CMC Practice Questions – AACN 2025 | Certified
Medical-Surgical Nurse Exam Prep Practice Tests
Questions with Answers and In-Depth
Explanation PDF
Section 1: Cardiovascular
1. A patient with heart failure has crackles in both lung bases, 2+ pitting edema in lower
extremities, and jugular vein distension. Which medication should the nurse expect to
administer first?
A) Metoprolol
B) Digoxin
C) Furosemide
D) Enalapril
C) Furosemide — This patient shows signs of fluid overload. Loop diuretics like furosemide
rapidly reduce preload and relieve pulmonary congestion. Beta-blockers (metoprolol) and
ACE inhibitors (enalapril) are chronic therapies; digoxin is for symptom control in systolic
failure but not first-line for acute fluid overload.
2. A patient post-MI has a new murmur and hypotension. The nurse suspects:
A) Pericarditis
B) Papillary muscle rupture
C) Pulmonary embolism
D) Ventricular aneurysm
B) Papillary muscle rupture — Sudden murmur + hypotension post-MI suggests
mechanical complication (papillary muscle rupture → acute mitral regurgitation).
Pericarditis causes chest pain but not usually new murmur/hypotension.
,3. Which ECG finding is most consistent with hyperkalemia?
A) U waves
B) Peaked T waves
C) Prolonged PR interval
D) ST elevation
B) Peaked T waves — Early hyperkalemia. U waves = hypokalemia. PR prolongation
occurs later in hyperkalemia but peaked T waves are earliest/most specific.
4. A patient on amiodarone reports cough and progressive dyspnea. The nurse should
prioritize:
A) Administering oxygen
B) Notifying the provider for possible pulmonary toxicity
C) Giving a beta-agonist inhaler
D) Checking a digoxin level
B) Notifying the provider for possible pulmonary toxicity — Amiodarone can cause
pulmonary fibrosis. Cough + dyspnea → stop drug and evaluate. Oxygen is supportive, but
the key is addressing the drug reaction.
5. After a cardiac catheterization via femoral artery, the patient reports numbness and
coolness of the right foot. The nurse’s priority action:
A) Reassure the patient this is normal
B) Apply heat to the foot
C) Check right pedal pulses
D) Elevate the leg
C) Check right pedal pulses — Signs of arterial occlusion (numbness, coolness) after
catheterization require immediate pulse assessment and notification of provider if absent.
,6. A patient with hypertension has a blood pressure of 190/110 mmHg but is
asymptomatic. The nurse should:
A) Administer IV hydralazine immediately
B) Recheck BP in 5 minutes
C) Give oral clonidine
D) Call a rapid response
B) Recheck BP in 5 minutes — Asymptomatic severe hypertension does not require
emergency treatment; recheck to confirm. Treat only if symptoms or target organ damage.
7. The nurse is teaching a patient with new-onset atrial fibrillation about warfarin. Which
statement indicates understanding?
A) “I can take ibuprofen if I have a headache.”
B) “I will eat the same amount of green vegetables each week.”
C) “I should stop warfarin if I see bruising.”
D) “I will check my blood sugar daily.”
B) “I will eat the same amount of green vegetables each week” — Vitamin K intake (green
veggies) should be consistent to maintain stable INR. Ibuprofen increases bleeding risk.
8. A patient with unstable angina is receiving nitroglycerin IV. The nurse notes
hypotension (80/50 mmHg). The priority action:
A) Increase the infusion rate
B) Stop the infusion
C) Administer fluids bolus
D) Give atropine
B) Stop the infusion — Hypotension from nitroglycerin requires stopping or reducing
infusion first. Fluids may be given after stopping if needed.
9. Which laboratory value is most critical to monitor in a patient receiving a heparin
infusion?
, A) PT/INR
B) aPTT
C) Platelet count
D) Hemoglobin
B) aPTT — Heparin effect is monitored by aPTT. PT/INR for warfarin. Platelets for HIT, but
aPTT is routine monitoring for therapeutic range.
10. A patient with peripheral arterial disease (PAD) complains of leg pain while walking
that stops with rest. This is termed:
A) Rest pain
B) Intermittent claudication
C) Venous insufficiency
D) Neuropathy
B) Intermittent claudication — Muscle pain during exercise relieved by rest due to
atherosclerosis. Rest pain indicates severe PAD.
11. Post-cardiac arrest, a patient is cool to touch with weak pulses. The nurse should:
A) Apply active rewarming blanket
B) Maintain therapeutic hypothermia
C) Increase room temperature
D) Administer warm IV fluids
B) Maintain therapeutic hypothermia — Post-arrest hypothermia improves neurological
outcomes; rewarming is gradual. Do not actively rewarm prematurely.
