1
MED SURG CMS PROCTORED EXAM 2026/2027 |
100% Correct Verified Q&A | Comprehensive Med-
Surg Mastery | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders
Q1: A nurse is assessing a client with heart failure who reports increasing
shortness of breath. The nurse notes jugular venous distention (JVD) and
bilateral ankle edema. Which type of heart failure is the client most likely
experiencing?
A. Right-sided heart failure
B. Left-sided heart failure
C. Biventricular heart failure
D. High-output heart failure
Correct Answer: A
Rationale: Jugular venous distention and peripheral edema are classic signs of
systemic venous congestion, which is indicative of right-sided heart failure. Left-
sided heart failure typically presents with pulmonary symptoms like dyspnea and
crackles due to backup into the lungs. While the client may ultimately have
biventricular failure, the specific findings of JVD and ankle edema directly point to
right-sided dysfunction.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q2: A client with chronic heart failure with reduced ejection fraction
(HFrEF) is prescribed enalapril. The nurse should monitor the client for
which primary adverse effect?
A. Hyperkalemia and a persistent dry cough
B. Hypokalemia and tachycardia
C. Reflex tachycardia and peripheral edema
D. Bradycardia and bronchospasm
pg. 1
,2
Correct Answer: A
Rationale: Enalapril is an ACE inhibitor, which inhibits the conversion of
angiotensin I to angiotensin II, reducing aldosterone secretion and decreasing
potassium excretion, which can lead to hyperkalemia. ACE inhibitors also block
the breakdown of bradykinin, leading to a persistent dry cough in up to 20% of
patients. Hypokalemia and reflex tachycardia are not associated with ACE
inhibitors.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q3: A nurse is providing discharge teaching to a client with heart failure.
Which statement by the client indicates an understanding of the dietary
modifications required?
A. "I will drink at least 3 liters of water daily to flush out toxins."
B. "I will use a salt substitute to flavor my food instead of table salt."
C. "I will limit my sodium intake to less than 2,000 to 3,000 mg per day."
D. "I will increase my intake of canned vegetables and soups for better nutrition."
Correct Answer: C
Rationale: Clients with heart failure are instructed to restrict sodium intake to
typically less than 2,000 to 3,000 mg per day to prevent fluid retention. Drinking
excessive fluids (3 liters) can worsen fluid overload. Salt substitutes are often
contraindicated because they contain potassium chloride, which combined with
ACE inhibitors or kidney dysfunction can cause dangerous hyperkalemia. Canned
foods are highly processed and contain excessive sodium.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q4: The nurse is caring for a client with heart failure who is receiving
intravenous furosemide. Which assessment finding requires immediate
intervention by the nurse?
A. Urine output of 50 mL per hour
B. Serum potassium level of 3.0 mEq/L
pg. 2
,3
C. Decreased bilateral ankle edema
D. Blood pressure of 110/70 mmHg
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium loss
(hypokalemia). A serum potassium level of 3.0 mEq/L is critically low and places
the client at high risk for fatal cardiac dysrhythmias, requiring immediate
intervention such as potassium replacement. Urine output of 50 mL/hr and
decreased edema indicate the medication is effective. Blood pressure of 110/70
mmHg is acceptable.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q5: A nurse is assessing a client with acute myocardial infarction. Which
finding is most indicative of cardiogenic shock?
A. Hypertension and bradycardia
B. Cool, clammy skin and decreased urine output
C. Warm, flushed skin and bounding pulses
D. Increased urine output and hyperthermia
Correct Answer: B
Rationale: Cardiogenic shock is characterized by decreased cardiac output leading
to poor tissue perfusion. Signs include cool, clammy skin, decreased urine output
(<30 mL/hr), hypotension, tachycardia, and altered mental status. Warm, flushed
skin and bounding pulses are signs of septic shock, not cardiogenic shock.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q6: The nurse is caring for a client with unstable angina who is receiving IV
nitroglycerin. Which assessment finding indicates the medication is effective?
A. Heart rate decreases from 88 to 82 bpm
B. Blood pressure decreases from 140/90 to 110/70 mmHg
C. Client reports chest pain has decreased from 7/10 to 2/10
D. Respiratory rate decreases from 22 to 18 breaths per minute
pg. 3
, 4
Correct Answer: C
Rationale: Nitroglycerin is a vasodilator used to relieve anginal chest pain by
decreasing preload and afterload, reducing myocardial oxygen demand. The
primary therapeutic goal is relief of chest pain. While blood pressure reduction is
an expected effect, the main indicator of effectiveness is pain relief.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q7: A client with atrial fibrillation has a new prescription for warfarin.
Which laboratory value should the nurse monitor to evaluate the therapeutic
effectiveness of this medication?
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Platelet count
D. Bleeding time
Correct Answer: B
Rationale: Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting
factors. The INR is the standard laboratory test used to monitor warfarin therapy,
with a therapeutic target typically between 2.0 and 3.0 for atrial fibrillation. aPTT
is used to monitor heparin therapy, not warfarin.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q8: A nurse is preparing to administer digoxin to a client with heart failure.
Which assessment finding would cause the nurse to hold the medication and
notify the healthcare provider?
A. Blood pressure of 118/76 mmHg
B. Apical heart rate of 52 bpm
C. Respiratory rate of 18 breaths per minute
D. Serum potassium level of 4.2 mEq/L
Correct Answer: B
Rationale: Digoxin has a narrow therapeutic index and can cause bradycardia,
pg. 4
MED SURG CMS PROCTORED EXAM 2026/2027 |
100% Correct Verified Q&A | Comprehensive Med-
Surg Mastery | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders
Q1: A nurse is assessing a client with heart failure who reports increasing
shortness of breath. The nurse notes jugular venous distention (JVD) and
bilateral ankle edema. Which type of heart failure is the client most likely
experiencing?
