Med Surg Certification Practice Test B with 200 Questions
and Correct Verified Answers/ ANCC Medical Surgical
Nursing Certification 2026 Practice Exam
The nurse is writing the care plan for a patient who is undergoing surgery to place
an ileostomy. Which of the following would be an appropriate nursing diagnosis?
a. Impaired nutrition: greater than body requirements related to increased output
and inadequate intake
b. Sexual dysfunction related to altered body structure
c. Knowledge deficit related to equipment usage
d. Anxiety related to loss of urinary control and autonomy
b. Placement of an ileostomy disturbs the patient's body image and may result in
sexual dysfunction. Provide support and education.
A postoperative patient complains of abdominal pain at the incision site. The
patient has had the prescribed dose of narcotic one hour ago. The most important
action for the nurse is to:
a. Tell the patient that it is too soon for more pain medication.
b. Conduct an assessment.
c. Document the patient's pain scale rating.
d. Teaching the patient relaxation and imagery.
b. The primary action for the nurse would be to conduct an assessment to
determine if there are any changes in status causing the changes in pain and to
gather information to report to the provider should a phone call be necessary.
A 70-year-old female patient is admitted for a small bowel obstruction. On
assessment the nurse notices the patient is third spacing with generalized anasarca
present. Due to her lack of adequate nutritional status the nurse suspects a decrease
in which protein molecule?
a. Albumin
b. Angiotensin
c. Atrial natriuretic peptide
d. Aldosterone
a. Albumin is a large molecule that draws water into the vascular system.
pg. 1
,The nurse hears a patient yelling "Help." Upon entering the room, the patient is
lying on the floor. The nurse suspects a possible fracture with which finding?
a. Shortening of the affected leg and external rotation of the foot
b. Confusion and shortness of breath
c. Bruising at the area of the hip joint and inability of the patient to dorsiflex the
foot on his affected side
d. Pallor and coolness of the affected extremity without any obvious signs of
deformity
a. Shortening of the affected leg and external rotation of the foot are classic signs
of a displaced hip fracture.
In a patient with thrombocytopenia, which of the following assessment findings
should be immediately reported to the physician?
a. Blood pressure (BP) of 210/120 mmHG
b. Heart rate of 90 bpm
c. Specks of blood in nasal discharge after vigorous blowing
d. Oxygen saturation of 95%
a. Thrombocytopenia increases the risk of cerebral bleeding during severe BP
elevation.
Which level of laminectomy and spinal fusion is at highest risk for respiratory
difficulties?
a. Lumbar 3-5
b. Sacral 2-5
c. Thoracic 6-8
d. Cervical 3-6
d. Respiratory difficulties arise from C6 and higher due to innervation of
respiratory components (i.e., diaphragm).
You are developing the care plan for an 80-year-old female with Parkinson's
disease. Which of the following could be an appropriate nursing diagnosis?
a. Altered comfort, pain, related to joint discomfort
b. Impaired skin integrity related to frequent diarrhea
c. Impaired mobility related to bradykinesia, rigidity, and tremor
d. Impaired nutrition, more than body requirements, related to ineffective eating
habits
pg. 2
,c. Mobility, self-care, and feeding difficulties are the most common nursing care
issues for Parkinson's patients.
The electrolyte imbalance most common with Addison's crisis is:
a. Hyponatremia and hyperkalemia.
b. Hyperkalemia and hypocalcemia.
c. Hypernatremia and hypokalemia.
d. Hypokalemia and hypercalcemia.
a. Adrenal hypofunction with the three hormones involved here are
glucocorticoids, mineralocorticoids, and androgens. This results in the lower levels
of sodium and higher levels of potassium, along with hypoglycemia and
dehydration.
Which diagnostic tool is essential to perform in the presence of thick toenails, cool,
pale, shiny skin with scaling, and poor wound healing?
a. Pulmonary function tests
b. TB skin test
c. Ankle-brachial index (ABI)
d. Chest x-ray
c. ABI is measured to confirm poor circulation indicated by the symptoms of
peripheral vascular disease.
