ORIGINAL PRACTICE RESOURCE • 2026–2027 EDITION
Adult Medical-Surgical Nursing
Practice Exam
ATI-style format • Original single-best-answer items • Evidence-linked rationales
3 100 300
VERSIONS QUESTIONS EACH QUESTIONS TOTAL
Four options per item • Balanced A–D answer positions • Answers and rationales integrated
Cardiovascular, respiratory, gastrointestinal, endocrine, renal, neurologic, perioperative, emergency, pharmacology, and
other adult-health topics
, ADULT MEDICAL-SURGICAL NURSING • PRACTICE EXAM
Introduction
This original practice set uses clinical scenarios to review adult medical-surgical nursing
priorities, safety, assessment, medication management, delegation, calculations, and patient
education across the 2026 NCLEX-RN framework [1]. Work each version independently, then
review the integrated bold-cyan answers and italic rationales; apply patient-specific orders and
current local protocols to clinical decisions [1, 23, 36].
2026–2027 Edition • Original practice resource Page 2
, ADULT MEDICAL-SURGICAL NURSING • PRACTICE EXAM
Version 1 — 100 Questions (V1-1 to V1-100)
Complete this 100-item set before reviewing the integrated answer and rationale for each item.
Cardiovascular
V1-1 A client arrives with new crushing substernal pressure, diaphoresis, and nausea. Which
action should the nurse prioritize?
A. Wait for the first troponin result before obtaining an ECG.
B. Ask the client to walk to determine whether the pain persists.
C. Give a meal and reassess the discomfort in 30 minutes.
D. Obtain a 12-lead ECG promptly while activating the acute chest-pain pathway.
Answer: D — Obtain a 12-lead ECG promptly while activating the acute chest-pain
pathway.
Rationale: A rapid ECG helps identify time-sensitive ischemia and guides reperfusion decisions;
obtain it as soon as possible, ideally within 10 minutes of arrival. Do not delay evaluation while
waiting for biomarkers or symptom evolution. [4]
V1-2 A client with heart failure asks how to recognize worsening fluid retention at home. Which
instruction is best?
A. Drink extra fluid whenever your weight rises.
B. Weigh yourself each morning under similar conditions and report a rapid gain using your
care plan's threshold.
C. Weigh yourself once each month unless your ankles swell.
D. Stop the prescribed diuretic as soon as breathing improves.
Answer: B — Weigh yourself each morning under similar conditions and report a rapid
gain using your care plan's threshold.
Rationale: Daily weights can reveal fluid accumulation before severe symptoms develop, and the
client should follow the clinician's specific call threshold. Extra fluid or stopping a diuretic without
guidance may worsen congestion. [3]
V1-3 A client with atrial fibrillation taking an anticoagulant asks why it is still needed when the
heart rate is controlled. Which response is most accurate?
A. Once the pulse is regular, the anticoagulant should be stopped.
B. The anticoagulant prevents every episode of atrial fibrillation.
C. Rate control does not remove the risk of clot-related stroke, so anticoagulation may still be
indicated.
D. The medicine is used only to lower blood pressure.
Answer: C — Rate control does not remove the risk of clot-related stroke, so
anticoagulation may still be indicated.
Rationale: Stroke-prevention decisions in atrial fibrillation are based on thromboembolic risk,
not simply whether the ventricular rate is controlled. The client should not stop an anticoagulant
without the prescriber's direction. [5]
2026–2027 Edition • Original practice resource Page 3
, ADULT MEDICAL-SURGICAL NURSING • PRACTICE EXAM
V1-4 A client with blood pressure 224/126 mm Hg reports severe headache and blurred vision.
What is the nurse's priority?
A. Urgently assess for acute target-organ injury and notify the emergency care team.
B. Encourage brisk walking to lower the blood pressure naturally.
C. Give the client's usual oral antihypertensive and recheck tomorrow.
D. Lower the pressure rapidly with an unprescribed medication.
Answer: A — Urgently assess for acute target-organ injury and notify the emergency care
team.
Rationale: Severe hypertension with neurologic or visual symptoms may represent a hypertensive
emergency requiring monitored evaluation and controlled treatment. Abrupt, unsupervised
blood-pressure reduction can impair organ perfusion. [2]
V1-5 A client with heart failure reports waking suddenly at night short of breath and needing
three pillows to sleep. Which interpretation is most appropriate?
A. The symptoms indicate dehydration from the prescribed diuretic.
B. The symptoms suggest worsening pulmonary congestion and require prompt assessment.
C. These findings are expected and need no follow-up if there is no ankle edema.
D. The client should increase salt intake before bedtime.
Answer: B — The symptoms suggest worsening pulmonary congestion and require
prompt assessment.
Rationale: Orthopnea and paroxysmal nocturnal dyspnea can signal worsening heart-failure
congestion even when peripheral edema is absent. Assess oxygenation and contact the treating
team promptly. [3]
V1-6 A client with stable angina has a prescribed sublingual nitroglycerin tablet. Which teaching
is safest?
A. Sit down before taking it and seek emergency help if pain persists after the first dose
according to the action plan.
B. Take the tablet only after eating a high-fat meal.
C. Take several tablets together whenever chest pain begins.
D. Store tablets in a weekly pill organizer exposed to light.
Answer: A — Sit down before taking it and seek emergency help if pain persists after the
first dose according to the action plan.
