49 Medical-Surgical Practice Questions & Answers
Every Medical-Surgical practice question from the NCLEX-RN Practice Test, with the correct answer and a short explanation.
Start practice test →1. A client with heart failure is receiving digoxin. Which serum potassium level places the client at greatest risk for digoxin toxicity?
- A.4.5 mEq/L
- B.4.0 mEq/L
- C.3.0 mEq/L✓ Answer
- D.5.0 mEq/L
Hypokalemia (potassium below 3.5 mEq/L) potentiates digoxin binding to cardiac cells and greatly increases the risk of digoxin toxicity.
2. A client with type 1 diabetes presents with fruity breath, Kussmaul respirations, and a blood glucose of 480 mg/dL. Which is the priority nursing intervention?
- A.Administer sodium bicarbonate IV push
- B.Administer regular insulin subcutaneously
- C.Initiate intravenous (IV) 0.9% normal saline✓ Answer
- D.Give the client orange juice to drink
In diabetic ketoacidosis (DKA) the priority is aggressive IV fluid replacement with 0.9% normal saline to correct profound dehydration before or alongside IV insulin.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min. The client's oxygen saturation is 90%. What is the best nursing action?
- A.Continue current oxygen and monitor the client✓ Answer
- B.Place the client on a non-rebreather mask at 15 L/min
- C.Increase oxygen to 6 L/min immediately
- D.Remove the oxygen to prevent oxygen toxicity
In COPD an oxygen saturation of 88-92% is an acceptable target; high-flow oxygen can suppress the hypoxic respiratory drive, so low-flow oxygen should be continued and the client monitored.
4. A client with acute kidney injury has a serum potassium of 6.8 mEq/L. Which electrocardiogram (ECG) change should the nurse expect?
- A.Prominent U waves with ST depression
- B.Flattened T waves and U waves
- C.Shortened QT interval only
- D.Tall, peaked T waves✓ Answer
Hyperkalemia (potassium above 5.0 mEq/L) characteristically produces tall, peaked T waves on the ECG.
5. A client is admitted with prolonged vomiting for three days. Which acid-base imbalance should the nurse anticipate?
- A.Respiratory alkalosis
- B.Metabolic alkalosis✓ Answer
- C.Metabolic acidosis
- D.Respiratory acidosis
Prolonged vomiting causes loss of hydrochloric acid from the stomach, leading to metabolic alkalosis.
6. A client is receiving intravenous heparin for a pulmonary embolism. Which laboratory value should the nurse monitor to evaluate therapeutic effect?
- A.Bleeding time
- B.Prothrombin time / international normalized ratio (PT/INR)
- C.Activated partial thromboplastin time (aPTT)✓ Answer
- D.Platelet count only
Heparin therapy is monitored with the activated partial thromboplastin time (aPTT), whereas PT/INR is used to monitor warfarin.
7. A client is 12 hours post cardiac catheterization via the right femoral artery. The nurse notes a rapidly enlarging hematoma at the insertion site. What is the priority action?
- A.Apply firm manual pressure above the insertion site✓ Answer
- B.Elevate the head of the bed to 90 degrees
- C.Encourage the client to ambulate to improve circulation
- D.Document the finding and reassess in one hour
A rapidly enlarging hematoma signals arterial bleeding, so the nurse must immediately apply firm manual pressure above the puncture site to control hemorrhage.
8. A client with cirrhosis has an elevated serum ammonia level and increasing confusion. Which medication should the nurse anticipate administering?
- A.Furosemide
- B.Propranolol
- C.Lactulose✓ Answer
- D.Vitamin K
Lactulose lowers serum ammonia by trapping it in the colon for excretion, treating hepatic encephalopathy.
9. A client presents with sudden slurred speech, right-sided facial droop, and right arm weakness that began 90 minutes ago. Which is the priority nursing assessment before treatment?
