Top Med-Surg NCLEX Topics You Can’t Afford to Miss

If Med-Surg feels huge, you’re not alone. The NCLEX tests how safely you apply knowledge—not how much you memorized. Use this focused guide to study the Med-Surg NCLEX topics that appear most and matter most for safe care.

How to use this guide

• Skim each system.

• Note red-flag findings and first actions.

• Drill questions daily and review rationales.

1) Cardiovascular (always high yield)

• Heart failure: Left vs right signs; daily weights; edema; diuretics; low-sodium diet.
  Red flags: Pink frothy sputum, new crackles, acute dyspnea → sit up, O₂, notify.

• Myocardial infarction (MI): Chest pain, diaphoresis, N/V.
  First steps: O₂, 12-lead ECG, aspirin (if not contraindicated), nitro per protocol.

• Hypertension: Lifestyle (DASH, exercise), meds (ACEi “-pril,” BB “-olol”).
  Watch for: ACEi cough/angioedema, hyperkalemia.

Practice tip: Mix priority + pharm items for these Med-Surg NCLEX topics to build clinical judgment.

2) Respiratory (oxygenation is priority)

• COPD: Low-flow O₂, pursed-lip breathing, prevent infection.
  Avoid: Excess O₂ in CO₂ retainers without orders/targets.

• Asthma: Rescue vs maintenance inhalers; peak-flow zones.
  Red flag: Silent chest = severe obstruction.

• Pneumonia: Fever, crackles, productive cough.
  Actions: Incentive spirometry, mobilize, antibiotics as ordered.

3) Endocrine (diabetes & thyroid)

• Diabetes: Insulin timing (onset/peak/duration); hypoglycemia vs DKA.
  DKA clues: Fruity breath, Kussmaul breathing, high glucose + ketones.

• Thyroid:
  Hypo: Fatigue, weight gain, bradycardia.
  Hyper: Heat intolerance, tachycardia; thyroid storm = emergency.

4) Gastrointestinal

• Peptic ulcer disease: H. pylori, NSAIDs; bleeding risk (melena, hematemesis).

• IBD: Crohn’s vs UC—location, bleeding, complications.

• Cirrhosis: Ascites, encephalopathy (asterixis), bleeding risk; monitor ammonia, safety.

5) Renal (fluids & electrolytes)

• AKI vs CKD: Causes, labs (BUN/Cr, GFR), strict I&O, daily weights.

• Dialysis: Pre/post care, fistula assessments (thrill/bruit), hold nephrotoxic meds per orders.

6) Neurological

• Stroke (CVA): FAST; time-critical thrombolytics for ischemic stroke.

• Seizures: Airway/safety first, side-lying, time the event—no objects in mouth.

• ↑ ICP: Early headache, restlessness; HOB ~30°, neutral neck, limit stimuli.

7) Infection control & isolation

• Precautions:
  Airborne: TB, measles (N95).
  Droplet: Flu, meningitis (mask).
  Contact: C. diff, MRSA (gloves/gown; soap & water for C. diff).

8) Fluids & electrolytes (test makers love these)

• Sodium:
  Hypo: Confusion, seizures.
  Hyper: Thirst, neuro changes.

• Potassium:
  Hypo: Weakness, U waves.
  Hyper: Peaked T waves—address quickly per protocol.

9) Perioperative & wound care

• Pre-op: Consent verified, NPO, baseline vitals.

• Post-op: Airway, breathing, circulation; pain; early DVT prevention.

• Wounds: Drainage types, infection vs normal healing.

10) Patient safety & quality

• Med safety: 5 rights, high-alert meds (insulin, heparin).

• Falls: Alarms, non-skid socks, hourly rounding.

• Prioritization: ABCs → safety → stability → time-sensitive problems.

Smart study plan for Med-Surg NCLEX topics

• Daily: 50–75 mixed questions + rationale review.

• 2–3×/week: Short system refresh + focused set (e.g., cardio 25 Qs).

• Weekly: One simulated block (CAT-style) to build stamina and pacing.

More reading 

• Clinical Judgment & Prioritization (ABCs → safest first) 

• Pharmacology Made Easy for NCLEX 

• Trend Items & Partial Credit (NGN) 

• Delegation & Scope Quick Guide 

• NCSBN NCLEX Test Plan — for official category weights and updates.

CTA

Ready to drill the highest-yield Med-Surg NCLEX topics with realistic rationales? Practice adaptive blocks and NGN-style cases on Nurseclex to boost speed, safety, and confidence before test day.