Advanced Medical-Surgical Nursing Exam 2026: Senior University Practice Test — Complex Conditions, Clinical Assessment, Critical Care, Nursing Interventions & Clinical Reasoning — 190 MultipleChoice Questions with Answers & Detailed Rationales

Advanced Medical-Surgical Nursing Exam 2026: Senior University
Practice Test — Complex Conditions, Clinical Assessment, Critical
Care, Nursing Interventions & Clinical Reasoning — 190 Multiple-
Choice Questions with Answers & Detailed Rationales




UNIT 1: CARDIOVASCULAR SYSTEM (Questions 1–25)

Question 1

A client with heart failure is prescribed furosemide. Which assessment finding most
concerns the nurse?

A. Blood pressure 118/72 mm Hg

B. Serum potassium 3.1 mEq/L

C. Urine output 1,200 mL/24 hr

D. Weight loss of 0.5 kg in 24 hr



Correct Answer: B

Explanation: Loop diuretics cause potassium loss; hypokalemia predisposes to dysrhythmias.
Monitor electrolytes closely.



Question 2

Which client is at greatest risk for developing infective endocarditis?

A. A 30-year-old with well-controlled asthma

B. A 45-year-old with a history of rheumatic fever

C. A 55-year-old with osteoarthritis

D. A 60-year-old with hypothyroidism



Correct Answer: B

Explanation: Prior rheumatic fever damages valves, creating a substrate for bacterial
adhesion and endocarditis.

,Question 3

A client reports chest pain that radiates to the left arm and jaw, unrelieved by rest. Which
action should the nurse take first?

A. Administer prescribed morphine

B. Obtain a 12-lead ECG

C. Apply supplemental oxygen

D. Draw serum troponin levels



Correct Answer: B

Explanation: ECG is the fastest way to identify ischemia or injury; it guides immediate
intervention.



Question 4

A nurse notes a client's apical pulse is 48 bpm and regular. The client is asymptomatic. Which
is the priority action?

A. Begin CPR immediately

B. Administer atropine

C. Continue to monitor and document

D. Place the client in Trendelenburg position



Correct Answer: C

Explanation: Asymptomatic bradycardia may be normal; intervention is based on symptoms,
not numbers alone.



Question 5

Which finding indicates a complication after cardiac catheterization?

A. Small hematoma at the puncture site

B. Pedal pulse equal to the opposite side

,C. Cool, pale extremity with absent pulse

D. Mild discomfort at the insertion site



Correct Answer: C

Explanation: Cool, pale extremity with absent pulse suggests arterial occlusion; requires
immediate intervention.



Question 6

A client with atrial fibrillation is prescribed warfarin. Which lab value should the nurse
monitor?

A. aPTT

B. INR

C. Platelet count

D. Bleeding time



Correct Answer: B

Explanation: Warfarin therapy is monitored with INR; therapeutic range is typically 2.0–3.0.



Question 7

Which client statement indicates understanding of a low-sodium diet for heart failure?

A. "I will use salt substitutes freely."

B. "I will read food labels for sodium content."

C. "I will add table salt only when cooking."

D. "I will drink more fluids to flush out sodium."



Correct Answer: B

Explanation: Label reading is essential for sodium restriction; salt substitutes may contain
potassium.

, Question 8

A client with myocardial infarction develops crackles and dyspnea. Which complication
should the nurse suspect?

A. Cardiogenic shock

B. Pulmonary edema

C. Pericarditis

D. Ventricular aneurysm



Correct Answer: B

Explanation: Crackles and dyspnea after MI suggest left ventricular failure with pulmonary
congestion.



Question 9

Which medication is contraindicated in a client with severe aortic stenosis?

A. Nitroglycerin

B. Metoprolol

C. Amlodipine

D. Lisinopril



Correct Answer: A

Explanation: Nitroglycerin reduces preload; in aortic stenosis, preload is needed to maintain
cardiac output.



Question 10

A client's ECG shows a prolonged PR interval. Which condition does this indicate?

A. First-degree heart block

B. Second-degree heart block, type I

C. Third-degree heart block

D. Premature ventricular contractions