Prepare smarter with this nursing study guide designed for
revision notes and exam practice. Elevate your nursing exam
prep with this ultimate success bundle of practice questions.
---
## 🏆 Medical-Surgical Nursing Study Bundle | Complete Prep
Questions – 2025/2026 Ultimate NCLEX-Style Practice Guide
---
1. A client with chronic heart failure is prescribed carvedilol. Which assessment finding indicates the
medication is having the desired therapeutic effect?
A. Increased heart rate.
B. Decreased blood pressure.
C. Improved ejection fraction.
D. Decreased peripheral edema.
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Carvedilol is a beta-blocker used in heart failure to improve cardiac function and
reduce mortality. The desired effect is an improved ejection fraction, indicating better pumping ability.
While it can decrease blood pressure and heart rate, the primary therapeutic goal is improved cardiac
output. Decreased peripheral edema is a sign of reduced fluid overload, which is also a goal, but
improved ejection fraction is the most direct measure of cardiac performance. This nursing exam prep
question emphasizes evaluating therapeutic responses to cardiovascular medications.
2. A nurse is calculating the intake and output for a client over an 8-hour shift. The client received 750
mL of IV fluids, 200 mL of water, and 150 mL of ice chips. The client's urinary output was 900 mL. What
is the client's net fluid balance?
A. Positive 200 mL.
,B. Positive 100 mL.
C. Negative 200 mL.
D. Negative 100 mL.
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Calculate total intake: 750 mL (IV) + 200 mL (water) + 150 mL (ice chips, measured as
half the volume of ice, so 75 mL of fluid) = 1025 mL. Total output = 900 mL. Net balance = intake - output
= 1025 - 900 = +125 mL, which is closest to +100 mL. This question highlights the importance of accurate
fluid measurement, a fundamental skill in nursing study guides and exam practice. The other options
represent miscalculations of intake or output.
3. A client is admitted with a diagnosis of bacterial pneumonia. The nurse assesses the client and notes
dullness to percussion over the right lower lobe. This finding is consistent with:
A. Pleural effusion.
B. Atelectasis.
C. Consolidation.
D. Pneumothorax.
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Dullness to percussion over a lung field indicates consolidation, which is the filling of
alveoli with fluid, exudate, or pus, as seen in pneumonia. Pleural effusion also causes dullness, but it is
more diffuse. Atelectasis causes a dull or flat sound due to collapsed lung tissue. Pneumothorax
produces hyperresonance. This assessment finding is a classic indicator for NCLEX-style prep and nursing
exam practice.
4. A client is receiving a continuous feeding via a nasogastric tube. The nurse checks the residual volume
and finds 250 mL. What is the most appropriate action?
A. Discard the residual and increase the feeding rate.
B. Re-instill the residual and continue the feeding.
C. Hold the feeding and recheck in 1 hour.
D. Notify the healthcare provider immediately.
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: A gastric residual volume of 250 mL is at the upper limit of normal for many
institutions (typically 200-250 mL). The best action is to hold the feeding and recheck in 1 hour to see if
the residual decreases. If it remains high or increases, the provider should be notified. Discarding the
,residual is not recommended. Re-instilling and continuing is not appropriate if the volume is borderline
high. This is a key safety protocol in enteral nutrition, a vital topic in nursing study guides.
5. A client is prescribed albuterol via a metered-dose inhaler (MDI). The nurse should instruct the client
to wait how long between inhalations if two puffs are prescribed?
A. 15 seconds.
B. 30 seconds.
C. 1 minute.
D. 5 minutes.
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: The recommended time between puffs of an MDI is 1 minute to allow the first dose
to be absorbed and to ensure that the second dose is delivered effectively. This practice maximizes
bronchodilation. Waiting 15-30 seconds is insufficient, and 5 minutes is unnecessarily long. This is a
crucial teaching point for student success in respiratory nursing and exam prep.
6. A nurse is assessing a client who is 4 hours post-operative following a total knee replacement. Which
finding should the nurse report to the healthcare provider?
A. The client's pain is 3/10.
B. The client's surgical dressing is dry and intact.
C. The client's toes are pale and cool.
D. The client's pulse oximetry is 95%.
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Pale, cool toes indicate possible arterial insufficiency or compromised circulation to
the lower extremity, a potential complication following knee surgery. This requires immediate
assessment. The other findings are expected and within normal limits. This nursing practice question
emphasizes the importance of neurovascular assessments post-operatively.
