🏥 NCLEX Medical-Surgical Nursing MCQs (Part 4: 151–200)
Practice NCLEX Medical-Surgical Nursing MCQs Part 4 (161–200) with correct answers and explanations. Free prep for NCLEX-RN, NCLEX-PN & nursing exams.
Preparing for the NCLEX can feel overwhelming, especially when it comes to mastering Medical-Surgical Nursing concepts. To help nursing students and professionals worldwide, we’ve created this comprehensive collection of NCLEX Medical-Surgical Nursing MCQs (Part 4: 151–200). Each question is carefully designed to reflect the type of content you’ll encounter on the NCLEX-RN and NCLEX-PN exams, covering conditions such as cardiovascular disorders, renal failure, respiratory diseases, neurological conditions, and more.
What makes this set unique is not just the correct answers but also the clear, concise explanations that reinforce learning and help you understand the rationale behind each answer. Whether you’re preparing in the USA, UK, Canada, Australia, or other regions, these MCQs provide reliable practice to boost your confidence and knowledge.
Use this set as part of your daily study routine and combine it with our earlier parts (1–3) for a complete, high-value preparation strategy.
151. A nurse is caring for a patient with congestive heart failure (CHF). Which symptom indicates worsening condition?
A. Increased urine output
B. Weight loss
C. Shortness of breath on exertion
D. Decreased edema
✅ Correct Answer: C. Shortness of breath on exertion
Explanation: Dyspnea on exertion, fatigue, and edema indicate worsening CHF. Weight loss and reduced edema show improvement.
152. A client with COPD is on 2L/min of oxygen. What should the nurse closely monitor?
A. Hypokalemia
B. Hypoxia
C. Oxygen toxicity
D. Respiratory depression
✅ Correct Answer: D. Respiratory depression
Explanation: COPD patients rely on hypoxic drive; too much oxygen can depress breathing.
153. Which electrolyte imbalance is most likely in a client with renal failure?
A. Hypocalcemia
B. Hypernatremia
C. Hypokalemia
D. Hyperkalemia
✅ Correct Answer: D. Hyperkalemia
Explanation: Failing kidneys cannot excrete potassium effectively, leading to hyperkalemia, a life-threatening condition.
154. Which intervention is priority for a client with suspected pulmonary embolism (PE)?
A. Start IV fluids
B. Administer oxygen
C. Encourage ambulation
D. Insert Foley catheter
✅ Correct Answer: B. Administer oxygen
Explanation: Pulmonary embolism causes impaired gas exchange; oxygen is priority before other interventions.
155. A patient with type 2 diabetes reports frequent urination, thirst, and fatigue. Which complication is suspected?
A. Hypoglycemia
B. Ketoacidosis
C. Hyperglycemia
D. Insulin shock
✅ Correct Answer: C. Hyperglycemia
Explanation: Polyuria, polydipsia, and fatigue are classic signs of uncontrolled high blood glucose.
156. Which sign suggests hypocalcemia after thyroid surgery?
A. Bradycardia
B. Chvostek’s sign
C. Hypertension
D. Polydipsia
✅ Correct Answer: B. Chvostek’s sign
Explanation: Chvostek’s and Trousseau’s signs indicate hypocalcemia due to possible parathyroid injury during surgery.
157. Which is the most important nursing intervention after a patient has undergone a bronchoscopy?
A. Encourage coughing
B. Assess for gag reflex
C. Monitor blood pressure
D. Start IV fluids
✅ Correct Answer: B. Assess for gag reflex
Explanation: Airway safety is priority. The nurse must confirm the gag reflex returns before giving oral fluids.
158. A patient with liver cirrhosis develops ascites. What is the primary cause?
A. Low protein diet
B. Portal hypertension
C. Increased sodium
D. Pancreatic insufficiency
✅ Correct Answer: B. Portal hypertension
Explanation: Portal hypertension leads to fluid leakage into the peritoneal cavity, causing ascites.
159. Which precaution is necessary for a patient with tuberculosis (TB)?
A. Droplet precautions
B. Contact precautions
C. Airborne precautions
D. Neutropenic precautions
✅ Correct Answer: C. Airborne precautions
Explanation: TB is spread through airborne particles; N95 masks and negative pressure rooms are essential.
