MEDICAL-SURGICAL NURSING
2026–2027:400
Original NCLEX-Style Practice Questions
Answers Marked • Clinical Rationales • Advanced Nursing Judgment • Practice Test Bank
QUESTIONS SECTIONS FORMAT FOCUS
Clinical
400 10 NCLEX-style
judgment
CONTENT MAP
Section Questions
Cardiovascular Disorders 40
Respiratory Disorders 40
Gastrointestinal Disorders 40
Endocrine Disorders 40
Renal & Urinary Disorders 40
Neurological Disorders 40
Musculoskeletal & Integumentary Disorders 40
Hematologic & Oncologic Disorders 40
Fluid, Electrolyte & Acid-Base Balance 40
Perioperative Nursing & Infection Control 40
DIFFICULTY: Advanced nursing licensure-level / NCLEX-style
Purpose: Independent practice and clinical-judgment review.
I
CARDIOVASCULAR DISORDERS
Q1. A client is being assessed for acute coronary syndrome. Which nursing action is the priority?
A. obtain a 12-lead ECG promptly and follow the acute coronary syndrome protocol
B. offer a full meal before assessment
C. encourage the client to walk in the hallway
D. delay assessment until the pain resolves
Correct Answer: A
Rationale: The best response is to obtain a 12-lead ecg promptly and follow the acute coronary syndrome protocol. This
addresses the client's immediate safety or physiologic priority associated with acute coronary syndrome. The other choices either
delay appropriate care, increase risk, or fail to address the underlying problem.
Medical-Surgical Nursing • 400 Original NCLEX-Style Practice Questions Page 1
, Q2. A client presents with ST-segment elevation with ongoing ischemic chest pain. Which finding or situation best
supports the nurse's immediate concern about STEMI?
A. give a routine antacid only
B. place the client flat and leave the room
C. wait for serial testing before notifying the provider
D. activate the reperfusion pathway and prepare for urgent coronary intervention as ordered
Correct Answer: D
Rationale: The best response is to activate the reperfusion pathway and prepare for urgent coronary intervention as ordered. This
addresses the client's immediate safety or physiologic priority associated with STEMI. The other choices either delay appropriate
care, increase risk, or fail to address the underlying problem.
Q3. The nurse is caring for a client with heart failure. Which intervention is most appropriate?
A. place the client supine
B. withhold all cardiac medications without an order
C. position upright, apply oxygen as prescribed, and rapidly reassess respiratory status
D. encourage large amounts of oral fluid
Correct Answer: C
Rationale: The best response is to position upright, apply oxygen as prescribed, and rapidly reassess respiratory status. This
addresses the client's immediate safety or physiologic priority associated with heart failure. The other choices either delay
appropriate care, increase risk, or fail to address the underlying problem.
Q4. Which statement by the nurse demonstrates correct clinical judgment when managing left-sided heart failure?
A. restrict all medications
B. prioritize oxygenation and respiratory assessment
C. measure calf circumference first
D. encourage vigorous exercise
Correct Answer: B
Rationale: The best response is to prioritize oxygenation and respiratory assessment. This addresses the client's immediate safety
or physiologic priority associated with left-sided heart failure. The other choices either delay appropriate care, increase risk, or fail to
address the underlying problem.
Q5. A client is being assessed for right-sided heart failure. Which nursing action is the priority?
A. assess fluid status and monitor daily weight
B. encourage unlimited sodium intake
C. place the client prone
D. stop all diuretics independently
Correct Answer: A
Rationale: The best response is to assess fluid status and monitor daily weight. This addresses the client's immediate safety or
physiologic priority associated with right-sided heart failure. The other choices either delay appropriate care, increase risk, or fail to
address the underlying problem.
Q6. A client presents with nausea, visual color changes, and bradycardia. Which finding or situation best supports
the nurse's immediate concern about digoxin toxicity?
A. give the next dose early
B. increase the dose to overcome bradycardia
C. administer potassium without checking the level
D. hold digoxin and notify the provider; review the potassium level
Correct Answer: D
Rationale: The best response is to hold digoxin and notify the provider; review the potassium level. This addresses the client's
immediate safety or physiologic priority associated with digoxin toxicity. The other choices either delay appropriate care, increase risk,
or fail to address the underlying problem.
Q7. The nurse is caring for a client with digoxin and hypokalemia. Which intervention is most appropriate?
