NCLEX-RN 2026 Med-Surg Nursing practice exam. This resource contains 200 questions covering adult
health topics including cardiovascular, respiratory, renal, endocrine, gastrointestinal, neurological, post-
operative care, chronic disease management, and acute complications. Use this exam to strengthen your
medical-surgical nursing knowledge and prepare for the NCLEX.
Key Topics Covered
• Cardiovascular – Heart failure, myocardial infarction, hypertension, arrhythmias, peripheral vascular
disease, shock
• Respiratory – COPD, asthma, pneumonia, pulmonary embolism, tuberculosis, ARDS, mechanical
ventilation
• Renal – Acute kidney injury, chronic kidney disease, dialysis, nephrolithiasis, urinary tract infections
• Endocrine – Diabetes mellitus (type 1 and 2), DKA, HHNS, thyroid disorders, adrenal insufficiency,
Cushing’s syndrome
• Gastrointestinal – GERD, peptic ulcer disease, hepatitis, pancreatitis, inflammatory bowel disease,
diverticulitis, liver failure
• Neurological – Stroke, seizures, head injury, Parkinson’s disease, multiple sclerosis, meningitis,
Alzheimer’s disease
• Post-operative & Chronic Disease – Wound healing, infection prevention, pain management,
complications (DVT, pneumonia), home care
• Acute Complications – Sepsis, anaphylaxis, respiratory failure, bleeding, electrolyte imbalances
Questions 1–200
1. A client with heart failure has an ejection fraction of 25%. Which medication is first-line to reduce
mortality?
A) Furosemide
B) Metoprolol succinate
C) Digoxin
D) Hydralazine
Answer B: Metoprolol succinate
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce mortality in HFrEF. Diuretics
control symptoms only.
,2. A client with COPD has a new prescription for home oxygen. Which instruction is most important?
A) Clean the nasal cannula weekly with soap
B) Do not smoke or allow anyone to smoke near the oxygen
C) Keep oxygen cylinders lying flat on the floor
D) Adjust the flow rate based on activity level
Answer B: Do not smoke or allow anyone to smoke near the oxygen
Rationale: Oxygen supports combustion; smoking is a fire hazard. Safety is the priority.
3. A client with chronic kidney disease (CKD) has a potassium level of 6.2 mEq/L. Which finding does
the nurse expect?
A) Hyporeflexia
B) Peaked T waves on ECG
C) Prolonged PR interval
D) Flaccid paralysis
Answer B: Peaked T waves on ECG
Rationale: Hyperkalemia (K+ >5.5) causes peaked T waves, then wide QRS, and eventually sine wave.
Hyporeflexia occurs in hypermagnesemia.
4. A client with diabetes mellitus type 1 has a blood glucose of 350 mg/dL, urine ketones large, and
Kussmaul respirations. Which intervention should the nurse implement first?
A) Administer regular insulin IV
B) Start an IV line with normal saline
C) Apply oxygen via nasal cannula
D) Notify the provider
Answer B: Start an IV line with normal saline
Rationale: In DKA, fluid resuscitation is the first priority to correct dehydration and improve perfusion.
Insulin follows after volume repletion.
5. A client 2 days post-operative after a bowel resection reports sudden chest pain and dyspnea. Vital
signs: HR 120, RR 28, SpO2 88%. What is the priority action?
A) Apply oxygen at 2 L/min via nasal cannula
,B) Elevate the head of the bed and apply oxygen at 10 L/min via non-rebreather
C) Administer aspirin 325 mg
D) Prepare for a stat chest X-ray
Answer B: Elevate the head of the bed and apply oxygen at 10 L/min via non-rebreather
Rationale: Suspected pulmonary embolism requires immediate oxygenation (high flow) and positioning to
support breathing.
6. A client with cirrhosis has ascites and a paracentesis is performed. Which finding indicates a
complication?
A) Clear, straw-colored fluid
B) Fluid with WBC count 500/mm³ and cloudy appearance
C) Albumin level of 2.5 g/dL in the fluid
D) Protein level of 1.0 g/dL in the fluid
Answer B: Fluid with WBC count 500/mm³ and cloudy appearance
Rationale: PMN count >250/mm³ suggests spontaneous bacterial peritonitis (SBP). Clear fluid with low
protein is typical of ascites.
7. A client with a stroke has left-sided neglect and difficulty with spatial awareness. Which nursing
intervention is most appropriate?
