A 58-year-old patient reports smoking 1.5 packs of cigarettes per day for 30 years and quitting 8 years ago. Which interpretation of this history is accurate?

45 pack-years; meets criteria for annual low-dose CT screening

38 pack-years; meets criteria for annual low-dose CT screening

45 pack-years; ineligible for screening because the patient quit

30 pack-years; ineligible for screening until age 60

Lab Result Potassium 6.6 mEq/L Creatinine 4.1 mg/dL BUN 68 mg/dL A patient with chronic kidney disease has the laboratory results shown, and the cardiac monitor shows tall, peaked T waves. Which prescribed intervention should the nurse implement FIRST?

Administer IV calcium gluconate

Administer oral sodium polystyrene sulfonate

Redraw the potassium level to rule out hemolysis

A nurse is reviewing the plan of care for a patient admitted with cellulitis of the lower leg. Which intervention is an independent nursing intervention?

Elevating the affected leg on pillows above heart level while the patient is in bed

Obtaining a venous duplex ultrasound of the leg to rule out a deep vein thrombosis

Administering IV cefazolin every 8 hours as prescribed by the attending provider for infection

Changing the patient's diet to high-protein after the dietitian's recommendation

A patient with Clostridioides difficile infection is on contact precautions. Which action by an assistive staff member leaving the room requires the nurse to intervene?

Cleans hands with alcohol-based rub after removing gloves and gown

Places soiled linen in a bag inside the room before transporting it

Removes the gown and gloves inside the room before exiting the door

Leaves the dedicated stethoscope and blood pressure cuff in the room

A patient whose discharge was delayed is shouting at the nurse in the hallway, fists clenched, saying no one tells him anything. Which action should the nurse take FIRST?

Speak in a calm, low voice, acknowledge his frustration, and keep a safe distance

Ask the patient to describe the specific events that led to his discharge delay

Leave to find the discharge paperwork so the delay can be explained in detail

Explain firmly that shouting will not be tolerated and he must return to his room

A patient's chest imaging shows new pleural thickening and calcified plaques. Which social history finding is MOST relevant?

Decades of work in shipbuilding and pipe insulation

Daily consumption of three cups of coffee

Regular use of a home humidifier in winter

Twenty years of full-time employment as a commercial airline pilot

A patient admitted for alcohol withdrawal has a serum magnesium of 1.0 mEq/L. Which assessment findings should the nurse expect?

Hyperactive reflexes and a prolonged QT interval

Peaked T waves with progressive ascending muscle weakness

Shortened QT interval and constipation

Diminished reflexes and facial flushing

A nurse proposes a goal of walking in the hallway four times daily for a patient recovering from pneumonia. The patient says, "I'm too tired for that; maybe I could walk to the bathroom and sit in the chair for meals." Which response by the nurse is BEST?

"Let's start with walking to the bathroom and sitting up for meals, then build from there."

"If you rest today, we can set all of your activity goals again tomorrow morning instead."

"The hallway walking goal is the hospital standard, so we need to keep it as it is written."

"I will ask your provider to order physical therapy to make sure that you meet the goal."

A patient has an indwelling urinary catheter on postoperative day 2 after an open colectomy. The patient is now ambulating and voiding criteria are being reviewed. Which nursing action BEST reduces the risk of catheter-associated urinary tract infection?

Advocate for catheter removal once criteria for its use are no longer met

Irrigate the catheter with sterile saline every shift to keep it patent

Replace the catheter every 72 hours to limit buildup of bacterial biofilm

Clamp the drainage tubing while the patient walks to prevent backflow

A nurse is preparing discharge teaching for an older adult with significant bilateral hearing loss who does not have hearing aids available. Which approach is MOST appropriate?

Face the patient in good light, reduce background noise, and speak in a lower pitch

Provide written instructions only and avoid spoken teaching altogether

Stand at the patient's side and speak directly into the ear that hears better

Raise the voice to a shout and exaggerate mouth movements for each word

Medical-Surgical Nursing (MEDSURG-BC / CMSRN)

Free Med-Surg Nurse Practice Questions

10 sample questions for the Medical-Surgical Nursing (MEDSURG-BC / CMSRN), with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Assessment and Diagnosis, Planning, Implementation, and Evaluation, Professional Role.

