EXAM 2 Advanced Concepts in Medical-Surgical Nursing EXAM 2 | Questions and Answers Rated A+ | 2026/2027 **2026/2027** - 2026/2027 Official Exam
OBJECTIVE ASSESSMENT - EXAM
EXAM 2 Advanced Concepts in
Medical-Surgical Nursing EXAM 2 |
Questions and Answers Rated A+ |
2026/2027 **2026/2027** - 2026/2027
Official Exam
75 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular & Respiratory Disorders Neurological & Musculoskeletal Disorders
Gastrointestinal & Renal Systems Complex Multisystem Management
Endocrine & Metabolic Conditions
COVER PAGE - 1
, SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q15 | EXAM 2 Advanced Concepts in Medical-Surgical Nursing EXAM 2 | Questions and Answers Rated A+ | 2026/2027 **2026/2027** - 20
Q1 Question 1 of 75
A 58-year-old male presents to the emergency department with crushing substernal chest pain that
began 45 minutes ago, diaphoresis, and dyspnea. The 12-lead ECG reveals ST-segment elevation in
leads II, III, and aVF with reciprocal changes in I and aVL. The patient is being evaluated for
reperfusion therapy. What is the maximum door-to-balloon time goal for primary percutaneous
coronary intervention in this patient
A. 90 minutes from arrival
B. 30 minutes from arrival
C. 60 minutes from arrival
D. 120 minutes from arrival
Correct Answer: A
Rationale:
Guidelines from the American Heart Association and American College of Cardiology establish a
door-to-balloon time of 90 minutes or less for patients with ST-elevation myocardial infarction undergoing
primary percutaneous coronary intervention. This benchmark maximizes myocardial salvage and reduces
mortality. The 30-minute target applies to door-to-needle time for fibrinolytic therapy, which is the alternative
when PCI cannot be achieved within 120 minutes.
EXAM 2 Advanced Concepts in Medical-Surgical Nursing EXAM 2 | Questions and Answers Rated A+ | 2026/2027 **2026/2027** - 2026/2027 Official Ex...
2026/2027 | Passing Score: 80% Page 2 of 43
, Q2 Question 2 of 75
A 72-year-old female with a history of systolic heart failure is admitted with progressive dyspnea,
orthopnea, and bilateral crackles throughout the lung fields. Her brain natriuretic peptide level is 1,840
pg/mL. The patient is started on intravenous furosemide. Which assessment finding best indicates that
the diuretic therapy is producing the desired therapeutic effect
A. Serum sodium decreases from 138 to 132 mEq/L
B. Urine output increases to 200 mL per hour
C. Body weight decreases by 0.5 kg in 24 hours
D. Blood pressure drops from 150/88 to 110/68 mmHg
Correct Answer: B
Rationale:
In acute decompensated heart failure, the primary therapeutic goal of intravenous loop diuretics is restoration
of euvolemia through augmented urine output, with a target of 150 to 300 mL per hour during the first six
hours. Weight loss and blood pressure changes lag behind urine output and may reflect other variables.
Hyponatremia may worsen with diuresis and is not a marker of effective volume removal.
Q3 Question 3 of 75
A 66-year-old male with persistent atrial fibrillation presents with palpitations and an irregularly irregular
pulse of 142 beats per minute. Blood pressure is 108/70 mmHg and the patient reports mild dyspnea
on exertion. The provider orders intravenous diltiazem. What is the primary therapeutic goal of rate
control in this patient during the acute presentation
A. Restore normal sinus rhythm within 60 minutes
B. Prevent thromboembolic stroke through anticoagulation
C. Reduce ventricular response rate to under 110 beats per minute
D. Achieve a ventricular rate between 60 and 80 beats per minute
Correct Answer: C
Rationale:
Acute rate control with intravenous calcium channel blockers targets a ventricular rate below 110 beats per
minute in hemodynamically stable patients with atrial fibrillation, which relieves symptoms and improves
cardiac output. Restoration of sinus rhythm requires either electrical or pharmacologic cardioversion after
appropriate anticoagulation. Stroke prevention requires anticoagulation based on CHA2DS2-VASc score and
is a long-term, not acute, goal.
EXAM 2 Advanced Concepts in Medical-Surgical Nursing EXAM 2 | Questions and Answers Rated A+ | 2026/2027 **2026/2027** - 2026/2027 Official Ex...
