ANCC Medical-Surgical Nursing Certification
(MEDSURG-BC™) Exam | 2026/2027 Edition
With Correct Answers – Verified & A+ Graded
Based on the ANCC Test Content Outline Effective September 10, 2024, and Current
Evidence-Based Practice Guidelines
SECTION 1: CLINICAL PRACTICE – ASSESSMENT, DIAGNOSIS, & PLANNING
(Questions 1-60)
Q1
A 72-year-old patient with a history of COPD and heart failure is admitted with increased
shortness of breath. Assessment reveals: BP 98/60, HR 128 (irregular), RR 32, SpO2
88% on 4L NC, temp 37.8°C. Lung sounds: diffuse wheezes and crackles bilaterally. JVD
is present, and there is +3 pitting edema in the lower extremities. Which of the following
is the priority nursing diagnosis?
A. Impaired Gas Exchange related to ventilation-perfusion imbalance
B. Decreased Cardiac Output related to altered preload and contractility [CORRECT]
C. Ineffective Airway Clearance related to increased bronchial secretions
D. Activity Intolerance related to imbalance between oxygen supply and demand
Correct Answer: B
Rationale: While the patient has both cardiac and pulmonary compromise, the
assessment findings (hypotension, tachycardia, JVD, significant edema) point to acute
,decompensated heart failure as the primary, life-threatening driver. The Decreased
Cardiac Output is the priority because it is causing pulmonary congestion (crackles,
wheezes, hypoxia) and systemic hypoperfusion (hypotension, tachycardia). Addressing
cardiac output through diuresis, afterload reduction, and inotropic support (if needed)
will ultimately improve gas exchange (A). Airway clearance (C) and activity intolerance
(D) are important but secondary to the immediate hemodynamic crisis. The irregular HR
suggests possible atrial fibrillation, further compromising cardiac output.
Q2
A 58-year-old patient with type 2 diabetes presents with confusion, lethargy, and
Kussmaul respirations. Laboratory results: glucose 680 mg/dL, pH 7.25, HCO3 18
mEq/L, ketones positive in urine. The nurse recognizes this as:
A. Hyperosmolar Hyperglycemic State (HHS)
B. Diabetic Ketoacidosis (DKA) [CORRECT]
C. Hypoglycemic coma
D. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Correct Answer: B
Rationale: Diabetic Ketoacidosis (DKA) is characterized by hyperglycemia (>250 mg/dL),
metabolic acidosis (pH <7.3, HCO3 <18), ketonemia/ketonuria, and anion gap acidosis.
The Kussmaul respirations (deep, rapid breathing) are compensatory for metabolic
acidosis. HHS (A) presents with severe hyperglycemia (>600 mg/dL) but no significant
ketosis or acidosis. Hypoglycemia (C) would show low glucose. SIADH (D) causes
hyponatremia and concentrated urine without hyperglycemia or acidosis. Immediate
,priorities for DKA include fluid resuscitation, insulin therapy, and electrolyte monitoring
(especially potassium).
Q3
(SATA) A nurse is assessing a patient 2 hours post-thyroidectomy. Which findings
require immediate intervention? Select all that apply.
A. Blood pressure 148/92 mmHg
B. Stridor and respiratory distress [CORRECT]
C. Tingling in fingers and toes [CORRECT]
D. Serous drainage on surgical dressing
E. Hoarseness of voice [CORRECT]
Correct Answer: B, C, E
Rationale: Post-thyroidectomy complications requiring immediate intervention include:
Respiratory distress/stridor (B) indicating airway obstruction from hematoma or
laryngeal edema; Hypocalcemia symptoms (C) (tingling, Chvostek's/Trousseau's signs)
from parathyroid injury requiring calcium replacement; and Hoarseness (E) suggesting
recurrent laryngeal nerve injury. Hypertension (A) requires monitoring but is not
immediately life-threatening. Serous drainage (D) is expected; bloody, rapid expansion
would indicate hemorrhage. The nurse must have tracheostomy kit and calcium
gluconate readily available.
Q4
, A patient with acute pancreatitis presents with severe epigastric pain radiating to the
back, vomiting, and fever. Laboratory values show amylase 450 U/L, lipase 620 U/L,
glucose 220 mg/dL, and calcium 7.8 mg/dL. Based on Ranson's criteria, which finding
indicates a poor prognosis?
A. Elevated amylase
B. Elevated lipase
C. Hypocalcemia [CORRECT]
D. Hyperglycemia
Correct Answer: C
Rationale: Ranson's criteria identify severe pancreatitis with increased mortality. Criteria
present at admission include: age >55, WBC >16,000, glucose >200, LDH >350, AST
>250. Criteria developing within 48 hours include: hematocrit fall >10%, BUN increase
>5, calcium <8, PaO2 <60, base deficit >4, fluid sequestration >6L. Hypocalcemia (C)
indicates saponification of fats (fat necrosis binding calcium) and is a marker of severe
necrotizing pancreatitis. Elevated enzymes (A, B) confirm diagnosis but not severity.
Glucose >200 (D) is an admission criterion but less specific for prognosis than
hypocalcemia.