A. Right-sided heart failure
B. Left-sided heart failure
C. Biventricular heart failure
D. High-output heart failure
Correct Answer: A
Rationale: Jugular venous distention and peripheral edema are classic signs of
systemic venous congestion, which is indicative of right-sided heart failure. Left-
sided heart failure typically presents with pulmonary symptoms like dyspnea and
crackles due to backup into the lungs. While the client may ultimately have
biventricular failure, the specific findings of JVD and ankle edema directly point to
right-sided dysfunction.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q2: A client with chronic heart failure with reduced ejection fraction
(HFrEF) is prescribed enalapril. The nurse should monitor the client for
which primary adverse effect?
A. Hyperkalemia and a persistent dry cough
B. Hypokalemia and tachycardia
C. Reflex tachycardia and peripheral edema
D. Bradycardia and bronchospasm
pg. 1
,2
Correct Answer: A
Rationale: Enalapril is an ACE inhibitor, which inhibits the conversion of
angiotensin I to angiotensin II, reducing aldosterone secretion and decreasing
potassium excretion, which can lead to hyperkalemia. ACE inhibitors also block
the breakdown of bradykinin, leading to a persistent dry cough in up to 20% of
patients. Hypokalemia and reflex tachycardia are not associated with ACE
inhibitors.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q3: A nurse is providing discharge teaching to a client with heart failure.
Which statement by the client indicates an understanding of the dietary
modifications required?
A. "I will drink at least 3 liters of water daily to flush out toxins."
B. "I will use a salt substitute to flavor my food instead of table salt."
C. "I will limit my sodium intake to less than 2,000 to 3,000 mg per day."
D. "I will increase my intake of canned vegetables and soups for better nutrition."
Correct Answer: C
Rationale: Clients with heart failure are instructed to restrict sodium intake to
typically less than 2,000 to 3,000 mg per day to prevent fluid retention. Drinking
excessive fluids (3 liters) can worsen fluid overload. Salt substitutes are often
contraindicated because they contain potassium chloride, which combined with
ACE inhibitors or kidney dysfunction can cause dangerous hyperkalemia. Canned
foods are highly processed and contain excessive sodium.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q4: The nurse is caring for a client with heart failure who is receiving
intravenous furosemide. Which assessment finding requires immediate
intervention by the nurse?
A. Urine output of 50 mL per hour
B. Serum potassium level of 3.0 mEq/L
pg. 2
,3
C. Decreased bilateral ankle edema
D. Blood pressure of 110/70 mmHg
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium loss
(hypokalemia). A serum potassium level of 3.0 mEq/L is critically low and places
the client at high risk for fatal cardiac dysrhythmias, requiring immediate
intervention such as potassium replacement. Urine output of 50 mL/hr and
decreased edema indicate the medication is effective. Blood pressure of 110/70
mmHg is acceptable.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q5: A nurse is assessing a client with acute myocardial infarction. Which
finding is most indicative of cardiogenic shock?
A. Hypertension and bradycardia
B. Cool, clammy skin and decreased urine output
C. Warm, flushed skin and bounding pulses
D. Increased urine output and hyperthermia
Correct Answer: B
Rationale: Cardiogenic shock is characterized by decreased cardiac output leading
to poor tissue perfusion. Signs include cool, clammy skin, decreased urine output
(<30 mL/hr), hypotension, tachycardia, and altered mental status. Warm, flushed
skin and bounding pulses are signs of septic shock, not cardiogenic shock.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q6: The nurse is caring for a client with unstable angina who is receiving IV
nitroglycerin. Which assessment finding indicates the medication is effective?
A. Heart rate decreases from 88 to 82 bpm
B. Blood pressure decreases from 140/90 to 110/70 mmHg
C. Client reports chest pain has decreased from 7/10 to 2/10
D. Respiratory rate decreases from 22 to 18 breaths per minute
pg. 3
, 4
Correct Answer: C
Rationale: Nitroglycerin is a vasodilator used to relieve anginal chest pain by
decreasing preload and afterload, reducing myocardial oxygen demand. The
primary therapeutic goal is relief of chest pain. While blood pressure reduction is
an expected effect, the main indicator of effectiveness is pain relief.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q7: A client with atrial fibrillation has a new prescription for warfarin.
Which laboratory value should the nurse monitor to evaluate the therapeutic
effectiveness of this medication?
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Platelet count
D. Bleeding time
Correct Answer: B
Rationale: Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting
factors. The INR is the standard laboratory test used to monitor warfarin therapy,
with a therapeutic target typically between 2.0 and 3.0 for atrial fibrillation. aPTT
is used to monitor heparin therapy, not warfarin.
VERIFIED ✓ 2026/2027 CMS Blueprint
Q8: A nurse is preparing to administer digoxin to a client with heart failure.
Which assessment finding would cause the nurse to hold the medication and
notify the healthcare provider?
A. Blood pressure of 118/76 mmHg
B. Apical heart rate of 52 bpm
C. Respiratory rate of 18 breaths per minute
D. Serum potassium level of 4.2 mEq/L
Correct Answer: B
Rationale: Digoxin has a narrow therapeutic index and can cause bradycardia,
pg. 4
