NUR201 Exam 4 Medical Surgical Nursing I
Ultimate Study Guide | Fortis College |
2026/2027 Updated | 300+ Q&A | 100%
Correct | A+ Guaranteed
Comprehensive Review & Practice Examination | Focus: Cardiovascular, Respiratory, &
Hematological Systems
Fortis College | Department of Nursing | Exam 4 Study Resource
PART 1 – KEY CONTENT REVIEW (High-Yield 2026-2027)
CARDIOVASCULAR SYSTEM
• Heart Failure (HF)
– Systolic HF: ↓ EF ≤ 40%, dilated LV, S3 gallop, cool extremities.
– Diastolic HF: Preserved EF ≥ 50%, stiff LV, S4, pulmonary edema.
– Key labs: BNP > 400 pg/mL (2026 AHA cut-off), NT-proBNP > 900 pg/mL.
– 1st-line 2027 GDMT: ARNI (Sac/Val) OR ACE/ARB + β-blocker (Carvedilol, Metoprolol
succinate) + SGLT2i (Dapagliflozin) + MRA (Spironolactone) ± loop diuretic for
congestion.
,– Daily weights: > 2 kg (3 lb) gain in 24 h → notify provider.
– Low-sodium diet ≤ 2 g/day; fluid restrict 1.5–2 L if hyponatremia < 130 mEq/L.
• Acute Coronary Syndrome (ACS)
– STEMI: ST ↑ ≥ 1 mm in 2 contiguous leads; door-to-balloon ≤ 90 min (2026 AHA).
– NSTEMI: ↑ Troponin without ST ↑; risk stratify (TIMI, HEART).
– MONA-B: Morphine ONLY if severe pain/STEMI, O2 if SpO2 < 90%, Nitroglycerin
(sublingual 0.4 mg q5 min × 3), Aspirin 325 mg chewed, β-blocker within 24 h if no
HF/shock.
– Contraindications to fibrinolytics: Prior hemorrhagic stroke, active bleeding, major
surgery < 2 wk, INR > 1.7.
• Hypertension (2026 ACC/AHA)
– Stage 1: 130–139/80–89 mmHg; Stage 2: ≥ 140/90 mmHg.
– First-line: thiazide (Chlorthalidone 12.5–25 mg), ACE/ARB, or CCB (Amlodipine).
– Goal < 130/80 mmHg for most adults; < 125/75 mmHg if albuminuria/DM.
• Common Dysrhythmias
– Afib: CHA₂DS₂-VASc ≥ 2 → anticoagulate (DOAC preferred 2027).
– Ventricular tachycardia: Pulseless → defibrillate; Stable → Amiodarone 150 mg IV
over 10 min.
RESPIRATORY SYSTEM
• COPD (GOLD 2027)
, – ABECDX: A (few symptoms, low risk) → D (high symptoms, high risk).
– 1st-line LABA/LAMA (Tiotropium + Formoterol) for group B–D.
– PO₂ < 55 mmHg or SaO₂ < 88% → continuous O₂; target SpO₂ 88–92%.
– Steroid burst: Prednisone 40 mg PO daily × 5 days for exacerbation.
• Asthma (2026 GINA)
– Step 1: PRN low-dose ICS-Formoterol; Step 3: Daily ICS-LABA.
– Peak-flow < 50% personal best → severe exacerbation; give SABA 2.5 mg q20 min × 3
+ ipratropium 500 mcg + PO steroids.
• Pneumonia (IDSA 2026)
– CURB-65: Confusion, Urea > 20 mg/dL, RR ≥ 30, BP < 90/60, Age ≥ 65. Score ≥ 2 →
consider ICU.
– Empiric CAP: Amoxicillin-clavulanate 1 g PO q12 h + Doxycycline 100 mg PO q12 h
(outpatient).
• Pulmonary Embolism (2026 ESC)
– High-risk (massive): SBP < 90 mmHg; immediate IV heparin + reperfusion (tPA).
– DOAC first-line for low/intermediate: Apixaban 10 mg BID × 7 d → 5 mg BID.
HEMATOLOGICAL SYSTEM
• Iron-Deficiency Anemia
– Ferritin < 30 ng/mL, TSAT < 20%.
