Medical-Surgical Nursing Exam 3 PREPARATION
MEDICAL-SURGICAL NURSING EXAM 3 PREPARATION NEWEST
2025/2026 WITH COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES| BRAND NEW VERSION!
The patient is being dismissed from the hospital after acute coronary syndrome
(ACS) and will be attending rehabilitation. What information would be taught in
the early recovery phase of rehabilitation?
A. Therapeutic lifestyle changes should become lifelong habits.
B. Physical activity is always started in the hospital and continued at home.
C. Attention will focus on managing chest pain, anxiety, dysrhythmias, and other
complications.
D. Activity level is gradually increased under cardiac rehabilitation team
supervision and monitoring.
correct answer: d
Rationale:
In the early recovery phase after the patient is dismissed from the hospital, the
activity level is gradually increased under supervision and with ECG monitoring.
The late recovery phase includes therapeutic lifestyle changes that become
lifelong habits. In the first phase of recovery, activity is dependent on the
severity of the angina or myocardial infarction, and attention is focused on the
management of chest pain, anxiety, dysrhythmias, and other complications.
With early recovery phase, the cardiac rehabilitation team may suggest that
physical activity be initiated at home, but this is not always done.
A patient admitted to the emergency department 24 hours ago with reports of
chest pain was diagnosed with a ST-segment-elevation myocardial infarction
(STEMI). What complication of myocardial infarction should the nurse anticipate?
A. Dysrhythmias
B. Unstable angina
C. Cardiac tamponade
D. Sudden cardiac death
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, Medical-Surgical Nursing Exam 3 PREPARATION
correct answer: a
Rationale:
Dysrhythmias are present in 80% to 90% of patients after myocardial infarction
(MI). Unstable angina is considered a precursor to MI rather than a
complication. Cardiac tamponade is a rare event, and sudden cardiac death is
defined as an unexpected death from cardiac causes. Cardiac dysfunction in the
period following an MI would not be characterized as sudden cardiac death.
A patient has received a bolus dose and an infusion of alteplase (Activase) for an
ST-segment elevation myocardial infarction (STEMI). Which patient assessment
would determine the effectiveness of the medication?
A. Presence of chest pain
B. Blood in the urine or stool
C. Tachycardia with hypotension
D. Decreased level of consciousness
correct answer: a
Rationale:
Alteplase is a fibrinolytic agent that is administered to patients who have had a
STEMI. If the medication is effective, the patient's chest pain will resolve
because the medication dissolves the thrombus in the coronary artery and
results in reperfusion of the myocardium. Bleeding is a major complication of
fibrinolytic therapy. Signs of major bleeding include decreased level of
consciousness, blood in the urine or stool, and increased heart rate with
decreased blood pressure.
The nurse would assess a patient with reports of chest pain for which clinical
manifestations associated with a myocardial infarction (MI)? (Select all that apply.)
A. Flushing
B. Ashen skin
C. Diaphoresis
D. Nausea and vomiting
E. S3 or S4 heart sounds
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, Medical-Surgical Nursing Exam 3 PREPARATION
correct answer: b, c, d, e
Rationale:
During the initial phase of an MI, catecholamines are released from the ischemic
myocardial cells, causing increased sympathetic nervous system stimulation.
This results in the release of glycogen, diaphoresis, and vasoconstriction of
peripheral blood vessels. The patient's skin may be ashen, cool, and clammy
(not flushed) because of this response. Nausea and vomiting may result from
reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction
resulting from the MI may lead to the presence of the abnormal S3 and S4 heart
sounds.
For which problem is percutaneous coronary intervention (PCI) most clearly
indicated?
A. Chronic stable angina
B. Left-sided heart failure
C. Coronary artery disease
D. Acute myocardial infarction
correct answer: d
Rationale:
PCI is indicated to restore coronary perfusion in cases of myocardial infarction.
Chronic stable angina and coronary artery disease are normally treated with
more conservative measures initially. PCI is not relevant to the pathophysiology
of heart failure.
Which assessment finding should be considered when caring for a woman with
suspected coronary artery disease?
A. Fatigue may be the first symptom.
B. Classic signs and symptoms are expected.
C. Increased risk is present before menopause.
D. Women are more likely to develop collateral circulation.
correct answer: a
Rationale:
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, Medical-Surgical Nursing Exam 3 PREPARATION
Fatigue, rather than pain or shortness of breath, may be the first symptom of
impaired cardiac circulation. Women may not exhibit the classic signs and
symptoms of ischemia such as chest pain which radiates down the left arm.
Neck, throat, or back pain may be symptoms experienced by women. Risk for
coronary artery disease increases four times after menopause. Men are more
likely to develop collateral circulation.
When planning emergent care for a patient with a suspected myocardial infarction
(MI), what should the nurse anticipate administering?
A. Oxygen, nitroglycerin, aspirin, and morphine
B. Aspirin, nitroprusside, dopamine, and oxygen
C. Oxygen, furosemide (Lasix), nitroglycerin, and meperidine
D. Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin)
correct answer: a
Rationale:
The American Heart Association's guidelines for emergency care of the patient
with chest pain include the administration of oxygen, nitroglycerin, aspirin, and
morphine. These interventions serve to relieve chest pain, improve oxygenation,
decrease myocardial workload, and prevent further platelet aggregation. The
other medications may be used later in the patient's treatment.
The nurse is examining the electrocardiogram (ECG) of a patient just admitted
with a suspected myocardial infarction (MI). Which ECG change is most indicative
of prolonged or complete coronary occlusion?
A. Sinus tachycardia
B. Pathologic Q wave
C. Fibrillatory P waves
D. Prolonged PR interval
correct answer: b
Rationale:
The presence of a pathologic Q wave, as often accompanies STEMI, is indicative
of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g.,
4|Page
MEDICAL-SURGICAL NURSING EXAM 3 PREPARATION NEWEST
2025/2026 WITH COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES| BRAND NEW VERSION!
