Learning Systems Med Surg Ultimate Exam
**Question 1. Which of the following is the most appropriate initial nursing intervention for a patient
experiencing sinus bradycardia with a heart rate of 45 bpm?**
A) Administer atropine 0.5 mg IV push
B) Increase the IV fluid rate
C) Place the patient in Trendelenburg position
D) Obtain a stat cardiac enzymes panel
Answer: A
Explanation: Atropine is the first-line medication for symptomatic sinus bradycardia because it blocks
vagal influences on the SA node, raising the heart rate.
**Question 2. A patient’s ECG shows irregularly irregular rhythm with absent P waves. Which
dysrhythmia is this most consistent with?**
A) Atrial flutter
B) Ventricular tachycardia
C) Atrial fibrillation
D) Sinus arrhythmia
Answer: C
Explanation: Atrial fibrillation is characterized by an irregularly irregular ventricular response and the
loss of discrete P waves.
**Question 3. Which medication is commonly used to treat ventricular tachycardia when the patient is
hemodynamically stable?**
A) Amiodarone
B) Metoprolol
C) Digoxin
D) Adenosine
Answer: A
Explanation: Amiodarone is a class III anti-arrhythmic effective for both stable and unstable ventricular
tachycardia.
**Question 4. In a patient with acute myocardial infarction, which cardiac biomarker rises first?**
, Learning Systems Med Surg Ultimate Exam
A) Troponin I
B) CK-MB
C) Myoglobin
D) LDH
Answer: C
Explanation: Myoglobin is released from necrotic myocardium within 1–4 hours, earlier than CK-MB and
troponins.
**Question 5. A nurse assesses a patient with left-sided heart failure. Which sign is most specific for
left-sided involvement?**
A) Peripheral edema
B) Hepatomegaly
C) Pulmonary crackles
D) Jugular venous distention
Answer: C
Explanation: Pulmonary crackles indicate pulmonary congestion, a hallmark of left-sided failure.
**Question 6. Which laboratory value is most useful for monitoring the severity of heart failure?**
A) Serum creatinine
B) BNP (B-type natriuretic peptide)
C) Hemoglobin
D) Serum calcium
Answer: B
Explanation: BNP rises in response to ventricular stretch and correlates with heart-failure severity.
**Question 7. A patient with mitral regurgitation will most likely exhibit which auscultatory finding?**
A) Mid-systolic click
B) Early diastolic decrescendo murmur
C) Holosystolic high-pitched “blowing” murmur at the apex radiating to the axilla
, Learning Systems Med Surg Ultimate Exam
D) Continuous machine-like murmur
Answer: C
Explanation: Mitral regurgitation produces a holosystolic, high-pitched blowing murmur heard best at
the apex and radiating to the left axilla.
**Question 8. Which of the following interventions helps prevent deep vein thrombosis in postoperative
patients?**
A) Encouraging strict bed rest
B) Applying sequential compression devices (SCDs)
C) Limiting fluid intake to 1 L/24 h
D) Using high-dose opioids for pain control
Answer: B
Explanation: SCDs promote venous return and are an evidence-based DVT prophylaxis.
**Question 9. A patient with a new peripheral arterial disease (PAD) presents with intermittent
claudication. Which assessment finding best confirms the diagnosis?**
A) Positive Homan’s sign
B) Decreased ankle-brachial index (ABI) < 0.9
C) Elevated D-dimer level
D) Bilateral pedal edema
Answer: B
Explanation: An ABI less than 0.9 indicates arterial insufficiency and is diagnostic for PAD.
**Question 10. When interpreting a pulmonary artery wedge pressure (PAWP) of 18 mm Hg, what does
this value most likely indicate?**
A) Hypovolemia
B) Normal left-atrial pressure
C) Elevated left-atrial pressure (e.g., left-sided heart failure)
D) Pulmonary embolism
Answer: C
, Learning Systems Med Surg Ultimate Exam
Explanation: PAWP reflects left-atrial pressure; values > 15 mm Hg suggest left-sided heart failure or
volume overload.
**Question 11. Which of the following is the most appropriate nursing action for a patient receiving
high-flow nasal cannula (HFNC) oxygen therapy?**
A) Keep the humidifier dry to prevent condensation
B) Check for nasal skin breakdown every 2 hours
C) Maintain the flow rate at 2 L/min regardless of SpO₂
D) Place the patient in a supine position to improve ventilation
Answer: B
Explanation: HFNC delivers heated, humidified gas; nasal mucosa is at risk for breakdown, requiring
frequent inspection.
**Question 12. A patient with COPD exacerbation is placed on non-invasive positive pressure ventilation
(NPPV). Which parameter indicates successful ventilation?**
A) PaCO₂ > 60 mm Hg
B) Respiratory rate > 30 breaths/min
C) pH > 7.35 after 1 hour
D) SpO₂ < 85 %
Answer: C
Explanation: An increasing pH (return toward normal) shows effective CO₂ clearance and ventilation.
**Question 13. Which organism is the most common cause of community-acquired bacterial
pneumonia?**
A) Streptococcus pneumoniae
B) Mycoplasma pneumoniae
C) Haemophilus influenzae
D) Pseudomonas aeruginosa
Answer: A
Explanation: Streptococcus pneumoniae accounts for the majority of typical community-acquired
bacterial pneumonia.
