RN Adult Medical-Surgical (Med-
Surg) 2026: The Ultimate Question
Practice Exam with In-Depth
Rationales for NCLEX-RN Success
A client with heart failure reports increasing shortness of breath and a 3-kg
weight gain in 3 days. What is the priority action?
Assess for pulmonary congestion.
Rapid weight gain and dyspnea suggest fluid retention and worsening
heart failure. Assessment is the priority before implementing any
intervention.
Which finding is most concerning in a client receiving digoxin?
Nausea and yellow-green visual changes.
These symptoms may indicate digoxin toxicity, which requires immediate
evaluation. A heart rate of 58/min may be acceptable for a client on
digoxin.
A client with chest pain is prescribed sublingual nitroglycerin. Which
statement requires immediate intervention?
“I took sildenafil earlier today.”
Combining nitrates with PDE-5 inhibitors can cause severe hypotension.
Mild headache is an expected side effect, and sitting before taking the
medication is correct.
A client with acute myocardial infarction is receiving streptokinase. Which
finding requires immediate nursing intervention?
,Any signs of bleeding, such as decreased level of consciousness or
hypotension.
Streptokinase is a thrombolytic agent that increases the risk of bleeding,
including intracranial hemorrhage.
A nurse is assessing a client with heart failure who reports dyspnea,
orthopnea, and a weight gain of 5 lb in 2 days. Which action should the
nurse take first?
Auscultate breath sounds.
Assessment of respiratory status is the priority to determine the severity of
fluid overload and guide further interventions.
A client with heart failure is prescribed furosemide. Which laboratory value
requires the most immediate attention?
Serum potassium of 3.0 mEq/L.
Furosemide is a loop diuretic that can cause hypokalemia. A potassium
level of 3.0 mEq/L is critically low and can precipitate cardiac dysrhythmias.
A client is 2 days post–myocardial infarction and reports chest pain that is
relieved by nitroglycerin. Which action should the nurse take first?
Obtain a 12-lead ECG.
New or recurrent chest pain in a post-MI client may indicate reinfarction or
unstable angina; the ECG is the priority to assess for ischemic changes.
A client with hypertension is prescribed lisinopril. Which adverse effect is
most important to teach the client to report immediately?
Swelling of the face or lips.
Angioedema is a rare but life-threatening adverse effect of ACE inhibitors
like lisinopril. Clients should be instructed to seek emergency care if this
occurs.
A client with atrial fibrillation is prescribed warfarin. Which laboratory test
must the nurse monitor to evaluate therapeutic effectiveness?
, International normalized ratio (INR).
Warfarin therapy is monitored by PT/INR, with a therapeutic INR typically
between 2.0 and 3.0 for atrial fibrillation.
A client with peripheral artery disease reports leg pain that occurs with
walking and is relieved by rest. Which instruction should the nurse include
in the teaching plan?
Walk until the pain occurs, then rest, and resume walking.
This “walk-rest-walk” pattern helps build collateral circulation and is the
recommended exercise program for clients with intermittent claudication.
Respiratory Disorders
A client with COPD is prescribed oxygen at 2 L/min via nasal cannula. Which
assessment finding indicates the therapy is effective?
Pulse oximetry reading of 92%.
For clients with COPD, oxygen saturation should be maintained between
88% and 92% to avoid suppressing the hypoxic drive.
A client with pneumonia has a prescription for levofloxacin. Which adverse
effect should the nurse teach the client to report immediately?
Tendon pain or swelling.
Fluoroquinolones like levofloxacin are associated with tendonitis and
tendon rupture, particularly in older adults and those taking corticosteroids.
A client is admitted with an acute exacerbation of asthma. Which
assessment finding indicates the client is experiencing respiratory failure?
PaCO₂ of 52 mm Hg and pH of 7.30.
Respiratory failure in asthma is indicated by rising PaCO₂ (hypercapnia) and
decreasing pH (respiratory acidosis), signifying impending exhaustion and
the need for mechanical ventilation.