The patient is being dismissed from the hospital after acute coronary syndrome
(ACS) and will be attending rehabilitation. What information would be taught in
the early recovery phase of rehabilitation?
A. Therapeutic lifestyle changes should become lifelong habits.
B. Physical activity is always started in the hospital and continued at home.
C. Attention will focus on managing chest pain, anxiety, dysrhythmias, and other
complications.
D. Activity level is gradually increased under cardiac rehabilitation team
supervision and monitoring.
correct answer: d
Rationale:
In the early recovery phase after the patient is dismissed from the hospital, the
activity level is gradually increased under supervision and with ECG monitoring.
The late recovery phase includes therapeutic lifestyle changes that become
lifelong habits. In the first phase of recovery, activity is dependent on the
severity of the angina or myocardial infarction, and attention is focused on the
management of chest pain, anxiety, dysrhythmias, and other complications.
With early recovery phase, the cardiac rehabilitation team may suggest that
physical activity be initiated at home, but this is not always done.
A patient admitted to the emergency department 24 hours ago with reports of
chest pain was diagnosed with a ST-segment-elevation myocardial infarction
(STEMI). What complication of myocardial infarction should the nurse anticipate?
A. Dysrhythmias
B. Unstable angina
C. Cardiac tamponade
D. Sudden cardiac death
1|Page
, Medical-Surgical Nursing Exam 3 PREPARATION
correct answer: a
Rationale:
Dysrhythmias are present in 80% to 90% of patients after myocardial infarction
(MI). Unstable angina is considered a precursor to MI rather than a
complication. Cardiac tamponade is a rare event, and sudden cardiac death is
defined as an unexpected death from cardiac causes. Cardiac dysfunction in the
period following an MI would not be characterized as sudden cardiac death.
A patient has received a bolus dose and an infusion of alteplase (Activase) for an
ST-segment elevation myocardial infarction (STEMI). Which patient assessment
would determine the effectiveness of the medication?
A. Presence of chest pain
B. Blood in the urine or stool
C. Tachycardia with hypotension
D. Decreased level of consciousness
correct answer: a
Rationale:
Alteplase is a fibrinolytic agent that is administered to patients who have had a
STEMI. If the medication is effective, the patient's chest pain will resolve
because the medication dissolves the thrombus in the coronary artery and
results in reperfusion of the myocardium. Bleeding is a major complication of
fibrinolytic therapy. Signs of major bleeding include decreased level of
consciousness, blood in the urine or stool, and increased heart rate with
decreased blood pressure.
The nurse would assess a patient with reports of chest pain for which clinical
manifestations associated with a myocardial infarction (MI)? (Select all that apply.)
A. Flushing
B. Ashen skin
C. Diaphoresis
D. Nausea and vomiting
E. S3 or S4 heart sounds
2|Page
, Medical-Surgical Nursing Exam 3 PREPARATION
correct answer: b, c, d, e
Rationale:
During the initial phase of an MI, catecholamines are released from the ischemic
myocardial cells, causing increased sympathetic nervous system stimulation.
This results in the release of glycogen, diaphoresis, and vasoconstriction of
peripheral blood vessels. The patient's skin may be ashen, cool, and clammy
(not flushed) because of this response. Nausea and vomiting may result from
reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction
resulting from the MI may lead to the presence of the abnormal S3 and S4 heart
sounds.
For which problem is percutaneous coronary intervention (PCI) most clearly
indicated?
A. Chronic stable angina
B. Left-sided heart failure
C. Coronary artery disease
D. Acute myocardial infarction
correct answer: d
Rationale:
PCI is indicated to restore coronary perfusion in cases of myocardial infarction.
Chronic stable angina and coronary artery disease are normally treated with
more conservative measures initially. PCI is not relevant to the pathophysiology
of heart failure.
Which assessment finding should be considered when caring for a woman with
suspected coronary artery disease?
A. Fatigue may be the first symptom.
B. Classic signs and symptoms are expected.
C. Increased risk is present before menopause.
D. Women are more likely to develop collateral circulation.
correct answer: a
Rationale:
3|Page
, Medical-Surgical Nursing Exam 3 PREPARATION
Fatigue, rather than pain or shortness of breath, may be the first symptom of
impaired cardiac circulation. Women may not exhibit the classic signs and
symptoms of ischemia such as chest pain which radiates down the left arm.
Neck, throat, or back pain may be symptoms experienced by women. Risk for
coronary artery disease increases four times after menopause. Men are more
likely to develop collateral circulation.
When planning emergent care for a patient with a suspected myocardial infarction
(MI), what should the nurse anticipate administering?
A. Oxygen, nitroglycerin, aspirin, and morphine
B. Aspirin, nitroprusside, dopamine, and oxygen
C. Oxygen, furosemide (Lasix), nitroglycerin, and meperidine
D. Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin)
correct answer: a
Rationale:
The American Heart Association's guidelines for emergency care of the patient
with chest pain include the administration of oxygen, nitroglycerin, aspirin, and
morphine. These interventions serve to relieve chest pain, improve oxygenation,
decrease myocardial workload, and prevent further platelet aggregation. The
other medications may be used later in the patient's treatment.
The nurse is examining the electrocardiogram (ECG) of a patient just admitted
with a suspected myocardial infarction (MI). Which ECG change is most indicative
of prolonged or complete coronary occlusion?
A. Sinus tachycardia
B. Pathologic Q wave
C. Fibrillatory P waves
D. Prolonged PR interval
correct answer: b
Rationale:
The presence of a pathologic Q wave, as often accompanies STEMI, is indicative
of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g.,
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