NCLEX-RN MEDICAL-SURGICAL PRACTICE
EXAMINATION – STUDY GUIDE | LATEST UPDATE
2026/2027 | ACTUAL EXAM | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS
1. A client with heart failure is receiving furosemide. Which assessment
finding would indicate an adverse response to the medication?
A) Weight loss of 2 lb in 24 hours
B) Serum potassium level of 3.1 mEq/L
C) Urine output of 50 mL/hour
D) Blood pressure of 110/70 mm Hg
Correct Answer: B
Furosemide is a loop diuretic that promotes potassium loss. A potassium level of
3.1 mEq/L indicates hypokalemia, an adverse effect that increases the risk of
cardiac arrhythmias. Weight loss, adequate urine output, and normal blood
pressure are expected or acceptable findings.
2. A client with an acute myocardial infarction reports new-onset shortness of
breath and crackles are auscultated in the lung bases. The nurse should
first:
A) Administer furosemide IV as prescribed.
B) Place the client in high Fowler’s position.
C) Obtain a 12-lead ECG.
D) Apply oxygen at 2 L/min via nasal cannula.
Correct Answer: B
Crackles and dyspnea suggest left ventricular failure and pulmonary congestion.
Elevating the head of the bed reduces venous return and improves ventilation; this
low-risk action should be done first. Oxygen and diuretics are important but
positioning can be performed immediately while preparing other interventions.
, 3. A client is receiving nitroglycerin IV for chest pain. Which side effect should
the nurse anticipate?
A) Bradycardia
B) Headache
C) Hypertension
D) Urinary retention
Correct Answer: B
Nitroglycerin is a vasodilator and commonly causes headache. It may also cause
reflex tachycardia, hypotension, and flushing. Bradycardia, hypertension, and
urinary retention are not typical side effects.
4. A client with a diagnosis of peripheral arterial disease (PAD) reports pain in
the calves that occurs with walking and is relieved by rest. The nurse should
document this finding as:
A) Raynaud’s phenomenon
B) Intermittent claudication
C) Venous stasis
D) Dependent edema
Correct Answer: B
Intermittent claudication is ischemic muscle pain caused by inadequate arterial
blood flow during exercise, typically relieved by rest. It is a classic symptom of
peripheral arterial disease. The other options describe different vascular
conditions.
5. A client with a new permanent pacemaker is being discharged. Which
statement by the client indicates understanding?
A) “I may have an MRI scan if needed.”
B) “I will avoid using a cellular phone on the same side as the pacemaker.”
C) “I can return to contact sports in 2 weeks.”
D) “The pacemaker will need to be replaced every year.”
Correct Answer: B
Cellular phones should be kept at least 6 inches from the pacemaker and used on
, the opposite side to avoid electromagnetic interference. MRI is often
contraindicated; contact sports should be avoided; pacemakers do not need
annual replacement.
6. A client has a chest tube connected to a water-seal drainage system. The
nurse notes continuous bubbling in the water-seal chamber. What is the
most appropriate interpretation?
A) The lung has fully re-expanded.
B) There is an air leak in the system.
C) The suction is functioning properly.
D) Normal fluctuation of pleural pressure is occurring.
Correct Answer: B
Continuous bubbling in the water-seal chamber indicates an air leak. The nurse
should assess the system for disconnections or leaks. Tidaling is normal; bubbling
in the suction control chamber indicates suction is on.
7. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 3 L/min via nasal cannula. The nurse notes the client has become
confused and the respiratory rate is 9 breaths/min. What is the priority
nursing action?
A) Increase the oxygen flow to 5 L/min.
B) Check the client’s oxygen saturation.
C) Assess the client’s level of consciousness and airway.
D) Place the client in a supine position.
Correct Answer: C
Clients with COPD and chronic CO₂ retention may rely on hypoxic drive. High-flow
oxygen can suppress this drive, causing hypoventilation and CO₂ narcosis. The
priority is to assess the client’s level of consciousness and airway. Increasing
oxygen would further depress respirations.
8. A client with acute asthma is receiving albuterol via nebulizer. Which finding
indicates improvement?
