MED SURG CMS PROCTORED EXAM 2026/2027 | Verified
Questions & Answers | Latest Update | Comprehensive
Med-Surg Mastery | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (25 Questions)
Q1: A 72-year-old with HFrEF (EF 32%) is admitted with acute dyspnea, 3+ pitting
edema, and an S3 gallop. Vital signs: BP 94/62, HR 118, RR 28, SpO2 89% on room air.
Which medication should the nurse prepare to administer first?
A. Digoxin 0.25 mg IV push
B. Metoprolol 25 mg PO
C. Furosemide 40 mg IV push [CORRECT]
D. Enalapril 5 mg PO
Correct Answer: C
Rationale: In acute decompensated heart failure with volume overload (S3 gallop,
edema, crackles), IV loop diuretics are first-line to reduce preload and improve
pulmonary congestion. Furosemide promotes rapid diuresis. Digoxin is not first-line for
acute decompensation. Metoprolol may worsen acute heart failure and hypotension.
Enalapril should be held until hemodynamic stabilization.
Q2: A 58-year-old with hypertension reports a blood pressure of 176/94 mmHg at home.
The provider orders lifestyle modifications and medication. According to JNC-8
guidelines, which medication class is first-line for this patient without compelling
indications?
A. Beta-blockers
B. ACE inhibitors
C. Thiazide diuretics, CCBs, ACE inhibitors, or ARBs [CORRECT]
D. Alpha-blockers
Correct Answer: C
,Rationale: JNC-8 recommends thiazide diuretics, CCBs, ACE inhibitors, or ARBs as
first-line for non-Black patients with hypertension. Beta-blockers (Option A) are not
first-line unless compelling indication (post-MI, heart failure). Alpha-blockers (Option D)
are not first-line due to cardiovascular events.
Q3: A patient with acute MI has crushing substernal chest pain, diaphoresis, and
nausea. The 12-lead EKG shows ST-segment elevation in leads V2-V5. Which
intervention is the priority?
A. Administer aspirin 325 mg chewable and establish IV access [CORRECT]
B. Prepare for immediate stress testing
C. Administer sublingual nitroglycerin every 5 minutes without other interventions
D. Obtain a chest X-ray before administering any medications
Correct Answer: A
Rationale: This patient has an STEMI. Immediate aspirin administration inhibits platelet
aggregation and prevents further thrombus formation, along with IV access for
anticipated reperfusion therapy. Stress testing is contraindicated in acute MI.
Nitroglycerin alone without aspirin is insufficient. Chest X-ray is not a priority over
immediate cardiac intervention.
Q4: A patient with atrial fibrillation is started on warfarin. Which dietary instruction is
most accurate?
A. "Avoid all green leafy vegetables completely"
B. "Keep your vitamin K intake consistent from day to day" [CORRECT]
C. "Double your vegetable intake on weekends"
D. "Cranberry juice will enhance your warfarin effect safely"
Correct Answer: B
Rationale: Warfarin antagonizes vitamin K-dependent clotting factors. The key teaching
is maintaining consistent vitamin K intake rather than avoiding it entirely, as fluctuations
destabilize INR. Variable intake causes unpredictable INR fluctuations. Cranberry juice
can potentiate warfarin and increase bleeding risk.
,Q5: A patient post-cardiac catheterization via the right femoral artery has a 5 cm
hematoma, diminished pedal pulse, and a cool, pale foot. What is the priority nursing
action?
A. Apply a pressure dressing and notify the provider immediately [CORRECT]
B. Elevate the leg above heart level to reduce swelling
C. Remove the existing dressing to assess the hematoma size
D. Document the findings and reassess in 30 minutes
Correct Answer: A
Rationale: Diminished pedal pulse, cool/pale extremity, and expanding hematoma
indicate possible arterial compromise or pseudoaneurysm formation
post-catheterization. This is a vascular emergency requiring immediate pressure
application and provider notification. Elevating the leg could further compromise arterial
flow. Removing the dressing may worsen bleeding. Delaying intervention risks
permanent vascular damage.
Q6: A patient with severe aortic stenosis becomes dizzy and hypotensive (BP 82/50)
after receiving sublingual nitroglycerin. Which pathophysiological concept explains this?
