🩺 NCLEX Medical-Surgical Nursing MCQs (Part 3: 101–150)
Medical-Surgical Nursing is one of the most crucial sections of the NCLEX exam. To help you practice effectively, we have compiled NCLEX Medical-Surgical Nursing MCQs (Part 3: Questions 101–150) with correct answers and detailed explanations. These practice questions cover high-yield topics such as cardiovascular disorders, respiratory conditions, renal complications, gastrointestinal diseases, hematology, and post-operative nursing care.
By practicing these NCLEX-style questions, nursing students, USRN candidates, and international nurses preparing for licensure in the USA, UK, Canada, Australia, and other countries can strengthen their exam preparation and clinical knowledge.
Q101.
A nurse is caring for a patient with a chest tube connected to a water-seal drainage system. Bubbling is observed in the water-seal chamber. What does this indicate?
A. Air leak in the system ✅
B. Normal drainage pattern
C. Need for chest tube removal
D. Blocked tubing
Answer & Explanation:
Bubbling in the water-seal chamber indicates an air leak either from the patient’s lung or from the drainage system. Intermittent bubbling during exhalation may be normal postoperatively, but continuous bubbling suggests a leak that requires investigation.
Q102.
A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). The nurse expects which initial treatment?
A. IV insulin infusion ✅
B. Subcutaneous insulin injection
C. Oral hypoglycemic medication
D. High-protein diet
Answer & Explanation:
The priority in DKA is IV insulin infusion to reduce blood glucose and correct acidosis. Fluid replacement and electrolyte monitoring, especially potassium, are also essential. Oral medications are ineffective in type 1 diabetes.
Q103.
During a blood transfusion, the patient develops chills, fever, and low back pain. What is the nurse’s first action?
A. Stop the transfusion immediately ✅
B. Administer antihistamines
C. Increase IV flow rate
D. Notify the laboratory
Answer & Explanation:
Chills, fever, and low back pain indicate an acute hemolytic transfusion reaction. The first priority is to stop the transfusion immediately to prevent further hemolysis, then maintain IV access with normal saline, and notify the provider and lab.
Q104.
A nurse is caring for a patient with chronic kidney disease (CKD). Which diet is most appropriate?
A. Low protein, low sodium ✅
B. High potassium, high protein
C. Low carbohydrate, high sodium
D. High fat, high protein
Answer & Explanation:
In CKD, a low protein diet helps reduce the accumulation of nitrogenous waste. Sodium restriction helps prevent hypertension and fluid retention. Potassium restriction may also be required if hyperkalemia develops.
Q105.
A patient with cirrhosis develops ascites. Which nursing intervention is most important?
A. Encourage increased fluid intake
B. Measure abdominal girth daily ✅
C. Encourage high-sodium diet
D. Limit rest and encourage ambulation
Answer & Explanation:
Daily measurement of abdominal girth helps monitor fluid accumulation in ascites. Sodium restriction and diuretics are usually prescribed. Increasing fluids or sodium intake would worsen ascites.
Q106.
Which symptom is most characteristic of left-sided heart failure?
A. Jugular vein distension
B. Pulmonary congestion ✅
C. Peripheral edema
D. Ascites
Answer & Explanation:
Left-sided heart failure primarily affects the lungs due to backup of blood into the pulmonary circulation, leading to pulmonary congestion (dyspnea, orthopnea, crackles). Right-sided heart failure causes systemic symptoms like JVD, edema, and ascites.
Q107.
A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse observes increasing drowsiness. What is the priority action?
A. Decrease oxygen flow to 1–2 L/min ✅
B. Place the patient in supine position
C. Increase oxygen flow further
D. Continue as ordered
Answer & Explanation:
Patients with COPD rely on hypoxic drive to stimulate breathing. High oxygen levels can reduce their respiratory drive, causing CO₂ retention and drowsiness. Oxygen should be maintained at the lowest effective dose (1–2 L/min).
Q108.
A nurse is caring for a patient with Addison’s disease. Which finding requires immediate intervention?
