CJE MedSurg I Exam Review | Latest Update 2026/2027 | 200
Practice Questions with Answers and Explanations
Question 1
A patient with leftsided heart failure is admitted with acute dyspnea and orthopnea. Which assessment
finding should the nurse anticipate?
A. Peripheral edema and jugular venous distention (JVD)
B. Crackles in the lung bases and pink, frothy sputum
C. Hepatomegaly and ascites
D. Bradycardia and hypotension
Answer: B. Crackles in the lung bases and pink, frothy sputum
Explanation: Leftsided heart failure leads to pulmonary congestion. Fluid backs up into the lungs, causing
crackles (rales) and potentially pulmonary edema, evidenced by pink, frothy sputum. Peripheral edema,
JVD, and hepatomegaly are signs of rightsided failure. Bradycardia is not typical in acute exacerbations;
tachycardia is.
Question 2
The nurse is caring for a patient on a continuous insulin drip for diabetic ketoacidosis (DKA). The blood
glucose is now 180 mg/dL. The provider orders to add dextrose to the IV fluids. The nurse understands
this is primarily to prevent which complication?
A. Hyperglycemia
B. Hypokalemia
C. Cerebral edema
D. Hypoglycemia
Answer: B. Hypokalemia
,Explanation: Insulin drives potassium into cells, causing serum potassium levels to drop. Once blood
glucose reaches approximately 250 mg/dL, dextrose is added to the IV fluids to prevent hypoglycemia
while continuing insulin, but the primary concern at this point is preventing hypokalemia as insulin
continues to shift potassium intracellularly.
Question 3
A patient with STelevation myocardial infarction (STEMI) develops a new holosystolic murmur and acute
hypotension. Which complication is most likely?
A. Free wall rupture
B. Ventricular septal rupture
C. Papillary muscle rupture
D. Pericarditis
Answer: C. Papillary muscle rupture
Explanation: Papillary muscle rupture causes acute mitral regurgitation, characterized by a new
holosystolic murmur, acute pulmonary edema, and hypotension. Free wall rupture presents with
tamponade and electromechanical dissociation, while ventricular septal rupture produces a harsh
murmur at the left lower sternal border. Pericarditis presents with a friction rub and chest pain.
Question 4
Angiotensinconverting enzyme (ACE) inhibitors may be prescribed for a client with diabetes mellitus to
reduce vascular changes and possibly prevent or delay the development of:
A. Chronic obstructive pulmonary disease (COPD)
B. Pancreatic cancer
C. Renal failure
D. Cerebrovascular accident
,Answer: C. Renal failure
Explanation: ACE inhibitors are prescribed for diabetic patients to slow the progression of diabetic
nephropathy by reducing intraglomerular pressure and proteinuria. This renoprotective effect makes
them a preferred antihypertensive in this population.
Question 5
A patient in the intensive care unit is in hypovolemic shock. Which finding is the best indicator that fluid
replacement is adequate?
A. Systolic blood pressure greater than 110 mm Hg
B. Urine output greater than 30 mL/h
C. Respiratory rate of 20 breaths/min
D. Diastolic blood pressure greater than 90 mm Hg
Answer: B. Urine output greater than 30 mL/h
Explanation: Urine output greater than 30 mL/h is the best indicator of adequate fluid resuscitation in
hypovolemic shock. It reflects adequate renal perfusion, which is a sensitive indicator of overall tissue
perfusion.
Question 6
The nurse is reviewing the medication list for a patient with heart failure. Which medication may cause a
complication with the treatment plan of a client with diabetes?
A. Aspirin
B. Steroids
C. Sulfonylureas
, D. Angiotensinconverting enzyme (ACE) inhibitors
Answer: B. Steroids
Explanation: Steroids can increase blood glucose levels, complicating diabetes management. The nurse
should monitor blood glucose levels more frequently when a diabetic patient is on steroids. ACE
inhibitors are actually beneficial for diabetic patients as they can slow the progression of renal disease.
Question 7
Which hemodynamic profile is consistent with cardiogenic shock?
A. Cardiac index < 2.2 L/min/m², pulmonary capillary wedge pressure > 18 mmHg
B. Cardiac index > 4.0 L/min/m², systemic vascular resistance < 600 dyness/cm
C. Central venous pressure < 4 mmHg, cardiac index < 2.2 L/min/m²
D. Pulmonary capillary wedge pressure < 10 mmHg, cardiac index > 3.5 L/min/m²
Answer: A. Cardiac index < 2.2 L/min/m², pulmonary capillary wedge pressure > 18 mmHg
Explanation: Cardiogenic shock is characterized by decreased cardiac output (cardiac index < 2.2
L/min/m²) and increased filling pressures (pulmonary capillary wedge pressure > 18 mmHg) due to
pump failure. This reflects the heart's inability to pump blood effectively.
Question 8
A client is admitted with dehydration and hyponatremia. The nurse should monitor for which
neurological manifestation?
