NSG-300 EXAM 3
Practice Questions With Complete
Solutions
2026/2027 Edition
Comprehensive Practice Examination
Medical-Surgical Nursing | 120 Questions with Detailed Rationales
Aligned With:
NSG-300 Course Syllabus
NCLEX-RN Test Plan (Next Generation NCLEX)
QSEN Competencies (Patient-Centered Care, Safety,
Evidence-Based Practice)
Medical-Surgical Nursing Standards (2026/2027 Edition)
Content Distribution:
10 Sections | 120 Questions Total
Cognitive Levels: 20% Recall | 50% Application | 30% Analysis
Question Style: 75% Scenario-Based | 25% Direct Knowledge
Special Inclusions:
20 Priority-Setting Questions
15 Pharmacology Questions
10 Laboratory Value Interpretation Questions
For Nursing Education Use | NSG-300 Course Examination Preparation
NSG-300 | Medical-Surgical Nursing | Aligned with NCLEX-RN Test Plan, QSEN, and 2026/2027 Standards Page 1
,NSG-300 Exam 3 Practice Questions With Complete Solutions 2026/2027 Medical-Surgical Nursing
Section 1: Cardiovascular Disorders
Q1: A 58-year-old African American male presents to the clinic for a routine checkup. His
blood pressure is 148/92 mmHg on two separate readings taken 2 minutes apart. He has no
history of hypertension. According to the 2017 ACC/AHA hypertension guidelines, how
should the nurse classify this blood pressure?
A. Stage 1 hypertension
B. Stage 2 hypertension [CORRECT]
C. Elevated blood pressure
D. Hypertensive crisis
Correct Answer: B
Rationale: Stage 2 hypertension is defined as systolic BP >= 140 mmHg or diastolic BP >= 90 mmHg
per the 2017 ACC/AHA guidelines. A reading of 148/92 mmHg meets criteria for Stage 2. Elevated BP is
120-129/<80; Stage 1 is 130-139/80-89; hypertensive crisis is >= 180/120 with target organ damage.
Q2: A patient with a history of stable angina is prescribed sublingual nitroglycerin (NTG)
tablets. Which statement by the patient indicates the need for further teaching?
A. I will sit or lie down before taking the nitroglycerin tablet.
B. I can take up to three tablets 5 minutes apart if chest pain continues.
C. I should swallow the tablet whole with a full glass of water. [CORRECT]
D. I will discard the tablets 6 months after opening the bottle.
Correct Answer: C
Rationale: Sublingual nitroglycerin must be dissolved under the tongue, not swallowed, because
sublingual absorption bypasses hepatic first-pass metabolism and provides rapid relief within 1-3
minutes. The patient should sit or lie down to prevent orthostatic hypotension, may take up to 3 doses 5
minutes apart, and should call 911 if pain persists after the first dose per current AHA recommendations.
Q3: The nurse is caring for four patients on a telemetry unit. Which patient should the nurse
assess FIRST?
A. A patient with chronic stable angina requesting pain medication for mild chest discomfort rated
2/10.
B. A patient who had a PCI 4 hours ago and has a mild ooze at the femoral insertion site.
C. A patient with new-onset atrial fibrillation with a ventricular response of 152 beats/min and
chest pain. [CORRECT]
D. A patient with heart failure whose weight has increased by 1 kg since yesterday.
Correct Answer: C
Rationale: New-onset atrial fibrillation with a rapid ventricular response (RVR) of 152 beats/min and
chest pain represents hemodynamic instability and possible myocardial ischemia. This patient is at risk
for stroke, heart failure exacerbation, and cardiogenic shock and requires immediate intervention. Using
the ABC priority framework and Maslow's hierarchy, unstable cardiac rhythms with ischemic symptoms
take precedence over controlled chronic conditions.
NSG-300 | Medical-Surgical Nursing | Aligned with NCLEX-RN Test Plan, QSEN, and 2026/2027 Standards Page 2
,NSG-300 Exam 3 Practice Questions With Complete Solutions 2026/2027 Medical-Surgical Nursing
Q4: A patient with heart failure has a B-type natriuretic peptide (BNP) level of 1,200 pg/mL.
The nurse understands that this value indicates:
A. Normal cardiac function with no heart failure present.
B. Mild heart failure with mild ventricular dysfunction.
C. Moderate to severe heart failure with significant ventricular overload. [CORRECT]
D. Acute myocardial infarction in progress.
Correct Answer: C
Rationale: BNP levels < 100 pg/mL generally exclude heart failure, 100-300 pg/mL suggest mild HF,
300-600 pg/mL indicate moderate HF, and > 900 pg/mL indicate severe HF. A BNP of 1,200 pg/mL
reflects significant ventricular volume overload and wall stretch. BNP is released from cardiac ventricles
in response to increased pressure and volume, making it a sensitive marker for HF severity.
