MEDICAL-SURGICAL NURSING
Comprehensive Exam Preparation: 330 NCLEX-Style Questions, Answers with
Detailed Rationales
Course: Medical-Surgical Nursing (Adult Health) | Format: 330 Q&A; | Edition: 2026 High-Yield NCLEX-RN |
Includes: Cardiovascular, Respiratory, GI, Endocrine, Renal, Fluids & Electrolytes, Neuro, Musculoskeletal,
Oncology, Perioperative
This document is original educational material created for study purposes. All questions are author-generated based on current nursing
standards (Lewis's Med-Surg, Saunders, AACN).
1. A client with heart failure is prescribed furosemide 40 mg PO daily. Which finding indicates the medication
is effective?
Weight loss of 1 kg overnight
Increased blood pressure
Decreased urine output
Increased heart rate
Correct Answer: A
Rationale: Loop diuretics remove excess fluid. Effectiveness is shown by weight loss (1 kg = 1L fluid), decreased
edema, lung sounds clearing, and increased urine output.
2. The nurse is caring for a client with angina. Which statement by client indicates need for further teaching
about nitroglycerin?
I will sit down when I take it
I can take up to 3 tablets 5 minutes apart
I will swallow the tablet with water
I will store it in its original dark container
Correct Answer: C
Rationale: Nitroglycerin is sublingual, not swallowed. It should dissolve under tongue. Sit due to hypotension risk.
3. Client post-MI has sudden shortness of breath, crackles, and frothy sputum. Nurse suspects?
Pulmonary edema due to left ventricular failure
Pulmonary embolism
Pneumonia
Pneumothorax
Correct Answer: A
Rationale: Left-sided HF after MI causes fluid backup into lungs -> pulmonary edema: dyspnea, crackles, frothy
sputum, tachypnea.
4. Which lab should nurse monitor for client on heparin infusion?
aPTT
INR
PT
Platelet count only
,Correct Answer: A
Rationale: Heparin is monitored by aPTT (target 60-80 sec). Also monitor platelets for HIT.
5. Client with atrial fibrillation is at risk for?
Stroke due to thrombus formation
Hyperkalemia
Peptic ulcer
Hypoglycemia
Correct Answer: A
Rationale: AFib causes stasis of blood in atria -> clot -> embolic stroke. Anticoagulation needed.
6. A client with COPD is receiving oxygen at 2L/min. What is target SpO2?
88-92%
94-98%
100%
85%
Correct Answer: A
Rationale: For chronic CO2 retainers, target 88-92% to avoid knocking out hypoxic drive and worsening
hypercapnia.
7. Early sign of hypoxia is?
Restlessness and anxiety
Cyanosis
Bradycardia
Decreased RR
Correct Answer: A
Rationale: Early: restlessness, anxiety, tachycardia, tachypnea. Late: cyanosis, bradycardia, decreased LOC.
8. Chest tube is accidentally dislodged. First action?
Cover insertion site with occlusive dressing taped on 3 sides
Reinsert tube
Give oxygen and leave open
Call provider only
Correct Answer: A
Rationale: Occlusive dressing on 3 sides allows air to escape but not enter, preventing tension pneumothorax until
provider arrives.
9. Which position for COPD client with dyspnea?
High-Fowler's and tripod leaning forward
Supine
Trendelenburg
Side-lying
Correct Answer: A
Rationale: High-Fowler's and tripod maximizes lung expansion.
,10. Client with cirrhosis has hematemesis. Priority nursing action?
Maintain airway and prepare for possible balloon tamponade/endoscopy
Give high-protein meal
Place supine with legs elevated only
Give NSAIDs
Correct Answer: A
Rationale: Esophageal varices bleed is life-threatening. Airway protection, large bore IV, octreotide/banding
expected.
11. After paracentesis, which assessment is priority?
Blood pressure and signs of hypovolemia
Bowel sounds
Urine color
Temperature
Correct Answer: A
Rationale: Fluid shift can cause hypovolemia/hypotension after large volume paracentesis.
12. Client with pancreatitis. Which diet initially?
NPO to rest pancreas
High-fat diet
High-protein 5000 kcal
Clear liquids with fat
Correct Answer: A
Rationale: NPO reduces pancreatic enzyme secretion. Later low-fat diet.
