🔹 Introduction
Medical-Surgical Nursing is the backbone of patient care and one of the most important sections of the NCLEX exam. To help you master this domain, we’ve created a set of 50 carefully designed MCQs with correct answers and explanations. These questions cover core nursing concepts such as cardiac care, renal function, electrolyte balance, respiratory system, and endocrine disorders.
Whether you’re preparing for NCLEX-USA, NCLEX-RN, NCLEX-PN, or international nursing exams, this practice set will guide you through essential topics tested worldwide. The explanations are written in simple, clear, and exam-oriented style, making it easy for both beginners and advanced learners to understand and retain concepts.
🏥 NCLEX Medical-Surgical Nursing MCQs – Part 1 (1–50)
1. A client with heart failure is prescribed furosemide. Which finding indicates the medication is effective?
(A) Decreased urine output
(B) Reduced lung crackles
(C) Increased blood pressure
(D) Edema in legs
Correct Answer: (B) Reduced lung crackles
Explanation: Furosemide is a loop diuretic that reduces fluid overload. A decrease in lung crackles indicates improved pulmonary status.
2. A nurse is caring for a client with COPD. Which oxygen delivery device is most appropriate?
(A) Simple mask
(B) Venturi mask
(C) Nasal cannula at 6 L/min
(D) Non-rebreather mask
Correct Answer: (B) Venturi mask
Explanation: The Venturi mask delivers a precise concentration of oxygen, which is essential in COPD to avoid suppressing the hypoxic drive to breathe.
3. Which lab value is most important to monitor in a client taking warfarin?
(A) PT/INR
(B) Platelet count
(C) Hemoglobin
(D) aPTT
Correct Answer: (A) PT/INR
Explanation: Warfarin affects the extrinsic clotting pathway; PT/INR is the primary lab test to evaluate therapeutic effect.
4. After thyroidectomy, a client develops tingling around the mouth and muscle spasms. What is the priority action?
(A) Administer oxygen
(B) Assess for bleeding
(C) Check serum calcium level
(D) Give potassium supplement
Correct Answer: (C) Check serum calcium level
Explanation: Hypocalcemia is a common complication due to accidental removal of parathyroid glands during thyroid surgery.
5. A client with type 1 diabetes is sweating, shaky, and pale. What should the nurse do first?
(A) Give insulin
(B) Provide orange juice
(C) Check urine ketones
(D) Start IV fluids
Correct Answer: (B) Provide orange juice
Explanation: Symptoms indicate hypoglycemia. Quick-acting carbohydrates like orange juice correct low blood sugar.
6. Which finding indicates peritonitis in a client with a perforated ulcer?
(A) Rebound tenderness
(B) Soft abdomen
(C) Hyperactive bowel sounds
(D) Bradycardia
Correct Answer: (A) Rebound tenderness
Explanation: Peritonitis typically presents with rebound tenderness, rigid abdomen, and severe pain.
7. Which ECG change is associated with hyperkalemia?
(A) U waves
(B) ST depression
(C) Peaked T waves
(D) Prolonged QT interval
Correct Answer: (C) Peaked T waves
Explanation: Elevated potassium levels cause tall, peaked T waves and can progress to cardiac arrest.
8. A client after hip replacement is at highest risk for which complication?
(A) Pneumonia
(B) Deep vein thrombosis (DVT)
(C) Renal stones
(D) Hypoglycemia
Correct Answer: (B) Deep vein thrombosis (DVT)
Explanation: Immobility and orthopedic surgery increase the risk for blood clots.
9. Which intervention is most important for a client with cirrhosis and ascites?
(A) Encourage high sodium intake
(B) Position flat in bed
(C) Restrict fluid and sodium
(D) Increase protein in diet
Correct Answer: (C) Restrict fluid and sodium
Explanation: Sodium and fluid restriction help manage ascites by preventing further fluid accumulation.
10. What is the priority nursing action during a tonic-clonic seizure?
(A) Insert an oral airway
(B) Restrain the client
(C) Protect the client from injury
(D) Administer anticonvulsant medication immediately
Correct Answer: (C) Protect the client from injury
Explanation: Safety is the top priority during a seizure. Do not insert objects or restrain.
11. A nurse is monitoring a client after abdominal surgery. Which finding requires immediate intervention?
(A) Absent bowel sounds in first 24 hrs
(B) Small serosanguinous drainage
(C) Evisceration of wound
(D) Pain at incision site
Correct Answer: (C) Evisceration of wound
Explanation: Evisceration is a medical emergency requiring sterile saline dressings and immediate surgical intervention.
