ANCC Medical-Surgical Nursing Certification
Exam (MEDSURG-BC™) – 2026 Update
SECTION I: ETHICAL AND LEGAL PRINCIPLES
Q1. Scenario: A competent adult patient refuses a life-saving blood transfusion due to religious
beliefs. The nurse respects this decision. Which ethical principle is the nurse demonstrating?
A) Beneficence
B) Nonmaleficence
C) Autonomy
D) Justice
Correct Answer: C – Autonomy
Rationale: Autonomy is the duty to allow the patient to make independent decisions regarding
their own healthcare. Even if the nurse disagrees, the patient's right to refuse treatment is
legally and ethically protected. Beneficence (A) is the duty to do good; Nonmaleficence (B) is
the duty to do no harm; Justice (D) is the duty of fairness and distribution of resources .
Q2. A nurse tells a patient, "I will be back to check your pain level in 30 minutes." Which ethical
principle is upheld by following through on this statement?
A) Veracity
B) Fidelity
C) Confidentiality
D) Advocacy
Correct Answer: B – Fidelity
Rationale: Fidelity is the duty to keep promises and commitments. Returning as promised builds
trust. Veracity (A) is the duty to tell the truth; Confidentiality (C) is the duty to protect private
information; Advocacy (D) is supporting the patient's best interest .
Q3. A nurse takes a photo of a patient's surgical wound with a personal cell phone to text to a
physician for advice. No patient identifiers are used. This is:
A) Acceptable because no identifiers are used
,B) A violation of HIPAA
C) Permissible with verbal physician consent
D) Standard practice for wound consults
Correct Answer: B – A violation of HIPAA
Rationale: Transmission of any patient health information, including clinical images, via
unsecured personal devices violates HIPAA regardless of the presence or absence of direct
identifiers .
Q4. A nurse fails to report a change in a patient's mental status to the provider, and the patient
experiences a preventable stroke. This is an example of:
A) Assault
B) Battery
C) Negligence
D) Malpractice
Correct Answer: D – Malpractice
Rationale: Malpractice is professional negligence. The nurse breached the duty of care (failing
to report a significant change) which directly caused harm to the patient. Negligence (C) is a
broader term. Assault (A) involves threat of harm, and Battery (B) involves actual physical
contact without consent .
Q5. Which ethical principle is described as the duty to provide equal and fair distribution of
resources?
A) Beneficence
B) Nonmaleficence
C) Autonomy
D) Justice
Correct Answer: D – Justice
Rationale: Justice requires equal and fair distribution of resources regardless of patient status,
diagnosis, or ability to pay .
, Q6. A nurse respects a patient's request to keep certain health information from family
members. The nurse is upholding which ethical principle?
A) Nonmaleficence
B) Confidentiality
C) Justice
D) Veracity
Correct Answer: B – Confidentiality
Rationale: Confidentiality is the duty to keep certain information from disclosure without the
patient's consent. Privacy protects the physical body or information from unauthorized view,
while confidentiality specifically relates to keeping information disclosed within the professional
relationship .
SECTION II: LEADERSHIP AND MANAGEMENT
Q7. A unit is implementing a new fall-prevention protocol with high staff resistance. Which
leadership style is MOST effective in this situation?
A) Laissez-faire
B) Autocratic
C) Democratic
D) Transactional
Correct Answer: C – Democratic
Rationale: A democratic approach (team participation) helps reduce resistance by involving staff
in decision-making. Laissez-faire is "hands-off" and works well with highly motivated experts but
not for resistant staff; autocratic may increase resistance with experienced staff .
Q8. Two nurses are arguing over who has to take a difficult patient assignment. What is the
manager's priority action?
A) Assign the patient based on seniority
B) Let the nurses decide to promote autonomy
C) Facilitate a calm discussion of the conflict
D) Split the patient's care between both nurses
Correct Answer: C – Facilitate a calm discussion of the conflict
Exam (MEDSURG-BC™) – 2026 Update
SECTION I: ETHICAL AND LEGAL PRINCIPLES
Q1. Scenario: A competent adult patient refuses a life-saving blood transfusion due to religious
beliefs. The nurse respects this decision. Which ethical principle is the nurse demonstrating?
A) Beneficence
B) Nonmaleficence
C) Autonomy
D) Justice
Correct Answer: C – Autonomy
Rationale: Autonomy is the duty to allow the patient to make independent decisions regarding
their own healthcare. Even if the nurse disagrees, the patient's right to refuse treatment is
legally and ethically protected. Beneficence (A) is the duty to do good; Nonmaleficence (B) is
the duty to do no harm; Justice (D) is the duty of fairness and distribution of resources .
Q2. A nurse tells a patient, "I will be back to check your pain level in 30 minutes." Which ethical
principle is upheld by following through on this statement?
A) Veracity
B) Fidelity
C) Confidentiality
D) Advocacy
Correct Answer: B – Fidelity
Rationale: Fidelity is the duty to keep promises and commitments. Returning as promised builds
trust. Veracity (A) is the duty to tell the truth; Confidentiality (C) is the duty to protect private
information; Advocacy (D) is supporting the patient's best interest .
Q3. A nurse takes a photo of a patient's surgical wound with a personal cell phone to text to a
physician for advice. No patient identifiers are used. This is:
A) Acceptable because no identifiers are used
,B) A violation of HIPAA
C) Permissible with verbal physician consent
D) Standard practice for wound consults
Correct Answer: B – A violation of HIPAA
Rationale: Transmission of any patient health information, including clinical images, via
unsecured personal devices violates HIPAA regardless of the presence or absence of direct
identifiers .
Q4. A nurse fails to report a change in a patient's mental status to the provider, and the patient
experiences a preventable stroke. This is an example of:
A) Assault
B) Battery
C) Negligence
D) Malpractice
Correct Answer: D – Malpractice
Rationale: Malpractice is professional negligence. The nurse breached the duty of care (failing
to report a significant change) which directly caused harm to the patient. Negligence (C) is a
broader term. Assault (A) involves threat of harm, and Battery (B) involves actual physical
contact without consent .
Q5. Which ethical principle is described as the duty to provide equal and fair distribution of
resources?
A) Beneficence
B) Nonmaleficence
C) Autonomy
D) Justice
Correct Answer: D – Justice
Rationale: Justice requires equal and fair distribution of resources regardless of patient status,
diagnosis, or ability to pay .
, Q6. A nurse respects a patient's request to keep certain health information from family
members. The nurse is upholding which ethical principle?
A) Nonmaleficence
B) Confidentiality
C) Justice
D) Veracity
Correct Answer: B – Confidentiality
Rationale: Confidentiality is the duty to keep certain information from disclosure without the
patient's consent. Privacy protects the physical body or information from unauthorized view,
while confidentiality specifically relates to keeping information disclosed within the professional
relationship .
SECTION II: LEADERSHIP AND MANAGEMENT
Q7. A unit is implementing a new fall-prevention protocol with high staff resistance. Which
leadership style is MOST effective in this situation?
A) Laissez-faire
B) Autocratic
C) Democratic
D) Transactional
Correct Answer: C – Democratic
Rationale: A democratic approach (team participation) helps reduce resistance by involving staff
in decision-making. Laissez-faire is "hands-off" and works well with highly motivated experts but
not for resistant staff; autocratic may increase resistance with experienced staff .
Q8. Two nurses are arguing over who has to take a difficult patient assignment. What is the
manager's priority action?
A) Assign the patient based on seniority
B) Let the nurses decide to promote autonomy
C) Facilitate a calm discussion of the conflict
D) Split the patient's care between both nurses
Correct Answer: C – Facilitate a calm discussion of the conflict
