NCLEX Practice Exam for Medical Surgical Nursing 1

1. Rhian has just returned from surgery and is displaying alarming vital signs: blood pressure of 80/50 mm Hg, a
pulse of 140, and respirations of 32. As her nurse, you suspect shock and review the doctor’s orders. Which of the
following orders would you question as inappropriate for this situation?

A) Administer oxygen at 100% to maximize oxygenation.

B) Put the client in a modified Trendelenburg’s position to improve blood flow.
C) Administer Demerol 50 mg IM every 4 hours for pain control.
D) Monitor urine output every hour to assess kidney function.

2. Following a gallbladder surgery, Roger, a 54-year-old patient, complains of mild incisional pain while performing
deep-breathing and coughing exercises as part of his postoperative care. As his nurse, you need to guide him on how
to manage the pain during these exercises. What would be your best response?

A) “With a pillow, apply pressure against the incision to support it during coughing.”
B) “Pain will become less each day, so just continue with the exercises.”
C) “This is a normal reaction after surgery, don’t worry about it.”
D) “I will give you the pain medication the physician ordered, so you can continue the exercises.”

3. Mr. Jackson, a 68-year-old individual diagnosed with Bladder Cancer, is on the schedule for a cystectomy along
with the formation of an ileal conduit come morning. Upon entering his room, you, as his dedicated nurse, observe
him anxiously pacing and wringing his hands. What is your best nursing approach to handle his evident anxiety?

A) “Mr. Jackson, you’ll certainly wear out both yourself and the hospital’s flooring at this pace.”
B) “Good evening, Mr. Jackson. Wasn’t today quite a pleasant day outside?”
C) “Mr. Jackson, you seem rather worried; perhaps I should leave you alone with your thoughts for now.”
D) “Mr. Jackson, you appear to be quite anxious to me. Can you tell me how you’re feeling about the surgery
tomorrow?”

4. After gallbladder surgery, Maya has been moved from the Post-anesthesia Care Unit (Recovery Room) and now
has a nasogastric tube in place. As her nurse, you note her continual complaints of nausea. In this postoperative
context, which nursing action would be most appropriate to address her nausea?

A) Carefully check the nasogastric tube’s patency to rule out any potential obstruction.
B) Promptly administer the physician-prescribed antiemetic medication as indicated.
C) Gently change the patient’s position to see if it alleviates the discomfort.
D) Immediately call the physician to report the ongoing issue.

5. Mr. Gerald, who is suffering from relentless pain due to cancer that has metastasized to his bones, finds little relief
from his pain medication and adamantly refuses to move. In this delicate situation, as his attentive nurse, what should
you plan to do in caring for him?

A) Approach him with care and handle him gently when assisting with required tasks.
B) Encourage him to perform his own activities of daily living to maintain independence.
C) Sincerely reassure him that the nursing staff will not hurt him during care.
D) Aim to complete A.M. care as swiftly as possible when it’s necessary.

6. A client has returned to the ward at 9AM, alert and oriented, with an IV infusing post-procedure. His vital signs are
stable and within normal range. However, at noon, you note a slight increase in his pulse rate (94), a decrease in
blood pressure to 116/74, and respirations at 24. As his nurse, what action would be the most appropriate in this
situation?

A) Plan to take his vital signs again in an hour to monitor any further changes.
B) Immediately place the patient in a shock position as a precaution.
C) Promptly notify his physician to report the alterations.
D) Decide to take his vital signs again in 15 minutes to closely monitor the changes.
7. A 56-year-old construction worker has been brought to the emergency department unconscious after falling from a
2-story building. As his nurse, you begin assessing the client. Which finding would raise the most concern during your
examination?

A) Evidence of bleeding from the ears.

B) A noticeable elevation in body temperature.
C) An apparent depressed fontanel, usually observed in infants.
D) The presence of reactive pupils responding to light.

8. You are conducting a health assessment on a middle-aged client to evaluate risk factors for Coronary Artery
Disease (CAD). During your conversation, which statement made by the client would indicate a significant risk factor
for developing CAD?