- A.Determine the exact time of symptom onset✓ Answer
- B.Measure the client's abdominal girth
- C.Obtain the client's baseline weight
- D.Assess the client's dietary preferences
For a suspected ischemic stroke, establishing the exact time of symptom onset is critical because thrombolytic therapy (tPA) must be given within a strict time window.
10. A client is receiving a unit of packed red blood cells. Fifteen minutes into the transfusion the client reports chills, low back pain, and has a temperature spike. What should the nurse do first?
- A.Stop the transfusion and keep the vein open with normal saline✓ Answer
- B.Administer an antipyretic and reassess in 30 minutes
- C.Slow the transfusion rate and continue monitoring
- D.Notify the blood bank before taking any action
Chills, back pain, and fever indicate a possible acute hemolytic transfusion reaction, so the nurse must immediately stop the transfusion and maintain IV access with normal saline.
11. A client with a nasogastric tube connected to continuous suction has muscle cramps, weakness, and a serum sodium of 128 mEq/L. Which condition does the nurse recognize?
- A.Hypernatremia
- B.Hypercalcemia
- C.Hyponatremia✓ Answer
- D.Hyperchloremia
A serum sodium of 128 mEq/L is below the normal range of 135-145 mEq/L, indicating hyponatremia, which can result from loss of gastric secretions via suction.
12. A client with hypothyroidism is started on levothyroxine. Which finding indicates the medication may be causing an adverse effect requiring provider notification?
- A.Increased energy and improved mood
- B.Gradual weight stabilization
- C.Resting heart rate of 118 beats per minute with palpitations✓ Answer
- D.Resolution of cold intolerance
Tachycardia and palpitations suggest levothyroxine overdose producing hyperthyroid effects, an adverse reaction the provider should be notified about.
13. A client with acute pancreatitis reports severe epigastric pain radiating to the back. Which laboratory result most specifically confirms the diagnosis?
- A.Elevated serum lipase✓ Answer
- B.Elevated blood urea nitrogen (BUN)
- C.Decreased serum albumin
- D.Elevated serum potassium
Elevated serum lipase is the most specific and sensitive laboratory marker for acute pancreatitis.
14. A client arrives in the emergency department reporting crushing chest pain radiating to the left arm. Which laboratory test is most specific for confirming an acute myocardial infarction?
- A.Troponin I✓ Answer
- B.Myoglobin
- C.C-reactive protein (CRP)
- D.Total creatine kinase (CK)
Troponin I is the most cardiac-specific biomarker for myocardial infarction, rising within hours and remaining elevated for days.
15. A client with left-sided heart failure is most likely to exhibit which assessment finding?
- A.Jugular vein distention
- B.Bibasilar crackles and dyspnea✓ Answer
- C.Dependent peripheral edema
- D.Hepatomegaly and ascites
Left-sided heart failure causes blood to back up into the lungs, producing pulmonary congestion with bibasilar crackles and dyspnea; the other findings reflect right-sided failure.
16. A client is prescribed sublingual nitroglycerin for stable angina. Which instruction should the nurse include?
- A.Swallow the tablet whole with a full glass of water
- B.Take up to five tablets five minutes apart before seeking help
- C.Take one tablet every 5 minutes up to 3 doses, calling 911 if pain persists✓ Answer
- D.Take the tablet only after chest pain has lasted 30 minutes
Sublingual nitroglycerin is taken one tablet every 5 minutes for up to 3 doses; if chest pain persists, emergency services should be called because it may signal myocardial infarction.
17. A client's cardiac monitor shows ventricular fibrillation and the client is unresponsive with no pulse. What is the priority nursing action?
- A.Administer intravenous amiodarone
- B.Prepare for synchronized cardioversion
- C.Defibrillate immediately and begin CPR✓ Answer
- D.Administer atropine 1 mg IV push
Pulseless ventricular fibrillation requires immediate defibrillation (an unsynchronized shock) and high-quality CPR; synchronized cardioversion is used for pulsed rhythms.
