ANCC MEDICAL-SURGICAL NURSING CERTIFICATION EXAM |
AMERICAN NURSES CREDENTIALING CENTER | ALL QUESTIONS
AND ANSWERS 2026/2027 | VERIFIED ANSWERS PLUS
RATIONALES | GRADED Q&A COMPREHENSIVE STUDY GUIDE
VERIFIED LATEST 2027
1. A nurse is caring for a adult client who underwent a total hip arthroplasty 6 hours ago.
Which of the following physical assessment findings requires immediate notification of the
surgical team?
A. Complaints of surgical site pain rated 6/10 following medication administration
B. Diminished bowel sounds in all four abdominal quadrants
C. Capillary refill of 5 seconds and pale toe beds on the affected extremity
D. Serosanguineous drainage measuring 50 mL in the closed-suction drain
A capillary refill greater than 3 seconds and pale nail beds indicate compromised
neurovascular status, which is a potential surgical emergency indicative of arterial
insufficiency or compartment syndrome. Mild to moderate pain, hypoactive bowel sounds
immediately post-anesthesia, and moderate serosanguineous drainage are expected post-
operative findings.
2. A post-operative client receiving intravenous morphine via a patient-controlled analgesia
(PCA) pump has a respiratory rate of 8 breaths per minute and is difficult to arouse. What
is the nurse's priority action?
A. Administer naloxone intravenous push immediately
B. Stop the PCA infusion and attempt to vigorously stimulate the client
C. Call the healthcare provider to request a decrease in the opioid dosage
D. Apply high-flow oxygen via a non-rebreather mask
The priority initial nursing action is to stop the administration of the causative agent and
attempt to arouse the client while assessing airway patency. If physical stimulation fails to
increase respiratory depth and rate, or if respiratory depression persists, naloxone
administration and oxygen therapy are indicated.
,3. A nurse prepares to administer a unit of packed red blood cells to a client with severe
anemia. Which intravenous solution is the only compatible fluid to infuse concurrently
through the primary blood administration tubing?
A. Lactated Ringer's solution
B. 5% Dextrose in water (D5W)
C. 0.9% Sodium chloride
D. 0.45% Sodium chloride
0.9% Sodium chloride (normal saline) is the only solution clinically compatible with blood
products. Dextrose solutions cause hemolysis of red blood cells, and Lactated Ringer's
contains calcium, which triggers clotting within the intravenous tubing.
4. A client with chronic kidney disease (CKD) presenting with severe hyperkalemia
displays tall, peaked T waves on the cardiac monitor. Which medication order should the
nurse execute first to prevent immediate lethal arrhythmias?
A. Sodium polystyrene sulfonate orally
B. Intravenous calcium gluconate
C. Regular insulin and 50% dextrose IV
D. Furosemide intravenous push
Intravenous calcium gluconate does not lower serum potassium levels directly, but it
immediately stabilizes the myocardial cellular membrane, raising the cardiac threshold
potential and protecting against hyperkalemia-induced fatal dysrhythmias. Insulin/dextrose
and sodium polystyrene sulfonate shift or eliminate potassium but take longer to act.
5. A client on a medical unit has a central venous catheter (CVC). During a tubing change,
the client suddenly develops acute dyspnea, cyanosis, and tachycardia. What position
should the nurse immediately place the client in?
A. High Fowlers position with feet dependent
B. Trendelenburg position on the left side
C. Supine position with legs elevated
D. Right lateral recumbent position
,The client's presentation strongly indicates an air embolism. Placing the client in
Trendelenburg position on the left side (Durant maneuver) traps the air bubble in the apex of
the right ventricle, preventing it from entering the pulmonary artery and blocking pulmonary
blood flow.
6. A client with acute pancreatitis develops severe hypocalcemia. Which clinical
manifestation should the nurse monitor for during the physical assessment?
A. Positive Chvostek sign
B. Hyporeflexia of deep tendons
C. Severe flaccid paralysis
D. Prominent U waves on EKG
Hypocalcemia increases neuromuscular excitability. A positive Chvostek sign (facial twitching
elicited by tapping the facial nerve) and Trousseau sign are key clinical indicators of severe
hypocalcemia. Hyporeflexia and U waves are linked to hypercalcemia and hypokalemia,
respectively.
7. A nurse is evaluating arterial blood gas (ABG) results for a client with exacerbation of
chronic obstructive pulmonary disease (COPD): pH 7.31, PaCO2 58 mmHg, HCO3 26
mEq/L, PaO2 62 mmHg. How should the nurse interpret these results?
