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Medical-Surgical Nursing · Med-Surg NCLEX Practice Test

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Showing all 15 practice questions with expert explanatory rationales.

Question 1 of 15

Case excerpt

During care in an outpatient clinic at 09:45, a patient with suspected acute stroke develops facial droop and unilateral weakness; the family identifies the last-known-well time.

What is the safest response by the nurse?

A. The date of the last dental visit
B. The exact last-known-well time
C. The usual bedtime
D. The name of the family physician
E. The patient's preferred pharmacy

Expert Explanatory Rationale

Correct Answer: B. The exact last-known-well time

Last-known-well time is essential for time-sensitive stroke decisions. Activate the stroke response without delay.

Question 2 of 15

Case excerpt

During care in a community health setting at 11:10, a patient with heart failure reports sudden worsening dyspnea and is unable to lie flat; crackles are heard bilaterally.

Which intervention should the nurse implement first?

A. Encourage ambulation
B. Place the patient flat
C. Position upright, assess oxygenation, and activate urgent clinical support
D. Encourage oral fluids
E. Delay assessment until the next medication round

Expert Explanatory Rationale

Correct Answer: C. Position upright, assess oxygenation, and activate urgent clinical support

Acute pulmonary congestion can impair gas exchange. Support breathing, assess promptly, and escalate care.

Question 3 of 15

Case excerpt

During care in an acute-care unit at 13:35, a patient with diabetes is confused, diaphoretic, and has a blood glucose of 48 mg/dL; the patient is unable to swallow safely.

How should the nurse respond to this finding?

A. Administer glucagon or IV dextrose according to protocol and access
B. Give orange juice by mouth
C. Encourage walking
D. Wait for the next meal
E. Administer rapid-acting insulin

Expert Explanatory Rationale

Correct Answer: A. Administer glucagon or IV dextrose according to protocol and access

Severe hypoglycemia with unsafe swallowing requires a nonoral treatment such as IV dextrose or glucagon per protocol.

Question 4 of 15

Case excerpt

During care in a rehabilitation unit at 15:50, a patient with a chest tube has sudden respiratory distress and the drainage system becomes disconnected.

Which action best protects the patient?

A. Remove the chest tube
B. Clamp the tube for an extended period without an order
C. Strip the tubing forcefully
D. Leave the patient to find supplies
E. Restore the system according to emergency chest-drainage policy and urgently assess the patient

Expert Explanatory Rationale

Correct Answer: E. Restore the system according to emergency chest-drainage policy and urgently assess the patient

A disconnection can compromise the drainage system. Follow emergency policy, assess respiratory status, and obtain immediate assistance.

Question 5 of 15

Case excerpt

During care in a specialty care unit at 18:15, a patient with chronic kidney disease has a potassium level of 6.3 mEq/L and peaked T waves.

Which nursing action is the priority?

A. Repeat the laboratory test next week
B. Encourage exercise
C. Offer a potassium-rich snack
D. Notify the provider or rapid response team immediately and prepare for emergency treatment
E. Administer a potassium supplement

Expert Explanatory Rationale

Correct Answer: D. Notify the provider or rapid response team immediately and prepare for emergency treatment

Hyperkalemia with ECG changes can cause life-threatening dysrhythmias and requires urgent treatment.

Question 6 of 15

Case excerpt

During care in a medical unit at 21:05, a patient with a new lower-leg cast reports severe pain unrelieved by analgesia and pain with passive toe movement.

What is the safest response by the nurse?

A. Expected cast discomfort
B. Mild dependent edema only
C. Simple muscle fatigue
D. Contact dermatitis
E. Compartment syndrome

Expert Explanatory Rationale

Correct Answer: E. Compartment syndrome

Severe escalating pain and pain with passive stretch are warning signs of compartment syndrome requiring urgent evaluation.

Question 7 of 15

Case excerpt

During care in an outpatient clinic at 07:20, a patient with COPD has increasing somnolence and shallow respirations after receiving an opioid.

Which intervention should the nurse implement first?

A. Encourage the patient to sleep
B. Remove oxygen without assessment
C. Offer a sedative
D. Assess airway and respiratory status and initiate urgent escalation
E. Administer another opioid dose

Expert Explanatory Rationale

Correct Answer: D. Assess airway and respiratory status and initiate urgent escalation

Opioids can depress ventilation. Assess respiratory status immediately and follow emergency reversal/escalation protocols.

Question 8 of 15

Case excerpt

During care in a community health setting at 09:45, a patient with suspected gastrointestinal bleeding has coffee-ground emesis, tachycardia, and falling blood pressure.

How should the nurse respond to this finding?

A. Delay notification until the next hemoglobin result
B. Assist the patient to walk
C. Administer a laxative
D. Activate urgent support, assess circulation, and maintain prescribed IV access
E. Offer oral fluids

Expert Explanatory Rationale

Correct Answer: D. Activate urgent support, assess circulation, and maintain prescribed IV access

Signs of hemodynamic instability with GI bleeding require immediate escalation and circulatory support.

Question 9 of 15

Case excerpt

During care in an acute-care unit at 11:10, a patient receiving a blood transfusion develops chills, back pain, and dyspnea shortly after initiation.

