Kaplan Med-Surg Comprehensive A & B
(2026/2027) – Full-Length Exam +
Detailed Rationales
EXAM A:
Cardiac, Respiratory, & Emergency Care
Q1. A patient with heart failure presents with dyspnea, crackles in lung bases,
and jugular venous distention. Which medication should the nurse anticipate
first?
A. Metoprolol
B. Digoxin
C. Furosemide
D. Spironolactone
Correct ,,,ANSWER,,,: C. Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion and edema in acute decompensated heart failure.
,Metoprolol and spironolactone are chronic therapies; digoxin is not first-line for
acute symptoms .
Content Area: Pharmacological Therapies | Kaplan Focus: Acute heart failure
management
Q2. A patient post-MI develops hypotension and muffled heart sounds. What
condition should the nurse suspect?
A. Cardiac tamponade
B. Acute mitral regurgitation
C. Papillary muscle rupture
D. Ventricular septal defect
Correct ,,,ANSWER,,,: A. Cardiac tamponade
Rationale: Beck's triad (hypotension, muffled heart sounds, JVD) indicates cardiac
tamponade—a medical emergency requiring pericardiocentesis. The others cause
murmurs or sudden hemodynamic collapse but not muffled sounds .
Content Area: Reduction of Risk Potential | Kaplan Focus: Pericardial disorders
Q3. Which ECG finding is most concerning in a patient with chest pain?
A. Sinus bradycardia
B. ST-segment elevation in leads II, III, aVF
C. First-degree AV block
D. Premature atrial contractions
Correct ,,,ANSWER,,,: B. ST-segment elevation in leads II, III, aVF
Rationale: ST elevation in inferior leads (II, III, aVF) suggests acute inferior STEMI,
requiring immediate reperfusion therapy. The other findings are not emergent .
Content Area: Physiological Adaptation | Kaplan Focus: Acute coronary syndrome
,Q4. A patient on a heparin drip has an aPTT of 110 seconds (normal 25–35).
What action should the nurse take?
A. Increase the drip rate
B. Continue monitoring
C. Hold the infusion and notify the provider
D. Administer protamine sulfate
Correct ,,,ANSWER,,,: C. Hold the infusion and notify the provider
Rationale: An aPTT >100 seconds indicates the client is over-anticoagulated and at
significantly increased bleeding risk. The heparin infusion should be stopped and
the provider notified .
Content Area: Pharmacological Therapies | Kaplan Focus: Heparin therapy
monitoring
Q5. A patient post-thyroidectomy develops stridor and respiratory distress.
What is the priority action?
A. Administer calcium gluconate
B. Prepare for emergency tracheostomy
C. Apply oxygen via non-rebreather mask
D. Elevate the head of the bed
Correct ,,,ANSWER,,,: B. Prepare for emergency tracheostomy
Rationale: Stridor after thyroidectomy indicates airway obstruction from laryngeal
edema or hematoma. This is a life-threatening emergency—prepare for emergency
tracheostomy or bedside decompression. Calcium gluconate is for hypocalcemia
(tetany), not stridor .
Content Area: Reduction of Risk Potential | Kaplan Focus: Post-thyroidectomy
complications
, Q6. A diabetic patient with HbA1c 9.5% reports taking metformin and glipizide.
What additional teaching is needed?
A. "Take your glipizide only on days you eat breakfast."
B. "Metformin can cause weight gain."
C. "Report any muscle pain or weakness to your provider."
D. "Your A1c is ideal for diabetic control."
Correct ,,,ANSWER,,,: C. "Report any muscle pain or weakness to your
provider."
Rationale: Metformin carries risk of lactic acidosis (muscle pain, malaise,
hyperventilation)—patients must report these symptoms immediately. HbA1c >7%
indicates poor control; glipizide should be taken before meals consistently;
metformin does not cause weight gain .
Content Area: Pharmacological Therapies | Kaplan Focus: Metformin adverse
effects
Q7. A patient with cirrhosis develops asterixis and confusion. Which lab finding
is most consistent?
A. Serum ammonia 180 mcg/dL (normal 15–45)
B. INR 1.2
C. Albumin 4.5 g/dL
D. Platelets 250,000
Correct ,,,ANSWER,,,: A. Serum ammonia 180 mcg/dL
Rationale: Asterixis and confusion suggest hepatic encephalopathy due to elevated
ammonia. Low albumin, elevated INR, and thrombocytopenia occur in cirrhosis but
do not directly cause asterixis. Ammonia level >150 mcg/dL is critical .
