Advanced Concepts in Medical-Surgical
Nursing Exam 2 Actual Exam 2026/2027
100% Verified | Detailed Rationales –
Pass Guaranteed – A+ Graded
Content Area Overview: This comprehensive examination assesses advanced nursing knowledge and
clinical reasoning in medical-surgical nursing as covered in the advanced med-surg curriculum. The exam
is designed to evaluate the student's ability to apply evidence-based practice, prioritize complex patient
care, and demonstrate clinical judgment across multiple organ systems. This verified question bank
serves as a comprehensive assessment tool.
Content Domains Covered:
1. Complex Cardiovascular Disorders : Advanced assessment and management of heart failure,
acute coronary syndrome, cardiac dysrhythmias, shock states, hypertensive crisis, peripheral
vascular disease, aortic aneurysm, and valvular heart disease. Includes hemodynamic
monitoring, pharmacological interventions, and priority nursing care.
2. Critical Respiratory Disorders : Advanced management of acute respiratory failure, ARDS,
pulmonary embolism, COPD exacerbation, status asthmaticus, pneumonia, respiratory acidosis,
and mechanical ventilation. Includes interpretation of ABGs, oxygen therapy, and priority
interventions.
3. Renal, Fluid, & Electrolyte Disorders : Complex fluid and electrolyte imbalances
(hyper/hyponatremia, hyper/hypokalemia, acid-base disturbances), acute kidney injury (AKI),
chronic kidney disease (CKD), and management of renal replacement therapies. Includes lab
interpretation and pharmacological management.
4. Gastrointestinal & Hepatic Disorders : Advanced management of GI bleeding, pancreatitis,
hepatitis, cirrhosis, hepatic encephalopathy, inflammatory bowel disease, and bowel
obstructions. Includes nutritional support, medication management, and complication
monitoring.
5. Endocrine & Metabolic Emergencies : Complex management of diabetic emergencies (DKA,
HHS), thyroid disorders (thyroid storm, myxedema coma), and adrenal crisis. Includes insulin
management, fluid resuscitation, and symptom management.
, 6. Multisystem & Complex Care : Sepsis and septic shock, multiple organ dysfunction syndrome
(MODS), critical care prioritization, end-of-life care, and advanced clinical judgment across
complex patient presentations. Includes NGN-style clinical reasoning and prioritization.
Section 1: Complex Cardiovascular Disorders (Questions 1–10)
Q1: A 68-year-old patient with a history of heart failure with reduced ejection fraction (HFrEF) presents
with increasing dyspnea, orthopnea, and a 5-pound weight gain over three days. Vital signs: BP 148/92,
HR 110, RR 26, SpO₂ 90% on room air. Lung auscultation reveals bilateral crackles, and there is 2+ pitting
edema in both lower extremities. Which medication should the nurse anticipate the provider will order
first?
A. Digoxin 0.25 mg IV push to improve cardiac contractility
B. Furosemide 40 mg IV push to promote diuresis and reduce fluid overload [CORRECT]
C. Metoprolol 25 mg PO to control the elevated heart rate
D. Aspirin 325 mg PO for antiplatelet effect
Correct Answer: B
Rationale: The best answer is B. This patient is in acute decompensated heart failure with clear signs of
fluid overload—weight gain, crackles, and peripheral edema—plus hypoxemia from pulmonary
congestion. IV furosemide is the priority because it rapidly reduces preload through diuresis, which
relieves pulmonary edema and improves oxygenation. Digoxin has a narrow therapeutic window and
isn't first-line for acute overload, metoprolol could worsen decompensation by further reducing
contractility, and aspirin doesn't address the immediate problem of fluid accumulation.
Correct Answer: B
Q2: A patient with acute coronary syndrome is receiving a heparin infusion. The nurse notes the aPTT is
95 seconds (therapeutic range 60–80 seconds). Which is the priority nursing action?
A. Continue the infusion at the current rate and recheck in 4 hours
B. Stop the infusion immediately and notify the provider
C. Reduce the infusion rate per protocol and recheck the aPTT in 2–4 hours [CORRECT]
D. Administer protamine sulfate as an antidote
Correct Answer: C
Rationale: The best answer is C. An aPTT of 95 seconds is supratherapeutic but not in the range that
typically causes active bleeding, so the standard response is to hold or reduce the infusion per
institutional protocol and recheck sooner. Stopping completely or giving protamine is reserved for
severe bleeding or markedly elevated levels with hemorrhage—this patient needs a dose adjustment,
, not full reversal.
