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ANCC MEDSURG-BC Cheat Sheet

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Assessment and Diagnosis

  • 39% of exam
  • Health history Physical assessment Psychosocial assessment Diagnostics Fluids and electrolytes

Planning, Implementation, and Evaluation

  • 40% of exam
  • Care planning Postoperative care Patient teaching Medication safety Health promotion

Professional Role

  • 21% of exam
  • Therapeutic communication Team collaboration Nursing ethics Evidence-based practice Delegation

Quick Facts

  • Credential MEDSURG-BC
  • Total questions 150
  • Scored questions 125
  • Pretest questions 25 unscored
  • Exam time 3 hours
  • Passing score 350 scaled
  • Testing vendor Prometric
  • Testing window 120 days
  • Credential term 5 years
  • Current fees $295 ANA | $395 nonmember

BE-FAST Stroke Screen AS

  • Balance, Eyes, Face, Arm, Speech, Time
  • Balance change Eye change Facial droop Arm weakness Speech change Time critical

Fluid Overload vs Deficit AS

Overload

  • Weight gain
  • Crackles and edema
  • JVD may appear

Deficit

  • Weight loss
  • Tachycardia and hypotension
  • Low urine output
  • Trend weight and perfusion

Priority Question Ladder AS

  • Unresponsive and pulseless → Start CPR ( Activate emergency response )
  • Airway threat present → Protect airway first ( Airway outranks comfort )
  • Breathing acutely impaired → Support ventilation ( Assess oxygenation )
  • Circulation unstable → Restore perfusion ( Escalate immediately )
  • Acute neurologic change → Rapid focused assessment ( Activate pathway )
  • No immediate threat → Assess before intervening ( Use nursing process )
  • Multiple stable needs → Actual before risk ( Acute before chronic )

Core Assessment Sequence AS

  • Primary survey Airway, breathing, circulation
  • Standard exam Inspect, palpate, percuss, auscultate
  • Abdominal exam Inspect, auscultate, percuss, palpate
  • Pain history Use PQRST or OLDCARTS
  • Medication reconciliation Include OTC and supplements
  • Allergy record Document specific reaction
  • Neurologic trend Level of consciousness first
  • Fluid trend Daily weight most reliable
  • Patient teaching Assess readiness before teaching

Hyperkalemia vs Hypokalemia AS

Hyperkalemia

  • Peaked T waves
  • Widened QRS
  • Weakness may occur

Hypokalemia

  • Flattened T waves
  • U waves
  • Digoxin risk rises
  • Both threaten cardiac rhythm

Fluid and Electrolyte Patterns AS

  • Sodium 135-145 mEq/L
  • Potassium 3.5-5.0 mEq/L
  • ABG pH 7.35-7.45
  • PaCO2 35-45 mmHg
  • Bicarbonate 22-26 mEq/L
  • Hyperkalemia Peaked T; widening QRS
  • Hypokalemia Flat T; U waves
  • Hypocalcemia Tetany; Chvostek; Trousseau
  • Volume overload Crackles, edema, JVD, weight gain
  • Volume deficit Tachycardia, hypotension, low urine

DKA vs HHS AS

DKA

  • Ketosis prominent
  • Metabolic acidosis
  • Often faster onset

HHS

  • Hyperosmolality prominent
  • Minimal ketosis
  • Profound dehydration
  • Fluids precede insulin

Cardiopulmonary Patterns AS

  • Acute coronary syndrome Ischemic symptoms need rapid ECG
  • Troponin Trend myocardial injury
  • Left heart failure Dyspnea, crackles, orthopnea
  • Right heart failure JVD, edema, hepatomegaly
  • Peripheral arterial disease Claudication, coolness, weak pulses
  • Venous insufficiency Edema, warmth, stasis changes
  • Pulmonary embolism Sudden dyspnea, pleuritic pain
  • Pneumothorax Unilateral diminished breath sounds
  • Asthma danger Silent chest signals obstruction
  • Tension pneumothorax Hypotension, deviation, severe distress

