Medical-Surgical Nursing Questions & Model
Answers – Comprehensive Review for 4th Year
Medical Students
CARDIOVASCULAR NURSING
Question 1: Post-MI Care
Q: A 58-year-old patient is admitted 6 hours post-STEMI following primary PCI. What are your
immediate nursing priorities for the first 24 hours?
A: Immediate priorities include:
Cardiac monitoring: Continuous ECG monitoring for arrhythmias, particularly VT/VF in
the first 24-48 hours
Pain assessment: Regular pain scoring using validated tools; ensure adequate analgesia
with GTN and morphine as prescribed
Haemodynamic stability: Monitor BP, HR, oxygen saturations hourly initially, watching
for signs of cardiogenic shock
Puncture site care: 4-hourly observations of femoral/radial access site for bleeding,
hematoma, or loss of distal pulses
Medication compliance: Ensure dual antiplatelet therapy (aspirin +
clopidogrel/ticagrelor), ACE inhibitor, beta-blocker, and statin are commenced as per
NICE guidelines
Early mobilization: Gradual mobilization from 4-6 hours post-procedure if no
complications
Patient education: Begin discharge planning early, focusing on cardiac rehabilitation
referral and lifestyle modifications
Question 2: Heart Failure Management
Q: Explain the nursing management of a patient with acute exacerbation of chronic heart
failure (NYHA Class III).
A: Nursing management focuses on:
, Fluid balance monitoring: Daily weights (same time, same scales, same clothing), strict
fluid balance charts, assess for peripheral oedema and JVP
Respiratory assessment: Monitor for orthopnea, PND, respiratory rate and effort,
oxygen saturations
Medication management: Ensure compliance with ACE inhibitors, beta-blockers, and
diuretics; monitor for side effects, including hypotension and electrolyte imbalance
Activity tolerance: Assess functional capacity, encourage gradual activity as tolerated,
refer to cardiac rehabilitation
Dietary advice: Low sodium diet (<2g/day), fluid restriction if severe (1.5-2L/day)
Patient education: Recognition of deterioration signs, importance of medication
compliance, when to contact healthcare services
Psychological support: Address anxiety and depression commonly associated with
chronic heart failure
RESPIRATORY NURSING
Question 3: COPD Exacerbation
Q: A 72-year-old patient with known COPD presents with increased dyspnea, purulent
sputum, and confusion. Outline your nursing assessment and management plan.
A: Assessment includes:
ABCDE approach: Airway patency, breathing pattern and effort, circulation, disability
(confusion may indicate CO2 retention), exposure to cyanosis
Arterial blood gas: Essential to determine type 1 vs type 2 respiratory failure and guide
oxygen therapy
Sputum assessment: Color, consistency, volume - purulent suggests bacterial infection
requiring antibiotics
Management priorities:
Controlled oxygen therapy: Target saturations 88-92% to avoid CO2 retention in type 2
respiratory failure
Nebulized bronchodilators: Salbutamol and ipratropium bromide via air-driven
nebulizers
, Oral corticosteroids: Prednisolone 30mg daily for 5 days as per NICE guidelines
Antibiotics: If signs of bacterial infection (purulent sputum, raised inflammatory
markers)
Physiotherapy: Chest physiotherapy to aid sputum clearance, encourage active cycle of
breathing techniques
Nutritional support: COPD patients often malnourished; dietitian referral if BMI <20
Smoking cessation: If applicable, refer to smoking cessation services
Question 4: Post-operative Pneumonia Prevention
Q: What evidence-based nursing interventions would you implement to prevent post-
operative pneumonia in a patient following major abdominal surgery?
A: Prevention strategies include:
Early mobilization: Encourage sitting out of bed within 24 hours post-operatively,
progressive mobility as tolerated
Respiratory physiotherapy: Deep breathing exercises, incentive spirometry, coughing,
and huffing techniques every 2 hours while awake
Positioning: Semi-Fowler's position (30-45 degrees) to optimize lung expansion and
reduce aspiration risk
Pain management: Adequate analgesia to enable effective breathing and coughing -
consider regional blocks or patient-controlled analgesia
Oral hygiene: Regular mouth care to reduce bacterial colonization, particularly
important in intubated patients
Nutritional support: Early enteral feeding when appropriate to maintain immune
function
Smoking cessation: Pre-operative counselling and support for cessation at least 4 weeks
before surgery
Infection control: Hand hygiene, appropriate use of PPE, equipment cleaning
Answers – Comprehensive Review for 4th Year
Medical Students
CARDIOVASCULAR NURSING
Question 1: Post-MI Care
Q: A 58-year-old patient is admitted 6 hours post-STEMI following primary PCI. What are your
immediate nursing priorities for the first 24 hours?
