Medical-Surgical Nursing by Body System Practice Questions and
Answers Updated 2026 | Complete Med-Surg Nursing Study Guide with
Verified Questions, Detailed Rationales, Cardiovascular, Respiratory,
Neurological, Gastrointestinal, Renal, Endocrine, Musculoskeletal,
Hematologic, Immune Disorders, Prioritization & NGN NCLEX-RN Exam
Prep
Question 1: A patient with heart failure is prescribed furosemide 40 mg IV. Which
assessment finding indicates the medication is achieving its therapeutic effect?
A. Increased serum potassium level
B. Decreased crackles in lung bases
C. Elevated blood pressure reading
D. Reduced urinary output
CORRECT ANSWER: B. Decreased crackles in lung bases
Rationale: Furosemide is a loop diuretic that promotes excretion of sodium and water,
reducing fluid volume overload in heart failure. Decreased crackles indicate improved
pulmonary congestion and effective diuresis. Increased serum potassium (A) is
incorrect because furosemide causes potassium loss. Elevated blood pressure (C) and
reduced urinary output (D) would indicate treatment failure, not success.
Question 2: When caring for a patient with acute coronary syndrome, which
electrocardiogram change requires immediate intervention?
A. Sinus bradycardia at 58 beats per minute
B. ST-segment elevation in leads II, III, and aVF
C. First-degree atrioventricular block
D. Occasional premature ventricular contractions
CORRECT ANSWER: B. ST-segment elevation in leads II, III, and aVF
Rationale: ST-segment elevation in inferior leads (II, III, aVF) indicates acute inferior wall
myocardial infarction, requiring immediate reperfusion therapy. Sinus bradycardia (A)
may be tolerated in inferior MI but is not the priority finding. First-degree AV block (C)
and occasional PVCs (D) are common and typically do not require emergent
intervention in this context.
Question 3: A patient with chronic obstructive pulmonary disease presents with
increased dyspnea and thick, yellow sputum. Which intervention should the nurse
prioritize?
A. Administer prescribed bronchodilator via nebulizer
B. Encourage increased oral fluid intake to 3 L/day
C. Obtain sputum culture before initiating antibiotics
D. Position patient in high-Fowler's position
CORRECT ANSWER: A. Administer prescribed bronchodilator via nebulizer
,Rationale: In acute COPD exacerbation with increased dyspnea, bronchodilators are
first-line therapy to relieve bronchospasm and improve airway patency. While
positioning (D) and hydration (B) support comfort and secretion mobilization, they do
not address the acute bronchoconstriction. Obtaining sputum culture (C) is important
but should not delay administration of urgent bronchodilator therapy.
Question 4: Which finding in a patient with pneumonia indicates adequate tissue
oxygenation?
A. Oxygen saturation of 92% on room air
B. Respiratory rate of 24 breaths per minute
C. Capillary refill less than 3 seconds
D. Absence of cyanosis in nail beds
CORRECT ANSWER: C. Capillary refill less than 3 seconds
Rationale: Capillary refill less than 3 seconds indicates adequate peripheral perfusion
and tissue oxygenation. Oxygen saturation of 92% (A) is below the target of ≥94% for
most pneumonia patients. Tachypnea (B) suggests respiratory compensation for
hypoxia. Absence of cyanosis (D) is a late and insensitive indicator of oxygenation
status.
Question 5: A patient with peptic ulcer disease reports sudden, severe epigastric
pain radiating to the back. Which complication should the nurse suspect?
A. Gastric outlet obstruction
B. Perforation of the ulcer
C. Hemorrhage from eroded vessel
D. Malignant transformation
CORRECT ANSWER: B. Perforation of the ulcer
Rationale: Sudden, severe epigastric pain radiating to the back is classic for ulcer
perforation, causing chemical peritonitis. Gastric outlet obstruction (A) presents with
vomiting and distension. Hemorrhage (C) manifests as hematemesis or melena.
Malignant transformation (D) is rare and presents with weight loss and anorexia, not
acute pain.
Question 6: When administering enteral feedings via nasogastric tube, which
action prevents aspiration?
A. Flushing the tube with 30 mL water before and after medications
B. Checking gastric residual volume every 4-6 hours
C. Elevating the head of the bed to 30-45 degrees during feeding
D. Using a continuous pump infusion rather than bolus feeding
CORRECT ANSWER: C. Elevating the head of the bed to 30-45 degrees during
feeding
, Rationale: Elevating the head of the bed reduces the risk of gastroesophageal reflux and
aspiration during enteral feeding. While checking residuals (B) and flushing (A) are
important for tube patency and tolerance, they do not directly prevent aspiration.
