Med-Surg NCLEX-Style Practice Exam – 150
Questions
1. A patient with chronic kidney disease has a serum potassium level
of 6.2 mEq/L. Which intervention should the nurse implement
first?
a. Administer sodium polystyrene sulfonate (Kayexalate)
b. Start an intravenous insulin and glucose infusion
c. Prepare the patient for dialysis
d. Encourage the patient to increase dietary potassium
b. Start an intravenous insulin and glucose infusion
Rationale: Insulin with glucose drives potassium into cells rapidly,
providing immediate treatment for hyperkalemia. Kayexalate and
dialysis are also interventions but are not first-line for acute
stabilization.
2. A patient with heart failure reports increasing shortness of breath
and orthopnea. Which assessment finding is most concerning?
a. Bilateral lower extremity edema
b. Crackles halfway up both lungs
c. Weight gain of 1 lb in 24 hours
d. Heart rate of 90 bpm
b. Crackles halfway up both lungs
Rationale: Crackles indicate fluid accumulation in the lungs,
suggesting worsening pulmonary congestion and potential pulmonary
edema, which is an urgent concern.
3. A patient is receiving a unit of packed red blood cells and develops
chills and back pain. What is the nurse’s priority action?
, a. Stop the transfusion immediately
b. Slow the transfusion and notify the provider
c. Administer acetaminophen and continue
d. Obtain a urine specimen for analysis
a. Stop the transfusion immediately
Rationale: These are signs of a hemolytic transfusion reaction.
Stopping the transfusion immediately prevents further complications.
4. A postoperative patient has a blood pressure of 88/52 mmHg,
heart rate 120 bpm, and cool, clammy skin. Which action should
the nurse take first?
a. Administer IV fluids as ordered
b. Place the patient in Trendelenburg position
c. Obtain a 12-lead ECG
d. Notify the healthcare provider
a. Administer IV fluids as ordered
Rationale: Hypotension with tachycardia and cool skin suggests
hypovolemic shock. Rapid fluid replacement is a priority to stabilize
perfusion.
5. A patient with cirrhosis presents with ascites. Which dietary
modification is most appropriate?
a. High-protein, low-carbohydrate diet
b. Low-sodium diet
c. High-potassium diet
d. Low-fat diet
b. Low-sodium diet
Rationale: Sodium restriction helps reduce fluid retention and ascites
formation in patients with cirrhosis.
, 6. A patient is receiving heparin therapy. Which laboratory value
should the nurse monitor to assess for therapeutic effect?
a. INR
b. aPTT
c. PT
d. Platelet count
b. aPTT
Rationale: Activated partial thromboplastin time (aPTT) measures the
therapeutic effect of unfractionated heparin. INR and PT monitor
warfarin therapy.
7. Which patient is at highest risk for developing hypovolemic
shock?
a. A patient with pneumonia
b. A patient with gastrointestinal bleeding
c. A patient with heart failure
d. A patient with chronic kidney disease
b. A patient with gastrointestinal bleeding
Rationale: GI bleeding leads to significant fluid loss, increasing the
risk for hypovolemic shock.
8. A patient with COPD is receiving oxygen at 2 L/min via nasal
cannula. The patient becomes drowsy and has a respiratory rate
of 8. What is the nurse’s priority action?
a. Increase the oxygen flow rate to 4 L/min
b. Stimulate the patient and monitor closely
c. Stop oxygen therapy immediately
d. Prepare for intubation
b. Stimulate the patient and monitor closely
Rationale: In COPD patients, hypoventilation can result from excessive
, oxygen. The first step is to stimulate the patient and reassess before
increasing oxygen or providing advanced airway support.
9. A patient with type 1 diabetes has blood glucose of 320 mg/dL
and reports nausea and vomiting. Which intervention should the
nurse anticipate?
a. Administer subcutaneous insulin as ordered
b. Encourage oral fluids and monitor
c. Prepare for intravenous insulin and fluids
d. Administer oral hypoglycemic medication
c. Prepare for intravenous insulin and fluids
Rationale: High blood glucose with nausea and vomiting suggests
diabetic ketoacidosis (DKA), which requires IV insulin and fluid
replacement.
10. A patient has a new prescription for digoxin. Which
assessment finding would prompt the nurse to hold the
medication?
a. Heart rate 72 bpm
b. Blood pressure 110/70 mmHg
c. Heart rate 48 bpm
d. Respiratory rate 18 bpm
c. Heart rate 48 bpm
Rationale: Digoxin can cause bradycardia. It should be held if the
heart rate is below 60 bpm in adults.