13. Signs of diabetic ketoacidosis include?
Kussmaul respirations, fruity breath, hyperglycemia
Shallow respirations, bradycardia
Hypoglycemia, sweating
Weight gain
Correct Answer: A
Rationale: DKA: hyperglycemia >250, ketosis, metabolic acidosis -> Kussmaul (deep rapid), fruity acetone breath.
14. During insulin administration, which site has fastest absorption?
Abdomen
Thigh
Arm
Buttock
Correct Answer: A
Rationale: Abdomen fastest, then arm, thigh, buttock slowest. Rotate within same site region.
15. Thyroidectomy post-op, client has tingling around mouth. Nurse suspects?
Hypocalcemia from parathyroid injury
, Hypercalcemia
Hyperkalemia
Hyponatremia
Correct Answer: A
Rationale: Parathyroid damage -> low Ca2+ -> Chvostek/Trousseau signs, tingling, muscle cramps.
16. Client with AKI, creatinine rising, urine output 100mL in 24h. This is?
Oliguric phase of AKI
Diuretic phase
Recovery
Normal
Correct Answer: A
Rationale: Oliguria <400mL/day. Monitor for hyperkalemia, fluid overload.
17. Hyperkalemia with tall peaked T waves. Antidote first given?
Calcium gluconate to stabilize myocardium
Sodium bicarbonate only
Regular insulin first
Furosemide only
Correct Answer: A
Rationale: Calcium gluconate stabilizes heart first, then insulin+glucose shifts K+ into cells, then
kayexalate/furosemide removes.
18. Which IV fluid for client with hypernatremia?
0.45% NS hypotonic
0.9% NS
LR
D10W
Correct Answer: A
Rationale: Hypernatremia = need free water. Hypotonic 0.45% NS or D5W slowly.
19. Glasgow Coma Scale less than 8 indicates?
Coma and need for airway protection
Alert
Mild confusion
Normal
Correct Answer: A
Rationale: GCS <8 = coma, inability to protect airway, intubation needed.
20. Client with ischemic stroke, tPA being considered. Which contraindicates?
Recent surgery within 14 days
BP 130/80
Age 60
Onset 1 hour ago
Comprehensive Exam Preparation: 330 NCLEX-Style Questions, Answers with
Detailed Rationales
Course: Medical-Surgical Nursing (Adult Health) | Format: 330 Q&A; | Edition: 2026 High-Yield NCLEX-RN |
Includes: Cardiovascular, Respiratory, GI, Endocrine, Renal, Fluids & Electrolytes, Neuro, Musculoskeletal,
Oncology, Perioperative
This document is original educational material created for study purposes. All questions are author-generated based on current nursing
standards (Lewis's Med-Surg, Saunders, AACN).
1. A client with heart failure is prescribed furosemide 40 mg PO daily. Which finding indicates the medication
is effective?
Weight loss of 1 kg overnight
Increased blood pressure
Decreased urine output
Increased heart rate
Correct Answer: A
Rationale: Loop diuretics remove excess fluid. Effectiveness is shown by weight loss (1 kg = 1L fluid), decreased
edema, lung sounds clearing, and increased urine output.
2. The nurse is caring for a client with angina. Which statement by client indicates need for further teaching
about nitroglycerin?
I will sit down when I take it
I can take up to 3 tablets 5 minutes apart
I will swallow the tablet with water
I will store it in its original dark container
Correct Answer: C
Rationale: Nitroglycerin is sublingual, not swallowed. It should dissolve under tongue. Sit due to hypotension risk.
3. Client post-MI has sudden shortness of breath, crackles, and frothy sputum. Nurse suspects?
Pulmonary edema due to left ventricular failure
Pulmonary embolism
Pneumonia
Pneumothorax
Correct Answer: A
Rationale: Left-sided HF after MI causes fluid backup into lungs -> pulmonary edema: dyspnea, crackles, frothy
sputum, tachypnea.
4. Which lab should nurse monitor for client on heparin infusion?
aPTT
INR
PT
Platelet count only
,Correct Answer: A
Rationale: Heparin is monitored by aPTT (target 60-80 sec). Also monitor platelets for HIT.
