2026 NCLEX Medical Surgical Nursing Practice
Questions Answer Rationales Adult Health
Disorders Prioritization Delegation Patient Safety
Clinical Judgment
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–20)
1. A nurse is caring for four patients. Which patient should the nurse assess
first?
A) Patient with heart failure reporting increased fatigue
B) Patient with atrial fibrillation and heart rate of 148 bpm
C) Patient with hypertension requesting pain medication
D) Patient with a venous stasis ulcer requesting repositioning
Answer: B) Patient with atrial fibrillation and heart rate of 148 bpm
Rationale: A heart rate of 148 bpm in atrial fibrillation indicates uncontrolled
rapid ventricular response, which can lead to decreased cardiac output and
hemodynamic instability. This patient requires immediate assessment and
intervention.
2. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which
task is appropriate to delegate?
A) Assessing a patient with chest pain
B) Administering nitroglycerin
C) Obtaining vital signs on a stable patient
D) Teaching a patient about warfarin
Answer: C) Obtaining vital signs on a stable patient
Rationale: Obtaining vital signs on a stable patient is within the scope of UAP.
Assessment, medication administration, and patient teaching require a licensed
nurse.
3. A patient with heart failure has a potassium level of 3.0 mEq/L. Which
action should the nurse take first?
A) Administer furosemide
B) Notify the provider
C) Encourage potassium-rich foods
,D) Recheck potassium in 24 hours
Answer: B) Notify the provider
Rationale: Hypokalemia can cause life-threatening arrhythmias. The provider
should be notified for potassium replacement orders.
4. A nurse is teaching a patient about a low-sodium diet. Which statement
indicates a need for further teaching?
A) "I will avoid canned soups."
B) "I will use salt substitutes."
C) "I will read food labels."
D) "I will limit processed meats."
Answer: B) "I will use salt substitutes."
Rationale: Salt substitutes often contain potassium chloride. Patients on
potassium-sparing diuretics or with renal impairment are at risk for hyperkalemia.
5. A patient with a myocardial infarction is prescribed aspirin. Which
instruction should the nurse include?
A) "Take this medication with food."
B) "Take this medication on an empty stomach."
C) "Take this medication with grapefruit juice."
D) "Take this medication only when you have chest pain."
Answer: A) "Take this medication with food."
Rationale: Aspirin should be taken with food to reduce gastrointestinal upset.
6. A nurse is assessing a patient with heart failure. Which finding indicates
worsening condition?
A) Weight loss of 1 kg
B) Urine output of 50 mL/hr
C) Crackles in bilateral lung bases
D) Heart rate of 88 bpm
Answer: C) Crackles in bilateral lung bases
Rationale: Crackles indicate pulmonary congestion from fluid accumulation, a
sign of worsening left-sided heart failure.
7. A patient with atrial fibrillation is prescribed warfarin. Which laboratory
test should the nurse monitor?
A) aPTT
B) PT/INR
C) Bleeding time
D) Platelet count
,Answer: B) PT/INR
Rationale: Warfarin therapy is monitored with PT/INR.
8. A nurse is delegating to a licensed practical nurse (LPN). Which task is
appropriate for the LPN?
A) Performing an initial assessment
B) Administering oral medications
C) Developing a care plan
D) Teaching a patient about discharge
Answer: B) Administering oral medications
Rationale: LPNs can administer oral medications. Initial assessments, care plan
development, and patient teaching require an RN.
9. A patient with heart failure is prescribed furosemide. Which laboratory
value requires notification?
A) Potassium 3.0 mEq/L
B) Sodium 138 mEq/L
C) BUN 18 mg/dL
D) Creatinine 1.0 mg/dL
Answer: A) Potassium 3.0 mEq/L
Rationale: Hypokalemia can cause arrhythmias; furosemide depletes potassium.
10. A nurse is caring for a patient with a new diagnosis of hypertension.
Which finding requires immediate intervention?