160. Which complication is most serious for a patient with deep vein thrombosis (DVT)?
A. Varicose veins
B. Pulmonary embolism
C. Phlebitis
D. Chronic swelling
✅ Correct Answer: B. Pulmonary embolism
Explanation: The greatest risk from DVT is clot migration to the lungs, causing PE, which is life-threatening.
161. A patient with Addison’s disease is at risk for which electrolyte imbalance?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypercalcemia
✅ Correct Answer: B. Hyperkalemia
Explanation: Addison’s disease causes low aldosterone → sodium loss and potassium retention → hyperkalemia.
162. Which medication is commonly prescribed to prevent stroke in atrial fibrillation?
A. Aspirin
B. Digoxin
C. Warfarin
D. Furosemide
✅ Correct Answer: C. Warfarin
Explanation: Warfarin prevents clot formation in atrial fibrillation, reducing stroke risk.
163. A patient with chronic kidney disease has pruritus. What is the cause?
A. Fluid overload
B. High urea levels
C. Vitamin deficiency
D. Anemia
✅ Correct Answer: B. High urea levels
Explanation: Uremia leads to crystal deposits in the skin, causing severe itching.
164. Which finding is most important to report in a patient receiving IV furosemide?
A. Weight loss
B. Leg cramps
C. Increased urine output
D. Low blood pressure
✅ Correct Answer: B. Leg cramps
Explanation: Leg cramps may indicate hypokalemia, a dangerous side effect of loop diuretics.
165. Which diet is most appropriate for a patient with celiac disease?
A. Low fat
B. Gluten-free
C. Low protein
D. High carbohydrate
✅ Correct Answer: B. Gluten-free
Explanation: Celiac disease requires lifelong avoidance of gluten-containing foods (wheat, rye, barley).
166. A client with myasthenia gravis is at greatest risk for which complication?
A. Hypertension
B. Respiratory failure
C. Heart failure
D. Liver damage
✅ Correct Answer: B. Respiratory failure
Explanation: Weakness of respiratory muscles can cause life-threatening myasthenic crisis.
167. Which assessment finding indicates hypovolemic shock?
A. Warm skin
B. Bounding pulse
C. Hypotension and tachycardia
D. Increased urine output
✅ Correct Answer: C. Hypotension and tachycardia
Explanation: Low blood pressure and rapid weak pulse are classic signs of hypovolemic shock.
168. Which medication is contraindicated in patients with peptic ulcer disease?
A. Acetaminophen
B. Ibuprofen
C. Antacids
D. Proton pump inhibitors
✅ Correct Answer: B. Ibuprofen
Explanation: NSAIDs like ibuprofen increase gastric acid and worsen ulcers.
169. A nurse should place a client with left-sided heart failure in which position?
A. Flat supine
B. Left lateral
C. High Fowler’s
D. Trendelenburg
✅ Correct Answer: C. High Fowler’s
Explanation: Upright position improves lung expansion and decreases dyspnea.
170. A patient with Guillain-Barré syndrome is most at risk for?
A. Respiratory failure
B. Hypertension
C. Kidney failure
D. Diabetes
✅ Correct Answer: A. Respiratory failure
Explanation: Paralysis can affect respiratory muscles, making breathing support critical.
171. Which lab result is expected in a patient with liver cirrhosis?
A. Low bilirubin
B. Low ALT/AST
C. High ammonia
D. High hemoglobin
✅ Correct Answer: C. High ammonia
Explanation: Liver dysfunction causes ammonia accumulation → hepatic encephalopathy.
172. Which type of isolation is required for a patient with MRSA?
A. Airborne
B. Droplet
C. Contact
D. Neutropenic
✅ Correct Answer: C. Contact
Explanation: MRSA is spread through direct contact; gown and gloves are necessary.
173. Which test confirms HIV infection?
A. ELISA only
B. Western blot
C. CBC
D. Chest X-ray
✅ Correct Answer: B. Western blot
Explanation: ELISA is a screening test, while Western blot confirms HIV diagnosis.
