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ANCC MEDSURG-BCFree Medical-Surgical Nursing Certification practice test
10 real ANCC MEDSURG-BC practice questions with instant answers and explanations — no account, no credit card, no email. Score yourself, then unlock the full bank of 1,500questions whenever you’re ready. The ANCC MEDSURG-BC passing score is 350 / 500 (scaled).
A 42-year-old woman arrives at the emergency department with nausea, rapid breathing, and increased urination. She states she ran out of insulin and antihypertensive medications three days ago. Which condition should the nurse prioritize when evaluating this patient?
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Q1. A 42-year-old woman arrives at the emergency department with nausea, rapid breathing, and increased urination. She states she ran out of insulin and antihypertensive medications three days ago. Which condition should the nurse prioritize when evaluating this patient?
Correct answer: A. Diabetic ketoacidosis (DKA)
DKA is the priority concern in an insulin-dependent diabetic who has missed doses. The combination of nausea, polyuria, and tachypnea — likely reflecting metabolic acidosis — distinguishes DKA from HHNS, which typically lacks rapid breathing. The symptom pattern does not fit thyroid storm or hypertensive urgency.
Q2. A 45-year-old patient is hospitalized after two months of unexplained weight loss, fatigue, intermittent low-grade fever, and night sweats. While completing the admission history, the nurse wants to identify information most relevant to ruling out an infectious cause. Which question should the nurse ask first?
Correct answer: A. Have you traveled anywhere recently?
Travel history is the highest priority because exposure to endemic areas can reveal risk for infections such as tuberculosis, which classically causes constitutional symptoms including weight loss, low-grade fever, fatigue, and night sweats. This information guides isolation decisions and testing priorities. Family history of hypertension, daily fluid intake, and exercise habits do not help clarify an infectious exposure pattern for this symptom cluster.
Q3. A 62-year-old patient with a history of rheumatic fever is admitted to the medical-surgical unit. Assessment reveals shortness of breath, chest pain, and syncope on the subjective side, and peripheral edema, jugular venous distension, weight gain, cyanosis, hepatomegaly, and cardiac arrhythmia on the objective side. Which diagnosis best accounts for these findings?
Correct answer: B. Aortic valve stenosis
Aortic valve stenosis is most consistent with this presentation. The classic triad of chest pain, syncope, and dyspnea, combined with rheumatic fever as a recognized cause of acquired valvular disease, strongly points to this diagnosis. Peripheral edema, jugular distension, and hepatomegaly can occur as valvular disease advances to heart failure. Infective endocarditis more often includes fever and embolic signs. Left heart failure can cause fluid overload but not the full aortic stenosis triad. Abdominal aortic aneurysm typically causes abdominal or back pain and does not explain this combination of valvular and congestive findings.
Q4. A gastric emptying study falls under which imaging category?
Correct answer: A. Nuclear imaging scan
Nuclear imaging scans use radioactive isotopes to evaluate the size, shape, position, and functional status of organs. A gastric emptying study belongs to this category — the patient ingests a radiolabeled meal, and a scanner tracks tracer movement through the stomach. Ultrasound identifies masses and fluid collections but does not assess gastric motility. CT is used primarily for hepatobiliary and pancreatic evaluation. Endoscopy provides direct visual inspection of luminal structures but does not measure emptying function.
Q5. A nurse is caring for a patient newly diagnosed with an autoimmune disorder. The patient asks why the immune system is attacking the body's own tissues. Which explanation most accurately describes the underlying mechanism?
Correct answer: C. B cells generate autoantibodies while T cells become reactive to self-antigens, both contributing to tissue injury.
Autoimmune disease arises when immune tolerance to self-antigens breaks down. B cells can differentiate into plasma cells that produce autoantibodies, and autoreactive T cells recognize self-tissues and promote inflammation or direct cellular destruction. Both humoral and cell-mediated mechanisms are often involved. Autoantibodies are made by B cells, not T cells. Cell-mediated immunity is a T-cell function, not B-cell. Loss of antibody production describes immunodeficiency, which is the opposite of autoimmunity.
