1|Page
MEDICAL-SURGICAL NURSING 11TH
EDITION — NGN CASE STUDY
PRACTICE EXAM [QUESTION 1-100]
AND ANSWERS UPDATED 2026/2027 |
100% VERIFIED | DETAILED
RATIONALES – PASS GUARANTEED A+
GRADED | INSTANT DOWNLOAD
INTRODUCTION
The Medical-Surgical Nursing 11th Edition — NGN Case Study Practice Exam is an
advanced practice assessment designed to strengthen clinical judgment, prioritization, and
decision-making in complex adult medical-surgical situations. It is intended for nursing students
preparing for comprehensive medical-surgical examinations, clinical evaluations, and Next
Generation NCLEX-style assessments. Rather than emphasizing simple recall, the questions
require the learner to recognize meaningful clinical cues, analyze trends, establish priorities,
select safe interventions, and evaluate outcomes.
The practice exam uses realistic patient scenarios involving cardiovascular, respiratory,
neurological, renal, endocrine, gastrointestinal, infectious, hematological, oncological, and
multisystem disorders. Questions progressively challenge the learner to connect assessment
findings with pathophysiology and nursing priorities. Each item contains four options with one
best answer and a detailed rationale explaining the clinical reasoning behind the answer and why
competing choices are less appropriate. Consistent practice with these scenarios can improve
recognition of deterioration, prioritization of nursing actions, and application of evidence-based
medical-surgical principles. Use the questions actively: identify the cues first, determine the
immediate threat, choose the safest intervention, and then compare your reasoning with the
rationale.
Study note: This is an original NGN-style practice resource based on medical-surgical nursing
concepts. It is not an official publisher examination, proprietary test bank, or guarantee of an
actual examination result.
CONTENT AREA OVERVIEW
Content Area Questions Key Topics Weight
Cardiovascular Clinical ACS, HF, dysrhythmias, shock, vascular
1–12 12%
Judgment disorders
,2|Page
Content Area Questions Key Topics Weight
COPD, asthma, pneumonia, PE, ARDS,
Respiratory Clinical Judgment 13–24 12%
airway emergencies
Neurological Disorders 25–34 Stroke, ICP, seizures, spinal cord injury 10%
AKI, CKD, dialysis, potassium, sodium,
Renal & Electrolytes 35–44 10%
acid-base
Endocrine Disorders 45–54 DKA, HHS, thyroid/adrenal emergencies 10%
GI bleeding, obstruction, pancreatitis,
GI & Hepatic Disorders 55–64 10%
cirrhosis
Sepsis, shock, isolation,
Infection & Sepsis 65–72 8%
immunocompromise
Neutropenia, transfusion, tumor lysis,
Oncology & Hematology 73–80 8%
bleeding
Burns, fractures, compartment syndrome,
Musculoskeletal/Integumentary 81–86 6%
wounds
Multisystem Prioritization 87–94 Deterioration, ABCs, prioritization, safety 8%
Delegation & Clinical
95–100 Delegation, evaluation, care coordination 6%
Evaluation
QUESTIONS 1–100
CASE STUDY 1 — ACUTE CORONARY SYNDROME
A 67-year-old client with hypertension and hyperlipidemia presents with crushing substernal
chest pressure radiating to the jaw. The client is diaphoretic and nauseated. BP is 92/58 mmHg,
HR 118/min, RR 26/min, and SpO₂ 91%.
Q1:
Which finding requires the nurse's most immediate attention?
A) Nausea
B) Hypotension with ongoing ischemic chest pain
C) Hyperlipidemia history
D) Mild tachypnea
Rationale: B is correct because hypotension accompanying ongoing ischemic symptoms suggests
compromised cardiac output and possible evolving cardiogenic shock. Nausea and tachypnea
are important associated findings but are not as immediately threatening. Hyperlipidemia is a
risk factor rather than an acute problem.
,3|Page
Q2:
Which prescription should the nurse question based on the client's current assessment?
A) Continuous ECG monitoring
B) Serial cardiac biomarkers
C) Sublingual nitroglycerin despite BP of 92/58 mmHg
D) Supplemental oxygen as clinically indicated
Rationale: C is correct because nitroglycerin can further reduce preload and blood pressure and
is generally avoided in significant hypotension. ECG monitoring and serial biomarkers are
appropriate for suspected acute coronary syndrome. Oxygen may be indicated because the
client's saturation is low.
Q3:
The client develops pulmonary crackles, increasing respiratory distress, and pink frothy sputum.
Which complication is most likely?
