CMS MED SURG PROCTORED EXAM 2026/2027 | Latest
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Section 1: Cardiovascular Disorders
Q1: A patient with chronic heart failure with reduced ejection fraction (HFrEF) is
prescribed enalapril. The nurse should monitor the patient for which primary adverse
effect during the initiation of this medication?
A. Hyperkalemia and angioedema [CORRECT]
B. Hypokalemia and severe constipation
C. Tachycardia and hypertension
D. Bronchospasm and hyperglycemia
Correct Answer: A
Rationale: ACE inhibitors like enalapril block the conversion of angiotensin I to
angiotensin II, which decreases aldosterone production, leading to a risk of
hyperkalemia. They also prevent the breakdown of bradykinin, which can cause a dry
cough or life-threatening angioedema. Hypokalemia is associated with loop diuretics,
not ACE inhibitors. VERIFIED ✓ - Cardiovascular: Heart Failure Pharmacology.
Q2: A patient arrives in the emergency department complaining of severe substernal
chest pain that began 2 hours ago. The 12-lead ECG reveals ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending (LAD) artery
B. Circumflex artery
C. Right coronary artery (RCA) [CORRECT]
D. Obtuse marginal branch
Correct Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is typically caused by occlusion of the right coronary artery
(RCA). The LAD supplies the anterior wall (leads V1-V4), and the circumflex supplies the
,lateral wall (leads I, aVL, V5, V6). VERIFIED ✓ - Cardiovascular: Coronary Artery Disease
& Diagnostics.
Q3: The nurse is assessing a patient with left-sided heart failure. Which clinical
manifestation is an expected finding?
A. Jugular vein distension
B. Hepatomegaly
C. Bilateral crackles in the lungs [CORRECT]
D. Dependent peripheral edema
Correct Answer: C
Rationale: Left-sided heart failure results in decreased cardiac output to the systemic
circulation and backup of blood into the pulmonary circulation, leading to pulmonary
congestion manifested as crackles, dyspnea, and orthopnea. Jugular vein distension,
hepatomegaly, and dependent edema are signs of right-sided heart failure due to
systemic venous backup. VERIFIED ✓ - Cardiovascular: Heart Failure Assessment.
Q4: A patient with heart failure with preserved ejection fraction (HFpEF) asks the nurse
what this means compared to systolic heart failure. What is the best response by the
nurse?
A. "Your heart muscle is too weak to pump effectively, so it empties less than half its
blood."
B. "Your heart muscle is stiff and does not relax properly, preventing it from filling with
enough blood." [CORRECT]
C. "Your heart valves are damaged, causing blood to leak back into the chambers."
D. "Your heart rate is too fast, which prevents the chambers from filling completely."
Correct Answer: B
Rationale: HFpEF (diastolic heart failure) is characterized by impaired relaxation and
increased stiffness of the left ventricle, leading to inadequate filling. The ejection
fraction is preserved (typically ≥50%). HFrEF (systolic heart failure) involves a weak
heart muscle that cannot contract effectively, leading to an ejection fraction <40%.
VERIFIED ✓ - Cardiovascular: Heart Failure Pathophysiology.
,Q5: A patient with a history of hypertension is admitted with a blood pressure of
210/120 mm Hg, confusion, and severe headache. Which nursing intervention is the
priority?
A. Administer intravenous antihypertensive therapy rapidly to lower the blood pressure
to 120/80 within 15 minutes.
B. Prepare the patient for an immediate CT scan of the head and initiate continuous
blood pressure monitoring. [CORRECT]
C. Encourage the patient to ambulate to increase peripheral vascular resistance.
D. Apply a warm blanket to induce vasodilation and lower blood pressure.
Correct Answer: B
Rationale: This patient is presenting with a hypertensive emergency (elevated BP with
target organ damage, likely the brain given the confusion and headache). The priority is
to assess for intracranial hemorrhage via CT scan. BP should be lowered gradually (not
rapidly to normal limits) to prevent cerebral hypoperfusion and ischemia. Ambulation
increases BP and stroke risk. VERIFIED ✓ - Cardiovascular: Hypertension Management.
Q6: A patient with atrial fibrillation is prescribed warfarin. Which laboratory test result
indicates that the patient's anticoagulation is within the desired therapeutic range?
A. Prothrombin time (PT) 10 seconds
B. International Normalized Ratio (INR) 2.5 [CORRECT]
C. Partial thromboplastin time (PTT) 35 seconds
D. Activated clotting time (ACT) 100 seconds
Correct Answer: B
Rationale: For most patients with atrial fibrillation, the target INR while on warfarin
therapy is 2.0 to 3.0. An INR of 2.5 is within this therapeutic range. PT is measured in
seconds but is standardized to the INR. PTT is used to monitor heparin therapy.
