Elevate your nursing exam prep with this ultimate success bundle of
practice questions. Achieve confidence in NCLEX-style prep with this
complete nursing study pack.
---
## 🏆 Critical Care & Medical-Surgical Nursing Study Guide – 2026
Ultimate Success Bundle | NCLEX Practice Questions
---
**1. A nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which
observation indicates that the system is functioning correctly?**
A. Continuous bubbling in the water-seal chamber
B. Fluctuation of water in the water-seal chamber with respirations
C. Absence of drainage in the collection chamber after 4 hours
D. Subcutaneous emphysema at the insertion site
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Tidaling (fluctuation) in the water-seal chamber is a normal finding that indicates the
chest tube is patent and the pleural space is intact. In nursing exam prep, understanding chest tube
function is vital for critical care. Continuous bubbling suggests an air leak, not normal function. Absence
of drainage does not indicate proper function, and subcutaneous emphysema is a complication. This
nursing study guide emphasizes the importance of monitoring chest tube systems for student success in
the clinical setting.
**2. A client is admitted with severe hypokalemia. Which finding is most concerning?**
A. Muscle weakness
B. ECG changes with a flat T wave
C. Respiratory muscle fatigue
,D. Abdominal cramping
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Respiratory muscle fatigue can lead to respiratory failure, making it the most critical
finding in severe hypokalemia. While muscle weakness, ECG changes, and abdominal cramping are all
signs, respiratory compromise poses an immediate threat to life. For nursing exam prep, recognizing the
priority assessment is key. These revision notes highlight the importance of monitoring potassium levels
and respiratory status for student success in medical-surgical nursing.
**3. A nurse is administering a blood transfusion. Fifteen minutes after the start, the client reports chills
and low back pain. What is the nurse's priority action?**
A. Slow the transfusion rate
B. Administer an antihistamine
C. Stop the transfusion immediately
D. Notify the healthcare provider
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Chills and low back pain are signs of an acute hemolytic transfusion reaction. The
priority is to stop the transfusion immediately to prevent further complications. This is a fundamental
concept in nursing exam prep for blood product administration. After stopping, the nurse would notify
the provider and maintain IV access. This nursing study guide stresses the importance of rapid
recognition and action for student success in critical care.
**4. A client with heart failure is prescribed digoxin. The nurse should monitor for which early sign of
toxicity?**
A. Tachycardia
B. Vomiting and anorexia
C. Hyperkalemia
D. Constipation
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Anorexia, nausea, and vomiting are early signs of digoxin toxicity, a critical concept in
pharmacology nursing exam prep. Tachycardia is not typically an early sign; bradycardia is more
common. Hypokalemia, not hyperkalemia, potentiates toxicity. Constipation is not a primary sign. This
study guide emphasizes the importance of monitoring serum drug levels and side effects for student
success in medication administration.
,**5. A nurse is preparing a client for a lumbar puncture. Which position is most appropriate?**
A. Prone with the head turned to the side
B. Lateral recumbent with knees to the chest
C. Supine with a pillow under the head
D. Sitting with the head extended back
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: The lateral recumbent or fetal position with knees drawn to the chest maximizes the
space between vertebrae for needle insertion. This is a standard nursing study guide procedure. The
other positions do not provide adequate access. For nursing exam prep, knowing proper patient
positioning for procedures is essential for student success in diagnostic testing and neurological care.
**6. A client with cirrhosis has ascites. Which dietary modification is most important?**
A. High-protein diet
B. Low-sodium diet
C. Low-potassium diet
D. High-carbohydrate diet
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: A low-sodium diet is crucial to decrease fluid retention and manage ascites in
cirrhosis. Sodium restriction helps reduce the accumulation of fluid in the abdominal cavity. A high-
protein diet is important for liver function but does not directly address ascites. This nursing study guide
highlights nutritional management for hepatic disorders, a key topic in nursing exam prep for medical-
surgical nursing.
