Updated/Latest Medical Surgical Nursing I 2025–2026 Comprehensive Test Bank Questions and Answers for Adult Health Nursing Foundations Medical Surgical Nursing Examination Preparation Clinical Judgment Patient Care Management and NCLEX Success Study Resou

MEDICAL SURGICAL NURSING 1 FF T FFT FFT


CARE OF CLIENTS WITH CARDIOVASCULAR DISORDERS
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SITUATION: Basic knowledge about the physiology of the cardiovascular system will greatly help the nurse
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FFto provide appropriate assessment and interventions. The key component of physical assessment includes a
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health history, physical examination, and monitoring of variety of laboratory and diagnostic test results.
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1. The pumping action of the heart is accomplished by the rhythmic contraction and relaxation of its
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muscular wall. What change occurs during systole?
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a. The chambers of the heart become smaller as the blood is ejected
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b. The heart chambers fill with blood in preparation for subsequent ejection.
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c. The heart chamber of the heart becomes bigger as it receives blood
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d. The myocardium becomes thinner as it blood enter the
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chamber. ANSWER: A
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Rationale: As the blood coming from the systemic circulation enters the inferior and superior vena cava, the
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FFatrium will receive the blood which makes the myocardium thin and enlarged. This occurs during diastole
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FFwhen the heart relaxes as the chamber of the heart is filled with blood. During systole or contraction, the
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heart become smaller as the blood is ejected to the circulation.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786 T
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2. Cardiac conduction system generates and transmits electrical impulses that stimulate contraction of
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FFthe myocardium. Impulses come from two specialized electrical cells. What are the physiologic
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characteristics of the electrical cell?
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a. Automaticity, excitability, potentiality FF T FF T


c. Conductivity, potentiality, refractivity
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b. Automaticity, conductivity, refractivity FF T FF T


d. Automaticity, conductivity, excitability
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ANSWER: D
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The two specialized electrical cells are the purkinje cells and the nodal cell that is physiologically characterized
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by its automaticity, conductivity, and excitability.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786 T
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3. Automaticity refers to: FF T FF T


a. Ability to transmit an electrical impulse from one cell to another
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b. Ability to respond to electrical impulse FF T FF T FF T FF T FF T


c. Ability to initiate an electrical impulse FF T FF T FF T FFT FF T


d. Ability to automatically respond to electrical FF T FF T FF T FF T FF T


impulse ANSWER: C
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The two specialized electrical cells are the purkinje cells and the nodal cell that is physiologically characterized
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by it its Automaticity, conductivity, and excitability. Automaticity refers to the ability to initiate an electrical
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FFimpulse. Option A refers to conductivity of the cell. Option B refers to excitability. Option D doesn’t refer to
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FFany of the three physiologic characteristic of the electrical cell.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786 T
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4. Cardiac output must be responsive to changes in the metabolic demand. You know that cardiac output
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can be determined by:
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a. Measuring the amount of blood ejected per heartbeat and multiplying it to the client’s heart rate.
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b. Summing up the stroke volume with the client’s heart rate FF T FFT FF T FF T FF T T
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c. Getting the heart rate of the client and the client’s stroke volume and BP
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d. Getting the BP of the client multiply to the client’s heart FF T FF T FF T FF T FF T FF T FF T FF T FF T T
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rate ANSWER: A
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Rationale: Cardiac output refers to the amount of blood pumped by each ventricle during a given period.
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FFCO is computed by multiplying the stroke volume by the heart rate. Stroke volume refers to the amount of
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blood ejected per heartbeat.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786 T
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5. Heart rate is stimulated by the following except: T
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a. Increased level of the catecholamine FF T FF T FFT FF T


c. The vagus nerve
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b. Excess thyroid hormone T
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d. The sympathetic system
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FFANSWER: C
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Rationale: The increase level of epinephrine and norepinephrine increases the contractility of the heart by
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stimulating the sympathetic nervous system. Excess thyroid hormone like in patients with hyperthyroidism,
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FFwhere metabolic demand is increased, you can observe an increase in the heart rate. Vagus nerve, which is
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FFthe longest nerve, will cause bradycardia when stimulated which can be a serious problem especially to
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FFpatients with cardiac diseases.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.787 T
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6. One student nurse asks you how to determine the stroke volume of the heart. You will answer the
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question, knowingly that stroke volume is determined by:
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a. The degree of cardiac muscle strength FF T FF T FF T FF T FF T