Medical-Surgical Nursing • 400 Original NCLEX-Style Practice Questions Page 2
, A. double the next digoxin dose
B. encourage vigorous exercise
C. hold the digoxin and notify the provider
D. administer digoxin immediately
Correct Answer: C
Rationale: The best response is to hold the digoxin and notify the provider. This addresses the client's immediate safety or
physiologic priority associated with digoxin and hypokalemia. The other choices either delay appropriate care, increase risk, or fail to
address the underlying problem.
Q8. Which statement by the nurse demonstrates correct clinical judgment when managing furosemide?
A. administer an extra dose
B. hold or clarify the dose and address the significant hypokalemia
C. give the medication without review
D. restrict all potassium-containing foods
Correct Answer: B
Rationale: The best response is to hold or clarify the dose and address the significant hypokalemia. This addresses the client's
immediate safety or physiologic priority associated with furosemide. The other choices either delay appropriate care, increase risk, or
fail to address the underlying problem.
Q9. A client is being assessed for ACE inhibitor. Which nursing action is the priority?
A. report the cough because an alternative medication may be needed
B. tell the client it always indicates fluid overload
C. double the dose
D. stop all antihypertensives permanently
Correct Answer: A
Rationale: The best response is to report the cough because an alternative medication may be needed. This addresses the client's
immediate safety or physiologic priority associated with ACE inhibitor. The other choices either delay appropriate care, increase risk,
or fail to address the underlying problem.
Q10. A client presents with tongue swelling and difficulty breathing. Which finding or situation best supports the
nurse's immediate concern about ACE inhibitor angioedema?
A. offer oral fluids
B. reassess in 4 hours
C. place the client prone
D. treat as an airway emergency and obtain immediate help
Correct Answer: D
Rationale: The best response is to treat as an airway emergency and obtain immediate help. This addresses the client's immediate
safety or physiologic priority associated with ACE inhibitor angioedema. The other choices either delay appropriate care, increase
risk, or fail to address the underlying problem.
Medical-Surgical Nursing • 400 Original NCLEX-Style Practice Questions Page 3
, Q11. The nurse is caring for a client with warfarin. Which intervention is most appropriate?
A. encourage aspirin
B. increase vitamin K restriction
C. hold the medication and notify the provider promptly
D. administer the next dose
Correct Answer: C
Rationale: The best response is to hold the medication and notify the provider promptly. This addresses the client's immediate
safety or physiologic priority associated with warfarin. The other choices either delay appropriate care, increase risk, or fail to
address the underlying problem.
Q12. Which statement by the nurse demonstrates correct clinical judgment when managing heparin infusion?
A. ambulate the client
B. stop the infusion and notify the provider; prepare for reversal if ordered
C. increase the infusion rate
D. give the next dose early
Correct Answer: B
Rationale: The best response is to stop the infusion and notify the provider; prepare for reversal if ordered. This addresses the
client's immediate safety or physiologic priority associated with heparin infusion. The other choices either delay appropriate care,
increase risk, or fail to address the underlying problem.
Q13. A client is being assessed for peripheral arterial disease. Which nursing action is the priority?
A. recognize intermittent claudication and promote prescribed walking therapy
B. elevate the legs continuously above the heart
C. apply tight compression without assessment
D. keep the legs dependent at all times
Correct Answer: A
Rationale: The best response is to recognize intermittent claudication and promote prescribed walking therapy. This addresses
the client's immediate safety or physiologic priority associated with peripheral arterial disease. The other choices either delay
appropriate care, increase risk, or fail to address the underlying problem.
Q14. A client presents with edema and brown discoloration around the ankles. Which finding or situation best
supports the nurse's immediate concern about peripheral venous disease?
A. keep the legs dangling continuously
B. avoid all mobility
C. apply a heating pad directly to the skin
D. use prescribed compression and elevate the legs when resting
Correct Answer: D
Rationale: The best response is to use prescribed compression and elevate the legs when resting. This addresses the client's
immediate safety or physiologic priority associated with peripheral venous disease. The other choices either delay appropriate
care, increase risk, or fail to address the underlying problem.
Q15. The nurse is caring for a client with deep-vein thrombosis. Which intervention is most appropriate?
