CEA MEDICAL-SURGICAL NURSING EXAM with Questions
and Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Cardiovascular and Hemodynamic Alterations, Critical Care, and Advanced Pathophysiology
2. Respiratory, Renal, and Acid-Base Critical Care Management
3. Endocrine, Neurological, Gastrointestinal, and Complex Multi-System Disorders
1. A 64-year-old male is admitted to the intensive care unit with acute anterior myocardial
infarction. He develops sudden dyspnea, tachypnea, pink frothy sputum, and bilateral crackles,
with a pulmonary artery wedge pressure (PAWP) of 24 mmHg. What is the priority nursing
intervention?
A. Administer a 500 mL bolus of normal saline to improve cardiac output
B. Administer IV furosemide and position the client in a high-Fowler position with legs
dangling
C. Prepare the client for immediate insertion of a temporary transvenous pacemaker
D. Administer sublingual nitroglycerin only if the systolic blood pressure is below 90 mmHg
CORRECT ANSWER : B
Rationale: The client is experiencing acute cardiogenic pulmonary edema due to left ventricular
failure, evidenced by the elevated PAWP and respiratory distress. Administering IV loop
diuretics reduces preload, while upright positioning decreases venous return to the heart. Saline
boluses would worsen pulmonary congestion, and nitroglycerin is contraindicated if systolic
blood pressure is hypotensive.
2. A 55-year-old female post-coronary artery bypass graft (CABG) exhibits jugular venous
distension, muffled heart sounds, and a sudden drop in blood pressure with equalizing diastolic
pressures on hemodynamic monitoring. What complication should the nurse suspect?
A. Left ventricular aneurysm
B. Cardiac tamponade
, C. Acute kidney injury
D. Tension pneumothorax
CORRECT ANSWER : B
Rationale: Beck's triad of hypotension, muffled heart sounds, and jugular venous distension
combined with hemodynamic equalization indicates cardiac tamponade from pericardial fluid
accumulation. Immediate pericardiocentesis or surgical intervention is required. Tension
pneumothorax involves tracheal deviation and absent breath sounds, not muffled heart sounds.
3. A client with septic shock is receiving norepinephrine infusion through a peripheral IV line in
the forearm. The nurse notes cool, pale skin and swelling around the insertion site, with
blanching along the vein. What is the immediate action?
A. Apply warm compresses to the site to encourage systemic absorption
B. Stop the infusion immediately, leave the catheter in place to aspirate residual drug, and
notify the provider for phentolamine administration
C. Flush the IV line aggressively with normal saline to clear the medication
D. Elevate the extremity and apply ice packs for 30 minutes
CORRECT ANSWER : B
Rationale: Norepinephrine is a potent vasoconstrictor that causes severe ischemic tissue
necrosis upon extravasation. The nurse must stop the infusion, attempt aspiration through the
cannula, and prepare phentolamine (an alpha-adrenergic blocker) for subcutaneous injection to
neutralize local vasoconstriction. Warm compresses, not ice, are used for vasopressor
extravasation.
4. A 70-year-old male client with chronic heart failure is prescribed digoxin and furosemide. He
presents with nausea, vomiting, yellow-green visual halos, and a heart rate of 52 beats per
minute. What laboratory value should be checked first?
A. Serum sodium and blood urea nitrogen
B. Serum potassium and digoxin levels
C. Serum calcium and ionized magnesium
D. White blood cell count and differential
CORRECT ANSWER : B
, Rationale: Hypokalemia potentiates digoxin binding at the myocardial Na+/K+-ATPase pump,
precipitating digitalis toxicity even within normal therapeutic serum levels. Assessing potassium
alongside serum digoxin is critical. Visual halos and bradycardia are classic signs of toxicity.
5. A client is admitted with acute respiratory distress syndrome (ARDS) secondary to severe sepsis.
Arterial blood gas results show pH 7.31, PaCO2 48 mmHg, PaO2 58 mmHg, and HCO3 24
mEq/L on an FiO2 of 0.8. What ventilator adjustment should the nurse anticipate?
A. Decreasing the positive end-expiratory pressure (PEEP) to zero
B. Increasing the positive end-expiratory pressure (PEEP) to improve alveolar recruitment
and oxygenation
C. Reducing the respiratory rate to normalize the PaCO2 immediately
D. Switching from mechanical ventilation to unassisted spontaneous breathing
CORRECT ANSWER : B
Rationale: ARDS is characterized by refractory hypoxemia and stiff, non-compliant lungs.
Increasing PEEP keeps collapsed alveoli open at the end of expiration, improves functional
residual capacity, and enhances oxygenation. Decreasing PEEP would worsen shunting and
hypoxemia.