Q6. A patient presents with decreased urine output and rising creatinine. The provider suspects acute kidney injury (AKI) and orders urinalysis and urine sodium tests to identify the cause. Which result would best help the nurse distinguish prerenal AKI from intrinsic renal AKI?
Correct answer: A. Urine sodium is low in prerenal AKI because intact tubules conserve sodium in response to decreased perfusion.
Prerenal AKI triggers compensatory sodium and water conservation by functioning tubules, producing low urine sodium (typically below 20 mEq/L) and a fractional excretion of sodium (FENa) under 1%. In intrinsic AKI — most often acute tubular necrosis — damaged tubules cannot reabsorb sodium effectively, so urine sodium rises above 40 mEq/L and FENa exceeds 2–3%. Urine sodium is not equally elevated in both types; the distinction depends on tubular integrity. In prerenal AKI, kidneys conserve rather than excrete sodium. Diuretics increase urinary sodium and falsely elevate FENa, making urine sodium unreliable in patients on these agents; fractional excretion of urea is preferable in that setting.
Q7. A nurse is evaluating a patient in the early compensatory phase of hypovolemic shock. The blood pressure reveals narrowing pulse pressure with a slight rise in diastolic pressure. Which physiological mechanism most directly accounts for this pattern?
Correct answer: A. Increased systemic vascular tone from sympathetic activation
In early compensated hypovolemic shock, sympathetic nervous system activation causes peripheral vasoconstriction to maintain perfusion of vital organs. Elevated systemic vascular resistance can increase diastolic pressure and narrow pulse pressure even before overt hypotension develops, making this the best explanation. Cardiac output typically decreases due to reduced preload, not increases. Improved contractility from catecholamines has less influence on diastolic pressure than vascular resistance. The stem identifies hypovolemic shock, so neurologic injury is not the most relevant mechanism.
Q8. A nurse is evaluating a patient who describes cramping pain in the right calf that starts after walking about one block and disappears within minutes of rest. Peripheral pulses in the right foot are weaker than in the left. Which vascular component is most likely responsible for these findings?
Correct answer: B. Peripheral arteries narrowed by atherosclerosis, reducing distal blood flow during exertion
The presentation describes intermittent claudication — reproducible, exertional calf pain relieved by rest — which is the hallmark of peripheral arterial disease. Exercise increases muscle oxygen demand, but atherosclerotic narrowing prevents adequate blood delivery, causing ischemic discomfort. Diminished distal pulses confirm arterial inflow impairment. Venule and capillary problems produce edema or aching rather than exertional claudication with absent pulses. The sinoatrial node controls rhythm and would affect output bilaterally, not produce unilateral claudication. Pulmonary vessel disease causes dyspnea and right heart strain rather than isolated exertional leg pain.
Q9. A nurse is evaluating a patient who complains of intense abdominal pain. On palpation, the nurse finds board-like rigidity and rebound tenderness. What is the MOST likely diagnosis?
Correct answer: D. Appendicitis
Appendicitis characteristically presents with severe abdominal pain, muscular guarding, and rebound tenderness — signs that indicate peritoneal irritation. Gastroenteritis causes diffuse cramping and diarrhea but not peritoneal signs. Peptic ulcer disease causes epigastric burning and may lead to hemorrhage but does not typically produce rigidity and rebound tenderness. Hepatitis involves hepatic inflammation with right upper quadrant pain but lacks the localized peritoneal irritation seen here.
Q10. A nurse is evaluating a patient for a reported lymph node abnormality. Which physical characteristic is most suggestive of malignancy?
Correct answer: B. The node is fixed and does not move
A non-mobile, fixed lymph node is the most concerning feature for malignancy because cancerous nodes often adhere to surrounding tissue and lose mobility. Painless nodes can occur with cancer but are also common in benign conditions, making this less specific. Well-marginated nodes are more consistent with benign processes. Smooth nodes are generally less worrisome than hard, irregular, or matted nodes, which raise greater suspicion for malignant disease.
Exam facts and objectives sourced from the official ANCC (American Nurses Credentialing Center) certification page. Last reviewed June 2026.
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