Arterial vs Venous Disease AS

Arterial

  • Cool pale limb
  • Weak pulses
  • Dependent positioning helps

Venous

  • Warm edematous limb
  • Stasis changes
  • Elevation may help
  • Perfusion versus return failure

Neurologic and Endocrine Patterns AS

  • Acute stroke BE-FAST; establish last-known-well
  • Delirium Acute, fluctuating, inattentive
  • Dementia Chronic, progressive decline
  • GCS Eye, verbal, motor responses
  • DKA Hyperglycemia, ketosis, metabolic acidosis
  • HHS Hyperglycemia, hyperosmolality, minimal ketosis
  • Thyroid storm Fever, tachycardia, agitation
  • Myxedema coma Hypothermia, bradycardia, hypoventilation
  • SIADH Hyponatremia, concentrated urine
  • Diabetes insipidus Polyuria, dilute urine, hypernatremia

Delirium vs Dementia AS

Delirium

  • Acute onset
  • Fluctuating attention
  • Usually reversible cause

Dementia

  • Gradual onset
  • Progressive decline
  • Attention preserved early
  • Acute fluctuation signals delirium

GI, Renal, and Hematology Patterns AS

  • Upper GI bleeding Hematemesis or melena
  • Lower GI bleeding Usually hematochezia
  • Pancreatitis Epigastric pain; elevated lipase
  • Bowel obstruction Distention, vomiting, altered sounds
  • Prerenal AKI Renal hypoperfusion
  • Intrarenal AKI Direct kidney injury
  • Postrenal AKI Urinary outflow obstruction
  • Nephritic pattern Hematuria, hypertension, mild proteinuria
  • Nephrotic pattern Heavy proteinuria, edema, hypoalbuminemia
  • DIC Systemic coagulation and bleeding

Diagnostic Danger Signals AS

  • Rising troponin Escalate suspected myocardial injury
  • ANC below 500 Severe neutropenia
  • Lactate trend Tracks tissue hypoperfusion
  • Creatinine trend Tracks renal function change
  • Falling platelets Assess bleeding and HIT
  • Sudden hemoglobin drop Assess active bleeding
  • New ST elevation Activate emergency cardiac pathway
  • New focal deficit Activate stroke pathway
  • Pain with passive stretch Suspect compartment syndrome

AEIOU Dialysis Indications PL

  • Acidosis, Electrolytes, Intoxication, Overload, Uremia
  • Refractory acidosis Dangerous electrolytes Dialyzable toxins Refractory overload Uremic complications

Contact vs Droplet Precautions PL

Contact

  • Gown and gloves
  • Contaminated surfaces matter
  • Examples: C. difficile, MRSA

Droplet

  • Surgical mask
  • Close respiratory spread
  • Examples: influenza, meningococcus
  • Match PPE to transmission

Clinical Escalation Actions PL

  • Transfusion reaction suspected → Stop transfusion ( Keep IV with saline )
  • Hyperkalemic ECG changes → Cardiac monitoring immediately ( Anticipate IV calcium )
  • Conscious hypoglycemia → Give 15g carbohydrate ( Recheck after 15 minutes )
  • Unconscious hypoglycemia → Dextrose or glucagon ( Protect airway )
  • Stroke signs appear → Activate stroke pathway ( Document last-known-well )
  • Sepsis with hypoperfusion → Execute sepsis protocol ( Time-sensitive treatment )
  • Opioid sedation worsens → Support ventilation ( Prepare naloxone )

Emergency First Actions PL

  • Transfusion reaction Stop transfusion immediately
  • Anaphylaxis Give IM epinephrine
  • Seizure Protect airway; time event
  • Evisceration Cover with moist sterile dressing
  • Autonomic dysreflexia Sit upright; remove trigger
  • Hyperkalemic ECG changes Anticipate IV calcium
  • Opioid respiratory depression Ventilate and give naloxone
  • Hypoglycemia, conscious Give 15g fast carbohydrate
  • Suspected stroke Check glucose; activate pathway
  • Pulseless arrest Start CPR; activate code

