JERSEY COLLEGE ADVANCED MEDICAL-SURGICAL NURSING EXAM STUDY GUIDE —
2026/2027
Jersey College School of Nursing | Comprehensive Adult Health Competency Assessment
75 Multiple-Choice & NGN-Style Questions | Evidence-Based Practice | Passing Score: 75–78% | Time: 120–
150 Minutes
Section I: Cardiovascular Disorders (Questions 1–8)
1. A patient arrives in the emergency department with crushing substernal chest pain that
began 45 minutes ago. The 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF.
Which laboratory marker is the MOST specific for confirming acute myocardial infarction in
this patient, and at what time does it typically begin to rise?
A. Creatine kinase-MB (CK-MB); rises within 3–6 B. High-sensitivity cardiac troponin I; rises within 1–3
hours hours
C. Myoglobin; rises within 1–2 hours D. B-type natriuretic peptide (BNP); rises within 2–4
hours
Answer: B. B. High-sensitivity cardiac troponin I; rises within 1–3 hours
Rationale: High-sensitivity cardiac troponin I (hs-cTnI) is the most specific and sensitive biomarker for
myocardial injury and is the preferred marker per current AHA/ACC guidelines. It begins to rise within 1
to 3 hours of symptom onset, peaks at 12 to 24 hours, and can remain elevated for up to 7 to 10 days. CK-
MB is less specific because it is also found in skeletal muscle, and myoglobin has poor cardiac specificity.
BNP is used for heart failure assessment, not acute MI diagnosis.
2. A patient with a diagnosis of STEMI is being prepared for percutaneous coronary
intervention (PCI). Which of the following medications should the nurse anticipate
administering BEFORE the patient is transported to the cardiac catheterization laboratory?
A. Aspirin 325 mg chewable, a P2Y12 inhibitor, and unfractionated heparin
B. Warfarin 5 mg PO, metoprolol 25 mg IV, and furosemide 40 mg IV
C. Aspirin 81 mg PO, enalapril 5 mg PO, and atorvastatin 80 mg PO
D. Morphine sulfate 4 mg IV only
Answer: A. A. Aspirin 325 mg chewable, a P2Y12 inhibitor, and unfractionated heparin
Rationale: Current ACC/AHA guidelines for STEMI management recommend administering aspirin (162–
325 mg chewable), a P2Y12 receptor inhibitor (clopidogrel, ticagrelor, or prasugrel), and anticoagulation
with unfractionated heparin prior to PCI. This pre-treatment reduces the risk of acute stent thrombosis and
periprocedural complications. Warfarin is not indicated in the acute setting, and morphine alone is
insufficient for pre-PCI preparation.
1
,3. A patient with heart failure is classified as NYHA Class III. Which clinical finding is MOST
consistent with this classification?
A. No limitation of physical activity; ordinary activity does not cause symptoms
B. Slight limitation of physical activity; comfortable at rest but ordinary activity causes fatigue or dyspnea
C. Marked limitation of physical activity; comfortable only at rest; less than ordinary activity causes
symptoms
D. Inability to carry on any physical activity without discomfort; symptoms present at rest
Answer: C. C. Marked limitation of physical activity; comfortable only at rest; less than
ordinary activity causes symptoms
Rationale: NYHA Class III heart failure is defined by marked limitation of physical activity. The patient is
comfortable only at rest, and any activity less than ordinary causes fatigue, palpitations, or dyspnea. Class
I patients have no limitations; Class II patients have slight limitations with ordinary activity; and Class IV
patients have symptoms at rest. Accurate classification guides therapy, including decisions about advanced
HF treatments and device therapy.
4. A patient with chronic heart failure has a BNP level of 1,200 pg/mL. The nurse understands
that this value indicates which of the following?
A. Normal cardiac function with a false-positive result B. Mild heart failure that is well compensated
C. Moderate to severe heart failure requiring D. Acute kidney injury unrelated to cardiac function
aggressive management
Answer: C. C. Moderate to severe heart failure requiring aggressive management
Rationale: B-type natriuretic peptide (BNP) levels above 400 pg/mL are generally considered indicative of
moderate to severe heart failure. A level of 1,200 pg/mL is significantly elevated and suggests
decompensated heart failure requiring aggressive diuretic therapy and volume management. Normal BNP
is typically less than 100 pg/mL, and levels between 100 and 400 pg/mL suggest mild or early heart
failure. BNP is released from ventricular myocytes in response to wall stretch from volume overload.
