NGN NCLEX-RN
MEDICAL-SURGICAL NURSING
Exam Elaborations Questions &
Answers
2026
,A 68-year-old patient with chronic heart failure presents with sudden weight gain, dyspnea,
and bilateral crackles. Which medication should the nurse anticipate administering first?
A. Metoprolol
B. Furosemide
C. Lisinopril
D. Digoxin
Answer: B. Furosemide
Rationale: Loop diuretics provide rapid fluid removal, reducing pulmonary congestion in
acute decompensated heart failure.
---
A patient with COPD is receiving 2 L/min oxygen via nasal cannula. The nurse notes the
patient is becoming drowsy with decreased respiratory rate. What is the priority action?
A. Increase oxygen flow
B. Notify the provider
C. Encourage deep breathing
D. Obtain arterial blood gas
Answer: D. Obtain arterial blood gas
Rationale: COPD patients rely on hypoxic drive; excessive oxygen can cause CO₂
retention. ABG confirms hypercapnia.
---
True/False: In acute pancreatitis, serum amylase is more specific than lipase.
Answer: False
Rationale: Lipase is more specific for pancreatitis and remains elevated longer.
---
Fill in the blank: The most sensitive indicator of kidney function is ________.
Answer: Serum creatinine
Rationale: Creatinine reflects glomerular filtration rate more accurately than BUN.
---
A postoperative patient develops sudden chest pain and dyspnea. Which intervention is
priority?
A. Administer morphine
B. Elevate legs
C. Administer oxygen
D. Start IV fluids
2
,Answer: C. Administer oxygen
Rationale: Suspected pulmonary embolism requires immediate oxygen to correct hypoxia.
---
True/False: Beta-blockers should be abruptly discontinued in patients with coronary artery
disease.
Answer: False
Rationale: Abrupt withdrawal can cause rebound tachycardia and ischemia.
---
A patient with type 1 diabetes presents with Kussmaul respirations. Which lab finding is
expected?
A. High pH
B. Low glucose
C. High ketones
D. Low potassium
Answer: C. High ketones
Rationale: Diabetic ketoacidosis involves ketone accumulation causing metabolic acidosis.
---
Fill in the blank: The antidote for heparin overdose is ________.
Answer: Protamine sulfate
Rationale: Protamine neutralizes heparin’s anticoagulant effect.
---
A patient with cirrhosis has ascites. Which diet is most appropriate?
A. High sodium
B. Low protein
C. Low sodium
D. High fat
Answer: C. Low sodium
Rationale: Sodium restriction reduces fluid retention and ascites.
---
True/False: Hyperkalemia can cause peaked T waves on ECG.
Answer: True
Rationale: Elevated potassium alters cardiac conduction, producing characteristic ECG
changes.
3
, ---
A patient receiving blood transfusion develops fever and chills. What is the nurse’s first
action?
A. Slow the infusion
B. Stop the transfusion
C. Give antipyretics
D. Notify lab
Answer: B. Stop the transfusion
Rationale: Immediate discontinuation prevents further reaction.
---
Fill in the blank: The priority nursing intervention for a tension pneumothorax is ________.
Answer: Needle decompression
Rationale: This relieves pressure and restores lung expansion.
---
A patient with stroke has dysphagia. Which intervention is priority?
A. Encourage fluids
B. Position upright during feeding
C. Provide thickened liquids
D. Insert NG tube
Answer: B. Position upright during feeding
Rationale: Prevents aspiration during swallowing.
---
True/False: NSAIDs are safe in patients with chronic kidney disease.
Answer: False
Rationale: NSAIDs reduce renal blood flow and worsen kidney function.
---
A patient with sepsis has BP 80/50 mmHg. What is the priority intervention?
A. Administer antibiotics
B. Start IV fluids
C. Give vasopressors
D. Insert catheter
Answer: B. Start IV fluids
Rationale: Fluid resuscitation restores perfusion before vasopressors.