Q5: A patient receiving digoxin 0.25 mg daily for heart failure has a digoxin level of 2.8
ng/mL (therapeutic range 0.5-2.0 ng/mL). The patient reports nausea and reports seeing
yellow halos around lights. Which action should the nurse take FIRST?
A. Administer the next dose of digoxin as scheduled.
B. Withhold the digoxin dose and notify the healthcare provider immediately. [CORRECT]
C. Administer activated charcoal to bind the medication.
D. Reassure the patient that these are expected side effects.
Correct Answer: B
Rationale: The patient is exhibiting classic signs of digoxin toxicity: serum level above 2.0 ng/mL,
gastrointestinal symptoms (nausea), and visual disturbances (yellow halos). The nurse must withhold the
dose and notify the provider immediately. Digoxin toxicity can progress to life-threatening dysrhythmias.
Activated charcoal is not the first action; the priority is to withhold further digoxin and possibly
administer digoxin immune Fab (Digibind) if severe.
Q6: A patient on a telemetry monitor develops a rhythm with no discernible P waves, an
irregular R-R interval, and a ventricular rate of 142 beats/min. The nurse interprets this
rhythm as:
A. Ventricular tachycardia
B. Atrial fibrillation with rapid ventricular response [CORRECT]
C. Supraventricular tachycardia
D. Sinus tachycardia
Correct Answer: B
Rationale: Atrial fibrillation is characterized by the absence of distinct P waves, an irregularly irregular
R-R interval, and a fibrillatory baseline. The rapid ventricular response of 142 beats/min increases the risk
of stroke due to stasis of blood in the atria requiring anticoagulation. Ventricular tachycardia shows wide
QRS complexes; SVT has a regular rate; sinus tachycardia has visible P waves.
NSG-300 | Medical-Surgical Nursing | Aligned with NCLEX-RN Test Plan, QSEN, and 2026/2027 Standards Page 3
, NSG-300 Exam 3 Practice Questions With Complete Solutions 2026/2027 Medical-Surgical Nursing
Q7: A patient is 6 hours postoperative after a coronary artery bypass graft (CABG) surgery.
Which finding requires IMMEDIATE intervention by the nurse?
A. Chest tube drainage of 75 mL in the last hour.
B. Serum potassium level of 4.2 mEq/L.
C. Systolic blood pressure of 88 mmHg with cool, clammy skin. [CORRECT]
D. Temperature of 99.1°F (37.3°C).
Correct Answer: C
Rationale: A systolic blood pressure of 88 mmHg with cool, clammy skin post-CABG suggests
cardiogenic shock or hemorrhage, both of which require immediate intervention to prevent organ failure.
Chest tube drainage of 75 mL/hr is concerning if it continues but is within acceptable limits (< 100
mL/hr). Potassium of 4.2 mEq/L is normal. Low-grade fever is expected postoperatively.
Q8: A patient with a newly implanted permanent pacemaker asks the nurse when they can
resume normal activities. Which instruction is MOST appropriate?
A. Avoid lifting the arm on the pacemaker side above shoulder level for 4-6 weeks. [CORRECT]
B. Resume full exercise including weightlifting within 1 week.
C. Avoid using microwave ovens permanently.
D. Carry a cell phone in the chest pocket over the pacemaker.
Correct Answer: A
Rationale: Patients with a new pacemaker should avoid lifting the affected arm above shoulder level for
4-6 weeks to prevent dislodgement of the pacemaker leads. Microwaves are safe with modern
pacemakers. Cell phones should be held to the opposite ear and kept at least 6 inches away from the
device. Full exercise can resume gradually after the healing period and pacemaker check.
Q9: A patient with chest pain has serial cardiac enzyme testing. The troponin I level at
admission is 0.04 ng/mL (normal < 0.04), and the level at 6 hours is 1.8 ng/mL. The nurse
recognizes that these findings indicate:
A. Stable angina without myocardial damage.
B. Acute myocardial infarction with myocardial necrosis. [CORRECT]
C. Pericarditis without cardiac muscle involvement.
D. Normal physiologic variation of cardiac enzymes.
Correct Answer: B
Rationale: Troponin I is the most specific and sensitive marker for myocardial injury. A rise from 0.04
ng/mL to 1.8 ng/mL indicates myocardial necrosis consistent with acute MI. Troponin rises within 3-4
hours of injury, peaks at 10-24 hours, and remains elevated for 7-10 days. The serial elevation confirms
ongoing cardiac injury rather than stable angina or pericarditis.
