Medical-surgical nursing makes up the largest part of most nursing licensing exams. These 30 practice questions cover the systems that come up most often, with short rationales to help you understand the reasoning.
Original revision questions, not real exam items. Always follow local protocols in practice.
Cardiovascular
1. A patient has crushing central chest pain radiating to the left arm and is sweating. What’s the nurse’s first action?
- Give a glass of water
- Call for help, record a 12-lead ECG and follow the acute coronary syndrome protocol
- Ask the patient to walk around
- Document and reassess in an hour
Answer: b. Time is muscle. Early ECG and treatment save heart tissue.
2. Which finding suggests left-sided heart failure?
- Ankle oedema only
- Breathlessness, orthopnoea and crackles in the lungs
- Raised jugular venous pressure only
- Ascites
Answer: b. Left-sided failure causes pulmonary congestion. Right-sided failure causes peripheral oedema and raised JVP.
3. What’s the best daily measure of fluid status in heart failure?
- Blood pressure
- Daily weight at the same time, on the same scales
- Urine colour
- Pulse
Answer: b. A gain of 1 kg in a day can indicate about 1 L of retained fluid.
4. A patient on furosemide complains of muscle cramps and weakness. Which electrolyte should be checked?
- Calcium only
- Potassium
- Sodium only
- Phosphate
Answer: b. Loop diuretics cause hypokalaemia.
5. Which sign suggests a deep vein thrombosis?
- Cold pale leg
- Unilateral calf swelling, warmth, redness and pain
- Bilateral ankle swelling at night
- Numbness in both feet
Answer: b.
Respiratory
6. A patient suddenly becomes breathless with pleuritic chest pain and tachycardia on day 4 after hip surgery. What’s suspected?
- Anxiety
- Pulmonary embolism
- Asthma
- Heartburn
Answer: b. Escalate urgently.
7. A patient with a tracheostomy has noisy breathing and falling SpO2. What’s the first action?
- Call the family
- Check the airway and suction the tracheostomy
- Remove the tracheostomy
- Give oral fluids
Answer: b. Follow the tracheostomy emergency algorithm if suctioning doesn’t help.
8. When teaching a patient to use a metered-dose inhaler with a spacer, which is correct?
- Press several puffs into the spacer at once
- Shake, press one puff into the spacer, then breathe in slowly or take several tidal breaths
- Use it without shaking
- Breathe out into the spacer after spraying
Answer: b.
Renal and fluids
9. Which result suggests acute kidney injury?
- Urine output 1 mL/kg/hour
- A rise in serum creatinine and urine output below 0.5 mL/kg/hour for 6 hours
- Normal creatinine
- Clear urine
Answer: b.
10. Which food should a patient with hyperkalaemia and chronic kidney disease limit?
- White rice
- Bananas, plantain, potatoes and tomatoes
- Apples
- Bread
Answer: b. These are high in potassium.
11. A patient with an arteriovenous fistula for dialysis is admitted. Which action is correct?
- Take blood pressure on the fistula arm
- Avoid BP, cannulation and blood tests on the fistula arm; check for a thrill and bruit
- Apply a tight bandage
- Elevate the arm above the head constantly
Answer: b.
Endocrine
12. A patient with diabetes is sweaty, shaky and confused. Blood glucose is 2.8 mmol/L and they can’t swallow safely. What’s the treatment?
- Oral glucose drink
- IV glucose or IM glucagon as per protocol
- Insulin
- Wait 30 minutes
Answer: b.
13. Which is a sign of hyperglycaemic hyperosmolar state (HHS)?
- Low blood glucose
- Very high glucose, severe dehydration and confusion, usually without significant ketones
- Ketones above 3 mmol/L with mild hyperglycaemia
- Weight gain
Answer: b. More common in older people with type 2 diabetes.
14. A patient on long-term steroids is vomiting and can’t take tablets. What’s the risk?
- Hypertension
- Adrenal crisis
- Hyperthyroidism
- Diabetes insipidus
Answer: b. Parenteral hydrocortisone may be needed. Escalate.
Neurological
15. A patient develops sudden facial droop, arm weakness and slurred speech. What’s the priority?
- Wait to see if it resolves
- Note the time of onset and activate the stroke pathway immediately
- Give aspirin before a scan
- Give food and fluids
Answer: b. Don’t give aspirin or anything by mouth until haemorrhage is excluded and swallowing is assessed.
