Comprehensive Medical-Surgical Nursing Prac ce Exam
NCLEX-Style Mul ple-Choice Ques ons | Applica on & Analysis Level
Ques on 1: Acute Heart Failure and Pulmonary Edema
Clinical Scenario: A 72-year-old client with a history of heart failure with reduced
ejec on frac on is admi ed with worsening dyspnea and bilateral lower-extremity
edema. The client is anxious, si ng upright, has a respiratory rate of 32/min, SpO₂ of
84% on room air, BP 168/94 mmHg, and bilateral coarse crackles extending to the mid-
lung fields.
Ques on Stem: Which ac on should the nurse take first?
Op ons:
o A. Administer IV furosemide as prescribed.
o B. Apply supplemental oxygen and posi on the client upright.
o C. Obtain the client's current serum potassium level.
o D. Restrict the client's oral fluid intake.
Answer and Ra onale
Correct Answer: B. Apply supplemental oxygen and posi on the client upright.
Cogni ve Level: Analyzing
Client Needs Category: Physiological Adapta on
Main Lesson / Takeaway: In acute pulmonary edema, immediate support of oxygena on
and ven la on takes priority before defini ve treatment.
, Detailed Ra onale: The client has severe hypoxemia, tachypnea, crackles, and clinical
evidence of acute pulmonary edema. Using the ABCs, oxygena on is the immediate
priority. Posi oning the client upright decreases venous return and improves lung
expansion, while supplemental oxygen addresses the dangerously low oxygen
satura on. IV loop diure cs will help remove excess fluid but do not correct the
immediate oxygena on problem as rapidly.
o A. Incorrect: IV furosemide is an important treatment for fluid overload, but the
client's immediate problem is severe hypoxemia. Airway and breathing
interven ons should occur first.
o C. Incorrect: Potassium monitoring is important because furosemide can cause
hypokalemia, but obtaining the laboratory value does not address the client's
current respiratory compromise.
o D. Incorrect: Fluid restric on may be appropriate for ongoing heart-failure
management, but it is not the immediate interven on for severe hypoxemia.
Ques on 2: Acute Ischemic Stroke
Clinical Scenario: A 68-year-old client with hypertension and atrial fibrilla on suddenly
develops right-sided weakness and expressive aphasia while ea ng breakfast. Symptoms
began approximately 45 minutes ago; BP is 178/96 mmHg, glucose is 104 mg/dL, and
the client is awake but unable to clearly ar culate words.
Ques on Stem: Which ac on is the nurse's priority?
Op ons:
o A. Administer aspirin immediately.
o B. Lower the blood pressure rapidly with IV an hypertensive medica on.
, o C. Determine the exact me the client was last known to be neurologically
normal.
o D. Give the client oral fluids to prevent dehydra on.
Answer and Ra onale
Correct Answer: C. Determine the exact me the client was last known to be
neurologically normal.
Cogni ve Level: Analyzing
Client Needs Category: Reduc on of Risk Poten al
Main Lesson / Takeaway: Establishing the last-known-well me is cri cal because me-
dependent stroke therapies have strict eligibility windows.
Detailed Ra onale: The sudden focal neurologic deficits strongly suggest an acute
stroke. Determining the last-known-well me is essen al for rapid stroke evalua on and
determining eligibility for reperfusion therapy. The nurse should ac vate the facility's
stroke response while con nuing rapid assessment and prepara on for diagnos c
imaging.
o A. Incorrect: Aspirin may be administered a er hemorrhage has been excluded
by appropriate imaging; giving it immediately could be harmful if the stroke is
hemorrhagic.
o B. Incorrect: Moderate hypertension can occur during acute ischemic stroke and
may support cerebral perfusion. Rapid reduc on without an appropriate
indica on can worsen cerebral ischemia.
o D. Incorrect: Oral fluids are unsafe because the client may have dysphagia and an
increased aspira on risk.
Ques on 3: Diabe c Ketoacidosis
, Clinical Scenario: A 24-year-old client with type 1 diabetes presents with vomi ng,
abdominal pain, and deep, rapid respira ons. Laboratory results include glucose 548
mg/dL, pH 7.18, bicarbonate 11 mEq/L, potassium 5.6 mEq/L, and posi ve serum
ketones; BP is 94/58 mmHg and heart rate is 124/min.
Ques on Stem: Which prescribed interven on should the nurse implement first?
Op ons:
o A. Begin IV regular insulin infusion.
o B. Administer IV isotonic crystalloid solu on.
o C. Administer IV potassium replacement.
o D. Administer IV sodium bicarbonate.
Answer and Ra onale
Correct Answer: B. Administer IV isotonic crystalloid solu on.
Cogni ve Level: Analyzing
Client Needs Category: Physiological Adapta on
Main Lesson / Takeaway: Ini al DKA management priori zes restora on of circula ng
volume before insulin and electrolyte correc on.
Detailed Ra onale: The client is hypotensive and tachycardic, indica ng significant
dehydra on and intravascular volume deple on. Ini al treatment generally involves
isotonic IV fluid replacement to restore perfusion. Insulin is subsequently essen al to
stop ketogenesis and lower glucose, but severe volume deple on should first be
addressed.
o A. Incorrect: Insulin is necessary, but ini a ng it before ini al fluid resuscita on
in a significantly volume-depleted client is not the immediate priority.