VERIFIED ✓ - Cardiovascular: Cardiac Arrhythmias & Pharmacology.
Q7: The nurse is providing discharge teaching to a patient who had a permanent
pacemaker inserted on the left side. Which statement by the patient indicates a need for
further teaching?
A. "I will avoid lifting my left arm above my shoulder for the next 4 to 6 weeks."
B. "I will carry a card in my wallet identifying that I have a pacemaker."
C. "I will use a microwave oven in my home without any worries."
, D. "I will place my cell phone directly over the pacemaker site when I talk." [CORRECT]
Correct Answer: D
Rationale: Patients with pacemakers should be instructed to avoid placing cell phones
directly over the pacemaker generator, as the electromagnetic interference can
potentially disrupt pacemaker function. They should use the phone on the ear opposite
the device. Microwaves are generally safe, arm restriction prevents lead dislodgement,
and a medical ID card is essential for emergencies. VERIFIED ✓ - Cardiovascular:
Cardiac Arrhythmias Management.
Q8: A patient with peripheral arterial disease (PAD) complains of intermittent
claudication. Which statement by the nurse is most appropriate regarding exercise?
A. "Stop walking immediately when you feel pain to prevent tissue damage."
B. "Walk until the pain becomes severe, then rest until it subsides completely before
walking again." [CORRECT]
C. "Engage in upper body weightlifting instead of walking to avoid leg pain."
D. "Walk only short distances and avoid any activity that causes discomfort."
Correct Answer: B
Rationale: The primary nonpharmacologic treatment for intermittent claudication in PAD
is a supervised exercise program. Patients are instructed to walk until they experience
moderate pain (not severe), rest until the pain subsides, and then resume walking. This
promotes the development of collateral circulation. VERIFIED ✓ - Cardiovascular:
Peripheral Vascular Disease.
Q9: A patient is admitted with acute decompensated heart failure and is receiving
intravenous furosemide. Which assessment finding indicates that the medication is
achieving the desired therapeutic effect?
A. Weight gain of 1 kg overnight
B. Decreased crackles in the lung bases [CORRECT]
C. Increased blood pressure
D. Bradycardia
Correct Answer: B
Update Questions & Verified Answers | Comprehensive
Med-Surg Nursing Mastery | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders
Q1: A patient with chronic heart failure with reduced ejection fraction (HFrEF) is
prescribed enalapril. The nurse should monitor the patient for which primary adverse
effect during the initiation of this medication?
A. Hyperkalemia and angioedema [CORRECT]
B. Hypokalemia and severe constipation
C. Tachycardia and hypertension
D. Bronchospasm and hyperglycemia
Correct Answer: A
Rationale: ACE inhibitors like enalapril block the conversion of angiotensin I to
angiotensin II, which decreases aldosterone production, leading to a risk of
hyperkalemia. They also prevent the breakdown of bradykinin, which can cause a dry
cough or life-threatening angioedema. Hypokalemia is associated with loop diuretics,
not ACE inhibitors. VERIFIED ✓ - Cardiovascular: Heart Failure Pharmacology.
Q2: A patient arrives in the emergency department complaining of severe substernal
chest pain that began 2 hours ago. The 12-lead ECG reveals ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending (LAD) artery
B. Circumflex artery
C. Right coronary artery (RCA) [CORRECT]
D. Obtuse marginal branch
Correct Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is typically caused by occlusion of the right coronary artery
(RCA). The LAD supplies the anterior wall (leads V1-V4), and the circumflex supplies the
,lateral wall (leads I, aVL, V5, V6). VERIFIED ✓ - Cardiovascular: Coronary Artery Disease
& Diagnostics.
Q3: The nurse is assessing a patient with left-sided heart failure. Which clinical
manifestation is an expected finding?
A. Jugular vein distension
B. Hepatomegaly
C. Bilateral crackles in the lungs [CORRECT]
D. Dependent peripheral edema
Correct Answer: C
Rationale: Left-sided heart failure results in decreased cardiac output to the systemic
circulation and backup of blood into the pulmonary circulation, leading to pulmonary
congestion manifested as crackles, dyspnea, and orthopnea. Jugular vein distension,
hepatomegaly, and dependent edema are signs of right-sided heart failure due to
systemic venous backup. VERIFIED ✓ - Cardiovascular: Heart Failure Assessment.
Q4: A patient with heart failure with preserved ejection fraction (HFpEF) asks the nurse
what this means compared to systolic heart failure. What is the best response by the
nurse?
