NCLEX-RN Practice Test 2026 - Medical Surgical Nursing
Cardiovascular Disorders
1. A nurse assesses a client with heart failure who reports shortness of breath
when walking to the bathroom. How should the nurse document this finding?
A. Orthopnea
B. Dyspnea on exertion
C. Paroxysmal nocturnal dyspnea
D. Platypnea
Answer: B. Dyspnea on exertion
Rationale: Dyspnea on exertion (DOE) occurs with activity (e.g., walking). Orthopnea (A)
is difficulty breathing while lying flat. Paroxysmal nocturnal dyspnea (C) awakens the
client from sleep. Platypnea (D) is dyspnea when upright, relieved by lying down.
2. A client with atrial fibrillation is prescribed warfarin. Which laboratory value
indicates a therapeutic effect?
A. INR of 2.5
B. aPTT of 60 seconds
C. Platelet count 150,000/mm³
D. PT of 10 seconds
Answer: A. INR of 2.5
Rationale: For atrial fibrillation, target INR is 2-3. aPTT (B) monitors heparin. Platelet
count (C) assesses bleeding risk but not warfarin effect. PT (D) without INR is not
standardized.
3. A client post-myocardial infarction develops crackles in lung bases, S3 gallop,
and jugular vein distension. What complication does the nurse suspect?
A. Cardiogenic shock
B. Pericarditis
C. Left-sided heart failure
D. Right-sided heart failure
Answer: C. Left-sided heart failure
Rationale: Left-sided failure causes pulmonary congestion (crackles, S3). Right-sided
failure (D) causes JVD, hepatomegaly, edema. Cardiogenic shock (A) includes
,hypotension and altered mental status. Pericarditis (B) presents with chest pain relieved
by leaning forward.
4. A client with unstable angina reports chest pain. The nurse administers
nitroglycerin sublingually. After 5 minutes, pain persists. What is the next action?
A. Administer aspirin 324 mg orally
B. Give a second nitroglycerin dose
C. Call a rapid response team
D. Obtain a 12-lead ECG
Answer: B. Give a second nitroglycerin dose
Rationale: Nitroglycerin can be given q5 minutes for up to 3 doses. Aspirin (A) is given
early but not as next step. Rapid response (C) if pain unrelieved after 3 doses. ECG (D) is
important but not before second dose.
5. A client with heart failure is prescribed furosemide. Which finding requires
immediate action?
A. Weight loss of 1 kg in 24 hours
B. Serum potassium 3.2 mEq/L
C. Dry mucous membranes
D. Blood pressure 110/70 mmHg
Answer: B. Serum potassium 3.2 mEq/L
Rationale: Furosemide causes hypokalemia (normal 3.5-5.0); level 3.2 increases risk of
dysrhythmias. Weight loss (A) indicates diuresis. Dry mucous membranes (C) are
expected. BP 110/70 (D) is acceptable.
Respiratory Disorders
6. A client with COPD has an SpO2 of 88% on room air. The nurse applies oxygen
at 2 L/min nasal cannula. What is the primary risk if oxygen is increased to 5
L/min?
A. Oxygen toxicity
B. Hypercapnia with decreased respiratory drive
C. Absorption atelectasis
D. Bronchopulmonary dysplasia
, Answer: B. Hypercapnia with decreased respiratory drive
Rationale: COPD clients may rely on hypoxic drive; high O2 can decrease respiratory
drive, causing CO2 retention. Oxygen toxicity (A) requires high FiO2 for >24h.
Absorption atelectasis (C) possible but not primary risk.
7. A client after thoracotomy has a chest tube with continuous bubbling in the
water seal chamber. What is the priority action?
A. Clamp the chest tube
B. Notify the healthcare provider
C. Check for an air leak
D. Milking the tubing
Answer: C. Check for an air leak
Rationale: Continuous bubbling indicates an air leak. Clamping (A) can cause tension
pneumothorax. Notify HCP (B) after assessment. Milking (D) is not recommended.
8. A client with pneumonia has a fever of 39.4°C (103°F), productive cough with
green sputum, and confusion. What is the nurse’s priority?
A. Administer antipyretic
B. Obtain sputum culture
C. Initiate oxygen therapy
D. Start IV antibiotics
Answer: C. Initiate oxygen therapy
Rationale: Confusion may indicate hypoxemia; airway/breathing first. Antipyretics (A)
and sputum culture (B) are important but not priority. Antibiotics (D) after culture but
oxygen first.
9. A client with asthma has a peak expiratory flow rate of 50% of personal best.
What action should the nurse take?
A. Continue current medication plan
B. Administer a rescue inhaler (albuterol)
C. Call 911 immediately
D. Schedule a follow-up in 1 week
Answer: B. Administer a rescue inhaler (albuterol)
Rationale: 50-80% indicates caution; 50% is severe; administer bronchodilator. Continue
plan (A) is wrong. Call 911 (C) if <50% or no improvement post-inhaler. Follow-up (D)
too delayed.
10. A client with pulmonary embolism is receiving heparin infusion. Which finding
indicates therapy is effective?
