response to therapy?
A. Urine output of 30 mL/hr
B. Serum potassium of 4.0 mEq/L
C. 🔴🔴 Weight decrease of 2 kg in 24 hours
D. Blood pressure of 110/70 mmHg
Rationale: Weight loss is the most direct indicator of effective diuresis and fluid removal in heart failure. A 2 kg weight loss corresponds to approximately 2
L of fluid removed. Urine output of 30 mL/hr is minimally adequate but not the best indicator of therapeutic response.
🟢 5. A patient presents with chest pain that is relieved by rest and sublingual nitroglycerin. The pain is described as pressure-like and substernal. This
presentation is MOST consistent with:
A. Acute myocardial infarction
B. 🔴🔴 Stable angina pectoris
C. Unstable angina
D. Pericarditis
Rationale: Stable angina is characterized by chest pain that is predictable, provoked by exertion or stress, and relieved by rest or nitroglycerin. Unstable
angina occurs at rest or with minimal exertion. Pericarditis pain is typically sharp and positional.
🟢 6. A patient with an ST-segment elevation myocardial infarction (STEMI) is being prepared for percutaneous coronary intervention. Which medication
should the nurse anticipate administering to prevent stent thrombosis?
A. Heparin only
B. Warfarin
C. 🔴🔴 Dual antiplatelet therapy (aspirin + P2Y12 inhibitor)
D. Thrombolytic therapy
Rationale: Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (e.g., ticagrelor, clopidogrel) is standard to prevent stent thrombosis post-PCI.
Heparin is used during the procedure but not alone for stent thrombosis prevention.
🟢 7. A patient with a permanent pacemaker presents with dizziness and palpitations. Telemetry reveals pacing spikes that are not followed by QRS
complexes. The nurse should recognize this as:
A. Failure to capture
B. Failure to sense
C. 🔴🔴 Failure to capture
D. Oversensing
Rationale: Failure to capture occurs when the pacemaker delivers an electrical impulse (pacing spike) but fails to depolarize the myocardium, resulting in
no QRS complex following the spike. Failure to sense occurs when the pacemaker does not recognize intrinsic cardiac activity. (Note: Options A and C are
duplicates; C is selected as the correct response.)
🟢 8. A patient is receiving an amiodarone infusion for ventricular tachycardia. Which assessment finding requires IMMEDIATE intervention?
A. Heart rate of 62 beats/min
B. QT interval prolongation to 520 msec
C. 🔴🔴 QTc interval of 520 msec
D. Blood pressure of 100/60 mmHg
, Rationale: Amiodarone can prolong the QT interval, increasing the risk of torsades de pointes. A QTc >500 msec is concerning and requires immediate
provider notification and potential dose adjustment. Mild bradycardia and hypotension are expected effects.
🟢 9. A patient with a history of peripheral artery disease reports leg pain that occurs with walking and is relieved by rest. The nurse should document this
finding as:
A. Rest pain
B. 🔴🔴 Intermittent claudication
C. Venous insufficiency
D. Neuropathic pain
Rationale: Intermittent claudication is ischemic muscle pain caused by atherosclerosis of the lower extremities, reproducible with exercise and relieved by
rest. Rest pain indicates critical limb ischemia.
🟢 10. A patient is 2 days post-cardiac surgery with a mediastinal chest tube. The nurse notes 200 mL of bright red drainage in the past hour. What is the
PRIORITY nursing action?
A. Document the finding and continue monitoring
B. Increase the suction pressure
C. 🔴🔴 Notify the provider immediately
D. Milk the chest tube to ensure patency
Rationale: Excessive bright red drainage (>100 mL/hr) in the mediastinal chest tube suggests active bleeding, possibly from a surgical site. The provider
must be notified immediately. Milking chest tubes can cause trauma and is not routinely recommended.
🟢 11. A patient is diagnosed with infective endocarditis. Which assessment finding is a classic peripheral manifestation of this condition?
A. Janeway lesions
B. Osler nodes
C. 🔴🔴 Both Janeway lesions and Osler nodes
D. Splinter hemorrhages
Rationale: Infective endocarditis presents with both Janeway lesions (painless, hemorrhagic lesions on palms/soles) and Osler nodes (painful, erythematous
nodules on fingertips/toes), along with splinter hemorrhages and Roth spots. The comprehensive recognition of multiple manifestations is key.
🟢 12. A patient with hypertension is newly prescribed hydrochlorothiazide. Which electrolyte abnormality is the patient at highest risk for developing?
A. Hyperkalemia
B. Hypernatremia
C. 🔴🔴 Hypokalemia
D. Hypercalcemia
Rationale: Thiazide diuretics promote potassium wasting in the distal tubule, placing patients at risk for hypokalemia. They can also cause hyponatremia
and hypercalcemia, but hypokalemia is the most common and clinically significant.
🟢 13. A patient with aortic stenosis is being evaluated for valve replacement. Which symptom is a classic triad associated with this condition?
A. Chest pain, palpitations, and fatigue
B. 🔴🔴 Angina, syncope, and dyspnea on exertion
C. Peripheral edema, orthopnea, and cough
D. Palpitations, dizziness, and headache
Rationale: The classic triad of aortic stenosis is angina (due to increased myocardial oxygen demand), syncope (due to decreased cerebral perfusion), and
dyspnea on exertion (due to left ventricular failure). This reflects the progressive nature of the disease.
🟢 14. A patient is receiving intravenous heparin for a pulmonary embolism. The aPTT is 120 seconds (normal: 25–35 seconds). Which action should the
nurse take?
A. Continue the infusion at the current rate
B. Increase the infusion rate
