PN Adult Medical Surgical Nursing
Edition 12.0 Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
[SECTION 1: Questions 1-10] - Cardiovascular Disorders
Q1: A 68-year-old male with heart failure (HF) presents with sudden weight gain of 3 lbs in
2 days, increased dyspnea, and bilateral pedal edema. Which nursing intervention is
priority?
A. Administer furosemide 40mg IV as ordered
B. Restrict sodium intake to 2g/day
C. Elevate head of bed to 45 degrees
D. Obtain 12-lead ECG immediately
C. Elevate head of bed to 45 degrees [CORRECT]
Correct Answer: C
Rationale: Elevating the head of the bed reduces venous return and alleviates dyspnea in
acute HF exacerbation, addressing the immediate airway/breathing priority (ABC
framework). While furosemide (A) is appropriate for fluid overload, positioning comes first
per emergency protocols. Sodium restriction (B) is a long-term measure, and ECG (D) is
not indicated without chest pain or arrhythmia symptoms. This aligns with NCLEX-PN
priority-setting and HF management guidelines.
,Q2: A patient with atrial fibrillation is prescribed warfarin. Which lab value must be
monitored most closely?
A. Platelet count
B. International Normalized Ratio (INR)
C. Activated Partial Thromboplastin Time (aPTT)
D. Hemoglobin
B. International Normalized Ratio (INR) [CORRECT]
Correct Answer: B
Rationale: Warfarin's therapeutic effect is measured by INR, which must be maintained
between 2.0-3.0 for atrial fibrillation to prevent stroke. Platelets (A) monitor bleeding risk
but not warfarin efficacy. aPTT (C) is for heparin, and hemoglobin (D) assesses anemia,
not anticoagulation status. This reflects evidence-based anticoagulation management per
ANCC guidelines.
Q3: A 72-year-old female with hypertension has a blood pressure of 160/95 mmHg. Which
lifestyle modification is most effective for long-term BP control?
A. Daily aspirin therapy
B. DASH diet and regular aerobic exercise
C. Stress management techniques only
D. Calcium supplementation
B. DASH diet and regular aerobic exercise [CORRECT]
Correct Answer: B
Rationale: The DASH diet (low sodium, high potassium/magnesium) combined with 150
minutes/week of moderate exercise reduces systolic BP by 5-8 mmHg, per JNC 8
guidelines. Aspirin (A) is for antiplatelet therapy, not BP control. Stress management (C)
alone is insufficient, and calcium (D) has minimal BP impact. This demonstrates
application of non-pharmacological HTN management.
,Q4: A patient with acute myocardial infarction (MI) receives morphine sulfate. Which
adverse effect requires immediate intervention?
A. Nausea and vomiting
B. Respiratory depression
C. Pruritus
D. Urinary retention
B. Respiratory depression [CORRECT]
Correct Answer: B
Rationale: Morphine can suppress respiratory drive, especially in older adults or those with
COPD, requiring naloxone readiness. Nausea (A) and pruritus (C) are common but not
life-threatening. Urinary retention (D) is a delayed effect. This prioritizes safety per QSEN
competencies and pain management standards.
Q5: A client with peripheral vascular disease (PVD) has a non-healing foot ulcer. Which
assessment finding indicates worsening perfusion?
A. Warm skin temperature
B. Capillary refill < 2 seconds
C. Absent pedal pulses
D. Pink nail beds
C. Absent pedal pulses [CORRECT]
Correct Answer: C
Rationale: Absent pulses indicate arterial occlusion, a critical sign of PVD progression
requiring vascular intervention. Warm skin (A) and pink nails (D) suggest adequate
perfusion. Capillary refill (B) is a non-specific indicator. This reflects clinical judgment in
assessing tissue perfusion per vascular nursing guidelines.
Q6: A patient with heart failure is prescribed digoxin. Which symptom suggests toxicity?
A. Bradycardia of 58 bpm
, B. Visual disturbances (yellow-green halos)
C. Hypokalemia
D. Hypertension
B. Visual disturbances (yellow-green halos) [CORRECT]
Correct Answer: B
Rationale: Visual changes are classic signs of digoxin toxicity, often accompanied by
arrhythmias. Bradycardia (A) can be therapeutic in HF but requires monitoring.
Hypokalemia (C) increases toxicity risk but is not a symptom. Hypertension (D) is
unrelated. This demonstrates medication safety and toxicity recognition per NCLEX-PN
pharmacology standards.
Q7: A 65-year-old male with CAD reports chest pain radiating to the left arm. Which action
should the nurse take first?
A. Administer nitroglycerin sublingual
B. Obtain vital signs
C. Apply oxygen via nasal cannula
D. Notify the healthcare provider
B. Obtain vital signs [CORRECT]
Correct Answer: B
Rationale: Assessing vital signs (especially BP and heart rate) is critical before
administering nitroglycerin, which can cause hypotension. Oxygen (C) is indicated if
hypoxic, but assessment comes first. Notifying the provider (D) follows initial assessment.
This follows the nursing process and safety protocols for acute coronary syndrome.
Q8: A patient with deep vein thrombosis (DVT) is on enoxaparin. Which instruction is
essential for home care?
