Kaplan Medical-Surgical Integrated Test –
Strong Expanded Practice Questions and
Answers|-2026
Questions 1–20: Cardiovascular & Respiratory
1. A client with heart failure has jugular vein distention, 3+ pitting edema, and
crackles in the lung bases. Which PRN medication should the nurse administer
first?
A) Digoxin 0.125 mg PO
B) Furosemide 40 mg IV
C) Metoprolol 25 mg PO
D) Nitroglycerin 0.4 mg SL
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion. Digoxin and metoprolol are not PRN for acute overload, and
nitroglycerin can worsen hypotension.
2. A client with COPD has an SpO₂ of 88% on 2 L/min oxygen via nasal cannula.
What should the nurse do first?
A) Increase oxygen to 4 L/min
B) Encourage pursed-lip breathing
C) Obtain ABGs
D) Notify the respiratory therapist
Rationale: Pursed-lip breathing is an immediate, non-invasive intervention that
improves gas exchange. Increasing oxygen may worsen CO₂ retention.
3. A postoperative client suddenly reports chest pain and dyspnea. HR 120, RR 32,
BP 100/70, SpO₂ 89% on room air. What should the nurse do first?
A) Give aspirin 324 mg
,B) Administer oxygen via non-rebreather mask
C) Obtain a 12-lead ECG
D) Call a rapid response
Rationale: The ABCs (airway, breathing, circulation) dictate oxygenation as the first
priority. Hypoxia must be corrected immediately.
4. Which laboratory finding is most specific for myocardial infarction?
A) CK-MB 5%
B) Troponin I 4.2 ng/mL
C) Myoglobin 110 ng/mL
D) AST 45 U/L
Rationale: Troponin I is highly specific to cardiac muscle. CK-MB and myoglobin
are less specific; AST is not cardiac-specific.
5. A client with atrial fibrillation is prescribed warfarin. Which statement indicates a
need for further teaching?
A) “I will have my INR checked regularly.”
B) “I will use a soft-bristled toothbrush.”
C) “I can take ibuprofen for headaches.”
D) “I will tell my dentist I’m on warfarin.”
Rationale: Ibuprofen increases bleeding risk and should be avoided. The other
statements are correct.
6. A client with deep vein thrombosis is on a heparin infusion. The aPTT is 110
seconds (control 30 seconds). What should the nurse do?
A) Continue the infusion
B) Increase the rate
C) Stop the infusion and notify the provider
D) Obtain an INR
Rationale: aPTT >100 seconds indicates high bleeding risk; the infusion should be
stopped and provider notified.
, 7. A client with heart failure has crackles, edema, and weight gain. Spironolactone
is prescribed. Which outcome indicates therapeutic effect?
A) Decreased abdominal girth and increased urinary output
B) Increased serum potassium
C) Decreased blood pressure
D) Increased liver enzymes
Rationale: Diuresis with reduced fluid overload is the therapeutic goal. Increased
potassium is an adverse effect, not a therapeutic outcome.
8. A client with an inferior STEMI has BP 85/50 mm Hg and HR 52 beats/min. Which
intervention should the nurse anticipate first?
A) IV metoprolol
B) Transfer for percutaneous coronary intervention
C) Sublingual nitroglycerin
D) IV fluids at 200 mL/hr
Rationale: Emergency reperfusion with PCI is the priority. Beta-blockers and
nitroglycerin can worsen hypotension.
9. A client with asthma uses a metered-dose inhaler. Which action indicates
correct use?
A) Activates the inhaler before beginning to inhale
B) Inhales deeply and holds breath for 10 seconds after activation
C) Exhales fully after activating the inhaler
D) Shakes the inhaler after each puff
Rationale: Holding the breath allows medication to deposit in the airways. Shaking
is done before use, not after.
10. A client with a chest tube for a pneumothorax is disconnected from the
drainage system. What is the priority action?
