Free Medical-Surgical Practice Questions

Core adult-health concepts spanning cardiac, respiratory, GI, renal, and endocrine systems — the largest single content area on the NCLEX-RN.

Question 1

A client reports new chest pain, diaphoresis, and shortness of breath. Which action should the nurse take FIRST?

ANotify the provider.
BAdminister sublingual nitroglycerin.
CPlace the client on a cardiac monitor and obtain a 12-lead ECG.
DDraw blood for cardiac biomarkers.

Correct answer: C. Place the client on a cardiac monitor and obtain a 12-lead ECG.

For chest pain, "MONA" remains a useful order — but assessment comes first. A 12-lead ECG identifies STEMI within 10 minutes per AHA guidelines and drives time-to-treatment. Oxygen and nitroglycerin follow after the ECG and assessment, with provider notification in parallel.

Key concept: Acute chest pain → ECG within 10 minutes. Assessment precedes intervention.

Question 2

A client with chronic COPD is admitted with an SpO2 of 87% on room air. The most appropriate initial action is to:

AAdminister 100% non-rebreather oxygen.
BStart oxygen at 2 L/min via nasal cannula and titrate to SpO2 88–92%.
CWithhold oxygen and notify the provider.
DPlace the client in Trendelenburg position.

Correct answer: B. Start oxygen at 2 L/min via nasal cannula and titrate to SpO2 88–92%.

Clients with chronic CO2 retention rely on a hypoxic drive. Excess oxygen can suppress respiratory drive and worsen hypercapnia. Target SpO2 is 88–92%, typically achieved with low-flow O2 (1–3 L/min nasal cannula).

Key concept: COPD target SpO2 is 88–92%. Start low (1–3 L NC) and titrate.

Question 3

Which assessment finding indicates that a client with heart failure is responding to diuretic therapy?

AWeight gain of 1 kg in 24 hours.
BBilateral basilar crackles.
CUrine output of 800 mL in 4 hours.
DNew-onset jugular venous distention.

Correct answer: C. Urine output of 800 mL in 4 hours.

Diuresis with measurable urine output, weight loss, decreased edema, reduced crackles, and improved oxygenation indicate response to therapy. Weight gain, crackles, and JVD all indicate worsening fluid overload.

Key concept: HF response to diuretics = output up, weight down, crackles and JVD improving.

Question 4

Using the ABC framework, which client should the nurse assess FIRST?

AA postoperative client reporting incisional pain rated 7/10.
BA client with COPD whose SpO2 dropped from 94% to 88% on 2 L NC.
CA client with a Foley catheter and clear urine.
DA diabetic client awaiting discharge teaching.

Correct answer: B. A client with COPD whose SpO2 dropped from 94% to 88% on 2 L NC.

The COPD client has a deteriorating airway/breathing status (B in ABC) and is the priority. Pain, stable urinary output, and discharge teaching are important but follow respiratory stabilization.

Key concept: Use Airway → Breathing → Circulation when ranking competing client needs.

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