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ANCC MedSurg-BC study materials
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ANCC MedSurg-BC practice questions

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Question 1Assessment and Diagnosis

A patient's blood pressure is 132/84 mm Hg while supine and 108/70 mm Hg after standing for 2 minutes. Which finding confirms orthostatic hypotension?

  1. A systolic decrease of at least 10 mm Hg
  2. A diastolic decrease of at least 5 mm Hg
  3. A systolic decrease of at least 20 mm Hg Correct answer.
  4. A pulse increase of at least 5 beats/min

Explanation

Orthostatic hypotension is defined as a fall in systolic pressure of at least 20 mm Hg or diastolic pressure of at least 10 mm Hg within 3 minutes of standing. A 24 mm Hg systolic drop therefore meets the criterion. Symptoms and pulse change support the finding but are not required for diagnosis.

Question 2Assessment and Diagnosis

Which sequence is correct for a focused abdominal assessment?

  1. Auscultation, inspection, palpation, percussion
  2. Percussion, inspection, auscultation, palpation
  3. Inspection, auscultation, percussion, palpation Correct answer.
  4. Inspection, palpation, percussion, auscultation

Explanation

Inspection precedes all other abdominal techniques, and auscultation is performed before percussion and palpation because those maneuvers can alter bowel sounds. The correct order is inspection, auscultation, percussion, palpation.

Question 3Assessment and Diagnosis

Which source is most reliable for assessing the intensity of a patient's pain?

  1. The family's description of the patient's behavior
  2. The patient's self-report using a validated scale Correct answer.
  3. The patient's heart rate and blood pressure
  4. The nurse's observation of guarding

Explanation

Pain is a subjective experience, and the patient's self-report on a validated scale is the most reliable measure of intensity. Physiologic signs and observer ratings are adjuncts, especially when self-report is unavailable.

Question 4Assessment and Diagnosis

A patient has a right pupil of 6 mm and a left pupil of 3 mm. Which term best describes this finding?

  1. Anisocoria Correct answer.
  2. Miosis
  3. Isocoria
  4. Ptosis

Explanation

Anisocoria is unequal pupil size and may be a normal variant or a sign of neurologic injury. A new unequal pupil, especially with decreased consciousness, requires urgent evaluation. Isocoria means equal pupils.

Question 5Assessment and Diagnosis

A pressure injury shows intact skin with nonblanchable redness over a bony prominence. Which stage is this?

  1. Stage 3
  2. Stage 1 Correct answer.
  3. Stage 4
  4. Stage 2

Explanation

Stage 1 pressure injury is intact skin with nonblanchable erythema over a bony prominence. Stage 2 involves partial-thickness skin loss, and stages 3 and 4 involve full-thickness loss.

Question 6Assessment and Diagnosis

Which breath sound is described as high-pitched, harsh, and heard over the trachea?

  1. Bronchial Correct answer.
  2. Bronchovesicular
  3. Crackles
  4. Vesicular

Explanation

Bronchial breath sounds are high-pitched and harsh and are normally heard over the trachea. Vesicular sounds are soft and low-pitched over peripheral lung fields, and bronchovesicular sounds are intermediate over the mainstem bronchi.

Question 7Assessment and Diagnosis

How is a pulse deficit calculated?

  1. Apical rate minus radial rate Correct answer.
  2. Radial rate divided by apical rate
  3. Radial rate plus apical rate
  4. Apical rate plus radial rate

Explanation

A pulse deficit is the difference between the apical rate and the radial rate counted simultaneously. A positive deficit suggests that some heartbeats are not producing a peripheral pulse. It is calculated as apical minus radial.

Question 8Assessment and Diagnosis

Which finding indicates that a patient is oriented to person, place, and time?

  1. Can count backward from 20
  2. States name, current location, and today's date Correct answer.
  3. Recalls three objects after five minutes
  4. Follows a two-step command

Explanation

Orientation is assessed by asking about person, place, and time. Counting backward tests attention, following commands tests comprehension and motor function, and recalling objects tests memory.

Question 9Assessment and Diagnosis

A monitor shows a regular rhythm at 150 beats/min with narrow QRS complexes and no visible P waves. Which rhythm is most likely?

