Medical-Surgical Nursing makes up the single largest portion of the NMCN CBT Paper II. No other subject contributes as many questions per sitting. A strong performance here lifts your aggregate significantly. A weak one is very hard to recover from across the other papers. Start practicing medical surgery past questions and answers here.
Students who take Medical-Surgical seriously — and back that seriousness with actual question practice — tend to pass. Students who read their notes without drilling past questions often find that what felt like solid knowledge during revision disappears under CBT time pressure.
Get the NMCN app on FreshNote to access Medical-Surgical Nursing past questions and answers from 2012 to 2026, complete with answer explanations, on your phone in full CBT format.
What Medical-Surgical Nursing Questions Test in the NMCN CBT
Medical-Surgical Nursing questions do not simply ask what a condition is. They test what a nurse does about it — before, during, and after clinical intervention. The focus is always on nursing action, nursing priority, and nursing judgement.
This means reading textbook descriptions of diseases is not sufficient preparation on its own. You need to practise making quick decisions between four clinical options under a timer. The option that sounds most thorough is not always the correct one. The option that reflects the correct nursing priority is.
Past questions teach you that distinction faster than any other study method.
Topics Covered in NMCN Medical-Surgical Past Questions (2012–2026)
Medical-Surgical Nursing covers a wide range of body systems and conditions. The 2012–2026 question bank shows consistent clustering around these high-yield areas:
Cardiovascular Nursing — Highest Frequency
Heart conditions generate more Medical-Surgical questions than any other system in NMCN papers:
- Myocardial infarction — signs, immediate nursing priorities, position, oxygen, monitoring
- Cardiac failure — left vs right heart failure, signs of each, nursing management
- Hypertension — nursing assessment, lifestyle education, medication compliance
- Shock — types (hypovolaemic, cardiogenic, septic), recognition, and emergency nursing response
- Deep vein thrombosis — risk factors, signs, prevention, and anticoagulation nursing
- Peripheral vascular disease — arterial vs venous insufficiency differences
Shock questions are a particular NMCN favourite. Questions ask students to distinguish between shock types based on clinical presentation and identify the priority nursing response for each.
Respiratory Nursing — Second Most Tested
- Pneumonia — signs, nursing care, positioning, oxygen administration
- Chronic Obstructive Pulmonary Disease (COPD) — oxygen therapy caution (hypoxic drive), pursed-lip breathing, activity tolerance
- Pulmonary embolism — sudden onset breathlessness, pleuritic chest pain, nursing priorities
- Pleural effusion and pneumothorax — distinguishing features, chest drain nursing care
- Asthma — triggers, signs of a severe attack, nebuliser administration, patient education
- Tuberculosis — mode of transmission, isolation precautions, directly observed therapy (DOT)
TB questions in the Nigerian context appear regularly — including questions on contact tracing, BCG vaccination, and DOTS implementation, which are directly relevant to Nigerian healthcare practice.
Fluid and Electrolyte Imbalances — Consistently Tested
This topic area bridges Medical-Surgical Nursing and Anatomy and Physiology. Questions test:
- Signs of dehydration vs fluid overload
- Hyponatraemia and hypernatraemia — causes and nursing management
- Hypokalaemia and hyperkalaemia — ECG changes, cardiac risks, dietary management
- IV fluid types — when to use normal saline, Ringer's lactate, dextrose solutions
- Calculating fluid balance — intake vs output monitoring
Students who built strong renal and cardiovascular A&P knowledge going into Paper II find fluid and electrolyte questions significantly more manageable.
