InstructioNUR242 Medical-Surgical Nursing
Comprehensive Practice Exam Actual Exam 2026/2027 |
Complete Exam-Style Questions with Detailed Rationales
| Pass Guaranteed – A+ Graded
This practice exam contains 100 questions covering Cardiovascular, Respiratory,
Gastrointestinal, Renal/Urinary, Neurological, Endocrine, Musculoskeletal,
Immunologic/Hematologic, and Perioperative Nursing. Select the best answer for each
question.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–18)
Q1: A patient admitted with acute coronary syndrome is receiving nitroglycerin
intravenously. Which assessment finding requires immediate intervention by the nurse?
A. Blood pressure decrease from 142/88 to 128/78 mmHg
B. Patient reports headache rated 3/10
C. Blood pressure decrease from 138/82 to 88/54 mmHg
D. Patient reports mild flushing of the face
Correct Answer: C
Rationale: Correct because significant hypotension (systolic drop >30 mmHg or below
90 mmHg) indicates excessive vasodilation from nitroglycerin and requires immediate
intervention to prevent cardiovascular collapse. The nurse should reduce the infusion
rate and notify the provider.
Q2: A nurse is caring for a patient with heart failure who is prescribed furosemide 40 mg
IV daily. Which laboratory value should the nurse monitor most closely before
administering this medication?
A. Serum creatinine
B. Serum potassium
,C. Hemoglobin
D. Blood urea nitrogen
Correct Answer: B
Rationale: Correct because loop diuretics such as furosemide promote potassium
wasting through the kidneys, and hypokalemia can precipitate life-threatening
dysrhythmias in patients with cardiac compromise.
Q3: A patient with atrial fibrillation is started on warfarin therapy. The nurse understands
that the therapeutic international normalized ratio (INR) range for this patient is:
A. 1.0 to 1.5
B. 1.5 to 2.0
C. 2.0 to 3.0
D. 3.0 to 4.5
Correct Answer: C
Rationale: Correct because the standard therapeutic INR range for warfarin
anticoagulation in atrial fibrillation is 2.0 to 3.0, which provides adequate stroke
prevention while minimizing bleeding risk.
Q4: A patient is recovering from a myocardial infarction and asks the nurse why
morphine was administered. The best response by the nurse is that morphine:
A. Prevents ventricular remodeling after cardiac damage
B. Reduces myocardial oxygen demand through vasodilation and pain relief
C. Dissolves the coronary thrombus causing the infarction
D. Increases heart rate to improve cardiac output
Correct Answer: B
Rationale: Correct because morphine reduces catecholamine release through pain relief,
decreases preload and afterload via venous and arterial vasodilation, and thereby
reduces myocardial oxygen demand.
Q5: A nurse is assessing a patient with suspected infective endocarditis. Which finding
is most characteristic of this condition?
A. Pulsus paradoxus greater than 10 mmHg
B. Janeway lesions on the palms and soles
C. Kussmaul respirations
D. Braden scale score of 18
Correct Answer: B
,Rationale: Correct because Janeway lesions are non-tender, erythematous macules on
the palms and soles caused by septic microemboli, representing a classic peripheral
manifestation of infective endocarditis.
Q6: A patient with hypertension is prescribed lisinopril. The nurse should instruct the
patient to report which side effect immediately?
A. Dry cough
B. Dizziness upon standing
C. Mild ankle swelling
D. Increased urination
Correct Answer: B
Rationale: Correct because dizziness upon standing indicates symptomatic
hypotension, which may lead to falls and injury; this requires immediate reporting for
medication adjustment.
Q7: A patient with peripheral arterial disease is instructed on foot care. Which statement
by the patient indicates correct understanding?
A. "I should soak my feet in warm water for 30 minutes daily."
B. "I will use a heating pad on my feet when they feel cold."
C. "I will inspect my feet daily and wear well-fitted protective shoes."
D. "I should trim my toenails in a curved shape to prevent ingrown nails."
Correct Answer: C
Rationale: Correct because daily foot inspection and protective footwear prevent trauma
and allow early detection of wounds; patients with PAD have impaired healing and
sensation, making prevention essential.
