1 | Page
MED-SURG NURSING 2026 ,180 VERIFIED QUESTIONS WITH DETAILED
RATIONALES (NEXT GEN NCLEX UPDATED) 100% CORRECT ALREADY
GRADED A+
1.
A 70-year-old client with heart failure is receiving IV furosemide. The nurse
reviews the client’s morning labs:
K⁺ = 2.9 mEq/L, Na⁺ = 138 mEq/L, BUN = 32 mg/dL, Creatinine = 1.3 mg/dL.
Which finding should the nurse report immediately to the healthcare provider?
A. Mild fatigue and thirst
B. Potassium level of 2.9 mEq/L
C. BUN of 32 mg/dL
D. Weight loss of 1.5 kg in two days
Answer: B. Potassium level of 2.9 mEq/L
Rationale: Furosemide causes potassium loss. Hypokalemia (<3.5 mEq/L) can
cause serious cardiac dysrhythmias. This finding requires urgent correction before
the next dose.
2.
A client with COPD is receiving oxygen therapy at 4 L/min via nasal cannula. The
nurse notices the client becoming increasingly lethargic and slow to respond.
Which action should the nurse take first?
A. Increase oxygen to 6 L/min
B. Notify the healthcare provider
C. Decrease oxygen to 2 L/min
D. Encourage coughing and deep breathing
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Answer: C. Decrease oxygen to 2 L/min
Rationale: High oxygen flow may suppress the hypoxic respiratory drive in
COPD, leading to CO₂ retention and respiratory depression. Oxygen should be
titrated to maintain saturation between 88–92%.
3.
A postoperative client reports pain, warmth, and swelling in the left calf. The nurse
notes a mild temperature elevation.
What is the priority nursing action?
A. Elevate the affected leg and notify the provider
B. Massage the calf gently to improve circulation
C. Apply warm compresses to relieve discomfort
D. Encourage ambulation to prevent stiffness
Answer: A. Elevate the affected leg and notify the provider
Rationale: These symptoms suggest deep vein thrombosis (DVT). Elevating the
leg promotes venous return. Massage or ambulation may dislodge the clot and
cause a pulmonary embolism.
4.
A client with chronic kidney disease presents with weakness and muscle cramps.
The laboratory results show:
K⁺ = 6.8 mEq/L, BUN = 65 mg/dL, Creatinine = 5.9 mg/dL.
Which ECG finding is most concerning?
A. Flattened T waves
B. Tall peaked T waves
C. Presence of U waves
D. Prolonged QT interval
Answer: B. Tall peaked T waves
Rationale: Hyperkalemia causes tall, peaked T waves and can progress to life-
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threatening ventricular dysrhythmias. This is a medical emergency requiring
immediate intervention.
5.
A client with pneumonia has a respiratory rate of 28/min, oxygen saturation of
88%, and productive cough with thick yellow sputum.
Which nursing diagnosis is the highest priority?
A. Ineffective airway clearance
B. Impaired gas exchange
C. Risk for fluid volume deficit
D. Activity intolerance
Answer: B. Impaired gas exchange
Rationale: The client’s low oxygen saturation and tachypnea indicate poor
alveolar gas exchange. Airway management and oxygenation take priority over
other nursing concerns.
6.
A client who underwent abdominal surgery 12 hours ago reports sudden, severe
abdominal pain, restlessness, and a hard, distended abdomen.
Which action should the nurse take first?
A. Administer prescribed pain medication
B. Notify the healthcare provider immediately
C. Reposition the client for comfort
D. Document the findings in the chart
Answer: B. Notify the healthcare provider immediately
Rationale: These findings suggest wound dehiscence or internal bleeding — a
surgical emergency. Immediate medical evaluation is required before any other
action.
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7.
A client admitted with cirrhosis is confused, drowsy, and has a flapping tremor of
the hands (asterixis).
Which laboratory finding is most consistent with this condition?
A. Elevated serum ammonia
B. Decreased bilirubin
C. Decreased alkaline phosphatase
D. Low potassium level
Answer: A. Elevated serum ammonia
Rationale: High ammonia levels indicate hepatic encephalopathy, a serious
complication of liver failure. Lactulose may be given to reduce ammonia
absorption from the intestine.
8.
The nurse is caring for a client who had a thyroidectomy six hours ago. The nurse
notes a hoarse voice and difficulty swallowing.
What should the nurse do first?
A. Document the finding as expected
B. Notify the healthcare provider immediately
C. Offer warm fluids to soothe the throat
D. Place a sandbag under the neck for support
Answer: B. Notify the healthcare provider immediately
Rationale: Hoarseness and difficulty swallowing may indicate laryngeal nerve
injury or airway obstruction from bleeding or swelling. Airway assessment is the
top priority.
9.
A client with diabetes mellitus is found confused and diaphoretic. The nurse
quickly checks the capillary glucose and finds it to be 48 mg/dL.
What is the nurse’s priority intervention?