A) Place all personal items on the client’s right side
B) Approach the client from the left side and remind to scan to the left
C) Restrain the right arm to encourage use of the left arm
D) Keep the room dark and quiet
Answer B: Approach the client from the left side and remind to scan to the left
Rationale: Encourage attention to the neglected side by positioning and verbal cues. Items should be placed
on the affected side.
8. A client with pneumonia has a fever of 39°C (102.2°F) and is reporting pleuritic chest pain. Which
intervention should the nurse implement first?
A) Administer acetaminophen as ordered
B) Position the client in semi-Fowler’s and encourage deep breathing
C) Apply a cold compress to the forehead
D) Notify the provider of the fever
, Answer B: Position the client in semi-Fowler’s and encourage deep breathing
Rationale: Positioning optimizes ventilation; deep breathing helps expand lungs. Treat fever after
airway/breathing addressed.
9. A client with hyperthyroidism (Graves’ disease) is prescribed propylthiouracil (PTU). Which
adverse effect requires immediate discontinuation?
A) Mild rash
B) Agranulocytosis (fever, sore throat)
C) Weight gain
D) Diarrhea
Answer B: Agranulocytosis (fever, sore throat)
Rationale: PTU can cause agranulocytosis; any fever or sore throat warrants CBC. Methimazole is preferred
except in first trimester pregnancy.
10. A client with a recent myocardial infarction develops crackles in bilateral lung bases, an S3
gallop, and oxygen saturation of 90%. Which complication does the nurse suspect?
A) Cardiogenic shock
B) Acute heart failure (pulmonary edema)
C) Pericarditis
D) Recurrent infarction
Answer B: Acute heart failure (pulmonary edema)
Rationale: Crackles, S3, and hypoxemia indicate left ventricular failure (pulmonary congestion). Cardiogenic
shock would include hypotension.
11. A client with chronic kidney disease on hemodialysis has an AV fistula in the left arm. Which
finding requires immediate action?
A) Palpable thrill and audible bruit
B) Absence of thrill and bruit with arm swelling
C) Mild erythema at the needle site
D) Small hematoma at the access site
Answer B: Absence of thrill and bruit with arm swelling
Rationale: Loss of thrill/bruit suggests thrombosis; notify provider immediately. Mild erythema/hematoma
can be monitored.
health topics including cardiovascular, respiratory, renal, endocrine, gastrointestinal, neurological, post-
operative care, chronic disease management, and acute complications. Use this exam to strengthen your
medical-surgical nursing knowledge and prepare for the NCLEX.
Key Topics Covered
• Cardiovascular – Heart failure, myocardial infarction, hypertension, arrhythmias, peripheral vascular
disease, shock
• Respiratory – COPD, asthma, pneumonia, pulmonary embolism, tuberculosis, ARDS, mechanical
ventilation
• Renal – Acute kidney injury, chronic kidney disease, dialysis, nephrolithiasis, urinary tract infections
• Endocrine – Diabetes mellitus (type 1 and 2), DKA, HHNS, thyroid disorders, adrenal insufficiency,
Cushing’s syndrome
• Gastrointestinal – GERD, peptic ulcer disease, hepatitis, pancreatitis, inflammatory bowel disease,
diverticulitis, liver failure
• Neurological – Stroke, seizures, head injury, Parkinson’s disease, multiple sclerosis, meningitis,
Alzheimer’s disease
• Post-operative & Chronic Disease – Wound healing, infection prevention, pain management,
complications (DVT, pneumonia), home care
• Acute Complications – Sepsis, anaphylaxis, respiratory failure, bleeding, electrolyte imbalances
Questions 1–200
1. A client with heart failure has an ejection fraction of 25%. Which medication is first-line to reduce
mortality?
A) Furosemide
B) Metoprolol succinate
C) Digoxin
D) Hydralazine
Answer B: Metoprolol succinate
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce mortality in HFrEF. Diuretics
control symptoms only.
,2. A client with COPD has a new prescription for home oxygen. Which instruction is most important?
A) Clean the nasal cannula weekly with soap
B) Do not smoke or allow anyone to smoke near the oxygen
C) Keep oxygen cylinders lying flat on the floor
D) Adjust the flow rate based on activity level
Answer B: Do not smoke or allow anyone to smoke near the oxygen
Rationale: Oxygen supports combustion; smoking is a fire hazard. Safety is the priority.
3. A client with chronic kidney disease (CKD) has a potassium level of 6.2 mEq/L. Which finding does
the nurse expect?