Correct Answer: C
Q3: A patient in the cardiac unit develops a new-onset irregularly irregular rhythm with a ventricular
rate of 160 bpm. The patient is hypotensive (BP 82/50), diaphoretic, and confused. Which intervention
should the nurse implement first?
A. Administer metoprolol 5 mg IV to slow the ventricular rate
B. Prepare for synchronized cardioversion [CORRECT]
C. Start a heparin infusion for anticoagulation
D. Obtain a 12-lead ECG and wait for the provider's orders
Correct Answer: B
Rationale: The best answer is B. This patient has unstable atrial fibrillation with rapid ventricular
response—hypotension, altered mental status, and signs of poor perfusion are the classic criteria for
instability. Unstable tachyarrhythmias require immediate synchronized cardioversion; rate-control drugs
like metoprolol could worsen hypotension, and anticoagulation or waiting for an ECG delays definitive
treatment when the patient is already decompensating.
Correct Answer: B
Q4: A patient with an abdominal aortic aneurysm (AAA) measuring 5.8 cm reports sudden, severe back
pain and a tearing sensation. Vital signs show BP 90/60, HR 128, RR 24. The nurse notes the abdomen is
rigid and tender. Which hypothesis should be prioritized?
A. Ruptured abdominal aortic aneurysm [CORRECT]
B. Acute pancreatitis
C. Renal colic from a kidney stone
D. Acute appendicitis
Correct Answer: A
Rationale: The best answer is A. Sudden severe back pain with a tearing quality in a patient with a
known large AAA is the classic presentation of rupture—hypotension and tachycardia confirm
hemorrhagic shock. This is a surgical emergency requiring immediate activation of the rapid response
team and preparation for emergent surgery. Pancreatitis, renal colic, and appendicitis don't fit the
sudden tearing pain pattern in a patient with this specific risk factor.
Correct Answer: A
Q5: A patient with hypertensive crisis presents with BP 220/130, headache, and blurred vision. The
provider orders IV labetalol. Fifteen minutes after administration, the patient's BP is 180/110. Which is
the most appropriate nursing response?
Nursing Exam 2 Actual Exam 2026/2027
100% Verified | Detailed Rationales –
Pass Guaranteed – A+ Graded
Content Area Overview: This comprehensive examination assesses advanced nursing knowledge and
clinical reasoning in medical-surgical nursing as covered in the advanced med-surg curriculum. The exam
is designed to evaluate the student's ability to apply evidence-based practice, prioritize complex patient
care, and demonstrate clinical judgment across multiple organ systems. This verified question bank
serves as a comprehensive assessment tool.
Content Domains Covered:
1. Complex Cardiovascular Disorders : Advanced assessment and management of heart failure,
acute coronary syndrome, cardiac dysrhythmias, shock states, hypertensive crisis, peripheral
vascular disease, aortic aneurysm, and valvular heart disease. Includes hemodynamic
monitoring, pharmacological interventions, and priority nursing care.
2. Critical Respiratory Disorders : Advanced management of acute respiratory failure, ARDS,
pulmonary embolism, COPD exacerbation, status asthmaticus, pneumonia, respiratory acidosis,
and mechanical ventilation. Includes interpretation of ABGs, oxygen therapy, and priority
interventions.
3. Renal, Fluid, & Electrolyte Disorders : Complex fluid and electrolyte imbalances
(hyper/hyponatremia, hyper/hypokalemia, acid-base disturbances), acute kidney injury (AKI),
chronic kidney disease (CKD), and management of renal replacement therapies. Includes lab
interpretation and pharmacological management.
4. Gastrointestinal & Hepatic Disorders : Advanced management of GI bleeding, pancreatitis,
hepatitis, cirrhosis, hepatic encephalopathy, inflammatory bowel disease, and bowel
obstructions. Includes nutritional support, medication management, and complication
monitoring.
5. Endocrine & Metabolic Emergencies : Complex management of diabetic emergencies (DKA,
HHS), thyroid disorders (thyroid storm, myxedema coma), and adrenal crisis. Includes insulin
management, fluid resuscitation, and symptom management.
, 6. Multisystem & Complex Care : Sepsis and septic shock, multiple organ dysfunction syndrome
(MODS), critical care prioritization, end-of-life care, and advanced clinical judgment across
complex patient presentations. Includes NGN-style clinical reasoning and prioritization.