  1. Sinus tachycardia at rest
  2. Ventricular tachycardia
  3. Atrial fibrillation with rapid ventricular response
  4. Supraventricular tachycardia Correct answer.

Explanation

A regular narrow-complex tachycardia at about 150 beats/min without visible P waves is most consistent with supraventricular tachycardia. Ventricular tachycardia has wide QRS complexes, atrial fibrillation is irregular, and sinus tachycardia usually has visible P waves.

Question 10Assessment and Diagnosis

Which ECG change is most associated with a serum potassium of 6.8 mEq/L?

  1. Atrial fibrillation with rapid response
  2. Prominent U waves
  3. Peaked T waves Correct answer.
  4. Prolonged QT interval

Explanation

Hyperkalemia produces tall, peaked T waves and can progress to widened QRS complexes and arrhythmias. U waves and QT prolongation are more typical of hypokalemia.

Question 11Assessment and Diagnosis

Which laboratory value is most specific for liver injury?

  1. Total bilirubin
  2. Alkaline phosphatase
  3. Prothrombin time
  4. ALT Correct answer.

Explanation

ALT is more liver-specific than AST, which is also found in muscle and other tissues. Alkaline phosphatase rises more with biliary obstruction, and bilirubin reflects clearance rather than hepatocellular injury alone.

Question 12Assessment and Diagnosis

Which assessment finding most increases the likelihood of a deep vein thrombosis in the calf?

  1. Erythema limited to the ankle
  2. Unilateral calf swelling and tenderness Correct answer.
  3. Pain that improves with elevation
  4. Bilateral dependent ankle edema

Explanation

DVT typically causes unilateral calf swelling, tenderness, warmth, and erythema. Bilateral edema suggests a systemic cause such as heart failure or fluid overload. Diagnosis is confirmed with ultrasound.

Question 13Assessment and Diagnosis

Which tool is designed to screen for delirium in hospitalized adults?

  1. Mini-Mental State Examination (MMSE)
  2. Morse Fall Scale
  3. Braden Scale
  4. Confusion Assessment Method (CAM) Correct answer.

Explanation

The Confusion Assessment Method (CAM) is a validated delirium screening tool based on acute onset, inattention, disorganized thinking, and altered consciousness. The MMSE measures cognitive function but does not distinguish delirium from dementia.

Question 14Assessment and Diagnosis

Which assessment finding is most consistent with fluid volume excess?

  1. Poor skin turgor
  2. Orthostatic hypotension
  3. Flat neck veins while supine
  4. Crackles with an S3 sound Correct answer.

Explanation

Fluid volume excess causes pulmonary crackles, an S3 gallop, jugular venous distention, and dependent edema. Flat neck veins, poor turgor, and orthostatic hypotension suggest volume depletion.

Question 15Assessment and Diagnosis

An arterial blood gas shows pH 7.30, PaCO2 50 mm Hg, HCO3 25 mEq/L. Which acid-base disturbance is present?

  1. Metabolic acidosis
  2. Respiratory acidosis Correct answer.
  3. Metabolic alkalosis
  4. Respiratory alkalosis

Explanation

A pH below 7.35 with an elevated PaCO2 indicates respiratory acidosis. The normal bicarbonate level shows that metabolic compensation has not yet occurred.

Question 16Assessment and Diagnosis

Which laboratory value is most useful for detecting recent nutritional decline?

  1. Serum calcium
  2. Serum sodium
  3. Serum prealbumin Correct answer.
  4. Serum albumin

Explanation

Prealbumin has a short half-life of about 2 days, so it reflects recent nutritional change more closely than albumin. Albumin has a long half-life and is affected by inflammation and fluid status.

Question 17Assessment and Diagnosis

Which qSOFA finding is used to identify a patient at risk for sepsis?

  1. Respiratory rate of 24 breaths/min Correct answer.
  2. Temperature of 37.8°C (100.0°F)
  3. Urine output of 40 mL/hr
  4. Heart rate of 92 beats/min

Explanation

The qSOFA criteria are respiratory rate ≥22 breaths/min, altered mental status, and systolic blood pressure ≤100 mm Hg. A respiratory rate of 24 meets one criterion.

