1
Med Surg 201 Final Exam West Coast University
Actual Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders (HF, CAD, MI, HTN, Dysrhythmias) — Questions 1-20]
Q1: A patient with heart failure presents with dyspnea, orthopnea, and bilateral crackles. The
nurse recognizes these symptoms as manifestations of which type of heart failure?
A. Right-sided heart failure
B. Left-sided heart failure
C. Biventricular failure
C. Left-sided heart failure [CORRECT]
D. Pulmonary embolism
Correct Answer: C
Rationale: Left-sided heart failure causes blood to back up into the left atrium and pulmonary
veins, resulting in pulmonary congestion and symptoms such as dyspnea, orthopnea, crackles,
and paroxysmal nocturnal dyspnea (PND). Right-sided heart failure typically causes systemic
congestion, leading to peripheral edema, jugular venous distention (JVD), and hepatomegaly.
Biventricular failure involves symptoms of both left and right failure. Pulmonary embolism
causes sudden onset of dyspnea and chest pain but not typically chronic orthopnea or bilateral
crackles initially.
Q2: The nurse is teaching a patient about dietary modifications for heart failure. Which
instruction should be included to prevent fluid retention and exacerbation of symptoms?
A. "Increase your intake of red meat to boost protein."
B. "Restrict your sodium intake to 2 grams or less per day."
B. "Restrict your sodium intake to 2 grams or less per day." [CORRECT]
C. "Drink at least 3 liters of water daily to flush toxins."
,2
D. "Limit your potassium intake to avoid heart rhythm issues."
Correct Answer: B
Rationale: Sodium restriction (typically less than 2-3 g/day) is the cornerstone of dietary
management for heart failure because sodium promotes water retention, increasing fluid overload
and cardiac workload. Increasing red meat is not specifically advised unless for anemia, and high
fluid intake is generally contraindicated in HF unless the patient is dehydrated. Potassium
restriction is only necessary if the patient has hyperkalemia or renal failure; often, HF patients on
diuretics need more potassium.
Q3: A patient with heart failure is prescribed furosemide (Lasix). Which electrolyte imbalance
should the nurse monitor for most closely as a side effect of this loop diuretic?
A. Hypernatremia
B. Hypokalemia [CORRECT]
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B
Rationale: Loop diuretics like furosemide inhibit sodium reabsorption in the ascending loop of
Henle, leading to increased excretion of sodium, water, and potassium, which places the patient
at high risk for hypokalemia. Hypokalemia can precipitate dangerous dysrhythmias, especially in
patients also taking digoxin. While hypomagnesemia can also occur, hypokalemia is the most
immediate and common concern requiring monitoring and potential supplementation.
Q4: The nurse is assessing a patient receiving digoxin (Lanoxin) for heart failure. Which finding
indicates the presence of digoxin toxicity?
A. Blood pressure of 110/70 mmHg
B. Heart rate of 60 bpm
C. Yellow-green halos around visual fields [CORRECT]
D. Weight loss of 1 lb in one day
,3
Correct Answer: C
Rationale: Yellow-green halos (visual disturbances), nausea, vomiting, and bradycardia (heart
rate <60 bpm) are classic signs of digoxin toxicity. A heart rate of 60 bpm is often the target rate
for digoxin therapy (apical pulse >60), provided it is not a new drop. Weight loss is generally
positive in HF management. Visual changes are a specific early warning sign necessitating
immediate discontinuation and serum level monitoring.
Q5: A patient is admitted with a suspected Myocardial Infarction (MI). The nurse administers
oxygen only if the SpO2 falls below what threshold?
A. 95%
B. 90%
C. 90% [CORRECT]
D. 85%
Correct Answer: C
Rationale: Current guidelines (AHA/ACC) recommend supplemental oxygen only if the patient's
oxygen saturation (SpO2) is less than 90% or if they are in respiratory distress. Routine
administration of oxygen to normoxic patients has not been shown to improve outcomes and may
actually cause vasoconstriction. Therefore, monitoring SpO2 and targeting a range of 90-94% (or
>90%) is the standard of care.
Q6: Immediately upon admission for an acute ST-Elevation Myocardial Infarction (STEMI), the
nurse prepares to administer which medication regimen known by the acronym MONA?