2026/2027 | Passing Score: 80% Page 3 of 43
, Q4 Question 4 of 75
A 49-year-old male arrives at the emergency department with a blood pressure of 220/128 mmHg,
blurred vision, and a severe headache. He has no chest pain and is alert and oriented. Fundoscopic
examination reveals papilledema. Which classification best describes this clinical presentation
A. Hypertensive urgency without end-organ damage
B. Severe hypertension of pregnancy
C. Rebound hypertension from medication nonadherence
D. Hypertensive emergency with end-organ damage
Correct Answer: D
Rationale:
Hypertensive emergency is defined as a severe elevation in blood pressure accompanied by acute
end-organ damage, which in this patient is evidenced by papilledema and neurological symptoms indicating
hypertensive encephalopathy. Hypertensive urgency describes elevated blood pressure without end-organ
damage. Immediate intravenous antihypertensive therapy with a controlled reduction of 10 to 20 percent in
the first hour is the appropriate management strategy.
Q5 Question 5 of 75
A 61-year-old male is in the cardiac intensive care unit two days after an anterior wall myocardial
infarction. He develops hypotension with a blood pressure of 84/52 mmHg, cool extremities, and
oliguria. Pulmonary artery catheter readings show a cardiac index of 1.8 L/min/m2 and a pulmonary
capillary wedge pressure of 22 mmHg. Which hemodynamic pattern best classifies this shock state
A. Cardiogenic shock with high wedge pressure
B. Distributive shock with low wedge pressure
C. Hypovolemic shock with low wedge pressure
D. Obstructive shock with high wedge pressure
Correct Answer: A
Rationale:
Cardiogenic shock following myocardial infarction is characterized by hypotension, end-organ hypoperfusion,
low cardiac index below 2.2 L/min/m2, and an elevated pulmonary capillary wedge pressure above 18 mmHg
indicating pump failure. Distributive and hypovolemic shock both present with a low wedge pressure.
Obstructive shock such as tamponade shows equalization of diastolic pressures rather than isolated wedge
pressure elevation.
EXAM 2 Advanced Concepts in Medical-Surgical Nursing EXAM 2 | Questions and Answers Rated A+ | 2026/2027 **2026/2027** - 2026/2027 Official Ex...
2026/2027 | Passing Score: 80% Page 4 of 43
OBJECTIVE ASSESSMENT - EXAM
EXAM 2 Advanced Concepts in
Medical-Surgical Nursing EXAM 2 |
Questions and Answers Rated A+ |
2026/2027 **2026/2027** - 2026/2027
Official Exam
75 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular & Respiratory Disorders Neurological & Musculoskeletal Disorders
Gastrointestinal & Renal Systems Complex Multisystem Management
Endocrine & Metabolic Conditions
COVER PAGE - 1
, SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q15 | EXAM 2 Advanced Concepts in Medical-Surgical Nursing EXAM 2 | Questions and Answers Rated A+ | 2026/2027 **2026/2027** - 20
Q1 Question 1 of 75
A 58-year-old male presents to the emergency department with crushing substernal chest pain that
began 45 minutes ago, diaphoresis, and dyspnea. The 12-lead ECG reveals ST-segment elevation in
leads II, III, and aVF with reciprocal changes in I and aVL. The patient is being evaluated for
reperfusion therapy. What is the maximum door-to-balloon time goal for primary percutaneous
coronary intervention in this patient
A. 90 minutes from arrival
B. 30 minutes from arrival
C. 60 minutes from arrival
D. 120 minutes from arrival
Correct Answer: A
Rationale:
Guidelines from the American Heart Association and American College of Cardiology establish a
door-to-balloon time of 90 minutes or less for patients with ST-elevation myocardial infarction undergoing
primary percutaneous coronary intervention. This benchmark maximizes myocardial salvage and reduces
mortality. The 30-minute target applies to door-to-needle time for fibrinolytic therapy, which is the alternative
when PCI cannot be achieved within 120 minutes.
EXAM 2 Advanced Concepts in Medical-Surgical Nursing EXAM 2 | Questions and Answers Rated A+ | 2026/2027 **2026/2027** - 2026/2027 Official Ex...
