MED SURG CMS PROCTORED EXAM 2026/2027 | 100%
Correct Verified Q&A | Comprehensive Med-Surg Mastery |
Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders
Q1: A nurse is assessing a client with heart failure who reports increasing shortness of
breath. The nurse notes jugular venous distention (JVD) and bilateral ankle edema.
Which type of heart failure is the client most likely experiencing?
A. Right-sided heart failure
B. Left-sided heart failure
C. Biventricular heart failure
D. High-output heart failure
Correct Answer: A
Rationale: Jugular venous distention and peripheral edema are classic signs of
systemic venous congestion, which is indicative of right-sided heart failure. Left-sided
heart failure typically presents with pulmonary symptoms like dyspnea and crackles due
to backup into the lungs. While the client may ultimately have biventricular failure, the
specific findings of JVD and ankle edema directly point to right-sided dysfunction.
VERIFIED ✓ 2026/2027 CMS Blueprint.
Q2: A client with chronic heart failure with reduced ejection fraction (HFrEF) is
prescribed enalapril. The nurse should monitor the client for which primary adverse
effect?
A. Hyperkalemia and a persistent dry cough
B. Hypokalemia and tachycardia
C. Reflex tachycardia and peripheral edema
D. Bradycardia and bronchospasm
Correct Answer: A
Rationale: Enalapril is an ACE inhibitor, which inhibits the conversion of angiotensin I to
angiotensin II, reducing aldosterone secretion and decreasing potassium excretion,
which can lead to hyperkalemia. ACE inhibitors also block the breakdown of bradykinin,
,leading to a persistent dry cough in up to 20% of patients. Hypokalemia and reflex
tachycardia are not associated with ACE inhibitors. VERIFIED ✓ 2026/2027 CMS
Blueprint.
Q3: A nurse is providing discharge teaching to a client with heart failure. Which
statement by the client indicates an understanding of the dietary modifications
required?
A. "I will drink at least 3 liters of water daily to flush out toxins."
B. "I will use a salt substitute to flavor my food instead of table salt."
C. "I will limit my sodium intake to less than 2,000 to 3,000 mg per day."
D. "I will increase my intake of canned vegetables and soups for better nutrition."
Correct Answer: C
Rationale: Clients with heart failure are instructed to restrict sodium intake to typically
less than 2,000 to 3,000 mg per day to prevent fluid retention. Drinking excessive fluids
(3 liters) can worsen fluid overload. Salt substitutes are often contraindicated because
they contain potassium chloride, which, combined with ACE inhibitors or kidney
dysfunction, can cause dangerous hyperkalemia. Canned foods are highly processed
and contain excessive sodium. VERIFIED ✓ 2026/2027 CMS Blueprint.
Q4: The nurse is caring for a client with heart failure who is receiving intravenous
furosemide. Which assessment finding requires immediate intervention by the nurse?
A. Urine output of 50 mL per hour
B. Serum potassium level of 3.0 mEq/L
C. Decreased bilateral ankle edema
D. Blood pressure of 110/70 mmHg
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium loss
(hypokalemia). A serum potassium level of 3.0 mEq/L is critically low and places the
client at high risk for fatal cardiac dysrhythmias, requiring immediate intervention such
as potassium replacement. Urine output of 50 mL/hr and decreased edema indicate the
,diuretic is working. A BP of 110/70 is normal and stable. VERIFIED ✓ 2026/2027 CMS
Blueprint.
Q5: A client with HFpEF (heart failure with preserved ejection fraction) asks the nurse
what "preserved ejection fraction" means. What is the best response by the nurse?
A. "It means your heart muscle is too weak to pump effectively."
B. "It means your heart muscle is stiff and cannot relax properly to fill with blood."
C. "It means the valves in your heart are narrowed, blocking blood flow."
D. "It means your heart is beating too fast to empty completely."
Correct Answer: B
Rationale: HFpEF is characterized by diastolic dysfunction; the ejection fraction is
normal or preserved (typically ≥50%), but the ventricle is stiff and noncompliant,
impairing filling. HFrEF (reduced ejection fraction) involves systolic dysfunction where
the heart muscle is weak and cannot contract effectively. Valvular narrowing describes
stenosis, not HFpEF. VERIFIED ✓ 2026/2027 CMS Blueprint.
Q6: A client arrives at the emergency department complaining of severe substernal
chest pain that radiates to the left arm. The 12-lead ECG shows ST-segment elevation in
leads II, III, and aVF. The nurse should recognize that the client is experiencing an acute
myocardial infarction in which area of the heart?
