PROPHECY HEALTH MEDICAL SURGICAL RN A EXAM 2026
| Questions & Answers | Verified Answers | 75 Questions w/ Detailed
Rationales | Comprehensive Practice | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR (Questions 1-10)
Q1: A 68-year-old male is admitted with acute decompensated heart failure (ADHF).
Assessment reveals: BP 158/92 mmHg, HR 118 bpm (irregularly irregular), RR 26/min,
SpO₂ 88% on room air, bilateral crackles in lower lung fields, 3+ pitting edema in lower
extremities, and reports orthopnea. Which intervention should the nurse implement
first?
A. Administer IV furosemide 40 mg as ordered
B. Apply supplemental oxygen via nasal cannula at 2 L/min
C. Place patient in high Fowler's position with legs dependent
D. Insert Foley catheter for strict intake and output monitoring
Correct Answer: B
Rationale: The nurse must prioritize interventions using the ABC framework (Airway,
Breathing, Circulation). This patient presents with hypoxemia (SpO₂ 88%) and increased
work of breathing (RR 26, crackles, orthopnea). Immediate oxygen therapy is required to
improve tissue oxygenation and reduce myocardial workload. While furosemide (A),
positioning (C), and I&O monitoring (D) are important interventions for ADHF, they do
not take precedence over correcting life-threatening hypoxemia. Applying oxygen first
,stabilizes the patient for subsequent interventions. The nasal cannula at 2 L/min is a
conservative starting point; titration may be needed based on response.
Q2: A patient with non-ST elevation myocardial infarction (NSTEMI) is receiving heparin
infusion and reports sudden onset of dyspnea, tachypnea, and pleuritic chest pain. Vital
signs: BP 92/58 mmHg, HR 124 bpm, RR 28/min, SpO₂ 84% on 2 L NC. Which actions
should the nurse take? Select all that apply.
A. Immediately stop the heparin infusion
B. Notify the provider stat
C. Prepare to administer protamine sulfate
D. Obtain a 12-lead ECG
E. Administer supplemental oxygen and titrate to maintain SpO₂ > 90%
F. Draw blood for aPTT level
Correct Answer: A, B, E
Rationale: This presentation is consistent with heparin-induced thrombocytopenia (HIT)
with thrombosis or a new pulmonary embolism—both medical emergencies requiring
immediate intervention.
● A is correct: All heparin must be stopped immediately (including flushes) to
prevent further immune-mediated platelet activation and thrombosis.
● B is correct: Provider notification is urgent for orders regarding alternative
anticoagulation (direct thrombin inhibitors like argatroban or fondaparinux) and
diagnostic workup.
● E is correct: The patient is severely hypoxemic; oxygen must be administered
immediately and titrated to maintain SpO₂ > 90% (or > 92% per facility protocol).
,Why others are incorrect:
● C (Protamine sulfate): This reverses heparin's anticoagulant effect but does NOT
treat HIT; in fact, it may worsen thrombosis by leaving HIT antibodies unopposed.
It is contraindicated in HIT with thrombosis.
● D (12-lead ECG): While eventually needed to rule out new MI, it is not the priority
over immediate oxygenation and stopping the offending agent.
● F (aPTT): Therapeutic monitoring is irrelevant when heparin must be
discontinued; platelet count and HIT antibody testing are more appropriate, but
not before stabilizing the patient.
Q3: A patient with chronic atrial fibrillation on warfarin therapy (INR 2.5 therapeutic)
presents with acute onset of slurred speech, right-sided facial droop, and right arm
weakness. CT scan shows no hemorrhage. Which medication should the nurse
anticipate administering?
A. Alteplase (tPA) 0.9 mg/kg IV
B. Aspirin 325 mg chewable
C. Vitamin K 10 mg IV
D. Idarucizumab (Praxbind)
Correct Answer: B
Rationale: This patient presents with acute ischemic stroke symptoms (left hemisphere
involvement based on right-sided deficits) with last known well time presumably recent
(implied by "acute onset"). The INR of 2.5 is at the upper limit of therapeutic range
(2.0-3.0 for AFib/stroke prevention) but does NOT contraindicate aspirin administration.
