Actual and Retake RN Adult
Medical-Surgical 2026 | Proctored
Exam, NGN Questions and Updated
Answer Key
1. A nurse is assessing a client with left-sided heart failure. Which finding should
the nurse expect?
A. Jugular venous distention
B. Peripheral edema
C. Crackles in the lungs
D. Hepatomegaly
Answer: C
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation, producing crackles, dyspnea, and orthopnea. A, B, and D are signs of
right-sided heart failure (systemic congestion).
2. A client with COPD has an O₂ saturation of 88%. Which action should the nurse
take?
A. Administer oxygen at 6 L/min via nasal cannula
B. Administer oxygen at 1–2 L/min via nasal cannula
C. Withhold oxygen and reassess in 1 hour
D. Place the client in a supine position
Answer: B
Rationale: Clients with COPD who are CO₂ retainers need low-flow oxygen (1–2
L/min) to avoid suppressing their hypoxic drive. High-flow oxygen (A) can cause
CO₂ narcosis.
3. A nurse is caring for a client with DKA. Which finding requires immediate
intervention?
A. Blood glucose 320 mg/dL
B. Potassium 3.1 mEq/L
,C. pH 7.28
D. Deep, rapid respirations
Answer: B
Rationale: During DKA treatment, potassium drops rapidly as insulin drives it into
cells. A potassium of 3.1 mEq/L risks fatal dysrhythmias and requires immediate
replacement. The other findings are expected in DKA.
4. A client is 24 hours post-TURP. Which finding should the nurse report
immediately?
A. Pink-tinged urine
B. Bladder spasms
C. Clots in the urinary catheter
D. Serum sodium 128 mEq/L
Answer: D
Rationale: TURP syndrome occurs when irrigation fluid is absorbed, causing
dilutional hyponatremia. A sodium of 128 mEq/L can lead to seizures and cerebral
edema. Pink urine and spasms are expected post-op.
5. A nurse is delegating to an LPN. Which task is appropriate?
A. Teaching a client about a new medication
B. Inserting an NG tube
C. Performing an initial admission assessment
D. Developing a care plan
Answer: B
Rationale: LPNs can perform stable, skilled tasks like NG tube insertion. Teaching,
initial assessments, and care plan development require an RN.
6. A client with a hip replacement reports calf pain and swelling. Which action is
priority?
A. Apply warm compresses
B. Massage the calf
C. Notify the provider immediately
D. Encourage ambulation
Answer: C
Rationale: Calf pain/swelling after hip surgery suggests DVT. Massaging (B) could
, dislodge a clot and cause PE. The provider must be notified for anticoagulation
and imaging.
7. A nurse finds a client's abdominal wound eviscerated. Which action should the
nurse take first?
A. Reinsert the organs
B. Cover the wound with sterile saline-soaked gauze
C. Position the client supine with knees bent
D. Notify the surgeon
Answer: B
Rationale: Covering the exposed organs with sterile saline-soaked gauze prevents
drying and infection. Positioning with knees bent (C) reduces tension but is done
after covering. Never reinsert organs (A).
8. A client with severe hyperkalemia (K 6.9 mEq/L) is admitted. Which
intervention should the nurse anticipate first?
A. Oral potassium binder
B. IV calcium gluconate
C. Insulin and glucose infusion
D. Dialysis
Answer: B
Rationale: Calcium gluconate is given first to stabilize the myocardium and
prevent dysrhythmias. Insulin/glucose and binders shift or remove potassium but
don't protect the heart immediately.
9. A nurse is assessing a client with increased ICP. Which finding is an early sign?
A. Decerebrate posturing
B. Decreased level of consciousness
C. Fixed, dilated pupils
D. Cushing's triad
Answer: B
Rationale: A change in LOC is the earliest and most sensitive indicator of increased
ICP. Posturing, fixed pupils, and Cushing's triad are late signs.
10. A client with a new colostomy has a stoma that is dark purple and dry. Which
action should the nurse take?