7. A client with a history of seizures is prescribed phenytoin. The nurse notes that the client's serum
phenytoin level is 22 mcg/mL. What is the most appropriate nursing action?
A. Administer the medication as ordered.
B. Hold the medication and notify the healthcare provider.
C. Increase the client's fluid intake.
, D. Assess the client for signs of toxicity.
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: The therapeutic range for phenytoin is typically 10-20 mcg/mL. A level of 22 mcg/mL
is above the therapeutic range and indicates toxicity. The nurse should hold the medication and notify
the healthcare provider. Assessing for toxicity is also important, but the primary action is to stop the
medication and report the result. This is a critical pharmacology safety question for nursing exam prep.
8. A client is admitted with severe dehydration and has a serum sodium level of 155 mEq/L. Which
intravenous fluid would the nurse anticipate being prescribed?
A. 0.9% sodium chloride (normal saline).
B. 0.45% sodium chloride (half-normal saline).
C. 3% sodium chloride (hypertonic saline).
D. 5% dextrose in water (D5W).
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: A serum sodium of 155 mEq/L indicates hypernatremia (elevated sodium). The
treatment is to administer a hypotonic solution like 0.45% sodium chloride to dilute the serum sodium.
Normal saline is isotonic and may worsen the hypernatremia. Hypertonic saline would be
contraindicated. D5W is also hypotonic but is often used for maintenance, whereas half-normal saline is
more direct for correcting hypernatremia. This is a key fluid and electrolyte concept in nursing study
guides.
9. A nurse is caring for a client with a newly placed ileostomy. Which assessment finding should be
reported to the healthcare provider immediately?
A. The stoma is pink and moist.
B. The stoma produces 500 mL of liquid stool in 24 hours.
C. The skin around the stoma is excoriated.
D. The stoma is dark purple in color.
💫ANSWER✔️✔️: D
💫RATIONALE✔️✔️: A dark purple or black stoma indicates ischemia or necrosis, a surgical emergency. A
pink, moist stoma is a normal finding. 500 mL of liquid output is expected for an ileostomy. Excoriated
skin around the stoma is a common issue that requires management but is not an emergency. This is a
priority assessment in ostomy care for nursing exam prep.
revision notes and exam practice. Elevate your nursing exam
prep with this ultimate success bundle of practice questions.
---
## 🏆 Medical-Surgical Nursing Study Bundle | Complete Prep
Questions – 2025/2026 Ultimate NCLEX-Style Practice Guide
---
1. A client with chronic heart failure is prescribed carvedilol. Which assessment finding indicates the
medication is having the desired therapeutic effect?
A. Increased heart rate.
B. Decreased blood pressure.
C. Improved ejection fraction.
D. Decreased peripheral edema.
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Carvedilol is a beta-blocker used in heart failure to improve cardiac function and
reduce mortality. The desired effect is an improved ejection fraction, indicating better pumping ability.
While it can decrease blood pressure and heart rate, the primary therapeutic goal is improved cardiac
output. Decreased peripheral edema is a sign of reduced fluid overload, which is also a goal, but
improved ejection fraction is the most direct measure of cardiac performance. This nursing exam prep
question emphasizes evaluating therapeutic responses to cardiovascular medications.
2. A nurse is calculating the intake and output for a client over an 8-hour shift. The client received 750
mL of IV fluids, 200 mL of water, and 150 mL of ice chips. The client's urinary output was 900 mL. What
is the client's net fluid balance?
A. Positive 200 mL.
,B. Positive 100 mL.
C. Negative 200 mL.
D. Negative 100 mL.
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Calculate total intake: 750 mL (IV) + 200 mL (water) + 150 mL (ice chips, measured as
half the volume of ice, so 75 mL of fluid) = 1025 mL. Total output = 900 mL. Net balance = intake - output
= 1025 - 900 = +125 mL, which is closest to +100 mL. This question highlights the importance of accurate
fluid measurement, a fundamental skill in nursing study guides and exam practice. The other options
represent miscalculations of intake or output.
3. A client is admitted with a diagnosis of bacterial pneumonia. The nurse assesses the client and notes
dullness to percussion over the right lower lobe. This finding is consistent with:
A. Pleural effusion.
B. Atelectasis.
C. Consolidation.
D. Pneumothorax.
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Dullness to percussion over a lung field indicates consolidation, which is the filling of
alveoli with fluid, exudate, or pus, as seen in pneumonia. Pleural effusion also causes dullness, but it is
more diffuse. Atelectasis causes a dull or flat sound due to collapsed lung tissue. Pneumothorax
produces hyperresonance. This assessment finding is a classic indicator for NCLEX-style prep and nursing
exam practice.