**Question 1. Which of the following is the most appropriate initial nursing intervention for a patient
experiencing sinus bradycardia with a heart rate of 45 bpm?**
A) Administer atropine 0.5 mg IV push
B) Increase the IV fluid rate
C) Place the patient in Trendelenburg position
D) Obtain a stat cardiac enzymes panel
Answer: A
Explanation: Atropine is the first-line medication for symptomatic sinus bradycardia because it blocks
vagal influences on the SA node, raising the heart rate.
**Question 2. A patient’s ECG shows irregularly irregular rhythm with absent P waves. Which
dysrhythmia is this most consistent with?**
A) Atrial flutter
B) Ventricular tachycardia
C) Atrial fibrillation
D) Sinus arrhythmia
Answer: C
Explanation: Atrial fibrillation is characterized by an irregularly irregular ventricular response and the
loss of discrete P waves.
**Question 3. Which medication is commonly used to treat ventricular tachycardia when the patient is
hemodynamically stable?**
A) Amiodarone
B) Metoprolol
C) Digoxin
D) Adenosine
Answer: A
Explanation: Amiodarone is a class III anti-arrhythmic effective for both stable and unstable ventricular
tachycardia.
**Question 4. In a patient with acute myocardial infarction, which cardiac biomarker rises first?**
, Learning Systems Med Surg Ultimate Exam
A) Troponin I
B) CK-MB
C) Myoglobin
D) LDH
Answer: C
Explanation: Myoglobin is released from necrotic myocardium within 1–4 hours, earlier than CK-MB and
troponins.
**Question 5. A nurse assesses a patient with left-sided heart failure. Which sign is most specific for
left-sided involvement?**
A) Peripheral edema
B) Hepatomegaly
C) Pulmonary crackles
D) Jugular venous distention
Answer: C
Explanation: Pulmonary crackles indicate pulmonary congestion, a hallmark of left-sided failure.
**Question 6. Which laboratory value is most useful for monitoring the severity of heart failure?**
A) Serum creatinine
B) BNP (B-type natriuretic peptide)
C) Hemoglobin
D) Serum calcium
Answer: B
Explanation: BNP rises in response to ventricular stretch and correlates with heart-failure severity.
**Question 7. A patient with mitral regurgitation will most likely exhibit which auscultatory finding?**
A) Mid-systolic click
B) Early diastolic decrescendo murmur
C) Holosystolic high-pitched “blowing” murmur at the apex radiating to the axilla
, Learning Systems Med Surg Ultimate Exam
D) Continuous machine-like murmur
Answer: C
Explanation: Mitral regurgitation produces a holosystolic, high-pitched blowing murmur heard best at
the apex and radiating to the left axilla.
**Question 8. Which of the following interventions helps prevent deep vein thrombosis in postoperative
patients?**
A) Encouraging strict bed rest
B) Applying sequential compression devices (SCDs)
C) Limiting fluid intake to 1 L/24 h
D) Using high-dose opioids for pain control
Answer: B
Explanation: SCDs promote venous return and are an evidence-based DVT prophylaxis.
**Question 9. A patient with a new peripheral arterial disease (PAD) presents with intermittent
claudication. Which assessment finding best confirms the diagnosis?**
A) Positive Homan’s sign
B) Decreased ankle-brachial index (ABI) < 0.9
C) Elevated D-dimer level
D) Bilateral pedal edema
Answer: B
Explanation: An ABI less than 0.9 indicates arterial insufficiency and is diagnostic for PAD.
**Question 10. When interpreting a pulmonary artery wedge pressure (PAWP) of 18 mm Hg, what does
this value most likely indicate?**
A) Hypovolemia
B) Normal left-atrial pressure
C) Elevated left-atrial pressure (e.g., left-sided heart failure)
D) Pulmonary embolism
Answer: C
, Learning Systems Med Surg Ultimate Exam
Explanation: PAWP reflects left-atrial pressure; values > 15 mm Hg suggest left-sided heart failure or
volume overload.
**Question 11. Which of the following is the most appropriate nursing action for a patient receiving
high-flow nasal cannula (HFNC) oxygen therapy?**
A) Keep the humidifier dry to prevent condensation
B) Check for nasal skin breakdown every 2 hours
C) Maintain the flow rate at 2 L/min regardless of SpO₂
D) Place the patient in a supine position to improve ventilation
Answer: B
Explanation: HFNC delivers heated, humidified gas; nasal mucosa is at risk for breakdown, requiring
frequent inspection.
**Question 12. A patient with COPD exacerbation is placed on non-invasive positive pressure ventilation
(NPPV). Which parameter indicates successful ventilation?**
A) PaCO₂ > 60 mm Hg
B) Respiratory rate > 30 breaths/min
C) pH > 7.35 after 1 hour
D) SpO₂ < 85 %
Answer: C
Explanation: An increasing pH (return toward normal) shows effective CO₂ clearance and ventilation.
**Question 13. Which organism is the most common cause of community-acquired bacterial
pneumonia?**
A) Streptococcus pneumoniae
B) Mycoplasma pneumoniae
C) Haemophilus influenzae
D) Pseudomonas aeruginosa
Answer: A
Explanation: Streptococcus pneumoniae accounts for the majority of typical community-acquired
bacterial pneumonia.
