EXAM 1 ADVANCED CONCEPTS IN MEDICAL-SURGICAL NURSING EXAM 1 | QUESTIONS AND ANSWERS RATED A+ | 2026/2027
OBJECTIVE ASSESSMENT - EXAM
EXAM 1 ADVANCED CONCEPTS IN
MEDICAL-SURGICAL NURSING EXAM
1 | QUESTIONS AND ANSWERS
RATED A+ | 2026/2027
75 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular & Respiratory Disorders Neurological & Musculoskeletal Disorders
Gastrointestinal & Renal Systems Complex Multisystem Management
Endocrine & Metabolic Conditions
EXAM 1 ADVANCED CONCEPTS IN MEDICAL-SURGICAL NURSING EXAM 1 | QUESTIONS AND ANSWERS RATED A+ | 2026/2027 - 2026/2027 | Passing Score: 80% Page 1 of 72
COVER PAGE - 1
, SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q18 | EXAM 1 ADVANCED CONCEPTS IN MEDICAL-SURGICAL NURSING EXAM 1 | QUESTIONS AND ANSWERS RATED A+ | 2026/2027 2026/20
Q1 Question 1 of 75
A 64-year-old male presents to the emergency department with substernal chest pressure radiating
to the jaw, diaphoresis, and dyspnea that began 45 minutes ago while shoveling snow. The 12-lead
ECG reveals ST-segment elevation in leads V2-V4 with reciprocal changes in II, III, and aVF.
Which intervention should the nurse anticipate implementing first?
A. Administer a beta-blocker IV push immediately, withhold aspirin until troponin results return, and
arrange for a stress test on the next available outpatient appointment.
B. Apply oxygen at 6 L/min via nasal cannula regardless of saturation, give IV morphine 4 mg as the
first medication, and defer all other interventions until the cardiologist arrives at the bedside.
C. Administer chewable aspirin 162-325 mg, initiate cardiac monitoring, establish two large-bore IVs,
draw cardiac biomarkers, and prepare the patient for emergent percutaneous coronary intervention
within 90 minutes of first medical contact.
D. Administer sublingual nitroglycerin every 5 minutes for three doses, then discharge the patient
home with instructions to follow up with the primary provider within 48 hours.
Correct Answer: C
Rationale:
ST-elevation in V2-V4 indicates an anterior wall STEMI, requiring immediate aspirin, monitoring, IV
access, biomarkers, and emergent PCI within 90 minutes (door-to-balloon time). Beta-blockers are
given but not before aspirin; high-flow oxygen is only used when SpO2 is below 90%; routine
discharge is contraindicated in STEMI.
EXAM 1 ADVANCED CONCEPTS IN MEDICAL-SURGICAL NURSING EXAM 1 | QUESTIONS AND ANSWERS RATED A+ | 2026/2027 - 2026/2027 | Passing Score: 80% Page 2 of 72
, Q2 Question 2 of 75
A 72-year-old female with a history of hypertension and atrial fibrillation is admitted with worsening
dyspnea, bilateral crackles, jugular venous distension, and 3+ pitting edema of the lower
extremities. Echocardiography shows an ejection fraction of 30%. Which class of medications has
been proven to reduce mortality in this patient with HFrEF and should be initiated?
A. Beta-blockers such as carvedilol or metoprolol succinate, ACE inhibitors or ARBs, and aldosterone
antagonists such as spironolactone, all titrated to target doses as tolerated along with diuretics for
symptom control.
B. Loop diuretics alone as monotherapy, because they relieve symptoms and improve survival in heart
failure with reduced ejection fraction without the need for additional agents.
C. Calcium channel blockers such as amlodipine and diltiazem, because they reduce afterload and
improve cardiac output without the bradycardia risk associated with beta-blockers.
D. Oral nitrates and digoxin as the primary combination, because these agents improve mortality in
HFrEF and can be used in place of neurohormonal blockade.