Q8: A patient with aortic stenosis develops syncope upon exertion. The nurse
understands that this symptom occurs because:
A. Exertion causes excessive vasodilation
B. The stenotic valve cannot increase cardiac output to meet metabolic demands
C. Exertion triggers fatal ventricular dysrhythmias
D. The left ventricle becomes hyperdynamic and ejects too rapidly
Correct Answer: B
, Rationale: Correct because the fixed obstruction of aortic stenosis prevents the valve
from opening sufficiently to increase cardiac output during exertion, causing cerebral
hypoperfusion and syncope.
Q9: A patient with acute decompensated heart failure has the following vital signs: BP
92/58, HR 118, RR 28, SpO2 88% on room air. Which intervention should the nurse
prioritize?
A. Administer IV morphine 2 mg
B. Initiate high-flow oxygen via non-rebreather mask
C. Insert a Foley catheter for strict intake and output
D. Begin dopamine infusion at 5 mcg/kg/min
Correct Answer: B
Rationale: Correct because the priority in any patient with hypoxemia is airway and
breathing; oxygenation must be addressed before pharmacological interventions to
prevent end-organ damage from hypoxia.
Q10: A patient is being discharged after coronary artery bypass graft surgery. Which
discharge instruction should the nurse emphasize?
A. "You may resume driving when you feel strong enough."
B. "Lift no more than 10 pounds for the first 6 weeks."
C. "Stop taking your aspirin if you notice bruising."
D. "You can return to work in 2 weeks if your job is sedentary."
Correct Answer: B
Rationale: Correct because sternal healing requires approximately 6 to 8 weeks; lifting
restrictions protect the sternal wound from dehiscence and promote proper bone
healing.
Q11: A patient with dilated cardiomyopathy is being evaluated for heart transplant.
Which psychosocial factor would most concern the transplant team?
A. Patient lives 45 minutes from the transplant center
B. Patient has a history of nonadherence to medication regimens
C. Patient is retired and has adequate time for recovery
D. Patient has a strong family support system
Correct Answer: B
Comprehensive Practice Exam Actual Exam 2026/2027 |
Complete Exam-Style Questions with Detailed Rationales
| Pass Guaranteed – A+ Graded
This practice exam contains 100 questions covering Cardiovascular, Respiratory,
Gastrointestinal, Renal/Urinary, Neurological, Endocrine, Musculoskeletal,
Immunologic/Hematologic, and Perioperative Nursing. Select the best answer for each
question.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–18)
Q1: A patient admitted with acute coronary syndrome is receiving nitroglycerin
intravenously. Which assessment finding requires immediate intervention by the nurse?
A. Blood pressure decrease from 142/88 to 128/78 mmHg
B. Patient reports headache rated 3/10
C. Blood pressure decrease from 138/82 to 88/54 mmHg
D. Patient reports mild flushing of the face
Correct Answer: C
Rationale: Correct because significant hypotension (systolic drop >30 mmHg or below
90 mmHg) indicates excessive vasodilation from nitroglycerin and requires immediate
intervention to prevent cardiovascular collapse. The nurse should reduce the infusion
rate and notify the provider.
Q2: A nurse is caring for a patient with heart failure who is prescribed furosemide 40 mg
IV daily. Which laboratory value should the nurse monitor most closely before
administering this medication?
A. Serum creatinine
B. Serum potassium
,C. Hemoglobin
D. Blood urea nitrogen
Correct Answer: B
Rationale: Correct because loop diuretics such as furosemide promote potassium
wasting through the kidneys, and hypokalemia can precipitate life-threatening
dysrhythmias in patients with cardiac compromise.
Q3: A patient with atrial fibrillation is started on warfarin therapy. The nurse understands
that the therapeutic international normalized ratio (INR) range for this patient is:
A. 1.0 to 1.5
B. 1.5 to 2.0
C. 2.0 to 3.0
D. 3.0 to 4.5
Correct Answer: C
Rationale: Correct because the standard therapeutic INR range for warfarin
anticoagulation in atrial fibrillation is 2.0 to 3.0, which provides adequate stroke
prevention while minimizing bleeding risk.