A. Hyperreflexia
B. Seizures
Practice Questions with Answers and Explanations
Question 1
A patient with leftsided heart failure is admitted with acute dyspnea and orthopnea. Which assessment
finding should the nurse anticipate?
A. Peripheral edema and jugular venous distention (JVD)
B. Crackles in the lung bases and pink, frothy sputum
C. Hepatomegaly and ascites
D. Bradycardia and hypotension
Answer: B. Crackles in the lung bases and pink, frothy sputum
Explanation: Leftsided heart failure leads to pulmonary congestion. Fluid backs up into the lungs, causing
crackles (rales) and potentially pulmonary edema, evidenced by pink, frothy sputum. Peripheral edema,
JVD, and hepatomegaly are signs of rightsided failure. Bradycardia is not typical in acute exacerbations;
tachycardia is.
Question 2
The nurse is caring for a patient on a continuous insulin drip for diabetic ketoacidosis (DKA). The blood
glucose is now 180 mg/dL. The provider orders to add dextrose to the IV fluids. The nurse understands
this is primarily to prevent which complication?
A. Hyperglycemia
B. Hypokalemia
C. Cerebral edema
D. Hypoglycemia
Answer: B. Hypokalemia
,Explanation: Insulin drives potassium into cells, causing serum potassium levels to drop. Once blood
glucose reaches approximately 250 mg/dL, dextrose is added to the IV fluids to prevent hypoglycemia
while continuing insulin, but the primary concern at this point is preventing hypokalemia as insulin
continues to shift potassium intracellularly.
Question 3
A patient with STelevation myocardial infarction (STEMI) develops a new holosystolic murmur and acute
hypotension. Which complication is most likely?
A. Free wall rupture
B. Ventricular septal rupture
C. Papillary muscle rupture
D. Pericarditis
Answer: C. Papillary muscle rupture
Explanation: Papillary muscle rupture causes acute mitral regurgitation, characterized by a new
holosystolic murmur, acute pulmonary edema, and hypotension. Free wall rupture presents with
tamponade and electromechanical dissociation, while ventricular septal rupture produces a harsh
murmur at the left lower sternal border. Pericarditis presents with a friction rub and chest pain.
Question 4
Angiotensinconverting enzyme (ACE) inhibitors may be prescribed for a client with diabetes mellitus to
reduce vascular changes and possibly prevent or delay the development of:
A. Chronic obstructive pulmonary disease (COPD)
B. Pancreatic cancer
C. Renal failure
D. Cerebrovascular accident
,Answer: C. Renal failure
Explanation: ACE inhibitors are prescribed for diabetic patients to slow the progression of diabetic
nephropathy by reducing intraglomerular pressure and proteinuria. This renoprotective effect makes
them a preferred antihypertensive in this population.
Question 5
A patient in the intensive care unit is in hypovolemic shock. Which finding is the best indicator that fluid
replacement is adequate?
A. Systolic blood pressure greater than 110 mm Hg
B. Urine output greater than 30 mL/h
C. Respiratory rate of 20 breaths/min
D. Diastolic blood pressure greater than 90 mm Hg
Answer: B. Urine output greater than 30 mL/h
Explanation: Urine output greater than 30 mL/h is the best indicator of adequate fluid resuscitation in
hypovolemic shock. It reflects adequate renal perfusion, which is a sensitive indicator of overall tissue
perfusion.
Question 6
The nurse is reviewing the medication list for a patient with heart failure. Which medication may cause a
complication with the treatment plan of a client with diabetes?
A. Aspirin
B. Steroids
C. Sulfonylureas
, D. Angiotensinconverting enzyme (ACE) inhibitors
Answer: B. Steroids
Explanation: Steroids can increase blood glucose levels, complicating diabetes management. The nurse
should monitor blood glucose levels more frequently when a diabetic patient is on steroids. ACE
inhibitors are actually beneficial for diabetic patients as they can slow the progression of renal disease.
Question 7
Which hemodynamic profile is consistent with cardiogenic shock?
A. Cardiac index < 2.2 L/min/m², pulmonary capillary wedge pressure > 18 mmHg
B. Cardiac index > 4.0 L/min/m², systemic vascular resistance < 600 dyness/cm
C. Central venous pressure < 4 mmHg, cardiac index < 2.2 L/min/m²
D. Pulmonary capillary wedge pressure < 10 mmHg, cardiac index > 3.5 L/min/m²
Answer: A. Cardiac index < 2.2 L/min/m², pulmonary capillary wedge pressure > 18 mmHg
Explanation: Cardiogenic shock is characterized by decreased cardiac output (cardiac index < 2.2
L/min/m²) and increased filling pressures (pulmonary capillary wedge pressure > 18 mmHg) due to
pump failure. This reflects the heart's inability to pump blood effectively.
Question 8
A client is admitted with dehydration and hyponatremia. The nurse should monitor for which
neurological manifestation?
A. Hyperreflexia
B. Seizures