A. Morphine, Oxygen, Nitroglycerin, Aspirin
A. Morphine, Oxygen, Nitroglycerin, Aspirin [CORRECT]
B. Metoprolol, Ondansetron, Nitroprusside, Atenolol
C. Magnesium, Oxygen, Nifedipine, Aspirin
D. Metformin, Oseltamivir, Nystatin, Atorvastatin
Correct Answer: A
, 4
Rationale: MONA stands for Morphine (for pain and anxiety), Oxygen (if hypoxic),
Nitroglycerin (for vasodilation and pain relief), and Aspirin (antiplatelet therapy). This is the
standard initial management for acute coronary syndrome (ACS). The other options list
medications not indicated for the immediate relief of ischemia or clot stabilization in this specific
context.
Q7: A patient with unstable angina is prescribed sublingual nitroglycerin. What instruction is
critical for the nurse to provide regarding the administration of this medication?
A. "Swallow the tablet with a full glass of water."
B. "Take the medication at the first sign of chest pain, up to three doses spaced 5 minutes apart."
B. "Take the medication at the first sign of chest pain, up to three doses spaced 5 minutes apart."
[CORRECT]
C. "Store the tablets in the refrigerator to maintain potency."
D. "Take the medication daily to prevent chest pain regardless of symptoms."
Correct Answer: B
Rationale: Sublingual nitroglycerin is used for acute relief of angina. The standard protocol is to
take one dose at the onset of pain; if pain persists after 5 minutes, call emergency services (911)
and take a second dose; if pain persists after another 5 minutes, take a third dose. Tablets should
be kept in the original container, tightly closed, and at room temperature (not refrigerated). It is
not a maintenance medication for daily prevention like long-acting nitrates.
Q8: Which cardiac biomarker is the most specific indicator of myocardial injury and remains
elevated for 7 to 10 days after an MI?
A. Myoglobin
B. Creatine Kinase-MB (CK-MB)
C. Troponin I or T [CORRECT]
D. C-reactive protein (CRP)
Correct Answer: C
Med Surg 201 Final Exam West Coast University
Actual Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders (HF, CAD, MI, HTN, Dysrhythmias) — Questions 1-20]
Q1: A patient with heart failure presents with dyspnea, orthopnea, and bilateral crackles. The
nurse recognizes these symptoms as manifestations of which type of heart failure?
A. Right-sided heart failure
B. Left-sided heart failure
C. Biventricular failure
C. Left-sided heart failure [CORRECT]
D. Pulmonary embolism
Correct Answer: C
Rationale: Left-sided heart failure causes blood to back up into the left atrium and pulmonary
veins, resulting in pulmonary congestion and symptoms such as dyspnea, orthopnea, crackles,
and paroxysmal nocturnal dyspnea (PND). Right-sided heart failure typically causes systemic
congestion, leading to peripheral edema, jugular venous distention (JVD), and hepatomegaly.
Biventricular failure involves symptoms of both left and right failure. Pulmonary embolism
causes sudden onset of dyspnea and chest pain but not typically chronic orthopnea or bilateral
crackles initially.
Q2: The nurse is teaching a patient about dietary modifications for heart failure. Which
instruction should be included to prevent fluid retention and exacerbation of symptoms?
A. "Increase your intake of red meat to boost protein."
B. "Restrict your sodium intake to 2 grams or less per day."
B. "Restrict your sodium intake to 2 grams or less per day." [CORRECT]
C. "Drink at least 3 liters of water daily to flush toxins."
,2
D. "Limit your potassium intake to avoid heart rhythm issues."
Correct Answer: B
Rationale: Sodium restriction (typically less than 2-3 g/day) is the cornerstone of dietary
management for heart failure because sodium promotes water retention, increasing fluid overload
and cardiac workload. Increasing red meat is not specifically advised unless for anemia, and high
fluid intake is generally contraindicated in HF unless the patient is dehydrated. Potassium
restriction is only necessary if the patient has hyperkalemia or renal failure; often, HF patients on
diuretics need more potassium.
Q3: A patient with heart failure is prescribed furosemide (Lasix). Which electrolyte imbalance
should the nurse monitor for most closely as a side effect of this loop diuretic?
