Med-Surg Nursing Test Bank | Next-Gen NCLEX Pass Guide

Comprehensive Medical-Surgical Nursing Prac ce Exam

High-Yield NCLEX/Medical-Surgical Ques ons



Ques on 1: Acute Coronary Syndrome & Myocardial Infarc on

 Clinical Scenario: A 62-year-old male with a history of hypertension and hyperlipidemia
presents to the emergency department repor ng crushing retrosternal chest pain
radia ng to his le jaw that began 45 minutes ago. His ini al vital signs are: BP 158/92
mmHg, HR 102 beats/min, RR 22 breaths/min, and $\text{SpO}_2$ 96% on room air. The
12-lead electrocardiogram (ECG) reveals 2-mm ST-segment eleva on in leads II, III, and
aVF.

 Ques on Stem: Which interven on should the nurse perform first?

 Op ons:

o A. Administer supplemental oxygen at 4 L/min via nasal cannula.

o B. Administer aspirin 325 mg chewed.

o C. Administer sublingual nitroglycerin 0.4 mg.

o D. Obtain blood samples for cardiac troponin levels.

Answer and Ra onale

 Correct Answer: B. Administer aspirin 325 mg chewed.

 Cogni ve Level: Applying

 Client Needs Category: Physiological Adapta on

 Main Lesson / Takeaway: Non-enteric coated aspirin chewed immediately inhibits
platelet aggrega on and reduces mortality in acute coronary syndrome.

 Detailed Ra onale:

, o Why op on B is correct: In acute myocardial infarc on (specifically inferior
STEMI), aspirin is the highest priority medical interven on to inhibit platelet
ac va on and thrombus propaga on. Chewing the tablet allows for rapid buccal
and systemic absorp on within minutes.

o Why op on A is incorrect: Rou ne supplemental oxygen is no longer
recommended for acute coronary syndrome unless the pa ent is hypoxemic
($\text{SpO}_2 < 90\%$), in respiratory distress, or exhibi ng heart failure
symptoms, as hyperoxia causes coronary vasoconstric on.

o Why op on C is incorrect: Sublingual nitroglycerin provides pain relief and
reduces preload/a erload, but in inferior STEMI (leads II, III, aVF), right
ventricular involvement must first be ruled out to prevent severe hypotension;
furthermore, it does not alter mortality compared to aspirin.

o Why op on D is incorrect: While cardiac biomarkers (troponin I/T) are essen al
diagnos c labs, drawn blood work should never delay me-sensi ve
revasculariza on therapies or an platelet administra on.

Ques on 2: Respiratory Failure & Tension Pneumothorax

 Clinical Scenario: A 28-year-old mechanically ven lated pa ent in the intensive care unit
following blunt chest trauma suddenly becomes agitated and cyano c. Assessment
reveals peak airway pressures elevated from 22 $\text{cm H}_2\text{O}$ to 48 $\text{cm
H}_2\text{O}$, trachea deviated to the right, absent breath sounds on the le , and HR
138 beats/min with BP 74/42 mmHg.

 Ques on Stem: Which immediate ac on should the nurse take?

 Op ons:

o A. Auscultate heart sounds for pericardial fric on rub.

o B. Perform immediate needle chest decompression on the le side.

o C. Increase the posi ve end-expiratory pressure (PEEP) on the ven lator.

, o D. Disconnect the pa ent from the ven lator and manual bag-ven late.

Answer and Ra onale

 Correct Answer: B. Perform immediate needle chest decompression on the le side.

 Cogni ve Level: Analyzing

 Client Needs Category: Physiological Adapta on

 Main Lesson / Takeaway: Tension pneumothorax causes obstruc ve shock and requires
immediate emergency decompression before diagnos c imaging or setup of chest tube
drainage.

 Detailed Ra onale:

o Why op on B is correct: The clinical triad of absent breath sounds on the
affected side, tracheal devia on to the contralateral side, and profound
hypotension/obstruc ve shock confirms a le tension pneumothorax. Immediate
needle thoracostomy (2nd intercostal space, midclavicular line or 5th intercostal
space, anterior axillary line) releases trapped air and restores venous return to
the heart.

o Why op on A is incorrect: Ausculta ng heart sounds delays life-saving therapy in
an emergency se ng where clinical signs clearly indicate tension pneumothorax
rather than cardiac tamponade.

o Why op on C is incorrect: Increasing PEEP will increase intrathoracic pressure
further, worsening tension dynamics, decreasing venous return, and exacerba ng
cardiac arrest risk.

o Why op on D is incorrect: Manual bag-ven la on with posi ve pressure will
force more air into the pleural space, accelera ng hemodynamic collapse.

Ques on 3: Neurological Trauma & Autonomic Dysreflexia

,  Clinical Scenario: A 34-year-old male with a T4 spinal cord injury (complete transec on)
reports a sudden, excrucia ng throbbing headache and blurred vision. The nurse notes
severe diaphoresis and flushing above the level of the injury (face and neck) with cold,
pale skin below. Vital signs are: BP 210/108 mmHg and HR 48 beats/min.

 Ques on Stem: Which nursing ac on must be performed first?

 Op ons:

o A. Administer IV hydralazine as prescribed.

o B. Elevate the head of the bed to a 90-degree si ng posi on.

o C. Palpate the suprapubic area and check the Foley catheter for kinks.

o D. Perform a digital rectal examina on to check for bowel impac on.

Answer and Ra onale

 Correct Answer: B. Elevate the head of the bed to a 90-degree si ng posi on.

 Cogni ve Level: Applying

 Client Needs Category: Reduc on of Risk Poten al

 Main Lesson / Takeaway: Si ng the pa ent upright immediately u lizes orthosta c
pooling to lower cri cal hypertension in autonomic dysreflexia before searching for
noxious triggers.

 Detailed Ra onale:

o Why op on B is correct: Eleva ng the head of the bed to high-Fowler's (90
degrees) with feet dangling immediately causes venous pooling in the lower
extremi es, lowering intracranial and systemic blood pressure through gravity
before any diagnos c or pharmacological interven ons.