MEDICAL-SURGICAL RN A PROPHECY RELIAS 2026 | Latest
Questions & Answers | Verified Answers | 75 Questions w/
Detailed Rationales | Practice Exam | Pass Guaranteed - A+
Graded
SECTION 1: CARDIOVASCULAR (Questions 1-10)
Q1: A 68-year-old male with a history of heart failure presents with increasing dyspnea,
orthopnea, and a 5-pound weight gain over 3 days. Vital signs: BP 162/94, HR 112, RR
26, SpO₂ 88% on room air. Crackles are audible bilaterally to the lung apices. Which
action should the nurse take first?
● A. Administer prescribed furosemide 40 mg IV push
● B. Apply supplemental oxygen at 2 L/min via nasal cannula [CORRECT]
● C. Insert indwelling urinary catheter for strict intake/output monitoring
● D. Obtain a 12-lead ECG immediately
Correct Answer: B
Rationale: This patient presents with acute decompensated heart failure (ADHF) with
hypoxemia (SpO₂ 88%). The ABC priority framework (Airway, Breathing, Circulation)
dictates addressing oxygenation first. The patient has signs of pulmonary edema
(crackles to apices, orthopnea, tachypnea) causing hypoxemia, which is immediately
life-threatening.
Why B is correct: Oxygen therapy is the priority intervention to correct hypoxemia and
prevent further cardiac strain from hypoxia-induced tachycardia. Start at 2 L/min and
titrate to maintain SpO₂ > 90% (or per provider orders/protocol).
,Why A is incorrect: While furosemide is essential for fluid management in ADHF, it does
not address the immediate oxygenation deficit. Hypoxemia must be corrected first;
diuresis can be initiated once oxygenation is stabilized.
Why C is incorrect: Strict I&O monitoring is important but not the first priority. This is a
nursing intervention that can be implemented after addressing the life-threatening
hypoxemia.
Why D is incorrect: While an ECG is important to assess for ischemia or arrhythmias
contributing to decompensation, it does not address the immediate respiratory
compromise. The ECG can be obtained after oxygenation is stabilized.
Clinical Pearl: In ADHF, remember "LMNOP" for management: Lasix (diuretics),
Morphine (if used), Nitrates, Oxygen, Position (upright). Oxygen is always first priority
when SpO₂ < 90%.
Q2: A patient with acute myocardial infarction (STEMI) received alteplase (tPA) 45
minutes ago. Which assessment finding requires immediate nursing intervention?
● A. Blood pressure 148/92 mmHg
● B. Oozing of blood from the previous IV insertion site
● C. Sudden onset of severe headache with altered mental status [CORRECT]
● D. Nausea rated 3/10 on pain scale
Correct Answer: C
Rationale: The patient received thrombolytic therapy (tPA), which carries significant
bleeding risk including intracranial hemorrhage (ICH).
Why C is correct: Sudden severe headache with altered mental status is the hallmark
presentation of ICH, a life-threatening complication of thrombolytic therapy. This
requires immediate discontinuation of the infusion (if still running), notification of the
,provider, emergent CT scan, and preparation for neurosurgical intervention. Time is
critical—ICH mortality increases rapidly without prompt management.
Why A is incorrect: While hypertension should be monitored and controlled (goal
typically < 180/110 mmHg post-tPA), this reading does not constitute a hypertensive
emergency requiring immediate intervention over the assessment findings in option C.
Why B is incorrect: Minor oozing at IV sites is expected with thrombolytics and is
managed with direct pressure and dressing changes. While documentation and
monitoring are needed, this does not require immediate intervention compared to
potential ICH.
Why D is incorrect: Nausea is a common side effect of MI (due to vagal stimulation or
medications) and is not life-threatening. Antiemetics can be administered per protocol.
Critical Action: Any neurological change post-thrombolytics = STOP infusion, assess,
notify provider STAT. ICH occurs in 0.5-1% of patients receiving tPA but has 50%
mortality if not addressed immediately.
Q3: [Select All That Apply] A nurse is caring for a patient with newly diagnosed atrial
fibrillation with rapid ventricular response (RVR). Which interventions are appropriate?
