Advanced Med-Surg Principles Exam 1
(Jersey College) | Verified Frequently Tested
Questions & Correct Answers | Complete
Updated Study Guide with Rationales | A+
Graded Nursing Exam Prep
• This study guide contains 200 verified, frequently tested Advanced Med-Surg
questions with correct answers and EXPERT RATIONALE to help you ace your
Jersey College exam.
• Each question is formatted with 5 options (A–E), the correct answer clearly
highlighted and bolded, and a EXPERT RATIONALE directly below it — study
actively by attempting each question before checking the answer.
1. A nurse is caring for a patient with heart failure who has an ejection
fraction of 35%. Which medication class is most important to include in this
patient's treatment plan?
A) Calcium channel blockers
B) Nitrates
C) Beta-blockers
D) Anticoagulants
E) Diuretics only
✔ Correct Answer: C) Beta-blockers
EXPERT RATIONALE: Beta-blockers are a cornerstone of treatment in heart failure
with reduced ejection fraction (HFrEF). They reduce mortality by blocking the
harmful effects of chronic sympathetic stimulation on the failing heart.
2. A patient with chronic kidney disease has a potassium level of 6.2 mEq/L.
Which ECG change would the nurse expect to see first?
A) Widened QRS complex
,B) Prolonged PR interval
C) Flattened P waves
D) Peaked T waves
E) ST elevation
✔ Correct Answer: D) Peaked T waves
EXPERT RATIONALE: The earliest ECG change in hyperkalemia is peaked (tall,
narrow, tented) T waves. As potassium rises further, the PR interval prolongs, then
QRS widens, and ultimately a sine wave pattern and cardiac arrest can occur.
3. A patient post-CABG surgery develops cardiac tamponade. Which set of
findings should the nurse anticipate?
A) Hypertension, bradycardia, wide pulse pressure
B) Hypotension, tachycardia, muffled heart sounds
C) Hypertension, tachycardia, bounding pulses
D) Hypotension, bradycardia, loud heart sounds
E) Normal BP, irregular rhythm, JVD
✔ Correct Answer: B) Hypotension, tachycardia, muffled heart sounds
EXPERT RATIONALE: Beck's triad — hypotension, muffled heart sounds, and
jugular venous distension (JVD) — is the classic presentation of cardiac tamponade.
Tachycardia is a compensatory response to decreased cardiac output.
4. A nurse is caring for a patient with a pulmonary embolism. Which arterial
blood gas result is most consistent with this condition?
A) pH 7.30, PaCO2 55, PaO2 90
B) pH 7.50, PaCO2 28, PaO2 60
C) pH 7.35, PaCO2 40, PaO2 95
,D) pH 7.28, PaCO2 50, PaO2 70
E) pH 7.42, PaCO2 38, PaO2 98
✔ Correct Answer: B) pH 7.50, PaCO2 28, PaO2 60
EXPERT RATIONALE: PE causes hypoxemia (low PaO2) triggering hyperventilation,
which blows off CO2, resulting in respiratory alkalosis (elevated pH, low PaCO2).
This is the classic ABG pattern in pulmonary embolism.
5. A patient with COPD is admitted with an exacerbation. The nurse knows
oxygen therapy should target which SpO2 range?
A) 98–100%
B) 95–98%
C) 92–94%
D) 85–88%
E) 80–84%
✔ Correct Answer: C) 92–94%
EXPERT RATIONALE: COPD patients may rely on hypoxic drive for breathing. Target
SpO2 of 88–94% is recommended; higher oxygen saturation can suppress
respiratory drive and worsen hypercapnia. 92–94% is the safest target range.
6. A nurse is assessing a patient with acute pancreatitis. Which finding is most
expected?
A) Right lower quadrant pain relieved by eating
B) Epigastric pain radiating to the back, worsened by eating
C) Left lower quadrant pain with bloody stools
D) Periumbilical pain relieved by flexion of knees
E) Right upper quadrant pain with inspiration
, ✔ Correct Answer: B) Epigastric pain radiating to the back, worsened by eating
EXPERT RATIONALE: Acute pancreatitis classically presents with severe epigastric
pain that radiates to the back. Eating stimulates pancreatic secretion and worsens
pain. The pain is often relieved by leaning forward (fetal position).
7. Which lab value is most specific for myocardial infarction?
A) CK-MM
B) Myoglobin
C) LDH
D) Troponin I
E) CRP
✔ Correct Answer: D) Troponin I
EXPERT RATIONALE: Troponin I is the most specific and sensitive biomarker for
myocardial injury. It rises within 3–6 hours of MI, peaks at 24 hours, and remains
elevated for 7–10 days, making it the gold standard for MI diagnosis.
8. A patient is prescribed furosemide. Which electrolyte imbalance should the
nurse monitor for most closely?
