ANCC Medical-Surgical Nursing
Exam | 2025/2026 Latest Edition
Real Exam-Based Questions and Verified Answers | 100%
Accuracy | ANCC Certification Preparation | Graded A+
Introduction
This resource includes 175+ verified multiple-choice questions and correct answers from the
most recent ANCC Medical-Surgical Nursing Certification Exam, fully aligned with
2025/2026 ANCC exam content outlines. Topics covered include assessment and diagnosis,
clinical decision-making, patient care management, professional practice, and safety and
infection control.
Answer Format
All correct answers are clearly marked in bold and green to enhance review efficiency and
support confident exam preparation.
Questions
1. A patient with type 2 diabetes presents with a blood glucose level of
350 mg/dL. What is the priority nursing action?
a) Administer oral hypoglycemic agents
b) Notify the healthcare provider and assess for dehydration
c) Encourage the patient to eat a high-carbohydrate meal
d) Administer regular insulin without provider order
b) Notify the healthcare provider and assess for dehydration
Rationale: Hyperglycemia requires immediate provider notification and assessment for
dehydration, a common complication.
2. A patient post-appendectomy reports severe abdominal pain and
fever. What is the most likely complication?
a) Paralytic ileus
b) Intra-abdominal abscess
c) Bowel obstruction
d) Wound dehiscence
b) Intra-abdominal abscess
Rationale: Severe pain and fever post-appendectomy suggest an intra-abdominal abscess,
requiring urgent evaluation.
3. What is the priority intervention for a patient with a suspected
pulmonary embolism?
a) Administer oxygen
b) Start IV fluids
,c) Apply compression stockings
d) Encourage ambulation
a) Administer oxygen
Rationale: Oxygen administration is the priority to address hypoxia in suspected pulmonary
embolism.
4. A patient with heart failure reports weight gain of 4 lbs in 2 days. What
is the nurse’s first action?
a) Increase diuretic dose
b) Assess lung sounds and edema
c) Restrict all fluids
d) Administer oxygen
b) Assess lung sounds and edema
Rationale: Rapid weight gain in heart failure indicates fluid retention, requiring assessment
for pulmonary edema and peripheral swelling.
5. Which precaution is most appropriate for a patient with MRSA in a
surgical wound?
a) Standard precautions
b) Contact precautions
c) Droplet precautions
d) Airborne precautions
b) Contact precautions
Rationale: MRSA requires contact precautions to prevent transmission via direct or indirect
contact.
6. A patient with COPD experiences acute dyspnea. What is the first
nursing action?
a) Administer a bronchodilator
b) Assess oxygen saturation
c) Place in supine position
d) Restrict fluids
b) Assess oxygen saturation
Rationale: Assessing oxygen saturation is the first step to determine the severity of hypoxia
in a COPD exacerbation.
7. What is the most common electrolyte imbalance in a patient with
prolonged vomiting?
a) Hyperkalemia
b) Hypokalemia
c) Hypernatremia
d) Hyponatremia
b) Hypokalemia
Rationale: Prolonged vomiting causes loss of potassium, leading to hypokalemia.
8. A patient with a new colostomy reports leakage around the appliance.
What is the nurse’s first action?
a) Change the appliance immediately
b) Assess the stoma and skin integrity
c) Administer an antidiarrheal
,d) Encourage a high-fiber diet
b) Assess the stoma and skin integrity
Rationale: Assessing the stoma and skin ensures proper fit and identifies causes of leakage.
9. What is the priority nursing diagnosis for a patient with acute
pancreatitis?
a) Imbalanced nutrition: Less than body requirements
b) Acute pain
c) Risk for infection
d) Deficient fluid volume
b) Acute pain
Rationale: Acute pain is the priority due to severe abdominal pain associated with
pancreatitis.
10. A patient with a history of atrial fibrillation is on warfarin. What lab
value should the nurse monitor?
a) PT/INR
b) aPTT
c) Platelet count
d) Hemoglobin
a) PT/INR
Rationale: PT/INR monitors the therapeutic effect of warfarin in preventing
thromboembolism.
11. A patient post-hip replacement reports sudden shortness of breath
and chest pain. What is the suspected diagnosis?
a) Myocardial infarction
b) Pulmonary embolism
c) Pneumonia
d) Heart failure
b) Pulmonary embolism
Rationale: Sudden shortness of breath and chest pain post-surgery suggest pulmonary
embolism, a common complication.