A: Immediate priorities include:
Cardiac monitoring: Continuous ECG monitoring for arrhythmias, particularly VT/VF in
the first 24-48 hours
Pain assessment: Regular pain scoring using validated tools; ensure adequate analgesia
with GTN and morphine as prescribed
Haemodynamic stability: Monitor BP, HR, oxygen saturations hourly initially, watching
for signs of cardiogenic shock
Puncture site care: 4-hourly observations of femoral/radial access site for bleeding,
hematoma, or loss of distal pulses
Medication compliance: Ensure dual antiplatelet therapy (aspirin +
clopidogrel/ticagrelor), ACE inhibitor, beta-blocker, and statin are commenced as per
NICE guidelines
Early mobilization: Gradual mobilization from 4-6 hours post-procedure if no
complications
Patient education: Begin discharge planning early, focusing on cardiac rehabilitation
referral and lifestyle modifications
Question 2: Heart Failure Management
Q: Explain the nursing management of a patient with acute exacerbation of chronic heart
failure (NYHA Class III).
A: Nursing management focuses on:
, Fluid balance monitoring: Daily weights (same time, same scales, same clothing), strict
fluid balance charts, assess for peripheral oedema and JVP
Respiratory assessment: Monitor for orthopnea, PND, respiratory rate and effort,
oxygen saturations
Medication management: Ensure compliance with ACE inhibitors, beta-blockers, and
diuretics; monitor for side effects, including hypotension and electrolyte imbalance
Activity tolerance: Assess functional capacity, encourage gradual activity as tolerated,
refer to cardiac rehabilitation
Dietary advice: Low sodium diet (<2g/day), fluid restriction if severe (1.5-2L/day)
Patient education: Recognition of deterioration signs, importance of medication
compliance, when to contact healthcare services
Psychological support: Address anxiety and depression commonly associated with
chronic heart failure
RESPIRATORY NURSING
Question 3: COPD Exacerbation
Q: A 72-year-old patient with known COPD presents with increased dyspnea, purulent
sputum, and confusion. Outline your nursing assessment and management plan.
A: Assessment includes:
ABCDE approach: Airway patency, breathing pattern and effort, circulation, disability
(confusion may indicate CO2 retention), exposure to cyanosis
Arterial blood gas: Essential to determine type 1 vs type 2 respiratory failure and guide
oxygen therapy
Sputum assessment: Color, consistency, volume - purulent suggests bacterial infection
requiring antibiotics
Management priorities:
Controlled oxygen therapy: Target saturations 88-92% to avoid CO2 retention in type 2
respiratory failure
Nebulized bronchodilators: Salbutamol and ipratropium bromide via air-driven
nebulizers
, Oral corticosteroids: Prednisolone 30mg daily for 5 days as per NICE guidelines
Antibiotics: If signs of bacterial infection (purulent sputum, raised inflammatory
markers)
Physiotherapy: Chest physiotherapy to aid sputum clearance, encourage active cycle of
breathing techniques
Nutritional support: COPD patients often malnourished; dietitian referral if BMI <20
Smoking cessation: If applicable, refer to smoking cessation services
Question 4: Post-operative Pneumonia Prevention
Q: What evidence-based nursing interventions would you implement to prevent post-
operative pneumonia in a patient following major abdominal surgery?
A: Prevention strategies include:
Early mobilization: Encourage sitting out of bed within 24 hours post-operatively,
progressive mobility as tolerated
Respiratory physiotherapy: Deep breathing exercises, incentive spirometry, coughing,
and huffing techniques every 2 hours while awake
Positioning: Semi-Fowler's position (30-45 degrees) to optimize lung expansion and
reduce aspiration risk
Pain management: Adequate analgesia to enable effective breathing and coughing -
consider regional blocks or patient-controlled analgesia
Oral hygiene: Regular mouth care to reduce bacterial colonization, particularly
important in intubated patients
Nutritional support: Early enteral feeding when appropriate to maintain immune
function
Smoking cessation: Pre-operative counselling and support for cessation at least 4 weeks
before surgery
Infection control: Hand hygiene, appropriate use of PPE, equipment cleaning