**7. A client on a mechanical ventilator has a high-pressure alarm sounding. Which action should the
nurse take first?**
A. Sedate the client
B. Suction the client's airway
C. Check the ventilator tubing for kinks
D. Assess the client's oxygen saturation
💫ANSWER✔️✔️: C
, 💫RATIONALE✔️✔️: A high-pressure alarm often indicates an obstruction in the airway or tubing. The
nurse should first check the ventilator tubing for kinks, water accumulation, or obstructions. Suctioning
is appropriate if the tubing is clear but the client has secretions. This is a priority in nursing exam prep
for critical care. This nursing study guide emphasizes systematic troubleshooting to ensure student
success in managing mechanical ventilation.
**8. A client is prescribed phenytoin for a seizure disorder. Which side effect is most likely to occur?**
A. Gingival hyperplasia
B. Weight gain
C. Hypoglycemia
D. Hepatotoxicity
💫ANSWER✔️✔️: A
💫RATIONALE✔️✔️: Gingival hyperplasia is a common side effect of phenytoin, requiring good oral
hygiene. Weight gain, hypoglycemia, and hepatotoxicity are less common or associated with other
medications. For nursing exam prep, recognizing medication-specific side effects is vital for
pharmacology and neurological nursing. This study guide provides essential revision notes on
anticonvulsant therapy for student success.
**9. A nurse is assessing a client's postoperative wound. The wound edges are well-approximated, but
there is a small amount of serosanguineous drainage. What is the most appropriate nursing action?**
A. Notify the healthcare provider immediately
B. Document the findings and continue to monitor
C. Apply a wet-to-dry dressing
D. Culture the drainage
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Serosanguineous drainage is normal in the early postoperative period, especially if
the wound edges are well-approximated. This indicates normal healing. For nursing exam prep,
understanding normal vs. abnormal wound healing is crucial. This nursing study guide emphasizes
proper documentation and wound assessment for student success in medical-surgical nursing.
**10. A client is receiving total parenteral nutrition (TPN). Which complication is the nurse most
concerned about?**
A. Hyperglycemia
practice questions. Achieve confidence in NCLEX-style prep with this
complete nursing study pack.
---
## 🏆 Critical Care & Medical-Surgical Nursing Study Guide – 2026
Ultimate Success Bundle | NCLEX Practice Questions
---
**1. A nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which
observation indicates that the system is functioning correctly?**
A. Continuous bubbling in the water-seal chamber
B. Fluctuation of water in the water-seal chamber with respirations
C. Absence of drainage in the collection chamber after 4 hours
D. Subcutaneous emphysema at the insertion site
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Tidaling (fluctuation) in the water-seal chamber is a normal finding that indicates the
chest tube is patent and the pleural space is intact. In nursing exam prep, understanding chest tube
function is vital for critical care. Continuous bubbling suggests an air leak, not normal function. Absence
of drainage does not indicate proper function, and subcutaneous emphysema is a complication. This
nursing study guide emphasizes the importance of monitoring chest tube systems for student success in
the clinical setting.
**2. A client is admitted with severe hypokalemia. Which finding is most concerning?**
A. Muscle weakness
B. ECG changes with a flat T wave
C. Respiratory muscle fatigue
,D. Abdominal cramping
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Respiratory muscle fatigue can lead to respiratory failure, making it the most critical
finding in severe hypokalemia. While muscle weakness, ECG changes, and abdominal cramping are all
signs, respiratory compromise poses an immediate threat to life. For nursing exam prep, recognizing the
priority assessment is key. These revision notes highlight the importance of monitoring potassium levels
and respiratory status for student success in medical-surgical nursing.
**3. A nurse is administering a blood transfusion. Fifteen minutes after the start, the client reports chills
and low back pain. What is the nurse's priority action?**
A. Slow the transfusion rate
B. Administer an antihistamine
C. Stop the transfusion immediately
D. Notify the healthcare provider
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Chills and low back pain are signs of an acute hemolytic transfusion reaction. The
priority is to stop the transfusion immediately to prevent further complications. This is a fundamental
concept in nursing exam prep for blood product administration. After stopping, the nurse would notify
the provider and maintain IV access. This nursing study guide stresses the importance of rapid
recognition and action for student success in critical care.
