NSG-4100 Advanced Medical-Surgical Nursing Questions With Verified Answer

NSG 4100/ NSG 4100 – Latest 2026/2027 Update
– Advanced Medical-Surgical Nursing Questions
with Verifi ed Answers and Elaborated Solutions
Academic Year


Cardiovascular Disorders (Questions 1–20)
1. A patient with acute decompensated heart failure (ADHF) presents with severe dyspnea,
crackles to mid-scapulae, and an SpO₂ of 86% on 4 L nasal cannula. What is the priority
intervention?
 A. Administer IV furosemide
 B. Start non-invasive positive pressure ventilation (NIPPV)
 C. Place the patient in Trendelenburg position
 D. Give IV metoprolol

✅ Verified Answer: B. Start NIPPV

Elaborated Solution: NIPPV (CPAP or BiPAP) improves oxygenation and reduces
preload/afterload more rapidly than furosemide alone in severe ADHF. Furosemide is
important but not first in acute hypoxemic respiratory failure. Trendelenburg worsens
breathing. Metoprolol is contraindicated in acute decompensation.

2. Which laboratory finding is most concerning in a patient with chest pain suspected of
having an acute myocardial infarction (MI)?
 A. Troponin I = 0.04 ng/mL
 B. CK-MB = 5% of total CK
 C. Troponin T = 0.8 ng/mL (normal <0.03)
 D. BNP = 100 pg/mL

✅ Verified Answer: C. Troponin T = 0.8 ng/mL

Elaborated Solution: Troponin T >0.1 ng/mL suggests myocardial necrosis. This level
indicates NSTEMI. Normal troponin rules out MI if done at appropriate times. BNP indicates
HF but not specific for MI.

3. A post-cardiac arrest patient has a Glasgow Coma Scale (GCS) score of 7. Targeted
temperature management (TTM) is initiated. What core temperature is recommended in
current 2026 AHA guidelines?
 A. 32–34°C for 48 hours
 B. 36°C for 24 hours
 C. 32–36°C for at least 24 hours
 D. 35°C for 12 hours

,✅ Verified Answer: C. 32–36°C for at least 24 hours

Elaborated Solution: Updated AHA 2025/2026 guidelines recommend maintaining a core
temperature between 32–36°C for at least 24 hours after ROSC in comatose patients. Strict
33°C is no longer mandatory.

4. A patient with severe aortic stenosis is scheduled for transcatheter aortic valve
replacement (TAVR). What post-procedure complication is most specific to this procedure?
 A. Hemorrhagic stroke
 B. Vascular access site complications
 C. Acute kidney injury from contrast
 D. Complete heart block requiring pacemaker

✅ Verified Answer: D. Complete heart block requiring pacemaker

Elaborated Solution: TAVR can compress the conduction system; new LBBB or complete
heart block occurs in ~15–25% of cases, especially with self-expanding valves. Vascular
access issues are common but not most specific.

5. Which ECG finding is most consistent with pericarditis?
 A. Diffuse ST-segment elevation with PR depression
 B. Deep Q waves in leads II, III, aVF
 C. ST elevation in V2–V4 with reciprocal changes
 D. Peaked T waves

✅ Verified Answer: A. Diffuse ST-segment elevation with PR depression

Elaborated Solution: Pericarditis causes widespread inflammation → diffuse ST elevation
(concave upward) and PR segment depression. Q waves suggest prior MI. Reciprocal changes
suggest STEMI.

6. A patient with heart failure with reduced ejection fraction (HFrEF) is on
sacubitril/valsartan. Which electrolyte abnormality requires immediate holding of the next
dose?
 A. Sodium 135 mEq/L
 B. Potassium 6.1 mEq/L
 C. Magnesium 1.8 mg/dL
 D. Chloride 100 mEq/L

✅ Verified Answer: B. Potassium 6.1 mEq/L

Elaborated Solution: Sacubitril/valsartan (an ARNI) blocks aldosterone → can cause
hyperkalemia. K+ >6.0 mEq/L increases arrhythmia risk. Hold dose and notify provider.

7. A patient with a ventricular assist device (VAD) presents with low flow alarms,
hypotension, and decreased device speed. What is the priority action?
 A. Increase IV fluids rapidly

,  B. Call the VAD coordinator
 C. Auscultate over the pump for a change in hum
 D. Immediately start epinephrine

✅ Verified Answer: C. Auscultate over the pump for a change in hum

Elaborated Solution: A change in hum (e.g., high-pitched or intermittent) suggests pump
thrombosis or inflow obstruction. Fluids may help hypovolemia but first assess for
mechanical cause. Epinephrine increases afterload, worsening VAD function.

8. Which patient is at highest risk for developing atrial fibrillation after cardiac surgery?
 A. 55-year-old with LVEF 60%
 B. 72-year-old with history of hypertension and COPD
 C. 45-year-old with no comorbidities
 D. 68-year-old with mild aortic stenosis

✅ Verified Answer: B. 72-year-old with history of hypertension and COPD

Elaborated Solution: Older age (>70), hypertension, and COPD are independent predictors
of post-op atrial fibrillation. LVEF normal reduces risk.

9. A patient with an acute type B aortic dissection has a blood pressure of 185/110 mm Hg
and heart rate 105 bpm. What is the first-line medication?
 A. Sodium nitroprusside alone
 B. IV metoprolol
 C. IV hydralazine
 D. IV labetalol

✅ Verified Answer: D. IV labetalol

Elaborated Solution: Labetalol (beta-1 and alpha blockade) reduces heart rate and BP
simultaneously. Beta-blockade without alpha blockade (e.g., metoprolol alone) may worsen
dissection by unopposed alpha effect. Goal HR <60, SBP 100–120.

10. A patient with a permanent pacemaker for complete heart block has a pacing spike but
no QRS after the spike. This is most consistent with:
 A. Failure to capture
 B. Failure to sense
 C. Oversensing
 D. Normal function

✅ Verified Answer: A. Failure to capture

Elaborated Solution: Spike with no subsequent depolarization = failure to capture. Causes
include lead dislodgement, increased threshold, or battery depletion.