(Select all that apply)
● A. Assess for signs and symptoms of hemodynamic instability [CORRECT]
● B. Administer adenosine 6 mg rapid IV push as first-line treatment
● C. Apply supplemental oxygen if SpO₂ < 94% [CORRECT]
● D. Monitor for signs of thromboembolism (stroke, PE) [CORRECT]
● E. Initiate therapeutic heparin or oral anticoagulation per protocol [CORRECT]
Correct Answer: A, C, D, E
Rationale:
, A is correct: Hemodynamic assessment is critical in AF with RVR. Unstable patients
(hypotension, altered mental status, signs of shock, ischemic chest pain, acute heart
failure) require immediate synchronized cardioversion per ACLS guidelines.
B is incorrect: Adenosine is contraindicated as first-line treatment for AF with RVR.
Adenosine causes transient AV block and may briefly slow the rate but will not convert
AF and can cause significant pause or bradycardia. First-line rate control includes
beta-blockers (metoprolol, esmolol) or calcium channel blockers (diltiazem) if
hemodynamically stable.
C is correct: Supplemental oxygen is indicated for hypoxemia. Not all patients with AF
require oxygen—titrate to maintain SpO₂ > 94% (or per institutional protocol).
D is correct: AF causes blood stasis in the atria, particularly the left atrial appendage,
creating high risk for thrombus formation and subsequent embolic stroke or systemic
embolism. Continuous monitoring for neurological changes is essential.
E is correct: Anticoagulation is indicated for stroke prevention in AF unless
contraindicated. CHA₂DS₂-VASc score guides long-term anticoagulation decisions.
Heparin may be used initially, bridging to warfarin or direct oral anticoagulants (DOACs).
Clinical Priority: Rate control vs. rhythm control vs. anticoagulation—the nurse must
understand that anticoagulation addresses stroke risk, not rate or rhythm.
Q4: A patient with a history of hypertension is receiving IV heparin for treatment of deep
vein thrombosis (DVT). The patient's current PTT is 98 seconds (control 30-40 seconds,
therapeutic range 60-80 seconds). The patient has no signs of active bleeding. Which is
the nurse's most appropriate action?
● A. Continue current infusion rate and recheck PTT in 4 hours
● B. Reduce the infusion rate per protocol and recheck PTT in 4-6 hours [CORRECT]
Questions & Answers | Verified Answers | 75 Questions w/
Detailed Rationales | Practice Exam | Pass Guaranteed - A+
Graded
SECTION 1: CARDIOVASCULAR (Questions 1-10)
Q1: A 68-year-old male with a history of heart failure presents with increasing dyspnea,
orthopnea, and a 5-pound weight gain over 3 days. Vital signs: BP 162/94, HR 112, RR
26, SpO₂ 88% on room air. Crackles are audible bilaterally to the lung apices. Which
action should the nurse take first?
● A. Administer prescribed furosemide 40 mg IV push
● B. Apply supplemental oxygen at 2 L/min via nasal cannula [CORRECT]
● C. Insert indwelling urinary catheter for strict intake/output monitoring
● D. Obtain a 12-lead ECG immediately
Correct Answer: B
Rationale: This patient presents with acute decompensated heart failure (ADHF) with
hypoxemia (SpO₂ 88%). The ABC priority framework (Airway, Breathing, Circulation)
dictates addressing oxygenation first. The patient has signs of pulmonary edema
(crackles to apices, orthopnea, tachypnea) causing hypoxemia, which is immediately
life-threatening.
Why B is correct: Oxygen therapy is the priority intervention to correct hypoxemia and
prevent further cardiac strain from hypoxia-induced tachycardia. Start at 2 L/min and
titrate to maintain SpO₂ > 90% (or per provider orders/protocol).
,Why A is incorrect: While furosemide is essential for fluid management in ADHF, it does
not address the immediate oxygenation deficit. Hypoxemia must be corrected first;
diuresis can be initiated once oxygenation is stabilized.
Why C is incorrect: Strict I&O monitoring is important but not the first priority. This is a
nursing intervention that can be implemented after addressing the life-threatening
hypoxemia.
Why D is incorrect: While an ECG is important to assess for ischemia or arrhythmias
contributing to decompensation, it does not address the immediate respiratory
compromise. The ECG can be obtained after oxygenation is stabilized.
