Medical-Surgical Nursing Comprehensive Review 2026–2027
EXAM REVIEW
2026–2027
PRACTICE QUESTIONS WITH
ANSWERS, DETAILED RATIONALES &
OPTION ANALYSIS
Medical-Surgical Nursing Comprehensive Review 2026–2027 | Practice Resource • Page 1
, Medical-Surgical Nursing Comprehensive Review 2026–2027
Medical-Surgical Nursing Comprehensive Review 2026–2027
Practice Questions & Detailed Rationales
This comprehensive review covers high-yield medical-surgical
nursing content organized by body system. Each question follows NCLEX-style
formatting with detailed rationales explaining both the correct answer and why
other options are incorrect.
Domain 1: Cardiovascular Disorders
Domain 1: Cardiovascular Disorders
Question 1
A patient with chronic heart failure presents with a
potassium level of 6.2 mEq/L. Which electrocardiogram (ECG) change should the
nurse expect to see first?
Options
A. Prominent U waves
B. Prolonged QT interval
C. ST-segment depression
D. Peaked T waves
Correct Answer: D. Peaked T waves
Detailed Rationale
Hyperkalemia (serum potassium greater than 5.0 mEq/L) typically manifests on an
ECG as tall, peaked T waves, which is a priority assessment due to the risk of
lethal dysrhythmias . The peaked T waves represent the initial cardiac
conduction disturbance as elevated extracellular potassium alters the resting
membrane potential, accelerating repolarization. This finding is clinically
significant because untreated hyperkalemia can progress to widened QRS
complexes, loss of P waves, and ultimately ventricular fibrillation or
asystole.
Why the Other Options Are Incorrect
• A. Prominent U waves: U waves are classically associated with hypokalemia, not hyperkalemia.
• B. Prolonged QT interval: This is associated with hypocalcemia and certain medication toxicities, not the
initial presentation of hyperkalemia.
• C. ST-segment depression: This indicates myocardial ischemia or injury, not the conduction changes of
hyperkalemia.
Clinical Pearl: In a patient with heart failure, hyperkalemia often results from medications such as ACE inhibitors,
ARBs, or potassium-sparing diuretics. The nurse should anticipate orders for potassium-lowering interventions such
as sodium polystyrene sulfonate, insulin with dextrose, or calcium gluconate for cardiac membrane stabilization.
Medical-Surgical Nursing Comprehensive Review 2026–2027 | Practice Resource • Page 2
, Medical-Surgical Nursing Comprehensive Review 2026–2027
Question 2
A 55-year-old male is admitted with chest pain. His ECG
shows ST-segment elevation in leads II, III, and aVF. His pain is not relieved
by sublingual nitroglycerin. Which of the following is the most appropriate
next step?
Options
A. Prepare for emergent PCI or thrombolytic therapy
B. Administer morphine sulfate 4 mg IV
C. Administer aspirin 324 mg chewed
D. Obtain a chest X-ray
Correct Answer: A. Prepare for emergent PCI or
Detailed Rationale
This patient is experiencing an acute ST-elevation myocardial infarction
(STEMI), specifically an inferior wall MI indicated by ST elevation in leads
II, III, and aVF . The priority intervention for STEMI is immediate reperfusion
therapy—either emergent percutaneous coronary intervention (PCI) if available
within 90 minutes, or thrombolytic therapy if PCI is not available. Time is
muscle in acute MI, and reperfusion is the definitive treatment that restores
blood flow to the ischemic myocardium.
Why the Other Options Are Incorrect
• B. Administer morphine sulfate: While morphine may be used for pain management in acute coronary
syndrome, it does not address the underlying coronary occlusion and would delay definitive reperfusion therapy.
• C. Administer aspirin: Aspirin should already have been given as a standard intervention for suspected acute
coronary syndrome. While important, it is not the definitive treatment for STEMI.
• D. Obtain a chest X-ray: This is a diagnostic study that would delay life-saving reperfusion therapy and is not
the priority in a confirmed STEMI.
Clinical Pearl: Inferior wall MI (leads II, III, aVF) may be accompanied by bradycardia and hypotension. The nurse
should monitor for right ventricular involvement and avoid nitroglycerin if the patient is hypotensive or has suspected
right ventricular infarction.
Question 3
A client post-PCI develops sudden hypotension, muffled heart
sounds, and jugular venous distention. Which complication should the nurse
suspect?
Options
A. Simple anxiety
B. Cardiac tamponade
C. Stable angina
D. Hypertensive urgency
Correct Answer: B. Cardiac tamponade
Detailed Rationale
Beck's triad of hypotension, muffled heart sounds, and elevated jugular venous
pressure is classic for cardiac tamponade and requires immediate intervention .
