MEDSURG-BC Exam Prep: Medical-Surgical Nursing (ANCC) Study Guide + 2,010 Practice Questions

A nurse is educating a patient newly diagnosed with heart failure (HF) on a low-sodium diet and daily weight monitoring. The patient nods affirmatively during teaching but later frequently misses follow-up appointments and lab draws. The nurse suspects a health literacy barrier. What is the nurse’s *priority* action to evaluate and address this potential barrier?

A nurse is evaluating the effectiveness of healthy lifestyle teaching for a 45-year-old woman with newly diagnosed type 2 diabetes and limited income. She states understanding the need for diet changes but says, “Healthy food is too expensive, and my family won’t eat that stuff.” Which strategy demonstrates the most effective application of health promotion principles?

According to current standards for patient safety, what is the minimum required frequency for assessing a patient placed in *behavioral health* restraints to ensure physiological needs and safety?

During admission assessment for pneumonia, a patient confides to the nurse, “I’ve been using cocaine a lot lately to cope with stress, but I think it’s making my anxiety worse.” The patient appears anxious and restless. What is the nurse’s most appropriate initial response to assess the psychosocial impact?

A nurse is preparing discharge teaching for a 68-year-old patient with expressive aphasia following a left-sided stroke. The patient becomes visibly frustrated when attempting to answer questions about their new warfarin regimen. Which action by the nurse best addresses the *communication barrier* to effective teaching?

An 85-year-old patient with osteoarthritis, hypertension (managed with lisinopril), and a history of falls is admitted after a syncopal episode. Their medication list includes over-the-counter diphenhydramine nightly for sleep. The medical-surgical nurse reviews the medications for high-risk agents in older adults. Which action aligns best with Beers Criteria recommendations?

A 78-year-old patient is admitted for heart failure exacerbation. Their home medications include warfarin, digoxin, furosemide, and atorvastatin. The provider prescribes clarithromycin for a suspected respiratory infection. The medical-surgical nurse recognizes a significant drug interaction risk. What is the priority nursing action?

A 70-year-old patient with atrial fibrillation is 3 days post-abdominal aortic aneurysm repair. The nurse assesses sudden, severe pain, pallor, pulselessness, and paresthesia in the right lower extremity. Capillary refill is >5 seconds. What is the nurse’s *most appropriate immediate action*?

A Medical Surgical Nurse discovers a colleague accessed a patient’s electronic health record without a clinical need. The colleague explains the patient is a neighbor and they were “just checking in.” Which action by the nurse aligns with the ethical principle of confidentiality and professional standards?

A patient with acute thrombocytopenia (platelet count 15,000/µL) and active bleeding requires transfusion. Which blood component is the most appropriate initial selection based on the specific deficiency?

Which patient factor represents an absolute contraindication to the application of sequential compression devices (SCDs) for postoperative emboli prevention, necessitating alternative mechanical prophylaxis?

A 68-year-old patient admitted for heart failure exacerbation has a history of atrial fibrillation and takes warfarin daily. The nurse reviews the morning lab results: INR 5.8 (therapeutic range 2.0-3.0), hemoglobin 10.2 g/dL (baseline 13.5 g/dL), and no signs of active bleeding. The patient reports slight gum bleeding when brushing teeth. What is the nurse’s priority action?

A nurse assesses a patient 4 hours post-abdominal surgery. Findings: T 99.1°F (37.3°C), HR 112 bpm, RR 26/min, SpO₂ 88% on room air, reports 7/10 incisional pain, and mild nausea. The patient appears anxious and is using accessory muscles. Which action should the nurse prioritize in the immediate care plan?

A diabetic patient’s care plan includes blood glucose monitoring and insulin administration before meals. The nurse observes a pattern: glucose is 210 mg/dL pre-lunch despite receiving morning insulin. The patient reports eating breakfast late due to a therapy session. What is the most appropriate initial nursing action to modify the care plan?

When monitoring therapeutic drug levels for vancomycin, why is it imperative to draw the trough level immediately *before* the next scheduled dose?

A nurse assesses a patient admitted for cellulitis with a history of chronic back pain managed with oxycodone. The patient is difficult to arouse, has pinpoint pupils, and a respiratory rate of 8 breaths/min. The nurse suspects opioid overdose. What action should the nurse take first?

A nurse cares for a terminally ill cancer patient with metastatic disease who is unresponsive and actively dying. The patient has a “Do Not Resuscitate” (DNR) order. The patient’s adult son arrives, distraught, and demands, “You have to do everything! Change it to a full code right now!” The healthcare team believes resuscitation would be medically futile and prolong suffering. What is the nurse’s best action?

During a rapid response for a postoperative patient with sudden hypotension and tachycardia, the nurse suspects a pulmonary embolism. The resident orders a STAT heparin bolus. The nurse recalls the patient’s morning lab results showed a platelet count of 85,000/mm³. What is the nurse’s most appropriate interprofessional communication?

When evaluating the effectiveness of a newly implemented diversional activity program for a group of long-term medical-surgical patients, which quantitative measure provides the *most direct and objective* indicator of the intervention’s success in achieving its primary purpose?

When conducting a psychosocial assessment for a hospitalized patient identified as being in young adulthood (ages 19-40), which developmental stage factor is most critical for the nurse to assess to identify potential psychosocial health risks?

During morning medication pass, an RN discovers a patient admitted for heart failure exacerbation has a blood pressure of 210/110 mmHg, severe headache, and blurred vision. The unit is short-staffed. The RN must administer scheduled IV furosemide and stat IV labetalol per protocol. Which action should the RN delegate to a competent Unlicensed Assistive Personnel (UAP)?

A medical-surgical nurse is evaluating the effectiveness of mandatory staff education on a new pressure injury prevention protocol. Which outcome measure most directly assesses the educational objective of sustained knowledge retention and application?

A 58-year-old patient is 48 hours post-total hip replacement. The nurse assesses tachycardia (HR 112 bpm), sudden onset dyspnea, and oxygen saturation dropping to 88% on room air. The patient reports sharp, pleuritic chest pain. Vital signs show BP 138/86 mmHg. Which action should the nurse take *first*?

When planning non-pharmacologic pain management for a patient with chronic low back pain, which intervention is specifically contraindicated if the patient has acute inflammation and impaired sensation in the affected area?

A nurse is preparing discharge teaching for a patient prescribed warfarin 5 mg daily for atrial fibrillation. The patient’s INR today is 2.1 (therapeutic range 2.0-3.0). During dietary assessment, the patient states, “I eat a big spinach salad for lunch every day and love broccoli with dinner.” Which teaching point is the *most* critical for the nurse to emphasize regarding diet?

A medical-surgical nurse unintentionally discusses a patient’s lab results with a colleague in a non-clinical hospital cafeteria area where visitors are present. Which principle of therapeutic communication and professional conduct is *most* directly violated?

A 72-year-old patient is postoperative day 5 from a bowel resection. The patient has received IV cefazolin for 48 hours post-op. The nurse assesses new-onset watery diarrhea (5 episodes in 8 hours), mild abdominal cramping, and tenderness. Vital signs are stable. Which action should the nurse take first?

When administering phenytoin to a patient concurrently taking fluoxetine, which pharmacodynamic interaction poses the greatest immediate safety concern requiring vigilant nursing assessment?

Following a positive suicide risk screen in a medical-surgical patient, which documentation element is *most critical* for ensuring continuity of care and mitigating legal risk, per Joint Commission standards?

When confirming NPO status for a patient undergoing a procedure with moderate sedation, which fasting duration minimizes aspiration risk according to standard guidelines?