Gastrointestinal Nursing
- Peptic ulcer disease — causes, signs of haemorrhage (haematemesis, melaena), nursing management
- Liver cirrhosis — signs (jaundice, ascites, varices, hepatic encephalopathy), nursing priorities
- Appendicitis — McBurney's point, signs, pre- and post-operative nursing care
- Intestinal obstruction — signs, nursing assessment, NG tube management
- Colostomy and ileostomy care — stoma assessment, skin care, patient education
Neurological Nursing
- Stroke — FAST assessment, types (ischaemic vs haemorrhagic), nursing priorities, positioning
- Increased intracranial pressure (ICP) — signs (Cushing's triad: hypertension, bradycardia, abnormal respirations), nursing management, positioning
- Seizure disorders — nursing care during a seizure, safety measures, post-ictal care
- Head injury — Glasgow Coma Scale assessment, nursing observations, warning signs
- Meningitis — signs (photophobia, neck stiffness, positive Kernig's and Brudzinski's signs), isolation precautions
Glasgow Coma Scale questions appear across multiple NMCN sittings. Know the three components (eye opening, verbal response, motor response), the scoring range (3–15), and what a score of 8 or below indicates (severe brain injury, airway at risk).
Musculoskeletal and Orthopaedic Nursing
- Fractures — types, signs, casting and traction nursing care, compartment syndrome warning signs
- Amputation — pre- and post-operative care, stump care, phantom limb pain
- Osteoporosis — risk factors, prevention, fall risk, calcium and vitamin D
- Arthritis — rheumatoid vs osteoarthritis differences, nursing management
Compartment syndrome is a medical emergency that appears in NMCN orthopaedic questions — the five Ps (Pain, Pallor, Pulselessness, Paraesthesia, Paralysis) and the nursing response of notifying the doctor immediately.
Endocrine Nursing
- Diabetes mellitus — Type 1 vs Type 2 differences, insulin management, signs of hypoglycaemia and hyperglycaemia, diabetic ketoacidosis
- Thyroid disorders — hypothyroidism vs hyperthyroidism, signs of each, myxoedema coma, thyroid storm
- Addison's disease and Cushing's syndrome — distinguishing features and nursing priorities
Diabetic ketoacidosis (DKA) questions are high-frequency. Know the signs (polyuria, polydipsia, Kussmaul respirations, fruity breath, altered consciousness), the nursing priorities (IV fluids, insulin infusion, electrolyte monitoring), and how it differs from hyperosmolar hyperglycaemic state (HHS).
Renal and Urological Nursing
- Acute kidney injury vs chronic kidney disease — distinguishing features, nursing management
- Dialysis — haemodialysis and peritoneal dialysis nursing care and complications
- Urinary tract infections — signs, catheter-associated UTI prevention, urine specimen collection
- Urinary retention — causes, catheterisation procedure, nursing assessment
- Nephrotic syndrome — massive proteinuria, oedema, nursing care
Pre- and Post-Operative Nursing — Always Present
Perioperative care questions appear in virtually every NMCN Medical-Surgical paper:
- Pre-operative assessment — consent, fasting instructions, bowel preparation, skin preparation
- Post-operative complications — atelectasis, wound dehiscence, haemorrhage, deep vein thrombosis, paralytic ileus
- Wound care — wound assessment, types of healing (primary, secondary, tertiary intention), dressing principles
- Pain management in the post-operative patient
Sample NMCN Medical-Surgical Nursing Questions With Answers
Attempt each question independently before checking the answer below it.
Question 1 — Cardiovascular: Shock
A patient who had abdominal surgery three hours ago is now restless, pale, and has a blood pressure of 90/60 mmHg with a heart rate of 118 beats per minute. The nurse's immediate priority is to:
A. Administer an oral analgesic for post-operative pain
B. Raise the foot of the bed, increase IV fluid rate, and notify the surgeon immediately
C. Reassure the patient and encourage deep breathing
D. Apply supplemental oxygen and document the vital signs for review in 30 minutes
Answer: B
This presentation — restlessness, pallor, hypotension, and tachycardia — indicates hypovolaemic shock, likely from post-operative haemorrhage. The Trendelenburg-modified position (legs elevated), IV fluid resuscitation, and immediate surgical notification are the priorities. Waiting 30 minutes (Option D) is dangerous. Oral analgesia (Option A) does not address the emergency.
