NCLEX-RN + NEW YORK RN LICENSURE MEDICAL-
SURGICAL NURSING PRACTICE EXAM | 100 NCLEX-
STYLE QUESTIONS WITH ANSWERS & RATIONALES
(BEST OVERALL)
1. A nurse is caring for a client admitted with acute heart failure. Which
assessment finding requires immediate intervention?
A. Bilateral ankle edema
B. Weight gain of 1 kg in 24 hours
C. Pink, frothy sputum
D. Fatigue on exertion
Rationale: Pink, frothy sputum indicates pulmonary edema, a life-threatening
complication requiring immediate treatment.
2. A client with chronic obstructive pulmonary disease (COPD) receives oxygen
therapy. Which oxygen saturation goal is most appropriate?
A. 100%
B. 98–100%
C. 88–92%
D. Above 95%
Rationale: Maintaining oxygen saturation between 88–92% helps prevent
suppression of the respiratory drive while ensuring adequate oxygenation.
3. Which laboratory value is most concerning in a client receiving warfarin?
A. INR 2.3
B. INR 2.8
C. INR 5.2
D. INR 2.0
Rationale: INR 5.2 significantly increases the risk of bleeding and requires prompt
intervention.
4. A nurse is caring for a client with bacterial meningitis. Which intervention
has the highest priority?
, A. Encourage oral fluids.
B. Provide a high-protein diet.
C. Initiate droplet precautions.
D. Place the client in Trendelenburg position.
Rationale: Preventing transmission through droplet precautions is the priority.
5. Which electrolyte imbalance is commonly associated with prolonged
vomiting?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemia
D. Hypercalcemia
Rationale: Vomiting causes potassium loss, resulting in hypokalemia.
6. A client with diabetes reports sweating, tremors, and confusion. What is the
nurse's first action?
A. Administer insulin.
B. Obtain urine ketones.
C. Check the blood glucose level.
D. Encourage ambulation.
Rationale: These are signs of hypoglycemia; blood glucose should be assessed
immediately.
7. Which assessment finding indicates worsening renal failure?
A. Urine output 45 mL/hr
B. Blood pressure 128/80 mmHg
C. Serum potassium 6.1 mEq/L
D. Heart rate 78 bpm
Rationale: Severe hyperkalemia can lead to fatal cardiac dysrhythmias.
8. Which finding is expected after a thyroidectomy?
A. Bradycardia
B. Hoarseness
, C. Polyuria
D. Hyperglycemia
Rationale: Temporary hoarseness may occur due to laryngeal nerve irritation.
9. A client with pancreatitis should receive which priority nursing
intervention?
A. Encourage high-fat meals.
B. Place in Trendelenburg position.
C. Keep the client NPO.
D. Restrict pain medication.
Rationale: Keeping the client NPO reduces pancreatic stimulation.
10.Which assessment finding suggests compartment syndrome?
A. Warm extremity
B. Bounding pulses
C. Pain unrelieved by analgesics
D. Mild swelling
Rationale: Severe pain disproportionate to injury is an early sign of compartment
syndrome.
11.Which client is at greatest risk for developing deep vein thrombosis?
A. Client with asthma
B. Client after hip replacement surgery
C. Client with hypertension
D. Client with migraine headaches
Rationale: Orthopedic surgery significantly increases DVT risk.
12.A nurse is assessing a client with hypocalcemia. Which finding is expected?
A. Bradycardia
B. Positive Chvostek sign
C. Flaccid muscles
D. Hyporeflexia
Rationale: Neuromuscular excitability produces a positive Chvostek sign.
SURGICAL NURSING PRACTICE EXAM | 100 NCLEX-
STYLE QUESTIONS WITH ANSWERS & RATIONALES
(BEST OVERALL)
1. A nurse is caring for a client admitted with acute heart failure. Which
assessment finding requires immediate intervention?
A. Bilateral ankle edema
B. Weight gain of 1 kg in 24 hours
C. Pink, frothy sputum
D. Fatigue on exertion
Rationale: Pink, frothy sputum indicates pulmonary edema, a life-threatening
complication requiring immediate treatment.
2. A client with chronic obstructive pulmonary disease (COPD) receives oxygen
therapy. Which oxygen saturation goal is most appropriate?
A. 100%
B. 98–100%
C. 88–92%
D. Above 95%
Rationale: Maintaining oxygen saturation between 88–92% helps prevent
suppression of the respiratory drive while ensuring adequate oxygenation.
3. Which laboratory value is most concerning in a client receiving warfarin?
A. INR 2.3
B. INR 2.8
C. INR 5.2
D. INR 2.0
Rationale: INR 5.2 significantly increases the risk of bleeding and requires prompt
intervention.
4. A nurse is caring for a client with bacterial meningitis. Which intervention
has the highest priority?
, A. Encourage oral fluids.
B. Provide a high-protein diet.
C. Initiate droplet precautions.
D. Place the client in Trendelenburg position.
Rationale: Preventing transmission through droplet precautions is the priority.
5. Which electrolyte imbalance is commonly associated with prolonged
vomiting?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemia
D. Hypercalcemia
Rationale: Vomiting causes potassium loss, resulting in hypokalemia.
6. A client with diabetes reports sweating, tremors, and confusion. What is the
nurse's first action?
A. Administer insulin.
B. Obtain urine ketones.
C. Check the blood glucose level.
D. Encourage ambulation.
Rationale: These are signs of hypoglycemia; blood glucose should be assessed
immediately.
7. Which assessment finding indicates worsening renal failure?
A. Urine output 45 mL/hr
B. Blood pressure 128/80 mmHg
C. Serum potassium 6.1 mEq/L
D. Heart rate 78 bpm
Rationale: Severe hyperkalemia can lead to fatal cardiac dysrhythmias.
8. Which finding is expected after a thyroidectomy?
A. Bradycardia
B. Hoarseness
, C. Polyuria
D. Hyperglycemia
Rationale: Temporary hoarseness may occur due to laryngeal nerve irritation.
9. A client with pancreatitis should receive which priority nursing
intervention?
A. Encourage high-fat meals.
B. Place in Trendelenburg position.
C. Keep the client NPO.
D. Restrict pain medication.
Rationale: Keeping the client NPO reduces pancreatic stimulation.
10.Which assessment finding suggests compartment syndrome?
A. Warm extremity
B. Bounding pulses
C. Pain unrelieved by analgesics
D. Mild swelling
Rationale: Severe pain disproportionate to injury is an early sign of compartment
syndrome.
11.Which client is at greatest risk for developing deep vein thrombosis?
A. Client with asthma
B. Client after hip replacement surgery
C. Client with hypertension
D. Client with migraine headaches
Rationale: Orthopedic surgery significantly increases DVT risk.
12.A nurse is assessing a client with hypocalcemia. Which finding is expected?
A. Bradycardia
B. Positive Chvostek sign
C. Flaccid muscles
D. Hyporeflexia
Rationale: Neuromuscular excitability produces a positive Chvostek sign.
