COMPLETE TEST BANK WITH ANSWER GUIDE
– NCLEX MED/SURG FINAL EXAM
UPDATED 2026/2027
Section 1: Cardiovascular System – Acute Myocardial
Infarction
Question 1: A 62-year-old male presents to the emergency
department with crushing substernal chest pain radiating to the
left arm, diaphoresis, and shortness of breath. Symptoms began
45 minutes ago. ECG shows ST-segment elevation in leads V1V4.
What is the priority nursing action?
A. Obtain a 12-lead ECG
B. Administer sublingual nitroglycerin
C. Apply oxygen via nasal cannula
D. Establish IV access
Correct Answer: A. Obtain a 12-lead ECG
Rationale: For a patient with suspected acute myocardial
infarction (AMI), the priority is to obtain a 12-lead ECG within 10
,minutes of arrival to confirm STEMI and guide reperfusion
therapy. While oxygen, nitroglycerin, and IV access are
important, ECG confirmation is time-sensitive because "door-
toballoon" time should be ≤90 minutes. The ECG shows ST
elevation in V1-V4, indicating anterior wall MI. Anterior wall MI
is associated with left ventricular dysfunction and carries higher
mortality. Monitor for heart failure, cardiogenic shock, and
arrhythmias .
Question 2: The patient's ECG confirms acute STEMI. Which
medication should be administered immediately to reduce
mortality?
A. Morphine sulfate 2-4 mg IV
B. Aspirin 324 mg chewed
C. Metoprolol 5 mg IV
D. Heparin 5,000 units IV
Correct Answer: B. Aspirin 324 mg chewed
Rationale: Aspirin is the first-line antiplatelet agent in acute MI.
Chewed aspirin allows rapid absorption and irreversible
inhibition of cyclooxygenase, reducing mortality by
approximately 20-30%. It should be administered immediately
,upon diagnosis, even before the ECG is completed if MI is
suspected. Morphine is for pain control but not first-line for
mortality reduction. Assess for aspirin allergy before
administration; if allergic, clopidogrel (Plavix) 300-600 mg
loading dose is an alternative .
Question 3: Which laboratory finding is most specific for
myocardial necrosis in this patient?
A. Creatinine kinase (CK)
B. Troponin I
C. Myoglobin
D. C-reactive protein (CRP)
Correct Answer: B. Troponin I
Rationale: Cardiac troponin I and T are the most specific and
sensitive biomarkers for myocardial necrosis. Troponin rises within
3-4 hours, peaks at 12-24 hours, and remains elevated for 7-14
days. CK-MB is less specific. Myoglobin rises early but is not
cardiac-specific. CRP is an inflammatory marker, not specific for
necrosis. Troponin levels are diagnostic for MI when >99th
percentile of the upper reference limit with a rising or falling
pattern .
, Question 4: The patient is prescribed metoprolol following MI.
What is the primary rationale for beta-blocker therapy post-MI?
A. Reduce preload and afterload
B. Decrease myocardial oxygen demand
C. Prevent ventricular remodeling
D. Reduce cholesterol levels
Correct Answer: B. Decrease myocardial oxygen demand
Rationale: Beta-blockers (metoprolol, carvedilol, bisoprolol)
reduce myocardial oxygen demand by decreasing heart rate,
contractility, and blood pressure. This reduces the risk of recurrent
ischemia and mortality. They also reduce the risk of ventricular
arrhythmias. Contraindications to beta-blockers: heart failure
with reduced ejection fraction (caution), bradycardia, heart
block, severe asthma, and cardiogenic shock .
Question 5: The patient is discharged on atorvastatin 80 mg
daily. What is the target LDL cholesterol level for secondary
prevention after MI?
A. <100 mg/dL
B. <70 mg/dL
– NCLEX MED/SURG FINAL EXAM
UPDATED 2026/2027
Section 1: Cardiovascular System – Acute Myocardial
Infarction
Question 1: A 62-year-old male presents to the emergency
department with crushing substernal chest pain radiating to the
left arm, diaphoresis, and shortness of breath. Symptoms began
45 minutes ago. ECG shows ST-segment elevation in leads V1V4.
What is the priority nursing action?
A. Obtain a 12-lead ECG
B. Administer sublingual nitroglycerin
C. Apply oxygen via nasal cannula
D. Establish IV access
Correct Answer: A. Obtain a 12-lead ECG
Rationale: For a patient with suspected acute myocardial
infarction (AMI), the priority is to obtain a 12-lead ECG within 10
,minutes of arrival to confirm STEMI and guide reperfusion
therapy. While oxygen, nitroglycerin, and IV access are
important, ECG confirmation is time-sensitive because "door-
toballoon" time should be ≤90 minutes. The ECG shows ST
elevation in V1-V4, indicating anterior wall MI. Anterior wall MI
is associated with left ventricular dysfunction and carries higher
mortality. Monitor for heart failure, cardiogenic shock, and
arrhythmias .
Question 2: The patient's ECG confirms acute STEMI. Which
medication should be administered immediately to reduce
mortality?
A. Morphine sulfate 2-4 mg IV
B. Aspirin 324 mg chewed
C. Metoprolol 5 mg IV
D. Heparin 5,000 units IV
Correct Answer: B. Aspirin 324 mg chewed
Rationale: Aspirin is the first-line antiplatelet agent in acute MI.
Chewed aspirin allows rapid absorption and irreversible
inhibition of cyclooxygenase, reducing mortality by
approximately 20-30%. It should be administered immediately
,upon diagnosis, even before the ECG is completed if MI is
suspected. Morphine is for pain control but not first-line for
mortality reduction. Assess for aspirin allergy before
administration; if allergic, clopidogrel (Plavix) 300-600 mg
loading dose is an alternative .
Question 3: Which laboratory finding is most specific for
myocardial necrosis in this patient?
A. Creatinine kinase (CK)
B. Troponin I
C. Myoglobin
D. C-reactive protein (CRP)
Correct Answer: B. Troponin I
Rationale: Cardiac troponin I and T are the most specific and
sensitive biomarkers for myocardial necrosis. Troponin rises within
3-4 hours, peaks at 12-24 hours, and remains elevated for 7-14
days. CK-MB is less specific. Myoglobin rises early but is not
cardiac-specific. CRP is an inflammatory marker, not specific for
necrosis. Troponin levels are diagnostic for MI when >99th
percentile of the upper reference limit with a rising or falling
pattern .
, Question 4: The patient is prescribed metoprolol following MI.
What is the primary rationale for beta-blocker therapy post-MI?
A. Reduce preload and afterload
B. Decrease myocardial oxygen demand
C. Prevent ventricular remodeling
D. Reduce cholesterol levels
Correct Answer: B. Decrease myocardial oxygen demand
Rationale: Beta-blockers (metoprolol, carvedilol, bisoprolol)
reduce myocardial oxygen demand by decreasing heart rate,
contractility, and blood pressure. This reduces the risk of recurrent
ischemia and mortality. They also reduce the risk of ventricular
arrhythmias. Contraindications to beta-blockers: heart failure
with reduced ejection fraction (caution), bradycardia, heart
block, severe asthma, and cardiogenic shock .
Question 5: The patient is discharged on atorvastatin 80 mg
daily. What is the target LDL cholesterol level for secondary
prevention after MI?
A. <100 mg/dL
B. <70 mg/dL