5. A patient with atrial fibrillation is prescribed warfarin therapy. The nurse reviews the
laboratory results and notes an INR of 4.8. Which action should the nurse take FIRST?
[Priority/Delegation]
A. Administer the next scheduled dose of warfarin as ordered
B. Hold the warfarin dose and notify the health care provider immediately
C. Administer vitamin K subcutaneously and continue the warfarin dose
D. Document the result and reassess the INR in 48 hours
Answer: B. B. Hold the warfarin dose and notify the health care provider immediately
Rationale: The target INR for most patients with atrial fibrillation on warfarin therapy is 2.0 to 3.0. An
INR of 4.8 is significantly above the therapeutic range and places the patient at high risk for serious
bleeding, including intracranial hemorrhage. The nurse should hold the warfarin dose immediately and
notify the health care provider for further instructions, which may include vitamin K administration or
2
,fresh frozen plasma depending on the presence of active bleeding. The nurse should never continue
warfarin when the INR is supratherapeutic.
6. A patient with new-onset atrial fibrillation with rapid ventricular response (RVR) has a
heart rate of 152 bpm and a blood pressure of 88/56 mmHg. Which of the following
medications should the nurse anticipate administering FIRST for rate control?
A. Diltiazem IV push for rate control B. Metoprolol IV push for rate control
C. Amiodarone IV infusion for rate and rhythm D. Heparin bolus for anticoagulation
control
Answer: C. C. Amiodarone IV infusion for rate and rhythm control
Rationale: In a hemodynamically unstable patient with atrial fibrillation (hypotension with SBP less than
90 mmHg), calcium channel blockers like diltiazem and beta-blockers like metoprolol are contraindicated
because they can further depress blood pressure and cardiac output. Amiodarone is the preferred agent in
this situation because it provides both rate and rhythm control with less negative inotropic effect.
Synchronized cardioversion may also be considered if the patient is critically unstable. Heparin addresses
thromboembolic risk but does not control the rate.
7. A patient with hypertension presents to the emergency department with a blood pressure of
220/130 mmHg, severe headache, blurred vision, and altered mental status. Which of the
following nursing interventions is the PRIORITY? [Priority/Delegation]
A. Administer oral antihypertensive medication and recheck BP in 1 hour
B. Initiate continuous IV antihypertensive therapy in an intensive care setting and reduce MAP by no more
than 25% in the first hour
C. Encourage the patient to rest in a quiet, dark room and apply a cold compress
D. Obtain a detailed dietary history and schedule a follow-up appointment
Answer: B. B. Initiate continuous IV antihypertensive therapy in an intensive care setting and
reduce MAP by no more than 25% in the first hour
Rationale: This patient presents with a hypertensive emergency, characterized by severely elevated BP
with evidence of end-organ damage (encephalopathy with altered mental status, visual changes).
Hypertensive emergencies require immediate IV antihypertensive therapy in an ICU setting with
continuous arterial monitoring. Current guidelines recommend reducing the mean arterial pressure (MAP)
by no more than 25% in the first hour to avoid cerebral hypoperfusion. Oral agents are too slow, and
conservative measures are inadequate for this life-threatening condition.
8. A nurse is caring for a patient with peripheral arterial disease (PAD). Which finding during
the ankle-brachial index (ABI) assessment is MOST consistent with moderate PAD?
A. ABI of 1.10, indicating normal arterial flow B. ABI of 0.92, indicating borderline or mild disease
C. ABI of 0.55, indicating moderate to severe arterial D. ABI of 0.25, indicating critical limb ischemia
insufficiency
3
, Answer: C. C. ABI of 0.55, indicating moderate to severe arterial insufficiency
Rationale: The ankle-brachial index compares systolic BP in the ankle to systolic BP in the arm. Normal
ABI is 1.00 to 1.40. An ABI of 0.91 to 0.99 indicates borderline disease, 0.41 to 0.90 indicates mild to
moderate PAD, and less than 0.40 indicates severe or critical limb ischemia. An ABI of 0.55 falls in the
moderate to severe range and is associated with claudication symptoms. ABI values above 1.40 may
suggest non-compressible vessels often seen in patients with diabetes or chronic kidney disease.
Section II: Respiratory Conditions (Questions 9–16)
9. A patient with severe COPD (GOLD Stage III) has a resting SpO2 of 82% on room air. Which
oxygen delivery device and target SpO2 should the nurse select?