MED-SURG NURSING 2026 ,180 VERIFIED QUESTIONS WITH DETAILED
RATIONALES (NEXT GEN NCLEX UPDATED) 100% CORRECT ALREADY
GRADED A+
1.
A 70-year-old client with heart failure is receiving IV furosemide. The nurse
reviews the client’s morning labs:
K⁺ = 2.9 mEq/L, Na⁺ = 138 mEq/L, BUN = 32 mg/dL, Creatinine = 1.3 mg/dL.
Which finding should the nurse report immediately to the healthcare provider?
A. Mild fatigue and thirst
B. Potassium level of 2.9 mEq/L
C. BUN of 32 mg/dL
D. Weight loss of 1.5 kg in two days
Answer: B. Potassium level of 2.9 mEq/L
Rationale: Furosemide causes potassium loss. Hypokalemia (<3.5 mEq/L) can
cause serious cardiac dysrhythmias. This finding requires urgent correction before
the next dose.
2.
A client with COPD is receiving oxygen therapy at 4 L/min via nasal cannula. The
nurse notices the client becoming increasingly lethargic and slow to respond.
Which action should the nurse take first?
A. Increase oxygen to 6 L/min
B. Notify the healthcare provider
C. Decrease oxygen to 2 L/min
D. Encourage coughing and deep breathing
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Answer: C. Decrease oxygen to 2 L/min
Rationale: High oxygen flow may suppress the hypoxic respiratory drive in
COPD, leading to CO₂ retention and respiratory depression. Oxygen should be
titrated to maintain saturation between 88–92%.
3.
A postoperative client reports pain, warmth, and swelling in the left calf. The nurse
notes a mild temperature elevation.
What is the priority nursing action?
A. Elevate the affected leg and notify the provider
B. Massage the calf gently to improve circulation
C. Apply warm compresses to relieve discomfort
D. Encourage ambulation to prevent stiffness
Answer: A. Elevate the affected leg and notify the provider
Rationale: These symptoms suggest deep vein thrombosis (DVT). Elevating the
leg promotes venous return. Massage or ambulation may dislodge the clot and
cause a pulmonary embolism.
4.
A client with chronic kidney disease presents with weakness and muscle cramps.
The laboratory results show:
K⁺ = 6.8 mEq/L, BUN = 65 mg/dL, Creatinine = 5.9 mg/dL.
Which ECG finding is most concerning?
A. Flattened T waves
B. Tall peaked T waves
C. Presence of U waves
D. Prolonged QT interval
Answer: B. Tall peaked T waves
Rationale: Hyperkalemia causes tall, peaked T waves and can progress to life-
,3 | Page
threatening ventricular dysrhythmias. This is a medical emergency requiring
immediate intervention.
5.
A client with pneumonia has a respiratory rate of 28/min, oxygen saturation of
88%, and productive cough with thick yellow sputum.
Which nursing diagnosis is the highest priority?
A. Ineffective airway clearance
B. Impaired gas exchange
C. Risk for fluid volume deficit
D. Activity intolerance
Answer: B. Impaired gas exchange
Rationale: The client’s low oxygen saturation and tachypnea indicate poor
alveolar gas exchange. Airway management and oxygenation take priority over
other nursing concerns.
6.
A client who underwent abdominal surgery 12 hours ago reports sudden, severe
abdominal pain, restlessness, and a hard, distended abdomen.
Which action should the nurse take first?
A. Administer prescribed pain medication
B. Notify the healthcare provider immediately
C. Reposition the client for comfort
D. Document the findings in the chart
Answer: B. Notify the healthcare provider immediately
Rationale: These findings suggest wound dehiscence or internal bleeding — a
surgical emergency. Immediate medical evaluation is required before any other
action.
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7.
A client admitted with cirrhosis is confused, drowsy, and has a flapping tremor of
the hands (asterixis).
Which laboratory finding is most consistent with this condition?
A. Elevated serum ammonia
B. Decreased bilirubin
C. Decreased alkaline phosphatase
D. Low potassium level
Answer: A. Elevated serum ammonia
Rationale: High ammonia levels indicate hepatic encephalopathy, a serious
complication of liver failure. Lactulose may be given to reduce ammonia
absorption from the intestine.
8.
The nurse is caring for a client who had a thyroidectomy six hours ago. The nurse
notes a hoarse voice and difficulty swallowing.
What should the nurse do first?
A. Document the finding as expected
B. Notify the healthcare provider immediately
C. Offer warm fluids to soothe the throat
D. Place a sandbag under the neck for support
Answer: B. Notify the healthcare provider immediately
Rationale: Hoarseness and difficulty swallowing may indicate laryngeal nerve
injury or airway obstruction from bleeding or swelling. Airway assessment is the
top priority.
9.
A client with diabetes mellitus is found confused and diaphoretic. The nurse
quickly checks the capillary glucose and finds it to be 48 mg/dL.
What is the nurse’s priority intervention?
