ADVANCED MED-SURG ACTUAL FINAL PRACTICE
EXAM PREP WITH ALL POSSIBLE COMPLETE
DETAILED AND MOST TESTED PRACTICE
QUESTIONS AND 100% CORRECT VERIFIED
ANSWERS FULLY SOLVED WITH CERTIFIED
RATIONALES PLUS RELIABLE ANSWER KEY (100%
COMPLETE SOLUTIONS) 2026-2027 Q&A UPDATED
VERSION 100% GUARANTEED PASS INSTANT
DOWNLOAD PDF
1. A nurse is assessing a client who is 72 hours post-coronary artery bypass
graft (CABG) and develops sudden atrial fibrillation with a heart rate of 160
bpm and blood pressure of 86/52 mmHg. Which action is the most urgent?
A. Administer amiodarone 150 mg IV over 10 minutes
B. Perform synchronized cardioversion at 100 J
C. Give diltiazem 20 mg IV push
D. Obtain a stat 12-lead ECG
B
Hemodynamic instability with a systolic blood pressure below 90 mmHg
and rapid atrial fibrillation warrants immediate synchronized
cardioversion per ACLS guidelines. Amiodarone or calcium-channel
blockers may further drop blood pressure. While an ECG is useful,
delaying shock increases mortality; electricity is the first intervention
when pulses are present and perfusion is poor.
2. A client in thyroid storm has a temperature of 40.2°C, heart rate of 170 bpm,
and agitation. Which prescribed intervention is the priority?
A. Give propylthiouracil 600 mg via NGT
B. Infuse propranolol 2 mg IV every 5 minutes
, C. Apply ice packs and a cooling blanket
D. Start hydrocortisone 300 mg IV
C
Rapid cooling reduces metabolic rate and prevents protein denaturation.
This is the first step in the "CHILL" mnemonic (Cool, Hydrate, Inhibit
hormone synthesis, Block adrenergic, Large steroids). While other drugs
are vital, hyperthermia above 40°C can cause irreversible tissue damage
within minutes.
3. An ARDS client on volume-controlled assist-control ventilation has a
plateau pressure of 35 cm H₂O and PEEP of 14 cm H₂O. Which ventilator
change best adheres to a lung-protective strategy?
A. Increase PEEP to 18 cm H₂O
B. Reduce tidal volume to 4 mL/kg predicted body weight
C. Switch to pressure-control ventilation
D. Initiate prone positioning
B
ARDSNet targets a plateau pressure of 30 cm H₂O or less by limiting tidal
volume to 4-6 mL/kg predicted body weight to prevent ventilator-induced
lung injury. Increasing PEEP would raise plateau pressure; mode change
does not lower pressure; proning is an adjunct after tidal volume
reduction.
4. Immediately after chest-tube insertion for empyema, a client becomes
hypotensive (78/46 mmHg) with neck-vein distention. Which complication
should the nurse suspect first?
A. Tension pneumothorax
B. Mediastinal perforation
C. Re-expansion pulmonary edema
D. Cardiac tamponade
D
Classic Beck's triad (hypotension, jugular venous distention, muffled heart
sounds) suggests cardiac tamponade, which is confirmed with bedside
echocardiography. It results from inadvertent right-ventricular laceration
by the trocar. Tension pneumothorax would show tracheal deviation and
, absent breath sounds; re-expansion edema presents later with hypoxia, not
shock.
5. A ventilated COPD client has an ABG of pH 7.48, PaCO₂ 48 mm Hg, and
HCO₃ 34 mEq/L. Which ventilator setting is most likely contributing to this
finding?
A. High tidal volume
B. Excessive respiratory rate
C. Too much PEEP
D. Low FiO₂
B
Minute ventilation (respiratory rate multiplied by tidal volume) that
"blows off" CO₂ below the patient's chronic baseline can cause a relative
alkalosis in a client with chronic CO₂ retention. Excessive respiratory rate
increases minute ventilation and lowers PaCO₂.
6. A nurse is assessing a client with suspected increased intracranial pressure
(ICP). Which finding is the earliest clinical manifestation?
