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ADVANCED MEDICAL SURGICAL NURSING EXAM XYZ UNIVERSITY
ADVANCED
EDITION MEDICAL-SURGICAL
FINAL PAPER CORRECT ANSWERS FULL SOLUTION
NURSING EXAM
────────────────────────────────────────
75 Questions with Correct Answers and Rationales
2026/2027 Edition
XYZ University
Already Graded A+ | 100% Verified
Aligned with NCSBN NCLEX-RN, AACN Essentials, AHA, SCCM, IDSA, NCCN Guidelines
NGN Clinical Judgment Measurement Model (CJMM) Aligned
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Advanced Medical-Surgical Nursing Exam 2026/2027
TABLE OF CONTENTS
INTRODUCTION................................................................................................................................. 1
SECTION 1: Cardiac & Hemodynamic Monitoring (Questions 1–10) ........................................... 1
SECTION 2: Respiratory & Neurological Critical Care (Questions 11–20) ................................... 4
SECTION 3: Renal & Endocrine Complex Care (Questions 21–30)............................................... 8
SECTION 4: Oncology & Immunocompromised Patient Care (Questions 31–40) ....................... 12
SECTION 5: Complex Surgical Care & Complications (Questions 41–48) .................................. 15
SECTION 6: Palliative & End-of-Life Care Integration (Questions 49–55) ................................. 18
SECTION 7: Pharmacology & High-Alert Medications (Questions 56–63) ................................. 21
SECTION 8: Interprofessional Collaboration & Quality Improvement (Questions 64–70) .......... 24
SECTION 9: Ethical/Legal Decision-Making & Advanced Prioritization (Questions 71–75) ...... 26
ANSWER KEY ................................................................................................................................... 28
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Advanced Medical-Surgical Nursing Exam 2026/2027
INTRODUCTION
This comprehensive Advanced Medical-Surgical Nursing Exam for 2026/2027 provides 75 expertly
crafted, evidence-based questions with verified correct answers and detailed rationales. The exam is
designed for senior-level pre-licensure nursing students, capstone course assessment, and transition-
to-practice preparation. Each question integrates advanced clinical reasoning frameworks including
the NCSBN Clinical Judgment Measurement Model (CJMM), ABCs/Maslow prioritization
hierarchies, and Next Generation NCLEX (NGN) item type formats.
The exam systematically covers multi-system critical illness management across cardiac, respiratory,
neurological, renal, and endocrine domains; hemodynamic monitoring and vasoactive medication
titration; complex oncology and immunocompromised patient care; surgical complications and wound
management; palliative and end-of-life care integration; pharmacology of high-alert and narrow-
therapeutic-index medications; interprofessional collaboration and quality improvement; and
ethical/legal decision-making in complex clinical scenarios. All content is aligned with the NCSBN
NCLEX-RN Detailed Test Plan, AACN Essentials for Baccalaureate Education, and current clinical
practice guidelines from the AHA, SCCM, IDSA, NCCN, KDIGO, and ATS.
SECTION 1: Cardiac & Hemodynamic Monitoring (Questions 1–10)
1. A nurse is caring for a client with acute decompensated heart failure (ADHF) who has a
pulmonary artery catheter. The cardiac output is 3.2 L/min, cardiac index is 1.6 L/min/m², and
systemic vascular resistance (SVR) is 1,800 dynes·sec/cm⁵. Which interpretation and
PRIORITY intervention are CORRECT?
A) Cardiogenic shock – administer IV normal saline bolus
B) Cardiogenic shock with high afterload – initiate milrinone infusion as prescribed
C) Hypovolemic shock – administer vasopressors
D) Septic shock – initiate aggressive fluid resuscitation
Correct Answer: B | Rationale: A cardiac index of 1.6 L/min/m² (normal 2.5–4.0) with elevated
SVR (normal 800–1,200) indicates cardiogenic shock with increased afterload. Milrinone, a
phosphodiesterase-3 inhibitor, improves contractility and reduces SVR (vasodilatory effect) without
increasing myocardial oxygen demand. Fluid bolus (A) worsens pulmonary congestion. Vasopressors
(C) increase afterload further. Fluid resuscitation (D) is contraindicated in ADHF.
2. A client on a norepinephrine drip for septic shock has a blood pressure of 74/42 mmHg
despite the current rate of 15 mcg/min. The MAP is 52 mmHg. Which action should the nurse
take FIRST?
A) Decrease the norepinephrine rate because the MAP exceeds 50 mmHg
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Advanced Medical-Surgical Nursing Exam 2026/2027
B) Increase the norepinephrine drip rate per titration protocol and reassess in 5 minutes
C) Discontinue norepinephrine and start dopamine
D) Administer a 500 mL normal saline bolus
Correct Answer: B | Rationale: The Surviving Sepsis Campaign target MAP is ≥65 mmHg (or ≥50
mmHg with lactate normalization). At 52 mmHg, the MAP is below target, so the norepinephrine
should be titrated upward per protocol (B) with reassessment in 5 minutes. Norepinephrine is the
first-line vasopressor for septic shock. Discontinuing (C) or decreasing (A) the first-line agent would
worsen hypotension. Fluid bolus (D) may be appropriate if assessment suggests ongoing volume
deficit, but the priority is titrating the current vasopressor to target.