b. The intrinsic contractility of the cardiac muscle
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c. The pressure gradient against which the muscle ejects blood during contraction
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d. All of the above T
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factors ANSWER: D
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,Rationale: Stroke volume is primarily affected by three factors- preload, afterload and contractility. Option A
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FFrefers to contractility, option B is refers to preload, option C refers to afterload.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.787 FFT FF T FFT FF T FF T FF T FF T T
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7. You know that there are factors that may bring changes in the cardiac structure associated with aging
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FFwhich includes all of the following except: FF T FF T T
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a. Elongation of the aorta FF T FF T T
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c. Increased sensitivity to baroreceptors
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b. Endocardial fibrosis FF T


d. Increased size of left atrium
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FFANSWER: C
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Rationale: The above changes are structural changes that occur as part of the aging process. Instead of
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FFincrease in baroreceptors sensitivity, the change that occurs is decrease in its sensitivity. Baroreceptors work
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FFunder negative feedback mechanism. When BP is elevated, it transmits impulses to the medulla to lower down
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FFthe HR and BP and the opposite.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.786 FFT FF T FFT FF T FF T FF T FF T T
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8. How are you going to assess a client with postural hypotension? Arrange the following in order of execution.
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i. Position the client supine and flat FF T FF T T
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ii. Do not remove the BP cuff between position changes but check to see if the BP is still correctly placed
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iii. Supine measurements should be measured before checking the upright position
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iv. Assess BP changes with client sitting on the edge of the bed with feet dangling and standing
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v. Record HR and BP FF T T
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a. i, ii, iii, iv, v FF T FFT FF T FF T


b. i, iii, ii, iv, v FF T FFT FF T FF T


c. i, iii, ii, v, iv FF T FF T FF T FF T


d. ii, i, iii, iv, v FF T FF T FFT T
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FFANSWER: B
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Rationale: Postural hypotension or orthostatic hypotension occurs when the BP decreases significantly after the
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FFpatient assumes an upright posture. It is usually accompanied by dizziness, lightheadedness, or syncope. The
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FFproper order in checking the BP changes should start by positioning the patient first and then measure first
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FFthe BP in supine position before an upright position but never remove the BP cuff to avoid any changes
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FFrelated to misplacing or adjusting the cuff. Lastly document the HR and BP.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.799 FFT FF T FFT FF T FF T FF T FF T T
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9. You assess a patient for postural hypotension and recognize the following are normal postural responses except:
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a. An unchanged systolic pressure T
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c. An increase of 10 mm Hg in the reading
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b. A heart rate of 5-20 bpm above the resting rate
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d. An increase of 5 mm Hg in diastolic
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T
FFpressure ANSWER: C FF T FF T


Rationale: Postural hypotension or orthostatic hypotension occurs when the BP decreases significantly after the
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FFpatient assumes an upright posture. It is usually accompanied by dizziness, lightheadedness, or syncope.
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FFOption C is incorrect. For us to say that it is normal postural response, it should be a slight decrease of up
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FFto 10 mm Hg and not an increase.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.799. FFT FF T FFT FF T FF T FF T FF T T
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10. You check the client’s chart and see on the assessment data that the client’s pulse strength is “left
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FFradial+2.” Based on 0-4 rating scale, this means: FF T FF T FF T FF T FF T FF T FF T


a. Diminished pulse and cannot be obliterated FF T FF T FFT T
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b. Pulse is weak, thready, difficult to palpate and obliterated with pressure
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c. Full pulse, easy to palpate, weak and thread
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d. Strong and bounding pulse, may be FF T FF T FFT FF T FF T


T
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Rationale: Pulse is weak, thready, and difficult to palpate only if pressure is applied. 0: pulse not palpable or absent.
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+1 Pulse is weak, thready, difficult to palpate and obliterated with pressure. +2 diminished pulse and cannot
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FFbe obliterated. +3 Full pulse, easy to palpate. +4 Strong and bounding pulse may be abnormal.
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Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.800 FFT FF T FFT FF T FF T FF T FF T T
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11. A nurse is explaining the anatomy and physiology of the heart to a group of adults participating in a
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FFwellness program. When a participant asks for an explanation of the purpose of the superior vena cava,
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FFthe nurse provides which of the following information?
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a. Returns blood from the body area above the diaphragm FF T FF T T
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b. Returns blood from the body below the diaphragm FF T FF T FF T FF T FF T FF T FF T


c. Drains blood from the heart FFT T
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d. Receives freshly oxygenated blood from the lungs through the pulmonary FFT FFT FFT FF T FF T FF T FF T T
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The superior vena cava returns blood from the body area above the diaphragm, the inferior vena cava returns
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FFblood from the body below the diaphragm, and the coronary sinus drains blood from the heart. The left
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FFatrium receives freshly oxygenated blood from the lungs through the pulmonary veins.
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SITUATION: Cardiovascular disease is the leading cause of death and showed in later studies that many of the
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FFpopulation, men and women of all racial and ethnic groups are seriously affected by these cardiac
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FFconditions.
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12. When do coronary arteries primarily receive blood flow? FFT FF T FF T FF T FF T FF T FF T


