ADVANCED CONCEPTS OF MEDICAL
SURGICAL NURSING GUIDE 2026 TEST PAPER
SOLVED QUESTIONS AND SOLUTIONS
◉ friction rub. Answer: heard w pericarditis (inflammation of
pericardium of heart); high-pitched scratchy sound
◉ heard better with bell. Answer: murmurs, S3, S4
◉ cardiac changes in pregnancy. Answer: everything moves up,
forward, and left
PMI 4th ICS, MC line
blood volume: increased 30-50%
HR increase 10-20 bpm
cardiac output increase 30-50%
edema
BP decreases
◉ peripheral vasodilation. Answer: why does bp decrease in
pregnancy
,◉ two arteries (deoxygenated) and one vein (oxygenated). Answer:
umbilical cord vessels
◉ fetal shunts. Answer: foramen ovale
ductus arteriosus
ductus venosus
◉ infant cardiac assessment. Answer: position more horizontal;
apex at 4th ICS
◉ bradycardia in newborn and child. Answer: newborn: <90 bpm
child: <60 bpm
◉ S3, normal. Answer: ___ in child is a ____ finding
◉ s/sx heart failure in infants. Answer: Persistent tachycardia
Tachypnea
Liver enlargement
Engorged veins
Gallop rhythm
Pulsus alternans
,◉ risk factors for CAD. Answer: diabetes, hyperlipidemia, obesity,
age, gender, sedentary lifestyle, diet, smoking
◉ diabetes as risk factor for CAD. Answer: damages vessels
◉ hyperlipidemia as risk factor for CAD. Answer: plaque build up;
atherosclerosis; makes vessels not as elastic
◉ obesity as risk factor for CAD. Answer: sudden or gradual weight
gain; makes heart work harder; lack of exercise, diet
◉ age as risk factor for CAD. Answer: weakened perfusion; age 35-
64: arteries lose elasticity
◉ gender as risk factor for CAD. Answer: men have higher risk until
menopause when women become equal with men; MI/heart attack
is more serious in women because symptoms are different and not
they don't always know it's occurring
◉ lifestyle as risk factor for CAD. Answer: not active/sitting all the
time/"couch potato"/lack of exercise (should do 30-60 mins of
activity/day at least 5x/week, low cholesterol & low sodium diet is
recommended, smoking bc of O2 demand, stress also a factor
, ◉ leading COD in US women. Answer: myocardial infarction (heart
attack)
◉ s/sx of MI in women. Answer: Fatigue
Sleep Disturbance
Shortness of breath
Indigestion, nausea
Radiating, aching pain
Flushed
◉ prevention of MI in women. Answer: behavior modification
smoking cessation
better diet
weight reduction
◉ reason women are more likely to die of MI. Answer: s/sx in
women can be caused by many other things, leading to delay in
diagnosis
◉ elderly cardiac changes. Answer: Gradual increase in SBP
Arteriosclerosis
Left ventricular wall thickens - can lead to hypertrophy &/or heart
failure
SURGICAL NURSING GUIDE 2026 TEST PAPER
SOLVED QUESTIONS AND SOLUTIONS
◉ friction rub. Answer: heard w pericarditis (inflammation of
pericardium of heart); high-pitched scratchy sound
◉ heard better with bell. Answer: murmurs, S3, S4
◉ cardiac changes in pregnancy. Answer: everything moves up,
forward, and left
PMI 4th ICS, MC line
blood volume: increased 30-50%
HR increase 10-20 bpm
cardiac output increase 30-50%
edema
BP decreases
◉ peripheral vasodilation. Answer: why does bp decrease in
pregnancy
,◉ two arteries (deoxygenated) and one vein (oxygenated). Answer:
umbilical cord vessels
◉ fetal shunts. Answer: foramen ovale
ductus arteriosus
ductus venosus
◉ infant cardiac assessment. Answer: position more horizontal;
apex at 4th ICS
◉ bradycardia in newborn and child. Answer: newborn: <90 bpm
child: <60 bpm
◉ S3, normal. Answer: ___ in child is a ____ finding
◉ s/sx heart failure in infants. Answer: Persistent tachycardia
Tachypnea
Liver enlargement
Engorged veins
Gallop rhythm
Pulsus alternans
,◉ risk factors for CAD. Answer: diabetes, hyperlipidemia, obesity,
age, gender, sedentary lifestyle, diet, smoking
◉ diabetes as risk factor for CAD. Answer: damages vessels
◉ hyperlipidemia as risk factor for CAD. Answer: plaque build up;
atherosclerosis; makes vessels not as elastic
◉ obesity as risk factor for CAD. Answer: sudden or gradual weight
gain; makes heart work harder; lack of exercise, diet
◉ age as risk factor for CAD. Answer: weakened perfusion; age 35-
64: arteries lose elasticity
◉ gender as risk factor for CAD. Answer: men have higher risk until
menopause when women become equal with men; MI/heart attack
is more serious in women because symptoms are different and not
they don't always know it's occurring
◉ lifestyle as risk factor for CAD. Answer: not active/sitting all the
time/"couch potato"/lack of exercise (should do 30-60 mins of
activity/day at least 5x/week, low cholesterol & low sodium diet is
recommended, smoking bc of O2 demand, stress also a factor
, ◉ leading COD in US women. Answer: myocardial infarction (heart
attack)
◉ s/sx of MI in women. Answer: Fatigue
Sleep Disturbance
Shortness of breath
Indigestion, nausea
Radiating, aching pain
Flushed
◉ prevention of MI in women. Answer: behavior modification
smoking cessation
better diet
weight reduction
◉ reason women are more likely to die of MI. Answer: s/sx in
women can be caused by many other things, leading to delay in
diagnosis
◉ elderly cardiac changes. Answer: Gradual increase in SBP
Arteriosclerosis
Left ventricular wall thickens - can lead to hypertrophy &/or heart
failure