A) “I smoke 1 1/2 packs of cigarettes daily, and I know it’s a bad habit.”
B) “I make sure to exercise every other day to stay fit.”
C) “My father passed away due to Myasthenia Gravis, a neuromuscular disease.”
D) “My cholesterol level is 180, which seems to be within the normal range.”

9. Mr. Briggs, a patient with heart failure, has been prescribed Digoxin 0.25 mg once daily. As his nurse, you’re
reviewing the teaching plan with him. Which of the following statements by Mr. Briggs would indicate poor
understanding or incorrect knowledge regarding this drug?

A) “The positive inotropic effect of Digoxin might decrease my urine output, right?”
B) “Toxicity can occur more easily if I have hypokalemia, or liver and renal problems, correct?”
C) “I should avoid taking the drug if my apical heart rate is less than 60 beats per minute, shouldn’t I?”
D) “Digoxin has both positive inotropic and negative chronotropic effects on my heart, doesn’t it?”

10. You are educating a patient about the Valsalva maneuver, which can lead to bradycardia, and the activities that
may stimulate it. Which of the following activities should you instruct the patient will not likely stimulate the Valsalva
maneuver?

A) Experiencing gagging sensations while brushing teeth.

B) Utilizing stool softeners to ease bowel movements.
C) Lifting heavy objects during daily activities.
D) Undergoing enema administration for constipation relief.

11. You are a charge nurse overseeing a teaching session between a staff nurse and a patient who has received a
permanent artificial cardiac pacemaker. During the session, you notice that the staff nurse makes one statement that
reveals a knowledge deficit about the care of an artificial cardiac pacemaker. Which statement was it?

A) “You may be allowed to use most everyday electrical appliances.”

B) “You may still engage in contact sports if you feel comfortable.”
C) “Take your pulse rate once a day, in the morning upon awakening, to monitor the pacemaker.”
D) “Make sure to have regular follow-up care with your healthcare provider.”

12. You are providing discharge education to a patient diagnosed with angina pectoris and prescribed nitroglycerine
tablets. As part of your patient teaching, which of the following instructions accurately conveys the correct procedure
for taking nitroglycerine tablets when experiencing chest pain?

A) “Take one tablet and swallow it with a full glass of water if you experience chest pain. Repeat every 5 minutes.”
B) “Place one tablet under your tongue, and if the pain does not go away in 5 minutes, take another tablet. You may
repeat this up to three times.”
C) “Chew one tablet and swallow it immediately if you experience chest pain. Do not take more than one tablet per
episode.”
D) “Dissolve one tablet in a glass of water and drink it if you feel chest pain. Repeat every 30 minutes as needed.”
13. You are attending a training session on pain assessment in elderly patients. The presenter emphasizes the
importance of careful assessment of pain in older individuals. According to best nursing practices, why must nurses
be particularly attentive to pain complaints in the elderly?

A) Because older people often experience a general reduction in sensory perception.

B) Because the aging process may contribute to altered mental function in some individuals.
C) Because chronic pain is an expected and normal part of aging.
D) Because elderly individuals typically have a decreased pain threshold and may feel pain more acutely.

14. You are assessing the understanding of a client with chronic heart failure who has been instructed to follow a
2000 mg sodium-restricted diet. During your discussion about dietary habits, the client demonstrates adequate
knowledge of this dietary restriction by not adding salt to food and mentioning the avoidance of which food item?

A) Canned sardines
B) Whole milk
C) Eggs
D) Plain nuts

15. As a clinical instructor, you are observing a student nurse who is caring for a client diagnosed with
thrombophlebitis. The student is determined to provide proper care. Which of the following actions taken by the
student nurse demonstrates the most appropriate intervention for a patient with thrombophlebitis?

A) Massaging the affected area to relieve pain.

B) Applying heat to the affected area and keeping the limb elevated.
C) Encouraging the patient to walk vigorously for exercise.
D) Administering an intramuscular injection into the affected limb.

16. You are a nurse caring for a client who is receiving heparin sodium to prevent clot formation. The client, eager to
understand his treatment, asks how the medication works. How would you explain the action of heparin sodium to the
client?

