,Kaplan Medical-Surgical integrated teSt –
Strong expanded practice QueStionS and
anSwerS|-2025/2026 lateSt releaSe-
1. Acute Myocardial Infarction With ST Elevation
Question
A 58-year-old man arrives at the emergency department complaining of severe crushing chest pain
radiating to his left arm and jaw. He reports nausea, diaphoresis, and shortness of breath. The pain started
45 minutes ago while he was mowing the lawn. Vital signs are BP 88/56 mmHg, HR 118 bpm, RR
24/min, SpO2 91% on room air. A 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF.
Laboratory results show elevated troponin levels.
The nurse is preparing the patient for immediate intervention. Which nursing action is the priority, and
why?
Answer
The priority nursing action is to administer oxygen as prescribed, establish IV access, prepare for
reperfusion therapy (such as percutaneous coronary intervention), and continuously monitor cardiac
rhythm and hemodynamic status.
This patient is experiencing an acute ST-elevation myocardial infarction (STEMI), specifically involving
the inferior wall of the heart. Inferior STEMIs can compromise cardiac output and place the patient at risk
for cardiogenic shock and lethal dysrhythmias.
The nurse must prioritize interventions using the ABCs (Airway, Breathing, Circulation):
• Oxygen improves myocardial oxygen supply.
• IV access allows rapid administration of emergency medications.
• Continuous ECG monitoring detects life-threatening arrhythmias.
• Reperfusion therapy restores blood flow to ischemic myocardium.
• Morphine and nitroglycerin may be administered cautiously depending on blood pressure.
The hypotension is especially concerning. Inferior wall MIs may involve right ventricular infarction,
making patients preload dependent. Excessive nitroglycerin administration can worsen hypotension.
Key nursing priorities include:
• Rapid recognition of STEMI
• Reduction of myocardial oxygen demand
• Restoration of perfusion
• Prevention of complications such as ventricular fibrillation and cardiogenic shock
,2. Acute Respiratory Distress Syndrome (ARDS)
Question
A patient admitted for sepsis suddenly develops severe dyspnea, tachypnea, restlessness, and refractory
hypoxemia. Bilateral crackles are auscultated. Chest x-ray reveals diffuse bilateral infiltrates. The patient
is transferred to the ICU and diagnosed with Acute Respiratory Distress Syndrome (ARDS).
What findings support this diagnosis, and what nursing interventions are most important?
Answer
ARDS is characterized by acute inflammatory lung injury leading to increased pulmonary capillary
permeability, noncardiogenic pulmonary edema, and severe hypoxemia.
Key findings supporting ARDS include:
• Severe refractory hypoxemia
• Bilateral pulmonary infiltrates on chest x-ray
• Tachypnea and respiratory distress
• Decreased lung compliance
• Crackles throughout the lungs
• History of major inflammatory insult such as sepsis
Unlike cardiogenic pulmonary edema, ARDS is not caused by heart failure.
Priority nursing interventions include:
• Administering high-flow oxygen or mechanical ventilation
• Applying positive end-expiratory pressure (PEEP)
• Monitoring arterial blood gases
• Positioning the patient prone if ordered
• Preventing ventilator-associated pneumonia
• Monitoring fluid balance carefully
PEEP is critical because it prevents alveolar collapse and improves oxygenation.
Nurses must closely monitor for:
• Barotrauma
• Multi-organ failure
• Hemodynamic instability
• Worsening respiratory fatigue
, Early recognition and aggressive supportive management significantly improve survival.
3. Diabetic Ketoacidosis (DKA)
Question
A 22-year-old patient with type 1 diabetes mellitus is brought to the emergency department after several
days of vomiting, excessive thirst, and abdominal pain. Assessment findings include Kussmaul
respirations, fruity breath odor, tachycardia, and lethargy. Blood glucose is 612 mg/dL.
Which interventions should the nurse anticipate, and what is the rationale for each?
Answer
This patient is experiencing diabetic ketoacidosis (DKA), a life-threatening complication caused by
severe insulin deficiency.
Key clinical findings include:
• Hyperglycemia
• Ketosis
• Metabolic acidosis
• Dehydration
• Kussmaul respirations
Expected interventions include:
1. Aggressive IV fluid replacement
• Corrects severe dehydration
• Restores circulatory volume
• Improves renal perfusion
2. Regular insulin infusion
• Stops ketone production
• Reduces blood glucose levels
• Reverses acidosis
3. Potassium monitoring and replacement
• Potassium initially appears elevated due to acidosis
• Total body potassium is depleted
• Insulin administration drives potassium into cells, risking hypokalemia
4. Frequent glucose and electrolyte monitoring
Strong expanded practice QueStionS and
anSwerS|-2025/2026 lateSt releaSe-
1. Acute Myocardial Infarction With ST Elevation
Question
A 58-year-old man arrives at the emergency department complaining of severe crushing chest pain
radiating to his left arm and jaw. He reports nausea, diaphoresis, and shortness of breath. The pain started
45 minutes ago while he was mowing the lawn. Vital signs are BP 88/56 mmHg, HR 118 bpm, RR
24/min, SpO2 91% on room air. A 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF.