A. Uncompensated metabolic acidosis
B. Fully compensated respiratory acidosis
C. Uncompensated respiratory acidosis
D. Partially compensated metabolic alkalosis
The pH is below normal (acidotic), the PaCO2 is elevated above normal (respiratory cause),
and the HCO3 is within normal limits (22-26 mEq/L), indicating that renal compensation has
not yet significantly occurred. This represents uncompensated respiratory acidosis.
8. Which dietary choice selected by a client diagnosed with heart failure indicates a correct
understanding of low-sodium dietary restrictions?
A. Canned vegetable soup with whole wheat crackers
B. Grilled chicken breast with fresh steamed broccoli and brown rice
C. Processed turkey breast sandwich with Swiss cheese on rye bread
, D. Canned tuna salad over mixed greens with commercially bottled Italian dressing
Fresh poultry, unprocessed vegetables, and brown rice are naturally low in sodium. Canned
soups, processed lunch meats, prepared salad dressings, and commercial snacks contain high
amounts of hidden sodium that exacerbate fluid retention in heart failure.
9. A client admitted with deep vein thrombosis (DVT) is receiving a continuous intravenous
unfractionated heparin infusion. The baseline activated partial thromboplastin time
(aPTT) was 30 seconds. Which therapeutic aPTT outcome demonstrates effective dosing?
A. 30 to 45 seconds
B. 45 to 60 seconds
C. 60 to 80 seconds
D. 100 to 120 seconds
The target therapeutic level for continuous heparin therapy is typically 1.5 to 2.5 times the
baseline control value. A control of 30 seconds yields a target therapeutic range of
approximately 45 to 75 (or 60 to 80) seconds. Values above 90-100 seconds elevate the risk of
major hemorrhage.
10. An older adult client with type 2 diabetes mellitus presents with altered mental status,
dehydration, blood glucose of 840 mg/dL, and negative serum ketones. Which condition
should the nurse anticipate managing?
A. Diabetic Ketoacidosis (DKA)
B. Hyperglycemic Hyperosmolar State (HHS)
C. Hypoglycemic Unawareness
D. Acute Adrenal Crisis
Hyperglycemic Hyperosmolar State (HHS) is characterized by extreme hyperglycemia (>600
mg/dL), high serum osmolality, severe dehydration, and minimal or absent ketoacidosis, most
commonly occurring in older adults with type 2 diabetes. DKA features prominent
ketoacidosis and lower glucose elevation.
11. A client diagnosed with unstable angina is prescribed nitroglycerin sublingual tablets
PRN for chest pain. Which statement by the client indicates a need for further discharge
teaching?
AMERICAN NURSES CREDENTIALING CENTER | ALL QUESTIONS
AND ANSWERS 2026/2027 | VERIFIED ANSWERS PLUS
RATIONALES | GRADED Q&A COMPREHENSIVE STUDY GUIDE
VERIFIED LATEST 2027
1. A nurse is caring for a adult client who underwent a total hip arthroplasty 6 hours ago.
Which of the following physical assessment findings requires immediate notification of the
surgical team?
A. Complaints of surgical site pain rated 6/10 following medication administration
B. Diminished bowel sounds in all four abdominal quadrants
C. Capillary refill of 5 seconds and pale toe beds on the affected extremity
D. Serosanguineous drainage measuring 50 mL in the closed-suction drain
A capillary refill greater than 3 seconds and pale nail beds indicate compromised
neurovascular status, which is a potential surgical emergency indicative of arterial
insufficiency or compartment syndrome. Mild to moderate pain, hypoactive bowel sounds
immediately post-anesthesia, and moderate serosanguineous drainage are expected post-
operative findings.
2. A post-operative client receiving intravenous morphine via a patient-controlled analgesia
(PCA) pump has a respiratory rate of 8 breaths per minute and is difficult to arouse. What
is the nurse's priority action?
A. Administer naloxone intravenous push immediately
B. Stop the PCA infusion and attempt to vigorously stimulate the client
C. Call the healthcare provider to request a decrease in the opioid dosage
D. Apply high-flow oxygen via a non-rebreather mask
The priority initial nursing action is to stop the administration of the causative agent and
attempt to arouse the client while assessing airway patency. If physical stimulation fails to
increase respiratory depth and rate, or if respiratory depression persists, naloxone
administration and oxygen therapy are indicated.
,3. A nurse prepares to administer a unit of packed red blood cells to a client with severe
anemia. Which intravenous solution is the only compatible fluid to infuse concurrently
through the primary blood administration tubing?
A. Lactated Ringer's solution
B. 5% Dextrose in water (D5W)
C. 0.9% Sodium chloride
D. 0.45% Sodium chloride
0.9% Sodium chloride (normal saline) is the only solution clinically compatible with blood
products. Dextrose solutions cause hemolysis of red blood cells, and Lactated Ringer's
contains calcium, which triggers clotting within the intravenous tubing.