174. Which symptom is most typical of Parkinson’s disease?
A. Tremors at rest
B. Muscle hypertrophy
C. Hyperactivity
D. Increased reflexes
✅ Correct Answer: A. Tremors at rest
Explanation: Resting tremors, rigidity, and bradykinesia are classic signs of Parkinson’s disease.
175. Which intervention is priority for a patient with severe asthma attack?
A. Encourage fluids
B. Administer bronchodilators
C. Provide sedatives
D. Encourage ambulation
✅ Correct Answer: B. Administer bronchodilators
Explanation: Bronchodilators (e.g., albuterol) open airways rapidly and relieve bronchospasm.
176. Which complication is associated with immobility?
A. Increased cardiac output
B. Pressure ulcers
C. Weight loss
D. Increased muscle strength
✅ Correct Answer: B. Pressure ulcers
Explanation: Prolonged immobility causes skin breakdown and ulcer formation.
177. Which finding is most important in a patient with diabetic ketoacidosis (DKA)?
A. Kussmaul breathing
B. Hypertension
C. Bradycardia
D. Weight gain
✅ Correct Answer: A. Kussmaul breathing
Explanation: Deep rapid breathing is a compensatory mechanism for metabolic acidosis.
178. Which sign indicates hypoglycemia?
A. Polyuria
B. Sweating and tremors
C. Slow pulse
D. Flushed skin
✅ Correct Answer: B. Sweating and tremors
Explanation: Low blood sugar causes adrenergic symptoms like sweating, tremors, and irritability.
179. A client with thyroid storm will most likely present with?
A. Bradycardia
B. Hypertension and fever
C. Hypotension and cold skin
D. Weight gain
✅ Correct Answer: B. Hypertension and fever
Explanation: Thyroid storm is life-threatening with tachycardia, hypertension, fever, and agitation.
180. Which medication is used to treat opioid overdose?
A. Atropine
B. Naloxone
C. Flumazenil
D. Diazepam
✅ Correct Answer: B. Naloxone
Explanation: Naloxone (Narcan) is an opioid antagonist that reverses respiratory depression.
181. Which test is best for diagnosing myocardial infarction (MI)?
A. ECG only
B. Troponin levels
C. Chest X-ray
D. CBC
✅ Correct Answer: B. Troponin levels
Explanation: Elevated troponin is the most specific marker for heart muscle damage.
182. Which food should be avoided in a patient taking warfarin?
A. Milk
B. Green leafy vegetables
C. Meat
D. Apples
✅ Correct Answer: B. Green leafy vegetables
Explanation: High vitamin K foods interfere with warfarin’s anticoagulant effect.
183. Which assessment is most critical after a thyroidectomy?
A. Pain level
B. Voice changes
C. Airway patency
D. Swallowing ability
✅ Correct Answer: C. Airway patency
Explanation: Swelling or bleeding may obstruct airway, making breathing priority.
184. Which condition is caused by deficiency of vitamin D?
A. Rickets
B. Scurvy
C. Pellagra
D. Beriberi
✅ Correct Answer: A. Rickets
Explanation: Vitamin D deficiency weakens bones, leading to rickets in children.
185. Which is the best diet for a patient with hypertension?
A. High sodium
B. DASH diet
C. High protein
D. High fat
✅ Correct Answer: B. DASH diet
Explanation: The DASH diet emphasizes fruits, vegetables, and low sodium, proven to reduce blood pressure.
186. Which symptom is expected in hypokalemia?
A. Muscle weakness
B. Tremors
C. Bradycardia
D. Seizures
✅ Correct Answer: A. Muscle weakness
Explanation: Low potassium affects muscle function, leading to weakness and cramps.
187. Which finding indicates peritonitis?
A. Soft abdomen
B. Rebound tenderness
C. Increased bowel sounds
D. Diarrhea
✅ Correct Answer: B. Rebound tenderness
Explanation: Severe abdominal pain with rebound tenderness suggests peritonitis.
188. Which nursing action is most important for a patient with seizure disorder?
A. Place tongue blade in mouth
B. Restrain patient during seizure
C. Protect airway and prevent injury
D. Give water during seizure
✅ Correct Answer: C. Protect airway and prevent injury
Explanation: The priority is safety and airway protection; do not insert objects or restrain.