Q4: A patient is recovering from a myocardial infarction and asks the nurse why
morphine was administered. The best response by the nurse is that morphine:
A. Prevents ventricular remodeling after cardiac damage
B. Reduces myocardial oxygen demand through vasodilation and pain relief
C. Dissolves the coronary thrombus causing the infarction
D. Increases heart rate to improve cardiac output
Correct Answer: B
Rationale: Correct because morphine reduces catecholamine release through pain relief,
decreases preload and afterload via venous and arterial vasodilation, and thereby
reduces myocardial oxygen demand.
Q5: A nurse is assessing a patient with suspected infective endocarditis. Which finding
is most characteristic of this condition?
A. Pulsus paradoxus greater than 10 mmHg
B. Janeway lesions on the palms and soles
C. Kussmaul respirations
D. Braden scale score of 18
Correct Answer: B
,Rationale: Correct because Janeway lesions are non-tender, erythematous macules on
the palms and soles caused by septic microemboli, representing a classic peripheral
manifestation of infective endocarditis.
Q6: A patient with hypertension is prescribed lisinopril. The nurse should instruct the
patient to report which side effect immediately?
A. Dry cough
B. Dizziness upon standing
C. Mild ankle swelling
D. Increased urination
Correct Answer: B
Rationale: Correct because dizziness upon standing indicates symptomatic
hypotension, which may lead to falls and injury; this requires immediate reporting for
medication adjustment.
Q7: A patient with peripheral arterial disease is instructed on foot care. Which statement
by the patient indicates correct understanding?
A. "I should soak my feet in warm water for 30 minutes daily."
B. "I will use a heating pad on my feet when they feel cold."
C. "I will inspect my feet daily and wear well-fitted protective shoes."
D. "I should trim my toenails in a curved shape to prevent ingrown nails."
Correct Answer: C
Rationale: Correct because daily foot inspection and protective footwear prevent trauma
and allow early detection of wounds; patients with PAD have impaired healing and
sensation, making prevention essential.
Q8: A patient with aortic stenosis develops syncope upon exertion. The nurse
understands that this symptom occurs because:
A. Exertion causes excessive vasodilation
B. The stenotic valve cannot increase cardiac output to meet metabolic demands
C. Exertion triggers fatal ventricular dysrhythmias
D. The left ventricle becomes hyperdynamic and ejects too rapidly
Correct Answer: B
, Rationale: Correct because the fixed obstruction of aortic stenosis prevents the valve
from opening sufficiently to increase cardiac output during exertion, causing cerebral
hypoperfusion and syncope.
Q9: A patient with acute decompensated heart failure has the following vital signs: BP
92/58, HR 118, RR 28, SpO2 88% on room air. Which intervention should the nurse
prioritize?
A. Administer IV morphine 2 mg
B. Initiate high-flow oxygen via non-rebreather mask
C. Insert a Foley catheter for strict intake and output
D. Begin dopamine infusion at 5 mcg/kg/min
Correct Answer: B
Rationale: Correct because the priority in any patient with hypoxemia is airway and
breathing; oxygenation must be addressed before pharmacological interventions to
prevent end-organ damage from hypoxia.
Q10: A patient is being discharged after coronary artery bypass graft surgery. Which
discharge instruction should the nurse emphasize?
A. "You may resume driving when you feel strong enough."
B. "Lift no more than 10 pounds for the first 6 weeks."
C. "Stop taking your aspirin if you notice bruising."
D. "You can return to work in 2 weeks if your job is sedentary."
Correct Answer: B
Rationale: Correct because sternal healing requires approximately 6 to 8 weeks; lifting
restrictions protect the sternal wound from dehiscence and promote proper bone
healing.
Q11: A patient with dilated cardiomyopathy is being evaluated for heart transplant.
Which psychosocial factor would most concern the transplant team?
A. Patient lives 45 minutes from the transplant center
B. Patient has a history of nonadherence to medication regimens
C. Patient is retired and has adequate time for recovery
D. Patient has a strong family support system
Correct Answer: B
