NCLEX-STYLE MED-SURG LATEST 2026 UPDATE 100
QUESTIONS AND DETAILED VERIFIED ANSWERS
FROM ACTUAL EXAMS TEST GRADE A+
Question 1
A nurse is caring for a client with heart failure who reports sudden onset of
dyspnea and coughing up pink, frothy sputum. Which action should the nurse take
first?
A. Administer oxygen via nasal cannula
B. Place the client in high-Fowler's position
C. Notify the healthcare provider immediately
D. Check the client's oxygen saturation
Correct Answer: B
Explanation:
Placing the client in high-Fowler's position is the priority intervention because it
reduces venous return to the heart, decreases pulmonary congestion, and
facilitates breathing. Oxygen administration (A) is important but positioning first
maximizes lung expansion. Notifying the provider (C) and checking oxygen
saturation (D) are secondary after immediate positioning.
Question 2
A client with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88% on room air. Which oxygen delivery method is most
appropriate?
A. Nasal cannula at 2 L/min
B. Simple face mask at 6 L/min
,C. Non-rebreather mask at 10 L/min
D. Venturi mask at 24% FiO2
Correct Answer: D
Explanation:
*The Venturi mask delivers precise oxygen concentrations, which is essential for
COPD clients to avoid suppressing the hypoxic drive. Nasal cannula (A) is less
precise. Simple face mask (B) and non-rebreather (C) deliver higher, less controlled
FiO2 that may cause carbon dioxide retention.*
Question 3
A nurse assesses a client with diabetes mellitus who has a blood glucose level of
55 mg/dL and is confused. What is the priority nursing action?
A. Administer 15 g of fast-acting carbohydrate
B. Recheck blood glucose in 15 minutes
C. Call the healthcare provider for insulin orders
D. Administer glucagon intramuscularly
Correct Answer: A
Explanation:
*The client is experiencing hypoglycemia with confusion but is still conscious;
therefore, the rule of 15 applies—give 15 g of fast-acting carbohydrate.
Rechecking (B) delays treatment. Insulin (C) would worsen hypoglycemia.
Glucagon (D) is for unconscious clients or those unable to swallow.*
Question 4
A post-operative client reports sudden chest pain, dyspnea, and hemoptysis. Vital
signs: HR 120, RR 28, BP 100/70. Which condition should the nurse suspect?
A. Pulmonary embolism
B. Atelectasis
,C. Pneumothorax
D. Myocardial infarction
Correct Answer: A
Explanation:
The triad of sudden chest pain, dyspnea, and hemoptysis in a post-operative client
is classic for pulmonary embolism due to venous thromboembolism. Atelectasis (B)
presents with low-grade fever and crackles. Pneumothorax (C) has absent breath
sounds. Myocardial infarction (D) presents with crushing chest pain radiating to
the jaw or arm.
Question 5
A client with cirrhosis develops asterixis and confusion. Which dietary
modification is most appropriate?
A. High-protein diet
B. Low-sodium diet
C. Low-protein diet
D. High-carbohydrate diet
Correct Answer: C
Explanation:
Asterixis and confusion indicate hepatic encephalopathy from ammonia
accumulation. A low-protein diet reduces ammonia production. High-protein (A)
worsens encephalopathy. Low-sodium (B) is for ascites, not encephalopathy. High-
carbohydrate (D) does not address ammonia levels.
Question 6
A nurse is administering furosemide to a client with pulmonary edema. Which
laboratory value requires immediate intervention?
A. Potassium 3.1 mEq/L
, B. Sodium 135 mEq/L
C. Creatinine 1.0 mg/dL
D. Glucose 110 mg/dL
Correct Answer: A
Explanation:
*Furosemide is a loop diuretic that causes potassium wasting; a level of 3.1 mEq/L
indicates hypokalemia, which increases the risk of cardiac dysrhythmias. Sodium
(B) is normal. Creatinine (C) is normal. Glucose (D) is normal; furosemide may
cause hyperglycemia but this level is not concerning.*
Question 7
A client with acute pancreatitis reports severe abdominal pain radiating to the
back. Which position should the nurse encourage to reduce pain?
A. Supine with legs flat
B. Prone position
C. Side-lying with knees flexed
D. Trendelenburg position
Correct Answer: C
Explanation:
Side-lying with knees flexed (fetal position) reduces tension on the pancreas and
decreases pain. Supine (A) increases pancreatic pressure. Prone (B) is
uncomfortable and ineffective. Trendelenburg (D) increases intra-abdominal
pressure and does not relieve pancreatic pain.
Question 8
A client with chronic kidney disease (CKD) has a hemoglobin of 8.5 g/dL. Which
medication does the nurse anticipate?