Surg) 2026: The Ultimate Question
Practice Exam with In-Depth
Rationales for NCLEX-RN Success
A client with heart failure reports increasing shortness of breath and a 3-kg
weight gain in 3 days. What is the priority action?
Assess for pulmonary congestion.
Rapid weight gain and dyspnea suggest fluid retention and worsening
heart failure. Assessment is the priority before implementing any
intervention.
Which finding is most concerning in a client receiving digoxin?
Nausea and yellow-green visual changes.
These symptoms may indicate digoxin toxicity, which requires immediate
evaluation. A heart rate of 58/min may be acceptable for a client on
digoxin.
A client with chest pain is prescribed sublingual nitroglycerin. Which
statement requires immediate intervention?
“I took sildenafil earlier today.”
Combining nitrates with PDE-5 inhibitors can cause severe hypotension.
Mild headache is an expected side effect, and sitting before taking the
medication is correct.
A client with acute myocardial infarction is receiving streptokinase. Which
finding requires immediate nursing intervention?
,Any signs of bleeding, such as decreased level of consciousness or
hypotension.
Streptokinase is a thrombolytic agent that increases the risk of bleeding,
including intracranial hemorrhage.
A nurse is assessing a client with heart failure who reports dyspnea,
orthopnea, and a weight gain of 5 lb in 2 days. Which action should the
nurse take first?
Auscultate breath sounds.
Assessment of respiratory status is the priority to determine the severity of
fluid overload and guide further interventions.
A client with heart failure is prescribed furosemide. Which laboratory value
requires the most immediate attention?
Serum potassium of 3.0 mEq/L.
Furosemide is a loop diuretic that can cause hypokalemia. A potassium
level of 3.0 mEq/L is critically low and can precipitate cardiac dysrhythmias.
A client is 2 days post–myocardial infarction and reports chest pain that is
relieved by nitroglycerin. Which action should the nurse take first?
Obtain a 12-lead ECG.
New or recurrent chest pain in a post-MI client may indicate reinfarction or
unstable angina; the ECG is the priority to assess for ischemic changes.
A client with hypertension is prescribed lisinopril. Which adverse effect is
most important to teach the client to report immediately?
Swelling of the face or lips.
Angioedema is a rare but life-threatening adverse effect of ACE inhibitors
like lisinopril. Clients should be instructed to seek emergency care if this
occurs.
A client with atrial fibrillation is prescribed warfarin. Which laboratory test
must the nurse monitor to evaluate therapeutic effectiveness?
, International normalized ratio (INR).
Warfarin therapy is monitored by PT/INR, with a therapeutic INR typically
between 2.0 and 3.0 for atrial fibrillation.
A client with peripheral artery disease reports leg pain that occurs with
walking and is relieved by rest. Which instruction should the nurse include
in the teaching plan?
Walk until the pain occurs, then rest, and resume walking.
This “walk-rest-walk” pattern helps build collateral circulation and is the
recommended exercise program for clients with intermittent claudication.
Respiratory Disorders
A client with COPD is prescribed oxygen at 2 L/min via nasal cannula. Which
assessment finding indicates the therapy is effective?
Pulse oximetry reading of 92%.
For clients with COPD, oxygen saturation should be maintained between
88% and 92% to avoid suppressing the hypoxic drive.
A client with pneumonia has a prescription for levofloxacin. Which adverse
effect should the nurse teach the client to report immediately?
Tendon pain or swelling.
Fluoroquinolones like levofloxacin are associated with tendonitis and
tendon rupture, particularly in older adults and those taking corticosteroids.
A client is admitted with an acute exacerbation of asthma. Which
assessment finding indicates the client is experiencing respiratory failure?
PaCO₂ of 52 mm Hg and pH of 7.30.
Respiratory failure in asthma is indicated by rising PaCO₂ (hypercapnia) and
decreasing pH (respiratory acidosis), signifying impending exhaustion and
the need for mechanical ventilation.