A. Pupil dilation
B. Altered level of consciousness
C. Widening pulse pressure
D. Projectile vomiting
B
Changes in consciousness, such as restlessness and irritability, are the
earliest indicators of rising ICP, occurring before vital sign changes like
Cushing's triad (bradycardia, hypertension, irregular respirations). Pupil
dilation, widening pulse pressure, and projectile vomiting are later signs.
7. In a patient with acute myocardial infarction, which laboratory marker is
most specific for cardiac muscle damage?
A. Myoglobin
B. CK-MB
C. Troponin I
D. LDH
C
Troponin I is highly specific to cardiac muscle and remains elevated for up
, to 10-14 days. Myoglobin rises early but is not cardiac-specific. CK-MB is
cardiac-specific but less sensitive than troponin. LDH is a late and
nonspecific marker.
8. What is the priority nursing action for a patient experiencing an acute
asthma attack?
A. Administer oxygen via nasal cannula
B. Start a nebulizer with a short-acting beta-agonist
C. Position the patient in High-Fowler's position
D. Obtain arterial blood gas analysis
C
Positioning the patient in High-Fowler's or orthopneic position should be
done immediately to facilitate maximal chest expansion and decrease the
work of breathing. While oxygen and bronchodilators are essential,
positioning is the first priority for immediate respiratory relief.
9. The primary purpose of using a water-seal drainage system after thoracic
surgery is to:
A. Measure the volume of drainage
B. Re-expand the lung and prevent air from returning to the pleural space
C. Provide a sterile environment for pleural fluids
D. Prevent infection of the surgical site
B
The water seal acts as a one-way valve, allowing air and fluid to escape the
pleural space but preventing atmospheric air from re-entering, which
allows lung re-expansion. Measuring drainage volume is a secondary
function; the sterile environment and infection prevention are not the
primary purposes of the water seal.
10.Which dietary instruction is crucial for a patient with chronic renal failure?
A. High protein, low potassium
B. Low protein, low potassium, low sodium
C. High carbohydrate, high sodium
D. Low fiber, high protein
B
A low-protein diet reduces nitrogenous waste buildup, while low potassium
EXAM PREP WITH ALL POSSIBLE COMPLETE
DETAILED AND MOST TESTED PRACTICE
QUESTIONS AND 100% CORRECT VERIFIED
ANSWERS FULLY SOLVED WITH CERTIFIED
RATIONALES PLUS RELIABLE ANSWER KEY (100%
COMPLETE SOLUTIONS) 2026-2027 Q&A UPDATED
VERSION 100% GUARANTEED PASS INSTANT
DOWNLOAD PDF
1. A nurse is assessing a client who is 72 hours post-coronary artery bypass
graft (CABG) and develops sudden atrial fibrillation with a heart rate of 160
bpm and blood pressure of 86/52 mmHg. Which action is the most urgent?
A. Administer amiodarone 150 mg IV over 10 minutes
B. Perform synchronized cardioversion at 100 J
C. Give diltiazem 20 mg IV push
D. Obtain a stat 12-lead ECG
B
Hemodynamic instability with a systolic blood pressure below 90 mmHg
and rapid atrial fibrillation warrants immediate synchronized
cardioversion per ACLS guidelines. Amiodarone or calcium-channel
blockers may further drop blood pressure. While an ECG is useful,
delaying shock increases mortality; electricity is the first intervention
when pulses are present and perfusion is poor.
2. A client in thyroid storm has a temperature of 40.2°C, heart rate of 170 bpm,
and agitation. Which prescribed intervention is the priority?
A. Give propylthiouracil 600 mg via NGT
B. Infuse propranolol 2 mg IV every 5 minutes
, C. Apply ice packs and a cooling blanket
D. Start hydrocortisone 300 mg IV
C
Rapid cooling reduces metabolic rate and prevents protein denaturation.
This is the first step in the "CHILL" mnemonic (Cool, Hydrate, Inhibit
hormone synthesis, Block adrenergic, Large steroids). While other drugs
are vital, hyperthermia above 40°C can cause irreversible tissue damage
within minutes.
