NCLEX RN Adult Medical Surgical
Nursing Exam 7 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026
Question 1
A nurse is assessing a client with heart failure. Which finding requires the
nurse's immediate attention?
A. Bilateral ankle edema
B. Weight gain of 1 kg (2.2 lb) in 24 hours
C. Pink, frothy sputum
D. Fatigue with activity
Answer: Pink, frothy sputum
Rationale: Pink, frothy sputum indicates acute pulmonary edema, a
lifethreatening complication of heart failure. The client requires immediate
respiratory assessment and intervention.
Question 2
A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen.
Which oxygen saturation should the nurse generally target?
A. 70%–75%
B. 80%–85%
C. 88%–92%
D. 98%–100%
Answer: 88%–92%
Rationale: Clients with COPD may have chronic carbon dioxide retention.
,Controlled oxygen therapy is commonly used to maintain oxygen saturation
around 88%–92%, while avoiding unnecessary excessive oxygen
administration.
Question 3
A client with diabetic ketoacidosis (DKA) has a blood glucose of 540 mg/dL and
a potassium level of 3.0 mEq/L. Which prescription should the nurse question?
A. IV regular insulin infusion
B. IV isotonic fluids
C. Potassium replacement
D. Cardiac monitoring
Answer: IV regular insulin infusion
Rationale: Insulin drives potassium into cells and can worsen hypokalemia.
With significant hypokalemia, potassium replacement is prioritized before
insulin is initiated.
Question 4
A client is receiving warfarin therapy. Which laboratory test is most important
for monitoring therapeutic effectiveness?
A. aPTT
B. INR
C. Platelet count
D. Hemoglobin A1c
Answer: INR
Rationale: The international normalized ratio (INR) is used to monitor the
therapeutic effect of warfarin and guide dosage adjustments.
Question 5
A nurse is caring for a client with suspected bacterial meningitis. Which
intervention is the priority?
A. Place the client on airborne precautions
B. Initiate droplet precautions
C. Encourage ambulation
,D. Restrict all fluids
Answer: Initiate droplet precautions
Rationale: Bacterial meningitis can spread through respiratory droplets.
Droplet precautions should be initiated promptly, along with appropriate
antimicrobial therapy and further evaluation.
Question 6
A client with acute kidney injury has a potassium level of 6.8 mEq/L and peaked
T waves on the ECG. Which medication should the nurse anticipate
administering first?
A. Calcium gluconate
B. Furosemide
C. Sodium polystyrene sulfonate
D. Oral potassium chloride
Answer: Calcium gluconate
Rationale: IV calcium gluconate stabilizes the cardiac membrane and reduces
the immediate risk of lethal dysrhythmias associated with severe
hyperkalemia.
Question 7
A client with a chest tube has continuous bubbling in the water-seal chamber.
What should the nurse suspect?
A. Normal functioning
B. An air leak
C. Fluid overload
D. Tube obstruction
Answer: An air leak
Rationale: Continuous bubbling in the water-seal chamber usually indicates
an air leak in the system. The nurse should assess the tubing connections and
insertion site.
, Question 8
A client with a new tracheostomy becomes restless and develops increasing
respiratory distress. What should the nurse do first?
A. Offer oral fluids
B. Assess the tracheostomy for obstruction
C. Place the client flat
D. Remove the tracheostomy ties
Answer: Assess the tracheostomy for obstruction
Rationale: Sudden respiratory distress in a client with a tracheostomy may
indicate obstruction from secretions, displacement, or another airway
problem. Airway assessment and intervention are the priority.
Question 9
Which finding is most characteristic of Addison disease?
A. Hypertension
B. Hypernatremia
C. Hyperpigmentation
D. Hypoglycemia with obesity
Answer: Hyperpigmentation
Rationale: Primary adrenal insufficiency can cause increased ACTH
production, resulting in characteristic hyperpigmentation. Hypotension,
hyponatremia, hyperkalemia, and hypoglycemia may also occur.
Question 10
A client with SIADH has a sodium level of 118 mEq/L. Which intervention is
most appropriate?
