CJE Med-Surg 1 Exam Review 2025-2026 | Complete Updated
Real Exam Bank With 100% Verified Questions & High-Level
Correct Answers | Guaranteed Pass Medical-Surgical Mastery
Edition - 250 Questions
This exam covers advanced concepts in cardiovascular disorders, including pathophysiology, hemodynamics,
diagnostic interpretation, pharmacotherapy, and nursing management. Questions require synthesis of complex
physiological principles and evidence-based interventions. It contains 250 multiple-choice questions, each with
four distractors and a fully worked rationale that explains why the keyed answer is correct. Content is organized
into 12 focused sections: Cardiovascular Disorders, Respiratory Disorders, Gastrointestinal Disorders,
Endocrine Disorders, Neurological Disorders, Renal and Urinary Disorders, Musculoskeletal Disorders,
Oncology and Hematology, Perioperative Care, Fluid and Electrolyte Balance, Shock and Sepsis Management,
Pain Management and Palliative Care. Targeted learning outcomes include: Analyze hemodynamic data to guide
interventions in acute coronary syndrome and heart failure.; Interpret ECG and laboratory findings to
differentiate arrhythmias and myocardial injury.; Evaluate pharmacologic and non-pharmacologic strategies for
managing hypertension and dysrhythmias.. Every item has been reviewed for clinical accuracy, current
guidelines, and clarity so that students can study with confidence and self-correct as they work through the bank.
Use it as a high-yield review immediately before the exam, or as a structured practice tool during the unit - the
rationales double as concise teaching notes. The recommended writing time is 3 hours, with a passing score of
80%. Aligned with This exam aligns with AACN and CCNE standards for baccalaureate nursing education in the
Section 1: Cardiovascular Disorders (Questions 1-21)
1 A patient with ST-elevation myocardial infarction (STEMI) develops a new
murmur and acute hypotension. Which complication is most likely?
A) Papillary muscle rupture
B) Free wall rupture
C) Ventricular septal rupture
D) Pericarditis
Answer: A
Rationale: Papillary muscle rupture causes acute mitral regurgitation with a new
holosystolic murmur and pulmonary edema, leading to hypotension. Free wall
rupture causes tamponade and electromechanical dissociation. Ventricular
septal rupture produces a harsh holosystolic murmur at the left lower sternal
border. Pericarditis presents with a pericardial friction rub and chest pain, not
acute hypotension.
2 Which hemodynamic profile is consistent with cardiogenic shock?
A) Cardiac index < 2.2 L/min/m², pulmonary capillary wedge pressure > 18
mmHg
,B) Cardiac index > 4.0 L/min/m², systemic vascular resistance < 600
dynes-s/cm
C) Central venous pressure < 4 mmHg, pulmonary artery occlusion pressure
< 8 mmHg
D) Mixed venous oxygen saturation > 75%, cardiac index > 3.5 L/min/m²
Answer: A
Rationale: Cardiogenic shock is characterized by low cardiac output (CI < 2.2)
and elevated filling pressures (PCWP > 18) due to pump failure. Option B
describes distributive shock, option C describes hypovolemic shock, and optio
n
D indicates high output states like sepsis.
3 A patient with atrial fibrillation and a CHADS-VASc score of 3 has a
contraindication to warfarin. Which anticoagulant requires dose adjustment
for creatinine clearance < 30 mL/min?
A) Dabigatran
B) Rivaroxaban
C) Apixaban
D) Edoxaban
Answer: A
Rationale: Dabigatran is contraindicated in CrCl < 30 mL/min due to renal
clearance. Rivaroxaban requires dose adjustment but is not contraindicated.
Apixaban can be used with caution. Edoxaban is not recommended if CrCl >
95 mL/min but can be used in lower CrCl.
4 In a patient with acute decompensated heart failure and a blood pressure of
88/56 mm Hg, which inotropic agent is preferred?
A) Dobutamine
B) Milrinone
C) Dopamine
D) Norepinephrine
Answer: C
Rationale: Dopamine at moderate doses (5-10 mcg/kg/min) provides both
inotropic and vasopressor support, suitable for hypotension. Dobutamine is a
pure inotrope that can worsen hypotension. Milrinone is a phosphodiesterase
inhibitor that may cause vasodilation. Norepinephrine is primarily a
,vasopressor with minimal inotropic effect.
5 Which ECG finding is most specific for acute pericarditis?
A) Diffuse ST-segment elevation with PR depression
B) Localized ST-segment elevation in leads II, III, aVF
C) T-wave inversion in leads V1-V4
D) Pathologic Q waves in anterior leads
Answer: A
Rationale: Diffuse ST elevation with PR depression is classic for pericarditis
due to subepicardial inflammation. Localized ST elevation suggests STEMI.
T-wave inversion in V1-V4 may indicate Wellens syndrome. Pathologic Q
waves indicate prior infarction.
6 A patient on amiodarone develops new-onset cough and bilateral interstitial
infiltrates on chest X-ray. What is the priority action?
