Med-surg practice topics: Cardiac, respiratory, neuro, GI, renal, endocrine, and oncology

Med-surg NCLEX practice covers the highest-yield systems on the exam, including cardiac, respiratory, neurological, gastrointestinal, renal, endocrine, and oncology. This list may not cover every med-surg topic, but it highlights areas to focus on as you prepare for your exam and embark on your nursing career.

Medical-surgical nursing, commonly called “med-surg,” is a high-impact area of the NCLEX-RN exam, with a heavy focus on bodily systems and procedures. Within the broader “Client Needs” categories of the test, adult health, pathophysiology, and clinical management questions make up a large portion. These questions prepare entry-level nurses to uphold high standards in med-surg settings such as hospitals and clinics.

Relevant bodily systems and related conditions can broadly categorize Med-surg subject areas. These areas prepare nurses for some of the most important aspects of their role, from diagnosing illness to administering care to supporting patient recovery. Comprehensive knowledge of med-surg topics is central to being a part of an effective healthcare team, regardless of setting.

About the NCLEX exam

The NCLEX-RN is a nursing licensure exam used in the U.S. and Canada. It includes standard multiple-choice questions plus newer, Next Generation NCLEX item types, such as Select All That Apply (SATA), bow-tie, matrix/grid, drag-and-drop, and drop-down (cloze) items, organized around four Client Needs categories:

• Safe and Effective Care Environment: Evaluates the ability to provide and direct nursing care in a delivery setting while ensuring the protection of clients and health care personnel.
  • Assesses knowledge of steps and protocols that must be taken to ensure clients and health care personnel are safe from health and environmental hazards.
• Health Promotion and Maintenance: Covers aspects of direct nursing care, understanding of treatment plans, prevention, and early detection of health issues, and strategies for optimal health.
• Psychosocial Integrity: Focuses on maintaining patients’ emotional, mental, and social well-being, supporting clients experiencing stress, and protocols for treating patients with mental illness.
• Physiological Integrity: Tests the ability to properly care for and treat clients, promoting physical health, wellness, and comfort while reducing risk through proper medication administration, emergency treatment, and other protocols.
  • These questions also test how well a nurse responds to changing situations.

Here’s a breakdown of the percentage of questions on the exam by topic. You’ll notice that Safe and Effective Care Environment and Physiological Integrity are split into several subcategories, and are some of the most heavily covered topics on the exam:

In terms of structure, the exam includes 85 to 150 questions to be finished within five hours. Unlike typical medical tests, it lacks a fixed passing score or percentage; instead, a computerized algorithm evaluates students’ performance against a set standard.

How it works: The exam automatically ends once more than 85 questions have been answered, allowing the computer to confidently determine whether you have passed or failed. If a student reaches the five-hour limit, the test concludes regardless of how many questions are answered.

The NCLEX also includes a series of case-study questions associated with a client presentation. These questions test candidates’ practical skills through real-world scenarios. Med-surg content is embedded throughout the exam and overlaps heavily with the Physiological Integrity categories, which make up roughly 40-60% of the total items.

What is med-surg in nursing?

Medical-surgical (med-surg) nursing is the largest nursing specialty, focusing on adult and child patients who are acutely ill, have chronic conditions, or are recovering from surgery. This field underpins inpatient hospital care and is typically practiced on general medical or surgical floors, distinguishing it from intensive care units (ICUs) or outpatient care in doctors’ offices.

The core duties and responsibilities of nurses who work in med-surg include:

• Patient assessments
• Medication administration
• Post-operative care: Preventing infection, managing surgical incisions and wound dressings, and helping patients move safely (e.g., to use the restroom)
• Discharge planning: Guiding at-home medication plans, checking for warning signs, and continuing follow-up care

These work environments can be fast-paced and intense, requiring nurses to multitask, act fast, and rely on quick critical thinking and clinical judgment to make decisions. Nurses must be able to balance the needs of several patients at once while also spotting warning signs when a patient’s health begins to decline.

