NCLEX Medical Surgical Nursing 2026 Study
Guide Practice Test Questions Detailed
Explanations Disease Management Nursing
Interventions Priority Patient Care
Section 1: Cardiovascular Medical-Surgical Nursing (Questions 1-30)
1. A nurse is caring for a patient who has just returned from surgery
following a coronary artery bypass graft (CABG). Which assessment finding
requires immediate intervention?
A. Blood pressure of 110/70 mmHg
B. Chest tube drainage of 250 mL in the first hour
C. Heart rate of 90 beats per minute
D. Temperature of 99.2°F (37.3°C)
Rationale: Chest tube drainage exceeding 200 mL in the first hour or 100 mL per
hour for two consecutive hours is considered excessive and may indicate
postoperative bleeding. This requires immediate notification of the surgeon and
preparation for potential return to surgery. The other findings are within normal
limits or expected postoperatively.
2. A patient with heart failure is prescribed furosemide. Which laboratory
value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Rationale: Furosemide is a loop diuretic that causes potassium excretion, leading
to a risk of hypokalemia. Hypokalemia can cause cardiac arrhythmias, muscle
weakness, and fatigue. The nurse should monitor serum potassium levels closely
and administer supplements as prescribed.
,3. A patient is admitted with a diagnosis of infective endocarditis. Which
nursing intervention is the priority?
A. Administer antipyretics for fever.
B. Obtain blood cultures before initiating antibiotic therapy.
C. Encourage the patient to ambulate.
D. Apply cool compresses to the extremities.
Rationale: The definitive diagnosis of infective endocarditis requires identifying
the causative organism from blood cultures. Blood cultures should be drawn from
at least three different sites at different times before antibiotics are started. Once
antibiotics are initiated, cultures may be negative.
4. A nurse is assessing a patient with peripheral artery disease (PAD). Which
finding is most consistent with this diagnosis?
A. Warm, swollen extremities
B. Intermittent claudication and cool extremities
C. Bounding pulses and edema
D. Shiny, taut, brown-pigmented skin
Rationale: Intermittent claudication (cramping leg pain with exercise that resolves
with rest) and cool extremities are classic signs of PAD. PAD is caused by
atherosclerosis, which reduces blood flow to the extremities, leading to ischemia.
Venous insufficiency causes warm, swollen extremities with brown pigmentation.
5. A patient is receiving heparin therapy for a deep vein thrombosis (DVT).
Which laboratory value should the nurse monitor?
A. International Normalized Ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Platelet count
D. D-dimer
Rationale: Unfractionated heparin therapy is monitored using the aPTT. The
therapeutic goal is to maintain the aPTT at 1.5 to 2.5 times the control value. INR
is used to monitor warfarin therapy.
6. A patient with atrial fibrillation is prescribed warfarin. The nurse should
teach the patient to avoid which of the following foods?
A. Bananas
B. Spinach and kale
C. White bread
D. Apples
,Rationale: Warfarin is a vitamin K antagonist. Foods high in vitamin K, such as
spinach, kale, broccoli, and Brussels sprouts, can decrease the effectiveness of
warfarin. Patients should maintain a consistent intake of vitamin K rather than
eliminating it entirely.
7. A patient is admitted with acute pericarditis. The nurse should expect to
hear which sound on auscultation?
A. Holosystolic murmur
B. Pericardial friction rub
C. Diastolic rumble
D. Crackles in the lung bases
Rationale: A pericardial friction rub is a high-pitched, scratching sound heard on
auscultation in patients with pericarditis. It is caused by the inflamed layers of the
pericardium rubbing against each other. It is best heard at the left lower sternal
border with the patient leaning forward.
8. A nurse is caring for a patient with a new diagnosis of hypertension. Which
lifestyle modification should the nurse recommend first?
A. Begin a rigorous exercise program.
B. Reduce sodium intake to less than 2,300 mg per day.
C. Eliminate all fats from the diet.
D. Take a daily multivitamin.
Rationale: Reducing sodium intake is one of the most effective lifestyle
modifications for lowering blood pressure. The nurse should recommend a gradual
reduction to less than 2,300 mg per day, with an ideal goal of 1,500 mg per day.
9. A patient is scheduled for a cardiac catheterization. Which pre-procedure
instruction is most important?