Section 1: Complex Cardiovascular Disorders (Questions 1–10)
Q1: A 68-year-old patient with a history of heart failure with reduced ejection fraction (HFrEF) presents
with increasing dyspnea, orthopnea, and a 5-pound weight gain over three days. Vital signs: BP 148/92,
HR 110, RR 26, SpO₂ 90% on room air. Lung auscultation reveals bilateral crackles, and there is 2+ pitting
edema in both lower extremities. Which medication should the nurse anticipate the provider will order
first?
A. Digoxin 0.25 mg IV push to improve cardiac contractility
B. Furosemide 40 mg IV push to promote diuresis and reduce fluid overload [CORRECT]
C. Metoprolol 25 mg PO to control the elevated heart rate
D. Aspirin 325 mg PO for antiplatelet effect
Correct Answer: B
Rationale: The best answer is B. This patient is in acute decompensated heart failure with clear signs of
fluid overload—weight gain, crackles, and peripheral edema—plus hypoxemia from pulmonary
congestion. IV furosemide is the priority because it rapidly reduces preload through diuresis, which
relieves pulmonary edema and improves oxygenation. Digoxin has a narrow therapeutic window and
isn't first-line for acute overload, metoprolol could worsen decompensation by further reducing
contractility, and aspirin doesn't address the immediate problem of fluid accumulation.
Correct Answer: B
Q2: A patient with acute coronary syndrome is receiving a heparin infusion. The nurse notes the aPTT is
95 seconds (therapeutic range 60–80 seconds). Which is the priority nursing action?
A. Continue the infusion at the current rate and recheck in 4 hours
B. Stop the infusion immediately and notify the provider
C. Reduce the infusion rate per protocol and recheck the aPTT in 2–4 hours [CORRECT]
D. Administer protamine sulfate as an antidote
Correct Answer: C
Rationale: The best answer is C. An aPTT of 95 seconds is supratherapeutic but not in the range that
typically causes active bleeding, so the standard response is to hold or reduce the infusion per
institutional protocol and recheck sooner. Stopping completely or giving protamine is reserved for
severe bleeding or markedly elevated levels with hemorrhage—this patient needs a dose adjustment,
, not full reversal.
Correct Answer: C
Q3: A patient in the cardiac unit develops a new-onset irregularly irregular rhythm with a ventricular
rate of 160 bpm. The patient is hypotensive (BP 82/50), diaphoretic, and confused. Which intervention
should the nurse implement first?
A. Administer metoprolol 5 mg IV to slow the ventricular rate
B. Prepare for synchronized cardioversion [CORRECT]
C. Start a heparin infusion for anticoagulation
D. Obtain a 12-lead ECG and wait for the provider's orders
Correct Answer: B
Rationale: The best answer is B. This patient has unstable atrial fibrillation with rapid ventricular
response—hypotension, altered mental status, and signs of poor perfusion are the classic criteria for
instability. Unstable tachyarrhythmias require immediate synchronized cardioversion; rate-control drugs
like metoprolol could worsen hypotension, and anticoagulation or waiting for an ECG delays definitive
treatment when the patient is already decompensating.
Correct Answer: B
Q4: A patient with an abdominal aortic aneurysm (AAA) measuring 5.8 cm reports sudden, severe back
pain and a tearing sensation. Vital signs show BP 90/60, HR 128, RR 24. The nurse notes the abdomen is
rigid and tender. Which hypothesis should be prioritized?
A. Ruptured abdominal aortic aneurysm [CORRECT]
B. Acute pancreatitis
C. Renal colic from a kidney stone
D. Acute appendicitis
Correct Answer: A
Rationale: The best answer is A. Sudden severe back pain with a tearing quality in a patient with a
known large AAA is the classic presentation of rupture—hypotension and tachycardia confirm
hemorrhagic shock. This is a surgical emergency requiring immediate activation of the rapid response
team and preparation for emergent surgery. Pancreatitis, renal colic, and appendicitis don't fit the
sudden tearing pain pattern in a patient with this specific risk factor.
Correct Answer: A
Q5: A patient with hypertensive crisis presents with BP 220/130, headache, and blurred vision. The
provider orders IV labetalol. Fifteen minutes after administration, the patient's BP is 180/110. Which is
the most appropriate nursing response?