Which nursing actions are appropriate? (Select all that apply)

A. Escalate promptly if the patient's condition worsens or remains outside the expected range
B. Reassess the patient after the intervention and compare findings with the baseline
C. Stop the transfusion and keep IV access open with normal saline using new tubing
D. Slow the transfusion and observe
E. Document objective findings, actions taken, and the patient's response
F. Discard the blood bag before reporting
G. Delay follow-up until the end of the shift even if the condition is worsening

Expert Explanatory Rationale

Correct Answer: A. Escalate promptly if the patient's condition worsens or remains outside the expected range; B. Reassess the patient after the intervention and compare findings with the baseline; C. Stop the transfusion and keep IV access open with normal saline using new tubing; E. Document objective findings, actions taken, and the patient's response

These findings may indicate a transfusion reaction. Stop the transfusion, maintain access with saline and new tubing, and follow reaction protocol. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 10 of 15

Case excerpt

During care in a rehabilitation unit at 13:35, a patient with pneumonia has an oxygen saturation that falls from 95% to 86% and increasing work of breathing.

Which nursing actions are appropriate? (Select all that apply)

A. Document the value and return later
B. Promptly assess respiratory status, support oxygenation per order, and escalate care
C. Delay follow-up until the end of the shift even if the condition is worsening
D. Escalate promptly if the patient's condition worsens or remains outside the expected range
E. Document objective findings, actions taken, and the patient's response
F. Encourage the patient to lie flat
G. Reassess the patient after the intervention and compare findings with the baseline

Expert Explanatory Rationale

Correct Answer: B. Promptly assess respiratory status, support oxygenation per order, and escalate care; D. Escalate promptly if the patient's condition worsens or remains outside the expected range; E. Document objective findings, actions taken, and the patient's response; G. Reassess the patient after the intervention and compare findings with the baseline

A significant oxygenation decline and increased work of breathing require immediate assessment and escalation. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 11 of 15

Case excerpt

During care in a specialty care unit at 15:50, a patient with cirrhosis becomes increasingly confused and has asterixis.

Which nursing actions are appropriate? (Select all that apply)

A. Escalate promptly if the patient's condition worsens or remains outside the expected range
B. Delay follow-up until the end of the shift even if the condition is worsening
C. Document objective findings, actions taken, and the patient's response
D. Reassess the patient after the intervention and compare findings with the baseline
E. Hepatic encephalopathy
F. Otitis media
G. Hypoglycemia as the only possible cause

Expert Explanatory Rationale

Correct Answer: A. Escalate promptly if the patient's condition worsens or remains outside the expected range; C. Document objective findings, actions taken, and the patient's response; D. Reassess the patient after the intervention and compare findings with the baseline; E. Hepatic encephalopathy

Confusion and asterixis in cirrhosis suggest hepatic encephalopathy; assess for triggers and implement prescribed treatment. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 12 of 15

Case excerpt

During care in a medical unit at 18:15, a patient after thyroidectomy develops stridor and difficulty breathing.

Which nursing actions are appropriate? (Select all that apply)

A. Offer sips of water
B. Escalate promptly if the patient's condition worsens or remains outside the expected range
C. Delay follow-up until the end of the shift even if the condition is worsening
D. Reassess the patient after the intervention and compare findings with the baseline
E. Activate emergency airway support and prepare for immediate intervention
F. Place a pillow over the neck
G. Document objective findings, actions taken, and the patient's response

Expert Explanatory Rationale

Correct Answer: B. Escalate promptly if the patient's condition worsens or remains outside the expected range; D. Reassess the patient after the intervention and compare findings with the baseline; E. Activate emergency airway support and prepare for immediate intervention; G. Document objective findings, actions taken, and the patient's response

Stridor after thyroid surgery may indicate airway obstruction from edema or hematoma and is an emergency. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 13 of 15

Case excerpt

During care in an outpatient clinic at 21:05, a patient with a suspected pulmonary embolism suddenly develops pleuritic chest pain, tachycardia, and hypoxemia.

Which nursing actions are appropriate? (Select all that apply)

A. Massage the affected leg
B. Encourage unassisted ambulation
C. Document objective findings, actions taken, and the patient's response
D. Escalate promptly if the patient's condition worsens or remains outside the expected range
E. Initiate emergency assessment and escalation while supporting oxygenation
F. Reassess the patient after the intervention and compare findings with the baseline
G. Delay follow-up until the end of the shift even if the condition is worsening

Expert Explanatory Rationale

Correct Answer: C. Document objective findings, actions taken, and the patient's response; D. Escalate promptly if the patient's condition worsens or remains outside the expected range; E. Initiate emergency assessment and escalation while supporting oxygenation; F. Reassess the patient after the intervention and compare findings with the baseline

Sudden chest pain, tachycardia, and hypoxemia may indicate pulmonary embolism and require emergency response. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 14 of 15

Case excerpt

A prescribed IV infusion contains 220 mL and must run evenly over 2 hours. The patient is receiving care related to medical-surgical nursing.

What rate should the nurse program in mL/hr? Enter the number only.

Expert Explanatory Rationale

Correct Answer: 110

Calculate volume divided by time: 220 mL ÷ 2 hr = 110 mL/hr. Verify the prescription, pump settings, and patient response.

Question 15 of 15

Case excerpt

The nurse is completing a safe nursing care sequence for a patient receiving medical-surgical nursing care.

Place the nursing actions in the safest order.

A. Verify the patient's identity, explain the planned care, and assess current status
B. Gather the required equipment and confirm that it is functioning
C. Perform the intervention using the prescribed procedure and appropriate safety measures
D. Reassess the patient and evaluate the response
E. Document the findings, intervention, and outcome

Expert Explanatory Rationale

Correct Answer: A. Verify the patient's identity, explain the planned care, and assess current status; B. Gather the required equipment and confirm that it is functioning; C. Perform the intervention using the prescribed procedure and appropriate safety measures; D. Reassess the patient and evaluate the response; E. Document the findings, intervention, and outcome

The nurse first verifies identity and assesses the patient, prepares equipment, performs the intervention safely, reassesses the response, and documents the care.

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