NUR 221 ADVANCED MED-SURG WITH QUESTIONS AND CORRECT
ANSWERS 2026 EDITION
A patient with acute coronary syndrome presents with crushing chest
pain, diaphoresis, and nausea. Which ECG finding would most strongly
indicate STEMI rather than unstable angina?
A. ST-segment depression in leads V2-V4
B. Transient ST-segment elevation that resolves with rest
C.ST-segment elevation ≥1mm in two contiguous leads
D. T-wave inversion in lateral leads
Correct Answer: C
Explanation: ST-segment elevation ≥1mm in two contiguous leads is the
hallmark ECG finding of STEMI, indicating transmural myocardial
ischemia. ST depression and T-wave inversion are seen in
NSTEMI/unstable angina, and transient elevation that resolves with rest
suggests variant (Prinzmetal) angina
A 68-year-old patient post-CABG surgery develops atrial fibrillation with
rapid ventricular response on postoperative day 2. What is the priority
nursing intervention?
A. Administer amiodarone 150mg IV push
B. Assess hemodynamic stability and oxygen saturation
C. Prepare for immediate synchronized cardioversion
D. Administer metoprolol 5mg IV bolus
Correct Answer: B
Explanation: The first priority is assessing hemodynamic stability (blood
pressure, mental status, oxygenation) to determine if the patient is
stable or unstable. Unstable patients require immediate cardioversion,
,while stable patients can be treated with medications. This follows ACLS
protocols
Which laboratory finding would most concern the nurse in a patient
receiving heparin therapy who develops sudden thrombocytopenia?
A. Platelet count of 85,000/mm³ from baseline of 250,000/mm³
B. INR of 2.5
C. aPTT of 65 seconds
D. Hemoglobin of 11.2 g/dL
Correct Answer: A
Explanation: A platelet count dropping below 100,000/mm³ or a 50%
decrease from baseline in a patient on heparin suggests Heparin-
Induced Thrombocytopenia (HIT), a serious complication requiring
immediate heparin discontinuation. INR and aPTT are expected to be
elevated during anticoagulation therapy
A patient with abdominal aortic aneurysm (AAA) presents with sudden
severe back pain, hypotension, and a pulsatile abdominal mass. What is
the nurse's priority action?
A. Administer IV pain medication
B. Obtain informed consent for emergency surgery
C. Start two large-bore IVs and initiate fluid resuscitation
D. Schedule CT angiography immediately
Correct Answer: C
Explanation: These are classic signs of AAA rupture, a surgical
emergency. Priority is establishing IV access and initiating fluid
resuscitation to maintain perfusion while preparing for emergency
,surgery. Pain control and consent are important but secondary to
hemodynamic stabilization
Which assessment finding would indicate cardiogenic shock in a patient
post-MI?
A. Blood pressure 90/60 mmHg, heart rate 120 bpm, urine output 25
mL/hr
B. Blood pressure 140/90 mmHg, heart rate 88 bpm, warm dry skin
C. Blood pressure 85/50 mmHg, heart rate 130 bpm, cold clammy skin,
pulmonary crackles
D. Blood pressure 100/70 mmHg, heart rate 95 bpm, flat neck veins
Correct Answer: C
Explanation: Cardiogenic shock presents with hypotension, tachycardia,
cold clammy skin (poor perfusion), and pulmonary crackles (pulmonary
edema from left ventricular failure). Option A could be hypovolemic
shock, B shows hypertension, and D suggests hypovolemia
A patient with acute kidney injury has a serum potassium of 6.8 mEq/L.
Which medication should the nurse anticipate administering first?
A. Furosemide 40mg IV
B. Sodium polystyrene sulfonate (Kayexalate) 30g orally
C. Calcium gluconate 10mL of 10% solution IV
D. Regular insulin 10 units IV with D50W
Correct Answer: C
Explanation: Calcium gluconate is given first to stabilize cardiac
membranes and prevent life-threatening arrhythmias from
hyperkalemia. It works immediately but doesn't lower potassium.
, Insulin/D50 and furosemide then shift or eliminate potassium, while
Kayexalate works more slowly
Which finding in a patient with acute pancreatitis requires immediate
notification of the healthcare provider?
A. Serum amylase of 450 U/L
B. Calcium level of 7.2 mg/dL
C. Blood glucose of 180 mg/dL
D. WBC count of 14,000/mm³
Correct Answer: B
Explanation: Hypocalcemia (calcium <8.5 mg/dL) in acute pancreatitis is
a serious complication indicating fat necrosis and is associated with
poor prognosis. It can cause tetany and cardiac arrhythmias. Elevated
amylase is expected, mild hyperglycemia is common, and leukocytosis is
an expected inflammatory response
A patient with liver failure develops hepatic encephalopathy. Which
medication should the nurse expect to be prescribed?
A. Furosemide 40mg daily
B. Lactulose 30mL orally three times daily
C. Propranolol 20mg twice daily
D. Spironolactone 100mg daily
Correct Answer: B
Explanation: Lactulose is the primary medication for hepatic
encephalopathy as it reduces ammonia absorption in the gut by
acidifying the colon and causing diarrhea. Spironolactone and
furosemide treat ascitis, while propranolol prevents variceal bleeding
ANSWERS 2026 EDITION
A patient with acute coronary syndrome presents with crushing chest
pain, diaphoresis, and nausea. Which ECG finding would most strongly
indicate STEMI rather than unstable angina?
