Page |1
ADVANCED MEDICAL-SURGICAL NURSING
FINAL REVIEW STUDY GUIDE | LATEST
UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW
TABLE OF CONTENTS
1. Cardiovascular Disorders and Hemodynamic Monitoring
2. Respiratory Failure, Ventilation, and Acid-Base Balance
3. Renal and Electrolyte Emergencies
4. Gastrointestinal, Hepatic, and Pancreatic Disorders
5. Endocrine Crises and Diabetes Management
6. Neurologic and Neurosurgical Emergencies
7. Musculoskeletal Trauma and Orthopedic Care
8. Hematology, Oncology, and Transfusion Practice
9. Immunology, Infection, and Sepsis
10. Critical Care, Emergency, and Prioritization
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Question 1: A patient with acute decompensated heart failure is receiving furosemide 80 mg
IV push. Which assessment finding best indicates a therapeutic response within the first
hour?
A) Urine output of 100 mL
B) Decreased jugular venous distention and improved breath sounds
C) Serum potassium increase from 3.4 to 4.0 mEq/L
D) Heart rate decrease from 118 to 96 beats/min
Correct Answer: B) Decreased jugular venous distention and improved breath sounds
Loop diuretics reduce preload by promoting diuresis, so the earliest clinical signs of effective
decongestion are reduced jugular venous distention, clearing crackles, and improved
dyspnea. Urine output may lag or be less specific, and potassium typically decreases rather
than increases with furosemide.
Question 2: A patient with ST-elevation myocardial infarction is scheduled for percutaneous
coronary intervention. Which medication should the nurse anticipate administering first
unless contraindicated?
A) Aspirin 162 to 325 mg chewed
B) Morphine sulfate 4 mg IV
C) Nitroglycerin sublingual
D) Metoprolol 5 mg IV
Correct Answer: A) Aspirin 162 to 325 mg chewed
Chewed aspirin rapidly inhibits platelet aggregation and is a Class I recommendation in
acute ST-elevation myocardial infarction unless the patient has a true allergy or active
bleeding. Morphine, nitroglycerin, and beta-blockers are adjunctive and may be given later
based on hemodynamics and symptoms.
Question 3: A patient with a new permanent pacemaker has a pacing spike followed by a
QRS complex on the monitor. What should the nurse document?
A) Failure to capture
B) Failure to sense
C) Normal pacemaker function
D) Pacemaker-mediated tachycardia
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Correct Answer: C) Normal pacemaker function
A pacing spike followed by a QRS complex indicates that the electrical stimulus is capturing
the myocardium and producing a depolarization. Failure to capture would show a spike
without a subsequent QRS, and failure to sense would show inappropriate pacing spikes.
Question 4: A patient receiving heparin infusion for venous thromboembolism has an aPTT
of 95 seconds, and the therapeutic range is 60 to 80 seconds. What is the priority nursing
action?
A) Increase the heparin infusion rate
B) Stop the infusion and prepare protamine sulfate
C) Hold the infusion and notify the provider
D) Administer vitamin K
Correct Answer: C) Hold the infusion and notify the provider
An aPTT above the therapeutic range increases bleeding risk, so the infusion should be held
and the provider notified for dose adjustment. Protamine sulfate is reserved for serious
bleeding or overdose, and vitamin K reverses warfarin, not heparin.
Question 5: A patient with pericarditis reports sharp chest pain that worsens with inspiration
and improves when sitting forward. Which finding is most consistent with this condition?
A) Pleural friction rub
B) Pericardial friction rub
C) Crackles at the bases
D) S3 heart sound
Correct Answer: B) Pericardial friction rub
Pericardial friction rub is the classic auscultatory finding in pericarditis and is caused by
inflamed pericardial layers rubbing together. Pleural friction rub is associated with pleurisy,
crackles with fluid or consolidation, and S3 with heart failure.
Question 6: A patient with hypertension crisis has a blood pressure of 220/124 mm Hg and
reports headache and blurred vision. Which action should the nurse take first?
A) Administer IV labetalol as ordered
B) Place the patient supine and elevate the legs
, Page |4
C) Obtain a 12-lead electrocardiogram
D) Assess neurologic status and establish IV access
Correct Answer: D) Assess neurologic status and establish IV access
The priority is to assess for hypertensive encephalopathy, stroke, or other end-organ damage
while obtaining IV access for controlled blood pressure reduction. IV antihypertensives are
usually given as ordered, but assessment and access come first to ensure safe titration.
Question 7: A patient with chronic heart failure is prescribed spironolactone. Which
laboratory value requires immediate follow-up?
A) Serum potassium 5.8 mEq/L
B) Serum sodium 134 mEq/L
C) Serum creatinine 1.1 mg/dL
D) Hemoglobin 11.8 g/dL
Correct Answer: A) Serum potassium 5.8 mEq/L
Spironolactone is a potassium-sparing diuretic, and hyperkalemia can cause life-threatening
dysrhythmias. A potassium level of 5.8 mEq/L is critically high and requires immediate
intervention. Mild hyponatremia and hemoglobin of 11.8 g/dL are common in heart failure.
Question 8: A patient develops sudden pleuritic chest pain, tachycardia, and hypoxemia after
hip replacement surgery. Which complication should the nurse suspect first?
A) Fat embolism syndrome
B) Pulmonary embolism
C) Atelectasis
D) Pneumonia
Correct Answer: B) Pulmonary embolism
Pulmonary embolism is a leading postoperative complication after orthopedic surgery and
presents with sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia. Fat
embolism can occur after long bone fractures but is less likely after uncomplicated hip
replacement and often includes petechiae and neurologic changes.
Question 9: A patient is admitted with severe aortic stenosis. Which assessment finding is
most concerning?
