ANCC Registered Nurse-Board Certified (RN-BC)
Medical-Surgical Nursing Certification Exam New
2025 Version with All Questions, Answers and
Rationale
Section 1: Assessment and Diagnosis (Questions 1–38)
1. A 60-year-old patient with chest pain. What initial assessment?
A) 12-lead ECG and cardiac enzymes.
B) No assessment.
C) Chest X-ray only.
D) Ignore pain.
Correct Answer: A) 12-lead ECG and cardiac enzymes.
Rationale: Rules out acute coronary syndrome. ANCC Domain 1: Assessment.
2. A patient with dyspnea and crackles. What diagnosis?
A) Pulmonary edema.
B) No diagnosis.
C) Asthma.
D) Pneumonia only.
Correct Answer: A) Pulmonary edema.
Rationale: Crackles suggest fluid overload. ANCC Domain 1: Diagnosis.
3. A 45-year-old with abdominal pain. What assessment?
A) Abdominal exam and labs.
B) No exam.
C) CT scan only.
D) Ignore pain.
Correct Answer: A) Abdominal exam and labs.
Rationale: Identifies causes like appendicitis. ANCC Domain 1: Assessment.
4. A patient with fever and cough. What data collection?
A) Sputum culture and chest X-ray.
B) No data.
C) Vitals only.
D) Ignore symptoms.
Correct Answer: A) Sputum culture and chest X-ray.
Rationale: Rules out pneumonia. ANCC Domain 1: Data collection.
5. A patient with diabetes has confusion. What assessment?
A) Blood glucose and mental status.
B) No assessment.
C) BP only.
D) Ignore confusion.
Correct Answer: A) Blood glucose and mental status.
Rationale: Hypoglycemia or hyperglycemia possible. ANCC Domain 1: Assessment.
6. A patient with leg swelling. What nursing diagnosis?
, A) Impaired tissue perfusion.
B) No diagnosis.
C) Pain only.
D) Ignore swelling.
Correct Answer: A) Impaired tissue perfusion.
Rationale: Suggests DVT or edema. ANCC Domain 1: Nursing diagnosis.
7. A patient with chest pain and diaphoresis. What assessment?
A) Cardiac monitor and troponin.
B) No assessment.
C) Pulse oximetry only.
D) Ignore symptoms.
Correct Answer: A) Cardiac monitor and troponin.
Rationale: Indicates possible MI. ANCC Domain 1: Assessment.
8. A patient with weight loss and fatigue. What diagnosis?
A) Risk for malnutrition.
B) No diagnosis.
C) Pain only.
D) Ignore symptoms.
Correct Answer: A) Risk for malnutrition.
Rationale: Suggests underlying disease. ANCC Domain 1: Nursing diagnosis.
9. A patient with shortness of breath. What data?
A) Oxygen saturation and lung sounds.
B) No data.
C) BP only.
D) Ignore symptoms.
Correct Answer: A) Oxygen saturation and lung sounds.
Rationale: Assesses respiratory status. ANCC Domain 1: Data collection.
10. A patient with flank pain. What assessment?
A) Urinalysis and renal ultrasound.
B) No assessment.
C) Vitals only.
D) Ignore pain.
Correct Answer: A) Urinalysis and renal ultrasound.
Rationale: Rules out kidney stones or infection. ANCC Domain 1: Assessment.
11. A patient with altered mental status. What nursing diagnosis?
A) Acute confusion.
B) No diagnosis.
C) Pain only.
D) Ignore status.
Correct Answer: A) Acute confusion.
Rationale: Indicates delirium or metabolic issue. ANCC Domain 1: Nursing diagnosis.
12. A patient with fever and chills. What assessment?
A) Blood cultures and WBC count.
B) No assessment.
C) Temp only.
D) Ignore fever.
, Correct Answer: A) Blood cultures and WBC count.
Rationale: Identifies infection. ANCC Domain 1: Assessment.
13. A patient with leg pain and redness. What diagnosis?
A) Risk for DVT.
B) No diagnosis.
C) Sprain only.
D) Ignore symptoms.
Correct Answer: A) Risk for DVT.
Rationale: Suggests thrombosis. ANCC Domain 1: Nursing diagnosis.
14. A patient with nausea and vomiting. What assessment?
A) Electrolytes and hydration status.
B) No assessment.
C) BP only.
D) Ignore symptoms.
Correct Answer: A) Electrolytes and hydration status.
Rationale: Assesses dehydration risk. ANCC Domain 1: Assessment.
15. A patient with chest pain. What data collection?
A) Pain scale and ECG.
B) No data.
C) Vitals only.
D) Ignore pain.
Correct Answer: A) Pain scale and ECG.
Rationale: Evaluates cardiac etiology. ANCC Domain 1: Data collection.
16. A patient with abdominal distension. What diagnosis?
A) Impaired gastrointestinal motility.
B) No diagnosis.
C) Pain only.
D) Ignore distension.
Correct Answer: A) Impaired gastrointestinal motility.
Rationale: Suggests ileus or obstruction. ANCC Domain 1: Nursing diagnosis.
17. A patient with fatigue and pallor. What assessment?
A) CBC and iron studies.
B) No assessment.
C) Vitals only.
D) Ignore symptoms.
Correct Answer: A) CBC and iron studies.
Rationale: Rules out anemia. ANCC Domain 1: Assessment.
18. A patient with dyspnea on exertion. What diagnosis?
A) Activity intolerance.
B) No diagnosis.
C) Pain only.
D) Ignore dyspnea.
Correct Answer: A) Activity intolerance.
Rationale: Indicates cardiopulmonary issue. ANCC Domain 1: Nursing diagnosis.
19. A patient with fever and rash. What assessment?
A) Skin exam and infectious workup.