16. On the Glasgow Coma Scale, a patient opens eyes to pain, makes incomprehensible sounds and localises pain. What’s the score?
- 8
- 9
- 10
- 11
Answer: b. Eyes 2 + Verbal 2 + Motor 5 = 9.
17. Which is a late sign of raised intracranial pressure?
- Headache
- Cushing’s triad: hypertension with widening pulse pressure, bradycardia and irregular breathing
- Restlessness
- Nausea
Answer: b.
Gastrointestinal
18. A patient vomits fresh blood and has HR 120 and BP 90/55. What’s the first priority?
- Give an antacid
- ABCDE assessment, large-bore IV access, bloods (including group and save/crossmatch) and urgent escalation
- Encourage oral fluids
- Book an endoscopy for next week
Answer: b.
19. Which finding suggests bowel obstruction?
- Diarrhoea with normal bowel sounds
- Colicky pain, distension, vomiting and absolute constipation
- Mild heartburn
- Increased appetite
Answer: b.
20. Before giving a feed through a nasogastric tube, how should placement be confirmed?
- Listening for a “whoosh” of air
- Aspirate pH of 5.5 or below (or chest X-ray if pH is unclear)
- Asking the patient
- Checking the tube is taped
Answer: b. The “whoosh” test is unsafe and shouldn’t be used.
Post-operative care
21. Two hours after surgery, a patient’s HR rises to 118, BP falls to 92/60 and the wound drain fills rapidly. What’s suspected?
- Pain
- Haemorrhage
- Anxiety
- Normal recovery
Answer: b. Escalate immediately.
22. Which measure helps prevent post-operative chest infection?
- Bed rest for 3 days
- Early mobilisation, deep breathing exercises and effective pain control
- Restricting fluids
- Lying flat
Answer: b.
23. A wound is red, swollen and leaking pus on day 5. What’s the likely problem?
- Normal healing
- Surgical site infection
- Allergy to dressing
- Dehiscence only
Answer: b. Swab, inform the team and monitor for sepsis.
24. A patient’s abdominal wound opens and bowel is visible. What’s the immediate action?
- Push the bowel back in
- Cover with sterile saline-soaked dressings, position with knees flexed, call for help urgently and keep nil by mouth
- Apply a dry dressing and wait
- Ask the patient to cough
Answer: b.
Haematology, infection and safety
25. During a blood transfusion, the patient develops fever, rigors, back pain and low BP. What’s the first action?
- Slow the transfusion
- Stop the transfusion, keep the line open with saline, check the patient and call for help
- Give paracetamol and continue
- Finish the unit quickly
Answer: b. Possible acute haemolytic reaction.
26. Which patient is at highest risk of pressure injury?
- A mobile 30-year-old after appendicectomy
- An immobile, incontinent, malnourished 85-year-old after a stroke
- A patient with a broken wrist
- A walking patient with asthma
Answer: b.
27. A patient on a ward develops MRSA in a wound. Which precautions are needed?
- Airborne precautions
- Contact precautions: single room if possible, gloves and apron, hand hygiene
- No precautions
- Droplet precautions only
Answer: b.
28. Which patient should the nurse assess first at the start of a shift?
- A patient waiting for discharge papers
- A post-operative patient whose SpO2 dropped from 96% to 89%
- A patient asking for a newspaper
- A stable patient due for routine observations
Answer: b. Breathing problems come first.
29. An older patient becomes acutely confused overnight. What should the nurse check first?
- Whether they have dementia
- Vital signs, blood glucose, oxygen saturation, pain, urine retention, constipation and recent medicines
- The diet chart only
- Nothing, it’s normal at night
Answer: b. Look for reversible causes of delirium.
30. A patient is prescribed IV potassium chloride. Which is correct?
- Give as an IV push
- Give only as a diluted infusion via a pump, never as a bolus
- Give undiluted for speed
- Give by IM injection
Answer: b. Concentrated potassium can cause fatal arrhythmias.
How to get the most from practice questions
- Read the question stem twice. Identify what it’s really asking: first action, priority, best response.
- Eliminate unsafe answers first.
- Apply ABCDE and Maslow when prioritising.
- Review rationales for questions you got right as well as wrong.