MED SURG 3 480 ATI Advanced Med Surg Final Exam West
Coast University Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Section A: Advanced Cardiovascular Disorders & Hemodynamic
Monitoring (Q1–Q12)
Q1: The nurse is reviewing a client's hemodynamic monitoring data. Which value
represents the normal range for central venous pressure (CVP)?
A. 0 to 2 mmHg
B. 2 to 8 mmHg [CORRECT]
C. 15 to 20 mmHg
D. 25 to 30 mmHg
Correct Answer: B
Rationale: Normal CVP, which reflects right atrial preload, is 2 to 8 mmHg. Values above
15 to 20 mmHg suggest fluid overload or right heart strain, and 0 to 2 mmHg suggests
hypovolemia.
Q2: A client with acute pulmonary edema has crackles throughout all lung fields and
orthopnea. Which hemodynamic value should the nurse expect to be elevated?
A. Central venous pressure of 3 mmHg
B. Systemic vascular resistance of 400 dynes/sec/cm⁵
C. Cardiac index of 4.2 L/min/m²
D. Pulmonary artery wedge pressure of 22 mmHg [CORRECT]
Correct Answer: D
Rationale: PAWP reflects left ventricular end-diastolic pressure and rises in left-sided
failure and pulmonary edema. A low CVP reflects right-sided or hypovolemic states, SVR
of 400 indicates vasodilation, and a normal cardiac index does not explain the findings.
Q3: A client's heart rate is 80 beats/min and stroke volume is 70 mL. Which cardiac
output should the nurse document?
A. 1.5 L/min
B. 0.86 L/min
C. 5.6 L/min [CORRECT]
,D. 150 L/min
Correct Answer: C
Rationale: Cardiac output = heart rate × stroke volume = 80 × 70 = 5,600 mL/min (5.6
L/min), which falls within the normal range of 4 to 8 L/min. The other answers reflect
division or addition rather than multiplication.
Q4: A client in septic shock has warm, flushed skin, BP 82/44 mmHg, and a cardiac
index of 5.0 L/min/m². Which hemodynamic profile should the nurse expect?
A. Decreased systemic vascular resistance [CORRECT]
B. Increased systemic vascular resistance
C. Decreased cardiac output with increased wedge pressure
D. Increased CVP with decreased cardiac index
Correct Answer: A
Rationale: Early (warm) septic shock produces massive vasodilation, so SVR is low and
cardiac output is compensatorily high. Increased SVR with decreased CO describes
cardiogenic or late (cold) shock, not the hyperdynamic distributive profile.
Q5: A client arrives with chest pain and ST-segment elevation in leads II, III, and aVF.
Which intervention should the nurse prioritize to meet evidence-based reperfusion
goals?
A. Schedule a stress test within 48 hours
B. Prepare the client for percutaneous coronary intervention with a door-to-balloon time
of 90 minutes or less [CORRECT]
C. Begin a 48-hour observation period before treatment
D. Administer sublingual nitroglycerin and discharge home if pain resolves
Correct Answer: B
Rationale: STEMI requires emergent reperfusion, with PCI performed within 90 minutes
of arrival. Delayed testing, observation, or symptom-only management increases
myocardial loss and mortality.
Q6: A client develops severe dyspnea, pink frothy sputum, and crackles, and is
diagnosed with acute pulmonary edema. Which action should the nurse take first?
A. Encourage increased oral fluid intake
B. Place the client flat with the head of the bed at 10 degrees
C. Restrict all activity until a cardiology consult is obtained
D. Position in high Fowler's with legs dependent and apply oxygen [CORRECT]
Correct Answer: D
Rationale: Sitting upright with legs dependent decreases venous return and preload
while oxygen improves hypoxemia—immediate priorities in pulmonary edema. Fluids
,and flat positioning worsen pulmonary congestion, and delaying treatment for a consult
is unsafe.
Q7: A client's monitor shows ventricular fibrillation and the client is unresponsive with
no pulse. Which action should the nurse take first?
A. Defibrillate as soon as the defibrillator is ready [CORRECT]
B. Prepare synchronized cardioversion
C. Administer IV adenosine
D. Begin a 12-lead ECG
Correct Answer: A
Rationale: Pulseless ventricular fibrillation is treated with immediate unsynchronized
defibrillation along with CPR. Synchronized cardioversion, adenosine, and obtaining an
ECG delay the definitive therapy.
Q8: A client develops new atrial fibrillation with a ventricular response of 132 beats/min
and mild hypotension. Which medication should the nurse anticipate to achieve rate
control?
A. Atropine
B. Adenosine
C. Diltiazem [CORRECT]
D. Isoproterenol
Correct Answer: C
Rationale: Diltiazem, a calcium channel blocker, is a first-line agent for ventricular rate
control in atrial fibrillation. Atropine and isoproterenol increase heart rate, and
adenosine is used to attempt conversion of reentrant SVT rather than sustained rate
control.
