At my school Med Surg 1 was much harder than Fundamentals. 6 of my classmates failed it. However these same students also barely passed Fundamentals. Like you I got an A in Fundamentals. Even with a lot going wrong in my personal life at the time, I still more than passed Med Surg 1. My clinical instructor for Fundamentals gave us some really good advice. She told us that if we failed the first test we needed to do something different. We needed to get help and change or otherwise we'd never pass. She was right. The people that failed the first two tests never pulled up their grades enough.