5. Client with atrial fibrillation is at risk for?
Stroke due to thrombus formation
Hyperkalemia
Peptic ulcer
Hypoglycemia
Correct Answer: A
Rationale: AFib causes stasis of blood in atria -> clot -> embolic stroke. Anticoagulation needed.
6. A client with COPD is receiving oxygen at 2L/min. What is target SpO2?
88-92%
94-98%
100%
85%
Correct Answer: A
Rationale: For chronic CO2 retainers, target 88-92% to avoid knocking out hypoxic drive and worsening
hypercapnia.
7. Early sign of hypoxia is?
Restlessness and anxiety
Cyanosis
Bradycardia
Decreased RR
Correct Answer: A
Rationale: Early: restlessness, anxiety, tachycardia, tachypnea. Late: cyanosis, bradycardia, decreased LOC.
8. Chest tube is accidentally dislodged. First action?
Cover insertion site with occlusive dressing taped on 3 sides
Reinsert tube
Give oxygen and leave open
Call provider only
Correct Answer: A
Rationale: Occlusive dressing on 3 sides allows air to escape but not enter, preventing tension pneumothorax until
provider arrives.
9. Which position for COPD client with dyspnea?
High-Fowler's and tripod leaning forward
Supine
Trendelenburg
Side-lying
Correct Answer: A
Rationale: High-Fowler's and tripod maximizes lung expansion.
,10. Client with cirrhosis has hematemesis. Priority nursing action?
Maintain airway and prepare for possible balloon tamponade/endoscopy
Give high-protein meal
Place supine with legs elevated only
Give NSAIDs
Correct Answer: A
Rationale: Esophageal varices bleed is life-threatening. Airway protection, large bore IV, octreotide/banding
expected.
11. After paracentesis, which assessment is priority?
Blood pressure and signs of hypovolemia
Bowel sounds
Urine color
Temperature
Correct Answer: A
Rationale: Fluid shift can cause hypovolemia/hypotension after large volume paracentesis.
12. Client with pancreatitis. Which diet initially?
NPO to rest pancreas
High-fat diet
High-protein 5000 kcal
Clear liquids with fat
Correct Answer: A
Rationale: NPO reduces pancreatic enzyme secretion. Later low-fat diet.
13. Signs of diabetic ketoacidosis include?
Kussmaul respirations, fruity breath, hyperglycemia
Shallow respirations, bradycardia
Hypoglycemia, sweating
Weight gain
Correct Answer: A
Rationale: DKA: hyperglycemia >250, ketosis, metabolic acidosis -> Kussmaul (deep rapid), fruity acetone breath.
14. During insulin administration, which site has fastest absorption?
Abdomen
Thigh
Arm
Buttock
Correct Answer: A
Rationale: Abdomen fastest, then arm, thigh, buttock slowest. Rotate within same site region.
15. Thyroidectomy post-op, client has tingling around mouth. Nurse suspects?
Hypocalcemia from parathyroid injury
, Hypercalcemia
Hyperkalemia
Hyponatremia
Correct Answer: A
Rationale: Parathyroid damage -> low Ca2+ -> Chvostek/Trousseau signs, tingling, muscle cramps.
16. Client with AKI, creatinine rising, urine output 100mL in 24h. This is?
Oliguric phase of AKI
Diuretic phase
Recovery
Normal
Correct Answer: A
Rationale: Oliguria <400mL/day. Monitor for hyperkalemia, fluid overload.
17. Hyperkalemia with tall peaked T waves. Antidote first given?
Calcium gluconate to stabilize myocardium
Sodium bicarbonate only
Regular insulin first
Furosemide only
Correct Answer: A
Rationale: Calcium gluconate stabilizes heart first, then insulin+glucose shifts K+ into cells, then
kayexalate/furosemide removes.
18. Which IV fluid for client with hypernatremia?
0.45% NS hypotonic
0.9% NS
LR
D10W
Correct Answer: A
Rationale: Hypernatremia = need free water. Hypotonic 0.45% NS or D5W slowly.
19. Glasgow Coma Scale less than 8 indicates?
Coma and need for airway protection
Alert
Mild confusion
Normal
Correct Answer: A
Rationale: GCS <8 = coma, inability to protect airway, intubation needed.
20. Client with ischemic stroke, tPA being considered. Which contraindicates?
Recent surgery within 14 days
BP 130/80
Age 60
Onset 1 hour ago
