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Medical-Surgical Nursing Practice Test

ANCC-MSN exam Format | Course Contents | Course Outline | exam Syllabus | exam Objectives

Exam ID : ANCC-MSN
Exam Title : Medical-Surgical Nursing Board Certification Examination
Questions : 125 (25 unscored)

The ANCC Medical-Surgical Nursing board certification examination is a competency based examination that provides a valid and reliable assessment of the entry-level clinical knowledge and skills of registered nurses in the medical-surgical specialty after initial RN licensure. Once you complete eligibility requirements to take the certification examination and successfully pass the exam- you are awarded the credential: Registered Nurse-Board Certified (RN-BC). This credential is valid for 5 years. You can continue to use this credential by maintaining your license to practice and meeting the renewal requirements in place at the time of your certification renewal. The Accreditation Board for Specialty Nursing Certification accredits this ANCC certification.

There are 150 questions on this examination. Of these- 125 are scored questions and 25 are pretest
questions that are not scored. Pretest questions are used to determine how well these questions will
perform before they are used on the scored portion of the examination. The pretest questions cannot
be distinguished from those that will be scored- so it is important for a candidate to answer all
questions. A candidate's score- however- is based solely on the 125 scored questions. Performance on
pretest questions does not affect a candidate's score.

Category Content Domain Number of Questions Percentage
I Assessment and Diagnosis 52 42%
II Planning- Implementation- and Evaluation 58 46%
III Professional Role 15 12%
TOTAL 125 100%

I Assessment and Diagnosis
A. Skill
1. Health history collection
2. Physical assessment (e.g.- disease process- review of systems- activities of daily living)
3. Psychosocial assessment (e.g.- developmental stages- suicide risk- abuse- substance use disorders)
4. Cognitive assessment (e.g.- neuro status- developmental age- impairment)
5. Diagnostic and laboratory testing (e.g.- patient preparation- response to abnormal values- medication considerations)
6. Nursing diagnosis identification and prioritization
B. Knowledge
1. Fluids and electrolytes (e.g.- imbalances- disease-related- blood products)
II Planning- Implementation- and Evaluation
A. Skill
1. Nursing care planning (e.g.- interventions- modifications- outcomes)
2. Postoperative complication prevention and management (e.g.- bleeding- infection- emboli)
3. Patient teaching (i.e.- learning preferences- barriers- and confirmation)
B. Knowledge
1. Education syllabus (e.g.- self-management- acute and chronic conditions- population specific)
2. Patient safety measures (e.g.- screening tools- infection prevention- restraints- medical equipment)
3. Non-pharmacologic treatments (e.g.- complementary and alternative medicine- diversional activities)
4. Medication interactions and adverse effects (e.g.- pain management- polypharmacy- drug-drug- food-drug)
5. Health and wellness promotion (e.g.- screenings- vaccinations- healthy lifestyle modifications)
III Professional Role
A. Skill
1. Therapeutic communication (e.g.- patient- and family-centered care- cultural competence)
B. Knowledge
1. Nursing ethics (e.g.- evidence-based practice- advocacy)