Continuous infusion (D) may improve tolerance but does not replace proper positioning
for aspiration prevention.
Question 7: A patient with cirrhosis has a serum ammonia level of 95 mcg/dL.
Which medication should the nurse anticipate administering?
A. Lactulose
B. Omeprazole
C. Spironolactone
D. Metoclopramide
CORRECT ANSWER: A. Lactulose
Rationale: Lactulose reduces serum ammonia by acidifying the colon and promoting
excretion of ammonia in feces, treating hepatic encephalopathy in cirrhosis.
Omeprazole (B) reduces gastric acid but does not affect ammonia. Spironolactone (C)
is a diuretic for ascites. Metoclopramide (D) promotes gastric emptying but is not
indicated for hyperammonemia.
Question 8: Which assessment finding in a patient with acute kidney injury requires
immediate notification of the provider?
A. Urine output of 25 mL/hr for 2 consecutive hours
B. Serum potassium level of 5.8 mEq/L
C. Blood urea nitrogen of 32 mg/dL
D. Mild peripheral edema
CORRECT ANSWER: B. Serum potassium level of 5.8 mEq/L
Rationale: Hyperkalemia (potassium >5.5 mEq/L) in acute kidney injury is life-
threatening due to risk of cardiac dysrhythmias and requires immediate intervention.
Oliguria (A) is expected in AKI but not immediately life-threatening. Elevated BUN (C)
and mild edema (D) are common findings that require monitoring but not emergent
action.
Question 9: A patient with type 1 diabetes mellitus reports feeling shaky,
diaphoretic, and confused. Blood glucose is 52 mg/dL. Which intervention should
the nurse implement first?
A. Administer 15 grams of fast-acting carbohydrate orally
B. Give intramuscular glucagon 1 mg
C. Start intravenous dextrose 50% solution
D. Recheck blood glucose in 15 minutes
CORRECT ANSWER: A. Administer 15 grams of fast-acting carbohydrate orally
Answers Updated 2026 | Complete Med-Surg Nursing Study Guide with
Verified Questions, Detailed Rationales, Cardiovascular, Respiratory,
Neurological, Gastrointestinal, Renal, Endocrine, Musculoskeletal,
Hematologic, Immune Disorders, Prioritization & NGN NCLEX-RN Exam
Prep
Question 1: A patient with heart failure is prescribed furosemide 40 mg IV. Which
assessment finding indicates the medication is achieving its therapeutic effect?
A. Increased serum potassium level
B. Decreased crackles in lung bases
C. Elevated blood pressure reading
D. Reduced urinary output
CORRECT ANSWER: B. Decreased crackles in lung bases
Rationale: Furosemide is a loop diuretic that promotes excretion of sodium and water,
reducing fluid volume overload in heart failure. Decreased crackles indicate improved
pulmonary congestion and effective diuresis. Increased serum potassium (A) is
incorrect because furosemide causes potassium loss. Elevated blood pressure (C) and
reduced urinary output (D) would indicate treatment failure, not success.
Question 2: When caring for a patient with acute coronary syndrome, which
electrocardiogram change requires immediate intervention?
A. Sinus bradycardia at 58 beats per minute
B. ST-segment elevation in leads II, III, and aVF
C. First-degree atrioventricular block
D. Occasional premature ventricular contractions
CORRECT ANSWER: B. ST-segment elevation in leads II, III, and aVF
Rationale: ST-segment elevation in inferior leads (II, III, aVF) indicates acute inferior wall
myocardial infarction, requiring immediate reperfusion therapy. Sinus bradycardia (A)
may be tolerated in inferior MI but is not the priority finding. First-degree AV block (C)
and occasional PVCs (D) are common and typically do not require emergent
intervention in this context.
Question 3: A patient with chronic obstructive pulmonary disease presents with
increased dyspnea and thick, yellow sputum. Which intervention should the nurse
prioritize?