12. Which lab result is expected in a client with chronic kidney disease (CKD)?
(A) Hypokalemia
(B) Elevated creatinine
(C) Low BUN
(D) High hemoglobin
Correct Answer: (B) Elevated creatinine
Explanation: CKD causes retention of waste products, leading to increased creatinine and BUN levels.
13. Which symptom is most concerning in a client with pneumonia?
(A) Productive cough
(B) Fever
(C) Restlessness and confusion
(D) Fatigue
Correct Answer: (C) Restlessness and confusion
Explanation: These indicate hypoxia, a priority concern in pneumonia patients.
14. A client with a chest tube accidentally disconnects it from the drainage system. What should the nurse do first?
(A) Clamp the tube
(B) Place the end in sterile water
(C) Call the physician
(D) Reinsert the tube
Correct Answer: (B) Place the end in sterile water
Explanation: This maintains a water seal to prevent air from entering the pleural cavity.
15. Which diet is recommended for a client with celiac disease?
(A) Low fat
(B) Gluten-free
(C) High protein
(D) Low fiber
Correct Answer: (B) Gluten-free
Explanation: Gluten triggers autoimmune reactions in celiac disease. Avoid wheat, barley, and rye.
16. Which assessment finding indicates hypovolemic shock?
(A) Hypertension
(B) Warm, flushed skin
(C) Tachycardia with weak pulse
(D) Increased urine output
Correct Answer: (C) Tachycardia with weak pulse
Explanation: In hypovolemic shock, low blood volume leads to tachycardia, weak pulse, hypotension, and low urine output.
17. A nurse is teaching a client with GERD. Which instruction is correct?
(A) Lie down after meals
(B) Avoid chocolate and caffeine
(C) Increase spicy food intake
(D) Drink large amounts of water before bed
Correct Answer: (B) Avoid chocolate and caffeine
Explanation: Chocolate, caffeine, alcohol, and spicy foods worsen GERD symptoms.
18. Which client is at highest risk for tuberculosis (TB)?
(A) A teacher
(B) A healthcare worker
(C) An office worker
(D) A college student
Correct Answer: (B) A healthcare worker
Explanation: TB exposure risk is high in healthcare settings.
19. Which electrolyte imbalance is a risk with nasogastric suctioning?
(A) Hyperkalemia
(B) Hyponatremia
(C) Hypokalemia
(D) Hypercalcemia
Correct Answer: (C) Hypokalemia
Explanation: NG suction removes gastric contents rich in potassium, causing hypokalemia.
20. Which position is best for a client with increased intracranial pressure (ICP)?
(A) Trendelenburg
(B) Supine with legs elevated
(C) Semi-Fowler’s (30 degrees)
(D) High Fowler’s (90 degrees)
Correct Answer: (C) Semi-Fowler’s (30 degrees)
Explanation: Elevating the head promotes venous drainage while maintaining cerebral perfusion.
21. A nurse is caring for a client receiving blood transfusion. Which symptom indicates a hemolytic reaction?
(A) Back pain and chills
(B) Itching only
(C) Fever after 24 hours
(D) Local redness at IV site
Correct Answer: (A) Back pain and chills
Explanation: Hemolytic reactions cause flank pain, fever, chills, and dark urine. Immediate action required.
22. Which finding is expected in hypoglycemia?
(A) Fruity breath odor
(B) Slow, deep respirations
(C) Sweating and tremors
(D) Polyuria and polydipsia
Correct Answer: (C) Sweating and tremors
Explanation: Hypoglycemia activates the sympathetic nervous system, causing sweating, tremors, and palpitations.
23. What is the priority nursing intervention for a client with myasthenia gravis?
(A) Encourage fluid intake
(B) Prevent respiratory compromise
(C) Monitor blood glucose
(D) Provide pain management
Correct Answer: (B) Prevent respiratory compromise
Explanation: Myasthenia gravis affects respiratory muscles; airway management is the priority.
24. Which client teaching is appropriate for iron supplements?
(A) Take with milk
(B) Expect black stools
(C) Take on full stomach
(D) Avoid vitamin C
Correct Answer: (B) Expect black stools
Explanation: Iron can darken stools. Best absorbed on empty stomach with vitamin C.
25. Which symptom is most important to monitor after administration of morphine?
(A) Constipation
(B) Respiratory depression
(C) Itching
(D) Nausea
Correct Answer: (B) Respiratory depression
Explanation: The most serious adverse effect of morphine is respiratory depression, requiring close monitoring.