Question 2 — Respiratory: COPD
A patient with severe COPD is brought to the ward in respiratory distress. The nurse is about to administer oxygen. Which concern is specific to this patient?
A. Oxygen may cause hypertension in COPD patients
B. High-flow oxygen may suppress the hypoxic drive and reduce the respiratory stimulus
C. Oxygen therapy is contraindicated in all COPD patients
D. COPD patients require 100% oxygen to correct their chronic hypoxia
Answer: B
COPD patients with chronic CO₂ retention rely on hypoxia (low oxygen levels) as their primary drive to breathe — the hypoxic drive. Administering high-flow oxygen removes this stimulus and can cause respiratory depression. Controlled low-flow oxygen (usually 24–28% via Venturi mask) is the correct approach, with close monitoring of respiratory rate and consciousness.
Question 3 — Neurological: Increased ICP
A nurse caring for a patient with a head injury notices the blood pressure is rising, the heart rate is slowing, and the respiratory pattern is becoming irregular. She recognises this as:
A. Septic shock developing
B. Normal recovery from a head injury
C. Cushing's triad — a sign of severely raised intracranial pressure
D. An adverse reaction to the patient's IV fluids
Answer: C — Cushing's triad
Hypertension, bradycardia, and abnormal (irregular or slow) breathing together constitute Cushing's triad — a late and ominous sign of critically raised ICP indicating brainstem compression. The doctor must be notified immediately. This is one of the most important neurological nursing recognition questions in the NMCN bank.
Question 4 — Post-Operative: Complication Recognition
On the first post-operative day following an abdominal operation, a patient develops a temperature of 38.2°C, reduced breath sounds at the lung bases, and a mild cough. The nurse suspects:
A. Wound infection
B. Pulmonary atelectasis
C. Urinary tract infection
D. Deep vein thrombosis
Answer: B — Pulmonary atelectasis
Atelectasis — collapse of small airways due to shallow breathing after surgery — is the most common cause of fever in the first 24–48 hours post-operatively. Reduced basal breath sounds and a cough following abdominal surgery are classic signs. Management includes deep breathing exercises, incentive spirometry, and early mobilisation. Wound infection typically presents after 72 hours.
Question 5 — Endocrine: Diabetic Ketoacidosis
A patient with Type 1 diabetes is brought to the ward confused, with rapid deep breathing, fruity-smelling breath, and a blood glucose of 28 mmol/L. The nurse identifies these findings as consistent with:
A. Hypoglycaemia
B. Hyperosmolar hyperglycaemic state
C. Diabetic ketoacidosis
D. Insulin resistance syndrome
Answer: C — Diabetic ketoacidosis
DKA presents with hyperglycaemia, metabolic acidosis, and ketosis. Kussmaul respirations (deep, rapid breathing) are the body's attempt to blow off CO₂ and compensate for acidosis. Fruity breath results from ketone (acetone) exhalation. Hypoglycaemia presents with sweating, tremors, and normal or low glucose — the opposite of this picture. Immediate nursing priorities are IV access, fluid resuscitation, and preparation for insulin infusion per protocol.
Question 6 — Gastrointestinal: Liver Cirrhosis
A patient with liver cirrhosis develops confusion, altered behaviour, and flapping tremor of the hands (asterixis). The nurse recognises these as signs of:
A. Alcohol intoxication
B. Hypoglycaemia from poor dietary intake
C. Hepatic encephalopathy
D. Wernicke's encephalopathy
Answer: C — Hepatic encephalopathy
Hepatic encephalopathy occurs when a failing liver cannot detoxify ammonia, which accumulates and affects the brain. Asterixis (flapping tremor) is a hallmark sign. Nursing management includes monitoring neurological status, avoiding high-protein foods temporarily, administering lactulose as prescribed (to reduce ammonia absorption), and maintaining a safe environment. This question type appears consistently in NMCN gastrointestinal nursing papers.
