ADVANCED NCLEX-STYLE PRACTICE QUESTIONS WITH
DETAILED ANSWERS. Graded A+ / 2024 version
Medical-Surgical Nursing Questions
1. A patient with congestive heart failure is prescribed digoxin and furosemide. What is the priority
nursing assessment?
Answer: Monitor potassium levels. Furosemide can cause hypokalemia, which increases the risk of
digoxin toxicity.
2. A patient with COPD is admitted with acute exacerbation. ABGs show pH 7.32, PaCO2 55 mm Hg,
HCO3 28 mEq/L, and PaO2 60 mm Hg. What is the interpretation?
Answer: Respiratory acidosis with partial compensation.
3. What is the priority nursing action for a patient in the emergency department with suspected
myocardial infarction?
Answer: Administer oxygen, nitroglycerin, aspirin, and morphine (MONA protocol).
4. A patient with a history of deep vein thrombosis (DVT) is on warfarin. The nurse notices bleeding
gums during an assessment. What lab value should be checked?
Answer: INR; therapeutic range is 2.0-3.0.
5. A patient with cirrhosis develops ascites. What is the best intervention to reduce fluid
accumulation?
Answer: Administer spironolactone (a potassium-sparing diuretic) and perform a paracentesis if
indicated.
6. A patient post-thyroidectomy complains of numbness and tingling in the hands. What is the nurse’s
priority action?
Answer: Check serum calcium levels; this could indicate hypocalcemia due to parathyroid gland
injury.
7. A nurse is caring for a patient with a chest tube. What is an appropriate intervention if there is
continuous bubbling in the water seal chamber?
Answer: Check for an air leak in the system.
8. What is the priority intervention for a patient who develops a pulmonary embolism?
Answer: Administer oxygen and prepare to administer anticoagulants.
9. A patient with acute pancreatitis reports severe abdominal pain. Which lab value should be closely
monitored?
Answer: Serum amylase and lipase.
, 10. A patient is admitted with hypertensive crisis. The physician orders an IV antihypertensive. What
should the nurse closely monitor during administration?
Answer: Blood pressure and signs of hypotension.
Pharmacology Questions
11. A patient receiving chemotherapy is prescribed ondansetron. What side effect should the nurse
monitor for?
Answer: QT interval prolongation.
12. A patient with chronic kidney disease is prescribed erythropoietin. What lab value should be
monitored to assess the effectiveness of the therapy?
Answer: Hemoglobin and hematocrit.
13. A nurse is administering morphine sulfate for pain management. What is the most important
assessment to perform?
Answer: Respiratory rate, as opioids can cause respiratory depression.
14. A patient with atrial fibrillation is prescribed amiodarone. What potential complication should the
nurse monitor for?
Answer: Pulmonary toxicity.
15. A patient is prescribed metformin for type 2 diabetes. What adverse effect should the nurse educate
the patient to report immediately?
Answer: Signs of lactic acidosis (e.g., muscle pain, fatigue, difficulty breathing).
16. A patient taking lithium for bipolar disorder reports diarrhea, vomiting, and tremors. What is the
nurse’s priority action?
Answer: Assess for lithium toxicity and notify the provider.
17. A patient with asthma is prescribed albuterol and fluticasone. What is the correct administration
sequence for these medications?
Answer: Administer albuterol first (bronchodilator), followed by fluticasone (inhaled
corticosteroid).
18. A patient is taking levothyroxine for hypothyroidism. What lab value should be monitored to assess
the effectiveness of the therapy?
Answer: TSH (Thyroid-Stimulating Hormone).
19. A nurse is administering heparin for DVT prophylaxis. What is the antidote in case of overdose?
Answer: Protamine sulfate.
20. A patient taking phenytoin for seizure control develops gingival hyperplasia. What should the nurse
include in patient teaching?
Answer: Maintain good oral hygiene and regular dental visits.
DETAILED ANSWERS. Graded A+ / 2024 version
Medical-Surgical Nursing Questions
1. A patient with congestive heart failure is prescribed digoxin and furosemide. What is the priority
nursing assessment?
Answer: Monitor potassium levels. Furosemide can cause hypokalemia, which increases the risk of
digoxin toxicity.
2. A patient with COPD is admitted with acute exacerbation. ABGs show pH 7.32, PaCO2 55 mm Hg,
HCO3 28 mEq/L, and PaO2 60 mm Hg. What is the interpretation?
Answer: Respiratory acidosis with partial compensation.
3. What is the priority nursing action for a patient in the emergency department with suspected
myocardial infarction?
Answer: Administer oxygen, nitroglycerin, aspirin, and morphine (MONA protocol).
4. A patient with a history of deep vein thrombosis (DVT) is on warfarin. The nurse notices bleeding
gums during an assessment. What lab value should be checked?
Answer: INR; therapeutic range is 2.0-3.0.
5. A patient with cirrhosis develops ascites. What is the best intervention to reduce fluid
accumulation?
Answer: Administer spironolactone (a potassium-sparing diuretic) and perform a paracentesis if
indicated.
6. A patient post-thyroidectomy complains of numbness and tingling in the hands. What is the nurse’s
priority action?
Answer: Check serum calcium levels; this could indicate hypocalcemia due to parathyroid gland
injury.
7. A nurse is caring for a patient with a chest tube. What is an appropriate intervention if there is
continuous bubbling in the water seal chamber?
Answer: Check for an air leak in the system.
8. What is the priority intervention for a patient who develops a pulmonary embolism?
Answer: Administer oxygen and prepare to administer anticoagulants.
9. A patient with acute pancreatitis reports severe abdominal pain. Which lab value should be closely
monitored?
Answer: Serum amylase and lipase.
, 10. A patient is admitted with hypertensive crisis. The physician orders an IV antihypertensive. What
should the nurse closely monitor during administration?
Answer: Blood pressure and signs of hypotension.
Pharmacology Questions
11. A patient receiving chemotherapy is prescribed ondansetron. What side effect should the nurse
monitor for?
Answer: QT interval prolongation.
12. A patient with chronic kidney disease is prescribed erythropoietin. What lab value should be
monitored to assess the effectiveness of the therapy?
Answer: Hemoglobin and hematocrit.
13. A nurse is administering morphine sulfate for pain management. What is the most important
assessment to perform?
Answer: Respiratory rate, as opioids can cause respiratory depression.
14. A patient with atrial fibrillation is prescribed amiodarone. What potential complication should the
nurse monitor for?
Answer: Pulmonary toxicity.
15. A patient is prescribed metformin for type 2 diabetes. What adverse effect should the nurse educate
the patient to report immediately?
Answer: Signs of lactic acidosis (e.g., muscle pain, fatigue, difficulty breathing).
16. A patient taking lithium for bipolar disorder reports diarrhea, vomiting, and tremors. What is the
nurse’s priority action?
Answer: Assess for lithium toxicity and notify the provider.
17. A patient with asthma is prescribed albuterol and fluticasone. What is the correct administration
sequence for these medications?
Answer: Administer albuterol first (bronchodilator), followed by fluticasone (inhaled
corticosteroid).
18. A patient is taking levothyroxine for hypothyroidism. What lab value should be monitored to assess
the effectiveness of the therapy?
Answer: TSH (Thyroid-Stimulating Hormone).
19. A nurse is administering heparin for DVT prophylaxis. What is the antidote in case of overdose?
Answer: Protamine sulfate.
20. A patient taking phenytoin for seizure control develops gingival hyperplasia. What should the nurse
include in patient teaching?
Answer: Maintain good oral hygiene and regular dental visits.
