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KAPLAN MEDICAL SURGICAL
INTEGRATED FINAL EXAM
Comprehensive Q&A Bank - New Set
(Questions 1-200)
CARDIAC & PERIPHERAL VASCULAR (1-40)
1. A client with unstable angina is prescribed nitroglycerin sublingual. Which instruction
should the nurse include regarding administration?
a) Swallow the tablet with water
b) Place the tablet under the tongue and allow it to dissolve
c) Chew the tablet for faster absorption
d) Place the tablet between the cheek and gum
Correct Answer: b) Place the tablet under the tongue and allow it to dissolve
Rationale: Nitroglycerin sublingual tablets should be placed under the tongue
and allowed to dissolve for rapid absorption through the oral mucosa.
Swallowing, chewing, or buccal placement reduces effectiveness and delays
absorption.
2. A client with heart failure has an ejection fraction of 25%. The nurse understands this
indicates:
a) Normal cardiac function
b) Mild heart failure
c) Severe heart failure with reduced systolic function
d) Diastolic dysfunction only
Correct Answer: c) Severe heart failure with reduced systolic function
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Rationale: An ejection fraction of 25% indicates severely reduced systolic
function (normal is >55%, HF with reduced EF is <40%). This represents
significant impairment of the heart's pumping ability.
3. A client with heart failure is receiving digoxin. Which finding indicates digoxin
toxicity?
a) Heart rate of 72 bpm
b) Serum potassium of 4.2 mEq/L
c) Visual disturbances with yellow-green halos
d) Serum digoxin level of 0.8 ng/mL
Correct Answer: c) Visual disturbances with yellow-green halos
Rationale: Visual disturbances (yellow-green halos, blurred vision) are classic
signs of digoxin toxicity. Normal digoxin level is 0.5-2.0 ng/mL, but toxicity can
occur at therapeutic levels with hypokalemia or renal impairment.
4. A client with pericarditis reports chest pain that worsens when lying flat. Which
action should the nurse take?
a) Administer prescribed pain medication
b) Position the client in high Fowler's with a forward lean
c) Apply a heating pad to the chest
d) Instruct the client to take deep breaths
Correct Answer: b) Position the client in high Fowler's with a forward lean
Rationale: Pericarditis pain is relieved by sitting upright and leaning forward,
which reduces pressure on the pericardium. Lying flat worsens the pain. Pain
medication is important but positioning is the immediate intervention.
5. A client with infective endocarditis has petechiae, splinter hemorrhages, and Osler's
nodes. The nurse should monitor for which complication?
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a) Heart failure
b) Systemic emboli
c) Renal failure
d) All of the above
Correct Answer: d) All of the above
Rationale: Endocarditis can cause heart failure (valvular damage), systemic
emboli (vegetations breaking off), and renal failure (emboli to kidneys or
immune complex deposition). All are potential complications requiring
monitoring.
6. A client with a mechanical heart valve is prescribed warfarin. Which instruction
should the nurse include in discharge teaching?
a) Take aspirin instead of warfarin if you have a headache
b) Report any signs of bleeding such as easy bruising
c) Increase intake of green leafy vegetables
d) Monitor blood glucose daily
Correct Answer: b) Report any signs of bleeding such as easy bruising
Rationale: Warfarin increases bleeding risk. Clients should report easy bruising,
bleeding gums, dark stools, or hematuria. Green leafy vegetables (high in
vitamin K) interfere with warfarin and should be eaten consistently, not
increased.
7. A client with a myocardial infarction develops a new systolic murmur. Which
complication should the nurse suspect?
a) Papillary muscle rupture
b) Ventricular septal defect
c) Cardiac tamponade
d) Pericarditis
Correct Answer: a) Papillary muscle rupture
Rationale: Papillary muscle rupture causes acute mitral regurgitation,
producing a new systolic murmur, pulmonary edema, and cardiogenic shock.
, 4|Page
Ventricular septal defect also causes a murmur but is less common. Tamponade
causes muffled heart sounds, not a murmur.
8. A client with a myocardial infarction has received thrombolytic therapy. Which
finding indicates reperfusion?
a) Continued chest pain
b) Resolution of ST-segment elevation
c) Development of new arrhythmias
d) Decreased cardiac enzymes
Correct Answer: b) Resolution of ST-segment elevation
Rationale: Resolution of ST-segment elevation indicates successful reperfusion.
Chest pain should decrease, not continue. Reperfusion arrhythmias can occur
but are not the primary indicator. Cardiac enzymes peak after reperfusion
initially.
9. A client with a myocardial infarction is prescribed aspirin. What is the primary
purpose of this medication?
a) Reduce pain
b) Reduce fever
c) Inhibit platelet aggregation
d) Decrease inflammation
Correct Answer: c) Inhibit platelet aggregation
Rationale: Aspirin inhibits platelet aggregation by blocking thromboxane A2,
reducing the risk of further thrombosis. While it also has analgesic and anti-
inflammatory effects, the primary purpose in MI is antiplatelet therapy.
10. A client with a myocardial infarction has a heart rate of 40 bpm and hypotension.
Which medication should the nurse anticipate?