6. A client with a massive pulmonary embolism experiences sudden cardiovascular collapse. The
provider orders recombinant tissue plasminogen activator (rt-PA). Which baseline assessment
finding is an absolute contraindication?
A. History of controlled essential hypertension
B. Active internal bleeding or history of hemorrhagic stroke
C. Recent minor elective dental surgery 6 months ago
D. Age greater than 65 years
CORRECT ANSWER : B
Rationale: Thrombolytic therapy carries a severe risk of hemorrhage. Active internal bleeding, a
history of hemorrhagic stroke, or recent intracranial trauma represent absolute
contraindications. Controlled hypertension is a relative contraindication, not absolute.
7. A nurse is caring for a client with type 1 diabetes mellitus admitted with diabetic ketoacidosis
(DKA). Initial lab values: blood glucose 420 mg/dL, pH 7.20, HCO3 14 mEq/L, serum
potassium 5.2 mEq/L. The provider initiates regular insulin infusion and IV fluids. When should
the nurse anticipate administering potassium replacement?
, A. Immediately before starting insulin therapy
B. When the serum potassium level drops below 5.3 mEq/L and urine output is adequate
C. Only after the blood glucose reaches normal levels and insulin is discontinued
D. Potassium is never required during DKA treatment
CORRECT ANSWER : B
Rationale: Although initial potassium may appear normal or elevated due to extracellular shifts
from acidosis, insulin administration drives potassium back into cells, rapidly causing severe
hypokalemia. Potassium is added to IV fluids once levels drop below 5.3 mEq/L, provided renal
function is confirmed.
8. A 42-year-old female is admitted with acute pancreatitis. Which serum laboratory marker is most
specific and remains elevated longest following the acute insult?
A. Serum amylase
B. Serum lipase
C. Alanine aminotransferase (ALT)
D. Alkaline phosphatase
CORRECT ANSWER : B
Rationale: Serum lipase is more specific to pancreatic acinar cell injury than amylase and
remains elevated for a longer duration (7 to 14 days), making it the superior diagnostic marker
for acute pancreatitis.
9. A client with chronic kidney disease (stage 4) presents with lethargy, muscle twitching,
Kussmaul respirations, and a pericardial friction rub. Serum creatinine is 8.2 mg/dL, and BUN is
95 mg/dL. What is the definitive management?
A. High-protein nutritional supplementation
B. Emergency hemodialysis
C. Oral sodium bicarbonate tablets alone
D. Intravenous normal saline boluses
CORRECT ANSWER : B
and Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Cardiovascular and Hemodynamic Alterations, Critical Care, and Advanced Pathophysiology
2. Respiratory, Renal, and Acid-Base Critical Care Management
3. Endocrine, Neurological, Gastrointestinal, and Complex Multi-System Disorders
1. A 64-year-old male is admitted to the intensive care unit with acute anterior myocardial
infarction. He develops sudden dyspnea, tachypnea, pink frothy sputum, and bilateral crackles,
with a pulmonary artery wedge pressure (PAWP) of 24 mmHg. What is the priority nursing
intervention?
A. Administer a 500 mL bolus of normal saline to improve cardiac output
B. Administer IV furosemide and position the client in a high-Fowler position with legs
dangling
C. Prepare the client for immediate insertion of a temporary transvenous pacemaker
D. Administer sublingual nitroglycerin only if the systolic blood pressure is below 90 mmHg
CORRECT ANSWER : B
Rationale: The client is experiencing acute cardiogenic pulmonary edema due to left ventricular
failure, evidenced by the elevated PAWP and respiratory distress. Administering IV loop
diuretics reduces preload, while upright positioning decreases venous return to the heart. Saline
boluses would worsen pulmonary congestion, and nitroglycerin is contraindicated if systolic
blood pressure is hypotensive.
2. A 55-year-old female post-coronary artery bypass graft (CABG) exhibits jugular venous
distension, muffled heart sounds, and a sudden drop in blood pressure with equalizing diastolic
pressures on hemodynamic monitoring. What complication should the nurse suspect?
A. Left ventricular aneurysm
B. Cardiac tamponade
, C. Acute kidney injury
D. Tension pneumothorax
CORRECT ANSWER : B
Rationale: Beck's triad of hypotension, muffled heart sounds, and jugular venous distension
combined with hemodynamic equalization indicates cardiac tamponade from pericardial fluid
accumulation. Immediate pericardiocentesis or surgical intervention is required. Tension
pneumothorax involves tracheal deviation and absent breath sounds, not muffled heart sounds.
3. A client with septic shock is receiving norepinephrine infusion through a peripheral IV line in
the forearm. The nurse notes cool, pale skin and swelling around the insertion site, with
blanching along the vein. What is the immediate action?
