Comprehensive
Medical-Surgical Nursing
Practice Bank
Volume 1: Core Body Systems & Rationales
ADVANCED STUDY GUIDE & PREPARATION RESOURCE
Medical-Surgical Nursing Practice Bank Page 1 of 21
,Cardiovascular System
Clinical Focus: The cardiovascular system is responsible for perfusing all vital organs. Key topics
include heart failure, myocardial infarction (MI), arrhythmias, and structural heart defects.
Understanding hemodynamics and preload/afterload is essential.
Question 1: A nurse is assessing a client with a new diagnosis of left-sided heart
failure. Which of the following clinical manifestations should the nurse expect to
find?
A) Jugular vein distention
B) Dependent pitting edema
C) Crackles auscultated in the lung bases
D) Hepatomegaly
Correct Answer: C
Rationale: Left-sided heart failure primarily affects the pulmonary system because the left
ventricle cannot effectively pump blood forward into the aorta, causing it to back up into the
lungs. This results in pulmonary congestion, manifested by crackles, shortness of breath, and
orthopnea.
Medical-Surgical Nursing Practice Bank Page 2 of 21
, Question 2: A patient is admitted to the emergency department reporting severe,
crushing chest pain that radiates to the left arm. An electrocardiogram (ECG)
reveals ST-segment elevation. What is the nurse's priority intervention?
A) Administer sublingual nitroglycerin
B) Provide 2L of oxygen via nasal cannula
C) Administer chewable aspirin as prescribed
D) Prepare the patient for immediate percutaneous coronary intervention (PCI)
Correct Answer: D
Rationale: While oxygen, nitroglycerin, and aspirin are all part of the acute management of a
myocardial infarction (MI), an ST-elevation MI (STEMI) indicates acute total occlusion of a
coronary artery. The highest priority and definitive treatment is reperfusion therapy via PCI
(cardiac catheterization) within 90 minutes of arrival.
Medical-Surgical Nursing Practice Bank Page 3 of 21
, Question 3: A nurse is caring for a patient with a history of atrial fibrillation. The
patient is prescribed warfarin (Coumadin). Which laboratory value is most
important for the nurse to monitor?
A) aPTT (Activated partial thromboplastin time)
B) PT/INR (Prothrombin time/International normalized ratio)
C) Platelet count
D) Serum potassium
Correct Answer: B
Rationale: Warfarin is an oral anticoagulant that works by inhibiting vitamin K-dependent clotting
factors. The effectiveness of warfarin therapy is monitored using the PT and INR. An INR of 2.0
to 3.0 is typically the therapeutic target for atrial fibrillation. aPTT is used to monitor heparin
therapy.
Medical-Surgical Nursing Practice Bank Page 4 of 21
, Question 4: A patient with infective endocarditis is scheduled for a dental
extraction. What instruction should the nurse emphasize?
A) Rinse the mouth with chlorhexidine twice daily for a week prior.
B) Ensure prophylactic antibiotics are taken before the procedure.
C) Avoid brushing teeth for 48 hours post-extraction.
D) Fast for 12 hours before the dental appointment.
Correct Answer: B
Rationale: Patients with a history of infective endocarditis are at high risk for recurrence,
especially during invasive procedures like dental work that can introduce bacteria into the
bloodstream. Prophylactic antibiotics are required before such procedures to prevent
colonization of the heart valves.
Question 5: Which assessment finding in a patient with right-sided heart failure
requires immediate follow-up by the nurse?
A) +2 bilateral pedal edema
B) Weight gain of 3 lbs in 24 hours
C) Fatigue with ambulation
D) Ascites
Correct Answer: B
Rationale: A rapid weight gain of 3 lbs (1.4 kg) in 24 hours indicates acute fluid retention and
worsening heart failure. One kilogram of weight gain is roughly equivalent to 1 liter of retained
fluid. This requires immediate intervention, often with intravenous diuretics, to prevent further
decompensation.
Medical-Surgical Nursing Practice Bank Page 5 of 21
, Respiratory System
Clinical Focus: Respiratory nursing focuses on oxygenation and ventilation. Key disease processes
include Asthma, COPD, Pneumonia, Tuberculosis, and Acute Respiratory Distress Syndrome (ARDS).
Question 1: A client with a history of severe Chronic Obstructive Pulmonary
Disease (COPD) is admitted with an acute exacerbation. Their arterial blood gas
(ABG) shows a PaO2 of 58 mm Hg and a PaCO2 of 64 mm Hg. Which oxygen
delivery method is the safest?
A) Non-rebreather mask at 15 L/min
B) Simple face mask at 8 L/min
C) Venturi mask at 28% FiO2
D) Nasal cannula at 6 L/min
Correct Answer: C
Rationale: Patients with chronic hypercapnia rely on mild hypoxia to stimulate their respiratory
drive. High-flow oxygen can suppress this drive, leading to respiratory arrest. A Venturi mask
delivers a precise, controlled fraction of inspired oxygen (FiO2) regardless of the patient's
respiratory pattern.