ADPIE Nursing Process PL

  • Assess, Diagnose, Plan, Implement, Evaluate
  • Assess first Name problem Set outcomes Perform care Reassess results

Palliative vs Hospice Care PL

Palliative

  • Any serious illness stage
  • May accompany curative care
  • Symptom relief focus

Hospice

  • Comfort-focused care
  • Terminal prognosis criteria
  • May occur across settings
  • Both prioritize quality of life

Isolation Precaution Picker PL

  • Every patient encounter → Standard precautions ( Risk-based PPE )
  • C. difficile diarrhea → Contact precautions ( Soap-and-water handwashing )
  • Draining MRSA wound → Contact precautions ( Gown and gloves )
  • Influenza suspected → Droplet precautions ( Wear surgical mask )
  • Pulmonary TB suspected → Airborne precautions ( N95 and negative pressure )
  • Varicella suspected → Airborne plus contact ( Follow facility policy )

Medication Safety and Reversals PL

  • Unfractionated heparin Monitor aPTT or anti-Xa
  • Heparin reversal Protamine sulfate
  • Warfarin monitoring Use INR
  • Warfarin reversal Vitamin K; PCC if severe
  • Opioid reversal Naloxone; monitor re-sedation
  • Digoxin reversal Digoxin immune Fab
  • Acetaminophen reversal N-acetylcysteine
  • Magnesium toxicity Stop magnesium; give calcium
  • IV potassium Never administer IV push
  • PCA safety Only patient presses button

Infection Prevention and Precautions PL

  • Standard precautions Apply to every patient
  • Contact precautions Gown and gloves
  • Droplet precautions Wear surgical mask
  • Airborne precautions N95; negative-pressure room
  • C. difficile Contact plus soap-and-water
  • CAUTI prevention Remove catheter early
  • CLABSI prevention Scrub hub; assess necessity
  • VAP prevention Elevate head; oral care
  • Needlestick Wash, report, seek evaluation
  • Neutropenic fever Culture and escalate urgently

Teaching and Discharge Essentials PL

  • Teach-back Patient explains instructions
  • Return demonstration Verifies psychomotor learning
  • Heart failure Daily same-scale weights
  • Warfarin Keep vitamin K consistent
  • Diabetes sick-day Continue insulin; monitor frequently
  • Limited English Use qualified interpreter
  • Inhaler technique Demonstrate and verify technique
  • Postoperative lungs Cough, deep breathe, ambulate
  • Discharge planning Begin at admission
  • Readiness to learn Address pain and anxiety

Devices, Tubes, and Access PL

  • Initial NG placement Confirm radiographically
  • Enteral feeding Elevate head 30-45 degrees
  • Chest tube Keep system below chest
  • Continuous water-seal bubbles Suspect air leak
  • AV fistula Check thrill and bruit
  • Fistula arm No BP or venipuncture
  • Urinary drainage Bag stays below bladder
  • Healthy stoma Pink-red and moist
  • Central line Use sterile access technique

Wounds, Mobility, and Postoperative Care PL

  • Stage 1 pressure injury Nonblanchable intact skin
  • Stage 2 pressure injury Partial-thickness skin loss
  • Stage 3 pressure injury Full-thickness; fat visible
  • Stage 4 pressure injury Exposed deep structures
  • Unstageable injury Base obscured by tissue
  • Posterior hip precautions Avoid flexion, adduction, rotation
  • Cane use Hold on strong side
  • Suspected DVT Do not massage limb
  • Early ambulation Prevents multiple postoperative complications

SBAR Communication PR

  • Situation, Background, Assessment, Recommendation
  • Current problem Relevant history Clinical interpretation Requested action

Stable vs Unstable Assignment PR

Stable

  • Predictable course
  • Routine established care
  • May suit LPN/LVN

Unstable

  • Changing condition
  • Frequent reassessment
  • Requires RN judgment
  • Instability stays with RN