Medical-Surgical Nursing Certification Exam New
2025 Version with All Questions, Answers and
Rationale
Section 1: Assessment and Diagnosis (Questions 1–38)
1. A 60-year-old patient with chest pain. What initial assessment?
A) 12-lead ECG and cardiac enzymes.
B) No assessment.
C) Chest X-ray only.
D) Ignore pain.
Correct Answer: A) 12-lead ECG and cardiac enzymes.
Rationale: Rules out acute coronary syndrome. ANCC Domain 1: Assessment.
2. A patient with dyspnea and crackles. What diagnosis?
A) Pulmonary edema.
B) No diagnosis.
C) Asthma.
D) Pneumonia only.
Correct Answer: A) Pulmonary edema.
Rationale: Crackles suggest fluid overload. ANCC Domain 1: Diagnosis.
3. A 45-year-old with abdominal pain. What assessment?
A) Abdominal exam and labs.
B) No exam.
C) CT scan only.
D) Ignore pain.
Correct Answer: A) Abdominal exam and labs.
Rationale: Identifies causes like appendicitis. ANCC Domain 1: Assessment.
4. A patient with fever and cough. What data collection?
A) Sputum culture and chest X-ray.
B) No data.
C) Vitals only.
D) Ignore symptoms.
Correct Answer: A) Sputum culture and chest X-ray.
Rationale: Rules out pneumonia. ANCC Domain 1: Data collection.
5. A patient with diabetes has confusion. What assessment?
A) Blood glucose and mental status.
B) No assessment.
C) BP only.
D) Ignore confusion.
Correct Answer: A) Blood glucose and mental status.
Rationale: Hypoglycemia or hyperglycemia possible. ANCC Domain 1: Assessment.
6. A patient with leg swelling. What nursing diagnosis?
, A) Impaired tissue perfusion.
B) No diagnosis.
C) Pain only.
D) Ignore swelling.
Correct Answer: A) Impaired tissue perfusion.
Rationale: Suggests DVT or edema. ANCC Domain 1: Nursing diagnosis.
7. A patient with chest pain and diaphoresis. What assessment?
A) Cardiac monitor and troponin.
B) No assessment.
C) Pulse oximetry only.
D) Ignore symptoms.
Correct Answer: A) Cardiac monitor and troponin.
Rationale: Indicates possible MI. ANCC Domain 1: Assessment.
8. A patient with weight loss and fatigue. What diagnosis?
A) Risk for malnutrition.
B) No diagnosis.
C) Pain only.
D) Ignore symptoms.
Correct Answer: A) Risk for malnutrition.
Rationale: Suggests underlying disease. ANCC Domain 1: Nursing diagnosis.
9. A patient with shortness of breath. What data?
A) Oxygen saturation and lung sounds.
B) No data.
C) BP only.
D) Ignore symptoms.
Correct Answer: A) Oxygen saturation and lung sounds.
Rationale: Assesses respiratory status. ANCC Domain 1: Data collection.
10. A patient with flank pain. What assessment?
A) Urinalysis and renal ultrasound.
B) No assessment.
C) Vitals only.
D) Ignore pain.
Correct Answer: A) Urinalysis and renal ultrasound.
Rationale: Rules out kidney stones or infection. ANCC Domain 1: Assessment.
11. A patient with altered mental status. What nursing diagnosis?
A) Acute confusion.
B) No diagnosis.
C) Pain only.
D) Ignore status.
Correct Answer: A) Acute confusion.
Rationale: Indicates delirium or metabolic issue. ANCC Domain 1: Nursing diagnosis.
12. A patient with fever and chills. What assessment?
A) Blood cultures and WBC count.
B) No assessment.
C) Temp only.
D) Ignore fever.
, Correct Answer: A) Blood cultures and WBC count.
Rationale: Identifies infection. ANCC Domain 1: Assessment.
13. A patient with leg pain and redness. What diagnosis?
A) Risk for DVT.
B) No diagnosis.
C) Sprain only.
D) Ignore symptoms.
Correct Answer: A) Risk for DVT.
Rationale: Suggests thrombosis. ANCC Domain 1: Nursing diagnosis.
14. A patient with nausea and vomiting. What assessment?
A) Electrolytes and hydration status.
B) No assessment.
C) BP only.
D) Ignore symptoms.
Correct Answer: A) Electrolytes and hydration status.
Rationale: Assesses dehydration risk. ANCC Domain 1: Assessment.
15. A patient with chest pain. What data collection?
A) Pain scale and ECG.
B) No data.
C) Vitals only.
D) Ignore pain.
Correct Answer: A) Pain scale and ECG.
Rationale: Evaluates cardiac etiology. ANCC Domain 1: Data collection.
16. A patient with abdominal distension. What diagnosis?
A) Impaired gastrointestinal motility.
B) No diagnosis.
C) Pain only.
D) Ignore distension.
Correct Answer: A) Impaired gastrointestinal motility.
Rationale: Suggests ileus or obstruction. ANCC Domain 1: Nursing diagnosis.
17. A patient with fatigue and pallor. What assessment?
A) CBC and iron studies.
B) No assessment.
C) Vitals only.
D) Ignore symptoms.
Correct Answer: A) CBC and iron studies.
Rationale: Rules out anemia. ANCC Domain 1: Assessment.
18. A patient with dyspnea on exertion. What diagnosis?
A) Activity intolerance.
B) No diagnosis.
C) Pain only.
D) Ignore dyspnea.
Correct Answer: A) Activity intolerance.
Rationale: Indicates cardiopulmonary issue. ANCC Domain 1: Nursing diagnosis.
19. A patient with fever and rash. What assessment?
A) Skin exam and infectious workup.