11. A patient with pneumonia is receiving IV antibiotics. The
nurse notes a rash and wheezing. What is the priority action?
a. Continue antibiotics and monitor
b. Administer antihistamines
Questions
1. A patient with chronic kidney disease has a serum potassium level
of 6.2 mEq/L. Which intervention should the nurse implement
first?
a. Administer sodium polystyrene sulfonate (Kayexalate)
b. Start an intravenous insulin and glucose infusion
c. Prepare the patient for dialysis
d. Encourage the patient to increase dietary potassium
b. Start an intravenous insulin and glucose infusion
Rationale: Insulin with glucose drives potassium into cells rapidly,
providing immediate treatment for hyperkalemia. Kayexalate and
dialysis are also interventions but are not first-line for acute
stabilization.
2. A patient with heart failure reports increasing shortness of breath
and orthopnea. Which assessment finding is most concerning?
a. Bilateral lower extremity edema
b. Crackles halfway up both lungs
c. Weight gain of 1 lb in 24 hours
d. Heart rate of 90 bpm
b. Crackles halfway up both lungs
Rationale: Crackles indicate fluid accumulation in the lungs,
suggesting worsening pulmonary congestion and potential pulmonary
edema, which is an urgent concern.
3. A patient is receiving a unit of packed red blood cells and develops
chills and back pain. What is the nurse’s priority action?
, a. Stop the transfusion immediately
b. Slow the transfusion and notify the provider
c. Administer acetaminophen and continue
d. Obtain a urine specimen for analysis
a. Stop the transfusion immediately
Rationale: These are signs of a hemolytic transfusion reaction.
Stopping the transfusion immediately prevents further complications.
4. A postoperative patient has a blood pressure of 88/52 mmHg,
heart rate 120 bpm, and cool, clammy skin. Which action should
the nurse take first?
a. Administer IV fluids as ordered
b. Place the patient in Trendelenburg position
c. Obtain a 12-lead ECG
d. Notify the healthcare provider
a. Administer IV fluids as ordered
Rationale: Hypotension with tachycardia and cool skin suggests
hypovolemic shock. Rapid fluid replacement is a priority to stabilize
perfusion.
5. A patient with cirrhosis presents with ascites. Which dietary
modification is most appropriate?
a. High-protein, low-carbohydrate diet
b. Low-sodium diet
c. High-potassium diet
d. Low-fat diet
b. Low-sodium diet
Rationale: Sodium restriction helps reduce fluid retention and ascites
formation in patients with cirrhosis.
, 6. A patient is receiving heparin therapy. Which laboratory value
should the nurse monitor to assess for therapeutic effect?
a. INR
b. aPTT
c. PT
d. Platelet count
b. aPTT
Rationale: Activated partial thromboplastin time (aPTT) measures the
therapeutic effect of unfractionated heparin. INR and PT monitor
warfarin therapy.
7. Which patient is at highest risk for developing hypovolemic
shock?
a. A patient with pneumonia
b. A patient with gastrointestinal bleeding
c. A patient with heart failure
d. A patient with chronic kidney disease
b. A patient with gastrointestinal bleeding
Rationale: GI bleeding leads to significant fluid loss, increasing the
risk for hypovolemic shock.
8. A patient with COPD is receiving oxygen at 2 L/min via nasal
cannula. The patient becomes drowsy and has a respiratory rate
of 8. What is the nurse’s priority action?
a. Increase the oxygen flow rate to 4 L/min
b. Stimulate the patient and monitor closely
c. Stop oxygen therapy immediately
d. Prepare for intubation
b. Stimulate the patient and monitor closely
Rationale: In COPD patients, hypoventilation can result from excessive
, oxygen. The first step is to stimulate the patient and reassess before
increasing oxygen or providing advanced airway support.
9. A patient with type 1 diabetes has blood glucose of 320 mg/dL
and reports nausea and vomiting. Which intervention should the
nurse anticipate?
a. Administer subcutaneous insulin as ordered
b. Encourage oral fluids and monitor
c. Prepare for intravenous insulin and fluids
d. Administer oral hypoglycemic medication
c. Prepare for intravenous insulin and fluids
Rationale: High blood glucose with nausea and vomiting suggests
diabetic ketoacidosis (DKA), which requires IV insulin and fluid
replacement.
10. A patient has a new prescription for digoxin. Which
assessment finding would prompt the nurse to hold the
medication?
a. Heart rate 72 bpm
b. Blood pressure 110/70 mmHg
c. Heart rate 48 bpm
d. Respiratory rate 18 bpm
c. Heart rate 48 bpm
Rationale: Digoxin can cause bradycardia. It should be held if the
heart rate is below 60 bpm in adults.
11. A patient with pneumonia is receiving IV antibiotics. The
nurse notes a rash and wheezing. What is the priority action?
a. Continue antibiotics and monitor
b. Administer antihistamines