Question 18Assessment and Diagnosis

A patient has no bowel sounds on auscultation for 2 minutes in all quadrants. What is the most appropriate next step?

  1. Percuss to stimulate bowel sounds
  2. Palpate deeply to confirm ileus
  3. Document bowel sounds as normal
  4. Listen for 5 minutes in each quadrant Correct answer.

Explanation

Absent bowel sounds should not be documented until each quadrant has been auscultated for at least 5 minutes. Palpation and percussion can alter findings and should follow auscultation.

Question 19Assessment and Diagnosis

A patient has 2+ pitting edema of the lower legs. Which description matches this grade?

  1. 8 mm indentation, rebound after 3 minutes
  2. 1 mm indentation, immediate rebound
  3. 4 mm indentation, rebound in 10 to 15 seconds Correct answer.
  4. 2 mm indentation, rebound in 5 seconds

Explanation

Pitting edema is graded by depth and duration of the indentation. Grade 2+ corresponds to a 4 mm indentation that rebounds in about 10 to 15 seconds. Grade 1+ is slight and rebounds quickly, while 4+ is very deep and persists.

Question 20Assessment and Diagnosis

A patient has a new fever and purulent wound drainage. Which action is most important before starting antibiotics?

  1. Apply a warm compress
  2. Obtain a wound culture Correct answer.
  3. Irrigate the wound with saline
  4. Measure the wound diameter

Explanation

A wound culture should be obtained before antibiotics are started so that the causative organism is not suppressed. Antibiotics can reduce culture yield and lead to false-negative results.

Question 21Assessment and Diagnosis

A patient with COPD has pH 7.37, PaCO2 58 mm Hg, HCO3 32 mEq/L. How should this be interpreted?

  1. Mixed respiratory and metabolic acidosis
  2. Uncompensated metabolic alkalosis
  3. Partially compensated respiratory alkalosis
  4. Fully compensated respiratory acidosis Correct answer.

Explanation

The pH is normal, the PaCO2 is elevated, and the bicarbonate is elevated, which indicates chronic respiratory acidosis with metabolic compensation. In COPD, chronic CO2 retention leads to a compensatory rise in bicarbonate that normalizes pH.

Question 22Assessment and Diagnosis

Which finding best distinguishes an S3 gallop from an S4 gallop?

  1. S3 is high-pitched and heard at the base
  2. S3 occurs just before S1
  3. S3 disappears with heart failure treatment
  4. S3 occurs early in diastole after S2 Correct answer.

Explanation

S3 occurs early in diastole, immediately after S2, during rapid ventricular filling. S4 occurs late in diastole, just before S1, during atrial contraction.

Question 23Assessment and Diagnosis

A patient with a head injury has a Glasgow Coma Scale score that dropped from 14 to 11 over 1 hour. What is the priority interpretation?

  1. Normal score variation
  2. Worsening neurologic status Correct answer.
  3. Effect of prescribed analgesia
  4. Expected postictal drowsiness

Explanation

A decline in Glasgow Coma Scale score of 2 or more points indicates neurologic deterioration and requires urgent evaluation. Early intervention can prevent secondary brain injury.

Question 24Assessment and Diagnosis

Which assessment combination best indicates adequate tissue perfusion?

  1. Blood pressure 88/50 mm Hg with confusion
  2. Warm skin and urine output of 15 mL/hr
  3. Heart rate 120 beats/min with cool skin
  4. MAP 70 mm Hg and urine output 0.8 mL/kg/hr Correct answer.

Explanation

Adequate perfusion is suggested by a mean arterial pressure of at least 65 mm Hg, urine output of at least 0.5 mL/kg/hr, and normal mentation. Warm extremities and adequate urine output support this assessment.

Question 25Assessment and Diagnosis

An older adult reports vague abdominal discomfort and has new confusion but no fever. Which principle best guides assessment?

  1. Confusion usually reflects irreversible dementia
  2. Atypical presentation is common, so evaluate thoroughly Correct answer.
  3. Constipation is the most likely cause
  4. Absence of fever rules out infection

Explanation

Older adults often present atypically with acute illness, such as confusion or functional decline without fever. A thorough evaluation is needed rather than attributing symptoms to aging or a single benign cause.

