NUR 170 EXAM 3 CONCEPTS OF
MEDICAL-SURGICAL NURSING
VERSION A, B, AND PRACTICE TEST
QUESTION BANK (2026 Edition)
VERSION A: CARDIOVASCULAR & RESPIRATORY CONCEPTS
According to 2026 AHA guidelines, what is the priority initial intervention for a patient
presenting with suspected acute myocardial infarction (MI)?
A) Administer morphine B) Obtain a 12-lead ECG C) Administer oxygen D) Insert an IV
line
Answer: B. Rationale: A is incorrect as pain management is secondary to diagnosis; B
is correct because a 12-lead ECG within 10 minutes is the priority to identify ST-
elevation; C is incorrect as oxygen is only given if SpO2 is <90%; D is incorrect as IV
access follows the ECG.
Which assessment finding is most specific to left-sided heart failure?
A) Peripheral edema B) Jugular venous distention C) Pulmonary crackles D)
Hepatomegaly
Answer: C. Rationale: A is a sign of right-sided HF; B is a sign of right-sided HF; C is
correct because left-sided HF causes pulmonary congestion leading to crackles; D is a
sign of right-sided HF.
A patient on digoxin reports nausea, vomiting, and seeing yellow halos around lights.
What is the nurse's priority action?
A) Administer an antiemetic B) Hold the digoxin and notify the provider C) Check the
patient's blood pressure D) Encourage oral fluid intake
Answer: B. Rationale: A is incorrect as it treats the symptom, not the cause; B is correct
because these are classic signs of digoxin toxicity requiring immediate hold and
,notification; C is incorrect as BP does not diagnose toxicity; D is incorrect as fluids do
not resolve toxicity.
Per 2026 guidelines, what is the specific antidote for a warfarin overdose?
A) Protamine sulfate B) Vitamin K (Phytonadione) C) Aminocaproic acid D)
Idarucizumab
Answer: B. Rationale: A is the antidote for heparin; B is correct as Vitamin K reverses
warfarin; C is an antifibrinolytic; D is the antidote for dabigatran.
What is the primary rationale for administering a beta-blocker to a patient post-MI?
A) To increase heart rate B) To decrease myocardial oxygen demand C) To increase
blood pressure D) To dilate coronary arteries
Answer: B. Rationale: A is incorrect as beta-blockers decrease HR; B is correct
because reducing HR and contractility decreases the heart's workload and oxygen
demand; C is incorrect as they lower BP; D is incorrect as they do not directly dilate
arteries.
A patient taking an ACE inhibitor develops a persistent, dry cough. What is the best
nursing action?
A) Instruct the patient to stop the medication immediately B) Administer a cough
suppressant C) Notify the healthcare provider to switch the medication class D)
Reassure the patient this is a normal side effect
Answer: C. Rationale: A is incorrect as meds shouldn't be stopped without provider
orders; B is incorrect as it doesn't solve the underlying bradykinin accumulation; C is
correct because the provider will likely switch to an ARB; D is incorrect as it requires
intervention.
How should a patient be instructed to take sublingual nitroglycerin for acute angina?
A) Swallow the tablet with a full glass of water B) Place the tablet under the tongue and
let it dissolve C) Chew the tablet thoroughly before swallowing D) Crush the tablet and
place it under the tongue
Answer: B. Rationale: A is incorrect as swallowing destroys the first-pass metabolism
effect; B is correct because sublingual absorption provides rapid relief; C is incorrect as
it is not meant to be chewed; D is incorrect as it is formulated to dissolve intact.
Which cardiac biomarker is the most specific and sensitive for diagnosing an acute MI
per 2026 standards?
A) Creatine kinase-MB (CK-MB) B) Myoglobin C) Troponin I and T D) B-type natriuretic
peptide (BNP)
,Answer: C. Rationale: A is less specific than troponin; B rises too early and is non-
specific; C is correct as troponins are the gold standard for myocardial necrosis; D is
used for heart failure, not acute MI.
What is the priority nursing intervention immediately following a femoral cardiac
catheterization?