18. A client on prolonged bed rest reports sudden unilateral calf pain, warmth, and swelling. Which nursing action is most appropriate?
- A.Vigorously massage the affected calf to improve circulation
- B.Maintain bed rest and notify the provider of suspected DVT✓ Answer
- C.Apply cold compresses and have the client ambulate
- D.Perform passive range-of-motion exercises to the leg
Unilateral calf pain, warmth, and swelling suggest deep vein thrombosis (DVT); the leg must not be massaged or exercised because this could dislodge a clot and cause a pulmonary embolism.
19. A client with a chest tube for a pneumothorax has continuous bubbling in the water-seal chamber. What does this finding most likely indicate?
- A.Normal, expected functioning of the drainage system
- B.Complete re-expansion of the lung
- C.An air leak in the system✓ Answer
- D.Obstruction of the chest tube
Continuous bubbling in the water-seal chamber indicates an air leak; only intermittent bubbling that fluctuates with respiration (tidaling) is expected.
20. A nurse reviews an arterial blood gas: pH 7.28, PaCO2 58 mmHg, HCO3 24 mEq/L. How should the nurse interpret this result?
- A.Uncompensated respiratory acidosis✓ Answer
- B.Uncompensated metabolic acidosis
- C.Fully compensated respiratory alkalosis
- D.Uncompensated metabolic alkalosis
The pH is low (acidosis) and the PaCO2 is high (above 45 mmHg) while HCO3 is normal, indicating uncompensated respiratory acidosis.
21. A client having an acute asthma exacerbation is prescribed albuterol and inhaled beclomethasone. In which order should the nurse teach the client to use these inhalers?
- A.Beclomethasone first, then albuterol immediately after
- B.Both inhalers together at the same time
- C.Beclomethasone only during acute attacks
- D.Albuterol first, then beclomethasone a few minutes later✓ Answer
The bronchodilator albuterol is used first to open the airways, allowing the inhaled corticosteroid beclomethasone to be deposited more effectively a few minutes later.
22. A client with community-acquired pneumonia has a pulse oximetry reading of 86% on room air and is using accessory muscles. Which is the priority nursing action?
- A.Administer supplemental oxygen and raise the head of the bed✓ Answer
- B.Administer the prescribed antibiotic immediately
- C.Obtain a sputum culture before doing anything else
- D.Encourage increased oral fluid intake
Hypoxemia with a saturation of 86% and accessory muscle use is an immediate oxygenation problem; giving oxygen and positioning the client upright takes priority (airway and breathing).
23. A client with type 2 diabetes is admitted with a blood glucose of 720 mg/dL, profound dehydration, and no ketones in the urine. Which condition does the nurse recognize?
- A.Diabetic ketoacidosis (DKA)
- B.Hyperosmolar hyperglycemic state (HHS)✓ Answer
- C.Hypoglycemia
- D.Somogyi phenomenon
Extremely high glucose with severe dehydration but no ketosis is characteristic of hyperosmolar hyperglycemic state (HHS), which occurs in type 2 diabetes because enough insulin is present to prevent ketone formation.
24. A client recovering from a thyroidectomy suddenly reports tingling around the mouth and muscle twitching. Which electrolyte imbalance should the nurse suspect?
- A.Hypernatremia
- B.Hyperkalemia
- C.Hypermagnesemia
- D.Hypocalcemia✓ Answer
Accidental removal of or damage to the parathyroid glands during thyroidectomy causes hypocalcemia, producing perioral tingling and muscle twitching (positive Chvostek and Trousseau signs).
25. A client with Addison's disease (adrenal insufficiency) is at risk for addisonian crisis. Which finding would the nurse expect during a crisis?
- A.Hypertension and hypokalemia
- B.Severe hypotension and hyperkalemia✓ Answer
- C.Hyperglycemia and weight gain
- D.Bradycardia and hypernatremia
Addisonian crisis results from a lack of cortisol and aldosterone, causing severe hypotension, hyperkalemia, hyponatremia, and hypoglycemia; it is a life-threatening emergency.