A. Blood pressure 80/50 mmHg ✅
B. Weight loss of 2 kg in a week
C. Increased skin pigmentation
D. Fatigue
Answer & Explanation:
Addison’s disease can cause adrenal crisis, characterized by severe hypotension due to cortisol deficiency. A BP of 80/50 requires immediate intervention with IV fluids and corticosteroids.
Q109.
Which laboratory finding is most important to monitor in a patient receiving heparin therapy?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT) ✅
C. Platelet count
D. Hematocrit
Answer & Explanation:
Heparin therapy is monitored by aPTT, which should be 1.5–2.5 times the normal control value. PT is used for warfarin monitoring. Platelets and hematocrit may also be checked but are not the primary monitoring parameter.
Q110.
A patient who had thyroidectomy develops tingling around the mouth and muscle twitching. What is the likely cause?
A. Hypokalemia
B. Hypocalcemia ✅
C. Hypernatremia
D. Hypermagnesemia
Answer & Explanation:
After thyroidectomy, there is a risk of hypocalcemia due to accidental removal or damage of parathyroid glands. Symptoms include tingling, twitching, and positive Chvostek’s and Trousseau’s signs.
Q111.
A patient with hyperthyroidism is prescribed propranolol. What is the purpose of this medication?
A. To block thyroid hormone production
B. To relieve anxiety and tremors ✅
C. To stimulate thyroid hormone release
D. To prevent goiter formation
Answer & Explanation:
Propranolol is a beta-blocker. It does not affect thyroid hormone production but helps manage symptoms like tachycardia, tremors, and anxiety associated with hyperthyroidism.
Q112.
Which position should a patient be placed in immediately after a liver biopsy?
A. Supine
B. Left side
C. Right side ✅
D. High Fowler’s
Answer & Explanation:
After a liver biopsy, the patient should be positioned on the right side to apply pressure and prevent bleeding from the biopsy site.
Q113.
A patient with myocardial infarction reports chest pain unrelieved by nitroglycerin. Which medication should the nurse anticipate administering?
A. Aspirin
B. Morphine sulfate ✅
C. Heparin
D. Furosemide
Answer & Explanation:
If chest pain persists despite nitroglycerin, morphine sulfate is used for pain relief and to reduce cardiac workload. Aspirin and heparin are important in MI management but not for immediate pain relief.
Q114.
Which electrolyte imbalance is most associated with loop diuretics (e.g., furosemide)?
A. Hyperkalemia
B. Hypokalemia ✅
C. Hypernatremia
D. Hypermagnesemia
Answer & Explanation:
Loop diuretics cause significant potassium loss, leading to hypokalemia, which can cause arrhythmias, muscle weakness, and fatigue.
Q115.
A nurse is caring for a patient with tuberculosis (TB). Which precaution is required?
A. Droplet
B. Contact
C. Airborne ✅
D. Standard only
Answer & Explanation:
TB spreads via airborne transmission, so airborne precautions (N95 mask, negative-pressure room) are necessary. Droplet precautions are for influenza and meningitis.
Q116.
Which finding in a patient with a tracheostomy requires immediate action?
A. Small amount of sputum
B. Subcutaneous emphysema around the tracheostomy site ✅
C. Patient coughing during suctioning
D. Slight redness around the stoma
Answer & Explanation:
Subcutaneous emphysema suggests an air leak into the tissues, which can compromise the airway. This requires immediate provider notification.
Q117.
A patient is admitted with suspected meningitis. Which action should the nurse take first?
A. Start IV antibiotics ✅
B. Administer antipyretics
C. Place in high Fowler’s position
D. Obtain a urine sample
Answer & Explanation:
IV antibiotics should be started immediately once meningitis is suspected, even before lab confirmation, to prevent rapid deterioration. Supportive care follows.
Q118.
Which assessment finding is most concerning in a patient with peritonitis?
A. Abdominal pain
B. Rigid, board-like abdomen ✅
C. Fever
D. Nausea
Answer & Explanation:
A rigid, board-like abdomen is a classic sign of peritonitis, indicating serious intra-abdominal infection and risk for sepsis.