Correct Answer: A
Rationale:
Beta-blockers, ACE inhibitors/ARBs, and aldosterone antagonists are the only medication classes
proven to reduce mortality in HFrEF. Loop diuretics manage symptoms but do not improve survival.
Most calcium channel blockers are contraindicated in HFrEF, and digoxin reduces hospitalizations
without improving mortality.
EXAM 1 ADVANCED CONCEPTS IN MEDICAL-SURGICAL NURSING EXAM 1 | QUESTIONS AND ANSWERS RATED A+ | 2026/2027 - 2026/2027 | Passing Score: 80% Page 3 of 72
, Q3 Question 3 of 75
A 58-year-old male with a mechanical mitral valve replacement presents with an INR of 8.5, gum
bleeding, and hematuria. He has no evidence of intracranial hemorrhage on CT. Which order
should the nurse anticipate from the provider?
A. Continue warfarin at the same dose, administer IV heparin to bridge until the INR falls below 5, and
discharge the patient home with weekly INR monitoring.
B. Hold warfarin, administer vitamin K 2.5-5 mg orally or IV depending on bleeding severity, monitor
INR every 6-12 hours, and consider fresh frozen plasma or prothrombin complex concentrate if
bleeding is life-threatening.
C. Administer IV protamine sulfate 50 mg immediately to reverse the anticoagulant effects of warfarin,
then restart warfarin at half the previous dose in 24 hours.
D. Discontinue warfarin permanently and transition the patient to dual antiplatelet therapy with aspirin
and clopidogrel for lifelong anticoagulation of the mechanical valve.
Correct Answer: B
Rationale:
An INR of 8.5 with bleeding requires holding warfarin, administering vitamin K, monitoring, and using
FFP or PCC for serious bleeding. Heparin bridging is inappropriate in over-anticoagulation, protamine
reverses heparin not warfarin, and dual antiplatelet therapy is insufficient for mechanical valves.
EXAM 1 ADVANCED CONCEPTS IN MEDICAL-SURGICAL NURSING EXAM 1 | QUESTIONS AND ANSWERS RATED A+ | 2026/2027 - 2026/2027 | Passing Score: 80% Page 4 of 72
OBJECTIVE ASSESSMENT - EXAM
EXAM 1 ADVANCED CONCEPTS IN
MEDICAL-SURGICAL NURSING EXAM
1 | QUESTIONS AND ANSWERS
RATED A+ | 2026/2027
75 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular & Respiratory Disorders Neurological & Musculoskeletal Disorders
Gastrointestinal & Renal Systems Complex Multisystem Management
Endocrine & Metabolic Conditions
EXAM 1 ADVANCED CONCEPTS IN MEDICAL-SURGICAL NURSING EXAM 1 | QUESTIONS AND ANSWERS RATED A+ | 2026/2027 - 2026/2027 | Passing Score: 80% Page 1 of 72
COVER PAGE - 1
, SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q18 | EXAM 1 ADVANCED CONCEPTS IN MEDICAL-SURGICAL NURSING EXAM 1 | QUESTIONS AND ANSWERS RATED A+ | 2026/2027 2026/20
Q1 Question 1 of 75
A 64-year-old male presents to the emergency department with substernal chest pressure radiating
to the jaw, diaphoresis, and dyspnea that began 45 minutes ago while shoveling snow. The 12-lead
ECG reveals ST-segment elevation in leads V2-V4 with reciprocal changes in II, III, and aVF.
Which intervention should the nurse anticipate implementing first?
A. Administer a beta-blocker IV push immediately, withhold aspirin until troponin results return, and
arrange for a stress test on the next available outpatient appointment.
B. Apply oxygen at 6 L/min via nasal cannula regardless of saturation, give IV morphine 4 mg as the
first medication, and defer all other interventions until the cardiologist arrives at the bedside.
C. Administer chewable aspirin 162-325 mg, initiate cardiac monitoring, establish two large-bore IVs,
draw cardiac biomarkers, and prepare the patient for emergent percutaneous coronary intervention
within 90 minutes of first medical contact.