Medical-Surgical Nursing Practice Bank Page 6 of 21
Medical-Surgical Nursing
Practice Bank
Volume 1: Core Body Systems & Rationales
ADVANCED STUDY GUIDE & PREPARATION RESOURCE
Medical-Surgical Nursing Practice Bank Page 1 of 21
,Cardiovascular System
Clinical Focus: The cardiovascular system is responsible for perfusing all vital organs. Key topics
include heart failure, myocardial infarction (MI), arrhythmias, and structural heart defects.
Understanding hemodynamics and preload/afterload is essential.
Question 1: A nurse is assessing a client with a new diagnosis of left-sided heart
failure. Which of the following clinical manifestations should the nurse expect to
find?
A) Jugular vein distention
B) Dependent pitting edema
C) Crackles auscultated in the lung bases
D) Hepatomegaly
Correct Answer: C
Rationale: Left-sided heart failure primarily affects the pulmonary system because the left
ventricle cannot effectively pump blood forward into the aorta, causing it to back up into the
lungs. This results in pulmonary congestion, manifested by crackles, shortness of breath, and
orthopnea.
Medical-Surgical Nursing Practice Bank Page 2 of 21
, Question 2: A patient is admitted to the emergency department reporting severe,
crushing chest pain that radiates to the left arm. An electrocardiogram (ECG)
reveals ST-segment elevation. What is the nurse's priority intervention?
A) Administer sublingual nitroglycerin
B) Provide 2L of oxygen via nasal cannula
C) Administer chewable aspirin as prescribed
D) Prepare the patient for immediate percutaneous coronary intervention (PCI)
Correct Answer: D
Rationale: While oxygen, nitroglycerin, and aspirin are all part of the acute management of a
myocardial infarction (MI), an ST-elevation MI (STEMI) indicates acute total occlusion of a
coronary artery. The highest priority and definitive treatment is reperfusion therapy via PCI
(cardiac catheterization) within 90 minutes of arrival.
Medical-Surgical Nursing Practice Bank Page 3 of 21
, Question 3: A nurse is caring for a patient with a history of atrial fibrillation. The
patient is prescribed warfarin (Coumadin). Which laboratory value is most
important for the nurse to monitor?
A) aPTT (Activated partial thromboplastin time)
B) PT/INR (Prothrombin time/International normalized ratio)
C) Platelet count
D) Serum potassium
Correct Answer: B
Rationale: Warfarin is an oral anticoagulant that works by inhibiting vitamin K-dependent clotting
factors. The effectiveness of warfarin therapy is monitored using the PT and INR. An INR of 2.0
to 3.0 is typically the therapeutic target for atrial fibrillation. aPTT is used to monitor heparin
therapy.
Medical-Surgical Nursing Practice Bank Page 4 of 21
, Question 4: A patient with infective endocarditis is scheduled for a dental
extraction. What instruction should the nurse emphasize?
A) Rinse the mouth with chlorhexidine twice daily for a week prior.
B) Ensure prophylactic antibiotics are taken before the procedure.
C) Avoid brushing teeth for 48 hours post-extraction.
D) Fast for 12 hours before the dental appointment.
Correct Answer: B
Rationale: Patients with a history of infective endocarditis are at high risk for recurrence,
especially during invasive procedures like dental work that can introduce bacteria into the
bloodstream. Prophylactic antibiotics are required before such procedures to prevent
colonization of the heart valves.
Question 5: Which assessment finding in a patient with right-sided heart failure
requires immediate follow-up by the nurse?
A) +2 bilateral pedal edema
B) Weight gain of 3 lbs in 24 hours
C) Fatigue with ambulation
D) Ascites
Correct Answer: B
Rationale: A rapid weight gain of 3 lbs (1.4 kg) in 24 hours indicates acute fluid retention and
worsening heart failure. One kilogram of weight gain is roughly equivalent to 1 liter of retained
fluid. This requires immediate intervention, often with intravenous diuretics, to prevent further
decompensation.
Medical-Surgical Nursing Practice Bank Page 5 of 21
, Respiratory System
Clinical Focus: Respiratory nursing focuses on oxygenation and ventilation. Key disease processes
include Asthma, COPD, Pneumonia, Tuberculosis, and Acute Respiratory Distress Syndrome (ARDS).
Question 1: A client with a history of severe Chronic Obstructive Pulmonary
Disease (COPD) is admitted with an acute exacerbation. Their arterial blood gas
(ABG) shows a PaO2 of 58 mm Hg and a PaCO2 of 64 mm Hg. Which oxygen
delivery method is the safest?
A) Non-rebreather mask at 15 L/min
B) Simple face mask at 8 L/min
C) Venturi mask at 28% FiO2
D) Nasal cannula at 6 L/min
Correct Answer: C
Rationale: Patients with chronic hypercapnia rely on mild hypoxia to stimulate their respiratory
drive. High-flow oxygen can suppress this drive, leading to respiratory arrest. A Venturi mask
delivers a precise, controlled fraction of inspired oxygen (FiO2) regardless of the patient's
respiratory pattern.
Medical-Surgical Nursing Practice Bank Page 6 of 21