A. Non-rebreather mask at 10–15 L/min; target SpO2 B. Nasal cannula at 1–2 L/min; target SpO2 88–92%
96–100%
C. Venturi mask at 28% FiO2; target SpO2 94–98% D. Simple face mask at 6 L/min; target SpO2 100%
Answer: B. B. Nasal cannula at 1–2 L/min; target SpO2 88–92%
Rationale: For patients with severe COPD, the target SpO2 is 88–92% per GOLD guidelines and current
evidence-based practice. These patients rely on a hypoxic drive for respiratory stimulation. Excessive
oxygen supplementation suppresses the hypoxic drive, leading to CO2 retention and hypercapnic
respiratory failure. A nasal cannula at 1 to 2 L/min provides controlled low-flow oxygen to achieve the
target range. Non-rebreather masks deliver high FiO2 and are contraindicated in uncomplicated COPD.
10. A nurse is teaching a patient with COPD about pursed-lip breathing. Which statement by
the patient indicates that the teaching has been effective?
A. I should breathe in through my mouth quickly and exhale through my nose slowly
B. I should inhale through my nose for 2 seconds and exhale through pursed lips for 4 seconds
C. I should only use pursed-lip breathing during emergency situations
D. I should breathe in through pursed lips and exhale through my nose
Answer: B. B. I should inhale through my nose for 2 seconds and exhale through pursed lips
for 4 seconds
Rationale: Pursed-lip breathing is a cornerstone technique for patients with COPD to manage dyspnea and
improve ventilation. The correct technique involves inhaling slowly through the nose for approximately 2
seconds (count of 2), then exhaling slowly through pursed lips for approximately 4 seconds (count of 4).
This prolongs exhalation, creates positive back-pressure that helps keep airways open, improves gas
exchange, and reduces air trapping. Pursed-lip breathing should be used regularly, not just in emergencies.
11. A patient with a history of asthma presents to the emergency department with severe
dyspnea, accessory muscle use, and inability to speak in complete sentences. The peak
expiratory flow (PEF) is 35% of predicted. Which classification of asthma severity does this
represent?
A. Mild intermittent asthma exacerbation B. Moderate persistent asthma exacerbation
4
2026/2027
Jersey College School of Nursing | Comprehensive Adult Health Competency Assessment
75 Multiple-Choice & NGN-Style Questions | Evidence-Based Practice | Passing Score: 75–78% | Time: 120–
150 Minutes
Section I: Cardiovascular Disorders (Questions 1–8)
1. A patient arrives in the emergency department with crushing substernal chest pain that
began 45 minutes ago. The 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF.
Which laboratory marker is the MOST specific for confirming acute myocardial infarction in
this patient, and at what time does it typically begin to rise?
A. Creatine kinase-MB (CK-MB); rises within 3–6 B. High-sensitivity cardiac troponin I; rises within 1–3
hours hours
C. Myoglobin; rises within 1–2 hours D. B-type natriuretic peptide (BNP); rises within 2–4
hours
Answer: B. B. High-sensitivity cardiac troponin I; rises within 1–3 hours
Rationale: High-sensitivity cardiac troponin I (hs-cTnI) is the most specific and sensitive biomarker for
myocardial injury and is the preferred marker per current AHA/ACC guidelines. It begins to rise within 1
to 3 hours of symptom onset, peaks at 12 to 24 hours, and can remain elevated for up to 7 to 10 days. CK-
MB is less specific because it is also found in skeletal muscle, and myoglobin has poor cardiac specificity.
BNP is used for heart failure assessment, not acute MI diagnosis.
2. A patient with a diagnosis of STEMI is being prepared for percutaneous coronary
intervention (PCI). Which of the following medications should the nurse anticipate
administering BEFORE the patient is transported to the cardiac catheterization laboratory?
A. Aspirin 325 mg chewable, a P2Y12 inhibitor, and unfractionated heparin
B. Warfarin 5 mg PO, metoprolol 25 mg IV, and furosemide 40 mg IV
C. Aspirin 81 mg PO, enalapril 5 mg PO, and atorvastatin 80 mg PO
D. Morphine sulfate 4 mg IV only
Answer: A. A. Aspirin 325 mg chewable, a P2Y12 inhibitor, and unfractionated heparin
Rationale: Current ACC/AHA guidelines for STEMI management recommend administering aspirin (162–
325 mg chewable), a P2Y12 receptor inhibitor (clopidogrel, ticagrelor, or prasugrel), and anticoagulation
with unfractionated heparin prior to PCI. This pre-treatment reduces the risk of acute stent thrombosis and
periprocedural complications. Warfarin is not indicated in the acute setting, and morphine alone is
insufficient for pre-PCI preparation.
