Medical-Surgical Nursing Comprehensive Review
Verified Questions with Correct Answers and Rationales
Section 1: Cardiovascular System (Questions 1-30)
1. What are the classic symptoms of myocardial infarction (MI)?
• A) Headache and dizziness
• B) Crushing chest pain radiating to left arm/jaw, diaphoresis, nausea,
dyspnea
• C) Back pain and leg swelling
• D) Cough and fever
Answer: B - Classic MI symptoms: crushing substernal chest pain radiating to left
arm, jaw, or back; diaphoresis; nausea; dyspnea; anxiety. Women may have
atypical symptoms (fatigue, indigestion, back pain). Elderly/diabetics may have
silent MI.
2. What is the priority intervention for a patient with chest pain?
• A) Take vital signs
• B) Obtain 12-lead ECG, administer oxygen, establish IV access, give aspirin
• C) Call family
• D) Complete admission paperwork
Answer: B - Priorities for chest pain: obtain 12-lead ECG within 10 minutes,
oxygen if SpO2 <90%, IV access, aspirin 160-325 mg (chewed), nitroglycerin SL if
no contraindications, morphine for pain. Time is muscle.
3. What does the acronym MONA stand for in MI treatment?
• A) Monitor, Oxygenate, Notify, Assess
• B) Morphine, Oxygen (if hypoxic), Nitroglycerin, Aspirin
, • C) Medication, Observation, Nursing, Assessment
• D) Movement, Oral intake, Nutrition, Ambulation
Answer: B - MONA protocol (modified): Morphine for pain/anxiety, Oxygen only if
SpO2 <90% (updated guidelines), Nitroglycerin for chest pain (contraindications:
hypotension, right ventricular MI, recent PDE5 inhibitor), Aspirin as antiplatelet.
4. What lab values indicate myocardial damage?
• A) Elevated WBC
• B) Elevated troponin I and T
• C) Decreased hemoglobin
• D) Elevated glucose
Answer: B - Troponin I and T are cardiac-specific enzymes. Rise 2-4 hours after MI,
peak 24 hours, remain elevated 1-3 weeks. Most sensitive/specific for MI. CK-MB
also rises but less specific.
5. What is the difference between STEMI and NSTEMI?
• A) STEMI less serious than NSTEMI
• B) STEMI shows ST elevation indicating complete occlusion; NSTEMI shows
ST depression/T-wave changes
• C) No difference
• D) NSTEMI requires immediate PCI
Answer: B - STEMI (ST-Elevation MI): complete coronary occlusion, ST elevation on
ECG, requires immediate reperfusion (PCI <90 min or fibrinolytics). NSTEMI:
partial occlusion, ST depression or T-wave inversion, troponin elevated, managed
medically unless high-risk.
6. What are modifiable risk factors for coronary artery disease?
• A) Age and gender
, • B) Smoking, hypertension, hyperlipidemia, diabetes, obesity, sedentary
lifestyle
• C) Family history and race
• D) Genetics only
Answer: B - Modifiable: smoking, hypertension, hyperlipidemia, diabetes, obesity,
physical inactivity, stress, poor diet. Non-modifiable: age, male gender, family
history, race. Focus interventions on modifiable factors.
7. What is the therapeutic INR range for atrial fibrillation?
• A) 0.5-1.0
• B) 1.5-2.0
• C) 2.0-3.0
• D) 4.0-5.0
Answer: C - Therapeutic INR for atrial fibrillation is 2.0-3.0 (higher 2.5-3.5 for
mechanical heart valves). Atrial fibrillation increases stroke risk from blood
pooling and clot formation in atria, requiring anticoagulation.
8. What are signs of left-sided heart failure?
• A) Peripheral edema and ascites
• B) Dyspnea, orthopnea, crackles, pink frothy sputum, pulmonary congestion
• C) Jugular venous distension
• D) Hepatomegaly
Answer: B - Left-sided failure: pulmonary congestion symptoms - dyspnea,
orthopnea, paroxysmal nocturnal dyspnea (PND), crackles, cough with pink frothy
sputum, tachycardia, fatigue. Blood backs up into lungs.