A. Anterior wall
B. Lateral wall
C. Inferior wall
D. Posterior wall
Correct Answer: C
Rationale: Leads II, III, and aVF look at the inferior surface of the heart. ST-segment
elevation in these leads indicates an acute inferior wall myocardial infarction. Anterior
wall MIs are seen in leads V1-V4. Lateral wall MIs are seen in leads I, aVL, V5, and V6.
VERIFIED ✓ 2026/2027 CMS Blueprint.
Q7: A client diagnosed with an acute MI is prescribed alteplase (tPA) thrombolytic
therapy. Which is the most critical nursing intervention during the infusion?
, A. Monitoring for signs of bleeding, particularly neurological changes
B. Assessing the client's apical pulse for bradycardia
C. Checking the blood pressure every 4 hours to detect hypotension
D. Encouraging the client to ambulate to prevent DVT
Correct Answer: A
Rationale: Thrombolytics like alteplase dissolve clots but carry a massive risk of severe
bleeding, particularly intracranial hemorrhage. The nurse must monitor vital signs
frequently and perform frequent neurological checks. BP should be monitored much
more frequently than every 4 hours (often every 15-30 mins). The client must be on
strict bed rest to prevent trauma/bleeding during the infusion. VERIFIED ✓ 2026/2027
CMS Blueprint.
Q8: A nurse is administering sublingual nitroglycerin to a client with stable angina.
Which instruction is most appropriate for the nurse to give the client?
A. "Swallow the tablet with a full glass of water."
B. "Let the tablet dissolve completely under your tongue, and sit or lie down."
C. "Chew the tablet slowly for rapid absorption in the stomach."
D. "Place the tablet between your cheek and gum."
Correct Answer: B
Rationale: Sublingual nitroglycerin is administered by placing it under the tongue, where
it absorbs rapidly into the systemic circulation via the highly vascular sublingual
mucosa. The client should sit or lie down because nitroglycerin causes rapid
vasodilation, which can lead to severe orthostatic hypotension and syncope. It should
not be swallowed or chewed, as the liver would inactivate it during first-pass
metabolism. VERIFIED ✓ 2026/2027 CMS Blueprint.
Q9: Following a percutaneous coronary intervention (PCI) with stent placement, a client
is prescribed dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel.
What is the primary purpose of this regimen?
A. To prevent restenosis of the newly placed coronary stent
B. To treat hyperlipidemia and reduce plaque buildup
C. To prevent myocardial remodeling and heart failure
Correct Verified Q&A | Comprehensive Med-Surg Mastery |
Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders
Q1: A nurse is assessing a client with heart failure who reports increasing shortness of
breath. The nurse notes jugular venous distention (JVD) and bilateral ankle edema.
Which type of heart failure is the client most likely experiencing?
A. Right-sided heart failure
B. Left-sided heart failure
C. Biventricular heart failure
D. High-output heart failure
Correct Answer: A
Rationale: Jugular venous distention and peripheral edema are classic signs of
systemic venous congestion, which is indicative of right-sided heart failure. Left-sided
heart failure typically presents with pulmonary symptoms like dyspnea and crackles due
to backup into the lungs. While the client may ultimately have biventricular failure, the
specific findings of JVD and ankle edema directly point to right-sided dysfunction.
VERIFIED ✓ 2026/2027 CMS Blueprint.
Q2: A client with chronic heart failure with reduced ejection fraction (HFrEF) is
prescribed enalapril. The nurse should monitor the client for which primary adverse
effect?
A. Hyperkalemia and a persistent dry cough
B. Hypokalemia and tachycardia
C. Reflex tachycardia and peripheral edema
D. Bradycardia and bronchospasm
Correct Answer: A
Rationale: Enalapril is an ACE inhibitor, which inhibits the conversion of angiotensin I to
angiotensin II, reducing aldosterone secretion and decreasing potassium excretion,
which can lead to hyperkalemia. ACE inhibitors also block the breakdown of bradykinin,
,leading to a persistent dry cough in up to 20% of patients. Hypokalemia and reflex
tachycardia are not associated with ACE inhibitors. VERIFIED ✓ 2026/2027 CMS
Blueprint.
Q3: A nurse is providing discharge teaching to a client with heart failure. Which
statement by the client indicates an understanding of the dietary modifications
required?
A. "I will drink at least 3 liters of water daily to flush out toxins."
B. "I will use a salt substitute to flavor my food instead of table salt."
C. "I will limit my sodium intake to less than 2,000 to 3,000 mg per day."
D. "I will increase my intake of canned vegetables and soups for better nutrition."
Correct Answer: C
Rationale: Clients with heart failure are instructed to restrict sodium intake to typically
less than 2,000 to 3,000 mg per day to prevent fluid retention. Drinking excessive fluids
(3 liters) can worsen fluid overload. Salt substitutes are often contraindicated because
they contain potassium chloride, which, combined with ACE inhibitors or kidney
dysfunction, can cause dangerous hyperkalemia. Canned foods are highly processed
and contain excessive sodium. VERIFIED ✓ 2026/2027 CMS Blueprint.