A) Hyporeflexia
B) Peaked T waves on ECG
C) Prolonged PR interval
D) Flaccid paralysis
Answer B: Peaked T waves on ECG
Rationale: Hyperkalemia (K+ >5.5) causes peaked T waves, then wide QRS, and eventually sine wave.
Hyporeflexia occurs in hypermagnesemia.
4. A client with diabetes mellitus type 1 has a blood glucose of 350 mg/dL, urine ketones large, and
Kussmaul respirations. Which intervention should the nurse implement first?
A) Administer regular insulin IV
B) Start an IV line with normal saline
C) Apply oxygen via nasal cannula
D) Notify the provider
Answer B: Start an IV line with normal saline
Rationale: In DKA, fluid resuscitation is the first priority to correct dehydration and improve perfusion.
Insulin follows after volume repletion.
5. A client 2 days post-operative after a bowel resection reports sudden chest pain and dyspnea. Vital
signs: HR 120, RR 28, SpO2 88%. What is the priority action?
A) Apply oxygen at 2 L/min via nasal cannula
,B) Elevate the head of the bed and apply oxygen at 10 L/min via non-rebreather
C) Administer aspirin 325 mg
D) Prepare for a stat chest X-ray
Answer B: Elevate the head of the bed and apply oxygen at 10 L/min via non-rebreather
Rationale: Suspected pulmonary embolism requires immediate oxygenation (high flow) and positioning to
support breathing.
6. A client with cirrhosis has ascites and a paracentesis is performed. Which finding indicates a
complication?
A) Clear, straw-colored fluid
B) Fluid with WBC count 500/mm³ and cloudy appearance
C) Albumin level of 2.5 g/dL in the fluid
D) Protein level of 1.0 g/dL in the fluid
Answer B: Fluid with WBC count 500/mm³ and cloudy appearance
Rationale: PMN count >250/mm³ suggests spontaneous bacterial peritonitis (SBP). Clear fluid with low
protein is typical of ascites.
7. A client with a stroke has left-sided neglect and difficulty with spatial awareness. Which nursing
intervention is most appropriate?
A) Place all personal items on the client’s right side
B) Approach the client from the left side and remind to scan to the left
C) Restrain the right arm to encourage use of the left arm
D) Keep the room dark and quiet
Answer B: Approach the client from the left side and remind to scan to the left
Rationale: Encourage attention to the neglected side by positioning and verbal cues. Items should be placed
on the affected side.
8. A client with pneumonia has a fever of 39°C (102.2°F) and is reporting pleuritic chest pain. Which
intervention should the nurse implement first?
A) Administer acetaminophen as ordered
B) Position the client in semi-Fowler’s and encourage deep breathing
C) Apply a cold compress to the forehead
D) Notify the provider of the fever
, Answer B: Position the client in semi-Fowler’s and encourage deep breathing
Rationale: Positioning optimizes ventilation; deep breathing helps expand lungs. Treat fever after
airway/breathing addressed.
9. A client with hyperthyroidism (Graves’ disease) is prescribed propylthiouracil (PTU). Which
adverse effect requires immediate discontinuation?
A) Mild rash
B) Agranulocytosis (fever, sore throat)
C) Weight gain
D) Diarrhea
Answer B: Agranulocytosis (fever, sore throat)
Rationale: PTU can cause agranulocytosis; any fever or sore throat warrants CBC. Methimazole is preferred
except in first trimester pregnancy.
10. A client with a recent myocardial infarction develops crackles in bilateral lung bases, an S3
gallop, and oxygen saturation of 90%. Which complication does the nurse suspect?
A) Cardiogenic shock
B) Acute heart failure (pulmonary edema)
C) Pericarditis
D) Recurrent infarction
Answer B: Acute heart failure (pulmonary edema)
Rationale: Crackles, S3, and hypoxemia indicate left ventricular failure (pulmonary congestion). Cardiogenic
shock would include hypotension.
11. A client with chronic kidney disease on hemodialysis has an AV fistula in the left arm. Which
finding requires immediate action?
A) Palpable thrill and audible bruit
B) Absence of thrill and bruit with arm swelling
C) Mild erythema at the needle site
D) Small hematoma at the access site
Answer B: Absence of thrill and bruit with arm swelling
Rationale: Loss of thrill/bruit suggests thrombosis; notify provider immediately. Mild erythema/hematoma
can be monitored.
