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PN ADULT MEDICAL-SURGICAL NURSING
ONLINE PRACTICE EXAM – COMPLETE GUIDE
VERIFIED ANSWERS & RATIONALES | NCLEX-
PN 2026–2027 EDITION | FIRST-TIME PASS
TABLE OF CONTENTS
| Section | Topic Area | Questions |
| 1 | Cardiovascular Disorders | 20 |
| 2 | Respiratory Disorders | 20 |
| 3 | Neurological Disorders | 15 |
| 4 | Gastrointestinal Disorders | 15 |
| 5 | Endocrine & Metabolic Disorders | 15 |
| 6 | Renal & Urinary Disorders | 10 |
| 7 | Musculoskeletal Disorders | 10 |
| 8 | Integumentary Disorders | 10 |
| 9 | Hematologic & Immunologic Disorders | 10 |
| 10 | Infectious & Communicable Diseases | 10 |
| 11 | Perioperative & Emergency Care | 10 |
| 12 | Pharmacology & Medication Administration | 15 |
| 13 | NGN Case Studies (4 cases × 5 items each) | 20 |
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SECTION 1 – CARDIOVASCULAR DISORDERS (20 Questions)
1. A patient with heart failure reports shortness of breath when lying flat.
The nurse documents this finding as:**
- A) Dyspnea on exertion
- B) Orthopnea
- C) Paroxysmal nocturnal dyspnea
- D) Tachypnea
** Correct Answer: B – Orthopnea**
**Rationale:** Orthopnea is difficulty breathing while lying flat.
Patients often sleep with multiple pillows. Paroxysmal nocturnal
dyspnea (PND) occurs hours after falling asleep.
2. A patient with hypertension is prescribed hydrochlorothiazide. Which
instruction should the nurse include?**
- A) Take at bedtime to avoid dizziness
- B) Take in the morning to avoid nocturia
- C) Avoid potassium-rich foods
- D) Take with antacids
** Correct Answer: B – Take in the morning to avoid nocturia**
**Rationale:** Thiazide diuretics increase urine output. Morning dosing
prevents sleep disruption. Monitor potassium (can cause hypokalemia).
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3. A patient with angina pectoris takes nitroglycerin sublingually. The
nurse instructs the patient to:**
- A) Swallow the tablet whole
- B) Take one tablet every 5 minutes up to 3 doses for chest pain
- C) Take with a full glass of water
- D) Avoid using if headache occurs
** Correct Answer: B – Take one tablet every 5 minutes up to 3
doses for chest pain**
**Rationale:** Nitroglycerin protocol: 1 tablet q5 min ×3 doses. Call
911 if no relief after first dose. Headache is a common side effect (not a
reason to avoid).
4. A patient with peripheral artery disease (PAD) complains of leg pain
when walking that resolves with rest. This is called:**
- A) Rest pain
- B) Intermittent claudication
- C) Venous stasis
- D) Neuropathy
** Correct Answer: B – Intermittent claudication**
**Rationale:** Intermittent claudication = muscle pain with exercise
relieved by rest. PAD: pain with elevation (rubor with dependency).
Venous disease: pain improves with elevation.
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5. A patient with heart failure has an order for furosemide 40 mg IV
push. Which lab value should the nurse monitor closely?**
- A) Sodium
- B) Potassium
- C) Calcium
- D) Magnesium
** Correct Answer: B – Potassium**
**Rationale:** Furosemide (loop diuretic) causes potassium wasting →
hypokalemia (increases risk of digoxin toxicity and arrhythmias).
Monitor potassium, creatinine, BP.
6. A patient is admitted with acute myocardial infarction (MI). Which
lab value is most specific for cardiac muscle damage?**
- A) CK-MB
- B) Troponin I
- C) Myoglobin
- D) BNP
** Correct Answer: B – Troponin I**
**Rationale:** Troponin is the most specific and sensitive marker for
myocardial necrosis. Remains elevated for 7–10 days. BNP indicates
heart failure.
