NCLEX Med-Surg Practice Questions
Free medical-surgical nursing practice questions covering the conditions, prioritization, and interventions the NCLEX-RN loves to test — with detailed rationales.
Question 1Multiple choiceMed-Surg
A client's potassium is 6.8 mEq/L. Which ECG change does the nurse expect to see first?
- ST depression and prominent U waves
- Tall, peaked T waves
- Prolonged QT interval
- Widened QRS with a normal T wave
Show answer & rationale
Correct: Tall, peaked T waves
Why: Hyperkalemia's earliest ECG sign is tall, peaked T waves, progressing to prolonged PR, widened QRS, and finally a sine-wave pattern leading to arrest. ST depression with prominent U waves plus muscle weakness is the mirror image — hypokalemia. Memory aid: hyperkalemia's peaked T waves look like tents — 'K+ pitches a tent'.
📚 Basis: Normal serum K+ 3.5–5.0 mEq/L; hyperkalemia ECG progression: peaked T waves → widened QRS → sine wave. · AHA cardiac arrhythmia guidance
Question 2Multiple choiceMed-Surg
A client has a chest tube after a pneumothorax. Which finding requires immediate nursing action?
- Tidaling in the water-seal chamber with respirations
- Continuous vigorous bubbling in the water-seal chamber
- Small amount of serosanguineous drainage in the collection chamber
- Client reports mild pain at the insertion site
Show answer & rationale
Correct: Continuous vigorous bubbling in the water-seal chamber
Why: Continuous vigorous bubbling in the water-seal chamber means air is leaking into the system — check for loose connections or a lung leak and fix it. Tidaling (fluid level rising and falling with breathing) is normal and expected. A small amount of serosanguineous drainage is normal early on; sudden large-volume or bright-red drainage is the concerning pattern. Memory aid: continuous bubbling means a leak somewhere — 'bubbles spell trouble'.
📚 Basis: Water-seal chamber: tidaling with respirations = patent system; continuous bubbling = air leak. · Standard thoracic drainage references
Question 3Multiple choiceMed-Surg
A client in DKA has a blood glucose of 520 mg/dL and is dehydrated. The nurse's first IV fluid action is to infuse:
- D5W at 125 mL/hr
- 0.9% sodium chloride wide open per protocol
- 0.45% sodium chloride at maintenance rate
- D5 0.45% NaCl at 75 mL/hr
Show answer & rationale
Correct: 0.9% sodium chloride wide open per protocol
Why: DKA causes profound osmotic diuresis and volume depletion, so resuscitation starts with isotonic crystalloids (0.9% NaCl or lactated Ringer's) wide open per protocol to restore perfusion. Dextrose is added only after glucose falls to ~250 mg/dL, so insulin can keep clearing ketones without causing hypoglycemia. Memory aid: DKA is dry — fill the tank with isotonic fluids before chasing the sugar.
📚 Basis: ADA DKA management: aggressive isotonic fluid resuscitation first; add dextrose when glucose falls to ~250 mg/dL. · ADA Standards of Care (DKA)
Question 4Multiple choiceMed-Surg
A client with SIADH has a serum sodium of 122 mEq/L. The nurse's priority intervention is to:
- Encourage oral fluids to 3 liters per day
- Restrict fluids per provider order
- Administer hypotonic IV fluids
- Encourage a high-sodium diet without limits
Show answer & rationale
Correct: Restrict fluids per provider order
Why: SIADH means excess ADH → water retention → dilutional hyponatremia. Treatment is fluid restriction (commonly 800–1,000 mL/day) plus addressing the cause. Giving free water or hypotonic fluids dilutes sodium further and risks worsening cerebral edema. Memory aid: SIADH means 'soaked inside' — too much retained water dilutes sodium, so restrict fluids.