Rationale: Nitroglycerin can cause dizziness or hypotension, so sitting reduces injury risk;
persistent or severe chest pain needs urgent escalation rather than delayed self-treatment. Store
tablets in their original, tightly closed container as directed. [4]
2026–2027 Edition • Original practice resource Page 4
Adult Medical-Surgical Nursing
Practice Exam
ATI-style format • Original single-best-answer items • Evidence-linked rationales
3 100 300
VERSIONS QUESTIONS EACH QUESTIONS TOTAL
Four options per item • Balanced A–D answer positions • Answers and rationales integrated
Cardiovascular, respiratory, gastrointestinal, endocrine, renal, neurologic, perioperative, emergency, pharmacology, and
other adult-health topics
, ADULT MEDICAL-SURGICAL NURSING • PRACTICE EXAM
Introduction
This original practice set uses clinical scenarios to review adult medical-surgical nursing
priorities, safety, assessment, medication management, delegation, calculations, and patient
education across the 2026 NCLEX-RN framework [1]. Work each version independently, then
review the integrated bold-cyan answers and italic rationales; apply patient-specific orders and
current local protocols to clinical decisions [1, 23, 36].
2026–2027 Edition • Original practice resource Page 2
, ADULT MEDICAL-SURGICAL NURSING • PRACTICE EXAM
Version 1 — 100 Questions (V1-1 to V1-100)
Complete this 100-item set before reviewing the integrated answer and rationale for each item.
Cardiovascular
V1-1 A client arrives with new crushing substernal pressure, diaphoresis, and nausea. Which
action should the nurse prioritize?
A. Wait for the first troponin result before obtaining an ECG.
B. Ask the client to walk to determine whether the pain persists.
C. Give a meal and reassess the discomfort in 30 minutes.
D. Obtain a 12-lead ECG promptly while activating the acute chest-pain pathway.
Answer: D — Obtain a 12-lead ECG promptly while activating the acute chest-pain
pathway.
Rationale: A rapid ECG helps identify time-sensitive ischemia and guides reperfusion decisions;
obtain it as soon as possible, ideally within 10 minutes of arrival. Do not delay evaluation while
waiting for biomarkers or symptom evolution. [4]
V1-2 A client with heart failure asks how to recognize worsening fluid retention at home. Which
instruction is best?
A. Drink extra fluid whenever your weight rises.
B. Weigh yourself each morning under similar conditions and report a rapid gain using your
care plan's threshold.
C. Weigh yourself once each month unless your ankles swell.
D. Stop the prescribed diuretic as soon as breathing improves.
Answer: B — Weigh yourself each morning under similar conditions and report a rapid
gain using your care plan's threshold.
Rationale: Daily weights can reveal fluid accumulation before severe symptoms develop, and the
client should follow the clinician's specific call threshold. Extra fluid or stopping a diuretic without
guidance may worsen congestion. [3]
V1-3 A client with atrial fibrillation taking an anticoagulant asks why it is still needed when the
heart rate is controlled. Which response is most accurate?
A. Once the pulse is regular, the anticoagulant should be stopped.
B. The anticoagulant prevents every episode of atrial fibrillation.
C. Rate control does not remove the risk of clot-related stroke, so anticoagulation may still be
indicated.
D. The medicine is used only to lower blood pressure.
Answer: C — Rate control does not remove the risk of clot-related stroke, so
anticoagulation may still be indicated.
Rationale: Stroke-prevention decisions in atrial fibrillation are based on thromboembolic risk,
not simply whether the ventricular rate is controlled. The client should not stop an anticoagulant
without the prescriber's direction. [5]
2026–2027 Edition • Original practice resource Page 3
, ADULT MEDICAL-SURGICAL NURSING • PRACTICE EXAM
V1-4 A client with blood pressure 224/126 mm Hg reports severe headache and blurred vision.
What is the nurse's priority?
A. Urgently assess for acute target-organ injury and notify the emergency care team.
B. Encourage brisk walking to lower the blood pressure naturally.
C. Give the client's usual oral antihypertensive and recheck tomorrow.
D. Lower the pressure rapidly with an unprescribed medication.
Answer: A — Urgently assess for acute target-organ injury and notify the emergency care
team.
Rationale: Severe hypertension with neurologic or visual symptoms may represent a hypertensive
emergency requiring monitored evaluation and controlled treatment. Abrupt, unsupervised
blood-pressure reduction can impair organ perfusion. [2]
V1-5 A client with heart failure reports waking suddenly at night short of breath and needing
three pillows to sleep. Which interpretation is most appropriate?
A. The symptoms indicate dehydration from the prescribed diuretic.
B. The symptoms suggest worsening pulmonary congestion and require prompt assessment.
C. These findings are expected and need no follow-up if there is no ankle edema.
D. The client should increase salt intake before bedtime.
Answer: B — The symptoms suggest worsening pulmonary congestion and require
prompt assessment.
Rationale: Orthopnea and paroxysmal nocturnal dyspnea can signal worsening heart-failure
congestion even when peripheral edema is absent. Assess oxygenation and contact the treating
team promptly. [3]
V1-6 A client with stable angina has a prescribed sublingual nitroglycerin tablet. Which teaching
is safest?
A. Sit down before taking it and seek emergency help if pain persists after the first dose
according to the action plan.
B. Take the tablet only after eating a high-fat meal.
C. Take several tablets together whenever chest pain begins.
D. Store tablets in a weekly pill organizer exposed to light.
Answer: A — Sit down before taking it and seek emergency help if pain persists after the
first dose according to the action plan.
Rationale: Nitroglycerin can cause dizziness or hypotension, so sitting reduces injury risk;
persistent or severe chest pain needs urgent escalation rather than delayed self-treatment. Store
tablets in their original, tightly closed container as directed. [4]
2026–2027 Edition • Original practice resource Page 4