26. A client with chronic kidney disease has a phosphorus level of 6.5 mg/dL. Which medication should the nurse administer with meals to manage this?
- A.Calcium acetate (a phosphate binder)✓ Answer
- B.Intravenous potassium chloride
- C.Furosemide
- D.Ferrous sulfate
Phosphate binders such as calcium acetate are given with meals to bind dietary phosphorus in the gut and lower elevated serum phosphorus in chronic kidney disease.
27. A client with an arteriovenous (AV) fistula for hemodialysis is admitted. Which nursing action protects the fistula?
- A.Take blood pressure in the arm with the fistula
- B.Draw blood specimens from the fistula arm for convenience
- C.Avoid blood pressure measurements and venipunctures in that arm✓ Answer
- D.Apply a tight compression bandage over the fistula
To preserve fistula patency, the nurse must avoid blood pressure measurements, venipunctures, and constriction of the fistula arm, which could cause clotting or damage.
28. A client with a new colostomy has a stoma that is dusky and dark purple. What does this finding indicate?
- A.Normal, healthy stoma tissue
- B.Impaired blood supply (ischemia) to the stoma✓ Answer
- C.Adequate healing of the stoma
- D.Expected postoperative bruising
A healthy stoma is pink or red and moist; a dusky, dark purple, or black stoma indicates impaired blood supply (ischemia) and must be reported immediately.
29. A client with cirrhosis and esophageal varices suddenly vomits a large amount of bright red blood. What is the priority nursing action?
- A.Administer oral lactulose immediately
- B.Place the client flat and encourage oral fluids
- C.Maintain a patent airway and prepare for volume resuscitation✓ Answer
- D.Obtain a stool sample for occult blood testing
Ruptured esophageal varices cause massive hemorrhage; the priority is protecting the airway from aspiration and preparing for fluid and blood resuscitation to prevent hypovolemic shock.
30. A client is admitted with a suspected increase in intracranial pressure (ICP). Which position should the nurse use to help reduce ICP?
- A.Head of bed elevated 30 degrees with the head midline✓ Answer
- B.Prone with the head turned to the side
- C.Trendelenburg position (head lower than feet)
- D.Flat supine with the neck flexed forward
Elevating the head of the bed to 30 degrees with the head midline promotes venous drainage from the brain and helps lower intracranial pressure; neck flexion or lowering the head increases ICP.
31. A nurse is caring for a client during a generalized tonic-clonic seizure. Which action is most appropriate?
- A.Turn the client to the side and protect the head✓ Answer
- B.Restrain the client's arms and legs firmly
- C.Insert a padded tongue blade into the mouth
- D.Leave the client to obtain suction equipment
During a seizure the nurse should turn the client to the side to maintain the airway and prevent aspiration, and protect the head; nothing should be forced into the mouth and the client should not be restrained.
32. A client with a cervical spinal cord injury develops a pounding headache, flushed face, and a blood pressure of 210/110 mmHg. Which is the priority nursing action?
- A.Lay the client flat and elevate the legs
- B.Raise the head of the bed and check for bladder distention✓ Answer
- C.Administer an oral analgesic for the headache
- D.Apply warm blankets to the client
These findings indicate autonomic dysreflexia, a medical emergency; the nurse should immediately raise the head of the bed to lower blood pressure and identify/remove the trigger, most often bladder distention.
33. A client with a long-bone fracture develops sudden dyspnea, confusion, and petechiae over the chest 24 hours after injury. Which complication should the nurse suspect?
- A.Compartment syndrome
- B.Fat embolism syndrome✓ Answer
- C.Osteomyelitis
- D.Deep vein thrombosis
The triad of respiratory distress, neurologic changes, and a petechial rash within 24-72 hours of a long-bone fracture is classic for fat embolism syndrome.
