Advanced Medical-Surgical Nursing Exam
ACTUAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST
RECENT!!)
Questions 1-20: Cardiovascular & Hematology
1. A patient with acute decompensated heart failure presents
with severe dyspnea, crackles in all lung fields, and an SpO2
of 82% on room air. The nurse administers furosemide 80mg
IV push. Which finding indicates the most therapeutic
response?
A. Decreased serum potassium level
B. Increased urine output of 500 mL in 1 hour
C. Blood pressure increase from 90/60 to 110/70
D. Respiratory rate increase from 28 to 32
Answer: B. Rationale: Furosemide is a loop diuretic that rapidly
reduces preload by promoting diuresis. The therapeutic goal in
acute decompensated HF is to reduce pulmonary congestion.
Increased urine output directly correlates with reduced
intravascular volume, decreased preload, and subsequent
improvement in dyspnea and oxygenation. Option A is an adverse
effect (hypokalemia), not a therapeutic response. Option C (BP
increase) is not the primary goal and could indicate over-diuresis.
Option D (↑ RR) indicates worsening respiratory distress.
,2. A patient is 2 hours post-percutaneous coronary
intervention (PCI) via the right femoral artery. Which
assessment finding requires immediate intervention by the
nurse?
A. Complaints of mild back pain
B. Right pedal pulse is 2+ and palpable
C. 2cm diameter hematoma at the insertion site
D. Saturation of the dressing with bright red blood
Answer: D. Rationale: Saturation of the dressing with bright red
blood indicates active arterial bleeding, which can lead to rapid
hypovolemia, hypotension, and shock. This requires immediate
manual pressure, possible reversal of anticoagulation, and surgical
consult. A small hematoma (C) is common but should be
monitored. Mild back pain (A) is common from lying flat. A
palpable pulse (B) is expected.
3. The nurse is caring for a patient with infective endocarditis.
Which assessment finding is most indicative of a systemic
embolic event?
A. Splinter hemorrhages in the nail beds
B. Painless, erythematous macules on the palms (Janeway lesions)
C. New onset right-sided weakness and slurred speech
D. Temperature of 101.2°F (38.4°C)
Answer: C. Rationale: Systemic emboli from vegetative growths
on heart valves (most commonly mitral or aortic) can travel to the
cerebral circulation, causing an embolic stroke. New focal
neurologic deficits are a medical emergency. Options A, B, and D
are classic manifestations of endocarditis (peripheral stigmata and
fever) but do not represent an acute embolic event requiring
immediate intervention like a stroke.
,4. A patient with chronic stable angina is prescribed
nitroglycerin 0.4mg sublingual PRN for chest pain. Which
instruction is most important regarding storage?
A. "Keep the bottle tightly sealed after each use."
B. "Store the medication in a cool, well-lit place."
C. "Replace the medication every 3 months even if unused."
D. "Carry the tablets in a metal pill container for safety."
Answer: A. Rationale: Nitroglycerin is volatile and degrades when
exposed to air, light, and moisture. Keeping the bottle tightly
sealed minimizes air exposure. It should be stored in a dark, cool
place (B is incorrect - not well-lit). It should be replaced every 6-12
months, not 3 months (C). Metal containers are not
recommended; original glass bottle is best (D).
5. The nurse assesses a patient with a suspected deep vein
thrombosis (DVT) in the left calf. Which finding is consistent
with this diagnosis?
A. Left calf circumference 2cm larger than the right
B. Sharp, stabbing chest pain with deep inspiration
C. Pallor and coolness of the left foot
D. Bilateral pitting edema in both lower extremities
Answer: A. Rationale: Unilateral swelling of the affected limb due
to venous outflow obstruction is a hallmark sign of DVT. A
difference of >2cm is significant. Option B indicates possible
pulmonary embolism. Option C indicates arterial insufficiency.
Option D indicates systemic fluid overload (e.g., heart failure).
6. A patient with a history of atrial fibrillation is taking
warfarin. The INR result is 4.5. The patient has no signs of
bleeding. What should the nurse do first?
A. Administer Vitamin K 10mg orally as ordered.
, B. Hold the next dose of warfarin and notify the provider.
C. Administer fresh frozen plasma immediately.
D. Reassure the patient that this is a therapeutic level.
Answer: B. Rationale: The therapeutic INR range for atrial
fibrillation is typically 2.0-3.0. An INR of 4.5 is supratherapeutic
but without active bleeding, the standard of care is to hold the
next dose(s) and notify the provider for a possible dose reduction.
Vitamin K (A) is reserved for significantly elevated INRs (>10) or
active bleeding. FFP (C) is for life-threatening bleeding. D is false.
7. A patient is admitted with sickle cell crisis in vaso-occlusive
pain. Which intervention is the priority?
A. Initiate a patient-controlled analgesia (PCA) pump
B. Administer maintenance IV fluids at 150mL/hr
C. Apply oxygen via nasal cannula at 2L/min
D. Encourage ambulation to prevent muscle wasting
Answer: A. Rationale: In vaso-occlusive crisis, sickled RBCs block
blood flow causing severe ischemia and pain. Pain management is
the immediate priority both for patient comfort and to reduce
metabolic demand, which can worsen sickling. While IV fluids (B)
and oxygen (C) are important adjuncts, pain relief is the top
priority. D (ambulation) is contraindicated in severe pain crisis.
8. The nurse is caring for a patient with heparin-induced
thrombocytopenia (HIT). Which medication order should the
nurse question?
A. Argatroban continuous infusion
B. Warfarin 5mg orally daily
C. Enoxaparin 40mg subcutaneously daily
D. Bivalirudin IV as needed for procedure
Answer: C. Rationale: HIT is an immune-mediated reaction to
ACTUAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST
RECENT!!)
