PN ADULT MEDICAL SURGICAL 2026 EDITION
WITH NGN 200 QUESTIONS | CORRECT
ANSWERS & DETAILED RATIONALES
Exam Blueprint (Based on NCLEX-PN Test Plan):
Cardiovascular & Hematologic Disorders (15%) – 30 Qs
Respiratory Disorders (15%) – 30 Qs
Gastrointestinal & Hepatic Disorders (15%) – 30 Qs
Renal & Genitourinary Disorders (10%) – 20 Qs
Endocrine & Metabolic Disorders (10%) – 20 Qs
Neurologic & Musculoskeletal Disorders (15%) – 30 Qs
Immunologic, Infectious & Perioperative Care (10%) – 20 Qs
NGN Case Studies & Clinical Judgment (10%) – 20 Qs
Exam Format: Next Generation NCLEX (NGN) – includes multiple-choice, select-all-that-
apply, matrix, cloze, and case study questions.
Time limit (simulated): 3 hours
Passing threshold: 70% (140/200)
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS – Questions 1–30
1. A client with heart failure has crackles in all lung fields, jugular venous distention, and
3+ pitting edema. Which medication should the nurse expect to administer first?
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
Answer: B
Rationale: Furosemide (loop diuretic) reduces preload by promoting diuresis, relieving
,pulmonary congestion and edema. It is first-line for acute decompensated heart failure
with fluid overload.
2. A client with atrial fibrillation is prescribed warfarin. Which laboratory test should the
nurse monitor to evaluate therapeutic effect?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Answer: B
Rationale: Warfarin anticoagulation is monitored by the INR (International Normalized
Ratio). For atrial fibrillation, the target INR is typically 2-3. aPTT monitors heparin, not
warfarin.
3. A client with chest pain is admitted with suspected acute coronary syndrome (ACS).
Which serum cardiac marker is most specific for myocardial necrosis?
A) CK-MB
B) Myoglobin
C) Troponin I or T
D) C-reactive protein
Answer: C
Rationale: Troponin is the most specific and sensitive marker for myocardial necrosis;
elevated troponin indicates MI.
4. A client on a cardiac monitor shows ST-segment elevation in leads V1-V4. Which
coronary artery is most likely occluded?
A) Left circumflex artery
B) Right coronary artery
C) Left anterior descending artery (LAD)
D) Posterior descending artery
Answer: C
Rationale: LAD occlusion causes anterior wall MI (ST elevation in V1-V4). Right coronary
artery occlusion causes inferior MI (II, III, aVF).
,5. A client with a history of deep vein thrombosis (DVT) is prescribed enoxaparin. The
nurse should administer this medication via which route?
A) Intravenous push
B) Subcutaneous injection in the abdomen
C) Intramuscular injection
D) Oral
Answer: B
Rationale: Enoxaparin (low-molecular-weight heparin) is given subcutaneously in the
abdomen; rotate sites; do not expel air bubble.
6. A client after cardiac catheterization via the femoral artery has a sandbag placed over
the insertion site. Which finding requires immediate nursing action?
A) Small amount of oozing around the site
B) Ecchymosis at the site
C) Expanding hematoma and loss of pulse in the affected leg
D) Mild groin discomfort
Answer: C
Rationale: Expanding hematoma with loss of distal pulse indicates possible
retroperitoneal bleeding or vessel occlusion; notify provider immediately.
7. A client with chronic heart failure has a prescription for carvedilol. The nurse should
monitor for which therapeutic effect?
A) Increased heart rate
B) Improved left ventricular ejection fraction (LVEF) and reduced mortality
C) Increased blood pressure
D) Decreased urinary output
Answer: B
Rationale: Carvedilol is a beta-blocker that reduces mortality, hospitalizations, and
improves LVEF in heart failure with reduced ejection fraction (HFrEF).
8. A client with hypertension is prescribed hydrochlorothiazide. Which electrolyte
imbalance should the nurse monitor?
A) Hyperkalemia
, B) Hypokalemia
C) Hypernatremia
D) Hypermagnesemia
Answer: B
Rationale: Thiazide diuretics cause hypokalemia (potassium wasting). Monitor potassium
levels and signs of hypokalemia (muscle weakness, fatigue, arrhythmias).
9. A client with peripheral artery disease (PAD) complains of calf pain when walking that
resolves with rest. This symptom is known as:
A) Rest pain
B) Intermittent claudication
C) Venous stasis
D) Neuropathic pain
Answer: B
Rationale: Intermittent claudication is reproducible ischemic leg pain with exercise,
relieved by rest; it is a classic symptom of PAD.
10. A client with chronic venous insufficiency (CVI) has lower extremity edema and
brownish discoloration. Which nursing intervention is most important?
A) Elevate legs above the heart and apply compression stockings
B) Keep legs in a dependent position
C) Apply heat packs to the legs
D) Encourage prolonged standing
Answer: A
Rationale: Elevation and compression stockings reduce edema and improve venous
return. Compression (30-40 mmHg) is standard for CVI.
