ANCC Registered Nurse-Board Certified (RN-BC)
Medical-Surgical Nursing Certification Exam New 2025
Version with All Questions, Answers and Rationale
RN-BC MED-SURG MOST TESTED & HARDEST QUESTIONS (1–25)
1. A postoperative patient suddenly becomes confused, restless, and tachycardic. What is the
PRIORITY action?
A. Administer prescribed sedative
B. Reorient the patient
C. Assess oxygen saturation
D. Notify the provider
✅ Correct Answer: C
Explanation:
Acute confusion = hypoxia until proven otherwise.
Airway and oxygenation always come before medications or provider notification.
2. Which laboratory value requires IMMEDIATE intervention?
A. Sodium 132 mEq/L
B. Potassium 6.1 mEq/L
C. Calcium 8.4 mg/dL
D. Magnesium 1.7 mg/dL
✅ Correct Answer: B
Explanation:
Hyperkalemia >6.0 mEq/L can cause fatal dysrhythmias.
3. A patient with heart failure gains 3 lb in 24 hours. This MOST likely indicates:
,A. Improved cardiac output
B. Fluid retention
C. Increased muscle mass
D. Normal variation
✅ Correct Answer: B
4. Which assessment finding in a patient with COPD requires IMMEDIATE action?
A. Barrel chest
B. Clubbing of fingers
C. Use of accessory muscles
D. PaO₂ of 58 mm Hg
✅ Correct Answer: C
Explanation:
Accessory muscle use = impending respiratory failure.
5. Which patient is at GREATEST risk for developing sepsis?
A. Patient with hypertension
B. Postoperative patient with indwelling catheter
C. Patient with controlled diabetes
D. Patient receiving oral antibiotics
✅ Correct Answer: B
6. Which medication requires the nurse to HOLD the dose and notify the provider?
A. Metoprolol with HR 58 bpm
B. Insulin with glucose 180 mg/dL
C. Warfarin with INR 4.5
D. Acetaminophen with mild fever
✅ Correct Answer: C
7. Which intervention BEST prevents hospital-acquired pneumonia?
A. Incentive spirometry
B. IV antibiotics
C. Continuous oxygen
D. Bed rest
,✅ Correct Answer: A
8. A patient receiving heparin develops petechiae and a platelet count of 90,000. What is the
PRIORITY action?
A. Reduce the dose
B. Administer vitamin K
C. Stop heparin and notify provider
D. Continue therapy
✅ Correct Answer: C
Explanation:
Suspected HIT (Heparin-Induced Thrombocytopenia) is life-threatening.
9. Which patient should the nurse assess FIRST?
A. Stable patient with chronic pain
B. Patient with new onset chest pain
C. Patient awaiting discharge
D. Patient requesting PRN medication
✅ Correct Answer: B
10. Which condition places a patient at highest risk for pressure injuries?
A. Obesity
B. Immobility
C. Hypertension
D. Anxiety
✅ Correct Answer: B
11. A patient with diabetes has fruity breath, Kussmaul respirations, and glucose of 550 mg/dL. This
indicates:
A. Hypoglycemia
B. DKA
C. HHS
D. Metabolic alkalosis
✅ Correct Answer: B
, 12. Which lab finding confirms acute kidney injury (AKI)?
A. Decreased hemoglobin
B. Elevated creatinine
C. Increased calcium
D. Decreased sodium
✅ Correct Answer: B
13. The BEST intervention to prevent DVT in a postoperative patient is:
A. Bed rest
B. Early ambulation
C. Fluid restriction
D. Passive ROM only
✅ Correct Answer: B
14. A patient with GI bleeding presents with tachycardia and hypotension. The PRIORITY intervention
is:
A. Pain management
B. Blood transfusion
C. IV fluid resuscitation
D. Endoscopy
✅ Correct Answer: C
15. Which electrolyte imbalance is MOST associated with dysrhythmias?
A. Hyponatremia
B. Hypokalemia
C. Hypocalcemia
D. Hypermagnesemia
✅ Correct Answer: B
16. A patient with pneumonia has increasing oxygen needs despite therapy. What does this indicate?
A. Recovery phase
B. Treatment success
C. Worsening gas exchange
D. Normal progression
Medical-Surgical Nursing Certification Exam New 2025
Version with All Questions, Answers and Rationale
RN-BC MED-SURG MOST TESTED & HARDEST QUESTIONS (1–25)
1. A postoperative patient suddenly becomes confused, restless, and tachycardic. What is the
PRIORITY action?