Question 26Assessment and Diagnosis

Which resting respiratory rate is expected for a healthy adult?

  1. 4 to 8 breaths/min
  2. 22 to 28 breaths/min
  3. 12 to 20 breaths/min Correct answer.
  4. 30 to 40 breaths/min

Explanation

The accepted adult resting reference range is about 12 to 20 breaths/min, counted over a full 60 seconds when the rhythm is irregular. Rates outside this range warrant further assessment for respiratory, metabolic, or neurologic causes.

Question 27Assessment and Diagnosis

In the PQRST method of pain assessment, which element captures what relieves or worsens the pain?

  1. Severity
  2. Timing
  3. Provocation Correct answer.
  4. Quality

Explanation

PQRST stands for Provocation, Quality, Region/Radiation, Severity, and Timing. Provocation addresses the factors that trigger or relieve the pain, which guides both diagnosis and intervention.

Question 28Assessment and Diagnosis

Which capillary refill time is considered normal for an adult at room temperature?

  1. 12 seconds
  2. 8 seconds
  3. 2 seconds Correct answer.
  4. 5 seconds

Explanation

Capillary refill of roughly 2 seconds or less indicates adequate peripheral perfusion in a warm adult. Prolonged refill suggests poor perfusion, dehydration, or vasoconstriction, though cool ambient temperature can also slow it.

Question 29Assessment and Diagnosis

At which location is the apical pulse best auscultated in an adult?

  1. Second intercostal space, right sternal border
  2. Fifth intercostal space, anterior axillary line
  3. Fifth intercostal space, left midclavicular line Correct answer.
  4. Fourth intercostal space, left sternal border

Explanation

The apical impulse corresponds to the mitral area at the fifth intercostal space in the left midclavicular line. This is the site used when an apical pulse is counted for a full minute, such as before administering digoxin.

Question 30Assessment and Diagnosis

Which oral temperature range is considered normal for an adult?

  1. 34.5 to 35.5 °C (94.1 to 95.9 °F)
  2. 36.1 to 37.2 °C (97 to 99 °F) Correct answer.
  3. 35.0 to 35.9 °C (95 to 96.6 °F)
  4. 38.0 to 39.0 °C (100.4 to 102.2 °F)

Explanation

Normal adult oral temperature is approximately 36.1 to 37.2 °C, with diurnal variation of up to about 0.5 °C. Values above this range suggest fever and warrant assessment for infection or inflammation.

Question 31Assessment and Diagnosis

An 80-year-old patient is being assessed for hydration status. Which finding is a normal age-related change rather than a sign of dehydration?

  1. Rapid unintentional weight loss
  2. Sunken-appearing eyes
  3. Dry mucous membranes
  4. Decreased skin turgor over the sternum Correct answer.

Explanation

Loss of subcutaneous elastic tissue and collagen makes skin turgor a less reliable dehydration indicator in older adults, particularly over the sternum and hands. Hydration assessment in this population should emphasize mucous membranes, orthostatic vital signs, intake and output, and daily weights.

Question 32Assessment and Diagnosis

Which tool is designed to assess pain in an older adult with advanced dementia who cannot self-report?

  1. Numeric rating scale
  2. Wong-Baker FACES scale
  3. PAINAD Correct answer.
  4. Visual analog scale

Explanation

The PAINAD scale relies on observed behaviors such as breathing, negative vocalization, facial expression, body language, and consolability. Observational tools are required when a patient cannot reliably use self-report scales.

Question 33Assessment and Diagnosis

Which percussion note is expected over normal lung tissue?

  1. Resonance Correct answer.
  2. Tympany
  3. Flatness
  4. Dullness

Explanation

Resonance is the low-pitched, hollow note produced by air-filled lung tissue. Dullness suggests fluid or solid tissue, and tympany is expected over the stomach.

Question 34Assessment and Diagnosis

A patient reports right upper quadrant pain that intensifies when the examiner's hand presses under the right costal margin during inspiration. Which sign is this?