A. encourage unrestricted ambulation before evaluation
Medical-Surgical Nursing • 400 Original NCLEX-Style Practice Questions Page 4
2026–2027:400
Original NCLEX-Style Practice Questions
Answers Marked • Clinical Rationales • Advanced Nursing Judgment • Practice Test Bank
QUESTIONS SECTIONS FORMAT FOCUS
Clinical
400 10 NCLEX-style
judgment
CONTENT MAP
Section Questions
Cardiovascular Disorders 40
Respiratory Disorders 40
Gastrointestinal Disorders 40
Endocrine Disorders 40
Renal & Urinary Disorders 40
Neurological Disorders 40
Musculoskeletal & Integumentary Disorders 40
Hematologic & Oncologic Disorders 40
Fluid, Electrolyte & Acid-Base Balance 40
Perioperative Nursing & Infection Control 40
DIFFICULTY: Advanced nursing licensure-level / NCLEX-style
Purpose: Independent practice and clinical-judgment review.
I
CARDIOVASCULAR DISORDERS
Q1. A client is being assessed for acute coronary syndrome. Which nursing action is the priority?
A. obtain a 12-lead ECG promptly and follow the acute coronary syndrome protocol
B. offer a full meal before assessment
C. encourage the client to walk in the hallway
D. delay assessment until the pain resolves
Correct Answer: A
Rationale: The best response is to obtain a 12-lead ecg promptly and follow the acute coronary syndrome protocol. This
addresses the client's immediate safety or physiologic priority associated with acute coronary syndrome. The other choices either
delay appropriate care, increase risk, or fail to address the underlying problem.
Medical-Surgical Nursing • 400 Original NCLEX-Style Practice Questions Page 1
, Q2. A client presents with ST-segment elevation with ongoing ischemic chest pain. Which finding or situation best
supports the nurse's immediate concern about STEMI?
A. give a routine antacid only
B. place the client flat and leave the room
C. wait for serial testing before notifying the provider
D. activate the reperfusion pathway and prepare for urgent coronary intervention as ordered
Correct Answer: D
Rationale: The best response is to activate the reperfusion pathway and prepare for urgent coronary intervention as ordered. This
addresses the client's immediate safety or physiologic priority associated with STEMI. The other choices either delay appropriate
care, increase risk, or fail to address the underlying problem.
Q3. The nurse is caring for a client with heart failure. Which intervention is most appropriate?
A. place the client supine
B. withhold all cardiac medications without an order
C. position upright, apply oxygen as prescribed, and rapidly reassess respiratory status
D. encourage large amounts of oral fluid
Correct Answer: C
Rationale: The best response is to position upright, apply oxygen as prescribed, and rapidly reassess respiratory status. This
addresses the client's immediate safety or physiologic priority associated with heart failure. The other choices either delay
appropriate care, increase risk, or fail to address the underlying problem.
Q4. Which statement by the nurse demonstrates correct clinical judgment when managing left-sided heart failure?
A. restrict all medications
B. prioritize oxygenation and respiratory assessment
C. measure calf circumference first
D. encourage vigorous exercise
Correct Answer: B
Rationale: The best response is to prioritize oxygenation and respiratory assessment. This addresses the client's immediate safety
or physiologic priority associated with left-sided heart failure. The other choices either delay appropriate care, increase risk, or fail to
address the underlying problem.
Q5. A client is being assessed for right-sided heart failure. Which nursing action is the priority?
A. assess fluid status and monitor daily weight
B. encourage unlimited sodium intake
C. place the client prone
D. stop all diuretics independently
Correct Answer: A
Rationale: The best response is to assess fluid status and monitor daily weight. This addresses the client's immediate safety or
physiologic priority associated with right-sided heart failure. The other choices either delay appropriate care, increase risk, or fail to
address the underlying problem.
Q6. A client presents with nausea, visual color changes, and bradycardia. Which finding or situation best supports
the nurse's immediate concern about digoxin toxicity?
A. give the next dose early
B. increase the dose to overcome bradycardia
C. administer potassium without checking the level
D. hold digoxin and notify the provider; review the potassium level
Correct Answer: D
Rationale: The best response is to hold digoxin and notify the provider; review the potassium level. This addresses the client's
immediate safety or physiologic priority associated with digoxin toxicity. The other choices either delay appropriate care, increase risk,
or fail to address the underlying problem.
Q7. The nurse is caring for a client with digoxin and hypokalemia. Which intervention is most appropriate?