A. "You will need to eat a full breakfast before the procedure."
B. "You should not eat or drink anything after midnight."
C. "You can take your metformin as usual."
D. "You will be able to drive yourself home after the procedure."
Rationale: Patients undergoing cardiac catheterization must be NPO (nothing by
mouth) after midnight to prevent aspiration during the procedure. Metformin is
often held before procedures involving contrast dye due to the risk of lactic
acidosis. Patients are not allowed to drive themselves home due to sedation.
10. A patient with a mechanical heart valve is prescribed warfarin. The nurse
should teach the patient that the therapeutic INR goal is:
, A. 1.0 to 1.5
B. 1.5 to 2.0
C. 2.5 to 3.5
D. 4.0 to 5.0
Rationale: For patients with mechanical heart valves, the risk of clot formation is
high. The therapeutic INR goal is typically 2.5 to 3.5, which is higher than the goal
for atrial fibrillation (2.0 to 3.0).
11. A nurse is assessing a patient with left-sided heart failure. Which finding
would the nurse expect?
A. Peripheral edema
B. Crackles in the lung bases
C. Jugular venous distension
D. Hepatomegaly
Rationale: Left-sided heart failure leads to the backup of blood into the pulmonary
circulation, causing pulmonary congestion. This manifests as crackles (rales) in the
lung bases, dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.
12. A patient is experiencing an acute myocardial infarction. Which
medication should the nurse anticipate administering first?
A. Morphine sulfate
B. Aspirin (chewable)
C. Nitroglycerin
D. Metoprolol
Rationale: According to the "MONA" mnemonic (Morphine, Oxygen,
Nitroglycerin, Aspirin), aspirin is a priority for a suspected MI. Chewable aspirin is
rapidly absorbed and works to inhibit platelet aggregation, reducing clot formation.
13. A nurse is teaching a patient about a low-cholesterol diet. Which food
should the patient be instructed to limit?
A. Fruits and vegetables
B. Red meat and full-fat dairy products
C. Whole grains
D. Fish and poultry
Rationale: Red meat and full-fat dairy products are high in saturated fats and
cholesterol. Patients should be instructed to limit these foods and choose lean
meats, low-fat dairy, and plant-based protein sources instead.
Guide Practice Test Questions Detailed
Explanations Disease Management Nursing
Interventions Priority Patient Care
Section 1: Cardiovascular Medical-Surgical Nursing (Questions 1-30)
1. A nurse is caring for a patient who has just returned from surgery
following a coronary artery bypass graft (CABG). Which assessment finding
requires immediate intervention?
A. Blood pressure of 110/70 mmHg
B. Chest tube drainage of 250 mL in the first hour
C. Heart rate of 90 beats per minute
D. Temperature of 99.2°F (37.3°C)
Rationale: Chest tube drainage exceeding 200 mL in the first hour or 100 mL per
hour for two consecutive hours is considered excessive and may indicate
postoperative bleeding. This requires immediate notification of the surgeon and
preparation for potential return to surgery. The other findings are within normal
limits or expected postoperatively.
2. A patient with heart failure is prescribed furosemide. Which laboratory
value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Rationale: Furosemide is a loop diuretic that causes potassium excretion, leading
to a risk of hypokalemia. Hypokalemia can cause cardiac arrhythmias, muscle
weakness, and fatigue. The nurse should monitor serum potassium levels closely
and administer supplements as prescribed.
,3. A patient is admitted with a diagnosis of infective endocarditis. Which
nursing intervention is the priority?
A. Administer antipyretics for fever.
B. Obtain blood cultures before initiating antibiotic therapy.
C. Encourage the patient to ambulate.
D. Apply cool compresses to the extremities.
Rationale: The definitive diagnosis of infective endocarditis requires identifying
the causative organism from blood cultures. Blood cultures should be drawn from
at least three different sites at different times before antibiotics are started. Once
antibiotics are initiated, cultures may be negative.
4. A nurse is assessing a patient with peripheral artery disease (PAD). Which
finding is most consistent with this diagnosis?
A. Warm, swollen extremities
B. Intermittent claudication and cool extremities
C. Bounding pulses and edema
D. Shiny, taut, brown-pigmented skin
Rationale: Intermittent claudication (cramping leg pain with exercise that resolves
with rest) and cool extremities are classic signs of PAD. PAD is caused by
atherosclerosis, which reduces blood flow to the extremities, leading to ischemia.