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ANCC (RN-BC) Medical-Surgical Nursing 2026
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Question: 60
The nurse includes the important measures for stump care in the teaching plan for
a client with an amputation. Which measure would be excluded from the teaching
plan?
A. Wash, dry, and inspect the stump daily
B. Treat superficial abrasions and blisters promptly
C. Apply a �shrinker� bandage with tighter arms around the proximal end of the
affected limb
D. Toughen the stump by pushing it against a progressively harder substance
(e.g., pillow on a foot-stool)
Answer: C
Apply a "shrinker" bandage with tighter arms around the proximal end of the
affected limb. The �shrinker� bandage is applied to prevent swelling of the stump.
It should be applied at the distal end with the tighter arms. Applying the tighter
arms at the proximal end will impair circulation and cause swelling by reducing
venous flow.
Question: 61
Which nursing action is the first priority during a generalized tonic-clonic seizure
episode?
A. Observe and record all events that occur before, during, and after the seizure
B. Maintain a patent airway by turning the head to the side
C. Protect the client from injury
D. Monitor vital signs, with special attention directed to respiratory status
Answer: C
The first priority is to protect the client from injury. Do not restrain the client�s
arms or legs, but make sure he or she does not hit anything. Protect the head with
the nurse�s hand, a towel, or a jacket. During the initial tonic phase, the client
usually stops breathing for up to minute. There is no cause for alarm, as
spontaneous breathing will, in most clients, return with no harm. In the absence of
breathing, airway patency by this position change (Choice B) is not the first
priority. Muscle contraction will prevent �positioning� of the head. A padded
tongue blade, once indicated during a seizure, is also no longer used. Choices A
and D are appropriate nursing actions after the seizure has ended.
Question: 62
Levin, age 27, was driving home when his car collided with another moving
vehicle. He obtained multiple injuries and a concussion. The paramedics placed a
hard neck brace to immobilize the spine. Upon arriving at the hospital, X-rays are
inconclusive because of swelling. To assess and care for the skin under the collar,
the nurse should:
A. Place the client flat and supine; remove the anterior section of the collar,
turning the head to the right or left to remove the back section.
B. Have the client sit up in a chair to remove the front and back sections without
turning the head from side to side.
C. Have at least one nurse stabilize the head in line with the torso, while the other
nurse removes the collar sections.
D. Wait until the X-rays are conclusive for any trauma before assessing the skin
or providing skin care under the collar.
Answer: C
The head and neck are maintained in an aligned position at all times and
supported. The collar is hard and can cause skin breakdown. The collar liner
should be changed daily and the underlying skin cleansed. Turning the head from
side to side may cause injury to the spine (Choice A). Choice B is incorrect
because the client may be experiencing weakness and there is no support for the
neck if the collar is removed. The collar liner must be changed and the skin
cleaned daily to prevent breakdown (Choice D). The presence or absence of a
spinal injury may not be determined in less than 24 hours.
Question: 63
Troy, 27 years old, suffered from multiple injuries after his car crashed into a
moving vehicle. He was then rushed to a nearby hospital where his left leg was
amputated below the knee. After surgery, the physician�s orders include elevation
of the foot of the bed for 24 hours. The nurse observes that the nursing assistant
has placed a pillow under Troy�s amputated limb. The nursing action is to:
A. Leave the pillow, as his stump is elevated
B. Remove the pillow and elevate the foot of the bed
C. Leave the pillow and elevate the foot of the bed
D. Check with the physician and clarify the orders
Answer: B
The orders call for bed elevation (this is done to reduce edema and prevent
hemorrhage). A pillow under the stump may lead to a flexion contracture of the
hip joint, so this is contraindicated. Also, further teaching is indicated so that the
nursing assistant understands why the pillow is contraindicated.
Question: 64
A client is scheduled for an electroencephalogram (EEG) early in the morning.
The nurse working the night shift prior to the procedure would write a note to do
which of the following per protocol order in the early morning on the day of the
test?
A. Instruct the client to refrain from washing the hair
B. Hold the daily dose of anticonvulsant
C. Place the client on NPO status
D. Reinforce client teaching that the test is only mildly uncomfortable
Answer: B
Antidepressants, tranquilizers, and anticonvulsants are generally withheld for 24
to 48 hours before an EEG. The client does not have to be on NPO, but should
avoid stimulants such as coffee, tea, cola, alcohol, and cigarettes. Pre-procedure
care for EEG involves teaching that there is no discomfort and shampooing the
hair.
Question: 65
S. McCormick, R.N., is one of several persons who witness a vehicle hit a
pedestrian at fairly low speed on a street. The person is dazed and tries to get up.
The leg appears fractured. Ms. McCormick would plan to:
A. Try to reduce the fracture manually
B. Assist the person to get up and walk to the sidewalk
C. Leave the person for a few moments to call an ambulance
D. Stay with the person and encourage the person to remain still
Answer: D
With a suspected fracture, the client is not moved unless it is dangerous to remain
in that spot. A fracture is not reduced at the scene (Choice A). Choice B is
incorrect because before the client is moved, the site of fracture is immobilized to
prevent further injury. Choice C is incorrect because the nurse should remain with
client and have someone else call for emergency help.
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