4. A client is receiving a continuous feeding via a nasogastric tube. The nurse checks the residual volume
and finds 250 mL. What is the most appropriate action?
A. Discard the residual and increase the feeding rate.
B. Re-instill the residual and continue the feeding.
C. Hold the feeding and recheck in 1 hour.
D. Notify the healthcare provider immediately.
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: A gastric residual volume of 250 mL is at the upper limit of normal for many
institutions (typically 200-250 mL). The best action is to hold the feeding and recheck in 1 hour to see if
the residual decreases. If it remains high or increases, the provider should be notified. Discarding the
,residual is not recommended. Re-instilling and continuing is not appropriate if the volume is borderline
high. This is a key safety protocol in enteral nutrition, a vital topic in nursing study guides.
5. A client is prescribed albuterol via a metered-dose inhaler (MDI). The nurse should instruct the client
to wait how long between inhalations if two puffs are prescribed?
A. 15 seconds.
B. 30 seconds.
C. 1 minute.
D. 5 minutes.
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: The recommended time between puffs of an MDI is 1 minute to allow the first dose
to be absorbed and to ensure that the second dose is delivered effectively. This practice maximizes
bronchodilation. Waiting 15-30 seconds is insufficient, and 5 minutes is unnecessarily long. This is a
crucial teaching point for student success in respiratory nursing and exam prep.
6. A nurse is assessing a client who is 4 hours post-operative following a total knee replacement. Which
finding should the nurse report to the healthcare provider?
A. The client's pain is 3/10.
B. The client's surgical dressing is dry and intact.
C. The client's toes are pale and cool.
D. The client's pulse oximetry is 95%.
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Pale, cool toes indicate possible arterial insufficiency or compromised circulation to
the lower extremity, a potential complication following knee surgery. This requires immediate
assessment. The other findings are expected and within normal limits. This nursing practice question
emphasizes the importance of neurovascular assessments post-operatively.
7. A client with a history of seizures is prescribed phenytoin. The nurse notes that the client's serum
phenytoin level is 22 mcg/mL. What is the most appropriate nursing action?
A. Administer the medication as ordered.
B. Hold the medication and notify the healthcare provider.
C. Increase the client's fluid intake.
, D. Assess the client for signs of toxicity.
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: The therapeutic range for phenytoin is typically 10-20 mcg/mL. A level of 22 mcg/mL
is above the therapeutic range and indicates toxicity. The nurse should hold the medication and notify
the healthcare provider. Assessing for toxicity is also important, but the primary action is to stop the
medication and report the result. This is a critical pharmacology safety question for nursing exam prep.
8. A client is admitted with severe dehydration and has a serum sodium level of 155 mEq/L. Which
intravenous fluid would the nurse anticipate being prescribed?
A. 0.9% sodium chloride (normal saline).
B. 0.45% sodium chloride (half-normal saline).
C. 3% sodium chloride (hypertonic saline).
D. 5% dextrose in water (D5W).
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: A serum sodium of 155 mEq/L indicates hypernatremia (elevated sodium). The
treatment is to administer a hypotonic solution like 0.45% sodium chloride to dilute the serum sodium.
Normal saline is isotonic and may worsen the hypernatremia. Hypertonic saline would be
contraindicated. D5W is also hypotonic but is often used for maintenance, whereas half-normal saline is
more direct for correcting hypernatremia. This is a key fluid and electrolyte concept in nursing study
guides.
9. A nurse is caring for a client with a newly placed ileostomy. Which assessment finding should be
reported to the healthcare provider immediately?
A. The stoma is pink and moist.
B. The stoma produces 500 mL of liquid stool in 24 hours.
C. The skin around the stoma is excoriated.
D. The stoma is dark purple in color.
💫ANSWER✔️✔️: D
💫RATIONALE✔️✔️: A dark purple or black stoma indicates ischemia or necrosis, a surgical emergency. A
pink, moist stoma is a normal finding. 500 mL of liquid output is expected for an ileostomy. Excoriated
skin around the stoma is a common issue that requires management but is not an emergency. This is a
priority assessment in ostomy care for nursing exam prep.