📚 Basis: SIADH: euvolemic hypo-osmolar hyponatremia from excess ADH; first-line treatment is fluid restriction. · Endocrine Society hyponatremia guidance
Question 5Multiple choiceMed-Surg
Using the Parkland formula, the 8-hour fluid requirement for a 70-kg client with 40% TBSA burns is:
- 2,800 mL
- 5,600 mL
- 11,200 mL
- 1,400 mL
Show answer & rationale
Correct: 5,600 mL
Why: Parkland: 4 mL × kg × %TBSA = 4 × 70 × 40 = 11,200 mL over 24 hours. Half (5,600 mL) is given in the first 8 hours post-burn, the rest over the next 16 hours. Titrate to urine output (0.5–1 mL/kg/hr in adults). Memory aid: 4 mL × kg × %burn, half in the first 8 hours — 'four for the floor, half in eight'.
📚 Basis: Parkland formula: 4 mL × kg × %TBSA per 24 h; half in first 8 h post-burn. · American Burn Association guidance
Question 6Multiple choiceMed-Surg
Before administering a blood transfusion, the nurse's priority verification step is to:
- Check the client's temperature
- Verify client identity with two identifiers and match the blood unit at the bedside with a second nurse
- Flush the line with dextrose
- Premedicate with diphenhydramine
Show answer & rationale
Correct: Verify client identity with two identifiers and match the blood unit at the bedside with a second nurse
Why: Fatal hemolytic reactions come from ABO mismatch, so two-nurse bedside verification with two client identifiers matched to the unit tag is the critical step. Blood infuses with normal saline only — dextrose causes hemolysis, and the calcium in lactated Ringer's can clot the blood. Memory aid: blood only likes normal saline — 'NS is blood's best friend'.
📚 Basis: AABB: two-identifier + two-nurse bedside verification; normal saline only with blood products. · AABB transfusion standards
Question 7Select all that applyMed-Surg
The nurse is teaching a client with heart failure about warning signs of fluid overload. Which findings should the client report immediately? Select all that apply.
- Weight gain of 3 lb in 24 hours
- Crackles heard in the lung bases
- Decreased urine output
- Pink, frothy sputum
- Increased appetite
- Visible neck vein distention when sitting upright
Show answer & rationale
Correct: Weight gain of 3 lb in 24 hours; Crackles heard in the lung bases; Decreased urine output; Pink, frothy sputum; Visible neck vein distention when sitting upright
Why: Heart failure exacerbation = fluid overload: rapid weight gain (2–3 lb in a day or 5 lb in a week), bibasilar crackles, oliguria, pink frothy sputum (pulmonary edema), and jugular vein distention. Increased appetite is the trap — these clients typically report anorexia and early satiety, not hunger. Memory aid: 2–3 lb overnight or 5 in a week — 'a few pounds means call the provider'.
📚 Basis: HF fluid-overload signs; daily weights — report 2–3 lb gain in 24 h or 5 lb in a week. · AHA/ACC/HFSA heart failure guidelines
Question 8Select all that applyMed-Surg
The nurse is planning care to prevent deep vein thrombosis in a post-operative client. Which interventions are appropriate? Select all that apply.
- Early ambulation as tolerated
- Sequential compression devices while in bed
- Ankle pump and leg exercises
- Encouraging adequate fluid intake
- Keeping the client on strict bed rest
- Crossing the legs at the knees
Show answer & rationale
Correct: Early ambulation as tolerated; Sequential compression devices while in bed; Ankle pump and leg exercises; Encouraging adequate fluid intake
Why: Virchow's triad (stasis, hypercoagulability, endothelial injury) drives DVT: ambulation, SCDs, leg exercises, and hydration all reduce stasis. Prolonged bed rest and crossing the legs promote venous stasis. Memory aid: Virchow's triad — stasis, sticky blood, scratched vessel.
📚 Basis: DVT prevention targets Virchow's triad (stasis, hypercoagulability, endothelial injury); mobility + mechanical measures reduce stasis. · CHEST VTE prevention guidelines
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NCLEX Drill offers practice questions for study purposes only — not medical advice, and not a substitute for professional judgment or official study materials. Question bank grows daily; last updated 2026-10-09.