A. "Your heart muscle is too weak to pump effectively, so it empties less than half its
blood."
B. "Your heart muscle is stiff and does not relax properly, preventing it from filling with
enough blood." [CORRECT]
C. "Your heart valves are damaged, causing blood to leak back into the chambers."
D. "Your heart rate is too fast, which prevents the chambers from filling completely."
Correct Answer: B
Rationale: HFpEF (diastolic heart failure) is characterized by impaired relaxation and
increased stiffness of the left ventricle, leading to inadequate filling. The ejection
fraction is preserved (typically ≥50%). HFrEF (systolic heart failure) involves a weak
heart muscle that cannot contract effectively, leading to an ejection fraction <40%.
VERIFIED ✓ - Cardiovascular: Heart Failure Pathophysiology.
,Q5: A patient with a history of hypertension is admitted with a blood pressure of
210/120 mm Hg, confusion, and severe headache. Which nursing intervention is the
priority?
A. Administer intravenous antihypertensive therapy rapidly to lower the blood pressure
to 120/80 within 15 minutes.
B. Prepare the patient for an immediate CT scan of the head and initiate continuous
blood pressure monitoring. [CORRECT]
C. Encourage the patient to ambulate to increase peripheral vascular resistance.
D. Apply a warm blanket to induce vasodilation and lower blood pressure.
Correct Answer: B
Rationale: This patient is presenting with a hypertensive emergency (elevated BP with
target organ damage, likely the brain given the confusion and headache). The priority is
to assess for intracranial hemorrhage via CT scan. BP should be lowered gradually (not
rapidly to normal limits) to prevent cerebral hypoperfusion and ischemia. Ambulation
increases BP and stroke risk. VERIFIED ✓ - Cardiovascular: Hypertension Management.
Q6: A patient with atrial fibrillation is prescribed warfarin. Which laboratory test result
indicates that the patient's anticoagulation is within the desired therapeutic range?
A. Prothrombin time (PT) 10 seconds
B. International Normalized Ratio (INR) 2.5 [CORRECT]
C. Partial thromboplastin time (PTT) 35 seconds
D. Activated clotting time (ACT) 100 seconds
Correct Answer: B
Rationale: For most patients with atrial fibrillation, the target INR while on warfarin
therapy is 2.0 to 3.0. An INR of 2.5 is within this therapeutic range. PT is measured in
seconds but is standardized to the INR. PTT is used to monitor heparin therapy.
VERIFIED ✓ - Cardiovascular: Cardiac Arrhythmias & Pharmacology.
Q7: The nurse is providing discharge teaching to a patient who had a permanent
pacemaker inserted on the left side. Which statement by the patient indicates a need for
further teaching?
A. "I will avoid lifting my left arm above my shoulder for the next 4 to 6 weeks."
B. "I will carry a card in my wallet identifying that I have a pacemaker."
C. "I will use a microwave oven in my home without any worries."
, D. "I will place my cell phone directly over the pacemaker site when I talk." [CORRECT]
Correct Answer: D
Rationale: Patients with pacemakers should be instructed to avoid placing cell phones
directly over the pacemaker generator, as the electromagnetic interference can
potentially disrupt pacemaker function. They should use the phone on the ear opposite
the device. Microwaves are generally safe, arm restriction prevents lead dislodgement,
and a medical ID card is essential for emergencies. VERIFIED ✓ - Cardiovascular:
Cardiac Arrhythmias Management.
Q8: A patient with peripheral arterial disease (PAD) complains of intermittent
claudication. Which statement by the nurse is most appropriate regarding exercise?
A. "Stop walking immediately when you feel pain to prevent tissue damage."
B. "Walk until the pain becomes severe, then rest until it subsides completely before
walking again." [CORRECT]
C. "Engage in upper body weightlifting instead of walking to avoid leg pain."
D. "Walk only short distances and avoid any activity that causes discomfort."
Correct Answer: B
Rationale: The primary nonpharmacologic treatment for intermittent claudication in PAD
is a supervised exercise program. Patients are instructed to walk until they experience
moderate pain (not severe), rest until the pain subsides, and then resume walking. This
promotes the development of collateral circulation. VERIFIED ✓ - Cardiovascular:
Peripheral Vascular Disease.
Q9: A patient is admitted with acute decompensated heart failure and is receiving
intravenous furosemide. Which assessment finding indicates that the medication is
achieving the desired therapeutic effect?
A. Weight gain of 1 kg overnight
B. Decreased crackles in the lung bases [CORRECT]
C. Increased blood pressure
D. Bradycardia
Correct Answer: B