Question 1 · Assessment and Diagnosis
A 58-year-old patient reports smoking 1.5 packs of cigarettes per day for 30 years and quitting 8 years ago. Which interpretation of this history is accurate?
- A.38 pack-years; meets criteria for annual low-dose CT screening
- B.45 pack-years; ineligible for screening because the patient quit
- C.45 pack-years; meets criteria for annual low-dose CT screening
- D.30 pack-years; ineligible for screening until age 60
Show answer and explanation
Answer: C. 45 pack-years; meets criteria for annual low-dose CT screening
Pack-years equal packs per day multiplied by years smoked, so 1.5 × 30 = 45 pack-years. USPSTF recommends annual low-dose CT for adults 50–80 with at least 20 pack-years who currently smoke or quit within the past 15 years, so quitting 8 years ago does not exclude this patient.
Question 2 · Assessment and Diagnosis
Lab Result
Potassium 6.6 mEq/L
Creatinine 4.1 mg/dL
BUN 68 mg/dL
A patient with chronic kidney disease has the laboratory results shown, and the cardiac monitor shows tall, peaked T waves. Which prescribed intervention should the nurse implement FIRST?
- A.Administer oral sodium polystyrene sulfonate
- B.Redraw the potassium level to rule out hemolysis
- C.Administer IV furosemide
- D.Administer IV calcium gluconate
Show answer and explanation
Answer: D. Administer IV calcium gluconate
With ECG changes from hyperkalemia, IV calcium gluconate is given first because it stabilizes the cardiac cell membrane within minutes and reduces the risk of lethal dysrhythmias. Binding resins and loop diuretics remove potassium but act too slowly to protect the heart. Delaying treatment to redraw the sample is inappropriate when ECG changes confirm a true elevation.
Question 3 · Planning, Implementation, and Evaluation
A nurse is reviewing the plan of care for a patient admitted with cellulitis of the lower leg. Which intervention is an independent nursing intervention?
- A.Elevating the affected leg on pillows above heart level while the patient is in bed
- B.Obtaining a venous duplex ultrasound of the leg to rule out a deep vein thrombosis
- C.Administering IV cefazolin every 8 hours as prescribed by the attending provider for infection
- D.Changing the patient's diet to high-protein after the dietitian's recommendation
Show answer and explanation
Answer: A. Elevating the affected leg on pillows above heart level while the patient is in bed
Positioning to reduce edema is within the nurse's own scope and requires no prescription, making elevation an independent intervention. Administering a prescribed antibiotic and obtaining an ordered diagnostic study are dependent interventions, and implementing a dietitian's recommendation is collaborative.
Question 4 · Planning, Implementation, and Evaluation
A patient with Clostridioides difficile infection is on contact precautions. Which action by an assistive staff member leaving the room requires the nurse to intervene?
- A.Places soiled linen in a bag inside the room before transporting it
- B.Removes the gown and gloves inside the room before exiting the door
- C.Cleans hands with alcohol-based rub after removing gloves and gown
- D.Leaves the dedicated stethoscope and blood pressure cuff in the room
Show answer and explanation
Answer: C. Cleans hands with alcohol-based rub after removing gloves and gown
Alcohol-based rub does not reliably kill C. difficile spores, so hand hygiene with soap and water is required after caring for these patients. Removing protective equipment before leaving the room, keeping dedicated equipment in the room, and bagging linen at the point of use are all correct contact-precaution practices.
Question 5 · Professional Role
A patient whose discharge was delayed is shouting at the nurse in the hallway, fists clenched, saying no one tells him anything. Which action should the nurse take FIRST?
- A.Ask the patient to describe the specific events that led to his discharge delay
- B.Leave to find the discharge paperwork so the delay can be explained in detail
- C.Explain firmly that shouting will not be tolerated and he must return to his room
- D.Speak in a calm, low voice, acknowledge his frustration, and keep a safe distance
Show answer and explanation
Answer: D. Speak in a calm, low voice, acknowledge his frustration, and keep a safe distance
Early de-escalation relies on a calm, nonthreatening tone, validation of the emotion, and maintaining personal safety space. Setting firm limits as the opening move tends to escalate an agitated person, leaving abandons the situation, and asking for a detailed account requires a level of calm the patient does not yet have.
Question 6 · Assessment and Diagnosis