Content Area: Physiological Adaptation | Kaplan Focus: Hepatic encephalopathy
(2026/2027) – Full-Length Exam +
Detailed Rationales
EXAM A:
Cardiac, Respiratory, & Emergency Care
Q1. A patient with heart failure presents with dyspnea, crackles in lung bases,
and jugular venous distention. Which medication should the nurse anticipate
first?
A. Metoprolol
B. Digoxin
C. Furosemide
D. Spironolactone
Correct ,,,ANSWER,,,: C. Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion and edema in acute decompensated heart failure.
,Metoprolol and spironolactone are chronic therapies; digoxin is not first-line for
acute symptoms .
Content Area: Pharmacological Therapies | Kaplan Focus: Acute heart failure
management
Q2. A patient post-MI develops hypotension and muffled heart sounds. What
condition should the nurse suspect?
A. Cardiac tamponade
B. Acute mitral regurgitation
C. Papillary muscle rupture
D. Ventricular septal defect
Correct ,,,ANSWER,,,: A. Cardiac tamponade
Rationale: Beck's triad (hypotension, muffled heart sounds, JVD) indicates cardiac
tamponade—a medical emergency requiring pericardiocentesis. The others cause
murmurs or sudden hemodynamic collapse but not muffled sounds .
Content Area: Reduction of Risk Potential | Kaplan Focus: Pericardial disorders
Q3. Which ECG finding is most concerning in a patient with chest pain?
A. Sinus bradycardia
B. ST-segment elevation in leads II, III, aVF
C. First-degree AV block
D. Premature atrial contractions
Correct ,,,ANSWER,,,: B. ST-segment elevation in leads II, III, aVF
Rationale: ST elevation in inferior leads (II, III, aVF) suggests acute inferior STEMI,
requiring immediate reperfusion therapy. The other findings are not emergent .
Content Area: Physiological Adaptation | Kaplan Focus: Acute coronary syndrome
,Q4. A patient on a heparin drip has an aPTT of 110 seconds (normal 25–35).
What action should the nurse take?
A. Increase the drip rate
B. Continue monitoring
C. Hold the infusion and notify the provider
D. Administer protamine sulfate
Correct ,,,ANSWER,,,: C. Hold the infusion and notify the provider
Rationale: An aPTT >100 seconds indicates the client is over-anticoagulated and at
significantly increased bleeding risk. The heparin infusion should be stopped and
the provider notified .
Content Area: Pharmacological Therapies | Kaplan Focus: Heparin therapy
monitoring
Q5. A patient post-thyroidectomy develops stridor and respiratory distress.
What is the priority action?
A. Administer calcium gluconate
B. Prepare for emergency tracheostomy
C. Apply oxygen via non-rebreather mask
D. Elevate the head of the bed
Correct ,,,ANSWER,,,: B. Prepare for emergency tracheostomy
Rationale: Stridor after thyroidectomy indicates airway obstruction from laryngeal
edema or hematoma. This is a life-threatening emergency—prepare for emergency
tracheostomy or bedside decompression. Calcium gluconate is for hypocalcemia
(tetany), not stridor .
Content Area: Reduction of Risk Potential | Kaplan Focus: Post-thyroidectomy
complications
, Q6. A diabetic patient with HbA1c 9.5% reports taking metformin and glipizide.
What additional teaching is needed?
A. "Take your glipizide only on days you eat breakfast."
B. "Metformin can cause weight gain."
C. "Report any muscle pain or weakness to your provider."
D. "Your A1c is ideal for diabetic control."
Correct ,,,ANSWER,,,: C. "Report any muscle pain or weakness to your
provider."
Rationale: Metformin carries risk of lactic acidosis (muscle pain, malaise,
hyperventilation)—patients must report these symptoms immediately. HbA1c >7%
indicates poor control; glipizide should be taken before meals consistently;
metformin does not cause weight gain .
Content Area: Pharmacological Therapies | Kaplan Focus: Metformin adverse
effects
Q7. A patient with cirrhosis develops asterixis and confusion. Which lab finding
is most consistent?
A. Serum ammonia 180 mcg/dL (normal 15–45)
B. INR 1.2
C. Albumin 4.5 g/dL
D. Platelets 250,000
Correct ,,,ANSWER,,,: A. Serum ammonia 180 mcg/dL
Rationale: Asterixis and confusion suggest hepatic encephalopathy due to elevated
ammonia. Low albumin, elevated INR, and thrombocytopenia occur in cirrhosis but
do not directly cause asterixis. Ammonia level >150 mcg/dL is critical .
Content Area: Physiological Adaptation | Kaplan Focus: Hepatic encephalopathy
