ANCC MED-SURG Certification Exam Questions and
Answers with Rationales 2026/2027 Update
1. A patient with acute pulmonary edema is severely dyspneic and
coughing pink, frothy sputum. Which intervention should the nurse
perform first?
A. Encourage oral fluids
B. Place the patient in high-Fowler position
C. Administer a sedative
D. Place the patient flat
Answer: B
Rationale: Upright positioning decreases venous return and improves
lung expansion, helping reduce respiratory distress.
2. Which assessment finding is most concerning in a patient with
heart failure?
A. Mild ankle edema at the end of the day
B. Weight gain of 2.5 kg in 3 days
C. Heart rate of 78/min
D. Occasional fatigue
Answer: B
Rationale: Rapid weight gain indicates fluid retention and possible
worsening heart failure.
3. A patient taking digoxin reports nausea, anorexia, and seeing
yellow halos. What should the nurse suspect?
A. Hypoglycemia
B. Digoxin toxicity
C. Hyperthyroidism
D. Dehydration
,Answer: B
Rationale: Gastrointestinal symptoms and visual disturbances are
classic manifestations of digoxin toxicity.
4. Which laboratory value should the nurse monitor most closely in a
patient receiving furosemide?
A. Potassium
B. Hemoglobin
C. Platelets
D. Calcium only
Answer: A
Rationale: Loop diuretics can cause significant potassium loss,
increasing dysrhythmia risk.
5. A patient with atrial fibrillation is prescribed an anticoagulant. The
primary purpose is to prevent:
A. Bradycardia
B. Pulmonary edema
C. Thromboembolic stroke
D. Ventricular hypertrophy
Answer: C
Rationale: Atrial fibrillation promotes atrial blood stasis and thrombus
formation, increasing embolic stroke risk.
6. Which finding suggests left-sided heart failure?
A. Ascites
B. Jugular venous distention
C. Pulmonary crackles
D. Dependent peripheral edema only
Answer: C
Rationale: Left ventricular failure causes pulmonary venous congestion
and pulmonary edema.
,7. Which finding is most characteristic of right-sided heart failure?
A. Pulmonary crackles
B. Peripheral edema and jugular venous distention
C. Pink frothy sputum
D. Severe hemoptysis
Answer: B
Rationale: Right-sided failure causes systemic venous congestion.
8. A patient reports crushing substernal chest pain radiating to the
jaw. What is the priority action?
A. Obtain a 12-lead ECG promptly
B. Offer a meal
C. Encourage ambulation
D. Schedule a routine appointment
Answer: A
Rationale: Acute coronary syndrome must be rapidly evaluated with
ECG and other emergency measures.
9. Which ECG change is classically associated with acute myocardial
injury?
A. ST-segment elevation
B. Shortened PR interval only
C. U waves
D. Sinus bradycardia alone
Answer: A
Rationale: ST-segment elevation can indicate acute myocardial injury in
the appropriate clinical context.
10. A patient receiving nitroglycerin develops severe dizziness and
hypotension. What should the nurse do?
A. Administer another dose immediately
B. Place the patient safely and assess blood pressure
, C. Encourage standing
D. Restrict oxygen
Answer: B
Rationale: Nitroglycerin can cause significant hypotension; the patient
should be protected from falls and reassessed.
11. Which symptom is most concerning for pulmonary embolism?
A. Sudden unexplained dyspnea
B. Gradual ankle swelling
C. Chronic productive cough
D. Mild sore throat
Answer: A
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and
hypoxemia are common warning signs of pulmonary embolism.
12. A patient with suspected pulmonary embolism becomes acutely
hypoxemic. What is the priority?
A. Support oxygenation and notify the appropriate provider/team
B. Encourage walking
C. Give oral fluids only
D. Place the patient prone without assessment
Answer: A
Rationale: Hypoxemia is immediately life-threatening and requires
prompt respiratory support and evaluation.
13. Which patient is at greatest risk for deep-vein thrombosis?
A. Ambulatory patient after a routine clinic visit
B. Patient immobilized after major orthopedic surgery
C. Patient with seasonal allergies
D. Patient with controlled hypertension
Answer: B
Answers with Rationales 2026/2027 Update
1. A patient with acute pulmonary edema is severely dyspneic and
coughing pink, frothy sputum. Which intervention should the nurse
perform first?