Q119.
A patient with COPD is prescribed theophylline. Which finding requires immediate provider notification?
A. Nausea and vomiting ✅
B. Increased appetite
C. Dry mouth
D. Coughing
Answer & Explanation:
Nausea, vomiting, restlessness, and arrhythmias indicate theophylline toxicity, which requires immediate intervention due to its narrow therapeutic range.
Q120.
A patient with rheumatoid arthritis reports morning stiffness. What is the nurse’s best advice?
A. “Take pain medication before bedtime.”
B. “Apply cold packs in the morning.”
C. “Take a warm shower to relieve stiffness.” ✅
D. “Avoid any activity until noon.”
Answer & Explanation:
Warm showers or moist heat in the morning help reduce joint stiffness in rheumatoid arthritis by improving circulation and flexibility.
Q121.
A patient has just returned from surgery with a nasogastric tube (NGT) in place. Which finding should be reported immediately?
A. Greenish drainage in the NGT
B. Absence of bowel sounds
C. NGT output of 300 mL in 4 hours ✅
D. Small amount of mucus in drainage
Answer & Explanation:
Excessive NGT drainage (>200 mL in a few hours) may indicate bleeding or gastric perforation. Absence of bowel sounds is normal postoperatively.
Q122.
Which is the most important nursing intervention for a patient on total parenteral nutrition (TPN)?
A. Monitor weight weekly
B. Change IV tubing every 24 hours ✅
C. Assess oral intake
D. Provide high-protein snacks
Answer & Explanation:
With TPN, infection control is critical. IV tubing must be changed every 24 hours to reduce risk of sepsis. Daily weights and blood glucose monitoring are also important.
Q123.
A patient with hypertension is prescribed lisinopril. Which side effect should the nurse monitor for?
A. Bradycardia
B. Cough ✅
C. Constipation
D. Hypoglycemia
Answer & Explanation:
ACE inhibitors like lisinopril often cause a dry cough due to increased bradykinin levels. They can also cause hyperkalemia and angioedema.
Q124.
Which clinical finding indicates hypoglycemia?
A. Increased thirst and urination
B. Shakiness and diaphoresis ✅
C. Slow wound healing
D. Blurred vision
Answer & Explanation:
Hypoglycemia presents with shakiness, sweating, confusion, and palpitations. Hyperglycemia causes polyuria, polydipsia, and long-term complications like poor wound healing.
Q125.
A patient on warfarin reports bleeding gums. What lab test should be reviewed?
A. aPTT
B. PT/INR ✅
C. Platelet count
D. Hemoglobin
Answer & Explanation:
Warfarin is monitored using PT/INR. An INR above the therapeutic range increases bleeding risk.
Q126.
A patient with heart failure is prescribed digoxin. Which symptom indicates possible digoxin toxicity?
A. Constipation
B. Yellow-green vision ✅
C. Increased appetite
D. Weight gain
Answer & Explanation:
Yellow-green halos around lights, nausea, vomiting, and bradycardia are classic signs of digoxin toxicity.
Q127.
Which intervention is most important when administering IV potassium chloride?
A. Give by IV push
B. Dilute in IV fluid and infuse slowly ✅
C. Give with dextrose solution
D. Mix with antibiotics
Answer & Explanation:
Potassium chloride must never be given IV push. It must always be diluted and infused slowly to prevent cardiac arrest.
Q128.
A patient is admitted with diabetic ketoacidosis (DKA). Which IV fluid is administered first?
A. Normal saline (0.9% NaCl) ✅
B. D5W
C. Lactated Ringer’s
D. 0.45% NaCl
Answer & Explanation:
In DKA, patients are severely dehydrated. The first priority is fluid resuscitation with isotonic saline (0.9% NaCl) before insulin therapy.
Q129.
Which finding in a patient with chest trauma requires immediate action?
A. Pain with breathing
B. Paradoxical chest movement ✅
C. Tachycardia
D. Bruising on chest wall
Answer & Explanation:
Paradoxical chest movement indicates flail chest, a medical emergency due to impaired ventilation.