A) Discontinue amiodarone immediately
B) Obtain a CT pulmonary angiogram
C) Start empiric antibiotics
D) Administer inhaled corticosteroids
Answer: A
Rationale: Amiodarone can cause pulmonary toxicity, presenting with cough
and infiltrates. The priority is to discontinue the drug to prevent progression.
CT pulmonary angiogram is for pulmonary embolism. Antibiotics are for
infection. Inhaled corticosteroids are not first-line for drug-induced
pneumonitis.
7 Which valvular lesion produces a diastolic murmur best heard at the apex?
A) Aortic stenosis
B) Aortic regurgitation
C) Mitral stenosis
D) Mitral regurgitation
Answer: C
Rationale: Mitral stenosis causes a diastolic rumbling murmur at the apex.
Aortic stenosis is systolic at the right upper sternal border. Aortic regurgitation
is diastolic at the left sternal border. Mitral regurgitation is systolic at the apex.
, 8 A patient with hypertrophic cardiomyopathy experiences syncope during
exercise. Which mechanism is most likely?
A) Dynamic left ventricular outflow tract obstruction
B) Sustained ventricular tachycardia
C) Paradoxical embolus
D) Complete heart block
Answer: A
Rationale: Exercise increases contractility and heart rate, reducing ventricular
volume and worsening LVOT obstruction in HCM, leading to syncope. VT can
occur but is less common with exercise. Paradoxical embolus is rare. Heart
block is not typical.
9 Which laboratory finding is most consistent with acute coronary syndrome?
A) Elevated high-sensitivity troponin I
B) Elevated brain natriuretic peptide
C) Elevated D-dimer
D) Elevated creatine kinase-MB
Answer: A
Rationale: High-sensitivity troponin is the preferred biomarker for myocardial
injury due to high specificity and sensitivity. BNP indicates heart failure.
D-dimer is for thrombosis. CK-MB is less sensitive and specific than troponin.
10 A patient with chronic heart failure and an ejection fraction of 35% is
started on carvedilol. What is the expected effect on cardiac output during
the first few weeks?
A) Transient decrease followed by gradual increase
B) Immediate increase due to afterload reduction
C) No change because beta-blockers do not affect cardiac output
D) Persistent decrease requiring discontinuation
Answer: A
Rationale: Carvedilol initially reduces cardiac output due to negative inotropy,
but long-term improves ventricular remodeling and function. Afterload
reduction is modest. Beta-blockers are known to improve outcomes despite
initial hemodynamic effects. Persistent decrease is not expected.
Real Exam Bank With 100% Verified Questions & High-Level
Correct Answers | Guaranteed Pass Medical-Surgical Mastery
Edition - 250 Questions
This exam covers advanced concepts in cardiovascular disorders, including pathophysiology, hemodynamics,
diagnostic interpretation, pharmacotherapy, and nursing management. Questions require synthesis of complex
physiological principles and evidence-based interventions. It contains 250 multiple-choice questions, each with
four distractors and a fully worked rationale that explains why the keyed answer is correct. Content is organized
into 12 focused sections: Cardiovascular Disorders, Respiratory Disorders, Gastrointestinal Disorders,
Endocrine Disorders, Neurological Disorders, Renal and Urinary Disorders, Musculoskeletal Disorders,
Oncology and Hematology, Perioperative Care, Fluid and Electrolyte Balance, Shock and Sepsis Management,
Pain Management and Palliative Care. Targeted learning outcomes include: Analyze hemodynamic data to guide
interventions in acute coronary syndrome and heart failure.; Interpret ECG and laboratory findings to
differentiate arrhythmias and myocardial injury.; Evaluate pharmacologic and non-pharmacologic strategies for
managing hypertension and dysrhythmias.. Every item has been reviewed for clinical accuracy, current
guidelines, and clarity so that students can study with confidence and self-correct as they work through the bank.
Use it as a high-yield review immediately before the exam, or as a structured practice tool during the unit - the
rationales double as concise teaching notes. The recommended writing time is 3 hours, with a passing score of
80%. Aligned with This exam aligns with AACN and CCNE standards for baccalaureate nursing education in the
Section 1: Cardiovascular Disorders (Questions 1-21)
1 A patient with ST-elevation myocardial infarction (STEMI) develops a new
murmur and acute hypotension. Which complication is most likely?
A) Papillary muscle rupture
B) Free wall rupture
C) Ventricular septal rupture
D) Pericarditis
Answer: A
Rationale: Papillary muscle rupture causes acute mitral regurgitation with a new
holosystolic murmur and pulmonary edema, leading to hypotension. Free wall
rupture causes tamponade and electromechanical dissociation. Ventricular
septal rupture produces a harsh holosystolic murmur at the left lower sternal
border. Pericarditis presents with a pericardial friction rub and chest pain, not
acute hypotension.