A) Clamp the tube near the insertion site
B) Submerge the open end in sterile water
C) Reconnect to a new system
Strong Expanded Practice Questions and
Answers|-2026
Questions 1–20: Cardiovascular & Respiratory
1. A client with heart failure has jugular vein distention, 3+ pitting edema, and
crackles in the lung bases. Which PRN medication should the nurse administer
first?
A) Digoxin 0.125 mg PO
B) Furosemide 40 mg IV
C) Metoprolol 25 mg PO
D) Nitroglycerin 0.4 mg SL
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion. Digoxin and metoprolol are not PRN for acute overload, and
nitroglycerin can worsen hypotension.
2. A client with COPD has an SpO₂ of 88% on 2 L/min oxygen via nasal cannula.
What should the nurse do first?
A) Increase oxygen to 4 L/min
B) Encourage pursed-lip breathing
C) Obtain ABGs
D) Notify the respiratory therapist
Rationale: Pursed-lip breathing is an immediate, non-invasive intervention that
improves gas exchange. Increasing oxygen may worsen CO₂ retention.
3. A postoperative client suddenly reports chest pain and dyspnea. HR 120, RR 32,
BP 100/70, SpO₂ 89% on room air. What should the nurse do first?
A) Give aspirin 324 mg
,B) Administer oxygen via non-rebreather mask
C) Obtain a 12-lead ECG
D) Call a rapid response
Rationale: The ABCs (airway, breathing, circulation) dictate oxygenation as the first
priority. Hypoxia must be corrected immediately.
4. Which laboratory finding is most specific for myocardial infarction?
A) CK-MB 5%
B) Troponin I 4.2 ng/mL
C) Myoglobin 110 ng/mL
D) AST 45 U/L
Rationale: Troponin I is highly specific to cardiac muscle. CK-MB and myoglobin
are less specific; AST is not cardiac-specific.
5. A client with atrial fibrillation is prescribed warfarin. Which statement indicates a
need for further teaching?
A) “I will have my INR checked regularly.”
B) “I will use a soft-bristled toothbrush.”
C) “I can take ibuprofen for headaches.”
D) “I will tell my dentist I’m on warfarin.”
Rationale: Ibuprofen increases bleeding risk and should be avoided. The other
statements are correct.
6. A client with deep vein thrombosis is on a heparin infusion. The aPTT is 110
seconds (control 30 seconds). What should the nurse do?
A) Continue the infusion
B) Increase the rate
C) Stop the infusion and notify the provider
D) Obtain an INR
Rationale: aPTT >100 seconds indicates high bleeding risk; the infusion should be
stopped and provider notified.
, 7. A client with heart failure has crackles, edema, and weight gain. Spironolactone
is prescribed. Which outcome indicates therapeutic effect?
A) Decreased abdominal girth and increased urinary output
B) Increased serum potassium
C) Decreased blood pressure
D) Increased liver enzymes
Rationale: Diuresis with reduced fluid overload is the therapeutic goal. Increased
potassium is an adverse effect, not a therapeutic outcome.
8. A client with an inferior STEMI has BP 85/50 mm Hg and HR 52 beats/min. Which
intervention should the nurse anticipate first?
A) IV metoprolol
B) Transfer for percutaneous coronary intervention
C) Sublingual nitroglycerin
D) IV fluids at 200 mL/hr
Rationale: Emergency reperfusion with PCI is the priority. Beta-blockers and
nitroglycerin can worsen hypotension.
9. A client with asthma uses a metered-dose inhaler. Which action indicates
correct use?
A) Activates the inhaler before beginning to inhale
B) Inhales deeply and holds breath for 10 seconds after activation
C) Exhales fully after activating the inhaler
D) Shakes the inhaler after each puff
Rationale: Holding the breath allows medication to deposit in the airways. Shaking
is done before use, not after.
10. A client with a chest tube for a pneumothorax is disconnected from the
drainage system. What is the priority action?
A) Clamp the tube near the insertion site
B) Submerge the open end in sterile water
C) Reconnect to a new system