D. Administer sublingual nitroglycerin every 5 minutes for three doses, then discharge the patient
home with instructions to follow up with the primary provider within 48 hours.
Correct Answer: C
Rationale:
ST-elevation in V2-V4 indicates an anterior wall STEMI, requiring immediate aspirin, monitoring, IV
access, biomarkers, and emergent PCI within 90 minutes (door-to-balloon time). Beta-blockers are
given but not before aspirin; high-flow oxygen is only used when SpO2 is below 90%; routine
discharge is contraindicated in STEMI.
EXAM 1 ADVANCED CONCEPTS IN MEDICAL-SURGICAL NURSING EXAM 1 | QUESTIONS AND ANSWERS RATED A+ | 2026/2027 - 2026/2027 | Passing Score: 80% Page 2 of 72
, Q2 Question 2 of 75
A 72-year-old female with a history of hypertension and atrial fibrillation is admitted with worsening
dyspnea, bilateral crackles, jugular venous distension, and 3+ pitting edema of the lower
extremities. Echocardiography shows an ejection fraction of 30%. Which class of medications has
been proven to reduce mortality in this patient with HFrEF and should be initiated?
A. Beta-blockers such as carvedilol or metoprolol succinate, ACE inhibitors or ARBs, and aldosterone
antagonists such as spironolactone, all titrated to target doses as tolerated along with diuretics for
symptom control.
B. Loop diuretics alone as monotherapy, because they relieve symptoms and improve survival in heart
failure with reduced ejection fraction without the need for additional agents.
C. Calcium channel blockers such as amlodipine and diltiazem, because they reduce afterload and
improve cardiac output without the bradycardia risk associated with beta-blockers.
D. Oral nitrates and digoxin as the primary combination, because these agents improve mortality in
HFrEF and can be used in place of neurohormonal blockade.
Correct Answer: A
Rationale:
Beta-blockers, ACE inhibitors/ARBs, and aldosterone antagonists are the only medication classes
proven to reduce mortality in HFrEF. Loop diuretics manage symptoms but do not improve survival.
Most calcium channel blockers are contraindicated in HFrEF, and digoxin reduces hospitalizations
without improving mortality.
EXAM 1 ADVANCED CONCEPTS IN MEDICAL-SURGICAL NURSING EXAM 1 | QUESTIONS AND ANSWERS RATED A+ | 2026/2027 - 2026/2027 | Passing Score: 80% Page 3 of 72
, Q3 Question 3 of 75
A 58-year-old male with a mechanical mitral valve replacement presents with an INR of 8.5, gum
bleeding, and hematuria. He has no evidence of intracranial hemorrhage on CT. Which order
should the nurse anticipate from the provider?
A. Continue warfarin at the same dose, administer IV heparin to bridge until the INR falls below 5, and
discharge the patient home with weekly INR monitoring.
B. Hold warfarin, administer vitamin K 2.5-5 mg orally or IV depending on bleeding severity, monitor
INR every 6-12 hours, and consider fresh frozen plasma or prothrombin complex concentrate if
bleeding is life-threatening.
C. Administer IV protamine sulfate 50 mg immediately to reverse the anticoagulant effects of warfarin,
then restart warfarin at half the previous dose in 24 hours.
D. Discontinue warfarin permanently and transition the patient to dual antiplatelet therapy with aspirin
and clopidogrel for lifelong anticoagulation of the mechanical valve.
Correct Answer: B
Rationale:
An INR of 8.5 with bleeding requires holding warfarin, administering vitamin K, monitoring, and using
FFP or PCC for serious bleeding. Heparin bridging is inappropriate in over-anticoagulation, protamine
reverses heparin not warfarin, and dual antiplatelet therapy is insufficient for mechanical valves.
EXAM 1 ADVANCED CONCEPTS IN MEDICAL-SURGICAL NURSING EXAM 1 | QUESTIONS AND ANSWERS RATED A+ | 2026/2027 - 2026/2027 | Passing Score: 80% Page 4 of 72
