KAPLAN MEDICAL SURGICAL INTEGRATED TEST EXAM 2026 WITH 100%
ACCURATE ANSWERS.
Cardiovascular Nursing (Questions 1–25)
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
Answer: B
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion. The IV route provides faster onset than oral. Digoxin and
metoprolol are not PRN for acute overload, and nitroglycerin can worsen
hypotension in this setting.
2. 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
Answer: C
Rationale: aPTT >100 seconds indicates high bleeding risk; the infusion should be
stopped immediately and the provider notified. The therapeutic range for aPTT on
heparin is typically 1.5–2.5 times the control (45–75 seconds).
3. 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
Answer: B
,Rationale: Troponin I is highly specific to cardiac muscle and is the gold standard
biomarker for MI. CK-MB and myoglobin are less specific; AST is not cardiac-
specific and is no longer used for MI diagnosis.
4. 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."
Answer: C
Rationale: Ibuprofen (NSAIDs) increases bleeding risk by affecting platelet
function and should be avoided. The other statements demonstrate correct
understanding: regular INR monitoring, soft-bristled toothbrush for bleeding
prevention, and informing healthcare providers.
5. A client with right-sided heart failure is expected to have which finding?
A) Crackles in lung bases
B) Jugular vein distention and peripheral edema
, C) Paroxysmal nocturnal dyspnea
D) Pink frothy sputum
Answer: B
Rationale: Right-sided heart failure causes systemic congestion from backup into
the venous system, presenting as jugular vein distention, peripheral edema,
hepatomegaly, and ascites. Crackles, PND, and pink frothy sputum are findings in
left-sided heart failure.
6. A client after cardiac catheterization via the right femoral artery has a
diminished right pedal pulse (+1) compared to left (+2). What should the nurse do
first?
A) Apply a cold pack to the site
B) Apply firm pressure 1 inch above the puncture site
C) Remove the pressure dressing
D) Document the finding
Answer: B
ACCURATE ANSWERS.
Cardiovascular Nursing (Questions 1–25)
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
Answer: B
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion. The IV route provides faster onset than oral. Digoxin and
metoprolol are not PRN for acute overload, and nitroglycerin can worsen
hypotension in this setting.
2. 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
Answer: C
Rationale: aPTT >100 seconds indicates high bleeding risk; the infusion should be
stopped immediately and the provider notified. The therapeutic range for aPTT on
heparin is typically 1.5–2.5 times the control (45–75 seconds).
3. 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
Answer: B
,Rationale: Troponin I is highly specific to cardiac muscle and is the gold standard
biomarker for MI. CK-MB and myoglobin are less specific; AST is not cardiac-
specific and is no longer used for MI diagnosis.
4. 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."
Answer: C
Rationale: Ibuprofen (NSAIDs) increases bleeding risk by affecting platelet
function and should be avoided. The other statements demonstrate correct
understanding: regular INR monitoring, soft-bristled toothbrush for bleeding
prevention, and informing healthcare providers.
5. A client with right-sided heart failure is expected to have which finding?
A) Crackles in lung bases
B) Jugular vein distention and peripheral edema
, C) Paroxysmal nocturnal dyspnea
D) Pink frothy sputum
Answer: B
Rationale: Right-sided heart failure causes systemic congestion from backup into
the venous system, presenting as jugular vein distention, peripheral edema,
hepatomegaly, and ascites. Crackles, PND, and pink frothy sputum are findings in
left-sided heart failure.
6. A client after cardiac catheterization via the right femoral artery has a
diminished right pedal pulse (+1) compared to left (+2). What should the nurse do
first?
A) Apply a cold pack to the site
B) Apply firm pressure 1 inch above the puncture site
C) Remove the pressure dressing
D) Document the finding
Answer: B
