Jersey College MedSurg 1 RN Final Exam
Comprehensive Practice Assessment Actual Exam
2026/2027 Complete Exam-Style Questions with
Detailed Rationales | 100% Verified | Pass Guaranteed
– A+ Graded
Part I: Cardiovascular & Respiratory Disorders (Questions 1–20)
Q1: A 68-year-old male is admitted with acute decompensated heart failure. His vital
signs are BP 162/94, HR 108, RR 26, SpO₂ 88% on room air. He has crackles bilaterally
and 3+ pitting edema in both legs. Which assessment finding requires the most
immediate intervention by the nurse?
A. Blood pressure of 162/94 mmHg
B. Oxygen saturation of 88%
C. Heart rate of 108 beats per minute
D. 3+ pitting edema in bilateral lower extremities
B. Oxygen saturation of 88% [CORRECT]
Correct Answer: B
Rationale: The best answer is B. When a patient is sitting at 88% on room air with
bilateral crackles and working hard to breathe at 26 respirations per minute, that
hypoxemia is your biggest threat right now. In MedSurg 1 we always come back to the
ABCs, and this gentleman’s airway is fine but his breathing and oxygenation are not. You
need to get him on oxygen immediately and notify the provider. The other findings are
absolutely important and you’ll address them, but they don’t trump inadequate
oxygenation.
Q2: Which laboratory value would the nurse expect to be elevated in a patient
diagnosed with heart failure?
,A. Hemoglobin 14.2 g/dL
B. BNP 1,250 pg/mL
C. Serum sodium 138 mEq/L
D. Troponin I 0.02 ng/mL
B. BNP 1,250 pg/mL [CORRECT]
Correct Answer: B
Rationale: The best answer is B. BNP, or B-type natriuretic peptide, gets released when
the ventricles are stretched and under pressure—exactly what happens in heart failure. A
normal BNP is usually under 100, so 1,250 is significantly elevated and supports the
diagnosis. Troponin would tell you about cardiac muscle injury like an MI, and the
hemoglobin and sodium values listed here are within normal limits and don’t point to
heart failure specifically.
Q3: A nurse is caring for a patient 24 hours post-MI who suddenly develops ventricular
tachycardia with a pulse. The patient is alert but diaphoretic and complaining of
dizziness. What is the nurse’s first action?
A. Administer amiodarone per protocol
B. Defibrillate immediately
C. Prepare for synchronized cardioversion
D. Assess the patient’s blood pressure and level of consciousness
D. Assess the patient’s blood pressure and level of consciousness [CORRECT]
Correct Answer: D
Rationale: The best answer is D. Even though the rhythm is V-tach, this patient still has
a pulse and is talking to you. Your first job is to do a quick assessment of how stable he
is—check that blood pressure and mental status. If he’s unstable, you move toward
cardioversion. If he’s stable, you have time to follow your facility’s V-tach with pulse
protocol, which usually starts with medications like amiodarone. You only defibrillate
pulseless rhythms, so don’t reach for the paddles here.
,Q4: A patient with chronic hypertension is prescribed lisinopril. The nurse should instruct
the patient to report which side effect immediately?
A. Dry, nonproductive cough
B. Occasional mild headache
C. Slight ankle swelling in the evening
D. One episode of loose stool
A. Dry, nonproductive cough [CORRECT]
Correct Answer: A
Rationale: The best answer is A. ACE inhibitors like lisinopril are notorious for causing
that dry, hacking cough because they block the breakdown of bradykinin. While it’s not
usually dangerous, it bothers patients enough that they often need to switch to an ARB.
The nurse should definitely have the patient call the provider about it. Mild headaches
and slight ankle swelling are pretty nonspecific and not urgent, and one loose stool is
nothing to worry about with this medication.
Q5: The nurse is reviewing the medication administration record for a patient with atrial
fibrillation. Which medication would the nurse expect to see prescribed for rate control?
