KAPLAN INTEGRATED EXAM: MED/SURG
(FORM 1A) A-LEVEL NEW UPDATE 2027/27
questions across multiple body systems
including cardiac, respiratory, neuro, renal,
and endocrine Comprehensive review with
rationales, excellent for final exam
preparation
1. 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
,,,answer,,,: C. Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion and edema in acute decompensated heart failure.
2. 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
,,,,answer,,,: A. Cardiac tamponade
Rationale: Beck's triad (hypotension, muffled heart sounds, JVD) indicates cardiac
tamponade.
3. 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
,,,answer,,,: B. ST-segment elevation in leads II, III, aVF
Rationale: ST elevation in inferior leads suggests acute inferior STEMI, requiring
immediate reperfusion therapy.
4. A patient on a heparin drip has an aPTT of 110 seconds (normal 25–35). What
action should the nurse take first?
A. Increase the heparin drip rate.
B. Administer protamine sulfate.
C. Hold the heparin drip and notify the provider.
D. Draw aPTT level again in 1 hour.
,,,answer,,,: C. Hold the heparin drip and notify the provider.
Rationale: An aPTT >100 seconds indicates a high risk of bleeding; the infusion
should be held and the provider notified.
5. A patient with chronic kidney disease (CKD) complains of bone pain. Which
laboratory value is most important to assess?
A. Hemoglobin
B. Parathyroid hormone (PTH)
C. Serum calcium
D. Serum albumin
,,,answer,,,: B. Parathyroid hormone (PTH)
,Rationale: CKD leads to secondary hyperparathyroidism due to hyperphosphatemia
and hypocalcemia, causing bone pain (renal osteodystrophy). PTH is key to evaluate.
6. A patient with acute pancreatitis is placed on NPO status with nasogastric (NG)
suction. Which assessment finding indicates that this treatment is effective?
A. Serum amylase is decreasing.
B. Abdominal girth is increasing.
C. Pain radiates to the back.
D. Patient emesis of bilious fluid.
,,,answer,,,: A. Serum amylase is decreasing.
Rationale: NG suction reduces pancreatic stimulation by removing gastric acid,
leading to decreased pancreatic enzyme release. Decreasing amylase indicates
improvement.
7. A patient with advanced HIV and a CD4 count of 180 cells/mm³ develops a
fever, nonproductive cough, and hypoxemia. The chest x-ray shows diffuse
bilateral interstitial infiltrates. The nurse suspects:
A. Pneumocystis jirovecii pneumonia (PCP)
B. Cytomegalovirus (CMV) pneumonitis
C. Streptococcus pneumoniae
D. Histoplasma capsulatum
,,,answer,,,: A. Pneumocystis jirovecii pneumonia (PCP)
Rationale: CD4 <200, diffuse interstitial infiltrates, and hypoxemia are classic for PJP.
8. A patient with Cushing's syndrome is being discharged. The nurse knows
discharge teaching has been effective when the patient makes which statement?
A. "I will eat foods high in potassium."
B. "I will take my hydrocortisone at bedtime."
C. "I will weigh myself weekly."
D. "I will avoid crowds and people who are sick."
, ,,,answer,,,: D. "I will avoid crowds and people who are sick."
Rationale: Cushing's causes immunosuppression; patients are at high risk for
infection and should avoid exposure.
9. A patient with Addison's disease presents with hypotension, hyponatremia,
and hyperkalemia. Which medication should the nurse prepare to administer?
A. Hydrocortisone IV
B. Fludrocortisone PO
C. Insulin with dextrose
D. Spironolactone
,,,answer,,,: A. Hydrocortisone IV
Rationale: This is an acute adrenal crisis requiring immediate glucocorticoid
replacement.
10. The nurse is caring for a patient with syndrome of inappropriate antidiuretic
hormone (SIADH). The patient's serum sodium level is 118 mEq/L. Which order
should the nurse question?
A. Fluid restriction of 800 mL/day
B. Infuse 3% normal saline at 50 mL/hour
C. Administer oral salt tablets
D. Administer intravenous furosemide 40 mg
,,,answer,,,: D. Administer intravenous furosemide 40 mg
Rationale: Furosemide may worsen hyponatremia by promoting electrolyte loss;
treatment focuses on fluid restriction and hypertonic saline.
11. A patient with diabetic ketoacidosis (DKA) has a blood glucose of 600 mg/dL.
The nurse expects which type of insulin to be administered intravenously?