3. A nurse is interpreting a client’s central venous pressure (CVP) waveform. The CVP reading
is 12 mmHg, and the nurse notes absent c and v waves with a prominent x descent. Which
condition should the nurse suspect?
A) Right ventricular failure
B) Cardiac tamponade
C) Hypovolemia
D) Tricuspid regurgitation
Correct Answer: B | Rationale: Cardiac tamponade presents with elevated CVP (normal 2–8
mmHg), absent y descent (prominent x descent with blunted y descent), and equalization of diastolic
pressures. Beck’s triad (muffled heart sounds, jugular venous distention, hypotension) is a classic but
late finding. RV failure (A) shows elevated CVP with prominent v waves. Hypovolemia (C) shows low
CVP. Tricuspid regurgitation (D) produces prominent cv waves.
4. A client with a left ventricular assist device (LVAD) has a driveline site with purulent
drainage and erythema extending 3 cm from the exit site. The client’s temperature is 101.5°F.
Which intervention is the PRIORITY?
A) Apply a sterile dressing and monitor
B) Obtain wound and blood cultures and notify the provider immediately
C) Administer prophylactic antibiotics without culture
D) Cleanse the site with hydrogen peroxide
Correct Answer: B | Rationale: LVAD driveline infection is a serious complication that may lead to
pump pocket infection, bacteremia, and sepsis. Obtaining cultures before initiating antibiotics (B) is
essential for targeted therapy. Purulent drainage with systemic fever indicates active infection
requiring prompt antimicrobial treatment. Prophylactic antibiotics without culture (C) may not cover
the causative organism. Hydrogen peroxide (D) is cytotoxic and contraindicated for driveline care.
5. A nurse is assessing a client 6 hours after a cardiac catheterization via the right femoral
artery. The client reports severe back pain and the blood pressure has dropped from 130/80 to
84/50 mmHg. Which is the PRIORITY action?
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ADVANCED MEDICAL SURGICAL NURSING EXAM XYZ UNIVERSITY
ADVANCED
EDITION MEDICAL-SURGICAL
FINAL PAPER CORRECT ANSWERS FULL SOLUTION
NURSING EXAM
────────────────────────────────────────
75 Questions with Correct Answers and Rationales
2026/2027 Edition
XYZ University
Already Graded A+ | 100% Verified
Aligned with NCSBN NCLEX-RN, AACN Essentials, AHA, SCCM, IDSA, NCCN Guidelines
NGN Clinical Judgment Measurement Model (CJMM) Aligned
Downloaded by: Want to earn $1,500
Distribution of this document is illegal extra per year?
, classmerit.com — The Marketplace to Buy and Sell Study Materials
Advanced Medical-Surgical Nursing Exam 2026/2027
TABLE OF CONTENTS
INTRODUCTION................................................................................................................................. 1
SECTION 1: Cardiac & Hemodynamic Monitoring (Questions 1–10) ........................................... 1
SECTION 2: Respiratory & Neurological Critical Care (Questions 11–20) ................................... 4
SECTION 3: Renal & Endocrine Complex Care (Questions 21–30)............................................... 8
SECTION 4: Oncology & Immunocompromised Patient Care (Questions 31–40) ....................... 12
SECTION 5: Complex Surgical Care & Complications (Questions 41–48) .................................. 15
SECTION 6: Palliative & End-of-Life Care Integration (Questions 49–55) ................................. 18
SECTION 7: Pharmacology & High-Alert Medications (Questions 56–63) ................................. 21
SECTION 8: Interprofessional Collaboration & Quality Improvement (Questions 64–70) .......... 24
SECTION 9: Ethical/Legal Decision-Making & Advanced Prioritization (Questions 71–75) ...... 26
ANSWER KEY ................................................................................................................................... 28
Page PAGE_NUMBER
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Advanced Medical-Surgical Nursing Exam 2026/2027
INTRODUCTION
This comprehensive Advanced Medical-Surgical Nursing Exam for 2026/2027 provides 75 expertly
crafted, evidence-based questions with verified correct answers and detailed rationales. The exam is
designed for senior-level pre-licensure nursing students, capstone course assessment, and transition-
to-practice preparation. Each question integrates advanced clinical reasoning frameworks including
the NCSBN Clinical Judgment Measurement Model (CJMM), ABCs/Maslow prioritization
hierarchies, and Next Generation NCLEX (NGN) item type formats.