Questions 1-20: Cardiovascular & Hematology
1. A patient with acute decompensated heart failure presents
with severe dyspnea, crackles in all lung fields, and an SpO2
of 82% on room air. The nurse administers furosemide 80mg
IV push. Which finding indicates the most therapeutic
response?
A. Decreased serum potassium level
B. Increased urine output of 500 mL in 1 hour
C. Blood pressure increase from 90/60 to 110/70
D. Respiratory rate increase from 28 to 32
Answer: B. Rationale: Furosemide is a loop diuretic that rapidly
reduces preload by promoting diuresis. The therapeutic goal in
acute decompensated HF is to reduce pulmonary congestion.
Increased urine output directly correlates with reduced
intravascular volume, decreased preload, and subsequent
improvement in dyspnea and oxygenation. Option A is an adverse
effect (hypokalemia), not a therapeutic response. Option C (BP
increase) is not the primary goal and could indicate over-diuresis.
Option D (↑ RR) indicates worsening respiratory distress.
,2. A patient is 2 hours post-percutaneous coronary
intervention (PCI) via the right femoral artery. Which
assessment finding requires immediate intervention by the
nurse?
A. Complaints of mild back pain
B. Right pedal pulse is 2+ and palpable
C. 2cm diameter hematoma at the insertion site
D. Saturation of the dressing with bright red blood
Answer: D. Rationale: Saturation of the dressing with bright red
blood indicates active arterial bleeding, which can lead to rapid
hypovolemia, hypotension, and shock. This requires immediate
manual pressure, possible reversal of anticoagulation, and surgical
consult. A small hematoma (C) is common but should be
monitored. Mild back pain (A) is common from lying flat. A
palpable pulse (B) is expected.
3. The nurse is caring for a patient with infective endocarditis.
Which assessment finding is most indicative of a systemic
embolic event?
A. Splinter hemorrhages in the nail beds
B. Painless, erythematous macules on the palms (Janeway lesions)
C. New onset right-sided weakness and slurred speech
D. Temperature of 101.2°F (38.4°C)
Answer: C. Rationale: Systemic emboli from vegetative growths
on heart valves (most commonly mitral or aortic) can travel to the
cerebral circulation, causing an embolic stroke. New focal
neurologic deficits are a medical emergency. Options A, B, and D
are classic manifestations of endocarditis (peripheral stigmata and
fever) but do not represent an acute embolic event requiring
immediate intervention like a stroke.
,4. A patient with chronic stable angina is prescribed
nitroglycerin 0.4mg sublingual PRN for chest pain. Which
instruction is most important regarding storage?
A. "Keep the bottle tightly sealed after each use."
B. "Store the medication in a cool, well-lit place."
C. "Replace the medication every 3 months even if unused."
D. "Carry the tablets in a metal pill container for safety."
Answer: A. Rationale: Nitroglycerin is volatile and degrades when
exposed to air, light, and moisture. Keeping the bottle tightly
sealed minimizes air exposure. It should be stored in a dark, cool
place (B is incorrect - not well-lit). It should be replaced every 6-12
months, not 3 months (C). Metal containers are not
recommended; original glass bottle is best (D).
5. The nurse assesses a patient with a suspected deep vein
thrombosis (DVT) in the left calf. Which finding is consistent
with this diagnosis?
A. Left calf circumference 2cm larger than the right
B. Sharp, stabbing chest pain with deep inspiration
C. Pallor and coolness of the left foot
D. Bilateral pitting edema in both lower extremities
Answer: A. Rationale: Unilateral swelling of the affected limb due
to venous outflow obstruction is a hallmark sign of DVT. A
difference of >2cm is significant. Option B indicates possible
pulmonary embolism. Option C indicates arterial insufficiency.
Option D indicates systemic fluid overload (e.g., heart failure).
6. A patient with a history of atrial fibrillation is taking
warfarin. The INR result is 4.5. The patient has no signs of
bleeding. What should the nurse do first?
A. Administer Vitamin K 10mg orally as ordered.
, B. Hold the next dose of warfarin and notify the provider.
C. Administer fresh frozen plasma immediately.
D. Reassure the patient that this is a therapeutic level.
Answer: B. Rationale: The therapeutic INR range for atrial
fibrillation is typically 2.0-3.0. An INR of 4.5 is supratherapeutic
but without active bleeding, the standard of care is to hold the
next dose(s) and notify the provider for a possible dose reduction.
Vitamin K (A) is reserved for significantly elevated INRs (>10) or
active bleeding. FFP (C) is for life-threatening bleeding. D is false.
7. A patient is admitted with sickle cell crisis in vaso-occlusive
pain. Which intervention is the priority?
A. Initiate a patient-controlled analgesia (PCA) pump
B. Administer maintenance IV fluids at 150mL/hr
C. Apply oxygen via nasal cannula at 2L/min
D. Encourage ambulation to prevent muscle wasting
Answer: A. Rationale: In vaso-occlusive crisis, sickled RBCs block
blood flow causing severe ischemia and pain. Pain management is
the immediate priority both for patient comfort and to reduce
metabolic demand, which can worsen sickling. While IV fluids (B)
and oxygen (C) are important adjuncts, pain relief is the top
priority. D (ambulation) is contraindicated in severe pain crisis.
8. The nurse is caring for a patient with heparin-induced
thrombocytopenia (HIT). Which medication order should the
nurse question?
A. Argatroban continuous infusion
B. Warfarin 5mg orally daily
C. Enoxaparin 40mg subcutaneously daily
D. Bivalirudin IV as needed for procedure
Answer: C. Rationale: HIT is an immune-mediated reaction to