While not all nurses work in med-surg, NCLEX questions on health and wellness that target specific systems cover topics central to all nursing practice.

Med-surg systems & disease questions

Below are brief introductions to major med-surg topic areas, along with mock questions that mimic what you may encounter on your actual NCLEX.

Cardiology/cardiac questions

Cardiology, the study of the heart and circulatory system, is heavily tested on the NCLEX. Here are some of the broader topics covered:

• Cardiac anatomy, conduction, and cycle physiology
• Hemodynamics and blood pressure regulation
• Common diseases: ischemic heart disease, heart failure, arrhythmias
• Pathophysiology of vascular disorders
• Pharmacology of cardiovascular drugs (e.g., beta blockers, ACE inhibitors)

Cardiovascular diseases are some of the most common and lethal conditions facing patients in the U.S. Nurses provide aid by coaching patients on healthy lifestyle habits and addressing issues that increase risks of cardiovascular disease, like high blood pressure and cholesterol, with medication and other therapies.

Example NCLEX question on cardiovascular med-surg:

A nurse is attending to her designated patients. She should initially evaluate the client who is exhibiting:

A. Atrial fibrillation, an elevated heart rate, and reports an occasional fluttering feeling in the chest

B. Chronic obstructive pulmonary disease, a pulse oximetry reading of 91% on room air, and reports a chronic cough

C. Heart failure, edema of the lower extremities, and reports of dyspnea

D. Fatigue and reports of generalized chest pain rated as 7 on a scale of 0-10

Answer: C. Heart failure, edema of the lower extremities, and dyspnea

Cardiovascular interventions require quick thinking and action, as these situations can quickly escalate to life-or-death cases if the heart stops working. The patient experiencing heart failure, edema (swelling), and dyspnea (shortness of breath) is at the highest risk for death, and should be the first to be taken care of out of this set of patients.

While the other patients are exhibiting earlier symptoms of issues like heart attacks or stroke, their conditions are not as advanced as the client experiencing heart failure.

When approaching these questions, remember the ABC framework. This helps nurses determine which patient should receive care first by focusing on the body’s most essential life-sustaining functions:

• Airway: Ensure the patient’s airway is open and unobstructed.
• Breathing: Assess whether the patient is breathing effectively and receiving adequate oxygen.
• Circulation: Evaluate blood flow, pulse, blood pressure, and signs of excessive bleeding.

Usually, airway issues are addressed first by ensuring oxygen flow, then by addressing breathing and circulation.

Respiratory questions

Respiratory system questions test your understanding of how we breathe and exchange gases, and illnesses or conditions that prevent normal function:

• Respiratory mechanics and ventilation
• Gas transport and oxygen-hemoglobin relationships
• Acid-base balance and respiratory control
• Pathologies: asthma, COPD, pulmonary embolism, pneumonia

The respiratory and cardiovascular systems are closely linked, and guiding patients toward a healthy lifestyle can add years to their lives.

Example NCLEX question on the respiratory system:

Aminophylline (theophylline) is given to a patient with acute bronchitis. A nurse administers the drug, understanding that its main function is to:

A. Relax smooth muscles of the bronchial airway.

B. Promote expectoration.

C. Suppress the cough.

D. Prevent an infection.

Answer: A. Relax smooth muscles of the bronchial airway

This question requires pharmacological knowledge, another important content area on the NCLEX-RN.

Neurology questions

Neurology covers the brain, spinal cord, and sensory pathways:

• Neuroanatomy and neurophysiology
• Neurotransmitters and synaptic signaling
• Neuropathology (e.g., stroke, multiple sclerosis, Parkinson’s)
• Sensory systems, vision, hearing, and balance
• Neuropharmacology and behavioral neuroscience

Consider the brain as the “central command,” with nerves functioning as the communication network that transmits vital signals. Symptoms involving the nervous system may signal serious problems related to the brain.