A patient is complaining of nausea and distention. Assessment reveals diffuse
abdominal tenderness and vomitus with fecal matter. What is the likely source of
the patient's symptoms?
a. Gastric tumor
b. Intestinal obstruction
c. Esophageal varices
d. Peptic ulcer
b. Feculent (fecal-smelling) vomitus is associated with the presence of an intestinal
obstruction.
On physical examination, the patient has left costovertebral angle (CVA)
tenderness. This finding is indicative of:
a. Colon inflammation.
b. Kidney inflammation.
c. Prostatic inflammation.
d. Ovarian inflammation.
pg. 3
, b. CVA tenderness indicates inflammation of the kidney on the affected side.
An 85-year-old patient is receiving 0.9% sodium chloride through a central venous
catheter. The nurse notes the patient becomes tachypneic, hypertensive, and
tachycardic. On further examination, the patient is confused and has bilateral
crackles on lung exam. These findings are most consistent with what complication
of IV therapy?
a. Volume overload
b. Septic shock
c. Venous thrombosis
d. Air embolism
a. The signs and symptoms listed are most consistent with circulatory volume
overload. This is a common complication in the older adult population.
Hypertonic intravenous solutions are generally used when:
a. Pulling fluid from the intravascular system.
b. Making no shift into or out of the intravascular system.
c. Pulling fluid from the cells.
d. Shifting fluid into the cells.
c. The osmotic pressure of the hypertonic solutions pulls fluid from cells into the
intravascular system.
Silent ischemia is often seen in the older adult with diabetes. Common signs and
symptoms of silent ischemia may include:
a. Heaviness in the chest.
b. Diaphoresis.
c. Indigestion.
d. Tingling of left arm.
c. Indigestion is considered a silent symptom of ischemia in this patient population.
The other responses are descriptions of typical chest pain.
Metabolic syndrome or syndrome X is a condition which places patients at high
risk for vascular events. Which of the following is not a risk factor for this
syndrome?
a. Elevated fasting blood sugar
b. Acanthosis nigricans
c. Elevated blood pressure
d. Abdominal obesity
pg. 4
and Correct Verified Answers/ ANCC Medical Surgical
Nursing Certification 2026 Practice Exam
The nurse is writing the care plan for a patient who is undergoing surgery to place
an ileostomy. Which of the following would be an appropriate nursing diagnosis?
a. Impaired nutrition: greater than body requirements related to increased output
and inadequate intake
b. Sexual dysfunction related to altered body structure
c. Knowledge deficit related to equipment usage
d. Anxiety related to loss of urinary control and autonomy
b. Placement of an ileostomy disturbs the patient's body image and may result in
sexual dysfunction. Provide support and education.
A postoperative patient complains of abdominal pain at the incision site. The
patient has had the prescribed dose of narcotic one hour ago. The most important
action for the nurse is to:
a. Tell the patient that it is too soon for more pain medication.
b. Conduct an assessment.
c. Document the patient's pain scale rating.
d. Teaching the patient relaxation and imagery.
b. The primary action for the nurse would be to conduct an assessment to
determine if there are any changes in status causing the changes in pain and to
gather information to report to the provider should a phone call be necessary.
A 70-year-old female patient is admitted for a small bowel obstruction. On
assessment the nurse notices the patient is third spacing with generalized anasarca
present. Due to her lack of adequate nutritional status the nurse suspects a decrease
in which protein molecule?
a. Albumin
b. Angiotensin
c. Atrial natriuretic peptide
d. Aldosterone
a. Albumin is a large molecule that draws water into the vascular system.
pg. 1
,The nurse hears a patient yelling "Help." Upon entering the room, the patient is
lying on the floor. The nurse suspects a possible fracture with which finding?
a. Shortening of the affected leg and external rotation of the foot
b. Confusion and shortness of breath
c. Bruising at the area of the hip joint and inability of the patient to dorsiflex the
foot on his affected side
d. Pallor and coolness of the affected extremity without any obvious signs of
deformity
a. Shortening of the affected leg and external rotation of the foot are classic signs
of a displaced hip fracture.
