Adult Medical-Surgical (Med-Surg) for the NCLEX-RN Exam

Common failure modes

These are the patterns that cause most candidates to lose marks on this topic. Recognising them in advance is half the work.

• !Selecting laboratory-order responses when a clinical assessment should come first
• !Missing the airway-priority rule in unstable patients (ABCs always first)
• !Confusing similar conditions: ARDS vs CHF, DKA vs HHS, MI vs PE
• !Wrong electrolyte priority in renal failure (K+ first, then Mg, then Phos)

Study tips

• 1Memorize ABC priority — airway issues always come before circulation in NCLEX scenarios.
• 2Drill electrolyte derangements: hyperkalemia ECG signs, hypocalcemia tetany, hyponatremia osmotic risk.
• 3Practice acid-base interpretation using the four-step Tic-Tac-Toe method.
• 4Know the priority assessment for each body system (e.g., neuro: Glasgow Coma Scale; cardiac: 12-lead).

Sample NCLEX-RN Adult Medical-Surgical (Med-Surg) questions

These sample items mirror the format and difficulty of real NCLEX-RN questions. Practice with thousands more on the free Koydo question bank.

1. 1

   A patient with diabetic ketoacidosis (DKA) has a blood glucose of 480 and arterial pH 7.18. The first nursing priority is:

   • AAdminister regular insulin IV bolus
   • BEstablish IV access and begin 0.9% NaClCorrect
   • CPlace on continuous cardiac monitor
   • DAdminister sodium bicarbonate
   Why this answer?

   DKA management starts with fluid resuscitation (0.9% NaCl) before insulin. Volume expansion alone reduces glucose levels and reverses acidosis. Insulin without fluids worsens hypovolemia.