ANCC Medical-Surgical Nursing
Certification (MEDSURG-BC)
Complete Practice Examination:
Questions with Detailed Rationales,
Clinical Prioritization, and
Comprehensive Domain Review for
Board Exam Success
1. A patient with heart failure reports increasing dyspnea on exertion
and bilateral ankle edema. Which finding requires immediate nurse
intervention?
A. Weight gain of 1 kg (2.2 lb) over the past week
B. Jugular venous distension (JVD) at 45 degrees
C. Serum BNP level of 900 pg/mL
D. New onset of orthopnea requiring two pillows to sleep ✅
Rationale: New-onset orthopnea indicates worsening left-sided heart
failure and pulmonary congestion requiring immediate intervention. While
elevated BNP, weight gain, and JVD are concerning, orthopnea represents
an acute change in respiratory status that signals decompensation requiring
,priority assessment and provider notification. The nurse should first assess
vital signs and oxygen saturation, elevate the head of bed, and notify the
healthcare provider promptly.
2. A patient is receiving a heparin drip for acute coronary syndrome
(ACS). The activated partial thromboplastin time (aPTT) is reported as
90 seconds. What is the most appropriate nursing action?
A. Stop the heparin infusion immediately ✅
B. Increase the heparin infusion rate per protocol
C. Administer protamine sulfate as prescribed
D. Continue the current infusion rate and recheck aPTT in 6 hours
Rationale: An aPTT of 90 seconds exceeds the therapeutic range (typically
60-80 seconds for ACS) and places the patient at significant risk for
bleeding. The nurse should stop the heparin infusion immediately and
notify the provider. Protamine sulfate is the reversal agent but requires a
provider order.
3. Which assessment finding in a patient with infective endocarditis is
most concerning for a potential embolic event?
A. Fever of 38.9°C (102°F)
B. New-onset left-sided weakness and slurred speech ✅
C. Splinter hemorrhages under the fingernails
D. Osler nodes on the fingertips
Rationale: New-onset left-sided weakness and slurred speech suggest a
cerebrovascular embolic event, which is a life-threatening complication of
infective endocarditis. This requires immediate neurologic assessment and
intervention. Fever and peripheral manifestations (splinter hemorrhages,
Osler nodes) are important findings but do not indicate an acute embolic
event requiring emergent action.
,4. A patient with a history of myocardial infarction (MI) complains of
chest pain while walking to the restroom. Which action should the
nurse perform first?
A. Assess patient's vital signs
B. Instruct patient to sit down ✅
C. Obtain a STAT EKG
D. Call the physician
Rationale: Having the patient sit down reduces myocardial oxygen demand
to help relieve pain and decrease stress on the heart. The other actions are
important but should follow after ensuring the patient's immediate safety
and reducing cardiac workload.
5. A patient complains of crushing chest pain that radiates to the left
arm. Which treatment should you anticipate?
A. Aspirin, oxygen, nitroglycerin, and morphine ✅
B. Aspirin, oxygen, nitroglycerin, and codeine
C. Oxygen, nitroglycerin, meperidine, and thrombolytics
D. Aspirin, oxygen, nitroprusside, and morphine
Rationale: The standard MONA protocol (Morphine, Oxygen, Nitroglycerin,
Aspirin) is the initial treatment for acute myocardial infarction. Morphine
provides analgesia and reduces preload; oxygen improves oxygenation;
nitroglycerin dilates coronary arteries; aspirin inhibits platelet aggregation.
6. A patient with heart failure has been started on metoprolol 12.5 mg
daily. The nurse should report which serious adverse reaction?
A. Crackles in lungs ✅
B. Edema
C. Dry, hacking cough
, D. Dry mouth
Rationale: Crackles in the lungs indicate exacerbation of heart failure
symptoms, a possible complication of starting beta blockers due to
decreased inotropic response. Edema is also a sign of worsening HF but is
less specific than lung crackles. Beta blockers may cause cough and dry
mouth, but these are not serious adverse reactions.
7. 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
Rationale: Rapid weight gain in heart failure indicates fluid retention,
requiring assessment for pulmonary edema and peripheral swelling before
implementing interventions. This assessment guides appropriate treatment
decisions.
8. A patient with atrial fibrillation is on warfarin. Which lab value
should the nurse monitor primarily?
A. aPTT
B. INR ✅
C. Platelet count
D. Bleeding time
Rationale: INR (International Normalized Ratio) is the standard monitoring
parameter for warfarin therapy, with a therapeutic target typically between
2.0-3.0 for atrial fibrillation. aPTT is used for heparin monitoring.