A. Administer prescribed bronchodilator via nebulizer
B. Encourage increased oral fluid intake to 3 L/day
C. Obtain sputum culture before initiating antibiotics
D. Position patient in high-Fowler's position
CORRECT ANSWER: A. Administer prescribed bronchodilator via nebulizer
,Rationale: In acute COPD exacerbation with increased dyspnea, bronchodilators are
first-line therapy to relieve bronchospasm and improve airway patency. While
positioning (D) and hydration (B) support comfort and secretion mobilization, they do
not address the acute bronchoconstriction. Obtaining sputum culture (C) is important
but should not delay administration of urgent bronchodilator therapy.
Question 4: Which finding in a patient with pneumonia indicates adequate tissue
oxygenation?
A. Oxygen saturation of 92% on room air
B. Respiratory rate of 24 breaths per minute
C. Capillary refill less than 3 seconds
D. Absence of cyanosis in nail beds
CORRECT ANSWER: C. Capillary refill less than 3 seconds
Rationale: Capillary refill less than 3 seconds indicates adequate peripheral perfusion
and tissue oxygenation. Oxygen saturation of 92% (A) is below the target of ≥94% for
most pneumonia patients. Tachypnea (B) suggests respiratory compensation for
hypoxia. Absence of cyanosis (D) is a late and insensitive indicator of oxygenation
status.
Question 5: A patient with peptic ulcer disease reports sudden, severe epigastric
pain radiating to the back. Which complication should the nurse suspect?
A. Gastric outlet obstruction
B. Perforation of the ulcer
C. Hemorrhage from eroded vessel
D. Malignant transformation
CORRECT ANSWER: B. Perforation of the ulcer
Rationale: Sudden, severe epigastric pain radiating to the back is classic for ulcer
perforation, causing chemical peritonitis. Gastric outlet obstruction (A) presents with
vomiting and distension. Hemorrhage (C) manifests as hematemesis or melena.
Malignant transformation (D) is rare and presents with weight loss and anorexia, not
acute pain.
Question 6: When administering enteral feedings via nasogastric tube, which
action prevents aspiration?
A. Flushing the tube with 30 mL water before and after medications
B. Checking gastric residual volume every 4-6 hours
C. Elevating the head of the bed to 30-45 degrees during feeding
D. Using a continuous pump infusion rather than bolus feeding
CORRECT ANSWER: C. Elevating the head of the bed to 30-45 degrees during
feeding
, Rationale: Elevating the head of the bed reduces the risk of gastroesophageal reflux and
aspiration during enteral feeding. While checking residuals (B) and flushing (A) are
important for tube patency and tolerance, they do not directly prevent aspiration.
Continuous infusion (D) may improve tolerance but does not replace proper positioning
for aspiration prevention.
Question 7: A patient with cirrhosis has a serum ammonia level of 95 mcg/dL.
Which medication should the nurse anticipate administering?
A. Lactulose
B. Omeprazole
C. Spironolactone
D. Metoclopramide
CORRECT ANSWER: A. Lactulose
Rationale: Lactulose reduces serum ammonia by acidifying the colon and promoting
excretion of ammonia in feces, treating hepatic encephalopathy in cirrhosis.
Omeprazole (B) reduces gastric acid but does not affect ammonia. Spironolactone (C)
is a diuretic for ascites. Metoclopramide (D) promotes gastric emptying but is not
indicated for hyperammonemia.
Question 8: Which assessment finding in a patient with acute kidney injury requires
immediate notification of the provider?
A. Urine output of 25 mL/hr for 2 consecutive hours
B. Serum potassium level of 5.8 mEq/L
C. Blood urea nitrogen of 32 mg/dL
D. Mild peripheral edema
CORRECT ANSWER: B. Serum potassium level of 5.8 mEq/L
Rationale: Hyperkalemia (potassium >5.5 mEq/L) in acute kidney injury is life-
threatening due to risk of cardiac dysrhythmias and requires immediate intervention.
Oliguria (A) is expected in AKI but not immediately life-threatening. Elevated BUN (C)
and mild edema (D) are common findings that require monitoring but not emergent
action.
Question 9: A patient with type 1 diabetes mellitus reports feeling shaky,
diaphoretic, and confused. Blood glucose is 52 mg/dL. Which intervention should
the nurse implement first?
A. Administer 15 grams of fast-acting carbohydrate orally
B. Give intramuscular glucagon 1 mg
C. Start intravenous dextrose 50% solution
D. Recheck blood glucose in 15 minutes
CORRECT ANSWER: A. Administer 15 grams of fast-acting carbohydrate orally