A) “It works by interfering with vitamin K absorption, affecting clotting.”

B) “Heparin sodium prevents the conversion of certain factors that are needed in the formation of clots.”
C) “The drug dissolves existing blood clots in your vessels.”
D) “It acts by inactivating thrombin, which then forms and dissolves existing blood clots.”

17. You are a nurse leading a “stop smoking” class and discussing the serious consequences of smoking, including
lung cancer. A participant asks what a common symptom of lung cancer might be. How would you describe one
typical sign of lung cancer?

A) Presence of foamy, blood-tinged sputum during coughing.

B) Experiencing shortness of breath (dyspnea) upon exertion.
C) Hearing a wheezing sound during inspiration.
D) Experiencing a new cough or a change in a pre-existing chronic cough.

18. As a nurse working in a respiratory unit, you are orienting a new nurse on caring for clients with COPD. When
discussing oxygen administration for these clients, which point would you emphasize as the most relevant
knowledge?

A) Monitoring blood gases through a pulse oximeter to maintain appropriate oxygen levels.
B) Administering oxygen at 1-2L/min to maintain the hypoxic stimulus for breathing, balancing oxygenation.
C) Explaining that hypoxia stimulates the central chemoreceptors in the medulla, initiating the client’s breath.
D) Teaching that oxygen is best administered using a non-rebreathing mask for optimal delivery.

19. You are a nursing educator demonstrating proper suctioning techniques to a group of student nurses. During a
simulation, one student asks what would be an incorrect action when suctioning mucus from a client’s lungs. Which of
the following would you indicate as the least appropriate action?
A) “You should suction until the client signals you to stop, but no longer than 20 seconds.”
B) “Make sure to lubricate the catheter tip with sterile saline before inserting it.”
C) “Remember to use a sterile technique, wearing two gloves during the procedure.”
D) “Always hyperoxygenate the client both before and after suctioning to maintain oxygenation.”

20. You are a nurse in a busy clinic, caring for a client who has recently tested positive for a Tuberculin skin test. Dr.
John prescribes a combination of oral rifampin (Rimactane) and isoniazid (INH). You need to explain the purpose of
this treatment to the client. What would you say is the main reason for this combination therapy?

A) “It’s designed to cause less irritation to your gastrointestinal tract.”

B) “This combination will help in gaining a more rapid systemic effect.”
C) “The combination is used to destroy resistant organisms and maintain proper blood levels of the drugs.”
D) “The two drugs work together to delay resistance and increase the tuberculostatic effect of the treatment.”

21. You are a surgical nurse caring for Mario, who has just undergone a left thoracotomy and partial
pneumonectomy. Chest tubes are in place with one-bottle water-seal drainage, and you are tasked with positioning
him correctly in the postanesthesia care unit. Mario is placed in Fowler’s position on his right side or back. As a
nursing student observing the procedure asks you the purpose of this positioning, what would be your response?

A) “This positioning is to facilitate ventilation of the left lung.”

B) “It’s mainly to reduce incisional pain that Mario might feel.”
C) “This position is to increase venous return.”
D) “The purpose is to equalize pressure in the pleural space.”

22. Your client, Mrs. Thompson, has COPD and is being prepared for discharge. You are instructing her on the use of
her prescribed oral inhaler. As a part of the patient education, you cover the following instructions EXCEPT:

A) “Remember to inhale slowly through your mouth as you press down on the canister.”
B) “Hold your breath for about 10 seconds before gently exhaling.”
C) “After inhaling the medication, slowly breathe out through your mouth with pursed lips.”
D) “Make sure to breathe in and out as fully as possible before placing the mouthpiece inside your mouth.”

23. You are a nurse on a preoperative unit, and your patient Grace has just received Atropine sulfate (AtSO4) as
premedication for surgery. 30 minutes later, she starts to complain of a dry mouth, and you notice that her pulse rate
is higher than before the medication was administered. You recognize this as:

A. A sign of anxiety due to Grace’s upcoming surgery.

B. A normal side-effect of Atropine sulfate (AtSO4).
C. An indication of an allergic reaction to the drug.
D. A sign that Grace needs a higher dose of this drug.