NCLEX-Style Mul ple-Choice Ques ons | Applica on & Analysis Level
Ques on 1: Acute Heart Failure and Pulmonary Edema
Clinical Scenario: A 72-year-old client with a history of heart failure with reduced
ejec on frac on is admi ed with worsening dyspnea and bilateral lower-extremity
edema. The client is anxious, si ng upright, has a respiratory rate of 32/min, SpO₂ of
84% on room air, BP 168/94 mmHg, and bilateral coarse crackles extending to the mid-
lung fields.
Ques on Stem: Which ac on should the nurse take first?
Op ons:
o A. Administer IV furosemide as prescribed.
o B. Apply supplemental oxygen and posi on the client upright.
o C. Obtain the client's current serum potassium level.
o D. Restrict the client's oral fluid intake.
Answer and Ra onale
Correct Answer: B. Apply supplemental oxygen and posi on the client upright.
Cogni ve Level: Analyzing
Client Needs Category: Physiological Adapta on
Main Lesson / Takeaway: In acute pulmonary edema, immediate support of oxygena on
and ven la on takes priority before defini ve treatment.
, Detailed Ra onale: The client has severe hypoxemia, tachypnea, crackles, and clinical
evidence of acute pulmonary edema. Using the ABCs, oxygena on is the immediate
priority. Posi oning the client upright decreases venous return and improves lung
expansion, while supplemental oxygen addresses the dangerously low oxygen
satura on. IV loop diure cs will help remove excess fluid but do not correct the
immediate oxygena on problem as rapidly.
o A. Incorrect: IV furosemide is an important treatment for fluid overload, but the
client's immediate problem is severe hypoxemia. Airway and breathing
interven ons should occur first.
o C. Incorrect: Potassium monitoring is important because furosemide can cause
hypokalemia, but obtaining the laboratory value does not address the client's
current respiratory compromise.
o D. Incorrect: Fluid restric on may be appropriate for ongoing heart-failure
management, but it is not the immediate interven on for severe hypoxemia.
Ques on 2: Acute Ischemic Stroke
Clinical Scenario: A 68-year-old client with hypertension and atrial fibrilla on suddenly
develops right-sided weakness and expressive aphasia while ea ng breakfast. Symptoms
began approximately 45 minutes ago; BP is 178/96 mmHg, glucose is 104 mg/dL, and
the client is awake but unable to clearly ar culate words.
Ques on Stem: Which ac on is the nurse's priority?
Op ons:
o A. Administer aspirin immediately.
o B. Lower the blood pressure rapidly with IV an hypertensive medica on.
, o C. Determine the exact me the client was last known to be neurologically
normal.
o D. Give the client oral fluids to prevent dehydra on.
Answer and Ra onale
Correct Answer: C. Determine the exact me the client was last known to be
neurologically normal.
Cogni ve Level: Analyzing
Client Needs Category: Reduc on of Risk Poten al
Main Lesson / Takeaway: Establishing the last-known-well me is cri cal because me-
dependent stroke therapies have strict eligibility windows.
Detailed Ra onale: The sudden focal neurologic deficits strongly suggest an acute
stroke. Determining the last-known-well me is essen al for rapid stroke evalua on and
determining eligibility for reperfusion therapy. The nurse should ac vate the facility's
stroke response while con nuing rapid assessment and prepara on for diagnos c
imaging.
o A. Incorrect: Aspirin may be administered a er hemorrhage has been excluded
by appropriate imaging; giving it immediately could be harmful if the stroke is
hemorrhagic.
o B. Incorrect: Moderate hypertension can occur during acute ischemic stroke and
may support cerebral perfusion. Rapid reduc on without an appropriate
indica on can worsen cerebral ischemia.
o D. Incorrect: Oral fluids are unsafe because the client may have dysphagia and an
increased aspira on risk.
Ques on 3: Diabe c Ketoacidosis
, Clinical Scenario: A 24-year-old client with type 1 diabetes presents with vomi ng,
abdominal pain, and deep, rapid respira ons. Laboratory results include glucose 548
mg/dL, pH 7.18, bicarbonate 11 mEq/L, potassium 5.6 mEq/L, and posi ve serum
ketones; BP is 94/58 mmHg and heart rate is 124/min.
Ques on Stem: Which prescribed interven on should the nurse implement first?
Op ons:
o A. Begin IV regular insulin infusion.
o B. Administer IV isotonic crystalloid solu on.
o C. Administer IV potassium replacement.
o D. Administer IV sodium bicarbonate.
Answer and Ra onale
Correct Answer: B. Administer IV isotonic crystalloid solu on.
Cogni ve Level: Analyzing
Client Needs Category: Physiological Adapta on
Main Lesson / Takeaway: Ini al DKA management priori zes restora on of circula ng
volume before insulin and electrolyte correc on.
Detailed Ra onale: The client is hypotensive and tachycardic, indica ng significant
dehydra on and intravascular volume deple on. Ini al treatment generally involves
isotonic IV fluid replacement to restore perfusion. Insulin is subsequently essen al to
stop ketogenesis and lower glucose, but severe volume deple on should first be
addressed.
o A. Incorrect: Insulin is necessary, but ini a ng it before ini al fluid resuscita on
in a significantly volume-depleted client is not the immediate priority.