34. A client is 1 day post total hip arthroplasty. Which position must the nurse ensure to prevent hip dislocation?
- A.Keep the affected leg adducted across midline
- B.Maintain hip flexion greater than 90 degrees
- C.Keep the legs abducted with an abduction pillow✓ Answer
- D.Internally rotate the affected leg
After total hip arthroplasty the legs must be kept abducted (often with an abduction pillow) and the client must avoid hip flexion beyond 90 degrees, adduction past midline, and internal rotation to prevent dislocation.
35. A client receiving chemotherapy has an absolute neutrophil count (ANC) of 480 cells/mm3. Which nursing intervention is the priority?
- A.Implement neutropenic precautions to prevent infection✓ Answer
- B.Place the client on bleeding precautions
- C.Encourage a diet high in fresh raw vegetables
- D.Restrict all oral fluids to prevent overload
An ANC below 500 cells/mm3 indicates severe neutropenia and high infection risk, so neutropenic precautions (including avoiding raw produce) are the priority to protect the client.
36. A client with iron-deficiency anemia is prescribed oral ferrous sulfate. Which instruction should the nurse provide to maximize absorption?
- A.Take the iron with an antacid to prevent upset stomach
- B.Take the iron with a glass of milk
- C.Take the iron with a source of vitamin C such as orange juice✓ Answer
- D.Take the iron immediately after a high-fiber meal
Vitamin C enhances the absorption of oral iron, so ferrous sulfate should be taken with a vitamin C source; antacids, milk, and high-fiber foods reduce iron absorption.
37. A client is receiving intravenous potassium chloride for hypokalemia. Which statement about administration is correct?
- A.Potassium chloride may be given by rapid IV push
- B.Potassium must always be diluted and infused via a pump, never IV push✓ Answer
- C.Potassium can be added to the bag at the bedside without mixing
- D.Undiluted potassium is safe for peripheral IV lines
IV potassium chloride must always be diluted and infused slowly via an infusion pump; direct IV push can cause fatal cardiac arrest.
38. A nurse reviews an arterial blood gas for a client with a severe anxiety attack and hyperventilation: pH 7.52, PaCO2 28 mmHg, HCO3 24 mEq/L. Which imbalance is present?
- A.Metabolic alkalosis
- B.Respiratory acidosis
- C.Respiratory alkalosis✓ Answer
- D.Metabolic acidosis
The pH is high (alkalosis) and the PaCO2 is low (below 35 mmHg) with a normal HCO3, indicating respiratory alkalosis from hyperventilation blowing off carbon dioxide.
39. A client with a serum calcium of 12.8 mg/dL is admitted. Which assessment finding should the nurse expect?
- A.Muscle weakness, constipation, and lethargy✓ Answer
- B.Hyperactive reflexes and muscle spasms
- C.Positive Trousseau and Chvostek signs
- D.Tingling of the fingers and circumoral numbness
A calcium of 12.8 mg/dL is hypercalcemia (normal 9-10.5 mg/dL), which depresses neuromuscular excitability, causing muscle weakness, constipation, and lethargy; the other findings occur with hypocalcemia.
40. A client is scheduled for surgery and reports taking warfarin daily. Which laboratory value is most important for the nurse to review preoperatively?
- A.Serum sodium
- B.International normalized ratio (INR)✓ Answer
- C.Serum glucose
- D.White blood cell count
Warfarin prolongs clotting; the INR must be reviewed preoperatively because an elevated INR greatly increases the risk of intraoperative and postoperative bleeding.
41. On the first day after abdominal surgery, a client has absent bowel sounds, abdominal distention, and no passage of flatus. Which condition should the nurse suspect?
- A.Dumping syndrome
- B.Paralytic ileus✓ Answer
- C.Gastroesophageal reflux
- D.Diverticulitis
Absent bowel sounds, distention, and no flatus after abdominal surgery indicate paralytic ileus, a temporary loss of intestinal peristalsis common after abdominal procedures.