KAPLAN MEDICAL SURGICAL
INTEGRATED FINAL EXAM
Comprehensive Q&A Bank - New Set
(Questions 1-200)
CARDIAC & PERIPHERAL VASCULAR (1-40)
1. A client with unstable angina is prescribed nitroglycerin sublingual. Which instruction
should the nurse include regarding administration?
a) Swallow the tablet with water
b) Place the tablet under the tongue and allow it to dissolve
c) Chew the tablet for faster absorption
d) Place the tablet between the cheek and gum
Correct Answer: b) Place the tablet under the tongue and allow it to dissolve
Rationale: Nitroglycerin sublingual tablets should be placed under the tongue
and allowed to dissolve for rapid absorption through the oral mucosa.
Swallowing, chewing, or buccal placement reduces effectiveness and delays
absorption.
2. A client with heart failure has an ejection fraction of 25%. The nurse understands this
indicates:
a) Normal cardiac function
b) Mild heart failure
c) Severe heart failure with reduced systolic function
d) Diastolic dysfunction only
Correct Answer: c) Severe heart failure with reduced systolic function
, 2|Page
Rationale: An ejection fraction of 25% indicates severely reduced systolic
function (normal is >55%, HF with reduced EF is <40%). This represents
significant impairment of the heart's pumping ability.
3. A client with heart failure is receiving digoxin. Which finding indicates digoxin
toxicity?
a) Heart rate of 72 bpm
b) Serum potassium of 4.2 mEq/L
c) Visual disturbances with yellow-green halos
d) Serum digoxin level of 0.8 ng/mL
Correct Answer: c) Visual disturbances with yellow-green halos
Rationale: Visual disturbances (yellow-green halos, blurred vision) are classic
signs of digoxin toxicity. Normal digoxin level is 0.5-2.0 ng/mL, but toxicity can
occur at therapeutic levels with hypokalemia or renal impairment.
4. A client with pericarditis reports chest pain that worsens when lying flat. Which
action should the nurse take?
a) Administer prescribed pain medication
b) Position the client in high Fowler's with a forward lean
c) Apply a heating pad to the chest
d) Instruct the client to take deep breaths
Correct Answer: b) Position the client in high Fowler's with a forward lean
Rationale: Pericarditis pain is relieved by sitting upright and leaning forward,
which reduces pressure on the pericardium. Lying flat worsens the pain. Pain
medication is important but positioning is the immediate intervention.
5. A client with infective endocarditis has petechiae, splinter hemorrhages, and Osler's
nodes. The nurse should monitor for which complication?
, 3|Page
a) Heart failure
b) Systemic emboli
c) Renal failure
d) All of the above
Correct Answer: d) All of the above
Rationale: Endocarditis can cause heart failure (valvular damage), systemic
emboli (vegetations breaking off), and renal failure (emboli to kidneys or
immune complex deposition). All are potential complications requiring
monitoring.
6. A client with a mechanical heart valve is prescribed warfarin. Which instruction
should the nurse include in discharge teaching?
a) Take aspirin instead of warfarin if you have a headache
b) Report any signs of bleeding such as easy bruising
c) Increase intake of green leafy vegetables
d) Monitor blood glucose daily
Correct Answer: b) Report any signs of bleeding such as easy bruising
Rationale: Warfarin increases bleeding risk. Clients should report easy bruising,
bleeding gums, dark stools, or hematuria. Green leafy vegetables (high in
vitamin K) interfere with warfarin and should be eaten consistently, not
increased.
7. A client with a myocardial infarction develops a new systolic murmur. Which
complication should the nurse suspect?
a) Papillary muscle rupture
b) Ventricular septal defect
c) Cardiac tamponade
d) Pericarditis
Correct Answer: a) Papillary muscle rupture
Rationale: Papillary muscle rupture causes acute mitral regurgitation,
producing a new systolic murmur, pulmonary edema, and cardiogenic shock.
, 4|Page
Ventricular septal defect also causes a murmur but is less common. Tamponade
causes muffled heart sounds, not a murmur.
8. A client with a myocardial infarction has received thrombolytic therapy. Which
finding indicates reperfusion?
a) Continued chest pain
b) Resolution of ST-segment elevation
c) Development of new arrhythmias
d) Decreased cardiac enzymes
Correct Answer: b) Resolution of ST-segment elevation
Rationale: Resolution of ST-segment elevation indicates successful reperfusion.
Chest pain should decrease, not continue. Reperfusion arrhythmias can occur
but are not the primary indicator. Cardiac enzymes peak after reperfusion
initially.
9. A client with a myocardial infarction is prescribed aspirin. What is the primary
purpose of this medication?
a) Reduce pain
b) Reduce fever
c) Inhibit platelet aggregation
d) Decrease inflammation
Correct Answer: c) Inhibit platelet aggregation
Rationale: Aspirin inhibits platelet aggregation by blocking thromboxane A2,
reducing the risk of further thrombosis. While it also has analgesic and anti-
inflammatory effects, the primary purpose in MI is antiplatelet therapy.
10. A client with a myocardial infarction has a heart rate of 40 bpm and hypotension.
Which medication should the nurse anticipate?