PN ADULT MEDICAL-SURGICAL NURSING
ONLINE PRACTICE EXAM – COMPLETE GUIDE
VERIFIED ANSWERS & RATIONALES | NCLEX-
PN 2026–2027 EDITION | FIRST-TIME PASS
TABLE OF CONTENTS
| Section | Topic Area | Questions |
| 1 | Cardiovascular Disorders | 20 |
| 2 | Respiratory Disorders | 20 |
| 3 | Neurological Disorders | 15 |
| 4 | Gastrointestinal Disorders | 15 |
| 5 | Endocrine & Metabolic Disorders | 15 |
| 6 | Renal & Urinary Disorders | 10 |
| 7 | Musculoskeletal Disorders | 10 |
| 8 | Integumentary Disorders | 10 |
| 9 | Hematologic & Immunologic Disorders | 10 |
| 10 | Infectious & Communicable Diseases | 10 |
| 11 | Perioperative & Emergency Care | 10 |
| 12 | Pharmacology & Medication Administration | 15 |
| 13 | NGN Case Studies (4 cases × 5 items each) | 20 |
,2|Page
SECTION 1 – CARDIOVASCULAR DISORDERS (20 Questions)
1. A patient with heart failure reports shortness of breath when lying flat.
The nurse documents this finding as:**
- A) Dyspnea on exertion
- B) Orthopnea
- C) Paroxysmal nocturnal dyspnea
- D) Tachypnea
** Correct Answer: B – Orthopnea**
**Rationale:** Orthopnea is difficulty breathing while lying flat.
Patients often sleep with multiple pillows. Paroxysmal nocturnal
dyspnea (PND) occurs hours after falling asleep.
2. A patient with hypertension is prescribed hydrochlorothiazide. Which
instruction should the nurse include?**
- A) Take at bedtime to avoid dizziness
- B) Take in the morning to avoid nocturia
- C) Avoid potassium-rich foods
- D) Take with antacids
** Correct Answer: B – Take in the morning to avoid nocturia**
**Rationale:** Thiazide diuretics increase urine output. Morning dosing
prevents sleep disruption. Monitor potassium (can cause hypokalemia).
,3|Page
3. A patient with angina pectoris takes nitroglycerin sublingually. The
nurse instructs the patient to:**
- A) Swallow the tablet whole
- B) Take one tablet every 5 minutes up to 3 doses for chest pain
- C) Take with a full glass of water
- D) Avoid using if headache occurs
** Correct Answer: B – Take one tablet every 5 minutes up to 3
doses for chest pain**
**Rationale:** Nitroglycerin protocol: 1 tablet q5 min ×3 doses. Call
911 if no relief after first dose. Headache is a common side effect (not a
reason to avoid).
4. A patient with peripheral artery disease (PAD) complains of leg pain
when walking that resolves with rest. This is called:**
- A) Rest pain
- B) Intermittent claudication
- C) Venous stasis
- D) Neuropathy
** Correct Answer: B – Intermittent claudication**
**Rationale:** Intermittent claudication = muscle pain with exercise
relieved by rest. PAD: pain with elevation (rubor with dependency).
Venous disease: pain improves with elevation.
, 4|Page
5. A patient with heart failure has an order for furosemide 40 mg IV
push. Which lab value should the nurse monitor closely?**
- A) Sodium
- B) Potassium
- C) Calcium
- D) Magnesium
** Correct Answer: B – Potassium**
**Rationale:** Furosemide (loop diuretic) causes potassium wasting →
hypokalemia (increases risk of digoxin toxicity and arrhythmias).
Monitor potassium, creatinine, BP.
6. A patient is admitted with acute myocardial infarction (MI). Which
lab value is most specific for cardiac muscle damage?**
- A) CK-MB
- B) Troponin I
- C) Myoglobin
- D) BNP
** Correct Answer: B – Troponin I**
**Rationale:** Troponin is the most specific and sensitive marker for
myocardial necrosis. Remains elevated for 7–10 days. BNP indicates
heart failure.