4
MEDICAL-SURGICAL NURSING
Exam Elaborations Questions &
Answers
2026
,A 68-year-old patient with chronic heart failure presents with sudden weight gain, dyspnea,
and bilateral crackles. Which medication should the nurse anticipate administering first?
A. Metoprolol
B. Furosemide
C. Lisinopril
D. Digoxin
Answer: B. Furosemide
Rationale: Loop diuretics provide rapid fluid removal, reducing pulmonary congestion in
acute decompensated heart failure.
---
A patient with COPD is receiving 2 L/min oxygen via nasal cannula. The nurse notes the
patient is becoming drowsy with decreased respiratory rate. What is the priority action?
A. Increase oxygen flow
B. Notify the provider
C. Encourage deep breathing
D. Obtain arterial blood gas
Answer: D. Obtain arterial blood gas
Rationale: COPD patients rely on hypoxic drive; excessive oxygen can cause CO₂
retention. ABG confirms hypercapnia.
---
True/False: In acute pancreatitis, serum amylase is more specific than lipase.
Answer: False
Rationale: Lipase is more specific for pancreatitis and remains elevated longer.
---
Fill in the blank: The most sensitive indicator of kidney function is ________.
Answer: Serum creatinine
Rationale: Creatinine reflects glomerular filtration rate more accurately than BUN.
---
A postoperative patient develops sudden chest pain and dyspnea. Which intervention is
priority?
A. Administer morphine
B. Elevate legs
C. Administer oxygen
D. Start IV fluids
2
,Answer: C. Administer oxygen
Rationale: Suspected pulmonary embolism requires immediate oxygen to correct hypoxia.
---
True/False: Beta-blockers should be abruptly discontinued in patients with coronary artery
disease.
Answer: False
Rationale: Abrupt withdrawal can cause rebound tachycardia and ischemia.
---
A patient with type 1 diabetes presents with Kussmaul respirations. Which lab finding is
expected?
A. High pH
B. Low glucose
C. High ketones
D. Low potassium
Answer: C. High ketones
Rationale: Diabetic ketoacidosis involves ketone accumulation causing metabolic acidosis.
---
Fill in the blank: The antidote for heparin overdose is ________.
Answer: Protamine sulfate
Rationale: Protamine neutralizes heparin’s anticoagulant effect.
---
A patient with cirrhosis has ascites. Which diet is most appropriate?
A. High sodium
B. Low protein
C. Low sodium
D. High fat
Answer: C. Low sodium
Rationale: Sodium restriction reduces fluid retention and ascites.
---
True/False: Hyperkalemia can cause peaked T waves on ECG.
Answer: True
Rationale: Elevated potassium alters cardiac conduction, producing characteristic ECG
changes.
3
, ---
A patient receiving blood transfusion develops fever and chills. What is the nurse’s first
action?
A. Slow the infusion
B. Stop the transfusion
C. Give antipyretics
D. Notify lab
Answer: B. Stop the transfusion
Rationale: Immediate discontinuation prevents further reaction.
---
Fill in the blank: The priority nursing intervention for a tension pneumothorax is ________.
Answer: Needle decompression
Rationale: This relieves pressure and restores lung expansion.
---
A patient with stroke has dysphagia. Which intervention is priority?
A. Encourage fluids
B. Position upright during feeding
C. Provide thickened liquids
D. Insert NG tube
Answer: B. Position upright during feeding
Rationale: Prevents aspiration during swallowing.
---
True/False: NSAIDs are safe in patients with chronic kidney disease.
Answer: False
Rationale: NSAIDs reduce renal blood flow and worsen kidney function.
---
A patient with sepsis has BP 80/50 mmHg. What is the priority intervention?
A. Administer antibiotics
B. Start IV fluids
C. Give vasopressors
D. Insert catheter
Answer: B. Start IV fluids
Rationale: Fluid resuscitation restores perfusion before vasopressors.
4
