Medical-Surgical Nursing Certification
Comprehensive Review Guide
Practice Questions with Detailed Rationales
Evidence-Based Med-Surg Nursing Practice
1. Cardiovascular Disorders
Question 1:
A patient presents with crushing chest pain radiating to the left arm, diaphoresis, and
nausea. The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. This
indicates:
A) Anterior wall myocardial infarction
B) Lateral wall myocardial infarction
C) Inferior wall myocardial infarction
D) Posterior wall myocardial infarction
Answer: C) Inferior wall myocardial infarction
ST elevation in leads II, III, and aVF indicates inferior wall MI, typically involving
the right coronary artery. These patients may also have right ventricular involvement,
so avoid nitrates and maintain preload. Always obtain right-sided ECG leads to
assess RV infarction.
Question 2:
A patient with heart failure is prescribed spironolactone. The nurse should monitor
for:
A) Hypokalemia
B) Hyperkalemia
C) Hypocalcemia
D) Hypernatremia
Answer: B) Hyperkalemia
Spironolactone is a potassium-sparing diuretic that can cause dangerous
hyperkalemia. Monitor serum potassium levels regularly, avoid potassium
supplements, and educate patients about limiting high-potassium foods. Signs of
hyperkalemia include muscle weakness, cardiac arrhythmias, and peaked T waves on
ECG.
Question 3:
Which assessment finding indicates left-sided heart failure?
A) Jugular venous distention
B) Peripheral edema
C) Crackles in lung bases
D) Hepatomegaly
Answer: C) Crackles in lung bases
Left-sided heart failure causes pulmonary congestion, resulting in crackles, dyspnea,
and orthopnea. Right-sided heart failure causes systemic congestion with JVD,
, peripheral edema, and hepatomegaly. Many patients have biventricular failure with
signs of both.
Question 4:
A patient on warfarin therapy has an INR of 5.5. The nurse should anticipate
administering:
A) Vitamin K
B) Protamine sulfate
C) Fresh frozen plasma
D) Platelets
Answer: A) Vitamin K
INR of 5.5 indicates supratherapeutic anticoagulation. Vitamin K reverses warfarin
effects. Protamine sulfate reverses heparin. The urgency and dose of vitamin K
depend on whether the patient is bleeding. Hold warfarin dose and reassess INR.
CRITICAL: For STEMI patients, door-to-balloon time should be <90 minutes
for PCI or door-to-needle time <30 minutes for thrombolytics.
2. Respiratory Disorders
Question 5:
A patient with COPD has ABG results: pH 7.32, PaCO2 58 mmHg, HCO3 30 mEq/L,
PaO2 55 mmHg. This indicates:
A) Metabolic acidosis
B) Respiratory acidosis with compensation
C) Metabolic alkalosis
D) Respiratory alkalosis
Answer: B) Respiratory acidosis with compensation
pH <7.35 indicates acidosis. Elevated PaCO2 shows respiratory cause. Elevated
HCO3 indicates metabolic compensation. This is common in chronic COPD where
kidneys retain bicarbonate to compensate for chronic CO2 retention.
Question 6:
A patient with asthma is using a metered-dose inhaler with albuterol and
beclomethasone. The correct teaching includes:
A) Use beclomethasone first, then albuterol
B) Use albuterol first, then beclomethasone
C) Use both medications simultaneously
D) Alternate medications each time
Answer: B) Use albuterol first, then beclomethasone
Use the bronchodilator (albuterol) first to open airways, wait 5 minutes, then use the
corticosteroid (beclomethasone) for better penetration. Rinse mouth after
corticosteroid use to prevent oral candidiasis.
Question 7:
Which finding indicates a pneumothorax requiring immediate intervention?
Comprehensive Review Guide
Practice Questions with Detailed Rationales
Evidence-Based Med-Surg Nursing Practice
1. Cardiovascular Disorders
Question 1:
A patient presents with crushing chest pain radiating to the left arm, diaphoresis, and
nausea. The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. This
indicates:
A) Anterior wall myocardial infarction
B) Lateral wall myocardial infarction
C) Inferior wall myocardial infarction
D) Posterior wall myocardial infarction
Answer: C) Inferior wall myocardial infarction
ST elevation in leads II, III, and aVF indicates inferior wall MI, typically involving
the right coronary artery. These patients may also have right ventricular involvement,
so avoid nitrates and maintain preload. Always obtain right-sided ECG leads to
assess RV infarction.
Question 2:
A patient with heart failure is prescribed spironolactone. The nurse should monitor
for:
A) Hypokalemia
B) Hyperkalemia
C) Hypocalcemia
D) Hypernatremia
Answer: B) Hyperkalemia
Spironolactone is a potassium-sparing diuretic that can cause dangerous
hyperkalemia. Monitor serum potassium levels regularly, avoid potassium
supplements, and educate patients about limiting high-potassium foods. Signs of
hyperkalemia include muscle weakness, cardiac arrhythmias, and peaked T waves on
ECG.
Question 3:
Which assessment finding indicates left-sided heart failure?
A) Jugular venous distention
B) Peripheral edema
C) Crackles in lung bases
D) Hepatomegaly
Answer: C) Crackles in lung bases
Left-sided heart failure causes pulmonary congestion, resulting in crackles, dyspnea,
and orthopnea. Right-sided heart failure causes systemic congestion with JVD,
, peripheral edema, and hepatomegaly. Many patients have biventricular failure with
signs of both.
Question 4:
A patient on warfarin therapy has an INR of 5.5. The nurse should anticipate
administering:
A) Vitamin K
B) Protamine sulfate
C) Fresh frozen plasma
D) Platelets
Answer: A) Vitamin K
INR of 5.5 indicates supratherapeutic anticoagulation. Vitamin K reverses warfarin
effects. Protamine sulfate reverses heparin. The urgency and dose of vitamin K
depend on whether the patient is bleeding. Hold warfarin dose and reassess INR.
CRITICAL: For STEMI patients, door-to-balloon time should be <90 minutes
for PCI or door-to-needle time <30 minutes for thrombolytics.
2. Respiratory Disorders
Question 5:
A patient with COPD has ABG results: pH 7.32, PaCO2 58 mmHg, HCO3 30 mEq/L,
PaO2 55 mmHg. This indicates:
A) Metabolic acidosis
B) Respiratory acidosis with compensation
C) Metabolic alkalosis
D) Respiratory alkalosis
Answer: B) Respiratory acidosis with compensation
pH <7.35 indicates acidosis. Elevated PaCO2 shows respiratory cause. Elevated
HCO3 indicates metabolic compensation. This is common in chronic COPD where
kidneys retain bicarbonate to compensate for chronic CO2 retention.
Question 6:
A patient with asthma is using a metered-dose inhaler with albuterol and
beclomethasone. The correct teaching includes:
A) Use beclomethasone first, then albuterol
B) Use albuterol first, then beclomethasone
C) Use both medications simultaneously
D) Alternate medications each time
Answer: B) Use albuterol first, then beclomethasone
Use the bronchodilator (albuterol) first to open airways, wait 5 minutes, then use the
corticosteroid (beclomethasone) for better penetration. Rinse mouth after
corticosteroid use to prevent oral candidiasis.
Question 7:
Which finding indicates a pneumothorax requiring immediate intervention?