A. ST-segment depression in leads V2-V4
B. Transient ST-segment elevation that resolves with rest
C.ST-segment elevation ≥1mm in two contiguous leads
D. T-wave inversion in lateral leads
Correct Answer: C
Explanation: ST-segment elevation ≥1mm in two contiguous leads is the
hallmark ECG finding of STEMI, indicating transmural myocardial
ischemia. ST depression and T-wave inversion are seen in
NSTEMI/unstable angina, and transient elevation that resolves with rest
suggests variant (Prinzmetal) angina
A 68-year-old patient post-CABG surgery develops atrial fibrillation with
rapid ventricular response on postoperative day 2. What is the priority
nursing intervention?
A. Administer amiodarone 150mg IV push
B. Assess hemodynamic stability and oxygen saturation
C. Prepare for immediate synchronized cardioversion
D. Administer metoprolol 5mg IV bolus
Correct Answer: B
Explanation: The first priority is assessing hemodynamic stability (blood
pressure, mental status, oxygenation) to determine if the patient is
stable or unstable. Unstable patients require immediate cardioversion,
,while stable patients can be treated with medications. This follows ACLS
protocols
Which laboratory finding would most concern the nurse in a patient
receiving heparin therapy who develops sudden thrombocytopenia?
A. Platelet count of 85,000/mm³ from baseline of 250,000/mm³
B. INR of 2.5
C. aPTT of 65 seconds
D. Hemoglobin of 11.2 g/dL
Correct Answer: A
Explanation: A platelet count dropping below 100,000/mm³ or a 50%
decrease from baseline in a patient on heparin suggests Heparin-
Induced Thrombocytopenia (HIT), a serious complication requiring
immediate heparin discontinuation. INR and aPTT are expected to be
elevated during anticoagulation therapy
A patient with abdominal aortic aneurysm (AAA) presents with sudden
severe back pain, hypotension, and a pulsatile abdominal mass. What is
the nurse's priority action?
A. Administer IV pain medication
B. Obtain informed consent for emergency surgery
C. Start two large-bore IVs and initiate fluid resuscitation
D. Schedule CT angiography immediately
Correct Answer: C
Explanation: These are classic signs of AAA rupture, a surgical
emergency. Priority is establishing IV access and initiating fluid
resuscitation to maintain perfusion while preparing for emergency
,surgery. Pain control and consent are important but secondary to
hemodynamic stabilization
Which assessment finding would indicate cardiogenic shock in a patient
post-MI?
A. Blood pressure 90/60 mmHg, heart rate 120 bpm, urine output 25
mL/hr
B. Blood pressure 140/90 mmHg, heart rate 88 bpm, warm dry skin
C. Blood pressure 85/50 mmHg, heart rate 130 bpm, cold clammy skin,
pulmonary crackles
D. Blood pressure 100/70 mmHg, heart rate 95 bpm, flat neck veins
Correct Answer: C
Explanation: Cardiogenic shock presents with hypotension, tachycardia,
cold clammy skin (poor perfusion), and pulmonary crackles (pulmonary
edema from left ventricular failure). Option A could be hypovolemic
shock, B shows hypertension, and D suggests hypovolemia
A patient with acute kidney injury has a serum potassium of 6.8 mEq/L.
Which medication should the nurse anticipate administering first?
A. Furosemide 40mg IV
B. Sodium polystyrene sulfonate (Kayexalate) 30g orally
C. Calcium gluconate 10mL of 10% solution IV
D. Regular insulin 10 units IV with D50W
Correct Answer: C
Explanation: Calcium gluconate is given first to stabilize cardiac
membranes and prevent life-threatening arrhythmias from
hyperkalemia. It works immediately but doesn't lower potassium.
, Insulin/D50 and furosemide then shift or eliminate potassium, while
Kayexalate works more slowly
Which finding in a patient with acute pancreatitis requires immediate
notification of the healthcare provider?
A. Serum amylase of 450 U/L
B. Calcium level of 7.2 mg/dL
C. Blood glucose of 180 mg/dL
D. WBC count of 14,000/mm³
Correct Answer: B
Explanation: Hypocalcemia (calcium <8.5 mg/dL) in acute pancreatitis is
a serious complication indicating fat necrosis and is associated with
poor prognosis. It can cause tetany and cardiac arrhythmias. Elevated
amylase is expected, mild hyperglycemia is common, and leukocytosis is
an expected inflammatory response
A patient with liver failure develops hepatic encephalopathy. Which
medication should the nurse expect to be prescribed?
A. Furosemide 40mg daily
B. Lactulose 30mL orally three times daily
C. Propranolol 20mg twice daily
D. Spironolactone 100mg daily
Correct Answer: B
Explanation: Lactulose is the primary medication for hepatic
encephalopathy as it reduces ammonia absorption in the gut by
acidifying the colon and causing diarrhea. Spironolactone and
furosemide treat ascitis, while propranolol prevents variceal bleeding