A. Administer prescribed sedative
B. Reorient the patient
C. Assess oxygen saturation
D. Notify the provider
✅ Correct Answer: C
Explanation:
Acute confusion = hypoxia until proven otherwise.
Airway and oxygenation always come before medications or provider notification.
2. Which laboratory value requires IMMEDIATE intervention?
A. Sodium 132 mEq/L
B. Potassium 6.1 mEq/L
C. Calcium 8.4 mg/dL
D. Magnesium 1.7 mg/dL
✅ Correct Answer: B
Explanation:
Hyperkalemia >6.0 mEq/L can cause fatal dysrhythmias.
3. A patient with heart failure gains 3 lb in 24 hours. This MOST likely indicates:
,A. Improved cardiac output
B. Fluid retention
C. Increased muscle mass
D. Normal variation
✅ Correct Answer: B
4. Which assessment finding in a patient with COPD requires IMMEDIATE action?
A. Barrel chest
B. Clubbing of fingers
C. Use of accessory muscles
D. PaO₂ of 58 mm Hg
✅ Correct Answer: C
Explanation:
Accessory muscle use = impending respiratory failure.
5. Which patient is at GREATEST risk for developing sepsis?
A. Patient with hypertension
B. Postoperative patient with indwelling catheter
C. Patient with controlled diabetes
D. Patient receiving oral antibiotics
✅ Correct Answer: B
6. Which medication requires the nurse to HOLD the dose and notify the provider?
A. Metoprolol with HR 58 bpm
B. Insulin with glucose 180 mg/dL
C. Warfarin with INR 4.5
D. Acetaminophen with mild fever
✅ Correct Answer: C
7. Which intervention BEST prevents hospital-acquired pneumonia?
A. Incentive spirometry
B. IV antibiotics
C. Continuous oxygen
D. Bed rest
,✅ Correct Answer: A
8. A patient receiving heparin develops petechiae and a platelet count of 90,000. What is the
PRIORITY action?
A. Reduce the dose
B. Administer vitamin K
C. Stop heparin and notify provider
D. Continue therapy
✅ Correct Answer: C
Explanation:
Suspected HIT (Heparin-Induced Thrombocytopenia) is life-threatening.
9. Which patient should the nurse assess FIRST?
A. Stable patient with chronic pain
B. Patient with new onset chest pain
C. Patient awaiting discharge
D. Patient requesting PRN medication
✅ Correct Answer: B
10. Which condition places a patient at highest risk for pressure injuries?
A. Obesity
B. Immobility
C. Hypertension
D. Anxiety
✅ Correct Answer: B
11. A patient with diabetes has fruity breath, Kussmaul respirations, and glucose of 550 mg/dL. This
indicates:
A. Hypoglycemia
B. DKA
C. HHS
D. Metabolic alkalosis
✅ Correct Answer: B
, 12. Which lab finding confirms acute kidney injury (AKI)?
A. Decreased hemoglobin
B. Elevated creatinine
C. Increased calcium
D. Decreased sodium
✅ Correct Answer: B
13. The BEST intervention to prevent DVT in a postoperative patient is:
A. Bed rest
B. Early ambulation
C. Fluid restriction
D. Passive ROM only
✅ Correct Answer: B
14. A patient with GI bleeding presents with tachycardia and hypotension. The PRIORITY intervention
is:
A. Pain management
B. Blood transfusion
C. IV fluid resuscitation
D. Endoscopy
✅ Correct Answer: C
15. Which electrolyte imbalance is MOST associated with dysrhythmias?
A. Hyponatremia
B. Hypokalemia
C. Hypocalcemia
D. Hypermagnesemia
✅ Correct Answer: B
16. A patient with pneumonia has increasing oxygen needs despite therapy. What does this indicate?
A. Recovery phase
B. Treatment success
C. Worsening gas exchange
D. Normal progression