Clinical Pearl: In ADHF, remember "LMNOP" for management: Lasix (diuretics),
Morphine (if used), Nitrates, Oxygen, Position (upright). Oxygen is always first priority
when SpO₂ < 90%.
Q2: A patient with acute myocardial infarction (STEMI) received alteplase (tPA) 45
minutes ago. Which assessment finding requires immediate nursing intervention?
● A. Blood pressure 148/92 mmHg
● B. Oozing of blood from the previous IV insertion site
● C. Sudden onset of severe headache with altered mental status [CORRECT]
● D. Nausea rated 3/10 on pain scale
Correct Answer: C
Rationale: The patient received thrombolytic therapy (tPA), which carries significant
bleeding risk including intracranial hemorrhage (ICH).
Why C is correct: Sudden severe headache with altered mental status is the hallmark
presentation of ICH, a life-threatening complication of thrombolytic therapy. This
requires immediate discontinuation of the infusion (if still running), notification of the
,provider, emergent CT scan, and preparation for neurosurgical intervention. Time is
critical—ICH mortality increases rapidly without prompt management.
Why A is incorrect: While hypertension should be monitored and controlled (goal
typically < 180/110 mmHg post-tPA), this reading does not constitute a hypertensive
emergency requiring immediate intervention over the assessment findings in option C.
Why B is incorrect: Minor oozing at IV sites is expected with thrombolytics and is
managed with direct pressure and dressing changes. While documentation and
monitoring are needed, this does not require immediate intervention compared to
potential ICH.
Why D is incorrect: Nausea is a common side effect of MI (due to vagal stimulation or
medications) and is not life-threatening. Antiemetics can be administered per protocol.
Critical Action: Any neurological change post-thrombolytics = STOP infusion, assess,
notify provider STAT. ICH occurs in 0.5-1% of patients receiving tPA but has 50%
mortality if not addressed immediately.
Q3: [Select All That Apply] A nurse is caring for a patient with newly diagnosed atrial
fibrillation with rapid ventricular response (RVR). Which interventions are appropriate?
(Select all that apply)
● A. Assess for signs and symptoms of hemodynamic instability [CORRECT]
● B. Administer adenosine 6 mg rapid IV push as first-line treatment
● C. Apply supplemental oxygen if SpO₂ < 94% [CORRECT]
● D. Monitor for signs of thromboembolism (stroke, PE) [CORRECT]
● E. Initiate therapeutic heparin or oral anticoagulation per protocol [CORRECT]
Correct Answer: A, C, D, E
Rationale:
, A is correct: Hemodynamic assessment is critical in AF with RVR. Unstable patients
(hypotension, altered mental status, signs of shock, ischemic chest pain, acute heart
failure) require immediate synchronized cardioversion per ACLS guidelines.
B is incorrect: Adenosine is contraindicated as first-line treatment for AF with RVR.
Adenosine causes transient AV block and may briefly slow the rate but will not convert
AF and can cause significant pause or bradycardia. First-line rate control includes
beta-blockers (metoprolol, esmolol) or calcium channel blockers (diltiazem) if
hemodynamically stable.
C is correct: Supplemental oxygen is indicated for hypoxemia. Not all patients with AF
require oxygen—titrate to maintain SpO₂ > 94% (or per institutional protocol).
D is correct: AF causes blood stasis in the atria, particularly the left atrial appendage,
creating high risk for thrombus formation and subsequent embolic stroke or systemic
embolism. Continuous monitoring for neurological changes is essential.
E is correct: Anticoagulation is indicated for stroke prevention in AF unless
contraindicated. CHA₂DS₂-VASc score guides long-term anticoagulation decisions.
Heparin may be used initially, bridging to warfarin or direct oral anticoagulants (DOACs).
Clinical Priority: Rate control vs. rhythm control vs. anticoagulation—the nurse must
understand that anticoagulation addresses stroke risk, not rate or rhythm.
Q4: A patient with a history of hypertension is receiving IV heparin for treatment of deep
vein thrombosis (DVT). The patient's current PTT is 98 seconds (control 30-40 seconds,
therapeutic range 60-80 seconds). The patient has no signs of active bleeding. Which is
the nurse's most appropriate action?
● A. Continue current infusion rate and recheck PTT in 4 hours
● B. Reduce the infusion rate per protocol and recheck PTT in 4-6 hours [CORRECT]