Q9: A client in septic shock is receiving a continuous norepinephrine infusion. Which
nursing action best reduces the risk of serious complications from this medication?
A. Dilute the infusion in dextrose and run it through a peripheral hand vein
B. Administer through a central line with frequent infusion site assessment [CORRECT]
C. Flush the line hourly with heparin and increase the rate if BP remains low
D. Stop the infusion whenever the systolic BP exceeds 100 mmHg without a provider
order
Correct Answer: B
Rationale: Norepinephrine is a potent vasoconstrictor that causes severe tissue
necrosis if extravasated, so central administration and close site monitoring are
recommended. Nurse-initiated rate changes, increased dosing without orders, and
peripheral small-vessel administration increase harm.
, Q10: A client 5 days post-MI develops sudden hypotension, distended neck veins, and
muffled heart sounds. Which condition do these findings indicate?
A. Left ventricular free wall rupture with exsanguination
B. Right ventricular infarction alone
C. Acute mitral valve regurgitation
D. Cardiac tamponade (Beck's triad) [CORRECT]
Correct Answer: D
Rationale: Hypotension, JVD, and muffled heart sounds constitute Beck's triad,
indicating pericardial fluid compressing the heart. The other complications do not
produce this classic triad together.
Q11: Which value represents the normal range for cardiac output in an adult?
A. 1 to 2 L/min
B. 10 to 12 L/min
C. 4 to 8 L/min [CORRECT]
D. 12 to 15 L/min
Correct Answer: C
Rationale: Normal adult cardiac output is 4 to 8 L/min, reflecting the product of heart
rate and stroke volume. Values below this range suggest impaired pump function and
above it, compensatory hyperdynamic states.
Q12: Two days after an MI, a client has BP 78/50 mmHg, cold clammy skin, PAWP 22
mmHg, and a cardiac index of 1.7 L/min/m². Which condition should the nurse suspect?
A. Cardiogenic shock [CORRECT]
B. Septic shock
C. Hypovolemic shock
D. Neurogenic shock
Correct Answer: A
Rationale: Pump failure after MI produces high filling pressures (elevated PAWP) with
low cardiac index and vasoconstricted, cool skin. Septic and neurogenic shock show
low SVR with warm extremities, and hypovolemic shock shows low filling pressures.
Section B: Advanced Respiratory Disorders & Mechanical Ventilation
(Q13–Q24)
Q13: A client on volume-controlled ventilation triggers the high-pressure alarm. Which
action should the nurse take first?
Coast University Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Section A: Advanced Cardiovascular Disorders & Hemodynamic
Monitoring (Q1–Q12)
Q1: The nurse is reviewing a client's hemodynamic monitoring data. Which value
represents the normal range for central venous pressure (CVP)?
A. 0 to 2 mmHg
B. 2 to 8 mmHg [CORRECT]
C. 15 to 20 mmHg
D. 25 to 30 mmHg
Correct Answer: B
Rationale: Normal CVP, which reflects right atrial preload, is 2 to 8 mmHg. Values above
15 to 20 mmHg suggest fluid overload or right heart strain, and 0 to 2 mmHg suggests
hypovolemia.
Q2: A client with acute pulmonary edema has crackles throughout all lung fields and
orthopnea. Which hemodynamic value should the nurse expect to be elevated?
A. Central venous pressure of 3 mmHg
B. Systemic vascular resistance of 400 dynes/sec/cm⁵
C. Cardiac index of 4.2 L/min/m²
D. Pulmonary artery wedge pressure of 22 mmHg [CORRECT]
Correct Answer: D
Rationale: PAWP reflects left ventricular end-diastolic pressure and rises in left-sided
failure and pulmonary edema. A low CVP reflects right-sided or hypovolemic states, SVR
of 400 indicates vasodilation, and a normal cardiac index does not explain the findings.
Q3: A client's heart rate is 80 beats/min and stroke volume is 70 mL. Which cardiac
output should the nurse document?
A. 1.5 L/min
B. 0.86 L/min
C. 5.6 L/min [CORRECT]
,D. 150 L/min
Correct Answer: C
Rationale: Cardiac output = heart rate × stroke volume = 80 × 70 = 5,600 mL/min (5.6
L/min), which falls within the normal range of 4 to 8 L/min. The other answers reflect
division or addition rather than multiplication.
Q4: A client in septic shock has warm, flushed skin, BP 82/44 mmHg, and a cardiac
index of 5.0 L/min/m². Which hemodynamic profile should the nurse expect?
A. Decreased systemic vascular resistance [CORRECT]
B. Increased systemic vascular resistance
C. Decreased cardiac output with increased wedge pressure
D. Increased CVP with decreased cardiac index
Correct Answer: A
Rationale: Early (warm) septic shock produces massive vasodilation, so SVR is low and
cardiac output is compensatorily high. Increased SVR with decreased CO describes
cardiogenic or late (cold) shock, not the hyperdynamic distributive profile.
