Comprehensive Nursing Practice Exam
Essential Questions with Detailed Answers for Quick Revision
SECTION A: MEDICAL-SURGICAL NURSING
CARDIOVASCULAR SYSTEM
Q1. A 68-year-old male presents with crushing substernal chest pain radiating to the
left arm, diaphoresis, and nausea. What is the priority nursing action?
Answer: This is a classic presentation of acute myocardial infarction (MI). Priority actions:
1) Call rapid response/activate STEMI protocol immediately, 2) Obtain 12-lead ECG within
10 minutes, 3) Administer aspirin 325 mg chewed (if not allergic), 4) Establish IV access, 5)
Administer oxygen if SpO2 <90%, 6) Prepare for thrombolytics or percutaneous coronary
intervention (PCI), 7) Continuous cardiac monitoring, and 8) Nitroglycerin sublingual (if
SBP >90 mmHg, no recent phosphodiesterase inhibitor use).
Q2. What are the hemodynamic monitoring parameters for a patient with cardiogenic
shock, and how do they guide treatment?
Answer: Hemodynamic parameters in cardiogenic shock: Cardiac output (CO) <4 L/min,
Cardiac index (CI) <2.2 L/min/m², Pulmonary artery wedge pressure (PAWP) >18 mmHg,
Systemic vascular resistance (SVR) elevated (>1,200 dynes/sec/cm⁻⁵), Central venous
pressure (CVP) >8 mmHg. Treatment guided by these parameters includes: Inotropes
(dobutamine, milrinone) to increase CO, vasopressors (norepinephrine) if MAP <65, intra-
aortic balloon pump (IABP) for refractory shock, and mechanical circulatory support
(LVAD, ECMO) if available.
Q3. A patient on a cardiac monitor develops a heart rate of 38 bpm with no P waves and
wide QRS complexes. What rhythm is this and what is the priority intervention?
Answer: This is Third-degree (complete) heart block. Priority interventions: 1) Assess
patient's hemodynamic stability (hypotension, altered mental status, chest pain, shock), 2)
, Prepare for transcutaneous pacing or transvenous pacemaker insertion if unstable, 3)
Administer atropine 0.5 mg IV (may be ineffective in complete heart block), 4) Dopamine or
epinephrine infusion for hemodynamic support, 5) Continuous monitoring, 6) Prepare for
temporary pacing until permanent pacemaker placement.
RESPIRATORY SYSTEM
Q4. A 72-year-old with COPD is receiving oxygen at 4 L/min via nasal cannula. The
patient becomes lethargic with respiratory rate of 8/min. What is happening and what
should the nurse do?
Answer: This patient is likely experiencing hypoxic drive suppression. In COPD patients
with chronic CO₂ retention, the respiratory drive shifts from CO₂ to hypoxic stimulation.
High-flow oxygen removes this stimulus. Interventions: 1) Reduce oxygen to 1-2 L/min or
24-28% Venturi mask, 2) Target SpO₂ 88-92%, 3) Assess ABGs, 4) Prepare for possible non-
invasive ventilation (BiPAP), 5) Monitor for respiratory depression, 6) Obtain stat ABG, 7)
Notify provider immediately, 8) Have intubation equipment available.
Q5. What are the key differences between asthma and COPD in terms of
pathophysiology, presentation, and management?
Answer:
Feature Asthma COPD
Reversible airway Chronic progressive airflow limitation, irreversible
Pathophysiology hyperresponsiveness, inflammation, airway remodeling, parenchymal destruction
bronchospasm (emphysema)
Onset Often childhood/young adulthood Typically >40 years with smoking history
Episodic, reversible wheezing, cough, Chronic progressive dyspnea, chronic productive
Symptoms
chest tightness cough
, Feature Asthma COPD
Significant reversibility with
Reversibility Partial to no reversibility
bronchodilators
Key triggers Allergens, exercise, cold air, infections Smoking, environmental pollutants
Long-acting bronchodilators (LABA, LAMA),
SABA rescue, ICS, LABA, leukotriene
Treatment ICS in select cases, oxygen therapy, pulmonary
modifiers
rehab
Prognosis Good with management Progressive decline, limited lifespan
Q6. A patient with pneumonia has the following ABG: pH 7.30, PaCO₂ 55 mmHg,
HCO₃ 26 mEq/L. Interpret these values and plan care.
Answer: This is Acute Respiratory Acidosis (pH <7.35, PaCO₂ >45 mmHg, HCO₃ normal).
Cause: alveolar hypoventilation due to pneumonia. Nursing interventions: 1) Assist with
positioning (semi-Fowler's to high-Fowler's), 2) Encourage deep breathing and coughing, 3)
Incentive spirometry, 4) Administer bronchodilators as ordered, 5) Monitor for need for non-
invasive or mechanical ventilation, 6) Frequent respiratory assessment, 7) If pH <7.2,
consider BiPAP or intubation.
NEUROLOGICAL SYSTEM
Q7. A patient is brought to the emergency department with facial drooping, arm
weakness, and slurred speech. Symptoms began 2 hours ago. What is the immediate
management?
Answer: This is an acute stroke presentation. Immediate management: 1) STAT non-contrast
head CT to rule out hemorrhage, 2) Neurological assessment (NIHSS), 3) Blood glucose, 4)
Determine time of symptom onset (last known well), 5) If ischemic stroke and within 4.5
hours of onset, evaluate for IV alteplase (tPA), 6) BP management (allow permissive HTN
Essential Questions with Detailed Answers for Quick Revision
SECTION A: MEDICAL-SURGICAL NURSING
CARDIOVASCULAR SYSTEM
Q1. A 68-year-old male presents with crushing substernal chest pain radiating to the
left arm, diaphoresis, and nausea. What is the priority nursing action?
