COMPREHENSIVE MEDICAL-SURGICAL NURSING
FINAL EXAM
INSTRUCTIONS:
1. Select the best answer for each question.
2. Mark your answers on the provided Scantron sheet.
3. Read each question carefully before selecting your response.
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SECTION I: CARDIOVASCULAR DISORDERS (Questions 1–15)
1. A client with chronic heart failure is prescribed furosemide (Lasix) and digoxin
(Lanoxin). Which laboratory value is most important for the nurse to monitor?
- A) Serum sodium
- B) Serum potassium
- C) Serum calcium
- D) Serum magnesium
Correct Answer: B) Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium wasting.
Hypokalemia increases the risk of digoxin toxicity, as digoxin binds to the same
myocardial receptor sites as potassium. The nurse must monitor potassium levels
closely to prevent life-threatening dysrhythmias. (Option A: Sodium is less directly
related to digoxin toxicity; Option C: Calcium is not the primary concern; Option D:
Magnesium is important but not the most critical with this combination.)
,---
2. A client is 2 hours post-percutaneous coronary intervention (PCI) via the femoral
artery. Which assessment finding requires immediate action?
- A) Blood pressure 110/72 mmHg
- B) Heart rate 88 bpm
- C) Groin site with a 5 cm hematoma and oozing
- D) Pedal pulses palpable at +2 bilaterally
Correct Answer: C) Groin site with a 5 cm hematoma and oozing
Rationale: A rapidly expanding hematoma with active oozing indicates potential
bleeding or inadequate hemostasis at the arterial puncture site. This is a priority
because it can lead to significant blood loss, hypovolemic shock, or
pseudoaneurysm. The nurse should immediately apply firm pressure and notify the
provider. (Options A, B, and D are within acceptable parameters.)
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3. A client with atrial fibrillation is prescribed warfarin (Coumadin). The client's INR
is 3.8. What is the nurse's priority action?
- A) Administer vitamin K as ordered.
- B) Hold the next dose of warfarin and notify the provider.
- C) Increase the warfarin dose per sliding scale.
- D) Document the finding as normal.
Correct Answer: B) Hold the next dose of warfarin and notify the provider.
Rationale: The therapeutic INR range for atrial fibrillation is typically 2.0–3.0. An
INR of 3.8 indicates a high risk of bleeding. The standard protocol is to hold the
dose and contact the provider for further instructions. Vitamin K is an antidote but is
,given for critical bleeding or very high INR (>5.0); it is not the first step at 3.8.
(Option A: Too aggressive; Option C: Would increase bleeding risk; Option D:
Incorrect—it is not normal.)
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4. A nurse is assessing a client with left-sided heart failure. Which finding is most
consistent with this condition?
- A) Jugular venous distention
- B) Peripheral edema
- C) Crackles in the lung bases
- D) Hepatomegaly
Correct Answer: C) Crackles in the lung bases
Rationale: Left-sided heart failure leads to pulmonary congestion due to backup
of blood into the left atrium and pulmonary veins. This results in fluid leaking into
the alveoli, causing crackles (rales) on auscultation. Options A, B, and D are signs of
right-sided heart failure (systemic congestion).
---
5. A client with unstable angina is receiving IV nitroglycerin. The nurse notes the
blood pressure is 88/52 mmHg. What is the priority action?
- A) Increase the IV rate.
- B) Decrease the IV rate.
- C) Administer normal saline bolus.
- D) Stop the infusion and call the provider.
Correct Answer: B) Decrease the IV rate.
, Rationale: Nitroglycerin is a potent vasodilator that can cause significant
hypotension. The first action is to reduce the infusion rate to allow blood pressure to
rise. Stopping the infusion abruptly can cause rebound hypertension and coronary
vasospasm. A saline bolus may be needed if the BP does not improve, but the initial
step is to slow the infusion.
---
6. Which ECG finding is characteristic of a myocardial infarction (MI)?
- A) Prolonged PR interval
- B) ST-segment elevation
- C) Tall, peaked T waves
- D) Wide QRS complex
Correct Answer: B) ST-segment elevation
Rationale: ST-segment elevation on an ECG indicates acute injury and transmural
ischemia, which is hallmark of an ST-elevation myocardial infarction (STEMI).
(Option A: PR prolongation is associated with first-degree heart block; Option C:
Tall, peaked T waves indicate hyperkalemia; Option D: Wide QRS is seen in bundle
branch blocks.)
---
7. A client post-MI is prescribed aspirin, clopidogrel, and metoprolol. Which
teaching point is essential for the nurse to include?
- A) "Take aspirin with food to prevent stomach upset."
- B) "Stop clopidogrel if you notice easy bruising."
- C) "Check your pulse before taking metoprolol."
