,Adult Medical-Surgical Nursing and
NCLEX-RN Practice Exam – Updated 2026
(Graded A+)
Subject: Adult Medical-Surgical Nursing
Subtopic: Cardiovascular and Respiratory Management
Question 1: A client is admitted with a diagnosis of acute heart failure. The nurse assesses the
client and notes bilateral crackles in the lungs, an $S_3$ heart sound, and dyspnea. Which
intervention should the nurse prioritize in the plan of care?
A) Administering a bolus of intravenous normal saline as prescribed.
B) Placing the client in a high-Fowler’s position.
C) Encouraging the client to perform active range-of-motion exercises.
D) Monitoring the client’s serum potassium levels every 2 hours.
Correct Answer: B - Placing the client in a high-Fowler’s position.
Rationale: The client is exhibiting signs of fluid volume overload and pulmonary congestion
(crackles, $S_3$ heart sound, dyspnea). Placing the client in a high-Fowler’s position decreases
venous return to the heart and reduces the work of breathing, improving oxygenation. Option A
is contraindicated as fluid volume overload is already present. Option C increases cardiac
demand, which is detrimental during acute failure. Option D is a routine nursing task but not the
immediate priority for respiratory distress.
Question 2: A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
therapy at 2 L/min via nasal cannula. The nurse notes the client’s oxygen saturation is 88%.
Which action is most appropriate?
A) Increasing the oxygen flow rate to 6 L/min to reach 95% saturation.
B) Assessing the client’s respiratory rate, depth, and level of consciousness.
C) Immediately initiating mechanical ventilation.
D) Discontinuing the oxygen therapy to prevent carbon dioxide narcosis.
Correct Answer: B - Assessing the client’s respiratory rate, depth, and level of
consciousness.
, Rationale: For clients with COPD, an oxygen saturation of 88–92% is often the therapeutic goal
to prevent the suppression of the hypoxic drive. The nurse must first perform a clinical
assessment to determine if the client is tolerating this saturation level before making
adjustments. Option A could be dangerous by suppressing the client's drive to breathe. Option C
is premature without clinical decompensation. Option D is incorrect as oxygen is still required.
Question 3: A nurse is caring for a client who had a cardiac catheterization via the femoral artery
2 hours ago. Which finding requires immediate notification of the healthcare provider?
A) The pedal pulse in the affected extremity is 1+ and diminished compared to the contralateral
side.
B) The client reports a mild aching sensation at the insertion site.
C) The client’s blood pressure is 118/76 mmHg.
D) The insertion site dressing is dry and intact.
Correct Answer: A - The pedal pulse in the affected extremity is 1+ and diminished
compared to the contralateral side.
Rationale: A diminished or absent pulse compared to the baseline or contralateral extremity
after a cardiac catheterization indicates potential arterial occlusion or hemorrhage and is a
medical emergency. Option B is an expected post-procedural finding. Options C and D are
stable, expected findings.
Question 4: A client is scheduled for a thoracentesis. During the procedure, the client begins to
cough violently and complains of sharp chest pain. What is the nurse's priority action?
A) Continue the procedure as the client is experiencing normal discomfort.
B) Stop the procedure and assess for signs of pneumothorax.
C) Instruct the client to take deep, rapid breaths.
D) Increase the suction pressure to clear the airway.
Correct Answer: B - Stop the procedure and assess for signs of pneumothorax.
Rationale: Sudden onset of sharp chest pain, dyspnea, and coughing during or after a
thoracentesis are classic signs of a pneumothorax (lung puncture). The procedure must be halted
immediately for assessment. Option A is dangerous. Option C could worsen a potential injury.
Option D is inappropriate as suction is not used to manage a suspected pneumothorax.
Question 5: A nurse identifies the rhythm shown above on a client’s cardiac monitor. Which
medication does the nurse anticipate the provider will order to address this dysrhythmia?
NCLEX-RN Practice Exam – Updated 2026
(Graded A+)
Subject: Adult Medical-Surgical Nursing
Subtopic: Cardiovascular and Respiratory Management
Question 1: A client is admitted with a diagnosis of acute heart failure. The nurse assesses the
client and notes bilateral crackles in the lungs, an $S_3$ heart sound, and dyspnea. Which
intervention should the nurse prioritize in the plan of care?
A) Administering a bolus of intravenous normal saline as prescribed.
B) Placing the client in a high-Fowler’s position.
C) Encouraging the client to perform active range-of-motion exercises.
D) Monitoring the client’s serum potassium levels every 2 hours.
Correct Answer: B - Placing the client in a high-Fowler’s position.
Rationale: The client is exhibiting signs of fluid volume overload and pulmonary congestion
(crackles, $S_3$ heart sound, dyspnea). Placing the client in a high-Fowler’s position decreases
venous return to the heart and reduces the work of breathing, improving oxygenation. Option A
is contraindicated as fluid volume overload is already present. Option C increases cardiac
demand, which is detrimental during acute failure. Option D is a routine nursing task but not the
immediate priority for respiratory distress.
Question 2: A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
therapy at 2 L/min via nasal cannula. The nurse notes the client’s oxygen saturation is 88%.
Which action is most appropriate?
A) Increasing the oxygen flow rate to 6 L/min to reach 95% saturation.
B) Assessing the client’s respiratory rate, depth, and level of consciousness.
C) Immediately initiating mechanical ventilation.
D) Discontinuing the oxygen therapy to prevent carbon dioxide narcosis.
Correct Answer: B - Assessing the client’s respiratory rate, depth, and level of
consciousness.
, Rationale: For clients with COPD, an oxygen saturation of 88–92% is often the therapeutic goal
to prevent the suppression of the hypoxic drive. The nurse must first perform a clinical
assessment to determine if the client is tolerating this saturation level before making
adjustments. Option A could be dangerous by suppressing the client's drive to breathe. Option C
is premature without clinical decompensation. Option D is incorrect as oxygen is still required.
Question 3: A nurse is caring for a client who had a cardiac catheterization via the femoral artery
2 hours ago. Which finding requires immediate notification of the healthcare provider?
A) The pedal pulse in the affected extremity is 1+ and diminished compared to the contralateral
side.
B) The client reports a mild aching sensation at the insertion site.
C) The client’s blood pressure is 118/76 mmHg.
D) The insertion site dressing is dry and intact.
Correct Answer: A - The pedal pulse in the affected extremity is 1+ and diminished
compared to the contralateral side.
Rationale: A diminished or absent pulse compared to the baseline or contralateral extremity
after a cardiac catheterization indicates potential arterial occlusion or hemorrhage and is a
medical emergency. Option B is an expected post-procedural finding. Options C and D are
stable, expected findings.
Question 4: A client is scheduled for a thoracentesis. During the procedure, the client begins to
cough violently and complains of sharp chest pain. What is the nurse's priority action?
A) Continue the procedure as the client is experiencing normal discomfort.
B) Stop the procedure and assess for signs of pneumothorax.
C) Instruct the client to take deep, rapid breaths.
D) Increase the suction pressure to clear the airway.
Correct Answer: B - Stop the procedure and assess for signs of pneumothorax.
Rationale: Sudden onset of sharp chest pain, dyspnea, and coughing during or after a
thoracentesis are classic signs of a pneumothorax (lung puncture). The procedure must be halted
immediately for assessment. Option A is dangerous. Option C could worsen a potential injury.
Option D is inappropriate as suction is not used to manage a suspected pneumothorax.
Question 5: A nurse identifies the rhythm shown above on a client’s cardiac monitor. Which
medication does the nurse anticipate the provider will order to address this dysrhythmia?