42. A client with hypertension is started on lisinopril, an ACE inhibitor. Which new symptom should the nurse teach the client to report?
- A.Increased appetite
- B.Mild drowsiness
- C.Improved skin turgor
- D.A persistent dry cough✓ Answer
A persistent dry cough is a well-known side effect of ACE inhibitors caused by bradykinin accumulation, and the client should report it because it may require switching medications.
43. A client with a full-thickness burn to 40% of the body is in the emergent phase. Which fluid and electrolyte change should the nurse expect during the first 24 hours?
- A.Hyperkalemia and hemoconcentration✓ Answer
- B.Hypokalemia and hypervolemia
- C.Hypernatremia and diuresis
- D.Hypocalcemia and hypoglycemia
In the emergent (first 24-hour) phase of a major burn, fluid shifts out of the vasculature cause hemoconcentration, and cellular damage releases potassium, producing hyperkalemia.
44. A client with chronic kidney disease has the following labs. Which value requires the most immediate nursing attention?
- A.Blood urea nitrogen (BUN) of 45 mg/dL
- B.Serum creatinine of 3.2 mg/dL
- C.Serum potassium of 6.7 mEq/L✓ Answer
- D.Hemoglobin of 10 g/dL
A potassium of 6.7 mEq/L is dangerously high and can cause life-threatening cardiac dysrhythmias, so it requires the most immediate attention; the other values are abnormal but expected in chronic kidney disease.
45. A client with an ischemic stroke affecting the left hemisphere is likely to exhibit which deficit?
- A.Left-sided neglect and impulsive behavior
- B.Aphasia and right-sided hemiparesis✓ Answer
- C.Loss of vision in the left eye only
- D.Left-sided facial droop with intact speech
The left hemisphere controls the right side of the body and, in most people, language; a left-hemisphere stroke typically causes right-sided hemiparesis and aphasia.
46. A client with type 1 diabetes reports feeling shaky, diaphoretic, and confused. A fingerstick glucose is 52 mg/dL and the client is alert and able to swallow. What should the nurse do first?
- A.Administer intravenous 50% dextrose
- B.Give 15 grams of a fast-acting oral carbohydrate✓ Answer
- C.Administer the client's scheduled insulin dose
- D.Give intramuscular glucagon
For a conscious client who can swallow, mild hypoglycemia is treated with 15 grams of fast-acting oral carbohydrate (the rule of 15); IV dextrose and glucagon are reserved for clients who cannot safely swallow.
47. A client is admitted with severe dehydration. Which set of assessment findings is most consistent with this fluid volume deficit?
- A.Bounding pulse, crackles, and jugular vein distention
- B.Tachycardia, hypotension, and poor skin turgor✓ Answer
- C.Bradycardia, hypertension, and edema
- D.Weight gain and moist mucous membranes
Fluid volume deficit (dehydration) produces tachycardia, hypotension, poor skin turgor, and dry mucous membranes; the other options describe fluid volume overload.
48. A client with atrial fibrillation is at increased risk for which complication that nursing care aims to prevent?
- A.Embolic stroke from atrial thrombus formation✓ Answer
- B.Hypoglycemia
- C.Pulmonary fibrosis
- D.Peptic ulcer disease
In atrial fibrillation, ineffective atrial contraction lets blood pool and clot in the atria; these clots can embolize to the brain, so anticoagulation is used to prevent embolic stroke.
49. A client with a deep vein thrombosis is receiving a continuous heparin infusion. The nurse should keep which antidote readily available in case of bleeding?
- A.Vitamin K (phytonadione)
- B.Protamine sulfate✓ Answer
- C.Naloxone
- D.Flumazenil
Protamine sulfate is the antidote for heparin overdose; vitamin K reverses warfarin, naloxone reverses opioids, and flumazenil reverses benzodiazepines.
Practice questions based on the NCSBN NCLEX-RN test plan. Not affiliated with NCSBN and not medical advice — always follow your program and current clinical guidelines. About the NCLEX →