Medical-Surgical Nursing Comprehensive Review 2026–2027 | Practice Resource • Page 3
, Medical-Surgical Nursing Comprehensive Review 2026–2027
Cardiac tamponade occurs when fluid accumulates in the pericardial sac,
compressing the heart and preventing adequate diastolic filling. This is a
life-threatening emergency that may occur post-PCI due to coronary perforation
or bleeding.
Why the Other Options Are Incorrect
• A. Simple anxiety: While anxiety may cause tachycardia, it does not produce Beck's triad or hemodynamic
compromise.
• C. Stable angina: Stable angina presents with predictable chest pain relieved by rest or nitroglycerin, not acute
hemodynamic instability.
• D. Hypertensive urgency: Hypertensive urgency presents with severely elevated blood pressure, not
hypotension with muffled heart sounds.
Clinical Pearl: The nurse should prepare for emergency pericardiocentesis, which is the definitive treatment for
cardiac tamponade. The provider may also order a bedside echocardiogram to confirm the diagnosis.
Domain 2: Respiratory Disorders
Question 4
A nurse is caring for a patient on a mechanical ventilator.
The high-pressure alarm sounds. Which action should the nurse take first?
Options
A. Assess the patient for a need to suction or biting the tube
B. Check for a disconnection in the ventilator tubing
C. Decrease the PEEP setting on the ventilator
D. Call the respiratory therapist immediately
Correct Answer: A. Assess the patient for a need to
Detailed Rationale
High-pressure alarms are triggered by increased resistance, often due to
secretions, biting the tube, or kinked tubing . The nurse's first action should
be to assess the patient to identify the cause of the increased airway
pressure. Common causes include accumulated secretions requiring suctioning,
patient biting on the endotracheal tube, tubing kinks, or bronchospasm.
Why the Other Options Are Incorrect
• B. Check for a disconnection: Disconnections typically trigger low-pressure alarms, not high-pressure
alarms.
• C. Decrease the PEEP setting: Adjusting ventilator settings without assessing the patient first is unsafe and
does not address the underlying cause.
• D. Call the respiratory therapist immediately: While collaboration is important, the nurse should first assess
the patient to identify and potentially correct the problem.
Clinical Pearl: After suctioning or correcting the cause, the nurse should document the intervention and monitor for
resolution of the alarm. If the alarm persists despite corrective measures, the provider should be notified.
Question 5
A patient with a history of multiple myocardial infarctions
and heavy smoking is admitted following angioplasty of a failed
Medical-Surgical Nursing Comprehensive Review 2026–2027 | Practice Resource • Page 4
EXAM REVIEW
2026–2027
PRACTICE QUESTIONS WITH
ANSWERS, DETAILED RATIONALES &
OPTION ANALYSIS
Medical-Surgical Nursing Comprehensive Review 2026–2027 | Practice Resource • Page 1
, Medical-Surgical Nursing Comprehensive Review 2026–2027
Medical-Surgical Nursing Comprehensive Review 2026–2027
Practice Questions & Detailed Rationales
This comprehensive review covers high-yield medical-surgical
nursing content organized by body system. Each question follows NCLEX-style
formatting with detailed rationales explaining both the correct answer and why
other options are incorrect.
Domain 1: Cardiovascular Disorders
Domain 1: Cardiovascular Disorders
Question 1
A patient with chronic heart failure presents with a
potassium level of 6.2 mEq/L. Which electrocardiogram (ECG) change should the
nurse expect to see first?
Options
A. Prominent U waves
B. Prolonged QT interval
C. ST-segment depression
D. Peaked T waves
Correct Answer: D. Peaked T waves
Detailed Rationale
Hyperkalemia (serum potassium greater than 5.0 mEq/L) typically manifests on an
ECG as tall, peaked T waves, which is a priority assessment due to the risk of
lethal dysrhythmias . The peaked T waves represent the initial cardiac
conduction disturbance as elevated extracellular potassium alters the resting
membrane potential, accelerating repolarization. This finding is clinically
significant because untreated hyperkalemia can progress to widened QRS
complexes, loss of P waves, and ultimately ventricular fibrillation or
asystole.
Why the Other Options Are Incorrect
• A. Prominent U waves: U waves are classically associated with hypokalemia, not hyperkalemia.
• B. Prolonged QT interval: This is associated with hypocalcemia and certain medication toxicities, not the
initial presentation of hyperkalemia.
• C. ST-segment depression: This indicates myocardial ischemia or injury, not the conduction changes of
hyperkalemia.
Clinical Pearl: In a patient with heart failure, hyperkalemia often results from medications such as ACE inhibitors,
ARBs, or potassium-sparing diuretics. The nurse should anticipate orders for potassium-lowering interventions such
as sodium polystyrene sulfonate, insulin with dextrose, or calcium gluconate for cardiac membrane stabilization.