A. Encourage large amounts of water
B. Restrict fluids
C. Administer hypotonic IV fluids
D. Encourage a low-sodium diet
Nursing Exam 7 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026
Question 1
A nurse is assessing a client with heart failure. Which finding requires the
nurse's immediate attention?
A. Bilateral ankle edema
B. Weight gain of 1 kg (2.2 lb) in 24 hours
C. Pink, frothy sputum
D. Fatigue with activity
Answer: Pink, frothy sputum
Rationale: Pink, frothy sputum indicates acute pulmonary edema, a
lifethreatening complication of heart failure. The client requires immediate
respiratory assessment and intervention.
Question 2
A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen.
Which oxygen saturation should the nurse generally target?
A. 70%–75%
B. 80%–85%
C. 88%–92%
D. 98%–100%
Answer: 88%–92%
Rationale: Clients with COPD may have chronic carbon dioxide retention.
,Controlled oxygen therapy is commonly used to maintain oxygen saturation
around 88%–92%, while avoiding unnecessary excessive oxygen
administration.
Question 3
A client with diabetic ketoacidosis (DKA) has a blood glucose of 540 mg/dL and
a potassium level of 3.0 mEq/L. Which prescription should the nurse question?
A. IV regular insulin infusion
B. IV isotonic fluids
C. Potassium replacement
D. Cardiac monitoring
Answer: IV regular insulin infusion
Rationale: Insulin drives potassium into cells and can worsen hypokalemia.
With significant hypokalemia, potassium replacement is prioritized before
insulin is initiated.
Question 4
A client is receiving warfarin therapy. Which laboratory test is most important
for monitoring therapeutic effectiveness?
A. aPTT
B. INR
C. Platelet count
D. Hemoglobin A1c
Answer: INR
Rationale: The international normalized ratio (INR) is used to monitor the
therapeutic effect of warfarin and guide dosage adjustments.
Question 5
A nurse is caring for a client with suspected bacterial meningitis. Which
intervention is the priority?
A. Place the client on airborne precautions
B. Initiate droplet precautions
C. Encourage ambulation
,D. Restrict all fluids
Answer: Initiate droplet precautions
Rationale: Bacterial meningitis can spread through respiratory droplets.
Droplet precautions should be initiated promptly, along with appropriate
antimicrobial therapy and further evaluation.
Question 6
A client with acute kidney injury has a potassium level of 6.8 mEq/L and peaked
T waves on the ECG. Which medication should the nurse anticipate
administering first?
A. Calcium gluconate
B. Furosemide
C. Sodium polystyrene sulfonate
D. Oral potassium chloride
Answer: Calcium gluconate
Rationale: IV calcium gluconate stabilizes the cardiac membrane and reduces
the immediate risk of lethal dysrhythmias associated with severe
hyperkalemia.
Question 7
A client with a chest tube has continuous bubbling in the water-seal chamber.
What should the nurse suspect?
A. Normal functioning
B. An air leak
C. Fluid overload
D. Tube obstruction
Answer: An air leak
Rationale: Continuous bubbling in the water-seal chamber usually indicates
an air leak in the system. The nurse should assess the tubing connections and
insertion site.
, Question 8
A client with a new tracheostomy becomes restless and develops increasing
respiratory distress. What should the nurse do first?
A. Offer oral fluids
B. Assess the tracheostomy for obstruction
C. Place the client flat
D. Remove the tracheostomy ties
Answer: Assess the tracheostomy for obstruction
Rationale: Sudden respiratory distress in a client with a tracheostomy may
indicate obstruction from secretions, displacement, or another airway
problem. Airway assessment and intervention are the priority.
Question 9
Which finding is most characteristic of Addison disease?
A. Hypertension
B. Hypernatremia
C. Hyperpigmentation
D. Hypoglycemia with obesity
Answer: Hyperpigmentation
Rationale: Primary adrenal insufficiency can cause increased ACTH
production, resulting in characteristic hyperpigmentation. Hypotension,
hyponatremia, hyperkalemia, and hypoglycemia may also occur.
Question 10
A client with SIADH has a sodium level of 118 mEq/L. Which intervention is
most appropriate?
A. Encourage large amounts of water
B. Restrict fluids
C. Administer hypotonic IV fluids
D. Encourage a low-sodium diet
