CJE MEDICAL-SURGICAL NURSING I
EXAM PREP COMPLETE 200-
QUESTION BANK WITH ANSWERS &
CLINICAL RATIONALES Most Recent
[Already Graded A+]
SECTION 1: CARDIAC & HEMODYNAMIC DISORDERS
Question 1:
A patient with ST-elevation myocardial infarction (STEMI) develops a new
murmur and acute hypotension. Which complication is most likely?
A. Free wall rupture
B. Ventricular septal rupture
C. Papillary muscle rupture
D. Pericarditis
Answer: C. Papillary muscle rupture
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 sternal border.
,Question 2:
A patient with heart failure has 2+ pitting edema and shortness of
breath. Which priority assessment should the nurse perform?
A. Review diet history
B. Ask about activity level
C. Daily weight
D. Measure abdominal girth
Answer: C. Daily weight
Rationale: Daily weight is the best indicator of fluid volume changes in
heart failure. A weight gain of 2-3 pounds in 24 hours or 5 pounds in a
week may indicate worsening fluid retention and require intervention.
Question 3:
A patient presents with a heart rate of 42 bpm and is cool and clammy.
What is the next expected intervention?
A. Adenosine
B. Epinephrine
C. Amiodarone
D. Atropine
Answer: D. Atropine
Rationale: Atropine is the first-line medication for symptomatic
bradycardia showing signs of low perfusion (pale, cool, clammy skin,
hypotension, altered mental status). The dose is 0.5 mg IV push.
Question 4:
A patient's ECG shows "tombstone-like" rhythms, and no pulse is
detected. What is the priority intervention?
,A. Synchronized cardioversion
B. Atropine
C. CPR only
D. Defibrillation
Answer: D. Defibrillation
Rationale: "Tombstone-like" heart rhythms typically indicate ventricular
tachycardia. Patients in V-tach with a pulse receive synchronized
cardioversion, while V-tach patients without a pulse receive immediate
defibrillation.
Question 5:
Before administering digoxin, which assessment finding would require
the nurse to hold the medication?
A. Blood pressure 140/90 mmHg
B. Respiratory rate 18/min
C. Apical pulse 52 bpm
D. Temperature 98.6°F
Answer: C. Apical pulse 52 bpm
Rationale: Digoxin should be held if the apical pulse is < 60 bpm in an
adult. The nurse should assess the apical pulse for a full minute before
administering digoxin. Bradycardia may indicate digoxin toxicity.
Question 6:
A patient receiving IV fluids develops crackles and dyspnea. What is the
priority action?
A. Increase the IV rate
B. Give analgesics
, C. Slow the infusion
D. Check blood glucose
Answer: C. Slow the infusion
Rationale: Crackles and dyspnea indicate fluid overload. The priority is
to slow the IV infusion rate and notify the healthcare provider. This
prevents further fluid accumulation in the lungs.
SECTION 2: RESPIRATORY DISORDERS
Question 7:
A patient with COPD has an oxygen saturation of 88% on room air. What
is the appropriate intervention?
A. Increase O₂ to 6 L/min
B. Keep patient on room air
C. Apply non-rebreather
D. Start 1-2 L/min via nasal cannula
Answer: D. Start 1-2 L/min via nasal cannula
Rationale: COPD patients require low-flow O₂ (1-2 L/min) to prevent
CO₂ retention. High-flow oxygen can decrease the hypoxic drive and
lead to respiratory failure in these patients.
Question 8:
A patient with pneumonia has a respiratory rate of 32/min and use of
accessory muscles. What is the priority action?
A. Lay flat
B. Encourage deep breathing only
C. Give warm fluids
D. Increase oxygen
EXAM PREP COMPLETE 200-
QUESTION BANK WITH ANSWERS &
CLINICAL RATIONALES Most Recent
[Already Graded A+]
SECTION 1: CARDIAC & HEMODYNAMIC DISORDERS
Question 1:
A patient with ST-elevation myocardial infarction (STEMI) develops a new
murmur and acute hypotension. Which complication is most likely?
A. Free wall rupture
B. Ventricular septal rupture
C. Papillary muscle rupture
D. Pericarditis
Answer: C. Papillary muscle rupture
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 sternal border.
,Question 2:
A patient with heart failure has 2+ pitting edema and shortness of
breath. Which priority assessment should the nurse perform?
A. Review diet history
B. Ask about activity level
C. Daily weight
D. Measure abdominal girth
Answer: C. Daily weight
Rationale: Daily weight is the best indicator of fluid volume changes in
heart failure. A weight gain of 2-3 pounds in 24 hours or 5 pounds in a
week may indicate worsening fluid retention and require intervention.
Question 3:
A patient presents with a heart rate of 42 bpm and is cool and clammy.
What is the next expected intervention?
A. Adenosine
B. Epinephrine
C. Amiodarone
D. Atropine
Answer: D. Atropine
Rationale: Atropine is the first-line medication for symptomatic
bradycardia showing signs of low perfusion (pale, cool, clammy skin,
hypotension, altered mental status). The dose is 0.5 mg IV push.
Question 4:
A patient's ECG shows "tombstone-like" rhythms, and no pulse is
detected. What is the priority intervention?
,A. Synchronized cardioversion
B. Atropine
C. CPR only
D. Defibrillation
Answer: D. Defibrillation
Rationale: "Tombstone-like" heart rhythms typically indicate ventricular
tachycardia. Patients in V-tach with a pulse receive synchronized
cardioversion, while V-tach patients without a pulse receive immediate
defibrillation.
Question 5:
Before administering digoxin, which assessment finding would require
the nurse to hold the medication?
A. Blood pressure 140/90 mmHg
B. Respiratory rate 18/min
C. Apical pulse 52 bpm
D. Temperature 98.6°F
Answer: C. Apical pulse 52 bpm
Rationale: Digoxin should be held if the apical pulse is < 60 bpm in an
adult. The nurse should assess the apical pulse for a full minute before
administering digoxin. Bradycardia may indicate digoxin toxicity.
Question 6:
A patient receiving IV fluids develops crackles and dyspnea. What is the
priority action?
A. Increase the IV rate
B. Give analgesics
, C. Slow the infusion
D. Check blood glucose
Answer: C. Slow the infusion
Rationale: Crackles and dyspnea indicate fluid overload. The priority is
to slow the IV infusion rate and notify the healthcare provider. This
prevents further fluid accumulation in the lungs.
SECTION 2: RESPIRATORY DISORDERS
Question 7:
A patient with COPD has an oxygen saturation of 88% on room air. What
is the appropriate intervention?
A. Increase O₂ to 6 L/min
B. Keep patient on room air
C. Apply non-rebreather
D. Start 1-2 L/min via nasal cannula
Answer: D. Start 1-2 L/min via nasal cannula
Rationale: COPD patients require low-flow O₂ (1-2 L/min) to prevent
CO₂ retention. High-flow oxygen can decrease the hypoxic drive and
lead to respiratory failure in these patients.
Question 8:
A patient with pneumonia has a respiratory rate of 32/min and use of
accessory muscles. What is the priority action?
A. Lay flat
B. Encourage deep breathing only
C. Give warm fluids
D. Increase oxygen
