CJE MED SURG I EXAM NEWEST 2026/2027
ACTUAL EXAM| CJE MED SURG I EXAM REVIEW
WITH COMPLETE 200 REAL EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS/ ALREADY
GRADED A+ (MOST RECENT!!)
Question 1
A patient with ST-elevation myocardial infarction (STEMI) develops a new murmur
and acute hypotension. Which complication is most likely?
A. Papillary muscle rupture
B. Free wall rupture
C. Ventricular septal rupture
D. Pericarditis
Correct Answer: A. Papillary muscle rupture
Rationale: Papillary muscle rupture causes acute mitral regurgitation with a new
holosystolic murmur and pulmonary edema, leading to hypotension. Free wall rupture
causes tamponade and electromechanical dissociation. Ventricular septal rupture
produces a harsh holosystolic murmur at the left lower sternal border. Pericarditis
presents with a pericardial friction rub and chest pain .
Question 2
Which hemodynamic profile is consistent with cardiogenic shock?
A. Cardiac index < 2.2 L/min/m², pulmonary capillary wedge pressure > 18 mmHg
B. Cardiac index > 4.0 L/min/m², systemic vascular resistance < 600 dynes-s/cm
C. Central venous pressure < 4 mmHg, pulmonary artery occlusion pressure < 8 mmHg
D. Mixed venous oxygen saturation > 75%, cardiac index > 3.5 L/min/m²
Correct Answer: A. Cardiac index < 2.2 L/min/m², pulmonary capillary wedge pressure
> 18 mmHg
,Rationale: Cardiogenic shock is characterized by low cardiac output (CI < 2.2) and
elevated filling pressures (PCWP > 18) due to pump failure. Option B describes
distributive shock, option C describes hypovolemic shock, and option D indicates high
output states like sepsis .
Question 3
A patient with heart failure has 2+ pitting edema and shortness of breath. Which
priority assessment should the nurse perform?
A. Daily weight
B. Review diet history
C. Ask about activity level
D. Measure abdominal girth
Correct Answer: A. Daily weight
Rationale: Daily weight is the best indicator of fluid volume changes in heart failure. A
weight gain of 2–3 pounds in 24 hours or 5 pounds in a week may indicate worsening
fluid retention and require intervention .
Question 4
A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 3 has a
contraindication to warfarin. Which anticoagulant requires dose adjustment for
creatinine clearance < 30 mL/min?
A. Dabigatran
B. Rivaroxaban
C. Apixaban
D. Edoxaban
Correct Answer: A. Dabigatran
Rationale: Dabigatran is contraindicated in CrCl < 30 mL/min due to renal clearance.
Rivaroxaban requires dose adjustment but is not contraindicated. Apixaban can be used
,with caution. Edoxaban is not recommended if CrCl > 95 mL/min but can be used in
lower CrCl .
Question 5
In a patient with acute decompensated heart failure and a blood pressure of 88/56
mm Hg, which inotropic agent is preferred?
A. Dobutamine
B. Milrinone
C. Dopamine
D. Norepinephrine
Correct Answer: C. Dopamine
Rationale: Dopamine at moderate doses (5–10 mcg/kg/min) provides both inotropic
and vasopressor support, suitable for hypotension. Dobutamine is a pure inotrope that
can worsen hypotension. Milrinone is a phosphodiesterase inhibitor that may cause
vasodilation. Norepinephrine is primarily a vasopressor .
Question 6
The nurse is reviewing the medication list for a patient with heart failure. Which
medication may cause a complication with the treatment plan of a client with
diabetes?
A. Aspirin
B. Steroids
C. Sulfonylureas
D. Angiotensin-converting enzyme (ACE) inhibitors
Correct Answer: B. Steroids
Rationale: Steroids can increase blood glucose levels, complicating diabetes
management. The nurse should monitor blood glucose levels more frequently when a
diabetic patient is on steroids. ACE inhibitors are actually beneficial for diabetic patients
as they can slow the progression of renal disease .
, Question 7
A patient presents with a heart rate of 42 bpm and is cool and clammy. What is the
next expected intervention?
A. Atropine
B. Adenosine
C. Epinephrine
D. Amiodarone
Correct Answer: A. Atropine
Rationale: Atropine is the first-line medication for symptomatic bradycardia showing
signs of low perfusion (pale, cool, clammy skin, hypotension, altered mental status). The
dose is 0.5 mg IV push .
Question 8
Which heart rhythms are considered shockable?
A. Ventricular fibrillation and pulseless ventricular tachycardia
B. Atrial fibrillation and atrial flutter
C. Asystole and PEA
D. Sinus tachycardia and bradycardia
Correct Answer: A. Ventricular fibrillation and pulseless ventricular tachycardia
Rationale: Ventricular fibrillation (V-fib) and pulseless ventricular tachycardia (V-tach)
are shockable rhythms. Asystole and pulseless electrical activity (PEA) are non-
shockable. Atrial fibrillation and atrial flutter are treated with synchronized
cardioversion, not defibrillation .
Question 9
A patient's ECG shows "tombstone-like" rhythms, and no pulse is detected. What is
the priority intervention?
