RN Adult Medical-Surgical Nursing
2026: Ultimate -Question Practice
Exam with In-Depth Rationales
Cardiovascular & Hematologic Disorders
A patient with chronic kidney disease stage 4 (eGFR 25
mL/min) is admitted with acute decompensated heart failure.
The provider orders furosemide 80 mg IV push. Which
assessment finding most warrants immediate notification of
the provider before administration?
A) Serum potassium 4.8 mEq/L
B) Serum potassium 3.2 mEq/L
C) Creatinine 2.2 mg/dL
D) Urine output 30 mL/hr
Correct Answer: B) Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that can further deplete
potassium levels. In a patient with CKD who is already
hypokalemic (normal range 3.5–5.0 mEq/L), administering
furosemide could precipitate dangerous hypokalemia, increasing
the risk of cardiac arrhythmias. The provider should be notified to
consider potassium supplementation or an alternative diuretic.
,A client with atrial fibrillation is prescribed warfarin. Which
laboratory test should the nurse monitor to evaluate
therapeutic effect?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Correct Answer: B) INR
Rationale: The International Normalized Ratio (INR) is the
standardized test used to monitor warfarin therapy. The
therapeutic INR range for atrial fibrillation is typically 2.0–3.0. aPTT
is used to monitor heparin therapy, not warfarin.
A client receiving IV heparin has a platelet count of
80,000/mm³. What should the nurse do?
A) Continue therapy and monitor labs
B) Hold heparin and notify the provider
C) Increase heparin dose
D) Administer vitamin K
Correct Answer: B) Hold heparin and notify the provider
Rationale: A platelet count below 100,000/mm³ in a patient
receiving heparin suggests heparin-induced thrombocytopenia
,(HIT), a life-threatening immune-mediated reaction. Heparin
should be discontinued immediately and the provider notified.
Vitamin K is the antidote for warfarin, not heparin.
Which adverse effects should the nurse monitor for in a client
receiving heparin? (Select all that apply)
A) Bleeding gums
B) Bruising
C) Hypertension
D) Thrombocytopenia
E) Hyperkalemia
Correct Answer: A, B, D
Rationale: Heparin's primary adverse effects include bleeding
(manifested as bleeding gums, bruising, hematuria, etc.) and
heparin-induced thrombocytopenia (HIT). Hypotension (not
hypertension) may occur with hemorrhage. Hyperkalemia is not a
typical adverse effect of heparin.
A patient with chronic heart failure (HFrEF, LVEF 30%)
presents with increased dyspnea on exertion, orthopnea, and
a 5-pound weight gain over 3 days. On examination, the
patient has jugular venous distension, crackles at the lung
bases, and 2+ pitting edema in the lower extremities. Which
medication adjustment is most appropriate?
, A) Increase furosemide dose
B) Decrease carvedilol dose
C) Add digoxin
D) Decrease lisinopril dose
Correct Answer: A) Increase furosemide dose
Rationale: The patient is showing signs of worsening fluid
overload (weight gain, JVD, crackles, edema). Increasing the
diuretic dose (furosemide) is the most appropriate initial
intervention to remove excess fluid. The beta-blocker (carvedilol)
and ACE inhibitor (lisinopril) are part of guideline-directed
medical therapy and should not be decreased unless there is
evidence of hypotension or hyperkalemia.
A 65-year-old patient with hypertension and type 2 diabetes
presents with substernal chest pain radiating to the left jaw.
The pain began 45 minutes ago and is unrelieved by rest. The
patient appears diaphoretic and anxious. What is the priority
nursing intervention?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead ECG stat
C) Administer aspirin 325 mg chewed
D) Draw blood for cardiac enzymes
Correct Answer: B) Obtain a 12-lead ECG stat
Rationale: The priority intervention is to obtain a 12-lead ECG
stat to evaluate for ST-segment elevation myocardial infarction
2026: Ultimate -Question Practice
Exam with In-Depth Rationales
Cardiovascular & Hematologic Disorders
A patient with chronic kidney disease stage 4 (eGFR 25
mL/min) is admitted with acute decompensated heart failure.
The provider orders furosemide 80 mg IV push. Which
assessment finding most warrants immediate notification of
the provider before administration?
A) Serum potassium 4.8 mEq/L
B) Serum potassium 3.2 mEq/L
C) Creatinine 2.2 mg/dL
D) Urine output 30 mL/hr
Correct Answer: B) Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that can further deplete
potassium levels. In a patient with CKD who is already
hypokalemic (normal range 3.5–5.0 mEq/L), administering
furosemide could precipitate dangerous hypokalemia, increasing
the risk of cardiac arrhythmias. The provider should be notified to
consider potassium supplementation or an alternative diuretic.
,A client with atrial fibrillation is prescribed warfarin. Which
laboratory test should the nurse monitor to evaluate
therapeutic effect?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Correct Answer: B) INR
Rationale: The International Normalized Ratio (INR) is the
standardized test used to monitor warfarin therapy. The
therapeutic INR range for atrial fibrillation is typically 2.0–3.0. aPTT
is used to monitor heparin therapy, not warfarin.
A client receiving IV heparin has a platelet count of
80,000/mm³. What should the nurse do?
A) Continue therapy and monitor labs
B) Hold heparin and notify the provider
C) Increase heparin dose
D) Administer vitamin K
Correct Answer: B) Hold heparin and notify the provider
Rationale: A platelet count below 100,000/mm³ in a patient
receiving heparin suggests heparin-induced thrombocytopenia
,(HIT), a life-threatening immune-mediated reaction. Heparin
should be discontinued immediately and the provider notified.
Vitamin K is the antidote for warfarin, not heparin.
Which adverse effects should the nurse monitor for in a client
receiving heparin? (Select all that apply)
A) Bleeding gums
B) Bruising
C) Hypertension
D) Thrombocytopenia
E) Hyperkalemia
Correct Answer: A, B, D
Rationale: Heparin's primary adverse effects include bleeding
(manifested as bleeding gums, bruising, hematuria, etc.) and
heparin-induced thrombocytopenia (HIT). Hypotension (not
hypertension) may occur with hemorrhage. Hyperkalemia is not a
typical adverse effect of heparin.
A patient with chronic heart failure (HFrEF, LVEF 30%)
presents with increased dyspnea on exertion, orthopnea, and
a 5-pound weight gain over 3 days. On examination, the
patient has jugular venous distension, crackles at the lung
bases, and 2+ pitting edema in the lower extremities. Which
medication adjustment is most appropriate?
, A) Increase furosemide dose
B) Decrease carvedilol dose
C) Add digoxin
D) Decrease lisinopril dose
Correct Answer: A) Increase furosemide dose
Rationale: The patient is showing signs of worsening fluid
overload (weight gain, JVD, crackles, edema). Increasing the
diuretic dose (furosemide) is the most appropriate initial
intervention to remove excess fluid. The beta-blocker (carvedilol)
and ACE inhibitor (lisinopril) are part of guideline-directed
medical therapy and should not be decreased unless there is
evidence of hypotension or hyperkalemia.
A 65-year-old patient with hypertension and type 2 diabetes
presents with substernal chest pain radiating to the left jaw.
The pain began 45 minutes ago and is unrelieved by rest. The
patient appears diaphoretic and anxious. What is the priority
nursing intervention?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead ECG stat
C) Administer aspirin 325 mg chewed
D) Draw blood for cardiac enzymes
Correct Answer: B) Obtain a 12-lead ECG stat
Rationale: The priority intervention is to obtain a 12-lead ECG
stat to evaluate for ST-segment elevation myocardial infarction