Q4: The nurse is caring for a client with heart failure who is receiving intravenous
furosemide. Which assessment finding requires immediate intervention by the nurse?
A. Urine output of 50 mL per hour
B. Serum potassium level of 3.0 mEq/L
C. Decreased bilateral ankle edema
D. Blood pressure of 110/70 mmHg
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium loss
(hypokalemia). A serum potassium level of 3.0 mEq/L is critically low and places the
client at high risk for fatal cardiac dysrhythmias, requiring immediate intervention such
as potassium replacement. Urine output of 50 mL/hr and decreased edema indicate the
,diuretic is working. A BP of 110/70 is normal and stable. VERIFIED ✓ 2026/2027 CMS
Blueprint.
Q5: A client with HFpEF (heart failure with preserved ejection fraction) asks the nurse
what "preserved ejection fraction" means. What is the best response by the nurse?
A. "It means your heart muscle is too weak to pump effectively."
B. "It means your heart muscle is stiff and cannot relax properly to fill with blood."
C. "It means the valves in your heart are narrowed, blocking blood flow."
D. "It means your heart is beating too fast to empty completely."
Correct Answer: B
Rationale: HFpEF is characterized by diastolic dysfunction; the ejection fraction is
normal or preserved (typically ≥50%), but the ventricle is stiff and noncompliant,
impairing filling. HFrEF (reduced ejection fraction) involves systolic dysfunction where
the heart muscle is weak and cannot contract effectively. Valvular narrowing describes
stenosis, not HFpEF. VERIFIED ✓ 2026/2027 CMS Blueprint.
Q6: A client arrives at the emergency department complaining of severe substernal
chest pain that radiates to the left arm. The 12-lead ECG shows ST-segment elevation in
leads II, III, and aVF. The nurse should recognize that the client is experiencing an acute
myocardial infarction in which area of the heart?
A. Anterior wall
B. Lateral wall
C. Inferior wall
D. Posterior wall
Correct Answer: C
Rationale: Leads II, III, and aVF look at the inferior surface of the heart. ST-segment
elevation in these leads indicates an acute inferior wall myocardial infarction. Anterior
wall MIs are seen in leads V1-V4. Lateral wall MIs are seen in leads I, aVL, V5, and V6.
VERIFIED ✓ 2026/2027 CMS Blueprint.
Q7: A client diagnosed with an acute MI is prescribed alteplase (tPA) thrombolytic
therapy. Which is the most critical nursing intervention during the infusion?
, A. Monitoring for signs of bleeding, particularly neurological changes
B. Assessing the client's apical pulse for bradycardia
C. Checking the blood pressure every 4 hours to detect hypotension
D. Encouraging the client to ambulate to prevent DVT
Correct Answer: A
Rationale: Thrombolytics like alteplase dissolve clots but carry a massive risk of severe
bleeding, particularly intracranial hemorrhage. The nurse must monitor vital signs
frequently and perform frequent neurological checks. BP should be monitored much
more frequently than every 4 hours (often every 15-30 mins). The client must be on
strict bed rest to prevent trauma/bleeding during the infusion. VERIFIED ✓ 2026/2027
CMS Blueprint.
Q8: A nurse is administering sublingual nitroglycerin to a client with stable angina.
Which instruction is most appropriate for the nurse to give the client?
A. "Swallow the tablet with a full glass of water."
B. "Let the tablet dissolve completely under your tongue, and sit or lie down."
C. "Chew the tablet slowly for rapid absorption in the stomach."
D. "Place the tablet between your cheek and gum."
Correct Answer: B
Rationale: Sublingual nitroglycerin is administered by placing it under the tongue, where
it absorbs rapidly into the systemic circulation via the highly vascular sublingual
mucosa. The client should sit or lie down because nitroglycerin causes rapid
vasodilation, which can lead to severe orthostatic hypotension and syncope. It should
not be swallowed or chewed, as the liver would inactivate it during first-pass
metabolism. VERIFIED ✓ 2026/2027 CMS Blueprint.
Q9: Following a percutaneous coronary intervention (PCI) with stent placement, a client
is prescribed dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel.
What is the primary purpose of this regimen?
A. To prevent restenosis of the newly placed coronary stent
B. To treat hyperlipidemia and reduce plaque buildup
C. To prevent myocardial remodeling and heart failure
