KAPLAN MEDICAL SURGICAL INTEGRATED
TEST ACTUAL PRACTICE EXAM) with
questions and well verified answers already
graded A+ 2026 EDITION
CARDIOVASCULAR (Questions 1-25)
1. A client with heart failure is prescribed furosemide 40 mg IV push. Which assessment finding requires
the nurse to hold the dose and contact the provider?
A. Blood pressure 110/70 mmHg
B. Serum potassium 3.2 mEq/L
C. Urine output 30 mL/hr
D. Weight loss of 1 kg in 24 hours
Answer: : B
Rationale
• B (Correct): Furosemide is a loop diuretic that causes potassium excretion. A serum potassium
of 3.2 mEq/L indicates hypokalemia, which increases risk for life-threatening dysrhythmias. The
dose should be held and potassium replacement considered.
• A (Incorrect): BP 110/70 is within normal limits and not a contraindication for furosemide in
heart failure.
• C (Incorrect): Urine output of 30 mL/hr is adequate (minimum acceptable is 30 mL/hr);
furosemide should increase output.
• D (Incorrect): Weight loss of 1 kg (~1 L fluid) in 24 hours is an expected therapeutic outcome in
heart failure management.
2. The nurse is caring for a client 2 hours post-cardiac catheterization via the right femoral artery. Which
finding requires immediate intervention?
A. Mild discomfort at the insertion site
B. Pedal pulse +1 on the right, +2 on the left
C. Small amount of dried blood on the dressing
D. Client reports feeling warm after contrast injection
Answer: : B
Rationale
, • B (Correct): A diminished pedal pulse (+1 vs +2) on the procedural side suggests possible arterial
occlusion, hematoma, or compartment syndrome—requires immediate assessment and
provider notification.
• A (Incorrect): Mild discomfort is expected post-procedure; managed with analgesics.
• C (Incorrect): Small dried blood is common; monitor for active bleeding but not emergent.
• D (Incorrect): Warmth/flushing is a normal reaction to iodinated contrast media.
3. A client with acute coronary syndrome has a prescription for sublingual nitroglycerin. Which
statement by the client indicates understanding of proper administration?
A. "I will swallow the tablet with water for faster absorption."
B. "I will take up to three tablets 5 minutes apart if pain persists."
C. "I should store the tablets in a clear plastic container for easy access."
D. "I will take this medication daily at bedtime to prevent angina."
Answer: : B
Rationale
• B (Correct): Standard protocol for acute angina: 1 SL tablet every 5 minutes × 3 doses; if pain
persists after 3 doses, activate EMS.
• A (Incorrect): Nitroglycerin must dissolve sublingually; swallowing reduces bioavailability due to
first-pass metabolism.
• C (Incorrect): Nitroglycerin degrades with light/air; must be stored in original dark glass bottle,
tightly closed.
• D (Incorrect): SL nitroglycerin is for acute relief, not prophylaxis; long-acting nitrates (e.g.,
isosorbide) are used for prevention.
4. Which ECG change is most indicative of myocardial ischemia in a client with chest pain?
A. ST-segment elevation
B. ST-segment depression
C. Pathological Q waves
D. Prolonged QT interval
Answer: : B
Rationale
• B (Correct): ST-segment depression is classic for subendocardial ischemia (e.g., unstable angina,
NSTEMI).
• A (Incorrect): ST elevation indicates transmural injury (STEMI), not just ischemia.
• C (Incorrect): Pathological Q waves indicate prior myocardial infarction (necrosis), not acute
ischemia.
• D (Incorrect): Prolonged QT relates to electrolyte imbalances or drug effects, not specific to
ischemia.
, 5. A client with hypertension is prescribed lisinopril. Which teaching point is priority for the nurse to
include?
A. "Rise slowly from sitting to standing to prevent dizziness."
B. "Take this medication with a high-potassium meal."
C. "Report a persistent dry cough to your provider."
D. "Avoid grapefruit juice while taking this medication."
Answer: : C
Rationale
• C (Correct): ACE inhibitors like lisinopril commonly cause a dry, nonproductive cough due to
bradykinin accumulation; may require discontinuation.
• A (Incorrect): While orthostatic hypotension can occur, it's less specific to ACE inhibitors than
cough; still important but not priority teaching.
• B (Incorrect): ACE inhibitors can cause hyperkalemia; high-potassium meals may increase risk—
teach moderation, not encouragement.
• D (Incorrect): Grapefruit juice interacts with calcium channel blockers (e.g., felodipine), not ACE
inhibitors.
6. The nurse assesses a client with peripheral artery disease (PAD). Which finding is most consistent with
this diagnosis?
A. Bilateral ankle edema
B. Cool, pale feet with diminished pulses
C. Red, warm calf with positive Homans' sign
D. Brown discoloration of lower legs
Answer: : B
Rationale
• B (Correct): PAD causes reduced arterial flow → cool, pale extremities, diminished/absent
pulses, claudication pain.
• A (Incorrect): Bilateral edema suggests heart failure or venous insufficiency, not arterial disease.
• C (Incorrect): Red, warm calf + Homans' sign suggests deep vein thrombosis (DVT), a venous
issue.
• D (Incorrect): Brown discoloration (hemosiderin deposition) is classic for chronic venous
insufficiency.
7. A client is admitted with acute decompensated heart failure. Which intervention should the nurse
implement first?