Q130.
What is the most important nursing action for a patient with neutropenia?
A. Encourage visitors
B. Maintain strict hand hygiene ✅
C. Give fresh flowers in the room
D. Allow raw fruits and vegetables
Answer & Explanation:
Infection prevention is critical in neutropenia. Strict hand hygiene and avoiding raw/uncooked foods reduce infection risk.
Q131.
A patient with cirrhosis develops ascites. Which intervention helps relieve discomfort?
A. Encourage fluid intake
B. Position in semi-Fowler’s ✅
C. Restrict sodium and fluids
D. Administer potassium supplements
Answer & Explanation:
Positioning in semi-Fowler’s improves breathing by reducing pressure from ascites. Sodium restriction and diuretics are also part of management.
Q132.
Which lab result is most concerning in a patient taking heparin?
A. Platelets 80,000/µL ✅
B. aPTT 55 seconds
C. Hemoglobin 12 g/dL
D. INR 1.2
Answer & Explanation:
A platelet count below 100,000 suggests heparin-induced thrombocytopenia (HIT), a dangerous complication.
Q133.
Which dietary instruction is best for a patient with celiac disease?
A. Eat high-protein diet
B. Avoid gluten-containing foods ✅
C. Increase dairy products
D. Limit sugar intake
Answer & Explanation:
Celiac disease requires a strict gluten-free diet (no wheat, barley, rye).
Q134.
A patient with chronic kidney disease has pruritus. What is the most appropriate intervention?
A. Encourage hot showers
B. Provide antihistamines ✅
C. Apply alcohol-based lotion
D. Increase protein intake
Answer & Explanation:
Pruritus in CKD is due to uremic toxins. Antihistamines and skin moisturizers provide relief. Hot showers worsen dryness.
Q135.
Which sign indicates hypocalcemia?
A. Positive Chvostek’s sign ✅
B. Hypertension
C. Flushed skin
D. Bradycardia
Answer & Explanation:
Chvostek’s and Trousseau’s signs are classic indicators of hypocalcemia, which causes neuromuscular irritability.
Q136.
A patient with sickle cell anemia reports severe pain. What is the priority intervention?
A. Apply ice packs
B. Administer IV fluids and oxygen ✅
C. Restrict activity
D. Give iron supplements
Answer & Explanation:
In sickle cell crisis, hydration and oxygen are priorities to reduce sickling and improve circulation.
Q137.
Which complication is most associated with long-term corticosteroid use?
A. Hypoglycemia
B. Osteoporosis ✅
C. Bradycardia
D. Hypotension
Answer & Explanation:
Chronic corticosteroid use leads to bone demineralization (osteoporosis), hyperglycemia, and increased infection risk.
Q138.
A nurse is teaching a patient with a permanent pacemaker. Which statement shows correct understanding?
A. “I can safely use an MRI scanner.”
B. “I should avoid close contact with microwave ovens.”
C. “I should avoid placing my cellphone directly over the pacemaker.” ✅
D. “I don’t need to carry any medical ID.”
Answer & Explanation:
Cellphones and strong magnets can interfere with pacemakers. Patients should avoid placing phones directly over the device and always carry ID.
Q139.
A patient with Parkinson’s disease is prescribed levodopa-carbidopa. Which finding suggests effectiveness?
A. Improved muscle rigidity ✅
B. Bradycardia
C. Increased tremors
D. Excessive salivation
Answer & Explanation:
Levodopa-carbidopa increases dopamine availability, reducing rigidity and bradykinesia in Parkinson’s disease.
Q140.
Which test confirms a diagnosis of HIV?
A. CBC
B. ELISA followed by Western blot ✅
C. Chest X-ray
D. Serum creatinine
Answer & Explanation:
HIV diagnosis is confirmed by a two-step process: ELISA screening followed by Western blot test.
Q141.
A nurse is caring for a patient with appendicitis. Which finding requires immediate provider notification?