- D) "Take all medications on an empty stomach."
FINAL EXAM
INSTRUCTIONS:
1. Select the best answer for each question.
2. Mark your answers on the provided Scantron sheet.
3. Read each question carefully before selecting your response.
---
SECTION I: CARDIOVASCULAR DISORDERS (Questions 1–15)
1. A client with chronic heart failure is prescribed furosemide (Lasix) and digoxin
(Lanoxin). Which laboratory value is most important for the nurse to monitor?
- A) Serum sodium
- B) Serum potassium
- C) Serum calcium
- D) Serum magnesium
Correct Answer: B) Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium wasting.
Hypokalemia increases the risk of digoxin toxicity, as digoxin binds to the same
myocardial receptor sites as potassium. The nurse must monitor potassium levels
closely to prevent life-threatening dysrhythmias. (Option A: Sodium is less directly
related to digoxin toxicity; Option C: Calcium is not the primary concern; Option D:
Magnesium is important but not the most critical with this combination.)
,---
2. A client is 2 hours post-percutaneous coronary intervention (PCI) via the femoral
artery. Which assessment finding requires immediate action?
- A) Blood pressure 110/72 mmHg
- B) Heart rate 88 bpm
- C) Groin site with a 5 cm hematoma and oozing
- D) Pedal pulses palpable at +2 bilaterally
Correct Answer: C) Groin site with a 5 cm hematoma and oozing
Rationale: A rapidly expanding hematoma with active oozing indicates potential
bleeding or inadequate hemostasis at the arterial puncture site. This is a priority
because it can lead to significant blood loss, hypovolemic shock, or
pseudoaneurysm. The nurse should immediately apply firm pressure and notify the
provider. (Options A, B, and D are within acceptable parameters.)
---
3. A client with atrial fibrillation is prescribed warfarin (Coumadin). The client's INR
is 3.8. What is the nurse's priority action?
- A) Administer vitamin K as ordered.
- B) Hold the next dose of warfarin and notify the provider.
- C) Increase the warfarin dose per sliding scale.
- D) Document the finding as normal.
Correct Answer: B) Hold the next dose of warfarin and notify the provider.
Rationale: The therapeutic INR range for atrial fibrillation is typically 2.0–3.0. An
INR of 3.8 indicates a high risk of bleeding. The standard protocol is to hold the
dose and contact the provider for further instructions. Vitamin K is an antidote but is
,given for critical bleeding or very high INR (>5.0); it is not the first step at 3.8.
(Option A: Too aggressive; Option C: Would increase bleeding risk; Option D:
Incorrect—it is not normal.)
---
4. A nurse is assessing a client with left-sided heart failure. Which finding is most
consistent with this condition?
- A) Jugular venous distention
- B) Peripheral edema
- C) Crackles in the lung bases
- D) Hepatomegaly
Correct Answer: C) Crackles in the lung bases
Rationale: Left-sided heart failure leads to pulmonary congestion due to backup
of blood into the left atrium and pulmonary veins. This results in fluid leaking into
the alveoli, causing crackles (rales) on auscultation. Options A, B, and D are signs of
right-sided heart failure (systemic congestion).
---
5. A client with unstable angina is receiving IV nitroglycerin. The nurse notes the
blood pressure is 88/52 mmHg. What is the priority action?
- A) Increase the IV rate.
- B) Decrease the IV rate.
- C) Administer normal saline bolus.
- D) Stop the infusion and call the provider.
Correct Answer: B) Decrease the IV rate.
, Rationale: Nitroglycerin is a potent vasodilator that can cause significant
hypotension. The first action is to reduce the infusion rate to allow blood pressure to
rise. Stopping the infusion abruptly can cause rebound hypertension and coronary
vasospasm. A saline bolus may be needed if the BP does not improve, but the initial
step is to slow the infusion.
---
6. Which ECG finding is characteristic of a myocardial infarction (MI)?
- A) Prolonged PR interval
- B) ST-segment elevation
- C) Tall, peaked T waves
- D) Wide QRS complex
Correct Answer: B) ST-segment elevation
Rationale: ST-segment elevation on an ECG indicates acute injury and transmural
ischemia, which is hallmark of an ST-elevation myocardial infarction (STEMI).
(Option A: PR prolongation is associated with first-degree heart block; Option C:
Tall, peaked T waves indicate hyperkalemia; Option D: Wide QRS is seen in bundle
branch blocks.)
---
7. A client post-MI is prescribed aspirin, clopidogrel, and metoprolol. Which
teaching point is essential for the nurse to include?
- A) "Take aspirin with food to prevent stomach upset."
- B) "Stop clopidogrel if you notice easy bruising."
- C) "Check your pulse before taking metoprolol."
- D) "Take all medications on an empty stomach."