9. What are signs of right-sided heart failure?
• A) Crackles and dyspnea
Verified Questions with Correct Answers and Rationales
Section 1: Cardiovascular System (Questions 1-30)
1. What are the classic symptoms of myocardial infarction (MI)?
• A) Headache and dizziness
• B) Crushing chest pain radiating to left arm/jaw, diaphoresis, nausea,
dyspnea
• C) Back pain and leg swelling
• D) Cough and fever
Answer: B - Classic MI symptoms: crushing substernal chest pain radiating to left
arm, jaw, or back; diaphoresis; nausea; dyspnea; anxiety. Women may have
atypical symptoms (fatigue, indigestion, back pain). Elderly/diabetics may have
silent MI.
2. What is the priority intervention for a patient with chest pain?
• A) Take vital signs
• B) Obtain 12-lead ECG, administer oxygen, establish IV access, give aspirin
• C) Call family
• D) Complete admission paperwork
Answer: B - Priorities for chest pain: obtain 12-lead ECG within 10 minutes,
oxygen if SpO2 <90%, IV access, aspirin 160-325 mg (chewed), nitroglycerin SL if
no contraindications, morphine for pain. Time is muscle.
3. What does the acronym MONA stand for in MI treatment?
• A) Monitor, Oxygenate, Notify, Assess
• B) Morphine, Oxygen (if hypoxic), Nitroglycerin, Aspirin
, • C) Medication, Observation, Nursing, Assessment
• D) Movement, Oral intake, Nutrition, Ambulation
Answer: B - MONA protocol (modified): Morphine for pain/anxiety, Oxygen only if
SpO2 <90% (updated guidelines), Nitroglycerin for chest pain (contraindications:
hypotension, right ventricular MI, recent PDE5 inhibitor), Aspirin as antiplatelet.
4. What lab values indicate myocardial damage?
• A) Elevated WBC
• B) Elevated troponin I and T
• C) Decreased hemoglobin
• D) Elevated glucose
Answer: B - Troponin I and T are cardiac-specific enzymes. Rise 2-4 hours after MI,
peak 24 hours, remain elevated 1-3 weeks. Most sensitive/specific for MI. CK-MB
also rises but less specific.
5. What is the difference between STEMI and NSTEMI?
• A) STEMI less serious than NSTEMI
• B) STEMI shows ST elevation indicating complete occlusion; NSTEMI shows
ST depression/T-wave changes
• C) No difference
• D) NSTEMI requires immediate PCI
Answer: B - STEMI (ST-Elevation MI): complete coronary occlusion, ST elevation on
ECG, requires immediate reperfusion (PCI <90 min or fibrinolytics). NSTEMI:
partial occlusion, ST depression or T-wave inversion, troponin elevated, managed
medically unless high-risk.
6. What are modifiable risk factors for coronary artery disease?
• A) Age and gender
, • B) Smoking, hypertension, hyperlipidemia, diabetes, obesity, sedentary
lifestyle
• C) Family history and race
• D) Genetics only
Answer: B - Modifiable: smoking, hypertension, hyperlipidemia, diabetes, obesity,
physical inactivity, stress, poor diet. Non-modifiable: age, male gender, family
history, race. Focus interventions on modifiable factors.
7. What is the therapeutic INR range for atrial fibrillation?
• A) 0.5-1.0
• B) 1.5-2.0
• C) 2.0-3.0
• D) 4.0-5.0
Answer: C - Therapeutic INR for atrial fibrillation is 2.0-3.0 (higher 2.5-3.5 for
mechanical heart valves). Atrial fibrillation increases stroke risk from blood
pooling and clot formation in atria, requiring anticoagulation.
8. What are signs of left-sided heart failure?
• A) Peripheral edema and ascites
• B) Dyspnea, orthopnea, crackles, pink frothy sputum, pulmonary congestion
• C) Jugular venous distension
• D) Hepatomegaly
Answer: B - Left-sided failure: pulmonary congestion symptoms - dyspnea,
orthopnea, paroxysmal nocturnal dyspnea (PND), crackles, cough with pink frothy
sputum, tachycardia, fatigue. Blood backs up into lungs.
9. What are signs of right-sided heart failure?
• A) Crackles and dyspnea