A. Hypernatremia
B. Hypokalemia [CORRECT]
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B
Rationale: Loop diuretics like furosemide inhibit sodium reabsorption in the ascending loop of
Henle, leading to increased excretion of sodium, water, and potassium, which places the patient
at high risk for hypokalemia. Hypokalemia can precipitate dangerous dysrhythmias, especially in
patients also taking digoxin. While hypomagnesemia can also occur, hypokalemia is the most
immediate and common concern requiring monitoring and potential supplementation.
Q4: The nurse is assessing a patient receiving digoxin (Lanoxin) for heart failure. Which finding
indicates the presence of digoxin toxicity?
A. Blood pressure of 110/70 mmHg
B. Heart rate of 60 bpm
C. Yellow-green halos around visual fields [CORRECT]
D. Weight loss of 1 lb in one day
,3
Correct Answer: C
Rationale: Yellow-green halos (visual disturbances), nausea, vomiting, and bradycardia (heart
rate <60 bpm) are classic signs of digoxin toxicity. A heart rate of 60 bpm is often the target rate
for digoxin therapy (apical pulse >60), provided it is not a new drop. Weight loss is generally
positive in HF management. Visual changes are a specific early warning sign necessitating
immediate discontinuation and serum level monitoring.
Q5: A patient is admitted with a suspected Myocardial Infarction (MI). The nurse administers
oxygen only if the SpO2 falls below what threshold?
A. 95%
B. 90%
C. 90% [CORRECT]
D. 85%
Correct Answer: C
Rationale: Current guidelines (AHA/ACC) recommend supplemental oxygen only if the patient's
oxygen saturation (SpO2) is less than 90% or if they are in respiratory distress. Routine
administration of oxygen to normoxic patients has not been shown to improve outcomes and may
actually cause vasoconstriction. Therefore, monitoring SpO2 and targeting a range of 90-94% (or
>90%) is the standard of care.
Q6: Immediately upon admission for an acute ST-Elevation Myocardial Infarction (STEMI), the
nurse prepares to administer which medication regimen known by the acronym MONA?
A. Morphine, Oxygen, Nitroglycerin, Aspirin
A. Morphine, Oxygen, Nitroglycerin, Aspirin [CORRECT]
B. Metoprolol, Ondansetron, Nitroprusside, Atenolol
C. Magnesium, Oxygen, Nifedipine, Aspirin
D. Metformin, Oseltamivir, Nystatin, Atorvastatin
Correct Answer: A
, 4
Rationale: MONA stands for Morphine (for pain and anxiety), Oxygen (if hypoxic),
Nitroglycerin (for vasodilation and pain relief), and Aspirin (antiplatelet therapy). This is the
standard initial management for acute coronary syndrome (ACS). The other options list
medications not indicated for the immediate relief of ischemia or clot stabilization in this specific
context.
Q7: A patient with unstable angina is prescribed sublingual nitroglycerin. What instruction is
critical for the nurse to provide regarding the administration of this medication?
A. "Swallow the tablet with a full glass of water."
B. "Take the medication at the first sign of chest pain, up to three doses spaced 5 minutes apart."
B. "Take the medication at the first sign of chest pain, up to three doses spaced 5 minutes apart."
[CORRECT]
C. "Store the tablets in the refrigerator to maintain potency."
D. "Take the medication daily to prevent chest pain regardless of symptoms."
Correct Answer: B
Rationale: Sublingual nitroglycerin is used for acute relief of angina. The standard protocol is to
take one dose at the onset of pain; if pain persists after 5 minutes, call emergency services (911)
and take a second dose; if pain persists after another 5 minutes, take a third dose. Tablets should
be kept in the original container, tightly closed, and at room temperature (not refrigerated). It is
not a maintenance medication for daily prevention like long-acting nitrates.
Q8: Which cardiac biomarker is the most specific indicator of myocardial injury and remains
elevated for 7 to 10 days after an MI?
A. Myoglobin
B. Creatine Kinase-MB (CK-MB)
C. Troponin I or T [CORRECT]
D. C-reactive protein (CRP)
Correct Answer: C