  1. Rovsing sign
  2. Obturator sign
  3. Murphy sign Correct answer.
  4. Psoas sign

Explanation

Murphy sign is inspiratory arrest caused by pain when the gallbladder is palpated under the right costal margin. It supports a diagnosis of acute cholecystitis.

Question 35Assessment and Diagnosis

Periumbilical ecchymosis in a patient with severe abdominal pain suggests which underlying process?

  1. Small bowel obstruction
  2. Retroperitoneal hemorrhage in acute pancreatitis Correct answer.
  3. Perforated peptic ulcer
  4. Acute cholecystitis

Explanation

Cullen sign is periumbilical bruising caused by retroperitoneal blood tracking along the fascial planes. It is associated with hemorrhagic pancreatitis and carries a poor prognosis.

Question 36Assessment and Diagnosis

A patient can stand with feet together and eyes open but sways and loses balance when the eyes are closed. Which function does this test primarily assess?

  1. Lower extremity strength
  2. Cortical sensation to light touch
  3. Cerebellar coordination
  4. Proprioception and vestibular input Correct answer.

Explanation

The Romberg test removes visual input to determine whether balance can be maintained by proprioceptive and vestibular information. A positive result indicates impaired position sense or vestibular dysfunction.

Question 37Assessment and Diagnosis

Which finding supports the presence of meningeal irritation?

  1. Loss of vibration sense in the feet
  2. Pain with straight leg raise at 30 degrees
  3. Facial droop on the left side
  4. Neck flexion that produces flexion of the hips and knees Correct answer.

Explanation

This describes the Brudzinski sign, in which passive neck flexion elicits reflexive hip and knee flexion. Along with nuchal rigidity and Kernig sign, it supports a diagnosis of meningitis.

Question 38Assessment and Diagnosis

Sustained jugular venous distention while firm pressure is held over the right upper quadrant indicates which abnormality?

  1. Increased right-sided filling pressures Correct answer.
  2. Superior vena cava syndrome
  3. Carotid artery stenosis
  4. Aortic stenosis

Explanation

Hepatojugular reflux occurs when compressing the liver increases venous return to a failing right heart, raising jugular venous pressure by more than 3 cm and sustaining it. It supports a diagnosis of right heart failure or volume overload.

Question 39Assessment and Diagnosis

Which condition most likely increases tactile fremitus over a lung region?

  1. Pleural effusion
  2. Pneumothorax
  3. Emphysema
  4. Lobar consolidation Correct answer.

Explanation

Consolidated lung tissue transmits sound more efficiently from the airways to the chest wall, intensifying tactile fremitus. Air or fluid between the lung and the chest wall reduces transmission.

Question 40Assessment and Diagnosis

Why is auscultation of the abdomen performed before percussion and palpation?

  1. Percussion is unreliable once auscultation has been completed
  2. Palpation and percussion can alter bowel sound frequency and intensity Correct answer.
  3. Auscultation is only valid when the patient has an empty stomach
  4. Palpation may cause pain that alters respiratory rate

Explanation

Manipulation of the abdomen stimulates bowel activity and can artificially change the character and frequency of bowel sounds. Performing auscultation first preserves the baseline information needed to evaluate motility.

Question 41Assessment and Diagnosis

A patient with tachycardia and distended neck veins has a systolic blood pressure that falls 12 mm Hg during inspiration compared with expiration. Which condition does this suggest?

  1. Aortic regurgitation
  2. Essential hypertension
  3. Cardiac tamponade Correct answer.
  4. Chronic obstructive pulmonary disease

Explanation

An inspiratory fall in systolic pressure greater than 10 mm Hg is pulsus paradoxus, a hallmark of cardiac tamponade. Impaired diastolic filling makes stroke volume highly dependent on intrathoracic pressure changes during respiration.

Question 42Assessment and Diagnosis

Which set of vital sign changes is most concerning for rising intracranial pressure?

  1. Hypertension, tachycardia, and hyperthermia
  2. Fever, hypotension, and warm flushed skin
  3. Falling blood pressure, tachycardia, and tachypnea
  4. Rising blood pressure with widening pulse pressure, bradycardia, and irregular respirations Correct answer.