ADVANCED MEDICAL-SURGICAL NURSING
FINAL REVIEW STUDY GUIDE | LATEST
UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW
TABLE OF CONTENTS
1. Cardiovascular Disorders and Hemodynamic Monitoring
2. Respiratory Failure, Ventilation, and Acid-Base Balance
3. Renal and Electrolyte Emergencies
4. Gastrointestinal, Hepatic, and Pancreatic Disorders
5. Endocrine Crises and Diabetes Management
6. Neurologic and Neurosurgical Emergencies
7. Musculoskeletal Trauma and Orthopedic Care
8. Hematology, Oncology, and Transfusion Practice
9. Immunology, Infection, and Sepsis
10. Critical Care, Emergency, and Prioritization
, Page |2
Question 1: A patient with acute decompensated heart failure is receiving furosemide 80 mg
IV push. Which assessment finding best indicates a therapeutic response within the first
hour?
A) Urine output of 100 mL
B) Decreased jugular venous distention and improved breath sounds
C) Serum potassium increase from 3.4 to 4.0 mEq/L
D) Heart rate decrease from 118 to 96 beats/min
Correct Answer: B) Decreased jugular venous distention and improved breath sounds
Loop diuretics reduce preload by promoting diuresis, so the earliest clinical signs of effective
decongestion are reduced jugular venous distention, clearing crackles, and improved
dyspnea. Urine output may lag or be less specific, and potassium typically decreases rather
than increases with furosemide.
Question 2: A patient with ST-elevation myocardial infarction is scheduled for percutaneous
coronary intervention. Which medication should the nurse anticipate administering first
unless contraindicated?
A) Aspirin 162 to 325 mg chewed
B) Morphine sulfate 4 mg IV
C) Nitroglycerin sublingual
D) Metoprolol 5 mg IV
Correct Answer: A) Aspirin 162 to 325 mg chewed
Chewed aspirin rapidly inhibits platelet aggregation and is a Class I recommendation in
acute ST-elevation myocardial infarction unless the patient has a true allergy or active
bleeding. Morphine, nitroglycerin, and beta-blockers are adjunctive and may be given later
based on hemodynamics and symptoms.
Question 3: A patient with a new permanent pacemaker has a pacing spike followed by a
QRS complex on the monitor. What should the nurse document?
A) Failure to capture
B) Failure to sense
C) Normal pacemaker function
D) Pacemaker-mediated tachycardia
, Page |3
Correct Answer: C) Normal pacemaker function
A pacing spike followed by a QRS complex indicates that the electrical stimulus is capturing
the myocardium and producing a depolarization. Failure to capture would show a spike
without a subsequent QRS, and failure to sense would show inappropriate pacing spikes.
Question 4: A patient receiving heparin infusion for venous thromboembolism has an aPTT
of 95 seconds, and the therapeutic range is 60 to 80 seconds. What is the priority nursing
action?
A) Increase the heparin infusion rate
B) Stop the infusion and prepare protamine sulfate
C) Hold the infusion and notify the provider
D) Administer vitamin K
Correct Answer: C) Hold the infusion and notify the provider
An aPTT above the therapeutic range increases bleeding risk, so the infusion should be held
and the provider notified for dose adjustment. Protamine sulfate is reserved for serious
bleeding or overdose, and vitamin K reverses warfarin, not heparin.
Question 5: A patient with pericarditis reports sharp chest pain that worsens with inspiration
and improves when sitting forward. Which finding is most consistent with this condition?
A) Pleural friction rub
B) Pericardial friction rub
C) Crackles at the bases
D) S3 heart sound
Correct Answer: B) Pericardial friction rub
Pericardial friction rub is the classic auscultatory finding in pericarditis and is caused by
inflamed pericardial layers rubbing together. Pleural friction rub is associated with pleurisy,
crackles with fluid or consolidation, and S3 with heart failure.
Question 6: A patient with hypertension crisis has a blood pressure of 220/124 mm Hg and
reports headache and blurred vision. Which action should the nurse take first?
A) Administer IV labetalol as ordered
B) Place the patient supine and elevate the legs
, Page |4
C) Obtain a 12-lead electrocardiogram
D) Assess neurologic status and establish IV access
Correct Answer: D) Assess neurologic status and establish IV access
The priority is to assess for hypertensive encephalopathy, stroke, or other end-organ damage
while obtaining IV access for controlled blood pressure reduction. IV antihypertensives are
usually given as ordered, but assessment and access come first to ensure safe titration.
Question 7: A patient with chronic heart failure is prescribed spironolactone. Which
laboratory value requires immediate follow-up?
A) Serum potassium 5.8 mEq/L
B) Serum sodium 134 mEq/L
C) Serum creatinine 1.1 mg/dL
D) Hemoglobin 11.8 g/dL
Correct Answer: A) Serum potassium 5.8 mEq/L
Spironolactone is a potassium-sparing diuretic, and hyperkalemia can cause life-threatening
dysrhythmias. A potassium level of 5.8 mEq/L is critically high and requires immediate
intervention. Mild hyponatremia and hemoglobin of 11.8 g/dL are common in heart failure.
Question 8: A patient develops sudden pleuritic chest pain, tachycardia, and hypoxemia after
hip replacement surgery. Which complication should the nurse suspect first?
A) Fat embolism syndrome
B) Pulmonary embolism
C) Atelectasis
D) Pneumonia
Correct Answer: B) Pulmonary embolism
Pulmonary embolism is a leading postoperative complication after orthopedic surgery and
presents with sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia. Fat
embolism can occur after long bone fractures but is less likely after uncomplicated hip
replacement and often includes petechiae and neurologic changes.
Question 9: A patient is admitted with severe aortic stenosis. Which assessment finding is
most concerning?