Ultimate Study Guide | Fortis College |
2026/2027 Updated | 300+ Q&A | 100%
Correct | A+ Guaranteed
Comprehensive Review & Practice Examination | Focus: Cardiovascular, Respiratory, &
Hematological Systems
Fortis College | Department of Nursing | Exam 4 Study Resource
PART 1 – KEY CONTENT REVIEW (High-Yield 2026-2027)
CARDIOVASCULAR SYSTEM
• Heart Failure (HF)
– Systolic HF: ↓ EF ≤ 40%, dilated LV, S3 gallop, cool extremities.
– Diastolic HF: Preserved EF ≥ 50%, stiff LV, S4, pulmonary edema.
– Key labs: BNP > 400 pg/mL (2026 AHA cut-off), NT-proBNP > 900 pg/mL.
– 1st-line 2027 GDMT: ARNI (Sac/Val) OR ACE/ARB + β-blocker (Carvedilol, Metoprolol
succinate) + SGLT2i (Dapagliflozin) + MRA (Spironolactone) ± loop diuretic for
congestion.
,– Daily weights: > 2 kg (3 lb) gain in 24 h → notify provider.
– Low-sodium diet ≤ 2 g/day; fluid restrict 1.5–2 L if hyponatremia < 130 mEq/L.
• Acute Coronary Syndrome (ACS)
– STEMI: ST ↑ ≥ 1 mm in 2 contiguous leads; door-to-balloon ≤ 90 min (2026 AHA).
– NSTEMI: ↑ Troponin without ST ↑; risk stratify (TIMI, HEART).
– MONA-B: Morphine ONLY if severe pain/STEMI, O2 if SpO2 < 90%, Nitroglycerin
(sublingual 0.4 mg q5 min × 3), Aspirin 325 mg chewed, β-blocker within 24 h if no
HF/shock.
– Contraindications to fibrinolytics: Prior hemorrhagic stroke, active bleeding, major
surgery < 2 wk, INR > 1.7.
• Hypertension (2026 ACC/AHA)
– Stage 1: 130–139/80–89 mmHg; Stage 2: ≥ 140/90 mmHg.
– First-line: thiazide (Chlorthalidone 12.5–25 mg), ACE/ARB, or CCB (Amlodipine).
– Goal < 130/80 mmHg for most adults; < 125/75 mmHg if albuminuria/DM.
• Common Dysrhythmias
– Afib: CHA₂DS₂-VASc ≥ 2 → anticoagulate (DOAC preferred 2027).
– Ventricular tachycardia: Pulseless → defibrillate; Stable → Amiodarone 150 mg IV
over 10 min.
RESPIRATORY SYSTEM
• COPD (GOLD 2027)
, – ABECDX: A (few symptoms, low risk) → D (high symptoms, high risk).
– 1st-line LABA/LAMA (Tiotropium + Formoterol) for group B–D.
– PO₂ < 55 mmHg or SaO₂ < 88% → continuous O₂; target SpO₂ 88–92%.
– Steroid burst: Prednisone 40 mg PO daily × 5 days for exacerbation.
• Asthma (2026 GINA)
– Step 1: PRN low-dose ICS-Formoterol; Step 3: Daily ICS-LABA.
– Peak-flow < 50% personal best → severe exacerbation; give SABA 2.5 mg q20 min × 3
+ ipratropium 500 mcg + PO steroids.
• Pneumonia (IDSA 2026)
– CURB-65: Confusion, Urea > 20 mg/dL, RR ≥ 30, BP < 90/60, Age ≥ 65. Score ≥ 2 →
consider ICU.
– Empiric CAP: Amoxicillin-clavulanate 1 g PO q12 h + Doxycycline 100 mg PO q12 h
(outpatient).
• Pulmonary Embolism (2026 ESC)
– High-risk (massive): SBP < 90 mmHg; immediate IV heparin + reperfusion (tPA).
– DOAC first-line for low/intermediate: Apixaban 10 mg BID × 7 d → 5 mg BID.
HEMATOLOGICAL SYSTEM
• Iron-Deficiency Anemia
– Ferritin < 30 ng/mL, TSAT < 20%.