12. Which finding is most concerning in a patient with a pacemaker?
A) Paced QRS complex on ECG
B) Hiccups
C) Mild bruising at insertion site
D) Heart rate 72 bpm
Medical-Surgical Nurse Exam Prep Practice Tests
Questions with Answers and In-Depth
Explanation PDF
Section 1: Cardiovascular
1. A patient with heart failure has crackles in both lung bases, 2+ pitting edema in lower
extremities, and jugular vein distension. Which medication should the nurse expect to
administer first?
A) Metoprolol
B) Digoxin
C) Furosemide
D) Enalapril
C) Furosemide — This patient shows signs of fluid overload. Loop diuretics like furosemide
rapidly reduce preload and relieve pulmonary congestion. Beta-blockers (metoprolol) and
ACE inhibitors (enalapril) are chronic therapies; digoxin is for symptom control in systolic
failure but not first-line for acute fluid overload.
2. A patient post-MI has a new murmur and hypotension. The nurse suspects:
A) Pericarditis
B) Papillary muscle rupture
C) Pulmonary embolism
D) Ventricular aneurysm
B) Papillary muscle rupture — Sudden murmur + hypotension post-MI suggests
mechanical complication (papillary muscle rupture → acute mitral regurgitation).
Pericarditis causes chest pain but not usually new murmur/hypotension.
,3. Which ECG finding is most consistent with hyperkalemia?
A) U waves
B) Peaked T waves
C) Prolonged PR interval
D) ST elevation
B) Peaked T waves — Early hyperkalemia. U waves = hypokalemia. PR prolongation
occurs later in hyperkalemia but peaked T waves are earliest/most specific.
4. A patient on amiodarone reports cough and progressive dyspnea. The nurse should
prioritize:
A) Administering oxygen
B) Notifying the provider for possible pulmonary toxicity
C) Giving a beta-agonist inhaler
D) Checking a digoxin level
B) Notifying the provider for possible pulmonary toxicity — Amiodarone can cause
pulmonary fibrosis. Cough + dyspnea → stop drug and evaluate. Oxygen is supportive, but
the key is addressing the drug reaction.
5. After a cardiac catheterization via femoral artery, the patient reports numbness and
coolness of the right foot. The nurse’s priority action:
A) Reassure the patient this is normal
B) Apply heat to the foot
C) Check right pedal pulses
D) Elevate the leg
C) Check right pedal pulses — Signs of arterial occlusion (numbness, coolness) after
catheterization require immediate pulse assessment and notification of provider if absent.
,6. A patient with hypertension has a blood pressure of 190/110 mmHg but is
asymptomatic. The nurse should:
A) Administer IV hydralazine immediately
B) Recheck BP in 5 minutes
C) Give oral clonidine
D) Call a rapid response
B) Recheck BP in 5 minutes — Asymptomatic severe hypertension does not require
emergency treatment; recheck to confirm. Treat only if symptoms or target organ damage.
7. The nurse is teaching a patient with new-onset atrial fibrillation about warfarin. Which
statement indicates understanding?
A) “I can take ibuprofen if I have a headache.”
B) “I will eat the same amount of green vegetables each week.”
C) “I should stop warfarin if I see bruising.”
D) “I will check my blood sugar daily.”
B) “I will eat the same amount of green vegetables each week” — Vitamin K intake (green
veggies) should be consistent to maintain stable INR. Ibuprofen increases bleeding risk.
8. A patient with unstable angina is receiving nitroglycerin IV. The nurse notes
hypotension (80/50 mmHg). The priority action:
A) Increase the infusion rate
B) Stop the infusion
C) Administer fluids bolus
D) Give atropine
B) Stop the infusion — Hypotension from nitroglycerin requires stopping or reducing
infusion first. Fluids may be given after stopping if needed.
9. Which laboratory value is most critical to monitor in a patient receiving a heparin
infusion?
, A) PT/INR
B) aPTT
C) Platelet count
D) Hemoglobin
B) aPTT — Heparin effect is monitored by aPTT. PT/INR for warfarin. Platelets for HIT, but
aPTT is routine monitoring for therapeutic range.
10. A patient with peripheral arterial disease (PAD) complains of leg pain while walking
that stops with rest. This is termed:
A) Rest pain
B) Intermittent claudication
C) Venous insufficiency
D) Neuropathy
B) Intermittent claudication — Muscle pain during exercise relieved by rest due to
atherosclerosis. Rest pain indicates severe PAD.
11. Post-cardiac arrest, a patient is cool to touch with weak pulses. The nurse should:
A) Apply active rewarming blanket
B) Maintain therapeutic hypothermia
C) Increase room temperature
D) Administer warm IV fluids
B) Maintain therapeutic hypothermia — Post-arrest hypothermia improves neurological
outcomes; rewarming is gradual. Do not actively rewarm prematurely.
12. Which finding is most concerning in a patient with a pacemaker?
A) Paced QRS complex on ECG
B) Hiccups
C) Mild bruising at insertion site
D) Heart rate 72 bpm