A. Warfarin 5 mg daily
B. Metoprolol 25 mg twice daily
C. Aspirin 81 mg daily
D. Clopidogrel 75 mg daily
B. Metoprolol 25 mg twice daily [CORRECT]
Correct Answer: B
Rationale: The best answer is B. Metoprolol is a beta-blocker, and beta-blockers are
first-line for controlling the ventricular rate in atrial fibrillation. They slow down that AV
node conduction so the heart doesn’t race. Warfarin, aspirin, and clopidogrel are all
, about preventing clots and strokes, which is also important in A-fib, but they don’t do
anything to control how fast the heart is beating.
Q6: A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse
notes the patient’s SpO₂ is 95%. Which action should the nurse take?
A. Increase the oxygen to 6 L/min to maintain optimal saturation
B. Decrease the oxygen to 2 L/min to avoid suppressing the respiratory drive
C. Maintain the current oxygen flow rate and continue monitoring
D. Switch the patient to a non-rebreather mask at 10 L/min
B. Decrease the oxygen to 2 L/min to avoid suppressing the respiratory drive
[CORRECT]
Correct Answer: B
Rationale: The best answer is B. In COPD patients, we have to be careful with oxygen
because they live with chronic hypercapnia and their respiratory drive is often triggered
by low oxygen levels rather than high CO₂. If you overshoot and get them to 95%, you
can actually knock out that hypoxic drive and cause them to stop breathing. We aim for
about 88–92% in these folks, so backing down to 2 L/min is the right call here.
Q7: A nurse is assessing a patient with pneumonia. Which finding indicates the patient
may be developing septic shock?
A. Temperature 101.2°F, heart rate 96
B. Blood pressure 88/52 mmHg, cool clammy skin
C. Respiratory rate 22, productive cough
D. Oxygen saturation 92% on 2 L nasal cannula
B. Blood pressure 88/52 mmHg, cool clammy skin [CORRECT]
Correct Answer: B
Rationale: The best answer is B. When pneumonia progresses to sepsis and then septic
Comprehensive Practice Assessment Actual Exam
2026/2027 Complete Exam-Style Questions with
Detailed Rationales | 100% Verified | Pass Guaranteed
– A+ Graded
Part I: Cardiovascular & Respiratory Disorders (Questions 1–20)
Q1: A 68-year-old male is admitted with acute decompensated heart failure. His vital
signs are BP 162/94, HR 108, RR 26, SpO₂ 88% on room air. He has crackles bilaterally
and 3+ pitting edema in both legs. Which assessment finding requires the most
immediate intervention by the nurse?
A. Blood pressure of 162/94 mmHg
B. Oxygen saturation of 88%
C. Heart rate of 108 beats per minute
D. 3+ pitting edema in bilateral lower extremities
B. Oxygen saturation of 88% [CORRECT]
Correct Answer: B
Rationale: The best answer is B. When a patient is sitting at 88% on room air with
bilateral crackles and working hard to breathe at 26 respirations per minute, that
hypoxemia is your biggest threat right now. In MedSurg 1 we always come back to the
ABCs, and this gentleman’s airway is fine but his breathing and oxygenation are not. You
need to get him on oxygen immediately and notify the provider. The other findings are
absolutely important and you’ll address them, but they don’t trump inadequate
oxygenation.
Q2: Which laboratory value would the nurse expect to be elevated in a patient
diagnosed with heart failure?
,A. Hemoglobin 14.2 g/dL
B. BNP 1,250 pg/mL
C. Serum sodium 138 mEq/L
D. Troponin I 0.02 ng/mL
B. BNP 1,250 pg/mL [CORRECT]
Correct Answer: B
Rationale: The best answer is B. BNP, or B-type natriuretic peptide, gets released when
the ventricles are stretched and under pressure—exactly what happens in heart failure. A
normal BNP is usually under 100, so 1,250 is significantly elevated and supports the
diagnosis. Troponin would tell you about cardiac muscle injury like an MI, and the
hemoglobin and sodium values listed here are within normal limits and don’t point to
heart failure specifically.