A) Hyperkalemia
B) Hypernatremia
C) Hypokalemia
D) Hypercalcemia
E) Hypermagnesemia
✔ Correct Answer: C) Hypokalemia
EXPERT RATIONALE: Furosemide is a loop diuretic that causes excretion of
potassium along with sodium and water. Hypokalemia is the most common and
(Jersey College) | Verified Frequently Tested
Questions & Correct Answers | Complete
Updated Study Guide with Rationales | A+
Graded Nursing Exam Prep
• This study guide contains 200 verified, frequently tested Advanced Med-Surg
questions with correct answers and EXPERT RATIONALE to help you ace your
Jersey College exam.
• Each question is formatted with 5 options (A–E), the correct answer clearly
highlighted and bolded, and a EXPERT RATIONALE directly below it — study
actively by attempting each question before checking the answer.
1. A nurse is caring for a patient with heart failure who has an ejection
fraction of 35%. Which medication class is most important to include in this
patient's treatment plan?
A) Calcium channel blockers
B) Nitrates
C) Beta-blockers
D) Anticoagulants
E) Diuretics only
✔ Correct Answer: C) Beta-blockers
EXPERT RATIONALE: Beta-blockers are a cornerstone of treatment in heart failure
with reduced ejection fraction (HFrEF). They reduce mortality by blocking the
harmful effects of chronic sympathetic stimulation on the failing heart.
2. A patient with chronic kidney disease has a potassium level of 6.2 mEq/L.
Which ECG change would the nurse expect to see first?
A) Widened QRS complex
,B) Prolonged PR interval
C) Flattened P waves
D) Peaked T waves
E) ST elevation
✔ Correct Answer: D) Peaked T waves
EXPERT RATIONALE: The earliest ECG change in hyperkalemia is peaked (tall,
narrow, tented) T waves. As potassium rises further, the PR interval prolongs, then
QRS widens, and ultimately a sine wave pattern and cardiac arrest can occur.
3. A patient post-CABG surgery develops cardiac tamponade. Which set of
findings should the nurse anticipate?
A) Hypertension, bradycardia, wide pulse pressure
B) Hypotension, tachycardia, muffled heart sounds
C) Hypertension, tachycardia, bounding pulses
D) Hypotension, bradycardia, loud heart sounds
E) Normal BP, irregular rhythm, JVD
✔ Correct Answer: B) Hypotension, tachycardia, muffled heart sounds
EXPERT RATIONALE: Beck's triad — hypotension, muffled heart sounds, and
jugular venous distension (JVD) — is the classic presentation of cardiac tamponade.
Tachycardia is a compensatory response to decreased cardiac output.
4. A nurse is caring for a patient with a pulmonary embolism. Which arterial
blood gas result is most consistent with this condition?
A) pH 7.30, PaCO2 55, PaO2 90
B) pH 7.50, PaCO2 28, PaO2 60
C) pH 7.35, PaCO2 40, PaO2 95
,D) pH 7.28, PaCO2 50, PaO2 70
E) pH 7.42, PaCO2 38, PaO2 98
✔ Correct Answer: B) pH 7.50, PaCO2 28, PaO2 60
EXPERT RATIONALE: PE causes hypoxemia (low PaO2) triggering hyperventilation,
which blows off CO2, resulting in respiratory alkalosis (elevated pH, low PaCO2).
This is the classic ABG pattern in pulmonary embolism.
5. A patient with COPD is admitted with an exacerbation. The nurse knows
oxygen therapy should target which SpO2 range?
A) 98–100%
B) 95–98%
C) 92–94%
D) 85–88%
E) 80–84%
✔ Correct Answer: C) 92–94%
EXPERT RATIONALE: COPD patients may rely on hypoxic drive for breathing. Target
SpO2 of 88–94% is recommended; higher oxygen saturation can suppress
respiratory drive and worsen hypercapnia. 92–94% is the safest target range.
6. A nurse is assessing a patient with acute pancreatitis. Which finding is most
expected?
A) Right lower quadrant pain relieved by eating
B) Epigastric pain radiating to the back, worsened by eating
C) Left lower quadrant pain with bloody stools
D) Periumbilical pain relieved by flexion of knees
E) Right upper quadrant pain with inspiration
, ✔ Correct Answer: B) Epigastric pain radiating to the back, worsened by eating
EXPERT RATIONALE: Acute pancreatitis classically presents with severe epigastric
pain that radiates to the back. Eating stimulates pancreatic secretion and worsens
pain. The pain is often relieved by leaning forward (fetal position).
7. Which lab value is most specific for myocardial infarction?
A) CK-MM
B) Myoglobin
C) LDH
D) Troponin I
E) CRP
✔ Correct Answer: D) Troponin I
EXPERT RATIONALE: Troponin I is the most specific and sensitive biomarker for
myocardial injury. It rises within 3–6 hours of MI, peaks at 24 hours, and remains
elevated for 7–10 days, making it the gold standard for MI diagnosis.
8. A patient is prescribed furosemide. Which electrolyte imbalance should the
nurse monitor for most closely?
A) Hyperkalemia
B) Hypernatremia
C) Hypokalemia
D) Hypercalcemia
E) Hypermagnesemia
✔ Correct Answer: C) Hypokalemia
EXPERT RATIONALE: Furosemide is a loop diuretic that causes excretion of
potassium along with sodium and water. Hypokalemia is the most common and