A. Nitroglycerin reduces afterload, which is essential in aortic stenosis
B. Nitroglycerin causes venodilation and reduced preload, which the stenotic valve
cannot compensate for [CORRECT]
C. Nitroglycerin increases myocardial oxygen demand in aortic stenosis
D. Nitroglycerin causes coronary vasospasm in valvular disease
Correct Answer: B
Rationale: In severe aortic stenosis, the fixed outflow obstruction prevents
compensatory increases in cardiac output. Nitroglycerin causes venodilation, reducing
preload and ventricular filling. The stenotic valve cannot accommodate the reduced
volume, leading to profound hypotension and syncope.
Q7: A patient with a newly placed permanent pacemaker asks when they can resume
driving. Which response is most appropriate?
A. "You can drive as soon as you feel comfortable"
B. "You should not drive until you receive clearance from your cardiologist, typically after
the first device check" [CORRECT]
, C. "You can resume driving in 1 week if you have no complications"
D. "Driving restrictions apply only to commercial vehicles"
Correct Answer: B
Rationale: Post-pacemaker implantation driving restrictions vary by institutional policy
and patient condition, but generally require cardiology clearance after the first device
interrogation (typically 2-6 weeks) to ensure proper lead placement and function. Option
A is unsafe as it lacks medical oversight. Option C provides an arbitrary timeline without
individual assessment.
Q8: A patient with hypertrophic cardiomyopathy (HCM) asks about activity restrictions.
Which recommendation is most appropriate?
A. Encourage vigorous aerobic exercise to improve cardiac output
B. Recommend participation in competitive sports to build cardiovascular endurance
C. Advise moderate activity while avoiding strenuous exercise and dehydration
[CORRECT]
D. Prescribe bedrest to prevent all physical exertion
Correct Answer: C
Rationale: HCM patients are at risk for sudden cardiac death due to dynamic outflow
obstruction. Strenuous exercise, dehydration, and Valsalva maneuvers worsen
obstruction. Moderate activity is encouraged, but competitive sports and vigorous
exercise are contraindicated. Complete bedrest is unnecessary and promotes
deconditioning.
Q9: A patient with a history of DVT is receiving a heparin infusion. The aPTT is 98
seconds (control 30-40 seconds). The patient has blood-tinged urine and oozing from
the IV site. Which is the priority nursing action?
A. Continue the heparin infusion and monitor closely
B. Stop the heparin infusion and prepare to administer protamine sulfate [CORRECT]
C. Administer vitamin K to reverse heparin effects
D. Increase the heparin rate to achieve therapeutic range
Correct Answer: B
Questions & Answers | Latest Update | Comprehensive
Med-Surg Mastery | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (25 Questions)
Q1: A 72-year-old with HFrEF (EF 32%) is admitted with acute dyspnea, 3+ pitting
edema, and an S3 gallop. Vital signs: BP 94/62, HR 118, RR 28, SpO2 89% on room air.
Which medication should the nurse prepare to administer first?
A. Digoxin 0.25 mg IV push
B. Metoprolol 25 mg PO
C. Furosemide 40 mg IV push [CORRECT]
D. Enalapril 5 mg PO
Correct Answer: C
Rationale: In acute decompensated heart failure with volume overload (S3 gallop,
edema, crackles), IV loop diuretics are first-line to reduce preload and improve
pulmonary congestion. Furosemide promotes rapid diuresis. Digoxin is not first-line for
acute decompensation. Metoprolol may worsen acute heart failure and hypotension.
Enalapril should be held until hemodynamic stabilization.
Q2: A 58-year-old with hypertension reports a blood pressure of 176/94 mmHg at home.
The provider orders lifestyle modifications and medication. According to JNC-8
guidelines, which medication class is first-line for this patient without compelling
indications?
A. Beta-blockers
B. ACE inhibitors
C. Thiazide diuretics, CCBs, ACE inhibitors, or ARBs [CORRECT]
D. Alpha-blockers
Correct Answer: C
,Rationale: JNC-8 recommends thiazide diuretics, CCBs, ACE inhibitors, or ARBs as
first-line for non-Black patients with hypertension. Beta-blockers (Option A) are not
first-line unless compelling indication (post-MI, heart failure). Alpha-blockers (Option D)
are not first-line due to cardiovascular events.
Q3: A patient with acute MI has crushing substernal chest pain, diaphoresis, and
nausea. The 12-lead EKG shows ST-segment elevation in leads V2-V5. Which
intervention is the priority?
A. Administer aspirin 325 mg chewable and establish IV access [CORRECT]
B. Prepare for immediate stress testing
C. Administer sublingual nitroglycerin every 5 minutes without other interventions
D. Obtain a chest X-ray before administering any medications
Correct Answer: A
Rationale: This patient has an STEMI. Immediate aspirin administration inhibits platelet
aggregation and prevents further thrombus formation, along with IV access for
anticipated reperfusion therapy. Stress testing is contraindicated in acute MI.
