NCLEX › Practice questions › Med-Surg
Med-Surg NCLEX practice questions
Med-surg is where most NCLEX physiology lives. These questions cover shock, emergencies and common complications, with the rationale for every option.
Question 1 · Reduction of Risk Potential
A client with a lower leg cast reports severe pain unrelieved by opioid analgesics, out of proportion to the injury. Which early sign of compartment syndrome does this represent?
Show answer and rationale
Answer: D. Pain out of proportion to the injury, and unrelieved by opioids, is the earliest and most reliable sign of compartment syndrome, occurring before other findings develop. Paralysis is a very late sign indicating significant nerve and muscle ischemia. Pallor and pulselessness are also later findings that occur as vascular compromise progresses. Because pain appears first, prompt recognition of this symptom allows for earlier intervention before irreversible damage occurs.
Checked against: OpenStax Clinical Nursing Skills, 25.2
Question 2 · Physiological Adaptation
A nurse is caring for a client who just received an IM injection of a medication and now has hives, wheezing, and a blood pressure of 82/50 mmHg. Which actions should the nurse take? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: B, C, D, E. Anaphylactic shock is a severe allergic distributive shock reaction requiring immediate IM epinephrine, airway management, positioning to support circulation, continuous monitoring, and calling for emergency assistance. Delaying treatment to confirm the specific allergen is inappropriate and dangerous because anaphylaxis can rapidly progress to airway obstruction and cardiovascular collapse. Every second counts in anaphylaxis, so rapid, protocol-driven intervention is essential rather than waiting for diagnostic confirmation. Prompt epinephrine administration is the single most important life-saving action.
Checked against: OpenStax Medical-Surgical Nursing, 24.7
Question 3 · Pharmacological and Parenteral Therapies
The nurse is preparing to administer digoxin to a client. Which action is most important before giving the medication?
Show answer and rationale
Answer: C. Digoxin slows and strengthens the heart, so the nurse must check the apical pulse for 1 full minute before administration and hold the dose if the rate is under 60 beats per minute. Orthostatic blood pressure, reflexes, and temperature are not the priority safety check specific to digoxin administration. Giving digoxin to a bradycardic client can worsen bradycardia and precipitate toxicity. This priority assessment prevents a serious adverse cardiac event.
Checked against: OpenStax Fundamentals of Nursing, 7.3
Question 4 · Reduction of Risk Potential
A client's arterial blood gas results are: pH 7.30, PaCO2 50 mmHg, HCO3 24 mEq/L. Which acid-base imbalance is present?
Show answer and rationale
Answer: B. Using ROME, the pH is low (under 7.35) and the CO2 is high (over 45 mmHg), and because pH and CO2 move in opposite directions in respiratory disorders, this pattern confirms respiratory acidosis. The HCO3 is within normal range (22-26 mEq/L), ruling out a primary metabolic problem. Common causes include hypoventilation, COPD with CO2 retention, or oversedation. Respiratory alkalosis and metabolic alkalosis would show a high pH, which is not seen here.
Checked against: OpenStax Fundamentals of Nursing, 20.3; OpenStax Medical-Surgical Nursing, 10.4
Question 5 · Pharmacological and Parenteral Therapies
A client's blood glucose is 58 mg/dL and the client is alert, shaky, and diaphoretic. What is the nurse's priority action?
Show answer and rationale
Answer: B. A blood glucose under 70 mg/dL with symptoms of hypoglycemia requires immediate treatment with the rule of 15: give 15 grams of fast-acting carbohydrate, recheck in 15 minutes, and repeat if needed. Giving insulin would dangerously lower glucose further and could cause loss of consciousness or seizure. Waiting for provider orders delays urgent treatment that the nurse is authorized to initiate immediately. Encouraging activity would worsen hypoglycemia by increasing glucose utilization.
Checked against: OpenStax Medical-Surgical Nursing, 21.2
Question 6 · Physiological Adaptation
A client meets criteria for sepsis. Which interventions should the nurse anticipate as part of the first-hour sepsis bundle? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, B, D, E. The first-hour sepsis bundle includes drawing blood cultures before giving antibiotics so the causative organism is not masked, starting broad-spectrum antibiotics promptly, measuring serum lactate to assess tissue hypoperfusion, and infusing 30 mL/kg of crystalloid fluid for hypotension or elevated lactate. Withholding fluids delays resuscitation and worsens hypoperfusion, which contradicts bundle guidelines. Delaying antibiotics for a specialist consult increases mortality risk because timely antibiotic administration is critical in sepsis management.
Checked against: OpenStax Medical-Surgical Nursing, 23.3
Question 7 · Physiological Adaptation
A client with a spinal cord injury at T4 reports a severe pounding headache and the nurse notes a blood pressure of 210/120 mmHg. What is the nurse's first action?
Show answer and rationale
Answer: C. Autonomic dysreflexia is a spinal cord injury emergency where systolic blood pressure can exceed 200 mmHg; the priority is to sit the client up immediately to lower blood pressure, then identify and remove the triggering stimulus, most often a full bladder or bowel impaction. Laying the client flat would worsen the dangerously high blood pressure. Pain medication does not address the underlying cause and delays urgent intervention. Waiting for orders wastes critical time in this hypertensive emergency that requires immediate nursing action.