Delegation Assignment Picker PR

  • New or unstable patient → Assign RN ( Needs clinical judgment )
  • Initial assessment needed → Assign RN ( Never delegate assessment )
  • New teaching needed → Assign RN ( Reinforcement may vary )
  • Stable predictable care → Consider LPN/LVN ( Follow local scope )
  • Routine ADL task → Consider UAP ( Give clear directions )
  • Abnormal result reported → RN assesses ( RN evaluates response )

Delegation and Supervision PR

  • RN retains Assessment and clinical judgment
  • RN teaching Initial education stays RN
  • RN evaluation Outcome evaluation stays RN
  • LPN/LVN Stable predictable assignments
  • UAP Routine standardized tasks
  • Abnormal findings RN evaluates promptly
  • Delegation accountability RN remains accountable
  • Five rights Task, circumstance, person, direction, supervision
  • Scope limits Follow law and policy

PICO Evidence Question PR

  • Population, Intervention, Comparison, Outcome
  • Target population Planned intervention Comparison option Desired outcome

EBP vs Quality Improvement PR

EBP

  • Applies best evidence
  • Includes patient preferences
  • Answers clinical questions

QI

  • Improves local process
  • Uses local data
  • Tests workflow changes
  • Evidence guides; QI improves

Communication and Legal Duties PR

  • SBAR Situation, background, assessment, recommendation
  • CUS Concerned, uncomfortable, safety issue
  • Informed consent Provider explains; nurse witnesses
  • Treatment refusal Competent adult may refuse
  • Confidentiality Use minimum necessary information
  • Documentation Objective, timely, factual
  • Incident report Quality record, not charted
  • Advance directive Records future care wishes
  • POLST Portable medical orders
  • Chain of command Escalate unresolved safety concerns

Five Delegation Rights PR

  • Task, Circumstance, Person, Direction, Supervision
  • Right task Right circumstance Right person Right directions Right supervision

Ethics, Evidence, and Quality PR

  • Autonomy Respect informed choices
  • Beneficence Promote patient good
  • Nonmaleficence Avoid preventable harm
  • Justice Distribute care fairly
  • Veracity Tell the truth
  • Fidelity Keep professional commitments
  • PICO Frames searchable clinical question
  • PDSA Tests small process changes
  • Root cause analysis Retrospective event review
  • FMEA Prospective risk analysis
  • Just culture Balances learning and accountability

Common Traps

Pretest Items Look Identical

  • Twenty-five items are unscored ≠ Answer every question

Scaled Score Is Not Percentage

  • Passing score is 350 ≠ Raw score gets converted

Assess Before Acting

  • Use nursing process ≠ Emergencies are exceptions

Stop Blood Before Calling

  • Stop suspected reaction first ≠ Then notify and investigate

Alcohol Rub Misses Spores

  • C. difficile needs soap ≠ Use contact precautions

Potassium Is Never IV Push

  • Dilute before infusion ≠ Use controlled pump rate

Delegation Keeps Accountability

  • RN chooses appropriate task ≠ RN evaluates outcomes

Nurse Does Not Obtain Consent

  • Provider explains procedure ≠ Nurse witnesses signature

PCA Means Patient Only

  • No family proxy dosing ≠ Monitor sedation closely

Last Minute

  • 1. Know 39-40-21 domain weights
  • 2. Answer all 150 questions
  • 3. Use ABCs before comfort
  • 4. Assess unless immediate danger
  • 5. Trend labs, not snapshots
  • 6. Recognize potassium ECG changes
  • 7. Stop suspected transfusion reactions
  • 8. Never IV-push potassium
  • 9. Check glucose during neuro changes
  • 10. Match isolation to transmission
  • 11. Use teach-back before discharge
  • 12. Keep unstable patients with RN
  • 13. Escalate unresolved safety concerns
  • 14. Separate EBP from QI
  • 15. Reassess every intervention

ANCC-MEDSURG-BC

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