Current AHA/ASA guidelines support aspirin within 24-48 hours of ischemic stroke
onset when thrombolytics are not indicated.
, ● A (tPA) is incorrect: The patient is anticoagulated with warfarin and INR > 1.7 is
an absolute contraindication to thrombolytic therapy due to hemorrhagic
conversion risk.
● C (Vitamin K) is incorrect: This reverses warfarin but takes hours to days; it is not
indicated for acute ischemic stroke management without hemorrhage.
● D (Idarucizumab) is incorrect: This is the reversal agent for dabigatran (Pradaxa),
not warfarin. For warfarin reversal, 4-factor PCC plus vitamin K would be used if
hemorrhage were present.
Q4: A patient post-CABG surgery (Day 2) suddenly develops muffled heart sounds,
jugular venous distension, and hypotension (BP 78/52). Heart rate increases from 88 to
118 bpm. Which complication should the nurse recognize?
A. Cardiac tamponade
B. Papillary muscle rupture
C. Ventricular septal defect
D. Pericarditis
Correct Answer: A
Rationale: The triad of Beck's Triad (hypotension, JVD, muffled heart sounds) is
pathognomonic for cardiac tamponade—compression of the heart by fluid
accumulation in the pericardial sac. Post-CABG patients are at risk for bleeding into the
pericardium from mediastinal chest tube occlusion or coagulopathy. The hemodynamic
profile (narrowed pulse pressure, tachycardia, hypotension) reflects impaired ventricular
filling due to external compression. This is a surgical emergency requiring immediate
pericardiocentesis or return to OR for mediastinal exploration.
● B (Papillary muscle rupture): Presents with acute mitral regurgitation, pulmonary
edema, and new holosystolic murmur—not muffled sounds.
| Questions & Answers | Verified Answers | 75 Questions w/ Detailed
Rationales | Comprehensive Practice | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR (Questions 1-10)
Q1: A 68-year-old male is admitted with acute decompensated heart failure (ADHF).
Assessment reveals: BP 158/92 mmHg, HR 118 bpm (irregularly irregular), RR 26/min,
SpO₂ 88% on room air, bilateral crackles in lower lung fields, 3+ pitting edema in lower
extremities, and reports orthopnea. Which intervention should the nurse implement
first?
A. Administer IV furosemide 40 mg as ordered
B. Apply supplemental oxygen via nasal cannula at 2 L/min
C. Place patient in high Fowler's position with legs dependent
D. Insert Foley catheter for strict intake and output monitoring
Correct Answer: B
Rationale: The nurse must prioritize interventions using the ABC framework (Airway,
Breathing, Circulation). This patient presents with hypoxemia (SpO₂ 88%) and increased
work of breathing (RR 26, crackles, orthopnea). Immediate oxygen therapy is required to
improve tissue oxygenation and reduce myocardial workload. While furosemide (A),
positioning (C), and I&O monitoring (D) are important interventions for ADHF, they do
not take precedence over correcting life-threatening hypoxemia. Applying oxygen first
,stabilizes the patient for subsequent interventions. The nasal cannula at 2 L/min is a
conservative starting point; titration may be needed based on response.
Q2: A patient with non-ST elevation myocardial infarction (NSTEMI) is receiving heparin
infusion and reports sudden onset of dyspnea, tachypnea, and pleuritic chest pain. Vital
signs: BP 92/58 mmHg, HR 124 bpm, RR 28/min, SpO₂ 84% on 2 L NC. Which actions
should the nurse take? Select all that apply.