11. A client with angina is prescribed nitroglycerin sublingual. The nurse instructs the
client to take one tablet every 5 minutes for up to 3 doses. If chest pain is not relieved
after 3 doses, the client should:
A) Take two more tablets
B) Call 911 immediately (possible MI)
C) Lie down and rest
WITH NGN 200 QUESTIONS | CORRECT
ANSWERS & DETAILED RATIONALES
Exam Blueprint (Based on NCLEX-PN Test Plan):
Cardiovascular & Hematologic Disorders (15%) – 30 Qs
Respiratory Disorders (15%) – 30 Qs
Gastrointestinal & Hepatic Disorders (15%) – 30 Qs
Renal & Genitourinary Disorders (10%) – 20 Qs
Endocrine & Metabolic Disorders (10%) – 20 Qs
Neurologic & Musculoskeletal Disorders (15%) – 30 Qs
Immunologic, Infectious & Perioperative Care (10%) – 20 Qs
NGN Case Studies & Clinical Judgment (10%) – 20 Qs
Exam Format: Next Generation NCLEX (NGN) – includes multiple-choice, select-all-that-
apply, matrix, cloze, and case study questions.
Time limit (simulated): 3 hours
Passing threshold: 70% (140/200)
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS – Questions 1–30
1. A client with heart failure has crackles in all lung fields, jugular venous distention, and
3+ pitting edema. Which medication should the nurse expect to administer first?
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
Answer: B
Rationale: Furosemide (loop diuretic) reduces preload by promoting diuresis, relieving
,pulmonary congestion and edema. It is first-line for acute decompensated heart failure
with fluid overload.
2. A client with atrial fibrillation is prescribed warfarin. Which laboratory test should the
nurse monitor to evaluate therapeutic effect?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Answer: B
Rationale: Warfarin anticoagulation is monitored by the INR (International Normalized
Ratio). For atrial fibrillation, the target INR is typically 2-3. aPTT monitors heparin, not
warfarin.
3. A client with chest pain is admitted with suspected acute coronary syndrome (ACS).
Which serum cardiac marker is most specific for myocardial necrosis?
A) CK-MB
B) Myoglobin
C) Troponin I or T
D) C-reactive protein
Answer: C
Rationale: Troponin is the most specific and sensitive marker for myocardial necrosis;
elevated troponin indicates MI.
4. A client on a cardiac monitor shows ST-segment elevation in leads V1-V4. Which
coronary artery is most likely occluded?
A) Left circumflex artery
B) Right coronary artery
C) Left anterior descending artery (LAD)
D) Posterior descending artery
Answer: C
Rationale: LAD occlusion causes anterior wall MI (ST elevation in V1-V4). Right coronary
artery occlusion causes inferior MI (II, III, aVF).
,5. A client with a history of deep vein thrombosis (DVT) is prescribed enoxaparin. The
nurse should administer this medication via which route?
A) Intravenous push
B) Subcutaneous injection in the abdomen
C) Intramuscular injection
D) Oral
Answer: B
Rationale: Enoxaparin (low-molecular-weight heparin) is given subcutaneously in the
abdomen; rotate sites; do not expel air bubble.
6. A client after cardiac catheterization via the femoral artery has a sandbag placed over
the insertion site. Which finding requires immediate nursing action?
A) Small amount of oozing around the site
B) Ecchymosis at the site
C) Expanding hematoma and loss of pulse in the affected leg
D) Mild groin discomfort
Answer: C
Rationale: Expanding hematoma with loss of distal pulse indicates possible
retroperitoneal bleeding or vessel occlusion; notify provider immediately.
7. A client with chronic heart failure has a prescription for carvedilol. The nurse should
monitor for which therapeutic effect?
A) Increased heart rate
B) Improved left ventricular ejection fraction (LVEF) and reduced mortality
C) Increased blood pressure
D) Decreased urinary output
Answer: B
Rationale: Carvedilol is a beta-blocker that reduces mortality, hospitalizations, and
improves LVEF in heart failure with reduced ejection fraction (HFrEF).
8. A client with hypertension is prescribed hydrochlorothiazide. Which electrolyte
imbalance should the nurse monitor?
A) Hyperkalemia
, B) Hypokalemia
C) Hypernatremia
D) Hypermagnesemia
Answer: B
Rationale: Thiazide diuretics cause hypokalemia (potassium wasting). Monitor potassium
levels and signs of hypokalemia (muscle weakness, fatigue, arrhythmias).
9. A client with peripheral artery disease (PAD) complains of calf pain when walking that
resolves with rest. This symptom is known as:
A) Rest pain
B) Intermittent claudication
C) Venous stasis
D) Neuropathic pain
Answer: B
Rationale: Intermittent claudication is reproducible ischemic leg pain with exercise,
relieved by rest; it is a classic symptom of PAD.
10. A client with chronic venous insufficiency (CVI) has lower extremity edema and
brownish discoloration. Which nursing intervention is most important?
A) Elevate legs above the heart and apply compression stockings
B) Keep legs in a dependent position
C) Apply heat packs to the legs
D) Encourage prolonged standing
Answer: A
Rationale: Elevation and compression stockings reduce edema and improve venous
return. Compression (30-40 mmHg) is standard for CVI.
11. A client with angina is prescribed nitroglycerin sublingual. The nurse instructs the
client to take one tablet every 5 minutes for up to 3 doses. If chest pain is not relieved
after 3 doses, the client should:
A) Take two more tablets
B) Call 911 immediately (possible MI)
C) Lie down and rest