A. Regular insulin
B. NPH insulin
C. Insulin glargine
(FORM 1A) A-LEVEL NEW UPDATE 2027/27
questions across multiple body systems
including cardiac, respiratory, neuro, renal,
and endocrine Comprehensive review with
rationales, excellent for final exam
preparation
1. 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
,,,answer,,,: C. Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion and edema in acute decompensated heart failure.
2. 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
,,,,answer,,,: A. Cardiac tamponade
Rationale: Beck's triad (hypotension, muffled heart sounds, JVD) indicates cardiac
tamponade.
3. 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
,,,answer,,,: B. ST-segment elevation in leads II, III, aVF
Rationale: ST elevation in inferior leads suggests acute inferior STEMI, requiring
immediate reperfusion therapy.
4. A patient on a heparin drip has an aPTT of 110 seconds (normal 25–35). What
action should the nurse take first?
A. Increase the heparin drip rate.
B. Administer protamine sulfate.
C. Hold the heparin drip and notify the provider.
D. Draw aPTT level again in 1 hour.
,,,answer,,,: C. Hold the heparin drip and notify the provider.
Rationale: An aPTT >100 seconds indicates a high risk of bleeding; the infusion
should be held and the provider notified.
5. A patient with chronic kidney disease (CKD) complains of bone pain. Which
laboratory value is most important to assess?
A. Hemoglobin
B. Parathyroid hormone (PTH)
C. Serum calcium
D. Serum albumin
,,,answer,,,: B. Parathyroid hormone (PTH)
,Rationale: CKD leads to secondary hyperparathyroidism due to hyperphosphatemia
and hypocalcemia, causing bone pain (renal osteodystrophy). PTH is key to evaluate.
6. A patient with acute pancreatitis is placed on NPO status with nasogastric (NG)
suction. Which assessment finding indicates that this treatment is effective?
A. Serum amylase is decreasing.
B. Abdominal girth is increasing.
C. Pain radiates to the back.
D. Patient emesis of bilious fluid.
,,,answer,,,: A. Serum amylase is decreasing.
Rationale: NG suction reduces pancreatic stimulation by removing gastric acid,
leading to decreased pancreatic enzyme release. Decreasing amylase indicates
improvement.
7. A patient with advanced HIV and a CD4 count of 180 cells/mm³ develops a
fever, nonproductive cough, and hypoxemia. The chest x-ray shows diffuse
bilateral interstitial infiltrates. The nurse suspects:
A. Pneumocystis jirovecii pneumonia (PCP)
B. Cytomegalovirus (CMV) pneumonitis
C. Streptococcus pneumoniae
D. Histoplasma capsulatum
,,,answer,,,: A. Pneumocystis jirovecii pneumonia (PCP)
Rationale: CD4 <200, diffuse interstitial infiltrates, and hypoxemia are classic for PJP.
8. A patient with Cushing's syndrome is being discharged. The nurse knows
discharge teaching has been effective when the patient makes which statement?
A. "I will eat foods high in potassium."
B. "I will take my hydrocortisone at bedtime."
C. "I will weigh myself weekly."
D. "I will avoid crowds and people who are sick."
, ,,,answer,,,: D. "I will avoid crowds and people who are sick."
Rationale: Cushing's causes immunosuppression; patients are at high risk for
infection and should avoid exposure.
9. A patient with Addison's disease presents with hypotension, hyponatremia,
and hyperkalemia. Which medication should the nurse prepare to administer?
A. Hydrocortisone IV
B. Fludrocortisone PO
C. Insulin with dextrose
D. Spironolactone
,,,answer,,,: A. Hydrocortisone IV
Rationale: This is an acute adrenal crisis requiring immediate glucocorticoid
replacement.
10. The nurse is caring for a patient with syndrome of inappropriate antidiuretic
hormone (SIADH). The patient's serum sodium level is 118 mEq/L. Which order
should the nurse question?
A. Fluid restriction of 800 mL/day
B. Infuse 3% normal saline at 50 mL/hour
C. Administer oral salt tablets
D. Administer intravenous furosemide 40 mg
,,,answer,,,: D. Administer intravenous furosemide 40 mg
Rationale: Furosemide may worsen hyponatremia by promoting electrolyte loss;
treatment focuses on fluid restriction and hypertonic saline.
11. A patient with diabetic ketoacidosis (DKA) has a blood glucose of 600 mg/dL.
The nurse expects which type of insulin to be administered intravenously?
A. Regular insulin
B. NPH insulin
C. Insulin glargine