A) Assess the pedal pulses and insertion site for bleeding B) Administer a sedative C)
Encourage the patient to ambulate D) Elevate the head of the bed to 90 degrees
Answer: A. Rationale: A is correct to ensure distal perfusion and check for
hematoma/bleeding; B is incorrect as sedation is not indicated post-procedure; C is
incorrect as the patient must remain on bedrest with the leg straight; D is incorrect as
the HOB should be elevated no more than 30 degrees.
A patient with a known abdominal aortic aneurysm (AAA) reports sudden, severe back
pain. What does the nurse suspect?
A) Renal colic B) Impending aneurysm rupture C) Muscular strain D) Gastroenteritis
Answer: B. Rationale: A is flank pain, not typically severe back pain; B is correct as
sudden severe back or abdominal pain indicates expansion or rupture, a medical
emergency; C is less severe; D presents with GI symptoms.
Which clinical manifestation is expected in a patient with peripheral arterial disease
(PAD)?
A) Warm, flushed extremities B) Intermittent claudication C) Brown pigmentation around
the ankles D) Pitting edema
Answer: B. Rationale: A is incorrect as PAD causes cool extremities; B is correct as it is
the hallmark symptom of PAD (pain with walking relieved by rest); C is seen in venous
disease; D is seen in venous disease.
What is the most appropriate nursing action if a chest tube is accidentally disconnected
from the drainage system?
A) Clamp the chest tube immediately B) Submerge the open end of the tube in sterile
water C) Call the provider immediately D) Instruct the patient to hold their breath
Answer: B. Rationale: A is incorrect as clamping can cause a tension pneumothorax; B
is correct as it re-establishes a temporary water seal to prevent air entry; C is incorrect
as the nurse must act first; D is incorrect as it does not prevent air entry into the pleural
space.
In a chest tube drainage system, what does continuous, vigorous bubbling in the water
seal chamber indicate?
A) Normal lung re-expansion B) An air leak in the system C) The suction is too high D)
The system is functioning correctly
, Answer: B. Rationale: A is incorrect as intermittent bubbling is normal; B is correct
because continuous bubbling indicates an unresolved air leak; C is incorrect as suction
affects the suction control chamber, not the water seal; D is incorrect as it indicates a
complication.
According to 2026 guidelines, what is the primary purpose of Positive End-Expiratory
Pressure (PEEP) in a patient with ARDS?
A) To prevent alveolar collapse and improve oxygenation B) To decrease the
respiratory rate C) To reduce the need for sedation D) To increase carbon dioxide
elimination
Answer: A. Rationale: A is correct as PEEP keeps alveoli open at the end of expiration,
improving V/Q matching and oxygenation; B is incorrect; C is incorrect; D is incorrect as
PEEP primarily targets oxygenation, not ventilation.
A patient with a mechanical ventilator triggers a high-pressure alarm. What is the most
likely cause?
A) The ventilator tubing has become disconnected B) The endotracheal cuff has
deflated C) The patient is biting on the endotracheal tube D) The oxygen source has
been interrupted
Answer: C. Rationale: A causes a low-pressure alarm; B causes a low-pressure alarm;
C is correct as biting the tube, mucous plugs, or pneumothorax increase airway
resistance, triggering a high-pressure alarm; D causes a low-pressure alarm.
What is the priority nursing action when caring for a patient in anaphylactic shock?
A) Administer IV diphenhydramine B) Administer intramuscular epinephrine C) Prepare
for endotracheal intubation D) Obtain a 12-lead ECG
Answer: B. Rationale: A is a secondary treatment; B is correct as IM epinephrine is the
first-line treatment to reverse bronchospasm and vasodilation per 2026 guidelines; C is
done if airway is completely lost; D is not the priority.
Which type of shock is characterized by a bounding pulse, warm flushed skin, and a
decreased systemic vascular resistance (SVR)?
A) Cardiogenic shock B) Hypovolemic shock C) Distributive (septic) shock D)
Obstructive shock
Answer: C. Rationale: A presents with weak pulses and cool skin; B presents with
tachycardia and cool skin; C is correct as early septic shock causes massive
vasodilation leading to warm skin and bounding pulses; D presents with elevated SVR.
A patient with atrial fibrillation is prescribed warfarin. What is the primary rationale for
this medication?