2026/2027 | Passing Score: 80% Page 2 of 43
, Q2 Question 2 of 75
A 72-year-old female with a history of systolic heart failure is admitted with progressive dyspnea,
orthopnea, and bilateral crackles throughout the lung fields. Her brain natriuretic peptide level is 1,840
pg/mL. The patient is started on intravenous furosemide. Which assessment finding best indicates that
the diuretic therapy is producing the desired therapeutic effect
A. Serum sodium decreases from 138 to 132 mEq/L
B. Urine output increases to 200 mL per hour
C. Body weight decreases by 0.5 kg in 24 hours
D. Blood pressure drops from 150/88 to 110/68 mmHg
Correct Answer: B
Rationale:
In acute decompensated heart failure, the primary therapeutic goal of intravenous loop diuretics is restoration
of euvolemia through augmented urine output, with a target of 150 to 300 mL per hour during the first six
hours. Weight loss and blood pressure changes lag behind urine output and may reflect other variables.
Hyponatremia may worsen with diuresis and is not a marker of effective volume removal.
Q3 Question 3 of 75
A 66-year-old male with persistent atrial fibrillation presents with palpitations and an irregularly irregular
pulse of 142 beats per minute. Blood pressure is 108/70 mmHg and the patient reports mild dyspnea
on exertion. The provider orders intravenous diltiazem. What is the primary therapeutic goal of rate
control in this patient during the acute presentation
A. Restore normal sinus rhythm within 60 minutes
B. Prevent thromboembolic stroke through anticoagulation
C. Reduce ventricular response rate to under 110 beats per minute
D. Achieve a ventricular rate between 60 and 80 beats per minute
Correct Answer: C
Rationale:
Acute rate control with intravenous calcium channel blockers targets a ventricular rate below 110 beats per
minute in hemodynamically stable patients with atrial fibrillation, which relieves symptoms and improves
cardiac output. Restoration of sinus rhythm requires either electrical or pharmacologic cardioversion after
appropriate anticoagulation. Stroke prevention requires anticoagulation based on CHA2DS2-VASc score and
is a long-term, not acute, goal.
EXAM 2 Advanced Concepts in Medical-Surgical Nursing EXAM 2 | Questions and Answers Rated A+ | 2026/2027 **2026/2027** - 2026/2027 Official Ex...
2026/2027 | Passing Score: 80% Page 3 of 43
, Q4 Question 4 of 75
A 49-year-old male arrives at the emergency department with a blood pressure of 220/128 mmHg,
blurred vision, and a severe headache. He has no chest pain and is alert and oriented. Fundoscopic
examination reveals papilledema. Which classification best describes this clinical presentation
A. Hypertensive urgency without end-organ damage
B. Severe hypertension of pregnancy
C. Rebound hypertension from medication nonadherence
D. Hypertensive emergency with end-organ damage
Correct Answer: D
Rationale:
Hypertensive emergency is defined as a severe elevation in blood pressure accompanied by acute
end-organ damage, which in this patient is evidenced by papilledema and neurological symptoms indicating
hypertensive encephalopathy. Hypertensive urgency describes elevated blood pressure without end-organ
damage. Immediate intravenous antihypertensive therapy with a controlled reduction of 10 to 20 percent in
the first hour is the appropriate management strategy.
Q5 Question 5 of 75
A 61-year-old male is in the cardiac intensive care unit two days after an anterior wall myocardial
infarction. He develops hypotension with a blood pressure of 84/52 mmHg, cool extremities, and
oliguria. Pulmonary artery catheter readings show a cardiac index of 1.8 L/min/m2 and a pulmonary
capillary wedge pressure of 22 mmHg. Which hemodynamic pattern best classifies this shock state
A. Cardiogenic shock with high wedge pressure
B. Distributive shock with low wedge pressure
C. Hypovolemic shock with low wedge pressure
D. Obstructive shock with high wedge pressure
Correct Answer: A
Rationale:
Cardiogenic shock following myocardial infarction is characterized by hypotension, end-organ hypoperfusion,
low cardiac index below 2.2 L/min/m2, and an elevated pulmonary capillary wedge pressure above 18 mmHg
indicating pump failure. Distributive and hypovolemic shock both present with a low wedge pressure.
Obstructive shock such as tamponade shows equalization of diastolic pressures rather than isolated wedge
pressure elevation.
EXAM 2 Advanced Concepts in Medical-Surgical Nursing EXAM 2 | Questions and Answers Rated A+ | 2026/2027 **2026/2027** - 2026/2027 Official Ex...
2026/2027 | Passing Score: 80% Page 4 of 43