Explanation

Cushing triad consists of hypertension with a widened pulse pressure, bradycardia, and irregular respirations. It reflects brainstem compression and signals a neurologic emergency requiring immediate intervention.

Question 43Assessment and Diagnosis

Which cognitive screening tool is most appropriate for detecting mild cognitive impairment?

  1. Montreal Cognitive Assessment Correct answer.
  2. Confusion Assessment Method
  3. Glasgow Coma Scale
  4. Richmond Agitation-Sedation Scale

Explanation

The Montreal Cognitive Assessment samples executive function, attention, memory, language, and visuospatial skills, making it sensitive to mild deficits. The MMSE is less sensitive to executive dysfunction in early disease.

Question 44Assessment and Diagnosis

A murmur is documented as grade 3 of 6. Which description matches this grade?

  1. Audible with the stethoscope but no thrill
  2. Barely audible with the stethoscope
  3. Moderately loud without a palpable thrill Correct answer.
  4. Loud with an associated palpable thrill

Explanation

Murmurs are graded 1 to 6 by intensity; grade 3 is moderately loud and is not accompanied by a thrill. Thrills become palpable at grade 4 and above.

Question 45Assessment and Diagnosis

Which hemodynamic change is suggested by a pulse pressure narrowed to 20 mm Hg?

  1. Reduced stroke volume Correct answer.
  2. Aortic regurgitation
  3. Increased stroke volume
  4. Hyperthyroidism

Explanation

Pulse pressure is the difference between systolic and diastolic pressure and reflects stroke volume and arterial compliance. A narrowed pulse pressure suggests a fall in stroke volume, as in hypovolemia, heart failure, or tamponade.

Question 46Assessment and Diagnosis

Tapping over the facial nerve just anterior to the ear produces ipsilateral facial muscle twitching. This finding is associated with which electrolyte imbalance?

  1. Hyperkalemia
  2. Hypernatremia
  3. Hyperchloremia
  4. Hypocalcemia Correct answer.

Explanation

Chvostek sign reflects increased neuromuscular irritability from low serum ionized calcium. It commonly accompanies hypocalcemia after thyroid or parathyroid surgery and should prompt a calcium level.

Question 47Assessment and Diagnosis

A patient with blunt abdominal trauma reports pain at the tip of the left shoulder. Which structure's irritation best explains this?

  1. Left kidney
  2. Diaphragm Correct answer.
  3. Appendix
  4. Gallbladder

Explanation

Kehr sign is referred pain to the shoulder tip caused by diaphragmatic irritation from blood or free air, transmitted by the phrenic nerve. It can indicate splenic rupture or other intra-abdominal bleeding.

Question 48Assessment and Diagnosis

A patient with a severe headache has a fixed, dilated pupil that does not respond to light. Which structure is most likely compressed?

  1. Trigeminal nerve (CN V)
  2. Optic nerve (CN II)
  3. Oculomotor nerve (CN III) Correct answer.
  4. Facial nerve (CN VII)

Explanation

The oculomotor nerve carries parasympathetic fibers that constrict the pupil, so compression causes a blown, unreactive pupil. This is an early sign of uncal herniation and requires urgent intervention.

Question 49Assessment and Diagnosis

Which condition classically produces paradoxical splitting of the second heart sound?

  1. Left bundle branch block Correct answer.
  2. Mitral stenosis
  3. Atrial septal defect
  4. Right bundle branch block

Explanation

Paradoxical splitting occurs when delayed left ventricular ejection causes the pulmonic valve to close before the aortic valve. The split is heard on expiration and disappears on inspiration, and is classically caused by left bundle branch block.

Question 50Assessment and Diagnosis

A patient with cirrhosis extends the arms with the wrists dorsiflexed, and the hands flap rapidly downward. Which term describes this finding?

  1. Resting tremor
  2. Myoclonus
  3. Asterixis Correct answer.
  4. Chorea

Explanation

Asterixis is a flapping tremor produced by brief loss of muscle tone and is a sign of hepatic encephalopathy. It resolves when consciousness improves, making it useful for monitoring response to treatment.