Question 7 — Musculoskeletal: Compartment Syndrome
A patient with a plaster cast on the right leg following a fracture reports severe pain that is worsening despite analgesia, and the nurse notices the toes are pale and the patient cannot feel them properly. The priority nursing action is:
A. Elevate the limb higher and administer additional analgesia
B. Apply ice to the cast to reduce swelling
C. Notify the doctor immediately — these are signs of compartment syndrome
D. Reassure the patient that swelling after a fracture is expected
Answer: C
Worsening pain unrelieved by analgesia, pallor, and loss of sensation in a casted limb are warning signs of compartment syndrome — a surgical emergency caused by rising pressure within a closed muscle compartment cutting off blood flow. Elevation (Option A) actually worsens arterial perfusion in compartment syndrome. Immediate medical review and likely emergency fasciotomy are required.
Question 8 — Fluid Balance: IV Fluid Choice
A patient is brought to the ward following a road traffic accident with significant blood loss. While awaiting blood transfusion, which IV fluid is most appropriate for initial resuscitation?
A. 5% dextrose solution
B. 0.9% normal saline or Ringer's lactate solution
C. 50% dextrose solution
D. Sterile water for injection
Answer: B — 0.9% normal saline or Ringer's lactate
Isotonic crystalloid solutions (normal saline or Ringer's lactate) are the standard for initial fluid resuscitation in haemorrhagic shock. They expand the intravascular volume. Dextrose solutions do not stay in the bloodstream — they distribute into cells and are not appropriate for volume replacement. Sterile water causes haemolysis. This is a foundational fluid management question tested across multiple NMCN sittings.
NMCN Medical-Surgical Nursing Topics by Frequency (2012–2026)
| System | Frequency | Highest-Yield Conditions |
|---|---|---|
| Cardiovascular | Very High | Shock, MI, cardiac failure, DVT |
| Respiratory | High | COPD, pneumonia, TB, asthma |
| Neurological | High | Raised ICP, stroke, seizures, GCS |
| Endocrine | High | DKA, hypoglycaemia, thyroid emergencies |
| Fluid and Electrolytes | High | Dehydration, IV fluid types, electrolyte imbalances |
| Gastrointestinal | Medium–High | Peptic ulcer, liver cirrhosis, stoma care |
| Perioperative | Medium–High | Pre/post-op care, wound complications |
| Musculoskeletal | Medium | Fractures, compartment syndrome, amputations |
| Renal and Urological | Medium | AKI vs CKD, dialysis, UTI prevention |
| Integumentary | Low–Medium | Burns, wound healing, pressure ulcer staging |
Why Medical-Surgical Questions Require a Different Study Strategy
Reading Medical-Surgical nursing notes gives you the content. Past questions give you something the notes cannot — the clinical decision-making speed the CBT demands.
Most Medical-Surgical questions present a patient scenario with four options that all sound clinically relevant. The skill being tested is priority setting. Which action comes first? What is the most dangerous outcome to prevent? What does the nurse do before calling the doctor vs after?
Three habits that sharpen this skill faster than anything else:
Read the question stem carefully for the priority word. Words like "immediate," "priority," "first," and "most important" are signals. They tell you the question is testing sequencing, not just knowledge.
Eliminate the option that only monitors without acting. In emergency scenarios, the option that says "document and monitor" is almost never correct. The NMCN exam expects nurses to act on danger signs.
Recognise the system being tested before reading the options. When you see Kussmaul respirations and fruity breath, you already know the answer involves DKA before you read choice A. Pattern recognition built from past questions makes this automatic.
How to Download NMCN Medical-Surgical Past Questions
The fastest route is the FreshNote NMCN app. No waiting for a WhatsApp PDF. No paying for materials before seeing them.
Download NMCN past questions via the app and go straight to the Medical-Surgical section. Practice questions are organised by body system — so you can drill cardiovascular nursing questions separately from respiratory, then mix everything in a timed mock paper when you are ready.