a. During inspiration FF T


b. During diastole FF T


c. During expiration FF T


d. During systole FF T

,ANSWER: B FF T


Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow
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to coronary arteries is supplied during diastole. This is the relaxation of the muscle, the heart chambers fill
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with blood in preparation for the subsequent ejection. Breathing patterns are irrelevant to blood flow.
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Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.
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10th Edition, Vol. 1. Page 647
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13. Atherosclerosis impedes coronary blood flow by which of the following mechanisms? T
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a. Plaques obstruct the vein T
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c. Blood clots form outside the vessel wall
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b. Plaques obstruct the artery FF T FF T FF T


d. Hardened vessels dilate to allow blood to flow through
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, ANSWER: B FF T


Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atheresclerosis is a direct
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result of plaque formation in the artery. Hardened vessels cannot dilate properly and therefore constrict
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blood flow.
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Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.
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10th Edition, Vol. 1. Page 713
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14. A murmur is heard at the second left intercostals space along the left sternal border. Which valve area is this?
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a. Aortic
b. Mitral
c. Pulmonic
d. Tricuspid
ANSWER:
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Abnormalities of the pulmonic valve are auscultated at the second left intercostals space along the left sternal
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border. Option A – aortic valve abnormalities are heard at the second intercostal space, to the right of the
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sternum.
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Option B – mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line.
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Option D – tricuspid valve abnormalities are heard at the third and fourth intercostals spaces along the sternal
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border. Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical
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Nursing. 10th Edition, Vol. 1. Page 664
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15. What position should the nurse place the head of the bed in to obtain the most accurate reading of
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jugular vein distention?
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a. High fowler’s FF T


b. Raised 10 degrees FF T FF T


c. Raised 30 degrees FF T FFT


d. Supine position T
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ANSWER: C
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Jugular venous pressure is measure with a centimeter ruler to obtain the vertical distance between the sternal
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angle and the point of highest pulsation with the head of the bed inclined between 15 and 30 degrees.
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Option A – in high fowler’s position, the veins would be barely discernible above the clavicle.
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Option B and D – increased pressure can’t be seen when the client is supine or when the head of the bed is
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raised 10 degrees because the point that marks the pressure level is above the jaw, therefore not visible.
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Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.
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10th Edition, Vol. 1. Page 664
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16. After teaching a group of adults about modifiable risk factors for coronary artery disease (CAD), the
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community health nurse knows that the group needs additional teaching if which finding is identified as
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one of these factors?
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a. Cigarette smoking FF T


b. Family history T
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c. Hypercholesterolemia
d. Hypertension
ANSWER: B
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Family history is a risk factor for CAD, but it is a non-modifiable risk factor. Cigarette smoking, elevated
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cholesterol levels (hypercholesterolemia), and hypertension are modifiable risk factors for CAD.
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Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.
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10th Edition, Vol. 1. Page 656
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17. A client is scheduled to undergo percutaneous transluminal coronary angioplasty (PTCA). Which statement
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by the nurse best explains the procedure to the client?
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a. "PTCA involves opening a blocked artery with an inflatable balloon located on the end of a catheter."
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b. "PTCA involves cutting away blockages with a special catheter."
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c. "PTCA involves passing a catheter through the coronary arteries to find blocked arteries."
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d. "PTCA involves inserting grafts to divert blood from blocked coronary
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arteries." ANSWER: A
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PTCA is best described as insertion of a balloon-tipped catheter into the coronary artery to compress a plaque,
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thereby opening a stenosed or blocked artery.
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Option B - this is a description of an atherectomy.
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Option C - this only describes a cardiac
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catheterization.
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Option D - Inserting grafts to divert blood from blocked arteries describes coronary artery bypass graft
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surgery. Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical
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Nursing. 10th Edition, Vol. 1. Page 733-735
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18. As initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3 mg
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given sublingually. This drug’s principal effects are produced by:
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a. Antispasmodic effects on the pericardium FFT FF T FF T T
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c. Vasodilation of peripheral vasculature
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b. Causing an increased myocardial oxygen T
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d. Improved conductivity in the myocardium
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ANSWER: C
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Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand.
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Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of
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the heart.
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Option A and D - nitroglycerin does not have an effect on pericardial spasticity or conductivity in the
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myocardium. Option B - nitroglycerin decreases myocardial oxygen demand.
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Reference: Bare, B.G. and Smeltzer, S.C. (2004). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.
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10th Edition, Vol. 1. Page 721
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19. A client is experiencing an acute myocardial infarction (MI) and I.V. morphine is prescribed. Morphine is
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given because it:
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