Medical-Surgical Nursing Comprehensive Review 2026–2027 | Practice Resource • Page 2
, Medical-Surgical Nursing Comprehensive Review 2026–2027
Question 2
A 55-year-old male is admitted with chest pain. His ECG
shows ST-segment elevation in leads II, III, and aVF. His pain is not relieved
by sublingual nitroglycerin. Which of the following is the most appropriate
next step?
Options
A. Prepare for emergent PCI or thrombolytic therapy
B. Administer morphine sulfate 4 mg IV
C. Administer aspirin 324 mg chewed
D. Obtain a chest X-ray
Correct Answer: A. Prepare for emergent PCI or
Detailed Rationale
This patient is experiencing an acute ST-elevation myocardial infarction
(STEMI), specifically an inferior wall MI indicated by ST elevation in leads
II, III, and aVF . The priority intervention for STEMI is immediate reperfusion
therapy—either emergent percutaneous coronary intervention (PCI) if available
within 90 minutes, or thrombolytic therapy if PCI is not available. Time is
muscle in acute MI, and reperfusion is the definitive treatment that restores
blood flow to the ischemic myocardium.
Why the Other Options Are Incorrect
• B. Administer morphine sulfate: While morphine may be used for pain management in acute coronary
syndrome, it does not address the underlying coronary occlusion and would delay definitive reperfusion therapy.
• C. Administer aspirin: Aspirin should already have been given as a standard intervention for suspected acute
coronary syndrome. While important, it is not the definitive treatment for STEMI.
• D. Obtain a chest X-ray: This is a diagnostic study that would delay life-saving reperfusion therapy and is not
the priority in a confirmed STEMI.
Clinical Pearl: Inferior wall MI (leads II, III, aVF) may be accompanied by bradycardia and hypotension. The nurse
should monitor for right ventricular involvement and avoid nitroglycerin if the patient is hypotensive or has suspected
right ventricular infarction.
Question 3
A client post-PCI develops sudden hypotension, muffled heart
sounds, and jugular venous distention. Which complication should the nurse
suspect?
Options
A. Simple anxiety
B. Cardiac tamponade
C. Stable angina
D. Hypertensive urgency
Correct Answer: B. Cardiac tamponade
Detailed Rationale
Beck's triad of hypotension, muffled heart sounds, and elevated jugular venous
pressure is classic for cardiac tamponade and requires immediate intervention .
Medical-Surgical Nursing Comprehensive Review 2026–2027 | Practice Resource • Page 3
, Medical-Surgical Nursing Comprehensive Review 2026–2027
Cardiac tamponade occurs when fluid accumulates in the pericardial sac,
compressing the heart and preventing adequate diastolic filling. This is a
life-threatening emergency that may occur post-PCI due to coronary perforation
or bleeding.
Why the Other Options Are Incorrect
• A. Simple anxiety: While anxiety may cause tachycardia, it does not produce Beck's triad or hemodynamic
compromise.
• C. Stable angina: Stable angina presents with predictable chest pain relieved by rest or nitroglycerin, not acute
hemodynamic instability.
• D. Hypertensive urgency: Hypertensive urgency presents with severely elevated blood pressure, not
hypotension with muffled heart sounds.
Clinical Pearl: The nurse should prepare for emergency pericardiocentesis, which is the definitive treatment for
cardiac tamponade. The provider may also order a bedside echocardiogram to confirm the diagnosis.
Domain 2: Respiratory Disorders
Question 4
A nurse is caring for a patient on a mechanical ventilator.
The high-pressure alarm sounds. Which action should the nurse take first?
Options
A. Assess the patient for a need to suction or biting the tube
B. Check for a disconnection in the ventilator tubing
C. Decrease the PEEP setting on the ventilator
D. Call the respiratory therapist immediately
Correct Answer: A. Assess the patient for a need to
Detailed Rationale
High-pressure alarms are triggered by increased resistance, often due to
secretions, biting the tube, or kinked tubing . The nurse's first action should
be to assess the patient to identify the cause of the increased airway
pressure. Common causes include accumulated secretions requiring suctioning,
patient biting on the endotracheal tube, tubing kinks, or bronchospasm.
Why the Other Options Are Incorrect
• B. Check for a disconnection: Disconnections typically trigger low-pressure alarms, not high-pressure
alarms.
• C. Decrease the PEEP setting: Adjusting ventilator settings without assessing the patient first is unsafe and
does not address the underlying cause.
• D. Call the respiratory therapist immediately: While collaboration is important, the nurse should first assess
the patient to identify and potentially correct the problem.
Clinical Pearl: After suctioning or correcting the cause, the nurse should document the intervention and monitor for
resolution of the alarm. If the alarm persists despite corrective measures, the provider should be notified.
Question 5
A patient with a history of multiple myocardial infarctions
and heavy smoking is admitted following angioplasty of a failed
Medical-Surgical Nursing Comprehensive Review 2026–2027 | Practice Resource • Page 4