A. Apply warm compresses to the site to encourage systemic absorption
B. Stop the infusion immediately, leave the catheter in place to aspirate residual drug, and
notify the provider for phentolamine administration
C. Flush the IV line aggressively with normal saline to clear the medication
D. Elevate the extremity and apply ice packs for 30 minutes
CORRECT ANSWER : B
Rationale: Norepinephrine is a potent vasoconstrictor that causes severe ischemic tissue
necrosis upon extravasation. The nurse must stop the infusion, attempt aspiration through the
cannula, and prepare phentolamine (an alpha-adrenergic blocker) for subcutaneous injection to
neutralize local vasoconstriction. Warm compresses, not ice, are used for vasopressor
extravasation.
4. A 70-year-old male client with chronic heart failure is prescribed digoxin and furosemide. He
presents with nausea, vomiting, yellow-green visual halos, and a heart rate of 52 beats per
minute. What laboratory value should be checked first?
A. Serum sodium and blood urea nitrogen
B. Serum potassium and digoxin levels
C. Serum calcium and ionized magnesium
D. White blood cell count and differential
CORRECT ANSWER : B
, Rationale: Hypokalemia potentiates digoxin binding at the myocardial Na+/K+-ATPase pump,
precipitating digitalis toxicity even within normal therapeutic serum levels. Assessing potassium
alongside serum digoxin is critical. Visual halos and bradycardia are classic signs of toxicity.
5. A client is admitted with acute respiratory distress syndrome (ARDS) secondary to severe sepsis.
Arterial blood gas results show pH 7.31, PaCO2 48 mmHg, PaO2 58 mmHg, and HCO3 24
mEq/L on an FiO2 of 0.8. What ventilator adjustment should the nurse anticipate?
A. Decreasing the positive end-expiratory pressure (PEEP) to zero
B. Increasing the positive end-expiratory pressure (PEEP) to improve alveolar recruitment
and oxygenation
C. Reducing the respiratory rate to normalize the PaCO2 immediately
D. Switching from mechanical ventilation to unassisted spontaneous breathing
CORRECT ANSWER : B
Rationale: ARDS is characterized by refractory hypoxemia and stiff, non-compliant lungs.
Increasing PEEP keeps collapsed alveoli open at the end of expiration, improves functional
residual capacity, and enhances oxygenation. Decreasing PEEP would worsen shunting and
hypoxemia.
6. A client with a massive pulmonary embolism experiences sudden cardiovascular collapse. The
provider orders recombinant tissue plasminogen activator (rt-PA). Which baseline assessment
finding is an absolute contraindication?
A. History of controlled essential hypertension
B. Active internal bleeding or history of hemorrhagic stroke
C. Recent minor elective dental surgery 6 months ago
D. Age greater than 65 years
CORRECT ANSWER : B
Rationale: Thrombolytic therapy carries a severe risk of hemorrhage. Active internal bleeding, a
history of hemorrhagic stroke, or recent intracranial trauma represent absolute
contraindications. Controlled hypertension is a relative contraindication, not absolute.
7. A nurse is caring for a client with type 1 diabetes mellitus admitted with diabetic ketoacidosis
(DKA). Initial lab values: blood glucose 420 mg/dL, pH 7.20, HCO3 14 mEq/L, serum
potassium 5.2 mEq/L. The provider initiates regular insulin infusion and IV fluids. When should
the nurse anticipate administering potassium replacement?
, A. Immediately before starting insulin therapy
B. When the serum potassium level drops below 5.3 mEq/L and urine output is adequate
C. Only after the blood glucose reaches normal levels and insulin is discontinued
D. Potassium is never required during DKA treatment
CORRECT ANSWER : B
Rationale: Although initial potassium may appear normal or elevated due to extracellular shifts
from acidosis, insulin administration drives potassium back into cells, rapidly causing severe
hypokalemia. Potassium is added to IV fluids once levels drop below 5.3 mEq/L, provided renal
function is confirmed.
8. A 42-year-old female is admitted with acute pancreatitis. Which serum laboratory marker is most
specific and remains elevated longest following the acute insult?
A. Serum amylase
B. Serum lipase
C. Alanine aminotransferase (ALT)
D. Alkaline phosphatase
CORRECT ANSWER : B
Rationale: Serum lipase is more specific to pancreatic acinar cell injury than amylase and
remains elevated for a longer duration (7 to 14 days), making it the superior diagnostic marker
for acute pancreatitis.
9. A client with chronic kidney disease (stage 4) presents with lethargy, muscle twitching,
Kussmaul respirations, and a pericardial friction rub. Serum creatinine is 8.2 mg/dL, and BUN is
95 mg/dL. What is the definitive management?
A. High-protein nutritional supplementation
B. Emergency hemodialysis
C. Oral sodium bicarbonate tablets alone
D. Intravenous normal saline boluses
CORRECT ANSWER : B
