Comprehensive Medical-Surgical Nursing
Practice Exam
Ques on 1: Cardiovascular – Cardiac Tamponade
Clinical Scenario: A 62-year-old client who underwent coronary artery bypass gra
(CABG) surgery 2 days ago reports sudden, severe dyspnea and retrosternal chest
fullness. On assessment, the nurse notes jugular venous disten on, muffled heart
sounds, and a heart rate of 124 bpm. Blood pressure is 84/60 mmHg, down from 128/76
mmHg an hour ago, and decreases by 16 mmHg during inhala on.
Ques on Stem: Which immediate nursing ac on is the highest priority?
Op ons:
o A. Place the client in High-Fowler’s posi on and administer prescribed prn
morphine.
o B. No fy the healthcare provider immediately and prepare for
pericardiocentesis.
o C. Administer an immediate 500 mL normal saline IV fluid bolus.
o D. Obtain a STAT 12-lead electrocardiogram (ECG) and portable chest radiograph.
Answer and Ra onale
Correct Answer: B. No fy the healthcare provider immediately and prepare for
pericardiocentesis.
Cogni ve Level: Analyzing
Client Needs Category: Physiological Adapta on
, Main Lesson / Takeaway: Cardiac tamponade is a life-threatening medical emergency
requiring immediate no fica on of the provider and emergency drainage of pericardial
fluid.
Detailed Ra onale:
o The client is exhibi ng the classic hallmarks of cardiac tamponade: Beck's triad
(hypotension, jugular venous disten on, and muffled/distant heart sounds)
alongside pulsus paradoxus (a drop in systolic BP > 10 mmHg during inspira on).
Pericardial effusion compresses the cardiac chambers, preven ng adequate
diastolic filling and dras cally dropping cardiac output. Immediate medical
interven on via pericardiocentesis or surgical window is required to relieve fluid
accumula on around the pericardium.
o Op on A is incorrect: Posi oning in High-Fowler's and giving opioids decreases
preload, which will further collapse the right atrium and ventricle in cardiac
tamponade, worsening hypotension and cardiac output.
o Op on C is incorrect: While temporary IV fluid administra on may help maintain
preload in tamponade un l defini ve care arrives, it is not the primary
interven on; no fying the provider and preparing for emergency
pericardiocentesis takes absolute priority.
o Op on D is incorrect: Diagnos cs like a 12-lead ECG or chest radiograph will
confirm low voltage/electrical alternans or cardiomegaly, but delaying
no fica on and emergent interven on for diagnos c tes ng in a rapidly
deteriora ng client can lead to cardiac arrest.
Ques on 2: Respiratory – Acute Asthma Exacerba on & "Silent Chest"
Clinical Scenario: A 24-year-old client with a history of severe persistent asthma
presents to the emergency department in acute respiratory distress. Ini al assessment
reveals tripod posi oning, intercostal retrac ons, a respiratory rate of 34 breaths/min,
and audible high-pitched wheezing throughout all lung fields. Ten minutes a er
, receiving an inhaled con nuous albuterol nebulizer treatment, the nurse re-evaluates
the client and notes that respiratory effort remains rapid but breath sounds are now
severely diminished with no audible wheezing.
Ques on Stem: What is the nurse's priority ac on?
Op ons:
o A. Document improved airway resistance and encourage the client to perform
deep-breathing exercises.
o B. Ac vate the rapid response team and prepare for immediate endotracheal
intuba on.
o C. Administer a second dose of nebulized albuterol and reassess in 15 minutes.
o D. Place the client in a supine posi on and obtain an arterial blood gas (ABG)
sample.
Answer and Ra onale
Correct Answer: B. Ac vate the rapid response team and prepare for immediate
endotracheal intuba on.
Cogni ve Level: Evalua ng
Client Needs Category: Physiological Adapta on
Main Lesson / Takeaway: The sudden cessa on of wheezing ("silent chest") during an
acute asthma exacerba on indicates cri cal airway obstruc on and impending
respiratory failure.