A. Encourage oral fluids
B. Place the patient in high-Fowler position
C. Administer a sedative
D. Place the patient flat
Answer: B
Rationale: Upright positioning decreases venous return and improves
lung expansion, helping reduce respiratory distress.
2. Which assessment finding is most concerning in a patient with
heart failure?
A. Mild ankle edema at the end of the day
B. Weight gain of 2.5 kg in 3 days
C. Heart rate of 78/min
D. Occasional fatigue
Answer: B
Rationale: Rapid weight gain indicates fluid retention and possible
worsening heart failure.
3. A patient taking digoxin reports nausea, anorexia, and seeing
yellow halos. What should the nurse suspect?
A. Hypoglycemia
B. Digoxin toxicity
C. Hyperthyroidism
D. Dehydration
,Answer: B
Rationale: Gastrointestinal symptoms and visual disturbances are
classic manifestations of digoxin toxicity.
4. Which laboratory value should the nurse monitor most closely in a
patient receiving furosemide?
A. Potassium
B. Hemoglobin
C. Platelets
D. Calcium only
Answer: A
Rationale: Loop diuretics can cause significant potassium loss,
increasing dysrhythmia risk.
5. A patient with atrial fibrillation is prescribed an anticoagulant. The
primary purpose is to prevent:
A. Bradycardia
B. Pulmonary edema
C. Thromboembolic stroke
D. Ventricular hypertrophy
Answer: C
Rationale: Atrial fibrillation promotes atrial blood stasis and thrombus
formation, increasing embolic stroke risk.
6. Which finding suggests left-sided heart failure?
A. Ascites
B. Jugular venous distention
C. Pulmonary crackles
D. Dependent peripheral edema only
Answer: C
Rationale: Left ventricular failure causes pulmonary venous congestion
and pulmonary edema.
,7. Which finding is most characteristic of right-sided heart failure?
A. Pulmonary crackles
B. Peripheral edema and jugular venous distention
C. Pink frothy sputum
D. Severe hemoptysis
Answer: B
Rationale: Right-sided failure causes systemic venous congestion.
8. A patient reports crushing substernal chest pain radiating to the
jaw. What is the priority action?
A. Obtain a 12-lead ECG promptly
B. Offer a meal
C. Encourage ambulation
D. Schedule a routine appointment
Answer: A
Rationale: Acute coronary syndrome must be rapidly evaluated with
ECG and other emergency measures.
9. Which ECG change is classically associated with acute myocardial
injury?
A. ST-segment elevation
B. Shortened PR interval only
C. U waves
D. Sinus bradycardia alone
Answer: A
Rationale: ST-segment elevation can indicate acute myocardial injury in
the appropriate clinical context.
10. A patient receiving nitroglycerin develops severe dizziness and
hypotension. What should the nurse do?
A. Administer another dose immediately
B. Place the patient safely and assess blood pressure
, C. Encourage standing
D. Restrict oxygen
Answer: B
Rationale: Nitroglycerin can cause significant hypotension; the patient
should be protected from falls and reassessed.
11. Which symptom is most concerning for pulmonary embolism?
A. Sudden unexplained dyspnea
B. Gradual ankle swelling
C. Chronic productive cough
D. Mild sore throat
Answer: A
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and
hypoxemia are common warning signs of pulmonary embolism.
12. A patient with suspected pulmonary embolism becomes acutely
hypoxemic. What is the priority?
A. Support oxygenation and notify the appropriate provider/team
B. Encourage walking
C. Give oral fluids only
D. Place the patient prone without assessment
Answer: A
Rationale: Hypoxemia is immediately life-threatening and requires
prompt respiratory support and evaluation.
13. Which patient is at greatest risk for deep-vein thrombosis?
A. Ambulatory patient after a routine clinic visit
B. Patient immobilized after major orthopedic surgery
C. Patient with seasonal allergies
D. Patient with controlled hypertension
Answer: B