A) Right-sided heart failure only
B) Acute cardiogenic pulmonary edema
C) Stable angina
D) Deep-vein thrombosis
Rationale: B is correct because crackles, severe respiratory distress, and pink frothy sputum are
characteristic of acute pulmonary edema caused by left ventricular failure. Stable angina does
not cause these findings, and DVT does not explain acute pulmonary edema.
Q4:
Which change best indicates worsening cardiac output?
A) Heart rate decreases from 118 to 104/min
B) Chest pressure decreases
C) Urine output falls to 15 mL/hr and the client becomes confused
D) Respiratory rate decreases from 26 to 22/min
Rationale: C is correct because oliguria and acute confusion indicate reduced renal and
cerebral perfusion, respectively. The other findings suggest improvement or are less specific for
systemic hypoperfusion.
Q5:
The client develops ventricular tachycardia with a pulse and BP 78/40 mmHg. Which
intervention should the nurse anticipate?
, 4|Page
A) Routine oral medication
B) Urgent synchronized cardioversion
C) Ambulation
D) Delayed reassessment
Rationale: B is correct because unstable ventricular tachycardia with a pulse requires
immediate synchronized cardioversion. The hypotension demonstrates hemodynamic instability.
Oral therapy or observation would dangerously delay definitive treatment.
Q6:
After stabilization, which finding best demonstrates improved tissue perfusion?
A) Increasing confusion
B) Cool, mottled skin
C) Urine output increases to 40 mL/hr with improved mentation
D) Increasing lactate
Rationale: C is correct because improved urine output and mental status indicate better renal
and cerebral perfusion. Confusion, mottling, and increasing lactate indicate persistent or
worsening hypoperfusion.
Q7:
Which laboratory result would most strongly support myocardial injury?
A) Sodium 139 mEq/L
B) Hemoglobin 13 g/dL
C) Elevated cardiac troponin
D) Calcium 9.2 mg/dL
Rationale: C is correct because cardiac troponin is a highly sensitive and specific marker of
myocardial injury when interpreted in the clinical context. The other values do not specifically
indicate myocardial injury.
Q8:
The client asks why continuous ECG monitoring is necessary. Which response is best?
A) "It measures your cholesterol."
B) "It allows us to detect potentially dangerous rhythm changes caused by myocardial
ischemia."
C) "It prevents another heart attack."
D) "It replaces blood testing."
MEDICAL-SURGICAL NURSING 11TH
EDITION — NGN CASE STUDY
PRACTICE EXAM [QUESTION 1-100]
AND ANSWERS UPDATED 2026/2027 |
100% VERIFIED | DETAILED
RATIONALES – PASS GUARANTEED A+
GRADED | INSTANT DOWNLOAD
INTRODUCTION
The Medical-Surgical Nursing 11th Edition — NGN Case Study Practice Exam is an
advanced practice assessment designed to strengthen clinical judgment, prioritization, and
decision-making in complex adult medical-surgical situations. It is intended for nursing students
preparing for comprehensive medical-surgical examinations, clinical evaluations, and Next
Generation NCLEX-style assessments. Rather than emphasizing simple recall, the questions
require the learner to recognize meaningful clinical cues, analyze trends, establish priorities,
select safe interventions, and evaluate outcomes.
The practice exam uses realistic patient scenarios involving cardiovascular, respiratory,
neurological, renal, endocrine, gastrointestinal, infectious, hematological, oncological, and
multisystem disorders. Questions progressively challenge the learner to connect assessment
findings with pathophysiology and nursing priorities. Each item contains four options with one
best answer and a detailed rationale explaining the clinical reasoning behind the answer and why
competing choices are less appropriate. Consistent practice with these scenarios can improve
recognition of deterioration, prioritization of nursing actions, and application of evidence-based
medical-surgical principles. Use the questions actively: identify the cues first, determine the
immediate threat, choose the safest intervention, and then compare your reasoning with the
rationale.
Study note: This is an original NGN-style practice resource based on medical-surgical nursing
concepts. It is not an official publisher examination, proprietary test bank, or guarantee of an
actual examination result.