Detailed Ra onale:
o A "silent chest" occurs when broncho-constric on and mucus plugging become
so severe that air movement through the bronchial tree is minimal or
nonexistent. The absence of wheezing in a client previously wheezing loudly who
remains in distress is an ominous sign of imminent complete airway obstruc on
, and fa gue, requiring immediate escala on, rapid response call, and emergency
intuba on.
o Op on A is incorrect: Misinterpre ng the loss of wheezing as clinical
improvement is a fatal nursing error; reduced sound in a tachypneic pa ent
indicates severe airflow obstruc on, not resolu on.
o Op on C is incorrect: Nebulized bronchodilators require airflow to deliver
medica on into distal airways. In a silent chest scenario, nebulized drugs cannot
reach the target ssue, and delaying mechanical ven la on puts the client at risk
of respiratory arrest.
o Op on D is incorrect: Supine posi oning compromises diaphragma c excursion
and worsens work of breathing. While ABGs provide valuable data, obtaining
them should not delay emergency airway management.
Ques on 3: Neurological – Increased Intracranial Pressure (ICP) & Cushing's Triad
Clinical Scenario: A 45-year-old client admi ed with a severe trauma c brain injury (TBI)
is being monitored in the intensive care unit. Over the last hour, the client’s Glasgow
Coma Scale (GCS) score has decreased from 12 to 8. Current vital signs are: BP 188/54
mmHg, HR 46 bpm (irregular), and RR 10 breaths/min (irregular/Cheyne-Stokes).
Ques on Stem: Based on these findings, which prescrip on should the nurse an cipate
implemen ng first?
Op ons:
o A. Administer IV push Hydralazine to reduce systolic blood pressure.
o B. Infuse IV Mannitol 20% over 30 minutes as prescribed.
o C. Administer Atropine IV push to correct the bradycardia.
o D. Lower the head of the bed to 0 degrees to improve cerebral perfusion
pressure (CPP).
Practice Exam
Ques on 1: Cardiovascular – Cardiac Tamponade
Clinical Scenario: A 62-year-old client who underwent coronary artery bypass gra
(CABG) surgery 2 days ago reports sudden, severe dyspnea and retrosternal chest
fullness. On assessment, the nurse notes jugular venous disten on, muffled heart
sounds, and a heart rate of 124 bpm. Blood pressure is 84/60 mmHg, down from 128/76
mmHg an hour ago, and decreases by 16 mmHg during inhala on.
Ques on Stem: Which immediate nursing ac on is the highest priority?
Op ons:
o A. Place the client in High-Fowler’s posi on and administer prescribed prn
morphine.
o B. No fy the healthcare provider immediately and prepare for
pericardiocentesis.
o C. Administer an immediate 500 mL normal saline IV fluid bolus.
o D. Obtain a STAT 12-lead electrocardiogram (ECG) and portable chest radiograph.
Answer and Ra onale
Correct Answer: B. No fy the healthcare provider immediately and prepare for
pericardiocentesis.
Cogni ve Level: Analyzing
Client Needs Category: Physiological Adapta on
, Main Lesson / Takeaway: Cardiac tamponade is a life-threatening medical emergency
requiring immediate no fica on of the provider and emergency drainage of pericardial
fluid.
Detailed Ra onale:
o The client is exhibi ng the classic hallmarks of cardiac tamponade: Beck's triad
(hypotension, jugular venous disten on, and muffled/distant heart sounds)
alongside pulsus paradoxus (a drop in systolic BP > 10 mmHg during inspira on).