Nitroglycerin alone without aspirin is insufficient. Chest X-ray is not a priority over
immediate cardiac intervention.
Q4: A patient with atrial fibrillation is started on warfarin. Which dietary instruction is
most accurate?
A. "Avoid all green leafy vegetables completely"
B. "Keep your vitamin K intake consistent from day to day" [CORRECT]
C. "Double your vegetable intake on weekends"
D. "Cranberry juice will enhance your warfarin effect safely"
Correct Answer: B
Rationale: Warfarin antagonizes vitamin K-dependent clotting factors. The key teaching
is maintaining consistent vitamin K intake rather than avoiding it entirely, as fluctuations
destabilize INR. Variable intake causes unpredictable INR fluctuations. Cranberry juice
can potentiate warfarin and increase bleeding risk.
,Q5: A patient post-cardiac catheterization via the right femoral artery has a 5 cm
hematoma, diminished pedal pulse, and a cool, pale foot. What is the priority nursing
action?
A. Apply a pressure dressing and notify the provider immediately [CORRECT]
B. Elevate the leg above heart level to reduce swelling
C. Remove the existing dressing to assess the hematoma size
D. Document the findings and reassess in 30 minutes
Correct Answer: A
Rationale: Diminished pedal pulse, cool/pale extremity, and expanding hematoma
indicate possible arterial compromise or pseudoaneurysm formation
post-catheterization. This is a vascular emergency requiring immediate pressure
application and provider notification. Elevating the leg could further compromise arterial
flow. Removing the dressing may worsen bleeding. Delaying intervention risks
permanent vascular damage.
Q6: A patient with severe aortic stenosis becomes dizzy and hypotensive (BP 82/50)
after receiving sublingual nitroglycerin. Which pathophysiological concept explains this?
A. Nitroglycerin reduces afterload, which is essential in aortic stenosis
B. Nitroglycerin causes venodilation and reduced preload, which the stenotic valve
cannot compensate for [CORRECT]
C. Nitroglycerin increases myocardial oxygen demand in aortic stenosis
D. Nitroglycerin causes coronary vasospasm in valvular disease
Correct Answer: B
Rationale: In severe aortic stenosis, the fixed outflow obstruction prevents
compensatory increases in cardiac output. Nitroglycerin causes venodilation, reducing
preload and ventricular filling. The stenotic valve cannot accommodate the reduced
volume, leading to profound hypotension and syncope.
Q7: A patient with a newly placed permanent pacemaker asks when they can resume
driving. Which response is most appropriate?
A. "You can drive as soon as you feel comfortable"
B. "You should not drive until you receive clearance from your cardiologist, typically after
the first device check" [CORRECT]
, C. "You can resume driving in 1 week if you have no complications"
D. "Driving restrictions apply only to commercial vehicles"
Correct Answer: B
Rationale: Post-pacemaker implantation driving restrictions vary by institutional policy
and patient condition, but generally require cardiology clearance after the first device
interrogation (typically 2-6 weeks) to ensure proper lead placement and function. Option
A is unsafe as it lacks medical oversight. Option C provides an arbitrary timeline without
individual assessment.
Q8: A patient with hypertrophic cardiomyopathy (HCM) asks about activity restrictions.
Which recommendation is most appropriate?
A. Encourage vigorous aerobic exercise to improve cardiac output
B. Recommend participation in competitive sports to build cardiovascular endurance
C. Advise moderate activity while avoiding strenuous exercise and dehydration
[CORRECT]
D. Prescribe bedrest to prevent all physical exertion
Correct Answer: C
Rationale: HCM patients are at risk for sudden cardiac death due to dynamic outflow
obstruction. Strenuous exercise, dehydration, and Valsalva maneuvers worsen
obstruction. Moderate activity is encouraged, but competitive sports and vigorous
exercise are contraindicated. Complete bedrest is unnecessary and promotes
deconditioning.
Q9: A patient with a history of DVT is receiving a heparin infusion. The aPTT is 98
seconds (control 30-40 seconds). The patient has blood-tinged urine and oozing from
the IV site. Which is the priority nursing action?
A. Continue the heparin infusion and monitor closely
B. Stop the heparin infusion and prepare to administer protamine sulfate [CORRECT]
C. Administer vitamin K to reverse heparin effects
D. Increase the heparin rate to achieve therapeutic range
Correct Answer: B
