,Congratulations on taking a powerful step in your NCLEX prep journey. This practice
guide includes 100 high-quality, NCLEX-style Medical-Surgical nursing questions,
organized by body system to help you master content the way the NCLEX tests it — in
real-world, clinical scenarios.
Each question is followed by a clear, concise rationale to reinforce your understanding
and strengthen critical thinking skills.
What to Expect:
● Systems-based layout (Cardiac, Respiratory, Neuro, GI, etc.)
● Application-level questions (not just recall!)
● Prioritization and clinical reasoning woven into practice
● Rationales that explain why the correct answer is right — and why others are wrong
How to Use This Guide:
● Answer questions on your own first, simulating exam conditions
● Review rationales carefully — they are where the learning happens
● Take notes on concepts you need to revisit
● Use this guide multiple times — mastery takes repetition!
Whether you're weeks away from the NCLEX or brushing up during clinicals, this guide is here
to help you feel confident, capable, and prepared.
Let’s dive in — you’ve got this!
1
,Cardiovascular Focus
Q1.
A client reports chest pain unrelieved by rest and has ST-segment elevation on
ECG. What is the priority action?
A. Administer morphine
✅
B. Apply oxygen
C. Prepare for cardiac catheterization
D. Encourage deep breathing
✅ Answer: C
Rationale: These are classic signs of an STEMI (ST-elevation MI). Immediate reperfusion via
catheterization (PCI) is priority.
Q2.
Which symptom is most concerning in a client with left-sided heart failure?
✅
A. Weight gain
B. Crackles in lungs
C. Jugular vein distention
D. Dependent edema
✅ Answer: B
Rationale: Left-sided HF causes pulmonary congestion — crackles indicate fluid buildup in
the lungs.
Q3.
A client with atrial fibrillation is prescribed warfarin. What is the most important
lab to monitor?
✅
A. PTT
B. INR
C. Platelet count
D. Creatinine
✅ Answer: B
Rationale: INR measures warfarin’s effect. Target range for Afib is usually 2.0 -- 3.0 to
prevent clots.
2
, Q4.
What should the nurse do first for a client with suspected DVT in the leg?
A. Apply warm compress
✅
B. Massage the area
C. Elevate the leg and notify the provider
D. Encourage ambulation
✅ Answer: C
Rationale: Elevation reduces swelling and immobilization prevents embolism. Massage and
ambulation are contraindicated.
Q5.
A client who had a femoral cardiac catheterization reports new back pain and low
blood pressure. What should the nurse suspect?
✅
A. Allergic reaction
B. Retroperitoneal hemorrhage
C. Renal colic
D. Constipation
✅ Answer: B
Rationale: Back pain and hypotension post-catheterization suggest bleeding into the
retroperitoneal space — a medical emergency.
Q6.
Which ECG change is most concerning?
✅
A. Bradycardia
B. ST elevation
C. Sinus tachycardia
D. First-degree AV block
✅ Answer: B
Rationale: ST elevation suggests myocardial infarction and requires immediate intervention.
3
guide includes 100 high-quality, NCLEX-style Medical-Surgical nursing questions,
organized by body system to help you master content the way the NCLEX tests it — in
real-world, clinical scenarios.
Each question is followed by a clear, concise rationale to reinforce your understanding
and strengthen critical thinking skills.
What to Expect:
● Systems-based layout (Cardiac, Respiratory, Neuro, GI, etc.)
● Application-level questions (not just recall!)
● Prioritization and clinical reasoning woven into practice
● Rationales that explain why the correct answer is right — and why others are wrong
How to Use This Guide:
● Answer questions on your own first, simulating exam conditions
● Review rationales carefully — they are where the learning happens
● Take notes on concepts you need to revisit
● Use this guide multiple times — mastery takes repetition!
Whether you're weeks away from the NCLEX or brushing up during clinicals, this guide is here
to help you feel confident, capable, and prepared.
Let’s dive in — you’ve got this!
1
,Cardiovascular Focus
Q1.
A client reports chest pain unrelieved by rest and has ST-segment elevation on
ECG. What is the priority action?
A. Administer morphine
✅
B. Apply oxygen
C. Prepare for cardiac catheterization
D. Encourage deep breathing
✅ Answer: C
Rationale: These are classic signs of an STEMI (ST-elevation MI). Immediate reperfusion via
catheterization (PCI) is priority.
Q2.
Which symptom is most concerning in a client with left-sided heart failure?
✅
A. Weight gain
B. Crackles in lungs
C. Jugular vein distention
D. Dependent edema
✅ Answer: B
Rationale: Left-sided HF causes pulmonary congestion — crackles indicate fluid buildup in
the lungs.
Q3.
A client with atrial fibrillation is prescribed warfarin. What is the most important
lab to monitor?
✅
A. PTT
B. INR
C. Platelet count
D. Creatinine
✅ Answer: B
Rationale: INR measures warfarin’s effect. Target range for Afib is usually 2.0 -- 3.0 to
prevent clots.
2
, Q4.
What should the nurse do first for a client with suspected DVT in the leg?
A. Apply warm compress
✅
B. Massage the area
C. Elevate the leg and notify the provider
D. Encourage ambulation
✅ Answer: C
Rationale: Elevation reduces swelling and immobilization prevents embolism. Massage and
ambulation are contraindicated.
Q5.
A client who had a femoral cardiac catheterization reports new back pain and low
blood pressure. What should the nurse suspect?
✅
A. Allergic reaction
B. Retroperitoneal hemorrhage
C. Renal colic
D. Constipation
✅ Answer: B
Rationale: Back pain and hypotension post-catheterization suggest bleeding into the
retroperitoneal space — a medical emergency.
Q6.
Which ECG change is most concerning?
✅
A. Bradycardia
B. ST elevation
C. Sinus tachycardia
D. First-degree AV block
✅ Answer: B
Rationale: ST elevation suggests myocardial infarction and requires immediate intervention.
3