4. A client with chronic kidney disease (CKD) presenting with severe hyperkalemia
displays tall, peaked T waves on the cardiac monitor. Which medication order should the
nurse execute first to prevent immediate lethal arrhythmias?
A. Sodium polystyrene sulfonate orally
B. Intravenous calcium gluconate
C. Regular insulin and 50% dextrose IV
D. Furosemide intravenous push
Intravenous calcium gluconate does not lower serum potassium levels directly, but it
immediately stabilizes the myocardial cellular membrane, raising the cardiac threshold
potential and protecting against hyperkalemia-induced fatal dysrhythmias. Insulin/dextrose
and sodium polystyrene sulfonate shift or eliminate potassium but take longer to act.
5. A client on a medical unit has a central venous catheter (CVC). During a tubing change,
the client suddenly develops acute dyspnea, cyanosis, and tachycardia. What position
should the nurse immediately place the client in?
A. High Fowlers position with feet dependent
B. Trendelenburg position on the left side
C. Supine position with legs elevated
D. Right lateral recumbent position
,The client's presentation strongly indicates an air embolism. Placing the client in
Trendelenburg position on the left side (Durant maneuver) traps the air bubble in the apex of
the right ventricle, preventing it from entering the pulmonary artery and blocking pulmonary
blood flow.
6. A client with acute pancreatitis develops severe hypocalcemia. Which clinical
manifestation should the nurse monitor for during the physical assessment?
A. Positive Chvostek sign
B. Hyporeflexia of deep tendons
C. Severe flaccid paralysis
D. Prominent U waves on EKG
Hypocalcemia increases neuromuscular excitability. A positive Chvostek sign (facial twitching
elicited by tapping the facial nerve) and Trousseau sign are key clinical indicators of severe
hypocalcemia. Hyporeflexia and U waves are linked to hypercalcemia and hypokalemia,
respectively.
7. A nurse is evaluating arterial blood gas (ABG) results for a client with exacerbation of
chronic obstructive pulmonary disease (COPD): pH 7.31, PaCO2 58 mmHg, HCO3 26
mEq/L, PaO2 62 mmHg. How should the nurse interpret these results?
A. Uncompensated metabolic acidosis
B. Fully compensated respiratory acidosis
C. Uncompensated respiratory acidosis
D. Partially compensated metabolic alkalosis
The pH is below normal (acidotic), the PaCO2 is elevated above normal (respiratory cause),
and the HCO3 is within normal limits (22-26 mEq/L), indicating that renal compensation has
not yet significantly occurred. This represents uncompensated respiratory acidosis.
8. Which dietary choice selected by a client diagnosed with heart failure indicates a correct
understanding of low-sodium dietary restrictions?
A. Canned vegetable soup with whole wheat crackers
B. Grilled chicken breast with fresh steamed broccoli and brown rice
C. Processed turkey breast sandwich with Swiss cheese on rye bread
, D. Canned tuna salad over mixed greens with commercially bottled Italian dressing
Fresh poultry, unprocessed vegetables, and brown rice are naturally low in sodium. Canned
soups, processed lunch meats, prepared salad dressings, and commercial snacks contain high
amounts of hidden sodium that exacerbate fluid retention in heart failure.
9. A client admitted with deep vein thrombosis (DVT) is receiving a continuous intravenous
unfractionated heparin infusion. The baseline activated partial thromboplastin time
(aPTT) was 30 seconds. Which therapeutic aPTT outcome demonstrates effective dosing?
A. 30 to 45 seconds
B. 45 to 60 seconds
C. 60 to 80 seconds
D. 100 to 120 seconds
The target therapeutic level for continuous heparin therapy is typically 1.5 to 2.5 times the
baseline control value. A control of 30 seconds yields a target therapeutic range of
approximately 45 to 75 (or 60 to 80) seconds. Values above 90-100 seconds elevate the risk of
major hemorrhage.
10. An older adult client with type 2 diabetes mellitus presents with altered mental status,
dehydration, blood glucose of 840 mg/dL, and negative serum ketones. Which condition
should the nurse anticipate managing?
A. Diabetic Ketoacidosis (DKA)
B. Hyperglycemic Hyperosmolar State (HHS)
C. Hypoglycemic Unawareness
D. Acute Adrenal Crisis
Hyperglycemic Hyperosmolar State (HHS) is characterized by extreme hyperglycemia (>600
mg/dL), high serum osmolality, severe dehydration, and minimal or absent ketoacidosis, most
commonly occurring in older adults with type 2 diabetes. DKA features prominent
ketoacidosis and lower glucose elevation.
11. A client diagnosed with unstable angina is prescribed nitroglycerin sublingual tablets
PRN for chest pain. Which statement by the client indicates a need for further discharge
teaching?