12. What is the first action for a patient with a suspected stroke?
a) Administer aspirin
b) Order a CT scan of the head
c) Start IV heparin
d) Perform a 12-lead EKG
b) Order a CT scan of the head
Rationale: A CT scan is critical to differentiate ischemic from hemorrhagic stroke.
13. A patient with a pressure ulcer requires a dressing change. What is
the priority nursing action?
a) Apply a dry gauze dressing
b) Assess the wound for signs of infection
c) Administer pain medication post-dressing
d) Restrict all mobility
b) Assess the wound for signs of infection
, Rationale: Assessing for infection ensures proper wound management and prevents
complications.
14. A patient with chronic renal failure reports nausea and muscle
cramps. What electrolyte imbalance is likely?
a) Hyperkalemia
b) Hypocalcemia
c) Hyponatremia
d) Hyperphosphatemia
a) Hyperkalemia
Rationale: Hyperkalemia is common in renal failure and causes nausea and muscle cramps.
15. What is the most appropriate infection control measure for a patient
with C. difficile?
a) Standard precautions
b) Contact precautions with soap and water handwashing
c) Droplet precautions
d) Airborne precautions
b) Contact precautions with soap and water handwashing
Rationale: C. difficile requires contact precautions and soap and water handwashing due to
spore resistance to alcohol.
16. A patient with a history of seizures is prescribed phenytoin. What
should the nurse monitor?
a) Blood glucose levels
b) Serum phenytoin levels
c) Platelet count
d) Blood pressure
b) Serum phenytoin levels
Rationale: Monitoring phenytoin levels ensures therapeutic dosing and prevents toxicity.
17. A patient with pneumonia develops respiratory distress. What is the
priority nursing action?
a) Administer antibiotics
b) Assess oxygen saturation and apply oxygen
c) Encourage coughing
d) Restrict fluids
b) Assess oxygen saturation and apply oxygen
Rationale: Addressing hypoxia is the priority in respiratory distress.
18. What is the most common cause of acute kidney injury in hospitalized
patients?
a) Dehydration
b) Glomerulonephritis
c) Kidney stones
d) Polycystic kidney disease
a) Dehydration
Rationale: Dehydration is a leading cause of acute kidney injury in hospitalized patients due
to reduced renal perfusion.
Exam | 2025/2026 Latest Edition
Real Exam-Based Questions and Verified Answers | 100%
Accuracy | ANCC Certification Preparation | Graded A+
Introduction
This resource includes 175+ verified multiple-choice questions and correct answers from the
most recent ANCC Medical-Surgical Nursing Certification Exam, fully aligned with
2025/2026 ANCC exam content outlines. Topics covered include assessment and diagnosis,
clinical decision-making, patient care management, professional practice, and safety and
infection control.
Answer Format
All correct answers are clearly marked in bold and green to enhance review efficiency and
support confident exam preparation.
Questions
1. A patient with type 2 diabetes presents with a blood glucose level of
350 mg/dL. What is the priority nursing action?
a) Administer oral hypoglycemic agents
b) Notify the healthcare provider and assess for dehydration
c) Encourage the patient to eat a high-carbohydrate meal
d) Administer regular insulin without provider order
b) Notify the healthcare provider and assess for dehydration
Rationale: Hyperglycemia requires immediate provider notification and assessment for
dehydration, a common complication.
2. A patient post-appendectomy reports severe abdominal pain and
fever. What is the most likely complication?
a) Paralytic ileus
b) Intra-abdominal abscess
c) Bowel obstruction
d) Wound dehiscence
b) Intra-abdominal abscess
Rationale: Severe pain and fever post-appendectomy suggest an intra-abdominal abscess,
requiring urgent evaluation.
3. What is the priority intervention for a patient with a suspected
pulmonary embolism?
a) Administer oxygen
b) Start IV fluids
,c) Apply compression stockings
d) Encourage ambulation
a) Administer oxygen
Rationale: Oxygen administration is the priority to address hypoxia in suspected pulmonary
embolism.
4. A patient with heart failure reports weight gain of 4 lbs in 2 days. What
is the nurse’s first action?
a) Increase diuretic dose
b) Assess lung sounds and edema
c) Restrict all fluids
d) Administer oxygen
b) Assess lung sounds and edema
Rationale: Rapid weight gain in heart failure indicates fluid retention, requiring assessment
for pulmonary edema and peripheral swelling.