A) Blood pressure 150/90 mm Hg
B) Blood pressure 190/120 mm Hg with headache
C) Heart rate 88 bpm
D) Respiratory rate 18 bpm
Answer: B) Blood pressure 190/120 mm Hg with headache
Rationale: Severe hypertension with headache may indicate hypertensive crisis
with neurological involvement.
11. A patient with a mechanical heart valve is prescribed warfarin. Which
instruction should the nurse include?
A) "Take this medication with food."
B) "Do not stop this medication abruptly."
C) "Take this medication with grapefruit juice."
D) "This medication will increase your heart rate."
Answer: B) "Do not stop this medication abruptly."
Rationale: Abrupt discontinuation of anticoagulants increases the risk of
thromboembolism.
, 12. A nurse is assessing a patient with peripheral arterial disease. Which
finding is expected?
A) Pitting edema
B) Warm, red skin
C) Absent pedal pulses
D) Copious drainage
Answer: C) Absent pedal pulses
Rationale: PAD causes decreased arterial blood flow, leading to absent or
diminished pulses.
13. A patient with a deep vein thrombosis is at risk for which life-threatening
complication?
A) Pulmonary embolism
B) Myocardial infarction
C) Stroke
D) Aortic dissection
Answer: A) Pulmonary embolism
Rationale: DVT can dislodge and travel to the pulmonary circulation, causing a
pulmonary embolism.
14. A nurse is teaching a patient about nitroglycerin. Which statement
indicates understanding?
A) "I will take this medication with food."
B) "I will take this medication sublingually at the onset of chest pain."
C) "I will take this medication only when I have symptoms."
D) "I will take this medication with grapefruit juice."
Answer: B) "I will take this medication sublingually at the onset of chest
pain."
Rationale: Nitroglycerin is taken sublingually at the onset of chest pain for rapid
relief.
15. A patient with heart failure has a BNP of 1,200 pg/mL. Which mechanism
explains this finding?
A) Increased renal excretion
B) Ventricular stretch from volume overload
C) Decreased myocardial contractility
D) Pulmonary vasoconstriction
Answer: B) Ventricular stretch from volume overload
Rationale: BNP is released by ventricular myocytes in response to stretch from
volume overload.
Questions Answer Rationales Adult Health
Disorders Prioritization Delegation Patient Safety
Clinical Judgment
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–20)
1. A nurse is caring for four patients. Which patient should the nurse assess
first?
A) Patient with heart failure reporting increased fatigue
B) Patient with atrial fibrillation and heart rate of 148 bpm
C) Patient with hypertension requesting pain medication
D) Patient with a venous stasis ulcer requesting repositioning
Answer: B) Patient with atrial fibrillation and heart rate of 148 bpm
Rationale: A heart rate of 148 bpm in atrial fibrillation indicates uncontrolled
rapid ventricular response, which can lead to decreased cardiac output and
hemodynamic instability. This patient requires immediate assessment and
intervention.
2. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which
task is appropriate to delegate?
A) Assessing a patient with chest pain
B) Administering nitroglycerin
C) Obtaining vital signs on a stable patient
D) Teaching a patient about warfarin
Answer: C) Obtaining vital signs on a stable patient
Rationale: Obtaining vital signs on a stable patient is within the scope of UAP.
Assessment, medication administration, and patient teaching require a licensed
nurse.
3. A patient with heart failure has a potassium level of 3.0 mEq/L. Which
action should the nurse take first?
A) Administer furosemide
B) Notify the provider
C) Encourage potassium-rich foods
,D) Recheck potassium in 24 hours
Answer: B) Notify the provider
Rationale: Hypokalemia can cause life-threatening arrhythmias. The provider
should be notified for potassium replacement orders.
4. A nurse is teaching a patient about a low-sodium diet. Which statement
indicates a need for further teaching?
A) "I will avoid canned soups."
B) "I will use salt substitutes."
C) "I will read food labels."
D) "I will limit processed meats."
Answer: B) "I will use salt substitutes."
Rationale: Salt substitutes often contain potassium chloride. Patients on
potassium-sparing diuretics or with renal impairment are at risk for hyperkalemia.
5. A patient with a myocardial infarction is prescribed aspirin. Which
instruction should the nurse include?