24. A client is scheduled for a bronchoscopy procedure, during which a flexible tube will be inserted through the nose
or mouth to examine the lungs. When educating the client about what to expect following the procedure, the nurse’s
information of utmost importance would be:

A. Regular coughing and deep-breathing exercises will be performed every 2 hours.

B. Consumption of food and fluids will be withheld for at least 2 hours.
C. Initially, only ice chips and cold liquids will be allowed.
D. Warm saline gargles will be performed every 2 hours.

25. Nurse Thomas enters the room of a patient diagnosed with chronic obstructive pulmonary disease (COPD).
Observing the patient’s nasal cannula oxygen running at 6 L per minute, pink skin color, and shallow respirations at 9
per minute, Thomas must quickly decide on the most appropriate initial intervention. What is Nurse Thomas’s best
initial action for this patient with COPD?

A. Reduce the oxygen rate to the prescribed level.

B. Position the patient in Fowler’s position.
C. Measure the patient’s heart rate and blood pressure.
D. Immediately call the physician.

26. While working at a weight loss clinic, Nurse Anderson evaluates a client exhibiting symptoms of a large abdomen
and a rounded face. In differentiating between obesity and another medical condition, Nurse Anderson considers the
additional assessment findings. Which one would lead her to suspect that the client may have Cushing’s syndrome
rather than obesity?

A. Presence of a fat pad on the posterior neck and thinning of the extremities.
B. Noticeable abdominal striae and enlargement around the ankles.
C. A pendulous abdomen paired with pronounced hips.
D. Pronounced size in the thighs and upper arms.

27. Nurse Taylor is educating a patient about the potential side effects of Prednisone therapy. The patient needs to
understand the importance of following the doctor’s instructions and the potential impact on their health. Which
statement made by the patient would indicate that they understand the potential side effects of Prednisone therapy?

A. “This medicine will shield me from acquiring colds or infections.”

B. “I should cut back on potassium in my diet since hyperkalemia is a consequence of this medication.”
C. “I need to follow the doctor’s directions in taking this medication, not missing any doses.”
D. “My surgical wound will recover more swiftly due to this medication.”

28. Nurse Williams is attending to a client suspected of having Pheochromocytoma, who is experiencing symptoms
like sweating, palpitation, and headache. In prioritizing the client’s care, what is the essential assessment that Nurse
Williams should make first?

A. Testing the strength of the hand grips.

B. Checking the blood glucose levels.
C. Monitoring the blood pressure.
D. Evaluating the pupil reaction.

29. While enjoying a bridal shower, Nurse Martinez notices another guest, known to be diabetic, beginning to tremble
and complain of dizziness. As a trained medical professional, what would be Nurse Martinez’s next best action to
assist the guest?

A. Propose a cup of coffee to the guest.

B. Urge the guest to consume some baked macaroni.
C. Reach out to the guest’s personal physician.
D. Provide the guest with a glass of orange juice.

30. An adult patient newly diagnosed with Graves’ disease is inquiring about the prescription of Propranolol (Inderal).
They ask Nurse Thompson, “Why do I need to take this medication?” Based on Nurse Thompson’s comprehensive
understanding of both the medication and Graves’ disease, the best response would be:

A. “The medication will mitigate the cardiovascular symptoms of Graves’ disease.”

B. “The medication will foster the production of thyroid hormones.”
C. “The medication will curtail thyroid hormone secretion.”
D. “The medication suppresses the synthesis of thyroid hormones.”

31. Nurse Mitchell is caring for a client during the first 24 hours after thyroid surgery. Understanding the unique needs
and potential complications following this type of surgery, what should be included in Nurse Mitchell’s care for the
client?