ACTUAL EXAM| CJE MED SURG I EXAM REVIEW
WITH COMPLETE 200 REAL EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS/ ALREADY
GRADED A+ (MOST RECENT!!)
Question 1
A patient with ST-elevation myocardial infarction (STEMI) develops a new murmur
and acute hypotension. Which complication is most likely?
A. Papillary muscle rupture
B. Free wall rupture
C. Ventricular septal rupture
D. Pericarditis
Correct Answer: A. Papillary muscle rupture
Rationale: Papillary muscle rupture causes acute mitral regurgitation with a new
holosystolic murmur and pulmonary edema, leading to hypotension. Free wall rupture
causes tamponade and electromechanical dissociation. Ventricular septal rupture
produces a harsh holosystolic murmur at the left lower sternal border. Pericarditis
presents with a pericardial friction rub and chest pain .
Question 2
Which hemodynamic profile is consistent with cardiogenic shock?
A. Cardiac index < 2.2 L/min/m², pulmonary capillary wedge pressure > 18 mmHg
B. Cardiac index > 4.0 L/min/m², systemic vascular resistance < 600 dynes-s/cm
C. Central venous pressure < 4 mmHg, pulmonary artery occlusion pressure < 8 mmHg
D. Mixed venous oxygen saturation > 75%, cardiac index > 3.5 L/min/m²
Correct Answer: A. Cardiac index < 2.2 L/min/m², pulmonary capillary wedge pressure
> 18 mmHg
,Rationale: Cardiogenic shock is characterized by low cardiac output (CI < 2.2) and
elevated filling pressures (PCWP > 18) due to pump failure. Option B describes
distributive shock, option C describes hypovolemic shock, and option D indicates high
output states like sepsis .
Question 3
A patient with heart failure has 2+ pitting edema and shortness of breath. Which
priority assessment should the nurse perform?
A. Daily weight
B. Review diet history
C. Ask about activity level
D. Measure abdominal girth
Correct Answer: A. Daily weight
Rationale: Daily weight is the best indicator of fluid volume changes in heart failure. A
weight gain of 2–3 pounds in 24 hours or 5 pounds in a week may indicate worsening
fluid retention and require intervention .
Question 4
A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 3 has a
contraindication to warfarin. Which anticoagulant requires dose adjustment for
creatinine clearance < 30 mL/min?
A. Dabigatran
B. Rivaroxaban
C. Apixaban
D. Edoxaban
Correct Answer: A. Dabigatran
Rationale: Dabigatran is contraindicated in CrCl < 30 mL/min due to renal clearance.
Rivaroxaban requires dose adjustment but is not contraindicated. Apixaban can be used
,with caution. Edoxaban is not recommended if CrCl > 95 mL/min but can be used in
lower CrCl .
Question 5
In a patient with acute decompensated heart failure and a blood pressure of 88/56
mm Hg, which inotropic agent is preferred?
A. Dobutamine
B. Milrinone
C. Dopamine
D. Norepinephrine
Correct Answer: C. Dopamine
Rationale: Dopamine at moderate doses (5–10 mcg/kg/min) provides both inotropic
and vasopressor support, suitable for hypotension. Dobutamine is a pure inotrope that
can worsen hypotension. Milrinone is a phosphodiesterase inhibitor that may cause
vasodilation. Norepinephrine is primarily a vasopressor .
Question 6
The nurse is reviewing the medication list for a patient with heart failure. Which
medication may cause a complication with the treatment plan of a client with
diabetes?
A. Aspirin
B. Steroids
C. Sulfonylureas
D. Angiotensin-converting enzyme (ACE) inhibitors
Correct Answer: B. Steroids
Rationale: Steroids can increase blood glucose levels, complicating diabetes
management. The nurse should monitor blood glucose levels more frequently when a
diabetic patient is on steroids. ACE inhibitors are actually beneficial for diabetic patients
as they can slow the progression of renal disease .
, Question 7
A patient presents with a heart rate of 42 bpm and is cool and clammy. What is the
next expected intervention?
A. Atropine
B. Adenosine
C. Epinephrine
D. Amiodarone
Correct Answer: A. Atropine
Rationale: Atropine is the first-line medication for symptomatic bradycardia showing
signs of low perfusion (pale, cool, clammy skin, hypotension, altered mental status). The
dose is 0.5 mg IV push .
Question 8
Which heart rhythms are considered shockable?
A. Ventricular fibrillation and pulseless ventricular tachycardia
B. Atrial fibrillation and atrial flutter
C. Asystole and PEA
D. Sinus tachycardia and bradycardia
Correct Answer: A. Ventricular fibrillation and pulseless ventricular tachycardia
Rationale: Ventricular fibrillation (V-fib) and pulseless ventricular tachycardia (V-tach)
are shockable rhythms. Asystole and pulseless electrical activity (PEA) are non-
shockable. Atrial fibrillation and atrial flutter are treated with synchronized
cardioversion, not defibrillation .
Question 9
A patient's ECG shows "tombstone-like" rhythms, and no pulse is detected. What is
the priority intervention?