2 Which hemodynamic profile is consistent with cardiogenic shock?
A) Cardiac index < 2.2 L/min/m², pulmonary capillary wedge pressure > 18
mmHg
,B) Cardiac index > 4.0 L/min/m², systemic vascular resistance < 600
dynes-s/cm
C) Central venous pressure < 4 mmHg, pulmonary artery occlusion pressure
< 8 mmHg
D) Mixed venous oxygen saturation > 75%, cardiac index > 3.5 L/min/m²
Answer: A
Rationale: Cardiogenic shock is characterized by low cardiac output (CI < 2.2)
and elevated filling pressures (PCWP > 18) due to pump failure. Option B
describes distributive shock, option C describes hypovolemic shock, and optio
n
D indicates high output states like sepsis.
3 A patient with atrial fibrillation and a CHADS-VASc score of 3 has a
contraindication to warfarin. Which anticoagulant requires dose adjustment
for creatinine clearance < 30 mL/min?
A) Dabigatran
B) Rivaroxaban
C) Apixaban
D) Edoxaban
Answer: A
Rationale: Dabigatran is contraindicated in CrCl < 30 mL/min due to renal
clearance. Rivaroxaban requires dose adjustment but is not contraindicated.
Apixaban can be used with caution. Edoxaban is not recommended if CrCl >
95 mL/min but can be used in lower CrCl.
4 In a patient with acute decompensated heart failure and a blood pressure of
88/56 mm Hg, which inotropic agent is preferred?
A) Dobutamine
B) Milrinone
C) Dopamine
D) Norepinephrine
Answer: C
Rationale: Dopamine at moderate doses (5-10 mcg/kg/min) provides both
inotropic and vasopressor support, suitable for hypotension. Dobutamine is a
pure inotrope that can worsen hypotension. Milrinone is a phosphodiesterase
inhibitor that may cause vasodilation. Norepinephrine is primarily a
,vasopressor with minimal inotropic effect.
5 Which ECG finding is most specific for acute pericarditis?
A) Diffuse ST-segment elevation with PR depression
B) Localized ST-segment elevation in leads II, III, aVF
C) T-wave inversion in leads V1-V4
D) Pathologic Q waves in anterior leads
Answer: A
Rationale: Diffuse ST elevation with PR depression is classic for pericarditis
due to subepicardial inflammation. Localized ST elevation suggests STEMI.
T-wave inversion in V1-V4 may indicate Wellens syndrome. Pathologic Q
waves indicate prior infarction.
6 A patient on amiodarone develops new-onset cough and bilateral interstitial
infiltrates on chest X-ray. What is the priority action?
A) Discontinue amiodarone immediately
B) Obtain a CT pulmonary angiogram
C) Start empiric antibiotics
D) Administer inhaled corticosteroids
Answer: A
Rationale: Amiodarone can cause pulmonary toxicity, presenting with cough
and infiltrates. The priority is to discontinue the drug to prevent progression.
CT pulmonary angiogram is for pulmonary embolism. Antibiotics are for
infection. Inhaled corticosteroids are not first-line for drug-induced
pneumonitis.
7 Which valvular lesion produces a diastolic murmur best heard at the apex?
A) Aortic stenosis
B) Aortic regurgitation
C) Mitral stenosis
D) Mitral regurgitation
Answer: C
Rationale: Mitral stenosis causes a diastolic rumbling murmur at the apex.
Aortic stenosis is systolic at the right upper sternal border. Aortic regurgitation
is diastolic at the left sternal border. Mitral regurgitation is systolic at the apex.
, 8 A patient with hypertrophic cardiomyopathy experiences syncope during
exercise. Which mechanism is most likely?
A) Dynamic left ventricular outflow tract obstruction
B) Sustained ventricular tachycardia
C) Paradoxical embolus
D) Complete heart block
Answer: A
Rationale: Exercise increases contractility and heart rate, reducing ventricular
volume and worsening LVOT obstruction in HCM, leading to syncope. VT can
occur but is less common with exercise. Paradoxical embolus is rare. Heart
block is not typical.
9 Which laboratory finding is most consistent with acute coronary syndrome?
A) Elevated high-sensitivity troponin I
B) Elevated brain natriuretic peptide
C) Elevated D-dimer
D) Elevated creatine kinase-MB
Answer: A
Rationale: High-sensitivity troponin is the preferred biomarker for myocardial
injury due to high specificity and sensitivity. BNP indicates heart failure.
D-dimer is for thrombosis. CK-MB is less sensitive and specific than troponin.
10 A patient with chronic heart failure and an ejection fraction of 35% is
started on carvedilol. What is the expected effect on cardiac output during
the first few weeks?
A) Transient decrease followed by gradual increase
B) Immediate increase due to afterload reduction
C) No change because beta-blockers do not affect cardiac output
D) Persistent decrease requiring discontinuation
Answer: A
Rationale: Carvedilol initially reduces cardiac output due to negative inotropy,
but long-term improves ventricular remodeling and function. Afterload
reduction is modest. Beta-blockers are known to improve outcomes despite
initial hemodynamic effects. Persistent decrease is not expected.