MEDICAL-SURGICAL NURSING
VERSION A, B, AND PRACTICE TEST
QUESTION BANK (2026 Edition)
VERSION A: CARDIOVASCULAR & RESPIRATORY CONCEPTS
According to 2026 AHA guidelines, what is the priority initial intervention for a patient
presenting with suspected acute myocardial infarction (MI)?
A) Administer morphine B) Obtain a 12-lead ECG C) Administer oxygen D) Insert an IV
line
Answer: B. Rationale: A is incorrect as pain management is secondary to diagnosis; B
is correct because a 12-lead ECG within 10 minutes is the priority to identify ST-
elevation; C is incorrect as oxygen is only given if SpO2 is <90%; D is incorrect as IV
access follows the ECG.
Which assessment finding is most specific to left-sided heart failure?
A) Peripheral edema B) Jugular venous distention C) Pulmonary crackles D)
Hepatomegaly
Answer: C. Rationale: A is a sign of right-sided HF; B is a sign of right-sided HF; C is
correct because left-sided HF causes pulmonary congestion leading to crackles; D is a
sign of right-sided HF.
A patient on digoxin reports nausea, vomiting, and seeing yellow halos around lights.
What is the nurse's priority action?
A) Administer an antiemetic B) Hold the digoxin and notify the provider C) Check the
patient's blood pressure D) Encourage oral fluid intake
Answer: B. Rationale: A is incorrect as it treats the symptom, not the cause; B is correct
because these are classic signs of digoxin toxicity requiring immediate hold and
,notification; C is incorrect as BP does not diagnose toxicity; D is incorrect as fluids do
not resolve toxicity.
Per 2026 guidelines, what is the specific antidote for a warfarin overdose?
A) Protamine sulfate B) Vitamin K (Phytonadione) C) Aminocaproic acid D)
Idarucizumab
Answer: B. Rationale: A is the antidote for heparin; B is correct as Vitamin K reverses
warfarin; C is an antifibrinolytic; D is the antidote for dabigatran.
What is the primary rationale for administering a beta-blocker to a patient post-MI?
A) To increase heart rate B) To decrease myocardial oxygen demand C) To increase
blood pressure D) To dilate coronary arteries
Answer: B. Rationale: A is incorrect as beta-blockers decrease HR; B is correct
because reducing HR and contractility decreases the heart's workload and oxygen
demand; C is incorrect as they lower BP; D is incorrect as they do not directly dilate
arteries.
A patient taking an ACE inhibitor develops a persistent, dry cough. What is the best
nursing action?
A) Instruct the patient to stop the medication immediately B) Administer a cough
suppressant C) Notify the healthcare provider to switch the medication class D)
Reassure the patient this is a normal side effect
Answer: C. Rationale: A is incorrect as meds shouldn't be stopped without provider
orders; B is incorrect as it doesn't solve the underlying bradykinin accumulation; C is
correct because the provider will likely switch to an ARB; D is incorrect as it requires
intervention.
How should a patient be instructed to take sublingual nitroglycerin for acute angina?
A) Swallow the tablet with a full glass of water B) Place the tablet under the tongue and
let it dissolve C) Chew the tablet thoroughly before swallowing D) Crush the tablet and
place it under the tongue
Answer: B. Rationale: A is incorrect as swallowing destroys the first-pass metabolism
effect; B is correct because sublingual absorption provides rapid relief; C is incorrect as
it is not meant to be chewed; D is incorrect as it is formulated to dissolve intact.
Which cardiac biomarker is the most specific and sensitive for diagnosing an acute MI
per 2026 standards?
A) Creatine kinase-MB (CK-MB) B) Myoglobin C) Troponin I and T D) B-type natriuretic
peptide (BNP)
,Answer: C. Rationale: A is less specific than troponin; B rises too early and is non-
specific; C is correct as troponins are the gold standard for myocardial necrosis; D is
used for heart failure, not acute MI.
What is the priority nursing intervention immediately following a femoral cardiac
catheterization?