A) "Take this medication with food."
B) "Take this medication on an empty stomach."
C) "Take this medication with grapefruit juice."
D) "Take this medication only when you have chest pain."
Answer: A) "Take this medication with food."
Rationale: Aspirin should be taken with food to reduce gastrointestinal upset.
6. A nurse is assessing a patient with heart failure. Which finding indicates
worsening condition?
A) Weight loss of 1 kg
B) Urine output of 50 mL/hr
C) Crackles in bilateral lung bases
D) Heart rate of 88 bpm
Answer: C) Crackles in bilateral lung bases
Rationale: Crackles indicate pulmonary congestion from fluid accumulation, a
sign of worsening left-sided heart failure.
7. A patient with atrial fibrillation is prescribed warfarin. Which laboratory
test should the nurse monitor?
A) aPTT
B) PT/INR
C) Bleeding time
D) Platelet count
,Answer: B) PT/INR
Rationale: Warfarin therapy is monitored with PT/INR.
8. A nurse is delegating to a licensed practical nurse (LPN). Which task is
appropriate for the LPN?
A) Performing an initial assessment
B) Administering oral medications
C) Developing a care plan
D) Teaching a patient about discharge
Answer: B) Administering oral medications
Rationale: LPNs can administer oral medications. Initial assessments, care plan
development, and patient teaching require an RN.
9. A patient with heart failure is prescribed furosemide. Which laboratory
value requires notification?
A) Potassium 3.0 mEq/L
B) Sodium 138 mEq/L
C) BUN 18 mg/dL
D) Creatinine 1.0 mg/dL
Answer: A) Potassium 3.0 mEq/L
Rationale: Hypokalemia can cause arrhythmias; furosemide depletes potassium.
10. A nurse is caring for a patient with a new diagnosis of hypertension.
Which finding requires immediate intervention?
A) Blood pressure 150/90 mm Hg
B) Blood pressure 190/120 mm Hg with headache
C) Heart rate 88 bpm
D) Respiratory rate 18 bpm
Answer: B) Blood pressure 190/120 mm Hg with headache
Rationale: Severe hypertension with headache may indicate hypertensive crisis
with neurological involvement.
11. A patient with a mechanical heart valve is prescribed warfarin. Which
instruction should the nurse include?
A) "Take this medication with food."
B) "Do not stop this medication abruptly."
C) "Take this medication with grapefruit juice."
D) "This medication will increase your heart rate."
Answer: B) "Do not stop this medication abruptly."
Rationale: Abrupt discontinuation of anticoagulants increases the risk of
thromboembolism.
, 12. A nurse is assessing a patient with peripheral arterial disease. Which
finding is expected?
A) Pitting edema
B) Warm, red skin
C) Absent pedal pulses
D) Copious drainage
Answer: C) Absent pedal pulses
Rationale: PAD causes decreased arterial blood flow, leading to absent or
diminished pulses.
13. A patient with a deep vein thrombosis is at risk for which life-threatening
complication?
A) Pulmonary embolism
B) Myocardial infarction
C) Stroke
D) Aortic dissection
Answer: A) Pulmonary embolism
Rationale: DVT can dislodge and travel to the pulmonary circulation, causing a
pulmonary embolism.
14. A nurse is teaching a patient about nitroglycerin. Which statement
indicates understanding?
A) "I will take this medication with food."
B) "I will take this medication sublingually at the onset of chest pain."
C) "I will take this medication only when I have symptoms."
D) "I will take this medication with grapefruit juice."
Answer: B) "I will take this medication sublingually at the onset of chest
pain."
Rationale: Nitroglycerin is taken sublingually at the onset of chest pain for rapid
relief.
15. A patient with heart failure has a BNP of 1,200 pg/mL. Which mechanism
explains this finding?
A) Increased renal excretion
B) Ventricular stretch from volume overload
C) Decreased myocardial contractility
D) Pulmonary vasoconstriction
Answer: B) Ventricular stretch from volume overload
Rationale: BNP is released by ventricular myocytes in response to stretch from
volume overload.