Laboratory results show elevated troponin levels.
The nurse is preparing the patient for immediate intervention. Which nursing action is the priority, and
why?
Answer
The priority nursing action is to administer oxygen as prescribed, establish IV access, prepare for
reperfusion therapy (such as percutaneous coronary intervention), and continuously monitor cardiac
rhythm and hemodynamic status.
This patient is experiencing an acute ST-elevation myocardial infarction (STEMI), specifically involving
the inferior wall of the heart. Inferior STEMIs can compromise cardiac output and place the patient at risk
for cardiogenic shock and lethal dysrhythmias.
The nurse must prioritize interventions using the ABCs (Airway, Breathing, Circulation):
• Oxygen improves myocardial oxygen supply.
• IV access allows rapid administration of emergency medications.
• Continuous ECG monitoring detects life-threatening arrhythmias.
• Reperfusion therapy restores blood flow to ischemic myocardium.
• Morphine and nitroglycerin may be administered cautiously depending on blood pressure.
The hypotension is especially concerning. Inferior wall MIs may involve right ventricular infarction,
making patients preload dependent. Excessive nitroglycerin administration can worsen hypotension.
Key nursing priorities include:
• Rapid recognition of STEMI
• Reduction of myocardial oxygen demand
• Restoration of perfusion
• Prevention of complications such as ventricular fibrillation and cardiogenic shock
,2. Acute Respiratory Distress Syndrome (ARDS)
Question
A patient admitted for sepsis suddenly develops severe dyspnea, tachypnea, restlessness, and refractory
hypoxemia. Bilateral crackles are auscultated. Chest x-ray reveals diffuse bilateral infiltrates. The patient
is transferred to the ICU and diagnosed with Acute Respiratory Distress Syndrome (ARDS).
What findings support this diagnosis, and what nursing interventions are most important?
Answer
ARDS is characterized by acute inflammatory lung injury leading to increased pulmonary capillary
permeability, noncardiogenic pulmonary edema, and severe hypoxemia.
Key findings supporting ARDS include:
• Severe refractory hypoxemia
• Bilateral pulmonary infiltrates on chest x-ray
• Tachypnea and respiratory distress
• Decreased lung compliance
• Crackles throughout the lungs
• History of major inflammatory insult such as sepsis
Unlike cardiogenic pulmonary edema, ARDS is not caused by heart failure.
Priority nursing interventions include:
• Administering high-flow oxygen or mechanical ventilation
• Applying positive end-expiratory pressure (PEEP)
• Monitoring arterial blood gases
• Positioning the patient prone if ordered
• Preventing ventilator-associated pneumonia
• Monitoring fluid balance carefully
PEEP is critical because it prevents alveolar collapse and improves oxygenation.
Nurses must closely monitor for:
• Barotrauma
• Multi-organ failure
• Hemodynamic instability
• Worsening respiratory fatigue
, Early recognition and aggressive supportive management significantly improve survival.
3. Diabetic Ketoacidosis (DKA)
Question
A 22-year-old patient with type 1 diabetes mellitus is brought to the emergency department after several
days of vomiting, excessive thirst, and abdominal pain. Assessment findings include Kussmaul
respirations, fruity breath odor, tachycardia, and lethargy. Blood glucose is 612 mg/dL.
Which interventions should the nurse anticipate, and what is the rationale for each?
Answer
This patient is experiencing diabetic ketoacidosis (DKA), a life-threatening complication caused by
severe insulin deficiency.
Key clinical findings include:
• Hyperglycemia
• Ketosis
• Metabolic acidosis
• Dehydration
• Kussmaul respirations
Expected interventions include:
1. Aggressive IV fluid replacement
• Corrects severe dehydration
• Restores circulatory volume
• Improves renal perfusion
2. Regular insulin infusion
• Stops ketone production
• Reduces blood glucose levels
• Reverses acidosis
3. Potassium monitoring and replacement
• Potassium initially appears elevated due to acidosis
• Total body potassium is depleted
• Insulin administration drives potassium into cells, risking hypokalemia
4. Frequent glucose and electrolyte monitoring