A. Informing the client that resuming normal activities right away is acceptable.
B. Inspecting the back and sides of the operative dressing for any signs of leakage or complications.
C. Encouraging the client to discuss her emotions regarding the surgery.
D. Assisting in supporting the head during mild range-of-motion exercises.
32. Upon discharge, Nurse Wallace educates the patient about observing for signs of surgically induced
hypothyroidism following thyroid surgery. The nurse would recognize that the patient comprehends the teaching when
the patient states that she should contact her medical doctor if she develops:

A) Persistent headaches and dizziness.

B) Increased appetite and weight loss.
C) Fatigue, constipation, and cold intolerance .
D) Palpitations and excessive sweating.

33. Nurse Robinson is developing a plan of care for a patient diagnosed with pneumonia. Being attuned to the
specific needs and challenges of treating pneumonia, which nursing diagnosis would be most appropriate for this
patient?

A. Impaired gas exchange.

B. Decreased tissue perfusion.
C. Risk for infection.
D. Fluid volume deficit.

34. Nurse Johnson is formulating a teaching plan for a diabetic patient. Understanding the special care and
precautions required for diabetes management, which of the following would be inappropriate to include in this
teaching plan?

A. Storing the insulin that’s not in use in the refrigerator.

B. Conducting daily inspections of feet and legs for any alterations.
C. Elevating the legs on 2 pillows while sleeping.
D. Altering the position hourly to enhance circulation.

35. Nurse Parker is formulating a plan of care for a patient in the immediate post-gastroscopy period. Recognizing the
specific needs and precautions following this procedure, what should be included in the plan of care?

A. Evaluate the gag reflex before administering fluids.

B. Keep the nasogastric tube (NGT) on intermittent suction.
C. Assess for pain and administer medication as prescribed.
D. Measure the abdominal girth every 4 hours.

36. Nurse Davis is assessing a patient’s pain and suspects a duodenal ulcer based on the description provided.
Which description of pain would be most characteristic of a duodenal ulcer?

A. Right upper quadrant (RUQ) pain that intensifies after a meal.

B. Sharp pain in the epigastric area that extends to the right shoulder.
C. Gnawing, dull, aching, hunger-like pain in the epigastric area that diminishes with food intake.
D. A sensation of painful pressure in the midsternal area.

37. Following Billroth surgery for a gastric ulcer, the client’s NGT (nasogastric tube) drainage becomes thick, and the
volume of secretions dramatically reduces in the last 2 hours. The client also feels nauseated. As Nurse Allen is
assessing the situation, what would be the most appropriate nursing action to take?

A. Irrigate the NGT with 50 cc of sterile solution.

B. Cease the low-intermittent suction.
C. Alert the medical doctor (MD) of the findings.
D. Reposition the NGT by advancing it gently with normal saline solution (NSS).

38. Following Billroth II Surgery, the client has developed dumping syndrome. Nurse Harris is creating a plan of care.
Recognizing the specifics of dumping syndrome management, which of the following should be excluded from the
plan?
A) Consuming small, frequent meals that are high in protein.
B) Sit upright for at least 30 minutes after meals.
C) Avoiding fluids with meals.
D) Reducing the amount of simple carbohydrates in the diet.

39. Nurse Thompson is discussing the laboratory results with a male patient diagnosed with a peptic ulcer, showing
an elevated titer of Helicobacter pylori. Which of the following statements made by the patient would indicate a proper
understanding of this data?

A. “I don’t need any treatment at this time.”

B. “The treatment will probably include medications like ranitidine and antibiotics.”
C. “Surgery is needed to treat this problem.”
D. “This result shows that I have gastric cancer caused by the organism.”

40. Nurse Williams is preparing a client for a paracentesis procedure. What instruction should be provided to the
client to ensure proper preparation for the procedure?

A. Empty the bladder before the procedure.

B. Empty the bowel before the procedure.
C. Maintain strict bed rest following the procedure.
D. Remain NPO (nothing by mouth) for 12 hours before the procedure.

41. A client’s husband is inquiring about the protein-restricted diet prescribed for his wife’s advanced liver disease.
Nurse Mitchell must explain the purpose of the diet. What statement by the nurse would best describe the reason for
this diet?