Q5
A 65-year-old patient with atrial fibrillation is started on warfarin. The nurse knows that
the therapeutic INR range for this condition is:
A. 1.5-2.0
B. 2.0-3.0 [CORRECT]
(MEDSURG-BC™) Exam | 2026/2027 Edition
With Correct Answers – Verified & A+ Graded
Based on the ANCC Test Content Outline Effective September 10, 2024, and Current
Evidence-Based Practice Guidelines
SECTION 1: CLINICAL PRACTICE – ASSESSMENT, DIAGNOSIS, & PLANNING
(Questions 1-60)
Q1
A 72-year-old patient with a history of COPD and heart failure is admitted with increased
shortness of breath. Assessment reveals: BP 98/60, HR 128 (irregular), RR 32, SpO2
88% on 4L NC, temp 37.8°C. Lung sounds: diffuse wheezes and crackles bilaterally. JVD
is present, and there is +3 pitting edema in the lower extremities. Which of the following
is the priority nursing diagnosis?
A. Impaired Gas Exchange related to ventilation-perfusion imbalance
B. Decreased Cardiac Output related to altered preload and contractility [CORRECT]
C. Ineffective Airway Clearance related to increased bronchial secretions
D. Activity Intolerance related to imbalance between oxygen supply and demand
Correct Answer: B
Rationale: While the patient has both cardiac and pulmonary compromise, the
assessment findings (hypotension, tachycardia, JVD, significant edema) point to acute
,decompensated heart failure as the primary, life-threatening driver. The Decreased
Cardiac Output is the priority because it is causing pulmonary congestion (crackles,
wheezes, hypoxia) and systemic hypoperfusion (hypotension, tachycardia). Addressing
cardiac output through diuresis, afterload reduction, and inotropic support (if needed)
will ultimately improve gas exchange (A). Airway clearance (C) and activity intolerance
(D) are important but secondary to the immediate hemodynamic crisis. The irregular HR
suggests possible atrial fibrillation, further compromising cardiac output.
Q2
A 58-year-old patient with type 2 diabetes presents with confusion, lethargy, and
Kussmaul respirations. Laboratory results: glucose 680 mg/dL, pH 7.25, HCO3 18
mEq/L, ketones positive in urine. The nurse recognizes this as:
A. Hyperosmolar Hyperglycemic State (HHS)
B. Diabetic Ketoacidosis (DKA) [CORRECT]
C. Hypoglycemic coma
D. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Correct Answer: B
Rationale: Diabetic Ketoacidosis (DKA) is characterized by hyperglycemia (>250 mg/dL),
metabolic acidosis (pH <7.3, HCO3 <18), ketonemia/ketonuria, and anion gap acidosis.
The Kussmaul respirations (deep, rapid breathing) are compensatory for metabolic
acidosis. HHS (A) presents with severe hyperglycemia (>600 mg/dL) but no significant
ketosis or acidosis. Hypoglycemia (C) would show low glucose. SIADH (D) causes
hyponatremia and concentrated urine without hyperglycemia or acidosis. Immediate
,priorities for DKA include fluid resuscitation, insulin therapy, and electrolyte monitoring
(especially potassium).
Q3
(SATA) A nurse is assessing a patient 2 hours post-thyroidectomy. Which findings
require immediate intervention? Select all that apply.
A. Blood pressure 148/92 mmHg
B. Stridor and respiratory distress [CORRECT]
C. Tingling in fingers and toes [CORRECT]
D. Serous drainage on surgical dressing
E. Hoarseness of voice [CORRECT]
Correct Answer: B, C, E
Rationale: Post-thyroidectomy complications requiring immediate intervention include:
Respiratory distress/stridor (B) indicating airway obstruction from hematoma or
laryngeal edema; Hypocalcemia symptoms (C) (tingling, Chvostek's/Trousseau's signs)
from parathyroid injury requiring calcium replacement; and Hoarseness (E) suggesting
recurrent laryngeal nerve injury. Hypertension (A) requires monitoring but is not
immediately life-threatening. Serous drainage (D) is expected; bloody, rapid expansion
would indicate hemorrhage. The nurse must have tracheostomy kit and calcium
gluconate readily available.
Q4
, A patient with acute pancreatitis presents with severe epigastric pain radiating to the
back, vomiting, and fever. Laboratory values show amylase 450 U/L, lipase 620 U/L,
glucose 220 mg/dL, and calcium 7.8 mg/dL. Based on Ranson's criteria, which finding
indicates a poor prognosis?
A. Elevated amylase
B. Elevated lipase
C. Hypocalcemia [CORRECT]
D. Hyperglycemia
Correct Answer: C
Rationale: Ranson's criteria identify severe pancreatitis with increased mortality. Criteria
present at admission include: age >55, WBC >16,000, glucose >200, LDH >350, AST
>250. Criteria developing within 48 hours include: hematocrit fall >10%, BUN increase
>5, calcium <8, PaO2 <60, base deficit >4, fluid sequestration >6L. Hypocalcemia (C)
indicates saponification of fats (fat necrosis binding calcium) and is a marker of severe
necrotizing pancreatitis. Elevated enzymes (A, B) confirm diagnosis but not severity.
Glucose >200 (D) is an admission criterion but less specific for prognosis than
hypocalcemia.
Q5
A 65-year-old patient with atrial fibrillation is started on warfarin. The nurse knows that
the therapeutic INR range for this condition is:
A. 1.5-2.0
B. 2.0-3.0 [CORRECT]