Cardiovascular Disorders
1. A nurse assesses a client with heart failure who reports shortness of breath
when walking to the bathroom. How should the nurse document this finding?
A. Orthopnea
B. Dyspnea on exertion
C. Paroxysmal nocturnal dyspnea
D. Platypnea
Answer: B. Dyspnea on exertion
Rationale: Dyspnea on exertion (DOE) occurs with activity (e.g., walking). Orthopnea (A)
is difficulty breathing while lying flat. Paroxysmal nocturnal dyspnea (C) awakens the
client from sleep. Platypnea (D) is dyspnea when upright, relieved by lying down.
2. A client with atrial fibrillation is prescribed warfarin. Which laboratory value
indicates a therapeutic effect?
A. INR of 2.5
B. aPTT of 60 seconds
C. Platelet count 150,000/mm³
D. PT of 10 seconds
Answer: A. INR of 2.5
Rationale: For atrial fibrillation, target INR is 2-3. aPTT (B) monitors heparin. Platelet
count (C) assesses bleeding risk but not warfarin effect. PT (D) without INR is not
standardized.
3. A client post-myocardial infarction develops crackles in lung bases, S3 gallop,
and jugular vein distension. What complication does the nurse suspect?
A. Cardiogenic shock
B. Pericarditis
C. Left-sided heart failure
D. Right-sided heart failure
Answer: C. Left-sided heart failure
Rationale: Left-sided failure causes pulmonary congestion (crackles, S3). Right-sided
failure (D) causes JVD, hepatomegaly, edema. Cardiogenic shock (A) includes
,hypotension and altered mental status. Pericarditis (B) presents with chest pain relieved
by leaning forward.
4. A client with unstable angina reports chest pain. The nurse administers
nitroglycerin sublingually. After 5 minutes, pain persists. What is the next action?
A. Administer aspirin 324 mg orally
B. Give a second nitroglycerin dose
C. Call a rapid response team
D. Obtain a 12-lead ECG
Answer: B. Give a second nitroglycerin dose
Rationale: Nitroglycerin can be given q5 minutes for up to 3 doses. Aspirin (A) is given
early but not as next step. Rapid response (C) if pain unrelieved after 3 doses. ECG (D) is
important but not before second dose.
5. A client with heart failure is prescribed furosemide. Which finding requires
immediate action?
A. Weight loss of 1 kg in 24 hours
B. Serum potassium 3.2 mEq/L
C. Dry mucous membranes
D. Blood pressure 110/70 mmHg
Answer: B. Serum potassium 3.2 mEq/L
Rationale: Furosemide causes hypokalemia (normal 3.5-5.0); level 3.2 increases risk of
dysrhythmias. Weight loss (A) indicates diuresis. Dry mucous membranes (C) are
expected. BP 110/70 (D) is acceptable.
Respiratory Disorders
6. A client with COPD has an SpO2 of 88% on room air. The nurse applies oxygen
at 2 L/min nasal cannula. What is the primary risk if oxygen is increased to 5
L/min?
A. Oxygen toxicity
B. Hypercapnia with decreased respiratory drive
C. Absorption atelectasis
D. Bronchopulmonary dysplasia
, Answer: B. Hypercapnia with decreased respiratory drive
Rationale: COPD clients may rely on hypoxic drive; high O2 can decrease respiratory
drive, causing CO2 retention. Oxygen toxicity (A) requires high FiO2 for >24h.
Absorption atelectasis (C) possible but not primary risk.
7. A client after thoracotomy has a chest tube with continuous bubbling in the
water seal chamber. What is the priority action?
A. Clamp the chest tube
B. Notify the healthcare provider
C. Check for an air leak
D. Milking the tubing
Answer: C. Check for an air leak
Rationale: Continuous bubbling indicates an air leak. Clamping (A) can cause tension
pneumothorax. Notify HCP (B) after assessment. Milking (D) is not recommended.
8. A client with pneumonia has a fever of 39.4°C (103°F), productive cough with
green sputum, and confusion. What is the nurse’s priority?
A. Administer antipyretic
B. Obtain sputum culture
C. Initiate oxygen therapy
D. Start IV antibiotics
Answer: C. Initiate oxygen therapy
Rationale: Confusion may indicate hypoxemia; airway/breathing first. Antipyretics (A)
and sputum culture (B) are important but not priority. Antibiotics (D) after culture but
oxygen first.
9. A client with asthma has a peak expiratory flow rate of 50% of personal best.
What action should the nurse take?
A. Continue current medication plan
B. Administer a rescue inhaler (albuterol)
C. Call 911 immediately
D. Schedule a follow-up in 1 week
Answer: B. Administer a rescue inhaler (albuterol)
Rationale: 50-80% indicates caution; 50% is severe; administer bronchodilator. Continue
plan (A) is wrong. Call 911 (C) if <50% or no improvement post-inhaler. Follow-up (D)
too delayed.
10. A client with pulmonary embolism is receiving heparin infusion. Which finding
indicates therapy is effective?