Q5: A client arrives with chest pain and ST-segment elevation in leads II, III, and aVF.
Which intervention should the nurse prioritize to meet evidence-based reperfusion
goals?
A. Schedule a stress test within 48 hours
B. Prepare the client for percutaneous coronary intervention with a door-to-balloon time
of 90 minutes or less [CORRECT]
C. Begin a 48-hour observation period before treatment
D. Administer sublingual nitroglycerin and discharge home if pain resolves
Correct Answer: B
Rationale: STEMI requires emergent reperfusion, with PCI performed within 90 minutes
of arrival. Delayed testing, observation, or symptom-only management increases
myocardial loss and mortality.
Q6: A client develops severe dyspnea, pink frothy sputum, and crackles, and is
diagnosed with acute pulmonary edema. Which action should the nurse take first?
A. Encourage increased oral fluid intake
B. Place the client flat with the head of the bed at 10 degrees
C. Restrict all activity until a cardiology consult is obtained
D. Position in high Fowler's with legs dependent and apply oxygen [CORRECT]
Correct Answer: D
Rationale: Sitting upright with legs dependent decreases venous return and preload
while oxygen improves hypoxemia—immediate priorities in pulmonary edema. Fluids
,and flat positioning worsen pulmonary congestion, and delaying treatment for a consult
is unsafe.
Q7: A client's monitor shows ventricular fibrillation and the client is unresponsive with
no pulse. Which action should the nurse take first?
A. Defibrillate as soon as the defibrillator is ready [CORRECT]
B. Prepare synchronized cardioversion
C. Administer IV adenosine
D. Begin a 12-lead ECG
Correct Answer: A
Rationale: Pulseless ventricular fibrillation is treated with immediate unsynchronized
defibrillation along with CPR. Synchronized cardioversion, adenosine, and obtaining an
ECG delay the definitive therapy.
Q8: A client develops new atrial fibrillation with a ventricular response of 132 beats/min
and mild hypotension. Which medication should the nurse anticipate to achieve rate
control?
A. Atropine
B. Adenosine
C. Diltiazem [CORRECT]
D. Isoproterenol
Correct Answer: C
Rationale: Diltiazem, a calcium channel blocker, is a first-line agent for ventricular rate
control in atrial fibrillation. Atropine and isoproterenol increase heart rate, and
adenosine is used to attempt conversion of reentrant SVT rather than sustained rate
control.
Q9: A client in septic shock is receiving a continuous norepinephrine infusion. Which
nursing action best reduces the risk of serious complications from this medication?
A. Dilute the infusion in dextrose and run it through a peripheral hand vein
B. Administer through a central line with frequent infusion site assessment [CORRECT]
C. Flush the line hourly with heparin and increase the rate if BP remains low
D. Stop the infusion whenever the systolic BP exceeds 100 mmHg without a provider
order
Correct Answer: B
Rationale: Norepinephrine is a potent vasoconstrictor that causes severe tissue
necrosis if extravasated, so central administration and close site monitoring are
recommended. Nurse-initiated rate changes, increased dosing without orders, and
peripheral small-vessel administration increase harm.
, Q10: A client 5 days post-MI develops sudden hypotension, distended neck veins, and
muffled heart sounds. Which condition do these findings indicate?
A. Left ventricular free wall rupture with exsanguination
B. Right ventricular infarction alone
C. Acute mitral valve regurgitation
D. Cardiac tamponade (Beck's triad) [CORRECT]
Correct Answer: D
Rationale: Hypotension, JVD, and muffled heart sounds constitute Beck's triad,
indicating pericardial fluid compressing the heart. The other complications do not
produce this classic triad together.
Q11: Which value represents the normal range for cardiac output in an adult?
A. 1 to 2 L/min
B. 10 to 12 L/min
C. 4 to 8 L/min [CORRECT]
D. 12 to 15 L/min
Correct Answer: C
Rationale: Normal adult cardiac output is 4 to 8 L/min, reflecting the product of heart
rate and stroke volume. Values below this range suggest impaired pump function and
above it, compensatory hyperdynamic states.
Q12: Two days after an MI, a client has BP 78/50 mmHg, cold clammy skin, PAWP 22
mmHg, and a cardiac index of 1.7 L/min/m². Which condition should the nurse suspect?
A. Cardiogenic shock [CORRECT]
B. Septic shock
C. Hypovolemic shock
D. Neurogenic shock
Correct Answer: A
Rationale: Pump failure after MI produces high filling pressures (elevated PAWP) with
low cardiac index and vasoconstricted, cool skin. Septic and neurogenic shock show
low SVR with warm extremities, and hypovolemic shock shows low filling pressures.
Section B: Advanced Respiratory Disorders & Mechanical Ventilation
(Q13–Q24)
Q13: A client on volume-controlled ventilation triggers the high-pressure alarm. Which
action should the nurse take first?