Answer: This is a classic presentation of acute myocardial infarction (MI). Priority actions:
1) Call rapid response/activate STEMI protocol immediately, 2) Obtain 12-lead ECG within
10 minutes, 3) Administer aspirin 325 mg chewed (if not allergic), 4) Establish IV access, 5)
Administer oxygen if SpO2 <90%, 6) Prepare for thrombolytics or percutaneous coronary
intervention (PCI), 7) Continuous cardiac monitoring, and 8) Nitroglycerin sublingual (if
SBP >90 mmHg, no recent phosphodiesterase inhibitor use).
Q2. What are the hemodynamic monitoring parameters for a patient with cardiogenic
shock, and how do they guide treatment?
Answer: Hemodynamic parameters in cardiogenic shock: Cardiac output (CO) <4 L/min,
Cardiac index (CI) <2.2 L/min/m², Pulmonary artery wedge pressure (PAWP) >18 mmHg,
Systemic vascular resistance (SVR) elevated (>1,200 dynes/sec/cm⁻⁵), Central venous
pressure (CVP) >8 mmHg. Treatment guided by these parameters includes: Inotropes
(dobutamine, milrinone) to increase CO, vasopressors (norepinephrine) if MAP <65, intra-
aortic balloon pump (IABP) for refractory shock, and mechanical circulatory support
(LVAD, ECMO) if available.
Q3. A patient on a cardiac monitor develops a heart rate of 38 bpm with no P waves and
wide QRS complexes. What rhythm is this and what is the priority intervention?
Answer: This is Third-degree (complete) heart block. Priority interventions: 1) Assess
patient's hemodynamic stability (hypotension, altered mental status, chest pain, shock), 2)
, Prepare for transcutaneous pacing or transvenous pacemaker insertion if unstable, 3)
Administer atropine 0.5 mg IV (may be ineffective in complete heart block), 4) Dopamine or
epinephrine infusion for hemodynamic support, 5) Continuous monitoring, 6) Prepare for
temporary pacing until permanent pacemaker placement.
RESPIRATORY SYSTEM
Q4. A 72-year-old with COPD is receiving oxygen at 4 L/min via nasal cannula. The
patient becomes lethargic with respiratory rate of 8/min. What is happening and what
should the nurse do?
Answer: This patient is likely experiencing hypoxic drive suppression. In COPD patients
with chronic CO₂ retention, the respiratory drive shifts from CO₂ to hypoxic stimulation.
High-flow oxygen removes this stimulus. Interventions: 1) Reduce oxygen to 1-2 L/min or
24-28% Venturi mask, 2) Target SpO₂ 88-92%, 3) Assess ABGs, 4) Prepare for possible non-
invasive ventilation (BiPAP), 5) Monitor for respiratory depression, 6) Obtain stat ABG, 7)
Notify provider immediately, 8) Have intubation equipment available.
Q5. What are the key differences between asthma and COPD in terms of
pathophysiology, presentation, and management?
Answer:
Feature Asthma COPD
Reversible airway Chronic progressive airflow limitation, irreversible
Pathophysiology hyperresponsiveness, inflammation, airway remodeling, parenchymal destruction
bronchospasm (emphysema)
Onset Often childhood/young adulthood Typically >40 years with smoking history
Episodic, reversible wheezing, cough, Chronic progressive dyspnea, chronic productive
Symptoms
chest tightness cough
, Feature Asthma COPD
Significant reversibility with
Reversibility Partial to no reversibility
bronchodilators
Key triggers Allergens, exercise, cold air, infections Smoking, environmental pollutants
Long-acting bronchodilators (LABA, LAMA),
SABA rescue, ICS, LABA, leukotriene
Treatment ICS in select cases, oxygen therapy, pulmonary
modifiers
rehab
Prognosis Good with management Progressive decline, limited lifespan
Q6. A patient with pneumonia has the following ABG: pH 7.30, PaCO₂ 55 mmHg,
HCO₃ 26 mEq/L. Interpret these values and plan care.
Answer: This is Acute Respiratory Acidosis (pH <7.35, PaCO₂ >45 mmHg, HCO₃ normal).
Cause: alveolar hypoventilation due to pneumonia. Nursing interventions: 1) Assist with
positioning (semi-Fowler's to high-Fowler's), 2) Encourage deep breathing and coughing, 3)
Incentive spirometry, 4) Administer bronchodilators as ordered, 5) Monitor for need for non-
invasive or mechanical ventilation, 6) Frequent respiratory assessment, 7) If pH <7.2,
consider BiPAP or intubation.
NEUROLOGICAL SYSTEM
Q7. A patient is brought to the emergency department with facial drooping, arm
weakness, and slurred speech. Symptoms began 2 hours ago. What is the immediate
management?
Answer: This is an acute stroke presentation. Immediate management: 1) STAT non-contrast
head CT to rule out hemorrhage, 2) Neurological assessment (NIHSS), 3) Blood glucose, 4)
Determine time of symptom onset (last known well), 5) If ischemic stroke and within 4.5
hours of onset, evaluate for IV alteplase (tPA), 6) BP management (allow permissive HTN
