ANCC Medical-Surgical Nursing Certification 1 — Questions and Answers
Question 1: A patient post-op for abdominal surgery develops a fever of 38.5°C on postoperative day 2. What is the most likely cause?
- Surgical site infection
- Deep vein thrombosis
- Pulmonary atelectasis (Correct answer)
- Urinary tract infection
Correct answer: Pulmonary atelectasis
Pulmonary atelectasis is the most common cause of fever in the first 48 hours after surgery due to hypoventilation.
Question 2: A patient develops acute respiratory distress with absent breath sounds on the left side after central line placement. What is the priority intervention?
- Administer supplemental oxygen and monitor
- Prepare for immediate needle decompression or chest tube insertion (Correct answer)
- Obtain a STAT chest X-ray before intervening
- Reposition the patient to the right lateral decubitus position
Correct answer: Prepare for immediate needle decompression or chest tube insertion
Absent breath sounds after central line placement indicate tension pneumothorax, requiring immediate decompression.
Question 3: Which electrolyte imbalance is most commonly associated with prolonged nasogastric suctioning?
- Hyperkalemia
- Hypernatremia
- Hypokalemia and metabolic alkalosis (Correct answer)
- Hypermagnesemia
Correct answer: Hypokalemia and metabolic alkalosis
NG suctioning causes loss of HCl and K+, resulting in hypokalemia and metabolic alkalosis.
Question 4: A patient with type 1 diabetes presents with Kussmaul respirations, fruity breath, and blood glucose of 480 mg/dL. This presentation is consistent with:
- Hyperosmolar hyperglycemic state (HHS)
- Diabetic ketoacidosis (DKA) (Correct answer)
- Severe hypoglycemia
- Lactic acidosis
Correct answer: Diabetic ketoacidosis (DKA)
DKA presents with Kussmaul respirations (compensatory for metabolic acidosis), fruity breath from ketones, and high glucose.
Question 5: A patient with a history of atrial fibrillation is anticoagulated. The nurse assesses sudden onset of severe right leg pain, pallor, and pulselessness. What is the priority action?
- Elevate the affected leg and apply warm compresses
- Notify the provider immediately for suspected acute arterial occlusion (Correct answer)
- Reassess in 1 hour for spontaneous improvement
- Apply compression stockings to the affected leg
Correct answer: Notify the provider immediately for suspected acute arterial occlusion
The 6 Ps of arterial occlusion (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia) require immediate provider notification and intervention.
Question 6: Which finding is most indicative of increased intracranial pressure (ICP) in a patient with a traumatic brain injury?
- Heart rate of 110 bpm with normal BP
- Cushing's triad: hypertension, bradycardia, and irregular respirations (Correct answer)
- Temperature of 38.1°C
- Mild confusion without vital sign changes
Correct answer: Cushing's triad: hypertension, bradycardia, and irregular respirations
Cushing's triad (hypertension, bradycardia, irregular respirations) is a late, ominous sign of severely elevated ICP.
ANCC Medical-Surgical Nursing Certification 1
A patient post-op for abdominal surgery develops a fever of 38.5°C on postoperative day 2.
What is the most likely cause?