1,300+ Medical-Surgical Nursing Questions for the PNLE (2026)
Introduction
Medical-Surgical Nursing feels endless because it is not one topic. It is a way of reading an adult patient: what is unstable, what can deteriorate, and what the nurse should do first. Sa PNLE, the disease name is often only the setting. The real question is priority.
This hub contains questions from Tangerine's live Medical-Surgical practice area. Use the filters and topic links to move from broad practice into the system that keeps costing you points. Read the rationale even when you are correct; a lucky answer is not yet a reliable nursing decision.
Key concepts
What to expect on the PNLE
Do not reduce MedSurg review to a list of diseases. Across NP3 and NP4, expect clinical scenarios that make you do four moves:
- Recognize instability. New stridor, falling oxygen saturation, acute confusion, uncontrolled bleeding, and sudden hypotension change the order immediately.
- Separate assessment from action. Assessment comes first when data are missing. When the stem already proves an emergency, another routine assessment may only delay care.
- Choose the nursing priority. Prefer the safe, immediate, in-scope action before documentation or non-urgent teaching.
- Reassess the response. After an intervention, the next best answer often checks whether airway, perfusion, pain, output, or mental status improved.
The official PNLE blueprint is the final guide to competencies and cognitive demand. Question counts by disease are not fixed promises, so this page does not invent them.
Study tips
- Practice one system, then mix. Build the rule in a focused set before testing whether you can retrieve it beside unrelated cases.
- Write the deciding clue. After every miss, note the phrase that should have changed your priority.
- Compare the two best options. Do not explain all four equally. Name why your tempting distractor comes second.
- Turn repeat misses into cards. In Tangerine, you can build custom packs or ask Cleo to create cards from the current question and rationale.
- Use the report. Review the concept and focus-area breakdown before choosing the next set. Huwag puro random kapag obvious na ang weak area.
Common mistakes to avoid
- Memorizing isolated normal values: a laboratory value matters because of the patient's trend, symptoms, medications, and risk—not because it looks red on a screen.
- Choosing a complete but delayed plan: the PNLE often asks for the first action, not everything the team will eventually do.
- Treating pain as automatically first: pain matters, but airway compromise, shock, active bleeding, and sudden neurologic change come before comfort.
- Ignoring medication context: new fever on an antithyroid drug, bleeding on an anticoagulant, or bradycardia on a rate-lowering drug can be the real clue.
- Doing hundreds of items without reviewing: volume can hide the fact that the same reasoning error is repeating.
Try a question
A real Medical-Surgical question from our bank. Give it a shot.
A client with age-related macular degeneration asks about expected vision changes. Which statement by the nurse is correct?
Age-related macular degeneration (AMD) is the primary cause of irreversible central vision loss in adults over age 60. Understanding its pathophysiology and clinical manifestations enables nurses to provide accurate education and anticipate care needs.
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Central vision — the area responsible for activities like reading, recognizing faces, and driving — is located in the macula of the retina. In AMD, degenerative changes occur specifically in this region, leading to a progressive, often painless decline in central visual acuity. The classic symptom is a gradual loss of central vision while peripheral (side) vision remains unaffected. Clients may report blurred central images, difficulty seeing fine details, or a dark/blank spot in the center of their visual field (a "central scotoma").
| Option | Analysis |
|---|---|
| A. Peripheral vision will be lost | Incorrect: Peripheral vision is typically spared in AMD. Conditions such as glaucoma or retinitis pigmentosa classically cause peripheral (tunnel) vision loss. AMD targets the macula, not the peripheral retina. |
| B. Color vision will be lost first | Incorrect: While subtle color discrimination may eventually be affected due to macular involvement, the initial and most prominent loss is in central visual acuity, not color vision. Early color loss is more characteristic of optic nerve diseases, not AMD. |
| C. Central vision will gradually decrease | Correct: This statement directly reflects the main feature of AMD. Central vision loss develops progressively, affecting tasks that require detailed focus. Peripheral vision, which is essential for general navigation, remains intact. |
| D. Night vision will be severely affected | Incorrect: Night (low-light) vision is more severely impacted in retinal diseases affecting rod photoreceptors, such as retinitis pigmentosa or advanced cataracts. In AMD, night vision is not the hallmark; central daylight vision is predominantly compromised. |
Clinical pearl: Remember that destruction of the macula (central retina) = loss of central vision. Think "Aging Macula = Diminished Middle Vision."
Nursing education focuses on supporting coping strategies, maximizing remaining vision (e.g., using magnifiers), and emphasizing regular ophthalmologic screening. It is important to guide clients to maintain independence and safety in daily living, as reading and identifying faces become challenging.
This question requires you to synthesize knowledge of anatomy, pathophysiology, and clinical manifestation, demonstrating nursing judgment in client teaching. Always connect disease location to the functional outcome: macula (center), so central vision is lost.
- Hinkle, Janice L., Cheever, Kerry H., & Overbaugh, Kristen J. (2022). Brunner & Suddarth's Textbook of Medical-Surgical Nursing (15th ed.). Wolters Kluwer. https://shop.lww.com/Brunner---Suddarth-s-Textbook-of-Medical-Surgical-Nursing/p/9781975161033
More Medical-Surgical questions
1361+ questions available. Sign up to practice all of them.
Which vision change creates the greatest driving hazard for a patient with chronic glaucoma?
A patient with ALS develops weak cough, orthopnea, morning headache, and declining forced vital capacity. Which intervention targets the complication most directly associated with this pattern and survival?
A patient with depression has low energy and early fullness after a few bites, but swallowing is safe. Preferred nutrient-dense foods are already selected, and intake and weight will be monitored. Which meal schedule should the nurse support next?
Practice questions
Q: A client two hours after thyroidectomy develops high-pitched breathing and restlessness. What is the priority?
Answer: C. Stridor suggests acute airway obstruction. Pain and possible hypocalcemia matter, but neither comes before a threatened airway. Practice more in Tangerine
Q: A client receiving heparin develops hematuria and spontaneous gum bleeding. What should the nurse do first?
Answer: B. The findings indicate active bleeding during anticoagulation. Hold the infusion according to protocol and escalate; protamine sulfate is the reversal agent the team may prepare. Practice more in Tangerine
Q: Which finding in a client with heart failure should the nurse report as the clearest sign of worsening fluid retention?
Answer: A. Rapid weight gain is a sensitive sign of fluid accumulation. The other findings are not, by themselves, the clearest evidence of acute retention. Practice more in Tangerine
Q: A conscious client with diabetes is trembling and diaphoretic. Capillary glucose is 54 mg/dL. What should the nurse give first?
Answer: A. A conscious client with hypoglycemia can receive fast-acting carbohydrate immediately, followed by reassessment. Fat slows absorption, insulin worsens the problem, and treatment should not be delayed. Practice more in Tangerine
Q: Fifteen minutes after a blood transfusion begins, a client develops chills, dyspnea, and back pain. What is the nurse's first action?
Answer: B. Stop the transfusion immediately when a reaction is suspected. Keep the IV line open with compatible normal saline using new tubing, then follow the facility's reaction protocol. Practice more in Tangerine
References and further reading
- PRC Enhanced Table of Specifications for Nurses Licensure Examination official
The official competency and cognitive-level blueprint used to frame PNLE review. - OpenStax Medical-Surgical Nursing textbook
An openly accessible medical-surgical nursing reference for concept repair. - Tangerine Prep question bank
The live source for current Tangerine question counts, rationales, reports, flashcards, cheat sheets, and practice modes.