CONTENT AREA OVERVIEW
Content Area Questions Key Topics Weight
Cardiovascular Clinical ACS, HF, dysrhythmias, shock, vascular
1–12 12%
Judgment disorders
,2|Page
Content Area Questions Key Topics Weight
COPD, asthma, pneumonia, PE, ARDS,
Respiratory Clinical Judgment 13–24 12%
airway emergencies
Neurological Disorders 25–34 Stroke, ICP, seizures, spinal cord injury 10%
AKI, CKD, dialysis, potassium, sodium,
Renal & Electrolytes 35–44 10%
acid-base
Endocrine Disorders 45–54 DKA, HHS, thyroid/adrenal emergencies 10%
GI bleeding, obstruction, pancreatitis,
GI & Hepatic Disorders 55–64 10%
cirrhosis
Sepsis, shock, isolation,
Infection & Sepsis 65–72 8%
immunocompromise
Neutropenia, transfusion, tumor lysis,
Oncology & Hematology 73–80 8%
bleeding
Burns, fractures, compartment syndrome,
Musculoskeletal/Integumentary 81–86 6%
wounds
Multisystem Prioritization 87–94 Deterioration, ABCs, prioritization, safety 8%
Delegation & Clinical
95–100 Delegation, evaluation, care coordination 6%
Evaluation
QUESTIONS 1–100
CASE STUDY 1 — ACUTE CORONARY SYNDROME
A 67-year-old client with hypertension and hyperlipidemia presents with crushing substernal
chest pressure radiating to the jaw. The client is diaphoretic and nauseated. BP is 92/58 mmHg,
HR 118/min, RR 26/min, and SpO₂ 91%.
Q1:
Which finding requires the nurse's most immediate attention?
A) Nausea
B) Hypotension with ongoing ischemic chest pain
C) Hyperlipidemia history
D) Mild tachypnea
Rationale: B is correct because hypotension accompanying ongoing ischemic symptoms suggests
compromised cardiac output and possible evolving cardiogenic shock. Nausea and tachypnea
are important associated findings but are not as immediately threatening. Hyperlipidemia is a
risk factor rather than an acute problem.
,3|Page
Q2:
Which prescription should the nurse question based on the client's current assessment?
A) Continuous ECG monitoring
B) Serial cardiac biomarkers
C) Sublingual nitroglycerin despite BP of 92/58 mmHg
D) Supplemental oxygen as clinically indicated
Rationale: C is correct because nitroglycerin can further reduce preload and blood pressure and
is generally avoided in significant hypotension. ECG monitoring and serial biomarkers are
appropriate for suspected acute coronary syndrome. Oxygen may be indicated because the
client's saturation is low.
Q3:
The client develops pulmonary crackles, increasing respiratory distress, and pink frothy sputum.
Which complication is most likely?
A) Right-sided heart failure only
B) Acute cardiogenic pulmonary edema
C) Stable angina
D) Deep-vein thrombosis
Rationale: B is correct because crackles, severe respiratory distress, and pink frothy sputum are
characteristic of acute pulmonary edema caused by left ventricular failure. Stable angina does
not cause these findings, and DVT does not explain acute pulmonary edema.
Q4:
Which change best indicates worsening cardiac output?
A) Heart rate decreases from 118 to 104/min
B) Chest pressure decreases
C) Urine output falls to 15 mL/hr and the client becomes confused
D) Respiratory rate decreases from 26 to 22/min
Rationale: C is correct because oliguria and acute confusion indicate reduced renal and
cerebral perfusion, respectively. The other findings suggest improvement or are less specific for
systemic hypoperfusion.
Q5:
The client develops ventricular tachycardia with a pulse and BP 78/40 mmHg. Which
intervention should the nurse anticipate?
, 4|Page
A) Routine oral medication
B) Urgent synchronized cardioversion
C) Ambulation
D) Delayed reassessment
Rationale: B is correct because unstable ventricular tachycardia with a pulse requires
immediate synchronized cardioversion. The hypotension demonstrates hemodynamic instability.
Oral therapy or observation would dangerously delay definitive treatment.
Q6:
After stabilization, which finding best demonstrates improved tissue perfusion?
A) Increasing confusion
B) Cool, mottled skin
C) Urine output increases to 40 mL/hr with improved mentation
D) Increasing lactate
Rationale: C is correct because improved urine output and mental status indicate better renal
and cerebral perfusion. Confusion, mottling, and increasing lactate indicate persistent or
worsening hypoperfusion.
Q7:
Which laboratory result would most strongly support myocardial injury?
A) Sodium 139 mEq/L
B) Hemoglobin 13 g/dL
C) Elevated cardiac troponin
D) Calcium 9.2 mg/dL
Rationale: C is correct because cardiac troponin is a highly sensitive and specific marker of
myocardial injury when interpreted in the clinical context. The other values do not specifically
indicate myocardial injury.
Q8:
The client asks why continuous ECG monitoring is necessary. Which response is best?
A) "It measures your cholesterol."
B) "It allows us to detect potentially dangerous rhythm changes caused by myocardial
ischemia."
C) "It prevents another heart attack."
D) "It replaces blood testing."