26. A client with liver cirrhosis develops ascites. Which electrolyte imbalance is most common?
(A) Hyperkalemia
(B) Hyponatremia
(C) Hypocalcemia
(D) Hypermagnesemia
Correct Answer: (B) Hyponatremia
Explanation: In cirrhosis, fluid shifts and water retention dilute sodium, leading to hyponatremia.
27. A patient with COPD is at greatest risk for which acid–base imbalance?
(A) Respiratory alkalosis
(B) Respiratory acidosis
(C) Metabolic alkalosis
(D) Metabolic acidosis
Correct Answer: (B) Respiratory acidosis
Explanation: COPD causes CO₂ retention due to hypoventilation, leading to respiratory acidosis.
28. The nurse should monitor a client on digoxin therapy for which critical electrolyte imbalance?
(A) Hypokalemia
(B) Hypernatremia
(C) Hypocalcemia
(D) Hypermagnesemia
Correct Answer: (A) Hypokalemia
Explanation: Low potassium increases digoxin toxicity risk, so levels must be closely monitored.
29. A client with a chest tube suddenly develops severe shortness of breath, absent breath sounds on one side, and tracheal deviation. What is the priority action?
(A) Notify the physician
(B) Clamp the chest tube
(C) Prepare for needle decompression
(D) Increase oxygen flow
Correct Answer: (C) Prepare for needle decompression
Explanation: These are signs of a tension pneumothorax, requiring emergency decompression.
30. A diabetic patient is sweating, trembling, and confused. Which intervention should the nurse perform first?
(A) Give insulin
(B) Administer glucose or juice
(C) Check ketones in urine
(D) Call the physician
Correct Answer: (B) Administer glucose or juice
Explanation: These are signs of hypoglycemia, which requires immediate glucose replacement.
31. A nurse caring for a client with heart failure notes pitting edema in the legs. What is the underlying cause?
(A) Increased oncotic pressure
(B) Fluid volume overload
(C) Decreased venous return
(D) Increased cardiac output
Correct Answer: (B) Fluid volume overload
Explanation: Heart failure reduces cardiac output, causing fluid retention and edema formation.
32. Which sign indicates hypocalcemia?
(A) Trousseau’s sign
(B) Chvostek’s sign
(C) Both A and B
(D) Babinski’s reflex
Correct Answer: (C) Both A and B
Explanation: Hypocalcemia causes neuromuscular irritability, leading to positive Trousseau’s and Chvostek’s signs.
33. A patient with a history of myocardial infarction is prescribed nitroglycerin. What is its primary action?
(A) Decreases preload and afterload
(B) Increases myocardial contractility
(C) Reduces heart rate
(D) Prevents clot formation
Correct Answer: (A) Decreases preload and afterload
Explanation: Nitroglycerin dilates veins and arteries, reducing cardiac workload and oxygen demand.
34. Which finding is an early sign of hypoxia?
(A) Cyanosis
(B) Restlessness
(C) Bradycardia
(D) Hypotension
Correct Answer: (B) Restlessness
Explanation: Restlessness, anxiety, and tachycardia appear before late signs like cyanosis.
35. Which laboratory test best indicates renal function?
(A) Serum creatinine
(B) Hemoglobin
(C) Serum albumin
(D) Blood glucose
Correct Answer: (A) Serum creatinine
Explanation: Creatinine is a reliable measure of kidney function since it is excreted only by kidneys.
36. A client with tuberculosis is started on isoniazid (INH). What vitamin supplement is prescribed to prevent complications?
(A) Vitamin A
(B) Vitamin B6 (pyridoxine)
(C) Vitamin C
(D) Vitamin D
Correct Answer: (B) Vitamin B6 (pyridoxine)
Explanation: INH therapy may cause peripheral neuropathy, prevented with pyridoxine supplementation.
37. Which condition is most associated with “moon face” and “buffalo hump”?
(A) Addison’s disease
(B) Cushing’s syndrome
(C) Hyperthyroidism
(D) Hypoparathyroidism
Correct Answer: (B) Cushing’s syndrome
Explanation: Excess cortisol causes fat redistribution, leading to moon face and buffalo hump.
38. A patient with chronic kidney disease has pruritus (itching). What causes this symptom?
(A) Fluid overload
(B) Uremic toxins in the skin
(C) Electrolyte imbalance
(D) High blood sugar
Correct Answer: (B) Uremic toxins in the skin
Explanation: Uremia leads to waste product accumulation in the skin, causing severe itching.
