# NCLEX Medical-Surgical Nursing Examination Semester 2
## Form: MS-NCLEX-003 | Total Questions: 50 | Time Limit: 90 Minutes
**Instructions:** Select the best answer for each question. For Select All That Apply (SATA),
choose all correct options. Mark only one answer unless otherwise indicated.
**1.** A client is scheduled for a lumbar puncture. The nurse places the client in which
position?
- A. Supine with legs extended
- B. Prone with arms at sides
- C. Lateral recumbent with knees drawn to chest
- D. Sitting upright with legs dangling
**Correct Answer: C – Lateral recumbent with knees drawn to chest**
**Rationale:** The lateral recumbent position with knees drawn to the chest (fetal position) maximally
opens the intervertebral spaces, allowing easier access to the subarachnoid space. Option A does not
open the vertebrae. Option B is incorrect. Option D (sitting upright) may be used in some cases but is
not the standard position; the fetal position is preferred for maximizing space and patient comfort.
---
**2.** The nurse is caring for a client immediately after a cardiac catheterization via the femoral artery.
Which finding requires immediate intervention?
- A. Heart rate of 88 bpm
- B. Blood pressure 118/76 mm Hg
- C. Client reports mild groin discomfort
- D. Expanding hematoma at the puncture site
,**Correct Answer: D – Expanding hematoma at the puncture site**
**Rationale:** An expanding hematoma indicates active bleeding into the tissue, which can lead to
significant blood loss and compartment syndrome. This requires immediate pressure application and
provider notification. Options A and B are normal vital signs. Option C is expected after the procedure.
---
**3.** A client with an arteriovenous (AV) fistula for hemodialysis asks, “How will I know if my fistula is
working?” Which response by the nurse is correct? *(Select all that apply)*
- A. “You should feel a buzzing sensation called a thrill.”
- B. “You should hear a whooshing sound called a bruit.”
- C. “The arm should feel cold to the touch.”
- D. “The fistula should be flat and soft.”
- E. “You should check it daily for these signs.”
**Correct Answers: A, B, E**
**Rationale:** A palpable thrill and audible bruit indicate patent blood flow through the fistula. Daily
assessment is essential. Option C is incorrect – the arm should be warm, not cold. Option D is incorrect –
a functioning fistula has a palpable pulse and fullness.
---
**4.** A client on continuous renal replacement therapy (CRRT) has a filter pressure that suddenly
drops to zero. The nurse should first:
- A. Increase the blood flow rate
- B. Assess for filter clotting
- C. Document the finding as normal
- D. Administer a fluid bolus
, **Correct Answer: B – Assess for filter clotting**
**Rationale:** A sudden drop in filter pressure to zero often indicates that the filter has clotted and is
no longer functioning. The nurse should assess the filter and circuit for visible clots. Option A could
worsen clotting. Option C is incorrect – this is not normal. Option D does not address the filter issue.
---
**5.** The nurse is preparing a client for a transesophageal echocardiogram (TEE). Which statement by
the client requires immediate notification of the provider?
- A. “I have a history of high blood pressure.”
- B. “I took my metformin this morning.”
- C. “I had a ham sandwich 2 hours ago.”
- D. “I am allergic to shellfish.”
**Correct Answer: C – “I had a ham sandwich 2 hours ago.”**
**Rationale:** TEE requires NPO status for 4-6 hours to prevent aspiration during the procedure (the
patient is sedated). Eating 2 hours prior is a safety risk and may require rescheduling. Option A is not an
absolute contraindication. Option B – metformin is often held but not as urgent as NPO violation. Option
D – shellfish allergy is not a contraindication to TEE (the probe does not contain shellfish).
---
### Section 2: Perioperative Nursing (Questions 6–12)
**6.** A client is being prepared for elective surgery. Which finding would most likely require
postponement of the procedure?