A patient's chest imaging shows new pleural thickening and calcified plaques. Which social history finding is MOST relevant?
- A.Decades of work in shipbuilding and pipe insulation
- B.Daily consumption of three cups of coffee
- C.Regular use of a home humidifier in winter
- D.Twenty years of full-time employment as a commercial airline pilot
Show answer and explanation
Answer: A. Decades of work in shipbuilding and pipe insulation
Pleural plaques and thickening are hallmark findings of asbestos exposure, which is common in shipbuilding and insulation work. The other exposures are not associated with pleural plaque formation.
Question 7 · Assessment and Diagnosis
A patient admitted for alcohol withdrawal has a serum magnesium of 1.0 mEq/L. Which assessment findings should the nurse expect?
- A.Peaked T waves with progressive ascending muscle weakness
- B.Hyperactive reflexes and a prolonged QT interval
- C.Shortened QT interval and constipation
- D.Diminished reflexes and facial flushing
Show answer and explanation
Answer: B. Hyperactive reflexes and a prolonged QT interval
Hypomagnesemia increases neuromuscular excitability, producing hyperreflexia, tremors, and positive Chvostek and Trousseau signs, and it prolongs the QT interval, raising the risk of torsades de pointes. Diminished reflexes and flushing occur with hypermagnesemia. Peaked T waves suggest hyperkalemia, and a shortened QT interval suggests hypercalcemia.
Question 8 · Planning, Implementation, and Evaluation
A nurse proposes a goal of walking in the hallway four times daily for a patient recovering from pneumonia. The patient says, "I'm too tired for that; maybe I could walk to the bathroom and sit in the chair for meals." Which response by the nurse is BEST?
- A."Let's start with walking to the bathroom and sitting up for meals, then build from there."
- B."If you rest today, we can set all of your activity goals again tomorrow morning instead."
- C."The hallway walking goal is the hospital standard, so we need to keep it as it is written."
- D."I will ask your provider to order physical therapy to make sure that you meet the goal."
Show answer and explanation
Answer: A. "Let's start with walking to the bathroom and sitting up for meals, then build from there."
Outcomes are more likely to be achieved when they are mutually set and realistic for the patient, so incorporating the patient's proposal and progressing gradually is best. Insisting on a standard goal disregards the patient's input, referral does not address goal setting, and postponing all activity increases deconditioning.
Question 9 · Planning, Implementation, and Evaluation
A patient has an indwelling urinary catheter on postoperative day 2 after an open colectomy. The patient is now ambulating and voiding criteria are being reviewed. Which nursing action BEST reduces the risk of catheter-associated urinary tract infection?
- A.Irrigate the catheter with sterile saline every shift to keep it patent
- B.Replace the catheter every 72 hours to limit buildup of bacterial biofilm
- C.Clamp the drainage tubing while the patient walks to prevent backflow
- D.Advocate for catheter removal once criteria for its use are no longer met
Show answer and explanation
Answer: D. Advocate for catheter removal once criteria for its use are no longer met
Duration of catheterization is the strongest risk factor for CAUTI, so prompt removal when the indication ends is the most effective prevention measure. Routine irrigation and scheduled catheter changes are not recommended, and the drainage bag should be kept below the bladder with unobstructed flow rather than clamped.
Question 10 · Professional Role
A nurse is preparing discharge teaching for an older adult with significant bilateral hearing loss who does not have hearing aids available. Which approach is MOST appropriate?
- A.Provide written instructions only and avoid spoken teaching altogether
- B.Face the patient in good light, reduce background noise, and speak in a lower pitch
- C.Stand at the patient's side and speak directly into the ear that hears better
- D.Raise the voice to a shout and exaggerate mouth movements for each word
Show answer and explanation
Answer: B. Face the patient in good light, reduce background noise, and speak in a lower pitch
Facing the patient in good light supports lip-reading and visual cues, minimizing noise improves the signal, and lower-pitched speech is heard more easily in age-related high-frequency loss. Standing to the side removes visual cues, shouting distorts speech and exaggerated mouthing hinders lip-reading, and written materials should supplement rather than replace spoken teaching.

Lab	Result
Potassium	6.6 mEq/L
Creatinine	4.1 mg/dL
BUN	68 mg/dL

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