Example NCLEX neurology question:

The nurse and UAP are caring for a client in a long-term care facility with right-sided paralysis. Which action by the UAP needs the nurse's intervention?

A. The assistant places a gait belt around the client’s waist before assisting them in walking.

B. The assistant commends the client for trying to complete ADLs independently.

C. The assistant places the client on their back with the client’s head to the side.

D. The assistant places her hand under the client’s right axilla to help them move up in bed.

Answer: D. The assistant places her hand under the client’s right axilla to help them move up in bed.

Placing a hand under a patient’s right axilla could be dangerous because the client lacks the joint stability and muscle tone to protect their right shoulder. This question is a great example of how the NCLEX requires future nurses to understand their supervisory roles in healthcare teams that may include unlicensed support staff.

CVA NCLEX questions

A cerebrovascular accident (CVA), or stroke, is a sudden loss of brain function resulting from interrupted blood flow. NCLEX questions often assess your skills in:

• Distinguishing different types of strokes
• Identifying signs and risk factors
• Determining the first interventions
• Rehabilitating patients with speech, mobility, or other difficulties

These questions address issues related to cardiovascular, respiratory, and neurological health, as a stroke can have a traumatic effect across the entire body. Like heart-related conditions, healthy lifestyle habits and an understanding of risk factors (such as family or smoking history) are key to lowering overall CVA risk.

Example NCLEX question on CVA/stroke-related illness:

A patient is admitted with uncontrolled atrial fibrillation. The patient’s medication history includes vitamin D and calcium supplements. What type of stroke is this patient at MOST risk for?

A. Hemorrhagic

B. Ischemic thrombosis

C. Ischemic embolism

D. Ischemic stenosis

Answer: C. Ischemic embolism

An ischemic embolism is a wandering blood clot or other obstruction that restricts oxygen flow to the brain, leading to a stroke. The main detail to focus on is atrial fibrillation, a major risk factor for this kind of stroke. The use of supplements is a red herring: NCLEX questions frequently include irrelevant details to purposely confuse test-takers, so read each question and all answer choices carefully.

Gastrointestinal (GI) questions

Gastrointestinal refers to anything related to digestion, absorption, and metabolism:

• Anatomy and physiology of the GI tract
• Liver, pancreas, and gallbladder function
• Digestive enzymes and nutrient absorption
• Pathophysiology: ulcers, IBD, hepatitis, gallstones
• Pharmacologic agents affecting the GI system

This is another heavily tested portion of the NCLEX, as understanding the gastrointestinal system is crucial for diagnosing disease and managing side effects from various treatments.

Example NCLEX question on GI-related conditions:

A nurse is caring for a 41-year-old patient with a chronic exacerbation of pancreatitis. Upon reviewing the lab results, the nurse expects to see a serum amylase level that indicates the condition of:

A. 45 units/L

B. 150 units/L

C. 200 units/L

D. 500 units/L

Answer: C. 200 units/L

This question requires knowledge of normal and abnormal lab values: normal serum amylase levels range from about 25 to 151 units/L. A markedly elevated value, such as 500 units/L, reflects acute pancreatitis, as amylase typically rises to several times the upper limit of normal. Flare-ups of chronic pancreatitis can lead to mildly to moderately elevated levels.

Renal questions

Renal questions focus on the kidneys, filtration, reabsorption, and homeostasis:

• Nephron structure and kidney function
• Fluid and electrolyte regulation
• Acid-base physiology
• Disorders: Acute kidney injury, chronic renal failure, nephritic/nephrotic syndromes

The kidneys are our body’s built-in filtration system, and renal failure can rapidly result in death if not treated promptly.

Example NCLEX renal question:

Which of the following symptoms do you expect to see in a patient diagnosed with acute cystitis?