A. Immediately stop the heparin infusion
B. Notify the provider stat
C. Prepare to administer protamine sulfate
D. Obtain a 12-lead ECG
E. Administer supplemental oxygen and titrate to maintain SpO₂ > 90%
F. Draw blood for aPTT level
Correct Answer: A, B, E
Rationale: This presentation is consistent with heparin-induced thrombocytopenia (HIT)
with thrombosis or a new pulmonary embolism—both medical emergencies requiring
immediate intervention.
● A is correct: All heparin must be stopped immediately (including flushes) to
prevent further immune-mediated platelet activation and thrombosis.
● B is correct: Provider notification is urgent for orders regarding alternative
anticoagulation (direct thrombin inhibitors like argatroban or fondaparinux) and
diagnostic workup.
● E is correct: The patient is severely hypoxemic; oxygen must be administered
immediately and titrated to maintain SpO₂ > 90% (or > 92% per facility protocol).
,Why others are incorrect:
● C (Protamine sulfate): This reverses heparin's anticoagulant effect but does NOT
treat HIT; in fact, it may worsen thrombosis by leaving HIT antibodies unopposed.
It is contraindicated in HIT with thrombosis.
● D (12-lead ECG): While eventually needed to rule out new MI, it is not the priority
over immediate oxygenation and stopping the offending agent.
● F (aPTT): Therapeutic monitoring is irrelevant when heparin must be
discontinued; platelet count and HIT antibody testing are more appropriate, but
not before stabilizing the patient.
Q3: A patient with chronic atrial fibrillation on warfarin therapy (INR 2.5 therapeutic)
presents with acute onset of slurred speech, right-sided facial droop, and right arm
weakness. CT scan shows no hemorrhage. Which medication should the nurse
anticipate administering?
A. Alteplase (tPA) 0.9 mg/kg IV
B. Aspirin 325 mg chewable
C. Vitamin K 10 mg IV
D. Idarucizumab (Praxbind)
Correct Answer: B
Rationale: This patient presents with acute ischemic stroke symptoms (left hemisphere
involvement based on right-sided deficits) with last known well time presumably recent
(implied by "acute onset"). The INR of 2.5 is at the upper limit of therapeutic range
(2.0-3.0 for AFib/stroke prevention) but does NOT contraindicate aspirin administration.
Current AHA/ASA guidelines support aspirin within 24-48 hours of ischemic stroke
onset when thrombolytics are not indicated.
, ● A (tPA) is incorrect: The patient is anticoagulated with warfarin and INR > 1.7 is
an absolute contraindication to thrombolytic therapy due to hemorrhagic
conversion risk.
● C (Vitamin K) is incorrect: This reverses warfarin but takes hours to days; it is not
indicated for acute ischemic stroke management without hemorrhage.
● D (Idarucizumab) is incorrect: This is the reversal agent for dabigatran (Pradaxa),
not warfarin. For warfarin reversal, 4-factor PCC plus vitamin K would be used if
hemorrhage were present.
Q4: A patient post-CABG surgery (Day 2) suddenly develops muffled heart sounds,
jugular venous distension, and hypotension (BP 78/52). Heart rate increases from 88 to
118 bpm. Which complication should the nurse recognize?
A. Cardiac tamponade
B. Papillary muscle rupture
C. Ventricular septal defect
D. Pericarditis
Correct Answer: A
Rationale: The triad of Beck's Triad (hypotension, JVD, muffled heart sounds) is
pathognomonic for cardiac tamponade—compression of the heart by fluid
accumulation in the pericardial sac. Post-CABG patients are at risk for bleeding into the
pericardium from mediastinal chest tube occlusion or coagulopathy. The hemodynamic
profile (narrowed pulse pressure, tachycardia, hypotension) reflects impaired ventricular
filling due to external compression. This is a surgical emergency requiring immediate
pericardiocentesis or return to OR for mediastinal exploration.
● B (Papillary muscle rupture): Presents with acute mitral regurgitation, pulmonary
edema, and new holosystolic murmur—not muffled sounds.