Checked against: pmc.ncbi.nlm.nih.gov; ncbi.nlm.nih.gov
Question 8 · Physiological Adaptation
A client with a spinal cord injury at T5 reports a sudden pounding headache and profuse sweating above the level of injury. The blood pressure is 198/110 mmHg. What should the nurse do first?
Show answer and rationale
Answer: C. The first action in suspected autonomic dysreflexia is to sit the client upright, which helps lower blood pressure by decreasing venous return, and then quickly search for and remove the triggering stimulus, most commonly a distended bladder or impacted bowel. Administering antihypertensive medication may eventually be needed, but positioning and identifying the trigger take priority as first-line actions. Laying the client flat would worsen the dangerously elevated blood pressure. Waiting for provider orders delays essential nursing actions that must be initiated immediately in this emergency.
Checked against: ncbi.nlm.nih.gov; pmc.ncbi.nlm.nih.gov
Question 9 · Reduction of Risk Potential
A client's laboratory results show a potassium level of 6.2 mEq/L. Which ECG change should the nurse anticipate first?
Show answer and rationale
Answer: A. Hyperkalemia, defined as potassium over 5.0 mEq/L, initially produces peaked T waves on the ECG, followed by widening of the QRS complex as levels rise further, with risk of cardiac arrest if untreated. Flattened P waves are more associated with hypokalemia, not hyperkalemia. ST depression and prolonged QT are not the classic first ECG change seen with rising potassium. Recognizing peaked T waves early allows the nurse to anticipate rapid clinical deterioration and prioritize treatment.
Checked against: OpenStax Medical-Surgical Nursing, 10.3
Question 10 · Reduction of Risk Potential
Which findings are included in the '6 Ps' used to assess for compartment syndrome? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, B, C, E, F. The 6 Ps of compartment syndrome are pain, pressure, paresthesia, pallor, pulselessness, and paralysis, reflecting the progression from early sensory changes to late vascular and motor compromise. Polyuria is not part of this assessment framework and is unrelated to compartment syndrome, making it incorrect. Recognizing pain and pressure early is critical, since pulselessness and paralysis are late findings indicating advanced, potentially irreversible tissue damage. This distinction helps nurses intervene before permanent limb damage occurs.
Checked against: OpenStax Clinical Nursing Skills, 25.2
Question 11 · Physiological Adaptation
A nurse notes that a client with a head injury now has a blood pressure of 168/54 mmHg, a heart rate of 46/min, and irregular respirations. Which condition is the client exhibiting?
Show answer and rationale
Answer: D. Cushing's triad consists of widening pulse pressure, bradycardia, and irregular respirations, and it indicates a late, ominous sign of increased intracranial pressure requiring immediate intervention. Autonomic dysreflexia occurs in spinal cord injury above T6 and presents with hypertension and often a pounding headache, but the classic triad described here is specific to increased ICP. Neurogenic shock presents with hypotension and bradycardia, which does not match the hypertensive picture in this scenario. Cardiogenic shock is characterized by hypotension and tachycardia related to pump failure, not this specific vital sign pattern.
Checked against: OpenStax Medical-Surgical Nursing, 23.4
Question 12 · Physiological Adaptation
A client involved in a motor vehicle collision develops absent breath sounds on the left side, tracheal deviation to the right, jugular venous distention, and a blood pressure of 76/48 mmHg. Which condition does the nurse suspect?
Show answer and rationale
Answer: C. Tension pneumothorax presents with absent breath sounds on the affected side, tracheal deviation away from the affected side as a late sign, jugular venous distention from impaired venous return, and rapid hypotension due to compression of the great vessels and heart. A simple pneumothorax does not typically cause tracheal deviation or such rapid hemodynamic collapse. Cardiac tamponade would present with muffled heart sounds, JVD, and hypotension, but would not cause absent breath sounds on one side. Flail chest presents with paradoxical chest wall movement, not absent unilateral breath sounds with tracheal shift.
Checked against: OpenStax Medical-Surgical Nursing, 11.6
Want more med-surg questions?
NurseLingo has 600+ NCLEX-style questions across 35+ topics with a rationale on every answer, and brings back the ones you miss.
Practice more in NurseLingoOn Android, the free NurseLingo app has 750+ study cards, NCLEX question decks and a home-screen widget. The full practice-question bank with rationales is on iPhone and iPad for now; get new questions by email below.
Watch the lesson
▶ Types of Shock Made Easy: 4 Types, 1 Pattern Each (NCLEX Review) · 10:38 · free on the Nurse Lingo YouTube channel
Frequently asked questions
Is med-surg on the NCLEX?
Yes. Most med-surg content falls under Physiological Adaptation (11 to 17%) and Reduction of Risk Potential (9 to 15%) on the NCLEX-RN test plan.
Review first
About these questions
Every question on this page was approved by a licensed RN, and its answer was checked against open nursing references (mostly OpenStax nursing textbooks) before publishing. They are NCLEX-style practice, not real NCLEX items. NurseLingo is not affiliated with NCSBN. Spot a problem? Tell us.