A. Administer IV furosemide as prescribed
B. Place the client in high-Fowler's position
C. Apply oxygen via nasal cannula at 2 L/min
D. Obtain daily weight on admission scale
TEST ACTUAL PRACTICE EXAM) with
questions and well verified answers already
graded A+ 2026 EDITION
CARDIOVASCULAR (Questions 1-25)
1. A client with heart failure is prescribed furosemide 40 mg IV push. Which assessment finding requires
the nurse to hold the dose and contact the provider?
A. Blood pressure 110/70 mmHg
B. Serum potassium 3.2 mEq/L
C. Urine output 30 mL/hr
D. Weight loss of 1 kg in 24 hours
Answer: : B
Rationale
• B (Correct): Furosemide is a loop diuretic that causes potassium excretion. A serum potassium
of 3.2 mEq/L indicates hypokalemia, which increases risk for life-threatening dysrhythmias. The
dose should be held and potassium replacement considered.
• A (Incorrect): BP 110/70 is within normal limits and not a contraindication for furosemide in
heart failure.
• C (Incorrect): Urine output of 30 mL/hr is adequate (minimum acceptable is 30 mL/hr);
furosemide should increase output.
• D (Incorrect): Weight loss of 1 kg (~1 L fluid) in 24 hours is an expected therapeutic outcome in
heart failure management.
2. The nurse is caring for a client 2 hours post-cardiac catheterization via the right femoral artery. Which
finding requires immediate intervention?
A. Mild discomfort at the insertion site
B. Pedal pulse +1 on the right, +2 on the left
C. Small amount of dried blood on the dressing
D. Client reports feeling warm after contrast injection
Answer: : B
Rationale
, • B (Correct): A diminished pedal pulse (+1 vs +2) on the procedural side suggests possible arterial
occlusion, hematoma, or compartment syndrome—requires immediate assessment and
provider notification.
• A (Incorrect): Mild discomfort is expected post-procedure; managed with analgesics.
• C (Incorrect): Small dried blood is common; monitor for active bleeding but not emergent.
• D (Incorrect): Warmth/flushing is a normal reaction to iodinated contrast media.
3. A client with acute coronary syndrome has a prescription for sublingual nitroglycerin. Which
statement by the client indicates understanding of proper administration?
A. "I will swallow the tablet with water for faster absorption."
B. "I will take up to three tablets 5 minutes apart if pain persists."
C. "I should store the tablets in a clear plastic container for easy access."
D. "I will take this medication daily at bedtime to prevent angina."
Answer: : B
Rationale
• B (Correct): Standard protocol for acute angina: 1 SL tablet every 5 minutes × 3 doses; if pain
persists after 3 doses, activate EMS.
• A (Incorrect): Nitroglycerin must dissolve sublingually; swallowing reduces bioavailability due to
first-pass metabolism.
• C (Incorrect): Nitroglycerin degrades with light/air; must be stored in original dark glass bottle,
tightly closed.
• D (Incorrect): SL nitroglycerin is for acute relief, not prophylaxis; long-acting nitrates (e.g.,
isosorbide) are used for prevention.
4. Which ECG change is most indicative of myocardial ischemia in a client with chest pain?
A. ST-segment elevation
B. ST-segment depression
C. Pathological Q waves
D. Prolonged QT interval
Answer: : B
Rationale
• B (Correct): ST-segment depression is classic for subendocardial ischemia (e.g., unstable angina,
NSTEMI).
• A (Incorrect): ST elevation indicates transmural injury (STEMI), not just ischemia.
• C (Incorrect): Pathological Q waves indicate prior myocardial infarction (necrosis), not acute
ischemia.
• D (Incorrect): Prolonged QT relates to electrolyte imbalances or drug effects, not specific to
ischemia.
, 5. A client with hypertension is prescribed lisinopril. Which teaching point is priority for the nurse to
include?
A. "Rise slowly from sitting to standing to prevent dizziness."
B. "Take this medication with a high-potassium meal."
C. "Report a persistent dry cough to your provider."
D. "Avoid grapefruit juice while taking this medication."
Answer: : C
Rationale
• C (Correct): ACE inhibitors like lisinopril commonly cause a dry, nonproductive cough due to
bradykinin accumulation; may require discontinuation.
• A (Incorrect): While orthostatic hypotension can occur, it's less specific to ACE inhibitors than
cough; still important but not priority teaching.
• B (Incorrect): ACE inhibitors can cause hyperkalemia; high-potassium meals may increase risk—
teach moderation, not encouragement.
• D (Incorrect): Grapefruit juice interacts with calcium channel blockers (e.g., felodipine), not ACE
inhibitors.
6. The nurse assesses a client with peripheral artery disease (PAD). Which finding is most consistent with
this diagnosis?
A. Bilateral ankle edema
B. Cool, pale feet with diminished pulses
C. Red, warm calf with positive Homans' sign
D. Brown discoloration of lower legs
Answer: : B
Rationale
• B (Correct): PAD causes reduced arterial flow → cool, pale extremities, diminished/absent
pulses, claudication pain.
• A (Incorrect): Bilateral edema suggests heart failure or venous insufficiency, not arterial disease.
• C (Incorrect): Red, warm calf + Homans' sign suggests deep vein thrombosis (DVT), a venous
issue.
• D (Incorrect): Brown discoloration (hemosiderin deposition) is classic for chronic venous
insufficiency.
7. A client is admitted with acute decompensated heart failure. Which intervention should the nurse
implement first?
A. Administer IV furosemide as prescribed
B. Place the client in high-Fowler's position
C. Apply oxygen via nasal cannula at 2 L/min
D. Obtain daily weight on admission scale