In a patient with thrombocytopenia, which of the following assessment findings
should be immediately reported to the physician?
a. Blood pressure (BP) of 210/120 mmHG
b. Heart rate of 90 bpm
c. Specks of blood in nasal discharge after vigorous blowing
d. Oxygen saturation of 95%
a. Thrombocytopenia increases the risk of cerebral bleeding during severe BP
elevation.
Which level of laminectomy and spinal fusion is at highest risk for respiratory
difficulties?
a. Lumbar 3-5
b. Sacral 2-5
c. Thoracic 6-8
d. Cervical 3-6
d. Respiratory difficulties arise from C6 and higher due to innervation of
respiratory components (i.e., diaphragm).
You are developing the care plan for an 80-year-old female with Parkinson's
disease. Which of the following could be an appropriate nursing diagnosis?
a. Altered comfort, pain, related to joint discomfort
b. Impaired skin integrity related to frequent diarrhea
c. Impaired mobility related to bradykinesia, rigidity, and tremor
d. Impaired nutrition, more than body requirements, related to ineffective eating
habits
pg. 2
,c. Mobility, self-care, and feeding difficulties are the most common nursing care
issues for Parkinson's patients.
The electrolyte imbalance most common with Addison's crisis is:
a. Hyponatremia and hyperkalemia.
b. Hyperkalemia and hypocalcemia.
c. Hypernatremia and hypokalemia.
d. Hypokalemia and hypercalcemia.
a. Adrenal hypofunction with the three hormones involved here are
glucocorticoids, mineralocorticoids, and androgens. This results in the lower levels
of sodium and higher levels of potassium, along with hypoglycemia and
dehydration.
Which diagnostic tool is essential to perform in the presence of thick toenails, cool,
pale, shiny skin with scaling, and poor wound healing?
a. Pulmonary function tests
b. TB skin test
c. Ankle-brachial index (ABI)
d. Chest x-ray
c. ABI is measured to confirm poor circulation indicated by the symptoms of
peripheral vascular disease.
A patient is complaining of nausea and distention. Assessment reveals diffuse
abdominal tenderness and vomitus with fecal matter. What is the likely source of
the patient's symptoms?
a. Gastric tumor
b. Intestinal obstruction
c. Esophageal varices
d. Peptic ulcer
b. Feculent (fecal-smelling) vomitus is associated with the presence of an intestinal
obstruction.
On physical examination, the patient has left costovertebral angle (CVA)
tenderness. This finding is indicative of:
a. Colon inflammation.
b. Kidney inflammation.
c. Prostatic inflammation.
d. Ovarian inflammation.
pg. 3
, b. CVA tenderness indicates inflammation of the kidney on the affected side.
An 85-year-old patient is receiving 0.9% sodium chloride through a central venous
catheter. The nurse notes the patient becomes tachypneic, hypertensive, and
tachycardic. On further examination, the patient is confused and has bilateral
crackles on lung exam. These findings are most consistent with what complication
of IV therapy?
a. Volume overload
b. Septic shock
c. Venous thrombosis
d. Air embolism
a. The signs and symptoms listed are most consistent with circulatory volume
overload. This is a common complication in the older adult population.
Hypertonic intravenous solutions are generally used when:
a. Pulling fluid from the intravascular system.
b. Making no shift into or out of the intravascular system.
c. Pulling fluid from the cells.
d. Shifting fluid into the cells.
c. The osmotic pressure of the hypertonic solutions pulls fluid from cells into the
intravascular system.
Silent ischemia is often seen in the older adult with diabetes. Common signs and
symptoms of silent ischemia may include:
a. Heaviness in the chest.
b. Diaphoresis.
c. Indigestion.
d. Tingling of left arm.
c. Indigestion is considered a silent symptom of ischemia in this patient population.
The other responses are descriptions of typical chest pain.
Metabolic syndrome or syndrome X is a condition which places patients at high
risk for vascular events. Which of the following is not a risk factor for this
syndrome?
a. Elevated fasting blood sugar
b. Acanthosis nigricans
c. Elevated blood pressure
d. Abdominal obesity
pg. 4