The exam systematically covers multi-system critical illness management across cardiac, respiratory,
neurological, renal, and endocrine domains; hemodynamic monitoring and vasoactive medication
titration; complex oncology and immunocompromised patient care; surgical complications and wound
management; palliative and end-of-life care integration; pharmacology of high-alert and narrow-
therapeutic-index medications; interprofessional collaboration and quality improvement; and
ethical/legal decision-making in complex clinical scenarios. All content is aligned with the NCSBN
NCLEX-RN Detailed Test Plan, AACN Essentials for Baccalaureate Education, and current clinical
practice guidelines from the AHA, SCCM, IDSA, NCCN, KDIGO, and ATS.
SECTION 1: Cardiac & Hemodynamic Monitoring (Questions 1–10)
1. A nurse is caring for a client with acute decompensated heart failure (ADHF) who has a
pulmonary artery catheter. The cardiac output is 3.2 L/min, cardiac index is 1.6 L/min/m², and
systemic vascular resistance (SVR) is 1,800 dynes·sec/cm⁵. Which interpretation and
PRIORITY intervention are CORRECT?
A) Cardiogenic shock – administer IV normal saline bolus
B) Cardiogenic shock with high afterload – initiate milrinone infusion as prescribed
C) Hypovolemic shock – administer vasopressors
D) Septic shock – initiate aggressive fluid resuscitation
Correct Answer: B | Rationale: A cardiac index of 1.6 L/min/m² (normal 2.5–4.0) with elevated
SVR (normal 800–1,200) indicates cardiogenic shock with increased afterload. Milrinone, a
phosphodiesterase-3 inhibitor, improves contractility and reduces SVR (vasodilatory effect) without
increasing myocardial oxygen demand. Fluid bolus (A) worsens pulmonary congestion. Vasopressors
(C) increase afterload further. Fluid resuscitation (D) is contraindicated in ADHF.
2. A client on a norepinephrine drip for septic shock has a blood pressure of 74/42 mmHg
despite the current rate of 15 mcg/min. The MAP is 52 mmHg. Which action should the nurse
take FIRST?
A) Decrease the norepinephrine rate because the MAP exceeds 50 mmHg
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Advanced Medical-Surgical Nursing Exam 2026/2027
B) Increase the norepinephrine drip rate per titration protocol and reassess in 5 minutes
C) Discontinue norepinephrine and start dopamine
D) Administer a 500 mL normal saline bolus
Correct Answer: B | Rationale: The Surviving Sepsis Campaign target MAP is ≥65 mmHg (or ≥50
mmHg with lactate normalization). At 52 mmHg, the MAP is below target, so the norepinephrine
should be titrated upward per protocol (B) with reassessment in 5 minutes. Norepinephrine is the
first-line vasopressor for septic shock. Discontinuing (C) or decreasing (A) the first-line agent would
worsen hypotension. Fluid bolus (D) may be appropriate if assessment suggests ongoing volume
deficit, but the priority is titrating the current vasopressor to target.
3. A nurse is interpreting a client’s central venous pressure (CVP) waveform. The CVP reading
is 12 mmHg, and the nurse notes absent c and v waves with a prominent x descent. Which
condition should the nurse suspect?
A) Right ventricular failure
B) Cardiac tamponade
C) Hypovolemia
D) Tricuspid regurgitation
Correct Answer: B | Rationale: Cardiac tamponade presents with elevated CVP (normal 2–8
mmHg), absent y descent (prominent x descent with blunted y descent), and equalization of diastolic
pressures. Beck’s triad (muffled heart sounds, jugular venous distention, hypotension) is a classic but
late finding. RV failure (A) shows elevated CVP with prominent v waves. Hypovolemia (C) shows low
CVP. Tricuspid regurgitation (D) produces prominent cv waves.
4. A client with a left ventricular assist device (LVAD) has a driveline site with purulent
drainage and erythema extending 3 cm from the exit site. The client’s temperature is 101.5°F.
Which intervention is the PRIORITY?
A) Apply a sterile dressing and monitor
B) Obtain wound and blood cultures and notify the provider immediately
C) Administer prophylactic antibiotics without culture
D) Cleanse the site with hydrogen peroxide
Correct Answer: B | Rationale: LVAD driveline infection is a serious complication that may lead to
pump pocket infection, bacteremia, and sepsis. Obtaining cultures before initiating antibiotics (B) is
essential for targeted therapy. Purulent drainage with systemic fever indicates active infection
requiring prompt antimicrobial treatment. Prophylactic antibiotics without culture (C) may not cover
the causative organism. Hydrogen peroxide (D) is cytotoxic and contraindicated for driveline care.
5. A nurse is assessing a client 6 hours after a cardiac catheterization via the right femoral
artery. The client reports severe back pain and the blood pressure has dropped from 130/80 to
84/50 mmHg. Which is the PRIORITY action?
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