Q3: A nurse is caring for a patient 24 hours post-MI who suddenly develops ventricular
tachycardia with a pulse. The patient is alert but diaphoretic and complaining of
dizziness. What is the nurse’s first action?
A. Administer amiodarone per protocol
B. Defibrillate immediately
C. Prepare for synchronized cardioversion
D. Assess the patient’s blood pressure and level of consciousness
D. Assess the patient’s blood pressure and level of consciousness [CORRECT]
Correct Answer: D
Rationale: The best answer is D. Even though the rhythm is V-tach, this patient still has
a pulse and is talking to you. Your first job is to do a quick assessment of how stable he
is—check that blood pressure and mental status. If he’s unstable, you move toward
cardioversion. If he’s stable, you have time to follow your facility’s V-tach with pulse
protocol, which usually starts with medications like amiodarone. You only defibrillate
pulseless rhythms, so don’t reach for the paddles here.
,Q4: A patient with chronic hypertension is prescribed lisinopril. The nurse should instruct
the patient to report which side effect immediately?
A. Dry, nonproductive cough
B. Occasional mild headache
C. Slight ankle swelling in the evening
D. One episode of loose stool
A. Dry, nonproductive cough [CORRECT]
Correct Answer: A
Rationale: The best answer is A. ACE inhibitors like lisinopril are notorious for causing
that dry, hacking cough because they block the breakdown of bradykinin. While it’s not
usually dangerous, it bothers patients enough that they often need to switch to an ARB.
The nurse should definitely have the patient call the provider about it. Mild headaches
and slight ankle swelling are pretty nonspecific and not urgent, and one loose stool is
nothing to worry about with this medication.
Q5: The nurse is reviewing the medication administration record for a patient with atrial
fibrillation. Which medication would the nurse expect to see prescribed for rate control?
A. Warfarin 5 mg daily
B. Metoprolol 25 mg twice daily
C. Aspirin 81 mg daily
D. Clopidogrel 75 mg daily
B. Metoprolol 25 mg twice daily [CORRECT]
Correct Answer: B
Rationale: The best answer is B. Metoprolol is a beta-blocker, and beta-blockers are
first-line for controlling the ventricular rate in atrial fibrillation. They slow down that AV
node conduction so the heart doesn’t race. Warfarin, aspirin, and clopidogrel are all
, about preventing clots and strokes, which is also important in A-fib, but they don’t do
anything to control how fast the heart is beating.
Q6: A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse
notes the patient’s SpO₂ is 95%. Which action should the nurse take?
A. Increase the oxygen to 6 L/min to maintain optimal saturation
B. Decrease the oxygen to 2 L/min to avoid suppressing the respiratory drive
C. Maintain the current oxygen flow rate and continue monitoring
D. Switch the patient to a non-rebreather mask at 10 L/min
B. Decrease the oxygen to 2 L/min to avoid suppressing the respiratory drive
[CORRECT]
Correct Answer: B
Rationale: The best answer is B. In COPD patients, we have to be careful with oxygen
because they live with chronic hypercapnia and their respiratory drive is often triggered
by low oxygen levels rather than high CO₂. If you overshoot and get them to 95%, you
can actually knock out that hypoxic drive and cause them to stop breathing. We aim for
about 88–92% in these folks, so backing down to 2 L/min is the right call here.
Q7: A nurse is assessing a patient with pneumonia. Which finding indicates the patient
may be developing septic shock?
A. Temperature 101.2°F, heart rate 96
B. Blood pressure 88/52 mmHg, cool clammy skin
C. Respiratory rate 22, productive cough
D. Oxygen saturation 92% on 2 L nasal cannula
B. Blood pressure 88/52 mmHg, cool clammy skin [CORRECT]
Correct Answer: B
Rationale: The best answer is B. When pneumonia progresses to sepsis and then septic