A. Avoid intramuscular injections
B. Monitor for signs of bleeding
Edition 12.0 Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
[SECTION 1: Questions 1-10] - Cardiovascular Disorders
Q1: A 68-year-old male with heart failure (HF) presents with sudden weight gain of 3 lbs in
2 days, increased dyspnea, and bilateral pedal edema. Which nursing intervention is
priority?
A. Administer furosemide 40mg IV as ordered
B. Restrict sodium intake to 2g/day
C. Elevate head of bed to 45 degrees
D. Obtain 12-lead ECG immediately
C. Elevate head of bed to 45 degrees [CORRECT]
Correct Answer: C
Rationale: Elevating the head of the bed reduces venous return and alleviates dyspnea in
acute HF exacerbation, addressing the immediate airway/breathing priority (ABC
framework). While furosemide (A) is appropriate for fluid overload, positioning comes first
per emergency protocols. Sodium restriction (B) is a long-term measure, and ECG (D) is
not indicated without chest pain or arrhythmia symptoms. This aligns with NCLEX-PN
priority-setting and HF management guidelines.
,Q2: A patient with atrial fibrillation is prescribed warfarin. Which lab value must be
monitored most closely?
A. Platelet count
B. International Normalized Ratio (INR)
C. Activated Partial Thromboplastin Time (aPTT)
D. Hemoglobin
B. International Normalized Ratio (INR) [CORRECT]
Correct Answer: B
Rationale: Warfarin's therapeutic effect is measured by INR, which must be maintained
between 2.0-3.0 for atrial fibrillation to prevent stroke. Platelets (A) monitor bleeding risk
but not warfarin efficacy. aPTT (C) is for heparin, and hemoglobin (D) assesses anemia,
not anticoagulation status. This reflects evidence-based anticoagulation management per
ANCC guidelines.
Q3: A 72-year-old female with hypertension has a blood pressure of 160/95 mmHg. Which
lifestyle modification is most effective for long-term BP control?
A. Daily aspirin therapy
B. DASH diet and regular aerobic exercise
C. Stress management techniques only
D. Calcium supplementation
B. DASH diet and regular aerobic exercise [CORRECT]
Correct Answer: B
Rationale: The DASH diet (low sodium, high potassium/magnesium) combined with 150
minutes/week of moderate exercise reduces systolic BP by 5-8 mmHg, per JNC 8
guidelines. Aspirin (A) is for antiplatelet therapy, not BP control. Stress management (C)
alone is insufficient, and calcium (D) has minimal BP impact. This demonstrates
application of non-pharmacological HTN management.
,Q4: A patient with acute myocardial infarction (MI) receives morphine sulfate. Which
adverse effect requires immediate intervention?
A. Nausea and vomiting
B. Respiratory depression
C. Pruritus
D. Urinary retention
B. Respiratory depression [CORRECT]
Correct Answer: B
Rationale: Morphine can suppress respiratory drive, especially in older adults or those with
COPD, requiring naloxone readiness. Nausea (A) and pruritus (C) are common but not
life-threatening. Urinary retention (D) is a delayed effect. This prioritizes safety per QSEN
competencies and pain management standards.
Q5: A client with peripheral vascular disease (PVD) has a non-healing foot ulcer. Which
assessment finding indicates worsening perfusion?
A. Warm skin temperature
B. Capillary refill < 2 seconds
C. Absent pedal pulses
D. Pink nail beds
C. Absent pedal pulses [CORRECT]
Correct Answer: C
Rationale: Absent pulses indicate arterial occlusion, a critical sign of PVD progression
requiring vascular intervention. Warm skin (A) and pink nails (D) suggest adequate
perfusion. Capillary refill (B) is a non-specific indicator. This reflects clinical judgment in
assessing tissue perfusion per vascular nursing guidelines.
Q6: A patient with heart failure is prescribed digoxin. Which symptom suggests toxicity?
A. Bradycardia of 58 bpm
, B. Visual disturbances (yellow-green halos)
C. Hypokalemia
D. Hypertension
B. Visual disturbances (yellow-green halos) [CORRECT]
Correct Answer: B
Rationale: Visual changes are classic signs of digoxin toxicity, often accompanied by
arrhythmias. Bradycardia (A) can be therapeutic in HF but requires monitoring.
Hypokalemia (C) increases toxicity risk but is not a symptom. Hypertension (D) is
unrelated. This demonstrates medication safety and toxicity recognition per NCLEX-PN
pharmacology standards.
Q7: A 65-year-old male with CAD reports chest pain radiating to the left arm. Which action
should the nurse take first?
A. Administer nitroglycerin sublingual
B. Obtain vital signs
C. Apply oxygen via nasal cannula
D. Notify the healthcare provider
B. Obtain vital signs [CORRECT]
Correct Answer: B
Rationale: Assessing vital signs (especially BP and heart rate) is critical before
administering nitroglycerin, which can cause hypotension. Oxygen (C) is indicated if
hypoxic, but assessment comes first. Notifying the provider (D) follows initial assessment.
This follows the nursing process and safety protocols for acute coronary syndrome.
Q8: A patient with deep vein thrombosis (DVT) is on enoxaparin. Which instruction is
essential for home care?
A. Avoid intramuscular injections
B. Monitor for signs of bleeding