39. Which dietary instruction is most important for a client taking warfarin?
(A) Avoid dairy products
(B) Limit foods high in vitamin K
(C) Increase protein intake
(D) Avoid citrus fruits
Correct Answer: (B) Limit foods high in vitamin K
Explanation: Vitamin K reduces warfarin’s effectiveness, so intake should be consistent and limited.
40. Which type of isolation is required for a patient with varicella (chickenpox)?
(A) Contact precautions
(B) Droplet precautions
(C) Airborne precautions
(D) Reverse isolation
Correct Answer: (C) Airborne precautions
Explanation: Varicella spreads through airborne particles, so N95 mask and negative pressure room are required.
41. Which electrolyte imbalance is most likely in a client taking loop diuretics like furosemide?
(A) Hyperkalemia
(B) Hypokalemia
(C) Hypercalcemia
(D) Hypernatremia
Correct Answer: (B) Hypokalemia
Explanation: Loop diuretics promote potassium loss, increasing risk of arrhythmias.
42. Which symptom indicates increased intracranial pressure (ICP)?
(A) Hypotension and bradycardia
(B) Hypertension, bradycardia, irregular respirations
(C) Tachycardia and hyperventilation
(D) Low temperature and tachypnea
Correct Answer: (B) Hypertension, bradycardia, irregular respirations
Explanation: This is Cushing’s triad, a classic sign of raised ICP.
43. A nurse is preparing to give blood transfusion. Which nursing action is priority?
(A) Verify patient identity and blood product with another nurse
(B) Start infusion with 5% dextrose
(C) Monitor hemoglobin level
(D) Warm the blood before infusion
Correct Answer: (A) Verify patient identity and blood product with another nurse
Explanation: Correct patient–blood match prevents fatal transfusion reactions.
44. Which clinical feature is seen in hyperthyroidism (Graves’ disease)?
(A) Cold intolerance
(B) Weight gain
(C) Exophthalmos
(D) Bradycardia
Correct Answer: (C) Exophthalmos
Explanation: Hyperthyroidism increases metabolism and causes bulging eyes (exophthalmos).
45. A client with acute pancreatitis should avoid which type of food?
(A) High-fiber
(B) High-protein
(C) High-fat
(D) Low-carbohydrate
Correct Answer: (C) High-fat
Explanation: Fat stimulates pancreatic enzymes and worsens inflammation.
46. Which finding is typical in Parkinson’s disease?
(A) Muscle rigidity, tremors, bradykinesia
(B) Spastic paralysis, memory loss
(C) Seizures and nystagmus
(D) Muscle wasting
Correct Answer: (A) Muscle rigidity, tremors, bradykinesia
Explanation: Parkinson’s is marked by dopamine deficiency, causing slow movement, tremors, and rigidity.
47. A nurse is teaching a patient with pernicious anemia about treatment. What is essential therapy?
(A) Oral iron supplements
(B) Vitamin B12 injections for life
(C) High-protein diet
(D) Folic acid tablets
Correct Answer: (B) Vitamin B12 injections for life
Explanation: Pernicious anemia results from B12 absorption failure, requiring lifelong B12 injections.
48. Which condition is a complication of uncontrolled hypertension?
(A) Cataracts
(B) Stroke
(C) Osteoporosis
(D) Peptic ulcer
Correct Answer: (B) Stroke
Explanation: Hypertension damages blood vessels, raising risk for cerebrovascular accidents.
49. Which lab test is used to monitor effectiveness of heparin therapy?
(A) PT/INR
(B) aPTT
(C) Platelet count
(D) D-dimer
Correct Answer: (B) aPTT
Explanation: Activated partial thromboplastin time (aPTT) is monitored for heparin effectiveness.
50. A patient with diabetes insipidus is at risk for which complication?
(A) Hyponatremia
(B) Dehydration
(C) Hypoglycemia
(D) Fluid overload
Correct Answer: (B) Dehydration
Explanation: Diabetes insipidus causes excessive water loss due to low ADH, leading to dehydration.
You’ve completed Part 1 (1–50 MCQs) of NCLEX Medical-Surgical Nursing. If you practiced carefully, you now have a stronger grasp on topics like cardiovascular health, electrolyte imbalances, fluid management, infection control, and endocrine conditions.
👉 Don’t stop here! Continue your preparation with Part 2 (51–100 MCQs) and beyond. Each part builds on critical nursing knowledge to ensure that when you sit for your exam, you are confident, accurate, and fully prepared.
Stay tuned — more NCLEX Medical-Surgical Nursing practice sets are coming soon to help you achieve your dream of becoming a licensed nurse.
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