Venous insufficiency causes warm, swollen extremities with brown pigmentation.
5. A patient is receiving heparin therapy for a deep vein thrombosis (DVT).
Which laboratory value should the nurse monitor?
A. International Normalized Ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Platelet count
D. D-dimer
Rationale: Unfractionated heparin therapy is monitored using the aPTT. The
therapeutic goal is to maintain the aPTT at 1.5 to 2.5 times the control value. INR
is used to monitor warfarin therapy.
6. A patient with atrial fibrillation is prescribed warfarin. The nurse should
teach the patient to avoid which of the following foods?
A. Bananas
B. Spinach and kale
C. White bread
D. Apples
,Rationale: Warfarin is a vitamin K antagonist. Foods high in vitamin K, such as
spinach, kale, broccoli, and Brussels sprouts, can decrease the effectiveness of
warfarin. Patients should maintain a consistent intake of vitamin K rather than
eliminating it entirely.
7. A patient is admitted with acute pericarditis. The nurse should expect to
hear which sound on auscultation?
A. Holosystolic murmur
B. Pericardial friction rub
C. Diastolic rumble
D. Crackles in the lung bases
Rationale: A pericardial friction rub is a high-pitched, scratching sound heard on
auscultation in patients with pericarditis. It is caused by the inflamed layers of the
pericardium rubbing against each other. It is best heard at the left lower sternal
border with the patient leaning forward.
8. A nurse is caring for a patient with a new diagnosis of hypertension. Which
lifestyle modification should the nurse recommend first?
A. Begin a rigorous exercise program.
B. Reduce sodium intake to less than 2,300 mg per day.
C. Eliminate all fats from the diet.
D. Take a daily multivitamin.
Rationale: Reducing sodium intake is one of the most effective lifestyle
modifications for lowering blood pressure. The nurse should recommend a gradual
reduction to less than 2,300 mg per day, with an ideal goal of 1,500 mg per day.
9. A patient is scheduled for a cardiac catheterization. Which pre-procedure
instruction is most important?
A. "You will need to eat a full breakfast before the procedure."
B. "You should not eat or drink anything after midnight."
C. "You can take your metformin as usual."
D. "You will be able to drive yourself home after the procedure."
Rationale: Patients undergoing cardiac catheterization must be NPO (nothing by
mouth) after midnight to prevent aspiration during the procedure. Metformin is
often held before procedures involving contrast dye due to the risk of lactic
acidosis. Patients are not allowed to drive themselves home due to sedation.
10. A patient with a mechanical heart valve is prescribed warfarin. The nurse
should teach the patient that the therapeutic INR goal is:
, A. 1.0 to 1.5
B. 1.5 to 2.0
C. 2.5 to 3.5
D. 4.0 to 5.0
Rationale: For patients with mechanical heart valves, the risk of clot formation is
high. The therapeutic INR goal is typically 2.5 to 3.5, which is higher than the goal
for atrial fibrillation (2.0 to 3.0).
11. A nurse is assessing a patient with left-sided heart failure. Which finding
would the nurse expect?
A. Peripheral edema
B. Crackles in the lung bases
C. Jugular venous distension
D. Hepatomegaly
Rationale: Left-sided heart failure leads to the backup of blood into the pulmonary
circulation, causing pulmonary congestion. This manifests as crackles (rales) in the
lung bases, dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.
12. A patient is experiencing an acute myocardial infarction. Which
medication should the nurse anticipate administering first?
A. Morphine sulfate
B. Aspirin (chewable)
C. Nitroglycerin
D. Metoprolol
Rationale: According to the "MONA" mnemonic (Morphine, Oxygen,
Nitroglycerin, Aspirin), aspirin is a priority for a suspected MI. Chewable aspirin is
rapidly absorbed and works to inhibit platelet aggregation, reducing clot formation.
13. A nurse is teaching a patient about a low-cholesterol diet. Which food
should the patient be instructed to limit?
A. Fruits and vegetables
B. Red meat and full-fat dairy products
C. Whole grains
D. Fish and poultry
Rationale: Red meat and full-fat dairy products are high in saturated fats and
cholesterol. Patients should be instructed to limit these foods and choose lean
meats, low-fat dairy, and plant-based protein sources instead.