1
,3. A patient with heart failure is classified as NYHA Class III. Which clinical finding is MOST
consistent with this classification?
A. No limitation of physical activity; ordinary activity does not cause symptoms
B. Slight limitation of physical activity; comfortable at rest but ordinary activity causes fatigue or dyspnea
C. Marked limitation of physical activity; comfortable only at rest; less than ordinary activity causes
symptoms
D. Inability to carry on any physical activity without discomfort; symptoms present at rest
Answer: C. C. Marked limitation of physical activity; comfortable only at rest; less than
ordinary activity causes symptoms
Rationale: NYHA Class III heart failure is defined by marked limitation of physical activity. The patient is
comfortable only at rest, and any activity less than ordinary causes fatigue, palpitations, or dyspnea. Class
I patients have no limitations; Class II patients have slight limitations with ordinary activity; and Class IV
patients have symptoms at rest. Accurate classification guides therapy, including decisions about advanced
HF treatments and device therapy.
4. A patient with chronic heart failure has a BNP level of 1,200 pg/mL. The nurse understands
that this value indicates which of the following?
A. Normal cardiac function with a false-positive result B. Mild heart failure that is well compensated
C. Moderate to severe heart failure requiring D. Acute kidney injury unrelated to cardiac function
aggressive management
Answer: C. C. Moderate to severe heart failure requiring aggressive management
Rationale: B-type natriuretic peptide (BNP) levels above 400 pg/mL are generally considered indicative of
moderate to severe heart failure. A level of 1,200 pg/mL is significantly elevated and suggests
decompensated heart failure requiring aggressive diuretic therapy and volume management. Normal BNP
is typically less than 100 pg/mL, and levels between 100 and 400 pg/mL suggest mild or early heart
failure. BNP is released from ventricular myocytes in response to wall stretch from volume overload.
5. A patient with atrial fibrillation is prescribed warfarin therapy. The nurse reviews the
laboratory results and notes an INR of 4.8. Which action should the nurse take FIRST?
[Priority/Delegation]
A. Administer the next scheduled dose of warfarin as ordered
B. Hold the warfarin dose and notify the health care provider immediately
C. Administer vitamin K subcutaneously and continue the warfarin dose
D. Document the result and reassess the INR in 48 hours
Answer: B. B. Hold the warfarin dose and notify the health care provider immediately
Rationale: The target INR for most patients with atrial fibrillation on warfarin therapy is 2.0 to 3.0. An
INR of 4.8 is significantly above the therapeutic range and places the patient at high risk for serious
bleeding, including intracranial hemorrhage. The nurse should hold the warfarin dose immediately and
notify the health care provider for further instructions, which may include vitamin K administration or
2
,fresh frozen plasma depending on the presence of active bleeding. The nurse should never continue
warfarin when the INR is supratherapeutic.
6. A patient with new-onset atrial fibrillation with rapid ventricular response (RVR) has a
heart rate of 152 bpm and a blood pressure of 88/56 mmHg. Which of the following
medications should the nurse anticipate administering FIRST for rate control?
A. Diltiazem IV push for rate control B. Metoprolol IV push for rate control
C. Amiodarone IV infusion for rate and rhythm D. Heparin bolus for anticoagulation
control
Answer: C. C. Amiodarone IV infusion for rate and rhythm control
Rationale: In a hemodynamically unstable patient with atrial fibrillation (hypotension with SBP less than
90 mmHg), calcium channel blockers like diltiazem and beta-blockers like metoprolol are contraindicated
because they can further depress blood pressure and cardiac output. Amiodarone is the preferred agent in
this situation because it provides both rate and rhythm control with less negative inotropic effect.
Synchronized cardioversion may also be considered if the patient is critically unstable. Heparin addresses
thromboembolic risk but does not control the rate.