Medical-Surgical 2026 | Proctored
Exam, NGN Questions and Updated
Answer Key
1. A nurse is assessing a client with left-sided heart failure. Which finding should
the nurse expect?
A. Jugular venous distention
B. Peripheral edema
C. Crackles in the lungs
D. Hepatomegaly
Answer: C
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation, producing crackles, dyspnea, and orthopnea. A, B, and D are signs of
right-sided heart failure (systemic congestion).
2. A client with COPD has an O₂ saturation of 88%. Which action should the nurse
take?
A. Administer oxygen at 6 L/min via nasal cannula
B. Administer oxygen at 1–2 L/min via nasal cannula
C. Withhold oxygen and reassess in 1 hour
D. Place the client in a supine position
Answer: B
Rationale: Clients with COPD who are CO₂ retainers need low-flow oxygen (1–2
L/min) to avoid suppressing their hypoxic drive. High-flow oxygen (A) can cause
CO₂ narcosis.
3. A nurse is caring for a client with DKA. Which finding requires immediate
intervention?
A. Blood glucose 320 mg/dL
B. Potassium 3.1 mEq/L
,C. pH 7.28
D. Deep, rapid respirations
Answer: B
Rationale: During DKA treatment, potassium drops rapidly as insulin drives it into
cells. A potassium of 3.1 mEq/L risks fatal dysrhythmias and requires immediate
replacement. The other findings are expected in DKA.
4. A client is 24 hours post-TURP. Which finding should the nurse report
immediately?
A. Pink-tinged urine
B. Bladder spasms
C. Clots in the urinary catheter
D. Serum sodium 128 mEq/L
Answer: D
Rationale: TURP syndrome occurs when irrigation fluid is absorbed, causing
dilutional hyponatremia. A sodium of 128 mEq/L can lead to seizures and cerebral
edema. Pink urine and spasms are expected post-op.
5. A nurse is delegating to an LPN. Which task is appropriate?
A. Teaching a client about a new medication
B. Inserting an NG tube
C. Performing an initial admission assessment
D. Developing a care plan
Answer: B
Rationale: LPNs can perform stable, skilled tasks like NG tube insertion. Teaching,
initial assessments, and care plan development require an RN.
6. A client with a hip replacement reports calf pain and swelling. Which action is
priority?
A. Apply warm compresses
B. Massage the calf
C. Notify the provider immediately
D. Encourage ambulation
Answer: C
Rationale: Calf pain/swelling after hip surgery suggests DVT. Massaging (B) could
, dislodge a clot and cause PE. The provider must be notified for anticoagulation
and imaging.
7. A nurse finds a client's abdominal wound eviscerated. Which action should the
nurse take first?
A. Reinsert the organs
B. Cover the wound with sterile saline-soaked gauze
C. Position the client supine with knees bent
D. Notify the surgeon
Answer: B
Rationale: Covering the exposed organs with sterile saline-soaked gauze prevents
drying and infection. Positioning with knees bent (C) reduces tension but is done
after covering. Never reinsert organs (A).
8. A client with severe hyperkalemia (K 6.9 mEq/L) is admitted. Which
intervention should the nurse anticipate first?
A. Oral potassium binder
B. IV calcium gluconate
C. Insulin and glucose infusion
D. Dialysis
Answer: B
Rationale: Calcium gluconate is given first to stabilize the myocardium and
prevent dysrhythmias. Insulin/glucose and binders shift or remove potassium but
don't protect the heart immediately.
9. A nurse is assessing a client with increased ICP. Which finding is an early sign?
A. Decerebrate posturing
B. Decreased level of consciousness
C. Fixed, dilated pupils
D. Cushing's triad
Answer: B
Rationale: A change in LOC is the earliest and most sensitive indicator of increased
ICP. Posturing, fixed pupils, and Cushing's triad are late signs.
10. A client with a new colostomy has a stoma that is dark purple and dry. Which
action should the nurse take?