Pericardial effusion compresses the cardiac chambers, preven ng adequate
diastolic filling and dras cally dropping cardiac output. Immediate medical
interven on via pericardiocentesis or surgical window is required to relieve fluid
accumula on around the pericardium.
o Op on A is incorrect: Posi oning in High-Fowler's and giving opioids decreases
preload, which will further collapse the right atrium and ventricle in cardiac
tamponade, worsening hypotension and cardiac output.
o Op on C is incorrect: While temporary IV fluid administra on may help maintain
preload in tamponade un l defini ve care arrives, it is not the primary
interven on; no fying the provider and preparing for emergency
pericardiocentesis takes absolute priority.
o Op on D is incorrect: Diagnos cs like a 12-lead ECG or chest radiograph will
confirm low voltage/electrical alternans or cardiomegaly, but delaying
no fica on and emergent interven on for diagnos c tes ng in a rapidly
deteriora ng client can lead to cardiac arrest.
Ques on 2: Respiratory – Acute Asthma Exacerba on & "Silent Chest"
Clinical Scenario: A 24-year-old client with a history of severe persistent asthma
presents to the emergency department in acute respiratory distress. Ini al assessment
reveals tripod posi oning, intercostal retrac ons, a respiratory rate of 34 breaths/min,
and audible high-pitched wheezing throughout all lung fields. Ten minutes a er
, receiving an inhaled con nuous albuterol nebulizer treatment, the nurse re-evaluates
the client and notes that respiratory effort remains rapid but breath sounds are now
severely diminished with no audible wheezing.
Ques on Stem: What is the nurse's priority ac on?
Op ons:
o A. Document improved airway resistance and encourage the client to perform
deep-breathing exercises.
o B. Ac vate the rapid response team and prepare for immediate endotracheal
intuba on.
o C. Administer a second dose of nebulized albuterol and reassess in 15 minutes.
o D. Place the client in a supine posi on and obtain an arterial blood gas (ABG)
sample.
Answer and Ra onale
Correct Answer: B. Ac vate the rapid response team and prepare for immediate
endotracheal intuba on.
Cogni ve Level: Evalua ng
Client Needs Category: Physiological Adapta on
Main Lesson / Takeaway: The sudden cessa on of wheezing ("silent chest") during an
acute asthma exacerba on indicates cri cal airway obstruc on and impending
respiratory failure.
Detailed Ra onale:
o A "silent chest" occurs when broncho-constric on and mucus plugging become
so severe that air movement through the bronchial tree is minimal or
nonexistent. The absence of wheezing in a client previously wheezing loudly who
remains in distress is an ominous sign of imminent complete airway obstruc on
, and fa gue, requiring immediate escala on, rapid response call, and emergency
intuba on.
o Op on A is incorrect: Misinterpre ng the loss of wheezing as clinical
improvement is a fatal nursing error; reduced sound in a tachypneic pa ent
indicates severe airflow obstruc on, not resolu on.
o Op on C is incorrect: Nebulized bronchodilators require airflow to deliver
medica on into distal airways. In a silent chest scenario, nebulized drugs cannot
reach the target ssue, and delaying mechanical ven la on puts the client at risk
of respiratory arrest.
o Op on D is incorrect: Supine posi oning compromises diaphragma c excursion
and worsens work of breathing. While ABGs provide valuable data, obtaining
them should not delay emergency airway management.
Ques on 3: Neurological – Increased Intracranial Pressure (ICP) & Cushing's Triad
Clinical Scenario: A 45-year-old client admi ed with a severe trauma c brain injury (TBI)
is being monitored in the intensive care unit. Over the last hour, the client’s Glasgow
Coma Scale (GCS) score has decreased from 12 to 8. Current vital signs are: BP 188/54
mmHg, HR 46 bpm (irregular), and RR 10 breaths/min (irregular/Cheyne-Stokes).
Ques on Stem: Based on these findings, which prescrip on should the nurse an cipate
implemen ng first?
Op ons:
o A. Administer IV push Hydralazine to reduce systolic blood pressure.
o B. Infuse IV Mannitol 20% over 30 minutes as prescribed.
o C. Administer Atropine IV push to correct the bradycardia.
o D. Lower the head of the bed to 0 degrees to improve cerebral perfusion
pressure (CPP).