A. Flank pain and jaundice

B. Costovertebral angle tenderness and chills

C. Extreme burning sensation on urination

D. Polyuria and nocturia

Answer: C. Extreme burning sensation on urination

Cystitis, or bladder inflammation, is characterized by burning and short bursts of urination. The other symptoms listed point to other issues, such as diabetes (polyuria) or liver issues (jaundice). CVA tenderness is a sign of pyelonephritis.

Endocrine system questions

Endocrine questions center on hormonal control and its role in metabolism and body regulation:

• Hormone synthesis, feedback, and signaling
• Glucose regulation and metabolic control
• Disorders: Diabetes, thyroid dysfunction, adrenal disorders, and parathyroid conditions

This section is relevant for all nurses, as hormonal imbalances or issues can be side effects of serious conditions such as thyroid disorders.

Example NCLEX endocrine question:

A female adult client with a history of chronic hypoparathyroidism admits to non-compliance. Based on the initial assessment, the nurse identifies the nursing diagnosis as Risk for injury. To complete this diagnosis, which “related-to” phrase should the nurse include?

A. Related to bone demineralization resulting in pathologic fractures.

B. Related to tetany secondary to decreased serum calcium.

C. Related to exhaustion secondary to an accelerated metabolic rate.

D. Related to edema and dry skin secondary to interstitial fluid infiltration.

Answer: B. Related to tetany secondary to decreased serum calcium

Hypoparathyroidism occurs due to low parathyroid hormone (PTH) levels, which leads to hypocalcemia (decreased serum calcium) and hyperphosphatemia. Nurses must be aware of whether a patient is complying with their approved treatment plan and act accordingly if the patient fails to follow prescribed instructions.

Oncology/Hematology questions

Oncology is the branch of medicine that covers cancers and their treatments, while hematology involves diagnosing and treating blood disorders such as sickle cell disease and anemia.

• Recognizing oncological emergencies
• Testing and understanding the differences between different cancers and their manifestations
• Managing treatment side effects from chemotherapy and radiation (bone marrow suppression, nausea, etc.)
• Providing safe patient care for those with compromised immune systems

Example NCLEX oncology/hematology question:

A pneumonectomy is a surgical procedure occasionally used to treat non-small-cell lung cancer. It involves removing:

A. The entire lung

B. One or more segments of a lung lobe

C. One lobe of a lung

D. A small, wedge-shaped section of the lung surface

Answer: A. The entire lung

A pneumonectomy involves the removal of an entire lung and is performed only in extreme cases (watch for the root pneumo-, meaning “lung”). Lobectomy is the removal of a lobe, and a wedge resection is the removal of a section, not restricted to the lobe delineation.

How to prepare for the NCLEX

To prepare for the NCLEX, you need to apply nursing knowledge to practical scenarios. The questions are designed to reflect real medical settings where information may be limited or incomplete. As a result, you must exercise critical thinking and use context clues to make optimal decisions for your patients and collaborate effectively with nurses, doctors, and other healthcare professionals.

Generally, an NCLEX study plan should incorporate these elements:

• Take a diagnostic NCLEX test and identify areas for improvement
• Practice with realistic practice questions and quizzes
• Review key topics from anatomy, physiology, pathophysiology, and pharmacology
• Target difficult areas and avoid passively reviewing all the content
• Apply previous clinical experiences to exam scenarios for better comprehension
• Keeping up with full-length practice tests to maximize familiarity with the format

NCLEX questions are challenging and demand expert medical knowledge along with high-stakes decision-making. Regular practice over several weeks will help you identify patterns in how questions are phrased and boost your confidence for test day.

Final thoughts

Med-surg subject areas are generally divided by key bodily systems and conditions. These topics are crucial in training nurses for vital aspects of their duties, such as diagnosing illnesses, providing care, and coordinating follow-ups with patients.

While med-surg nursing specifically refers to caring for adult and pediatric patients recovering from surgery or managing acute/chronic illnesses, a thorough understanding of these topics is needed across settings. From general to emergency to specialty care, med-surg is at the core of all nursing practice.