The question bank covers 2012 to 2026, every answer carries an explanation, and your scores are tracked across sessions so your weak systems are always visible.
Connecting Medical-Surgical to Your Full NMCN Preparation
Medical-Surgical Nursing sits in Paper II alongside Pharmacology. Understanding how those two subjects share time within the same paper — and how to pace yourself across both — is covered in the NMCN CBT format breakdown.
The pharmacology questions in Paper II connect directly to Medical-Surgical content — drugs for cardiac conditions, respiratory management, diabetic emergencies, and perioperative pain all appear as pharmacology questions within the same paper. Studying both subjects together in the final preparation weeks is more efficient than treating them separately.
For students working through Paper III alongside Paper II, the NMCN mental health nursing download page covers psychiatric nursing preparation and how it connects to clinical nursing priorities across the broader exam.
And the NMCN anatomy and physiology past questions guide explains how Paper I knowledge — cardiovascular, respiratory, and renal physiology — feeds directly into the Medical-Surgical scenarios you will face in Paper II.
Frequently Asked Questions
Where can I download NMCN Medical-Surgical Nursing past questions and answers PDF?
The FreshNote NMCN app holds the complete Medical-Surgical question bank from 2012 to 2026 with answers and explanations. Get the app here — no PDF hunting required.
Is Medical-Surgical Nursing the hardest paper in the NMCN CBT?
It is the most content-heavy paper. The difficulty comes from volume — multiple body systems, each with conditions, complications, and nursing priorities to know. Students who use past questions to identify which systems are tested most heavily prepare more efficiently and feel less overwhelmed.
How many Medical-Surgical questions appear in the NMCN CBT?
Paper II — which includes Medical-Surgical Nursing and Pharmacology — is one of the longer papers in the NMCN exam. Medical-Surgical contributes the majority of Paper II questions. The exact number varies by sitting.
What is the most tested topic in NMCN Medical-Surgical Nursing?
Cardiovascular nursing — particularly shock, myocardial infarction, cardiac failure, and hypertension — generates the most questions per sitting across the 2012–2026 question bank. Neurological nursing (especially raised ICP and stroke) and diabetic emergencies follow closely.
What does Cushing's triad mean in NMCN Medical-Surgical Nursing?
Hypertension, bradycardia, and abnormal (irregular or slow) breathing together. This triad signals critically raised intracranial pressure with brainstem involvement. It is a medical emergency. The nurse's immediate response is to notify the doctor and prepare for emergency intervention.
How is Medical-Surgical Nursing different from Pharmacology in Paper II?
Medical-Surgical questions focus on clinical recognition, nursing priorities, and patient management. Pharmacology questions focus on drug actions, calculations, contraindications, and nursing considerations related to specific drugs. In practice, both subjects overlap — many Medical-Surgical scenarios involve drug administration decisions.
Can I practise NMCN Medical-Surgical questions on my phone?
Yes. The FreshNote NMCN app is mobile-friendly and lets you practise by subject, by body system, or in full timed mock mode — whichever suits your preparation stage.
What is the five Ps sign in NMCN musculoskeletal nursing?
Pain, Pallor, Pulselessness, Paraesthesia (tingling/numbness), and Paralysis — the classic warning signs of compartment syndrome. Any combination of these in a casted or injured limb requires immediate medical notification.
Start Practising Today — Paper II Will Not Wait
Medical-Surgical Nursing is too broad to master through notes alone and too important to under-prepare for. It is the paper where strong students pull ahead and underprepared students fall behind — because the volume of content means the gap between prepared and unprepared is wide.
Every question you practise from the 2012–2026 bank sharpens your clinical decision-making. Every wrong answer you review teaches you a priority principle you will use again in the real exam.
Practice on the FreshNote app — start with cardiovascular nursing, drill the shock and cardiac failure questions first, then work through the respiratory and neurological sections. Build your Paper II strength one system at a time.
The question bank is waiting. The exam is coming. Start now.