7. A patient with hypertension presents to the emergency department with a blood pressure of
220/130 mmHg, severe headache, blurred vision, and altered mental status. Which of the
following nursing interventions is the PRIORITY? [Priority/Delegation]
A. Administer oral antihypertensive medication and recheck BP in 1 hour
B. Initiate continuous IV antihypertensive therapy in an intensive care setting and reduce MAP by no more
than 25% in the first hour
C. Encourage the patient to rest in a quiet, dark room and apply a cold compress
D. Obtain a detailed dietary history and schedule a follow-up appointment
Answer: B. B. Initiate continuous IV antihypertensive therapy in an intensive care setting and
reduce MAP by no more than 25% in the first hour
Rationale: This patient presents with a hypertensive emergency, characterized by severely elevated BP
with evidence of end-organ damage (encephalopathy with altered mental status, visual changes).
Hypertensive emergencies require immediate IV antihypertensive therapy in an ICU setting with
continuous arterial monitoring. Current guidelines recommend reducing the mean arterial pressure (MAP)
by no more than 25% in the first hour to avoid cerebral hypoperfusion. Oral agents are too slow, and
conservative measures are inadequate for this life-threatening condition.
8. A nurse is caring for a patient with peripheral arterial disease (PAD). Which finding during
the ankle-brachial index (ABI) assessment is MOST consistent with moderate PAD?
A. ABI of 1.10, indicating normal arterial flow B. ABI of 0.92, indicating borderline or mild disease
C. ABI of 0.55, indicating moderate to severe arterial D. ABI of 0.25, indicating critical limb ischemia
insufficiency
3
, Answer: C. C. ABI of 0.55, indicating moderate to severe arterial insufficiency
Rationale: The ankle-brachial index compares systolic BP in the ankle to systolic BP in the arm. Normal
ABI is 1.00 to 1.40. An ABI of 0.91 to 0.99 indicates borderline disease, 0.41 to 0.90 indicates mild to
moderate PAD, and less than 0.40 indicates severe or critical limb ischemia. An ABI of 0.55 falls in the
moderate to severe range and is associated with claudication symptoms. ABI values above 1.40 may
suggest non-compressible vessels often seen in patients with diabetes or chronic kidney disease.
Section II: Respiratory Conditions (Questions 9–16)
9. A patient with severe COPD (GOLD Stage III) has a resting SpO2 of 82% on room air. Which
oxygen delivery device and target SpO2 should the nurse select?
A. Non-rebreather mask at 10–15 L/min; target SpO2 B. Nasal cannula at 1–2 L/min; target SpO2 88–92%
96–100%
C. Venturi mask at 28% FiO2; target SpO2 94–98% D. Simple face mask at 6 L/min; target SpO2 100%
Answer: B. B. Nasal cannula at 1–2 L/min; target SpO2 88–92%
Rationale: For patients with severe COPD, the target SpO2 is 88–92% per GOLD guidelines and current
evidence-based practice. These patients rely on a hypoxic drive for respiratory stimulation. Excessive
oxygen supplementation suppresses the hypoxic drive, leading to CO2 retention and hypercapnic
respiratory failure. A nasal cannula at 1 to 2 L/min provides controlled low-flow oxygen to achieve the
target range. Non-rebreather masks deliver high FiO2 and are contraindicated in uncomplicated COPD.
10. A nurse is teaching a patient with COPD about pursed-lip breathing. Which statement by
the patient indicates that the teaching has been effective?
A. I should breathe in through my mouth quickly and exhale through my nose slowly
B. I should inhale through my nose for 2 seconds and exhale through pursed lips for 4 seconds
C. I should only use pursed-lip breathing during emergency situations
D. I should breathe in through pursed lips and exhale through my nose
Answer: B. B. I should inhale through my nose for 2 seconds and exhale through pursed lips
for 4 seconds
Rationale: Pursed-lip breathing is a cornerstone technique for patients with COPD to manage dyspnea and
improve ventilation. The correct technique involves inhaling slowly through the nose for approximately 2
seconds (count of 2), then exhaling slowly through pursed lips for approximately 4 seconds (count of 4).
This prolongs exhalation, creates positive back-pressure that helps keep airways open, improves gas
exchange, and reduces air trapping. Pursed-lip breathing should be used regularly, not just in emergencies.
11. A patient with a history of asthma presents to the emergency department with severe
dyspnea, accessory muscle use, and inability to speak in complete sentences. The peak
expiratory flow (PEF) is 35% of predicted. Which classification of asthma severity does this
represent?
A. Mild intermittent asthma exacerbation B. Moderate persistent asthma exacerbation
4