5. Which precaution is most appropriate for a patient with MRSA in a
surgical wound?
a) Standard precautions
b) Contact precautions
c) Droplet precautions
d) Airborne precautions
b) Contact precautions
Rationale: MRSA requires contact precautions to prevent transmission via direct or indirect
contact.
6. A patient with COPD experiences acute dyspnea. What is the first
nursing action?
a) Administer a bronchodilator
b) Assess oxygen saturation
c) Place in supine position
d) Restrict fluids
b) Assess oxygen saturation
Rationale: Assessing oxygen saturation is the first step to determine the severity of hypoxia
in a COPD exacerbation.
7. What is the most common electrolyte imbalance in a patient with
prolonged vomiting?
a) Hyperkalemia
b) Hypokalemia
c) Hypernatremia
d) Hyponatremia
b) Hypokalemia
Rationale: Prolonged vomiting causes loss of potassium, leading to hypokalemia.
8. A patient with a new colostomy reports leakage around the appliance.
What is the nurse’s first action?
a) Change the appliance immediately
b) Assess the stoma and skin integrity
c) Administer an antidiarrheal
,d) Encourage a high-fiber diet
b) Assess the stoma and skin integrity
Rationale: Assessing the stoma and skin ensures proper fit and identifies causes of leakage.
9. What is the priority nursing diagnosis for a patient with acute
pancreatitis?
a) Imbalanced nutrition: Less than body requirements
b) Acute pain
c) Risk for infection
d) Deficient fluid volume
b) Acute pain
Rationale: Acute pain is the priority due to severe abdominal pain associated with
pancreatitis.
10. A patient with a history of atrial fibrillation is on warfarin. What lab
value should the nurse monitor?
a) PT/INR
b) aPTT
c) Platelet count
d) Hemoglobin
a) PT/INR
Rationale: PT/INR monitors the therapeutic effect of warfarin in preventing
thromboembolism.
11. A patient post-hip replacement reports sudden shortness of breath
and chest pain. What is the suspected diagnosis?
a) Myocardial infarction
b) Pulmonary embolism
c) Pneumonia
d) Heart failure
b) Pulmonary embolism
Rationale: Sudden shortness of breath and chest pain post-surgery suggest pulmonary
embolism, a common complication.
12. What is the first action for a patient with a suspected stroke?
a) Administer aspirin
b) Order a CT scan of the head
c) Start IV heparin
d) Perform a 12-lead EKG
b) Order a CT scan of the head
Rationale: A CT scan is critical to differentiate ischemic from hemorrhagic stroke.
13. A patient with a pressure ulcer requires a dressing change. What is
the priority nursing action?
a) Apply a dry gauze dressing
b) Assess the wound for signs of infection
c) Administer pain medication post-dressing
d) Restrict all mobility
b) Assess the wound for signs of infection
, Rationale: Assessing for infection ensures proper wound management and prevents
complications.
14. A patient with chronic renal failure reports nausea and muscle
cramps. What electrolyte imbalance is likely?
a) Hyperkalemia
b) Hypocalcemia
c) Hyponatremia
d) Hyperphosphatemia
a) Hyperkalemia
Rationale: Hyperkalemia is common in renal failure and causes nausea and muscle cramps.
15. What is the most appropriate infection control measure for a patient
with C. difficile?
a) Standard precautions
b) Contact precautions with soap and water handwashing
c) Droplet precautions
d) Airborne precautions
b) Contact precautions with soap and water handwashing
Rationale: C. difficile requires contact precautions and soap and water handwashing due to
spore resistance to alcohol.
16. A patient with a history of seizures is prescribed phenytoin. What
should the nurse monitor?
a) Blood glucose levels
b) Serum phenytoin levels
c) Platelet count
d) Blood pressure
b) Serum phenytoin levels
Rationale: Monitoring phenytoin levels ensures therapeutic dosing and prevents toxicity.
17. A patient with pneumonia develops respiratory distress. What is the
priority nursing action?
a) Administer antibiotics
b) Assess oxygen saturation and apply oxygen
c) Encourage coughing
d) Restrict fluids
b) Assess oxygen saturation and apply oxygen
Rationale: Addressing hypoxia is the priority in respiratory distress.
18. What is the most common cause of acute kidney injury in hospitalized
patients?
a) Dehydration
b) Glomerulonephritis
c) Kidney stones
d) Polycystic kidney disease
a) Dehydration
Rationale: Dehydration is a leading cause of acute kidney injury in hospitalized patients due
to reduced renal perfusion.