NSG-300 | Medical-Surgical Nursing | Aligned with NCLEX-RN Test Plan, QSEN, and 2026/2027 Standards Page 4
Practice Questions With Complete
Solutions
2026/2027 Edition
Comprehensive Practice Examination
Medical-Surgical Nursing | 120 Questions with Detailed Rationales
Aligned With:
NSG-300 Course Syllabus
NCLEX-RN Test Plan (Next Generation NCLEX)
QSEN Competencies (Patient-Centered Care, Safety,
Evidence-Based Practice)
Medical-Surgical Nursing Standards (2026/2027 Edition)
Content Distribution:
10 Sections | 120 Questions Total
Cognitive Levels: 20% Recall | 50% Application | 30% Analysis
Question Style: 75% Scenario-Based | 25% Direct Knowledge
Special Inclusions:
20 Priority-Setting Questions
15 Pharmacology Questions
10 Laboratory Value Interpretation Questions
For Nursing Education Use | NSG-300 Course Examination Preparation
NSG-300 | Medical-Surgical Nursing | Aligned with NCLEX-RN Test Plan, QSEN, and 2026/2027 Standards Page 1
,NSG-300 Exam 3 Practice Questions With Complete Solutions 2026/2027 Medical-Surgical Nursing
Section 1: Cardiovascular Disorders
Q1: A 58-year-old African American male presents to the clinic for a routine checkup. His
blood pressure is 148/92 mmHg on two separate readings taken 2 minutes apart. He has no
history of hypertension. According to the 2017 ACC/AHA hypertension guidelines, how
should the nurse classify this blood pressure?
A. Stage 1 hypertension
B. Stage 2 hypertension [CORRECT]
C. Elevated blood pressure
D. Hypertensive crisis
Correct Answer: B
Rationale: Stage 2 hypertension is defined as systolic BP >= 140 mmHg or diastolic BP >= 90 mmHg
per the 2017 ACC/AHA guidelines. A reading of 148/92 mmHg meets criteria for Stage 2. Elevated BP is
120-129/<80; Stage 1 is 130-139/80-89; hypertensive crisis is >= 180/120 with target organ damage.
Q2: A patient with a history of stable angina is prescribed sublingual nitroglycerin (NTG)
tablets. Which statement by the patient indicates the need for further teaching?
A. I will sit or lie down before taking the nitroglycerin tablet.
B. I can take up to three tablets 5 minutes apart if chest pain continues.
C. I should swallow the tablet whole with a full glass of water. [CORRECT]
D. I will discard the tablets 6 months after opening the bottle.
Correct Answer: C
Rationale: Sublingual nitroglycerin must be dissolved under the tongue, not swallowed, because
sublingual absorption bypasses hepatic first-pass metabolism and provides rapid relief within 1-3
minutes. The patient should sit or lie down to prevent orthostatic hypotension, may take up to 3 doses 5
minutes apart, and should call 911 if pain persists after the first dose per current AHA recommendations.
Q3: The nurse is caring for four patients on a telemetry unit. Which patient should the nurse
assess FIRST?
A. A patient with chronic stable angina requesting pain medication for mild chest discomfort rated
2/10.
B. A patient who had a PCI 4 hours ago and has a mild ooze at the femoral insertion site.
C. A patient with new-onset atrial fibrillation with a ventricular response of 152 beats/min and
chest pain. [CORRECT]
D. A patient with heart failure whose weight has increased by 1 kg since yesterday.
Correct Answer: C
Rationale: New-onset atrial fibrillation with a rapid ventricular response (RVR) of 152 beats/min and
chest pain represents hemodynamic instability and possible myocardial ischemia. This patient is at risk
for stroke, heart failure exacerbation, and cardiogenic shock and requires immediate intervention. Using
the ABC priority framework and Maslow's hierarchy, unstable cardiac rhythms with ischemic symptoms
take precedence over controlled chronic conditions.
NSG-300 | Medical-Surgical Nursing | Aligned with NCLEX-RN Test Plan, QSEN, and 2026/2027 Standards Page 2
,NSG-300 Exam 3 Practice Questions With Complete Solutions 2026/2027 Medical-Surgical Nursing
Q4: A patient with heart failure has a B-type natriuretic peptide (BNP) level of 1,200 pg/mL.
The nurse understands that this value indicates:
A. Normal cardiac function with no heart failure present.
B. Mild heart failure with mild ventricular dysfunction.
C. Moderate to severe heart failure with significant ventricular overload. [CORRECT]
D. Acute myocardial infarction in progress.
Correct Answer: C
Rationale: BNP levels < 100 pg/mL generally exclude heart failure, 100-300 pg/mL suggest mild HF,
300-600 pg/mL indicate moderate HF, and > 900 pg/mL indicate severe HF. A BNP of 1,200 pg/mL
reflects significant ventricular volume overload and wall stretch. BNP is released from cardiac ventricles
in response to increased pressure and volume, making it a sensitive marker for HF severity.