Certification (MEDSURG-BC)
Complete Practice Examination:
Questions with Detailed Rationales,
Clinical Prioritization, and
Comprehensive Domain Review for
Board Exam Success
1. A patient with heart failure reports increasing dyspnea on exertion
and bilateral ankle edema. Which finding requires immediate nurse
intervention?
A. Weight gain of 1 kg (2.2 lb) over the past week
B. Jugular venous distension (JVD) at 45 degrees
C. Serum BNP level of 900 pg/mL
D. New onset of orthopnea requiring two pillows to sleep ✅
Rationale: New-onset orthopnea indicates worsening left-sided heart
failure and pulmonary congestion requiring immediate intervention. While
elevated BNP, weight gain, and JVD are concerning, orthopnea represents
an acute change in respiratory status that signals decompensation requiring
,priority assessment and provider notification. The nurse should first assess
vital signs and oxygen saturation, elevate the head of bed, and notify the
healthcare provider promptly.
2. A patient is receiving a heparin drip for acute coronary syndrome
(ACS). The activated partial thromboplastin time (aPTT) is reported as
90 seconds. What is the most appropriate nursing action?
A. Stop the heparin infusion immediately ✅
B. Increase the heparin infusion rate per protocol
C. Administer protamine sulfate as prescribed
D. Continue the current infusion rate and recheck aPTT in 6 hours
Rationale: An aPTT of 90 seconds exceeds the therapeutic range (typically
60-80 seconds for ACS) and places the patient at significant risk for
bleeding. The nurse should stop the heparin infusion immediately and
notify the provider. Protamine sulfate is the reversal agent but requires a
provider order.
3. Which assessment finding in a patient with infective endocarditis is
most concerning for a potential embolic event?
A. Fever of 38.9°C (102°F)
B. New-onset left-sided weakness and slurred speech ✅
C. Splinter hemorrhages under the fingernails
D. Osler nodes on the fingertips
Rationale: New-onset left-sided weakness and slurred speech suggest a
cerebrovascular embolic event, which is a life-threatening complication of
infective endocarditis. This requires immediate neurologic assessment and
intervention. Fever and peripheral manifestations (splinter hemorrhages,
Osler nodes) are important findings but do not indicate an acute embolic
event requiring emergent action.
,4. A patient with a history of myocardial infarction (MI) complains of
chest pain while walking to the restroom. Which action should the
nurse perform first?
A. Assess patient's vital signs
B. Instruct patient to sit down ✅
C. Obtain a STAT EKG
D. Call the physician
Rationale: Having the patient sit down reduces myocardial oxygen demand
to help relieve pain and decrease stress on the heart. The other actions are
important but should follow after ensuring the patient's immediate safety
and reducing cardiac workload.
5. A patient complains of crushing chest pain that radiates to the left
arm. Which treatment should you anticipate?
A. Aspirin, oxygen, nitroglycerin, and morphine ✅
B. Aspirin, oxygen, nitroglycerin, and codeine
C. Oxygen, nitroglycerin, meperidine, and thrombolytics
D. Aspirin, oxygen, nitroprusside, and morphine
Rationale: The standard MONA protocol (Morphine, Oxygen, Nitroglycerin,
Aspirin) is the initial treatment for acute myocardial infarction. Morphine
provides analgesia and reduces preload; oxygen improves oxygenation;
nitroglycerin dilates coronary arteries; aspirin inhibits platelet aggregation.
6. A patient with heart failure has been started on metoprolol 12.5 mg
daily. The nurse should report which serious adverse reaction?
A. Crackles in lungs ✅
B. Edema
C. Dry, hacking cough
, D. Dry mouth
Rationale: Crackles in the lungs indicate exacerbation of heart failure
symptoms, a possible complication of starting beta blockers due to
decreased inotropic response. Edema is also a sign of worsening HF but is
less specific than lung crackles. Beta blockers may cause cough and dry
mouth, but these are not serious adverse reactions.
7. 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
Rationale: Rapid weight gain in heart failure indicates fluid retention,
requiring assessment for pulmonary edema and peripheral swelling before
implementing interventions. This assessment guides appropriate treatment
decisions.
8. A patient with atrial fibrillation is on warfarin. Which lab value
should the nurse monitor primarily?
A. aPTT
B. INR ✅
C. Platelet count
D. Bleeding time
Rationale: INR (International Normalized Ratio) is the standard monitoring
parameter for warfarin therapy, with a therapeutic target typically between
2.0-3.0 for atrial fibrillation. aPTT is used for heparin monitoring.