A. “The liver’s inability to eliminate ammonia produced by protein breakdown in the digestive system necessitates this
diet.”
B. “Most people consume too much protein; this diet is better suited for liver healing.”
C. “Due to portal hypertension, blood bypasses the liver, causing protein-derived ammonia to accumulate in the brain,
leading to hallucinations.”
D. “The liver heals more effectively with a high-carbohydrate diet rather than a protein-rich one.”

42. Nurse Franklin is faced with the task of managing pain for a patient diagnosed with acute pancreatitis. Among the
options available, which medication is typically selected for pain control in this particular medical condition?

A. Utilization of NSAIDS (Non-Steroidal Anti-Inflammatory Drugs).

B. Administration of Meperidine.
C. Prescription of Codeine.
D. Usage of Morphine.

43. Nurse Anderson is caring for a client immediately after a cholecystectomy. Among the various nursing actions
that need to be undertaken, which one should be prioritized as the most crucial at this stage?

A. Frequently irrigating the T-tube.

B. Encouraging the client to take deep breaths orally with adequate frequency.
C. Prompting the client to engage in both coughing and deep breathing exercises.
D. Ensuring the dressing is changed at least twice daily (BID).

44. Nurse Johnson is caring for a patient with complicated liver cirrhosis who has had a Sengstaken-Blakemore tube
inserted to halt bleeding esophageal varices. After the insertion, the patient reports difficulty breathing. What should
be the nurse’s initial response to this complaint?

A. Carefully monitor vital signs (VS).

B. Promptly deflate the esophageal balloon.
C. Immediately notify the medical doctor (MD).
D. Encourage the patient to engage in deep breathing exercises.
45. Nurse Taylor is attending to a client who arrives with symptoms including severe rectal bleeding, frequent
diarrheal stools (16 times a day), intense abdominal pain, tenesmus, and dehydration. Recognizing these symptoms,
the nurse should be vigilant for complications associated with which specific disease?

A. Presentation of Ulcerative Colitis.

B. Indication of Crohn’s Disease.
C. Manifestation of Peritonitis.
D. Signs of Diverticulitis.

46. Nurse Wallace is educating a diabetic client about the importance of rotating insulin injection sites. What is the
primary reason for the nurse to emphasize this particular practice?

A. The belief that injection sites should never be reused.

B. The potential development of lipodystrophic areas, leading to erratic insulin absorption from those sites.
C. The risk that poor rotation technique may induce superficial hemorrhaging.
D. The concern that lipodystrophy can occur and cause severe pain.

47. Nurse Parker is caring for a client who is to be evaluated for potential colon cancer with a barium enema. What
preparation should the nurse specifically include to ensure the client is ready for this study?

A. Implement complete bed rest (CBR) a day prior to the study.

B. Advise the client to consume 6 radiopaque tablets the evening before the study.
C. Administer laxatives the night before and provide a cleansing enema on the morning of the test.
D. Administer an oil retention enema and give a laxative the evening prior.

48. Several days following abdominal surgery, Nurse Adams notices that the client’s wound has dehisced. What is
the safest nursing intervention to undertake when this complication occurs?

A. Bring the wound edges together using tapes.

B. Maintain the abdominal contents’ position with a sterile gloved hand.
C. Cleanse the wound using sterile saline.
D. Protect the wound with a sterile, moist saline dressing.

49. Peter, a 38-year-old patient, has been diagnosed with a renal calculus through an intravenous pyelogram. Nurse
Thompson believes the small stone will pass spontaneously. Along with instructing the patient to increase fluid intake,
what additional guidance should the nurse provide?

A. Encourage the patient to limit physical activity.

B. Advise the patient to strain all urine.
C. Recommend a diet high in calcium.
D. Suggest using antacids to dissolve the stone.

50. Nurse Martinez is discussing with a client various strategies that can decrease the risk of developing colon
cancer. The client reveals proper comprehension of these measures when stating:

A. “I will make sure to get an annual chest x-ray done.”

B. “I will make a point to engage in daily physical exercise.”
C. “I will make an effort to include an abundance of fresh fruits and vegetables in my daily meals.”
D. “I plan to add more red meat to my diet for overall health.”