A. Nausea and vomiting
B. Sudden relief of abdominal pain ✅
C. Low-grade fever
D. Loss of appetite
Answer & Explanation:
Sudden relief of pain in appendicitis may indicate rupture of appendix, a surgical emergency.
Q142.
A patient with chronic obstructive pulmonary disease (COPD) is prescribed oxygen at home. Which instruction is correct?
A. Use up to 6 L/min by nasal cannula
B. Maintain oxygen at 1–2 L/min ✅
C. Use non-rebreather mask at all times
D. Turn off oxygen when feeling better
Answer & Explanation:
COPD patients rely on hypoxic drive to breathe. High oxygen levels can suppress their drive; hence, low-flow oxygen (1–2 L/min) is prescribed.
Q143.
Which symptom is most associated with left-sided heart failure?
A. Jugular vein distension
B. Peripheral edema
C. Pulmonary crackles ✅
D. Ascites
Answer & Explanation:
Left-sided HF leads to pulmonary congestion, causing crackles, dyspnea, and orthopnea. Right-sided HF causes systemic congestion.
Q144.
A patient is receiving chemotherapy. Which lab value is most concerning?
A. WBC 2,000/µL ✅
B. Platelets 180,000/µL
C. Hemoglobin 13 g/dL
D. Potassium 4.2 mEq/L
Answer & Explanation:
Severe leukopenia (WBC <4,000/µL) increases infection risk, a life-threatening complication in chemotherapy patients.
Q145.
A patient is post-op thyroidectomy. Which finding requires immediate action?
A. Hoarseness
B. Difficulty swallowing
C. Stridor ✅
D. Sore throat
Answer & Explanation:
Stridor indicates airway obstruction due to swelling or hemorrhage and requires emergency intervention.
Q146.
Which nursing intervention is most appropriate for a patient with renal calculi (kidney stones)?
A. Encourage fluid intake ✅
B. Restrict movement
C. Give high-calcium diet
D. Limit urine output
Answer & Explanation:
Adequate fluid intake helps flush stones and prevents further stone formation.
Q147.
A patient with a gastric ulcer is prescribed omeprazole. What is its mechanism of action?
A. Neutralizes stomach acid
B. Blocks histamine receptors
C. Inhibits gastric acid secretion ✅
D. Protects mucosal lining
Answer & Explanation:
Omeprazole (PPI) works by inhibiting gastric acid secretion, promoting ulcer healing.
Q148.
Which is the priority intervention for a patient with suspected pulmonary embolism?
A. Start IV fluids
B. Administer oxygen ✅
C. Obtain ABG
D. Prepare for surgery
Answer & Explanation:
The first priority is to stabilize oxygenation by giving oxygen, then diagnostic and definitive treatments follow.
Q149.
A patient is admitted with severe pancreatitis. Which finding is most concerning?
A. Severe abdominal pain
B. Hypotension ✅
C. Elevated amylase levels
D. Nausea and vomiting
Answer & Explanation:
Hypotension in pancreatitis indicates hemorrhage or shock, which can be life-threatening.
Q150.
Which assessment is most important in a patient with a chest tube?
A. Small bubbling in the water seal chamber
B. Continuous bubbling in suction chamber
C. Sudden absence of drainage ✅
D. Fluctuation with inspiration
Answer & Explanation:
A sudden absence of drainage may indicate a blocked tube or dislodgment, which is dangerous and requires immediate intervention.
Previous Part: NCLEX Medical-Surgical Nursing Part 2
Previous Part: NCLEX Medical-Surgical Nursing Part 1
Next Part: NCLEX Medical Surgical Nursing Part 4
These NCLEX Medical-Surgical Nursing MCQs (101–150) with explanations are designed to improve your test readiness and critical thinking. By practicing consistently, you’ll gain the confidence needed to answer similar questions in the real exam.
👉 Explore our full series of NCLEX MCQs in Pharmacology, Physiology, Anatomy, Pathology, Microbiology, and Fundamentals of Nursing to complete your preparation.
Stay consistent, practice daily, and success in NCLEX will be yours! 🌟