Medical-Surgical Nursing • 400 Original NCLEX-Style Practice Questions Page 2
, A. double the next digoxin dose
B. encourage vigorous exercise
C. hold the digoxin and notify the provider
D. administer digoxin immediately
Correct Answer: C
Rationale: The best response is to hold the digoxin and notify the provider. This addresses the client's immediate safety or
physiologic priority associated with digoxin and hypokalemia. The other choices either delay appropriate care, increase risk, or fail to
address the underlying problem.
Q8. Which statement by the nurse demonstrates correct clinical judgment when managing furosemide?
A. administer an extra dose
B. hold or clarify the dose and address the significant hypokalemia
C. give the medication without review
D. restrict all potassium-containing foods
Correct Answer: B
Rationale: The best response is to hold or clarify the dose and address the significant hypokalemia. This addresses the client's
immediate safety or physiologic priority associated with furosemide. The other choices either delay appropriate care, increase risk, or
fail to address the underlying problem.
Q9. A client is being assessed for ACE inhibitor. Which nursing action is the priority?
A. report the cough because an alternative medication may be needed
B. tell the client it always indicates fluid overload
C. double the dose
D. stop all antihypertensives permanently
Correct Answer: A
Rationale: The best response is to report the cough because an alternative medication may be needed. This addresses the client's
immediate safety or physiologic priority associated with ACE inhibitor. The other choices either delay appropriate care, increase risk,
or fail to address the underlying problem.
Q10. A client presents with tongue swelling and difficulty breathing. Which finding or situation best supports the
nurse's immediate concern about ACE inhibitor angioedema?
A. offer oral fluids
B. reassess in 4 hours
C. place the client prone
D. treat as an airway emergency and obtain immediate help
Correct Answer: D
Rationale: The best response is to treat as an airway emergency and obtain immediate help. This addresses the client's immediate
safety or physiologic priority associated with ACE inhibitor angioedema. The other choices either delay appropriate care, increase
risk, or fail to address the underlying problem.
Medical-Surgical Nursing • 400 Original NCLEX-Style Practice Questions Page 3
, Q11. The nurse is caring for a client with warfarin. Which intervention is most appropriate?
A. encourage aspirin
B. increase vitamin K restriction
C. hold the medication and notify the provider promptly
D. administer the next dose
Correct Answer: C
Rationale: The best response is to hold the medication and notify the provider promptly. This addresses the client's immediate
safety or physiologic priority associated with warfarin. The other choices either delay appropriate care, increase risk, or fail to
address the underlying problem.
Q12. Which statement by the nurse demonstrates correct clinical judgment when managing heparin infusion?
A. ambulate the client
B. stop the infusion and notify the provider; prepare for reversal if ordered
C. increase the infusion rate
D. give the next dose early
Correct Answer: B
Rationale: The best response is to stop the infusion and notify the provider; prepare for reversal if ordered. This addresses the
client's immediate safety or physiologic priority associated with heparin infusion. The other choices either delay appropriate care,
increase risk, or fail to address the underlying problem.
Q13. A client is being assessed for peripheral arterial disease. Which nursing action is the priority?
A. recognize intermittent claudication and promote prescribed walking therapy
B. elevate the legs continuously above the heart
C. apply tight compression without assessment
D. keep the legs dependent at all times
Correct Answer: A
Rationale: The best response is to recognize intermittent claudication and promote prescribed walking therapy. This addresses
the client's immediate safety or physiologic priority associated with peripheral arterial disease. The other choices either delay
appropriate care, increase risk, or fail to address the underlying problem.
Q14. A client presents with edema and brown discoloration around the ankles. Which finding or situation best
supports the nurse's immediate concern about peripheral venous disease?
A. keep the legs dangling continuously
B. avoid all mobility
C. apply a heating pad directly to the skin
D. use prescribed compression and elevate the legs when resting
Correct Answer: D
Rationale: The best response is to use prescribed compression and elevate the legs when resting. This addresses the client's
immediate safety or physiologic priority associated with peripheral venous disease. The other choices either delay appropriate
care, increase risk, or fail to address the underlying problem.
Q15. The nurse is caring for a client with deep-vein thrombosis. Which intervention is most appropriate?
A. encourage unrestricted ambulation before evaluation
Medical-Surgical Nursing • 400 Original NCLEX-Style Practice Questions Page 4