**4. A client with heart failure is prescribed digoxin. The nurse should monitor for which early sign of
toxicity?**
A. Tachycardia
B. Vomiting and anorexia
C. Hyperkalemia
D. Constipation
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Anorexia, nausea, and vomiting are early signs of digoxin toxicity, a critical concept in
pharmacology nursing exam prep. Tachycardia is not typically an early sign; bradycardia is more
common. Hypokalemia, not hyperkalemia, potentiates toxicity. Constipation is not a primary sign. This
study guide emphasizes the importance of monitoring serum drug levels and side effects for student
success in medication administration.
,**5. A nurse is preparing a client for a lumbar puncture. Which position is most appropriate?**
A. Prone with the head turned to the side
B. Lateral recumbent with knees to the chest
C. Supine with a pillow under the head
D. Sitting with the head extended back
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: The lateral recumbent or fetal position with knees drawn to the chest maximizes the
space between vertebrae for needle insertion. This is a standard nursing study guide procedure. The
other positions do not provide adequate access. For nursing exam prep, knowing proper patient
positioning for procedures is essential for student success in diagnostic testing and neurological care.
**6. A client with cirrhosis has ascites. Which dietary modification is most important?**
A. High-protein diet
B. Low-sodium diet
C. Low-potassium diet
D. High-carbohydrate diet
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: A low-sodium diet is crucial to decrease fluid retention and manage ascites in
cirrhosis. Sodium restriction helps reduce the accumulation of fluid in the abdominal cavity. A high-
protein diet is important for liver function but does not directly address ascites. This nursing study guide
highlights nutritional management for hepatic disorders, a key topic in nursing exam prep for medical-
surgical nursing.
**7. A client on a mechanical ventilator has a high-pressure alarm sounding. Which action should the
nurse take first?**
A. Sedate the client
B. Suction the client's airway
C. Check the ventilator tubing for kinks
D. Assess the client's oxygen saturation
💫ANSWER✔️✔️: C
, 💫RATIONALE✔️✔️: A high-pressure alarm often indicates an obstruction in the airway or tubing. The
nurse should first check the ventilator tubing for kinks, water accumulation, or obstructions. Suctioning
is appropriate if the tubing is clear but the client has secretions. This is a priority in nursing exam prep
for critical care. This nursing study guide emphasizes systematic troubleshooting to ensure student
success in managing mechanical ventilation.
**8. A client is prescribed phenytoin for a seizure disorder. Which side effect is most likely to occur?**
A. Gingival hyperplasia
B. Weight gain
C. Hypoglycemia
D. Hepatotoxicity
💫ANSWER✔️✔️: A
💫RATIONALE✔️✔️: Gingival hyperplasia is a common side effect of phenytoin, requiring good oral
hygiene. Weight gain, hypoglycemia, and hepatotoxicity are less common or associated with other
medications. For nursing exam prep, recognizing medication-specific side effects is vital for
pharmacology and neurological nursing. This study guide provides essential revision notes on
anticonvulsant therapy for student success.
**9. A nurse is assessing a client's postoperative wound. The wound edges are well-approximated, but
there is a small amount of serosanguineous drainage. What is the most appropriate nursing action?**
A. Notify the healthcare provider immediately
B. Document the findings and continue to monitor
C. Apply a wet-to-dry dressing
D. Culture the drainage
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Serosanguineous drainage is normal in the early postoperative period, especially if
the wound edges are well-approximated. This indicates normal healing. For nursing exam prep,
understanding normal vs. abnormal wound healing is crucial. This nursing study guide emphasizes
proper documentation and wound assessment for student success in medical-surgical nursing.
**10. A client is receiving total parenteral nutrition (TPN). Which complication is the nurse most
concerned about?**
A. Hyperglycemia