189. Which hormone is deficient in diabetes insipidus?
A. Insulin
B. ADH
C. Cortisol
D. Thyroxine
✅ Correct Answer: B. ADH
Explanation: Diabetes insipidus results from lack of antidiuretic hormone, causing excessive urination.
190. Which intervention prevents ventilator-associated pneumonia (VAP)?
A. Elevating head of bed 30–45°
B. Giving extra fluids
C. Increasing suctioning
D. Providing sedatives
✅ Correct Answer: A. Elevating head of bed 30–45°
Explanation: Upright positioning reduces aspiration risk and lowers VAP incidence.
191. Which complication is most associated with prolonged immobility?
A. Hypoglycemia
B. Thrombophlebitis
C. Hypertension
D. Diarrhea
✅ Correct Answer: B. Thrombophlebitis
Explanation: Stasis of blood in immobile patients increases risk of clot formation.
192. Which electrolyte imbalance is common in dehydration?
A. Hyponatremia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
✅ Correct Answer: B. Hypernatremia
Explanation: Water loss without sodium loss concentrates sodium in blood.
193. Which intervention is priority for a patient with increased intracranial pressure (ICP)?
A. Flat supine position
B. Encourage coughing
C. Keep head midline, 30° elevation
D. Increase fluids
✅ Correct Answer: C. Keep head midline, 30° elevation
Explanation: Proper positioning promotes venous drainage and reduces ICP.
194. Which vaccine is recommended for adults over 65 years?
A. MMR
B. Tetanus
C. Pneumococcal
D. Varicella
✅ Correct Answer: C. Pneumococcal
Explanation: Pneumococcal vaccine helps protect elderly from pneumonia and sepsis.
195. Which lab finding is expected in a patient with anemia?
A. High hemoglobin
B. Low hemoglobin and hematocrit
C. High platelets
D. Low WBC
✅ Correct Answer: B. Low hemoglobin and hematocrit
Explanation: Anemia is defined by reduced hemoglobin and hematocrit levels.
196. Which intervention is priority for a client experiencing anaphylaxis?
A. Administer epinephrine
B. Give IV fluids
C. Administer antihistamines
D. Monitor vital signs
✅ Correct Answer: A. Administer epinephrine
Explanation: Epinephrine immediately reverses airway obstruction and shock in anaphylaxis.
197. Which finding is typical in left-sided heart failure?
A. Peripheral edema
B. Ascites
C. Pulmonary congestion
D. Jugular vein distension
✅ Correct Answer: C. Pulmonary congestion
Explanation: Left-sided failure leads to blood backing up into the lungs, causing dyspnea and crackles.
198. Which medication is commonly used for status epilepticus?
A. Lorazepam
B. Warfarin
C. Furosemide
D. Atropine
✅ Correct Answer: A. Lorazepam
Explanation: Lorazepam is the first-line drug for stopping prolonged seizures.
199. Which blood test is used to monitor heparin therapy?
A. INR
B. aPTT
C. PT
D. CBC
✅ Correct Answer: B. aPTT
Explanation: Activated partial thromboplastin time (aPTT) monitors heparin effectiveness.
200. Which electrolyte is most critical to monitor in a patient with burns?
A. Calcium
B. Sodium
C. Potassium
D. Magnesium
✅ Correct Answer: C. Potassium
Explanation: Burns cause massive cell damage, releasing potassium into the blood → hyperkalemia.
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This concludes NCLEX Medical-Surgical Nursing MCQs Part 4 (151–200). By now, you should have a stronger understanding of key topics like cardiovascular emergencies, electrolyte imbalances, respiratory complications, and critical care interventions. These questions are not just exam-oriented but also reflect real-world nursing scenarios, making them valuable for clinical practice.
We recommend reviewing all four parts of our NCLEX Medical-Surgical Nursing MCQs series to maximize your preparation. Don’t forget to explore our other NCLEX sections, including Pharmacology, Physiology, Anatomy, Pathology, Microbiology, and Fundamentals of Nursing, for complete coverage.
💡 Keep practicing, revisit explanations often, and stay consistent. With the right preparation, you’ll be ready to succeed on your NCLEX exam and step confidently into your nursing career.