A) Assess the pedal pulses and insertion site for bleeding B) Administer a sedative C)
Encourage the patient to ambulate D) Elevate the head of the bed to 90 degrees
Answer: A. Rationale: A is correct to ensure distal perfusion and check for
hematoma/bleeding; B is incorrect as sedation is not indicated post-procedure; C is
incorrect as the patient must remain on bedrest with the leg straight; D is incorrect as
the HOB should be elevated no more than 30 degrees.
A patient with a known abdominal aortic aneurysm (AAA) reports sudden, severe back
pain. What does the nurse suspect?
A) Renal colic B) Impending aneurysm rupture C) Muscular strain D) Gastroenteritis
Answer: B. Rationale: A is flank pain, not typically severe back pain; B is correct as
sudden severe back or abdominal pain indicates expansion or rupture, a medical
emergency; C is less severe; D presents with GI symptoms.
Which clinical manifestation is expected in a patient with peripheral arterial disease
(PAD)?
A) Warm, flushed extremities B) Intermittent claudication C) Brown pigmentation around
the ankles D) Pitting edema
Answer: B. Rationale: A is incorrect as PAD causes cool extremities; B is correct as it is
the hallmark symptom of PAD (pain with walking relieved by rest); C is seen in venous
disease; D is seen in venous disease.
What is the most appropriate nursing action if a chest tube is accidentally disconnected
from the drainage system?
A) Clamp the chest tube immediately B) Submerge the open end of the tube in sterile
water C) Call the provider immediately D) Instruct the patient to hold their breath
Answer: B. Rationale: A is incorrect as clamping can cause a tension pneumothorax; B
is correct as it re-establishes a temporary water seal to prevent air entry; C is incorrect
as the nurse must act first; D is incorrect as it does not prevent air entry into the pleural
space.
In a chest tube drainage system, what does continuous, vigorous bubbling in the water
seal chamber indicate?
A) Normal lung re-expansion B) An air leak in the system C) The suction is too high D)
The system is functioning correctly
, Answer: B. Rationale: A is incorrect as intermittent bubbling is normal; B is correct
because continuous bubbling indicates an unresolved air leak; C is incorrect as suction
affects the suction control chamber, not the water seal; D is incorrect as it indicates a
complication.
According to 2026 guidelines, what is the primary purpose of Positive End-Expiratory
Pressure (PEEP) in a patient with ARDS?
A) To prevent alveolar collapse and improve oxygenation B) To decrease the
respiratory rate C) To reduce the need for sedation D) To increase carbon dioxide
elimination
Answer: A. Rationale: A is correct as PEEP keeps alveoli open at the end of expiration,
improving V/Q matching and oxygenation; B is incorrect; C is incorrect; D is incorrect as
PEEP primarily targets oxygenation, not ventilation.
A patient with a mechanical ventilator triggers a high-pressure alarm. What is the most
likely cause?
A) The ventilator tubing has become disconnected B) The endotracheal cuff has
deflated C) The patient is biting on the endotracheal tube D) The oxygen source has
been interrupted
Answer: C. Rationale: A causes a low-pressure alarm; B causes a low-pressure alarm;
C is correct as biting the tube, mucous plugs, or pneumothorax increase airway
resistance, triggering a high-pressure alarm; D causes a low-pressure alarm.
What is the priority nursing action when caring for a patient in anaphylactic shock?
A) Administer IV diphenhydramine B) Administer intramuscular epinephrine C) Prepare
for endotracheal intubation D) Obtain a 12-lead ECG
Answer: B. Rationale: A is a secondary treatment; B is correct as IM epinephrine is the
first-line treatment to reverse bronchospasm and vasodilation per 2026 guidelines; C is
done if airway is completely lost; D is not the priority.
Which type of shock is characterized by a bounding pulse, warm flushed skin, and a
decreased systemic vascular resistance (SVR)?
A) Cardiogenic shock B) Hypovolemic shock C) Distributive (septic) shock D)
Obstructive shock
Answer: C. Rationale: A presents with weak pulses and cool skin; B presents with
tachycardia and cool skin; C is correct as early septic shock causes massive
vasodilation leading to warm skin and bounding pulses; D presents with elevated SVR.
A patient with atrial fibrillation is prescribed warfarin. What is the primary rationale for
this medication?