A) Decreased wheezing after treatment
EXAMINATION – STUDY GUIDE | LATEST UPDATE
2026/2027 | ACTUAL EXAM | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS
1. A client with heart failure is receiving furosemide. Which assessment
finding would indicate an adverse response to the medication?
A) Weight loss of 2 lb in 24 hours
B) Serum potassium level of 3.1 mEq/L
C) Urine output of 50 mL/hour
D) Blood pressure of 110/70 mm Hg
Correct Answer: B
Furosemide is a loop diuretic that promotes potassium loss. A potassium level of
3.1 mEq/L indicates hypokalemia, an adverse effect that increases the risk of
cardiac arrhythmias. Weight loss, adequate urine output, and normal blood
pressure are expected or acceptable findings.
2. A client with an acute myocardial infarction reports new-onset shortness of
breath and crackles are auscultated in the lung bases. The nurse should
first:
A) Administer furosemide IV as prescribed.
B) Place the client in high Fowler’s position.
C) Obtain a 12-lead ECG.
D) Apply oxygen at 2 L/min via nasal cannula.
Correct Answer: B
Crackles and dyspnea suggest left ventricular failure and pulmonary congestion.
Elevating the head of the bed reduces venous return and improves ventilation; this
low-risk action should be done first. Oxygen and diuretics are important but
positioning can be performed immediately while preparing other interventions.
, 3. A client is receiving nitroglycerin IV for chest pain. Which side effect should
the nurse anticipate?
A) Bradycardia
B) Headache
C) Hypertension
D) Urinary retention
Correct Answer: B
Nitroglycerin is a vasodilator and commonly causes headache. It may also cause
reflex tachycardia, hypotension, and flushing. Bradycardia, hypertension, and
urinary retention are not typical side effects.
4. A client with a diagnosis of peripheral arterial disease (PAD) reports pain in
the calves that occurs with walking and is relieved by rest. The nurse should
document this finding as:
A) Raynaud’s phenomenon
B) Intermittent claudication
C) Venous stasis
D) Dependent edema
Correct Answer: B
Intermittent claudication is ischemic muscle pain caused by inadequate arterial
blood flow during exercise, typically relieved by rest. It is a classic symptom of
peripheral arterial disease. The other options describe different vascular
conditions.
5. A client with a new permanent pacemaker is being discharged. Which
statement by the client indicates understanding?
A) “I may have an MRI scan if needed.”
B) “I will avoid using a cellular phone on the same side as the pacemaker.”
C) “I can return to contact sports in 2 weeks.”
D) “The pacemaker will need to be replaced every year.”
Correct Answer: B
Cellular phones should be kept at least 6 inches from the pacemaker and used on
, the opposite side to avoid electromagnetic interference. MRI is often
contraindicated; contact sports should be avoided; pacemakers do not need
annual replacement.
6. A client has a chest tube connected to a water-seal drainage system. The
nurse notes continuous bubbling in the water-seal chamber. What is the
most appropriate interpretation?
A) The lung has fully re-expanded.
B) There is an air leak in the system.
C) The suction is functioning properly.
D) Normal fluctuation of pleural pressure is occurring.
Correct Answer: B
Continuous bubbling in the water-seal chamber indicates an air leak. The nurse
should assess the system for disconnections or leaks. Tidaling is normal; bubbling
in the suction control chamber indicates suction is on.
7. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 3 L/min via nasal cannula. The nurse notes the client has become
confused and the respiratory rate is 9 breaths/min. What is the priority
nursing action?
A) Increase the oxygen flow to 5 L/min.
B) Check the client’s oxygen saturation.
C) Assess the client’s level of consciousness and airway.
D) Place the client in a supine position.
Correct Answer: C
Clients with COPD and chronic CO₂ retention may rely on hypoxic drive. High-flow
oxygen can suppress this drive, causing hypoventilation and CO₂ narcosis. The
priority is to assess the client’s level of consciousness and airway. Increasing
oxygen would further depress respirations.
8. A client with acute asthma is receiving albuterol via nebulizer. Which finding
indicates improvement?
A) Decreased wheezing after treatment