Q5: A patient receiving digoxin 0.25 mg daily for heart failure has a digoxin level of 2.8
ng/mL (therapeutic range 0.5-2.0 ng/mL). The patient reports nausea and reports seeing
yellow halos around lights. Which action should the nurse take FIRST?
A. Administer the next dose of digoxin as scheduled.
B. Withhold the digoxin dose and notify the healthcare provider immediately. [CORRECT]
C. Administer activated charcoal to bind the medication.
D. Reassure the patient that these are expected side effects.
Correct Answer: B
Rationale: The patient is exhibiting classic signs of digoxin toxicity: serum level above 2.0 ng/mL,
gastrointestinal symptoms (nausea), and visual disturbances (yellow halos). The nurse must withhold the
dose and notify the provider immediately. Digoxin toxicity can progress to life-threatening dysrhythmias.
Activated charcoal is not the first action; the priority is to withhold further digoxin and possibly
administer digoxin immune Fab (Digibind) if severe.
Q6: A patient on a telemetry monitor develops a rhythm with no discernible P waves, an
irregular R-R interval, and a ventricular rate of 142 beats/min. The nurse interprets this
rhythm as:
A. Ventricular tachycardia
B. Atrial fibrillation with rapid ventricular response [CORRECT]
C. Supraventricular tachycardia
D. Sinus tachycardia
Correct Answer: B
Rationale: Atrial fibrillation is characterized by the absence of distinct P waves, an irregularly irregular
R-R interval, and a fibrillatory baseline. The rapid ventricular response of 142 beats/min increases the risk
of stroke due to stasis of blood in the atria requiring anticoagulation. Ventricular tachycardia shows wide
QRS complexes; SVT has a regular rate; sinus tachycardia has visible P waves.
NSG-300 | Medical-Surgical Nursing | Aligned with NCLEX-RN Test Plan, QSEN, and 2026/2027 Standards Page 3
, NSG-300 Exam 3 Practice Questions With Complete Solutions 2026/2027 Medical-Surgical Nursing
Q7: A patient is 6 hours postoperative after a coronary artery bypass graft (CABG) surgery.
Which finding requires IMMEDIATE intervention by the nurse?
A. Chest tube drainage of 75 mL in the last hour.
B. Serum potassium level of 4.2 mEq/L.
C. Systolic blood pressure of 88 mmHg with cool, clammy skin. [CORRECT]
D. Temperature of 99.1°F (37.3°C).
Correct Answer: C
Rationale: A systolic blood pressure of 88 mmHg with cool, clammy skin post-CABG suggests
cardiogenic shock or hemorrhage, both of which require immediate intervention to prevent organ failure.
Chest tube drainage of 75 mL/hr is concerning if it continues but is within acceptable limits (< 100
mL/hr). Potassium of 4.2 mEq/L is normal. Low-grade fever is expected postoperatively.
Q8: A patient with a newly implanted permanent pacemaker asks the nurse when they can
resume normal activities. Which instruction is MOST appropriate?
A. Avoid lifting the arm on the pacemaker side above shoulder level for 4-6 weeks. [CORRECT]
B. Resume full exercise including weightlifting within 1 week.
C. Avoid using microwave ovens permanently.
D. Carry a cell phone in the chest pocket over the pacemaker.
Correct Answer: A
Rationale: Patients with a new pacemaker should avoid lifting the affected arm above shoulder level for
4-6 weeks to prevent dislodgement of the pacemaker leads. Microwaves are safe with modern
pacemakers. Cell phones should be held to the opposite ear and kept at least 6 inches away from the
device. Full exercise can resume gradually after the healing period and pacemaker check.
Q9: A patient with chest pain has serial cardiac enzyme testing. The troponin I level at
admission is 0.04 ng/mL (normal < 0.04), and the level at 6 hours is 1.8 ng/mL. The nurse
recognizes that these findings indicate:
A. Stable angina without myocardial damage.
B. Acute myocardial infarction with myocardial necrosis. [CORRECT]
C. Pericarditis without cardiac muscle involvement.
D. Normal physiologic variation of cardiac enzymes.
Correct Answer: B
Rationale: Troponin I is the most specific and sensitive marker for myocardial injury. A rise from 0.04
ng/mL to 1.8 ng/mL indicates myocardial necrosis consistent with acute MI. Troponin rises within 3-4
hours of injury, peaks at 10-24 hours, and remains elevated for 7-10 days. The serial elevation confirms
ongoing cardiac injury rather than stable angina or pericarditis.
NSG-300 | Medical-Surgical Nursing | Aligned with NCLEX-RN Test Plan, QSEN, and 2026/2027 Standards Page 4