- A. Serum potassium 3.6 mEq/L
- B. Hemoglobin 11.5 g/dL
## Form: MS-NCLEX-003 | Total Questions: 50 | Time Limit: 90 Minutes
**Instructions:** Select the best answer for each question. For Select All That Apply (SATA),
choose all correct options. Mark only one answer unless otherwise indicated.
**1.** A client is scheduled for a lumbar puncture. The nurse places the client in which
position?
- A. Supine with legs extended
- B. Prone with arms at sides
- C. Lateral recumbent with knees drawn to chest
- D. Sitting upright with legs dangling
**Correct Answer: C – Lateral recumbent with knees drawn to chest**
**Rationale:** The lateral recumbent position with knees drawn to the chest (fetal position) maximally
opens the intervertebral spaces, allowing easier access to the subarachnoid space. Option A does not
open the vertebrae. Option B is incorrect. Option D (sitting upright) may be used in some cases but is
not the standard position; the fetal position is preferred for maximizing space and patient comfort.
---
**2.** The nurse is caring for a client immediately after a cardiac catheterization via the femoral artery.
Which finding requires immediate intervention?
- A. Heart rate of 88 bpm
- B. Blood pressure 118/76 mm Hg
- C. Client reports mild groin discomfort
- D. Expanding hematoma at the puncture site
,**Correct Answer: D – Expanding hematoma at the puncture site**
**Rationale:** An expanding hematoma indicates active bleeding into the tissue, which can lead to
significant blood loss and compartment syndrome. This requires immediate pressure application and
provider notification. Options A and B are normal vital signs. Option C is expected after the procedure.
---
**3.** A client with an arteriovenous (AV) fistula for hemodialysis asks, “How will I know if my fistula is
working?” Which response by the nurse is correct? *(Select all that apply)*
- A. “You should feel a buzzing sensation called a thrill.”
- B. “You should hear a whooshing sound called a bruit.”
- C. “The arm should feel cold to the touch.”
- D. “The fistula should be flat and soft.”
- E. “You should check it daily for these signs.”
**Correct Answers: A, B, E**
**Rationale:** A palpable thrill and audible bruit indicate patent blood flow through the fistula. Daily
assessment is essential. Option C is incorrect – the arm should be warm, not cold. Option D is incorrect –
a functioning fistula has a palpable pulse and fullness.
---
**4.** A client on continuous renal replacement therapy (CRRT) has a filter pressure that suddenly
drops to zero. The nurse should first:
- A. Increase the blood flow rate
- B. Assess for filter clotting
- C. Document the finding as normal
- D. Administer a fluid bolus
, **Correct Answer: B – Assess for filter clotting**
**Rationale:** A sudden drop in filter pressure to zero often indicates that the filter has clotted and is
no longer functioning. The nurse should assess the filter and circuit for visible clots. Option A could
worsen clotting. Option C is incorrect – this is not normal. Option D does not address the filter issue.
---
**5.** The nurse is preparing a client for a transesophageal echocardiogram (TEE). Which statement by
the client requires immediate notification of the provider?
- A. “I have a history of high blood pressure.”
- B. “I took my metformin this morning.”
- C. “I had a ham sandwich 2 hours ago.”
- D. “I am allergic to shellfish.”
**Correct Answer: C – “I had a ham sandwich 2 hours ago.”**
**Rationale:** TEE requires NPO status for 4-6 hours to prevent aspiration during the procedure (the
patient is sedated). Eating 2 hours prior is a safety risk and may require rescheduling. Option A is not an
absolute contraindication. Option B – metformin is often held but not as urgent as NPO violation. Option
D – shellfish allergy is not a contraindication to TEE (the probe does not contain shellfish).
---
### Section 2: Perioperative Nursing (Questions 6–12)
**6.** A client is being prepared for elective surgery. Which finding would most likely require
postponement of the procedure?
- A. Serum potassium 3.6 mEq/L
- B. Hemoglobin 11.5 g/dL