A. Iron sulfate
QUESTIONS AND DETAILED VERIFIED ANSWERS
FROM ACTUAL EXAMS TEST GRADE A+
Question 1
A nurse is caring for a client with heart failure who reports sudden onset of
dyspnea and coughing up pink, frothy sputum. Which action should the nurse take
first?
A. Administer oxygen via nasal cannula
B. Place the client in high-Fowler's position
C. Notify the healthcare provider immediately
D. Check the client's oxygen saturation
Correct Answer: B
Explanation:
Placing the client in high-Fowler's position is the priority intervention because it
reduces venous return to the heart, decreases pulmonary congestion, and
facilitates breathing. Oxygen administration (A) is important but positioning first
maximizes lung expansion. Notifying the provider (C) and checking oxygen
saturation (D) are secondary after immediate positioning.
Question 2
A client with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88% on room air. Which oxygen delivery method is most
appropriate?
A. Nasal cannula at 2 L/min
B. Simple face mask at 6 L/min
,C. Non-rebreather mask at 10 L/min
D. Venturi mask at 24% FiO2
Correct Answer: D
Explanation:
*The Venturi mask delivers precise oxygen concentrations, which is essential for
COPD clients to avoid suppressing the hypoxic drive. Nasal cannula (A) is less
precise. Simple face mask (B) and non-rebreather (C) deliver higher, less controlled
FiO2 that may cause carbon dioxide retention.*
Question 3
A nurse assesses a client with diabetes mellitus who has a blood glucose level of
55 mg/dL and is confused. What is the priority nursing action?
A. Administer 15 g of fast-acting carbohydrate
B. Recheck blood glucose in 15 minutes
C. Call the healthcare provider for insulin orders
D. Administer glucagon intramuscularly
Correct Answer: A
Explanation:
*The client is experiencing hypoglycemia with confusion but is still conscious;
therefore, the rule of 15 applies—give 15 g of fast-acting carbohydrate.
Rechecking (B) delays treatment. Insulin (C) would worsen hypoglycemia.
Glucagon (D) is for unconscious clients or those unable to swallow.*
Question 4
A post-operative client reports sudden chest pain, dyspnea, and hemoptysis. Vital
signs: HR 120, RR 28, BP 100/70. Which condition should the nurse suspect?
A. Pulmonary embolism
B. Atelectasis
,C. Pneumothorax
D. Myocardial infarction
Correct Answer: A
Explanation:
The triad of sudden chest pain, dyspnea, and hemoptysis in a post-operative client
is classic for pulmonary embolism due to venous thromboembolism. Atelectasis (B)
presents with low-grade fever and crackles. Pneumothorax (C) has absent breath
sounds. Myocardial infarction (D) presents with crushing chest pain radiating to
the jaw or arm.
Question 5
A client with cirrhosis develops asterixis and confusion. Which dietary
modification is most appropriate?
A. High-protein diet
B. Low-sodium diet
C. Low-protein diet
D. High-carbohydrate diet
Correct Answer: C
Explanation:
Asterixis and confusion indicate hepatic encephalopathy from ammonia
accumulation. A low-protein diet reduces ammonia production. High-protein (A)
worsens encephalopathy. Low-sodium (B) is for ascites, not encephalopathy. High-
carbohydrate (D) does not address ammonia levels.
Question 6
A nurse is administering furosemide to a client with pulmonary edema. Which
laboratory value requires immediate intervention?
A. Potassium 3.1 mEq/L
, B. Sodium 135 mEq/L
C. Creatinine 1.0 mg/dL
D. Glucose 110 mg/dL
Correct Answer: A
Explanation:
*Furosemide is a loop diuretic that causes potassium wasting; a level of 3.1 mEq/L
indicates hypokalemia, which increases the risk of cardiac dysrhythmias. Sodium
(B) is normal. Creatinine (C) is normal. Glucose (D) is normal; furosemide may
cause hyperglycemia but this level is not concerning.*
Question 7
A client with acute pancreatitis reports severe abdominal pain radiating to the
back. Which position should the nurse encourage to reduce pain?
A. Supine with legs flat
B. Prone position
C. Side-lying with knees flexed
D. Trendelenburg position
Correct Answer: C
Explanation:
Side-lying with knees flexed (fetal position) reduces tension on the pancreas and
decreases pain. Supine (A) increases pancreatic pressure. Prone (B) is
uncomfortable and ineffective. Trendelenburg (D) increases intra-abdominal
pressure and does not relieve pancreatic pain.
Question 8
A client with chronic kidney disease (CKD) has a hemoglobin of 8.5 g/dL. Which
medication does the nurse anticipate?
A. Iron sulfate