3. An ARDS client on volume-controlled assist-control ventilation has a
plateau pressure of 35 cm H₂O and PEEP of 14 cm H₂O. Which ventilator
change best adheres to a lung-protective strategy?
A. Increase PEEP to 18 cm H₂O
B. Reduce tidal volume to 4 mL/kg predicted body weight
C. Switch to pressure-control ventilation
D. Initiate prone positioning
B
ARDSNet targets a plateau pressure of 30 cm H₂O or less by limiting tidal
volume to 4-6 mL/kg predicted body weight to prevent ventilator-induced
lung injury. Increasing PEEP would raise plateau pressure; mode change
does not lower pressure; proning is an adjunct after tidal volume
reduction.
4. Immediately after chest-tube insertion for empyema, a client becomes
hypotensive (78/46 mmHg) with neck-vein distention. Which complication
should the nurse suspect first?
A. Tension pneumothorax
B. Mediastinal perforation
C. Re-expansion pulmonary edema
D. Cardiac tamponade
D
Classic Beck's triad (hypotension, jugular venous distention, muffled heart
sounds) suggests cardiac tamponade, which is confirmed with bedside
echocardiography. It results from inadvertent right-ventricular laceration
by the trocar. Tension pneumothorax would show tracheal deviation and
, absent breath sounds; re-expansion edema presents later with hypoxia, not
shock.
5. A ventilated COPD client has an ABG of pH 7.48, PaCO₂ 48 mm Hg, and
HCO₃ 34 mEq/L. Which ventilator setting is most likely contributing to this
finding?
A. High tidal volume
B. Excessive respiratory rate
C. Too much PEEP
D. Low FiO₂
B
Minute ventilation (respiratory rate multiplied by tidal volume) that
"blows off" CO₂ below the patient's chronic baseline can cause a relative
alkalosis in a client with chronic CO₂ retention. Excessive respiratory rate
increases minute ventilation and lowers PaCO₂.
6. A nurse is assessing a client with suspected increased intracranial pressure
(ICP). Which finding is the earliest clinical manifestation?
A. Pupil dilation
B. Altered level of consciousness
C. Widening pulse pressure
D. Projectile vomiting
B
Changes in consciousness, such as restlessness and irritability, are the
earliest indicators of rising ICP, occurring before vital sign changes like
Cushing's triad (bradycardia, hypertension, irregular respirations). Pupil
dilation, widening pulse pressure, and projectile vomiting are later signs.
7. In a patient with acute myocardial infarction, which laboratory marker is
most specific for cardiac muscle damage?
A. Myoglobin
B. CK-MB
C. Troponin I
D. LDH
C
Troponin I is highly specific to cardiac muscle and remains elevated for up
, to 10-14 days. Myoglobin rises early but is not cardiac-specific. CK-MB is
cardiac-specific but less sensitive than troponin. LDH is a late and
nonspecific marker.
8. What is the priority nursing action for a patient experiencing an acute
asthma attack?
A. Administer oxygen via nasal cannula
B. Start a nebulizer with a short-acting beta-agonist
C. Position the patient in High-Fowler's position
D. Obtain arterial blood gas analysis
C
Positioning the patient in High-Fowler's or orthopneic position should be
done immediately to facilitate maximal chest expansion and decrease the
work of breathing. While oxygen and bronchodilators are essential,
positioning is the first priority for immediate respiratory relief.
9. The primary purpose of using a water-seal drainage system after thoracic
surgery is to:
A. Measure the volume of drainage
B. Re-expand the lung and prevent air from returning to the pleural space
C. Provide a sterile environment for pleural fluids
D. Prevent infection of the surgical site
B
The water seal acts as a one-way valve, allowing air and fluid to escape the
pleural space but preventing atmospheric air from re-entering, which
allows lung re-expansion. Measuring drainage volume is a secondary
function; the sterile environment and infection prevention are not the
primary purposes of the water seal.
10.Which dietary instruction is crucial for a patient with chronic renal failure?
A. High protein, low potassium
B. Low protein, low potassium, low sodium
C. High carbohydrate, high sodium
D. Low fiber, high protein
B
A low-protein diet reduces nitrogenous waste buildup, while low potassium
