NURS 2356 EXAM 2 VERIFIED EXAM SOLUTIONS - COMPREHENSIVE
QUESTIONS AND ANSWERS - CURRENT VERSION (2026/2027)
Cardiovascular | Respiratory | Renal | Neurological
1. What is the primary difference between left-sided and right-sided heart failure?
Answer: Left-sided heart failure causes pulmonary congestion (dyspnea, crackles, frothy
sputum), while right-sided heart failure causes systemic venous congestion (peripheral
edema, JVD, hepatomegaly).
2. What are the hallmark signs of left-sided heart failure?
Answer: Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND), crackles in lung
bases, S3 gallop, pulmonary edema, and decreased activity tolerance.
3. What are the hallmark signs of right-sided heart failure?
Answer: Jugular venous distension (JVD), dependent peripheral edema, ascites,
hepatomegaly, weight gain, and fatigue.
4. What does BNP (B-type natriuretic peptide) indicate in heart failure?
Answer: Elevated BNP indicates ventricular wall stress and volume overload; it is used
to diagnose and monitor heart failure severity. Levels above 100 pg/mL suggest heart
failure.
5. What is the nursing priority for a patient in acute pulmonary edema?
Answer: Place patient in high Fowler's position, administer supplemental oxygen,
prepare for possible intubation, administer prescribed diuretics (furosemide IV), and
monitor vital signs and O2 saturation continuously.
6. What is orthopnea and what does it indicate?
Answer: Orthopnea is shortness of breath when lying flat, relieved by sitting upright. It
indicates left-sided heart failure due to redistribution of fluid to the lungs.
7. What are the common medications used in heart failure management?
,Answer: ACE inhibitors (or ARBs), beta-blockers, diuretics (furosemide), digoxin, and
aldosterone antagonists (spironolactone). These reduce preload, afterload, and improve
cardiac output.
8. What is the mechanism of action of furosemide in heart failure?
Answer: Furosemide is a loop diuretic that inhibits sodium-potassium-chloride
reabsorption in the loop of Henle, promoting fluid excretion and reducing preload and
pulmonary congestion.
9. What electrolyte imbalance is a major concern with loop diuretic use?
Answer: Hypokalemia. Loop diuretics cause potassium wasting, which can lead to
dangerous cardiac arrhythmias, especially in patients taking digoxin.
10. What is ejection fraction and what value indicates systolic heart failure?
Answer: Ejection fraction (EF) is the percentage of blood pumped out of the left
ventricle with each beat. Normal is 55-70%. An EF below 40% indicates systolic
(HFrEF) heart failure.
11. What does HFpEF mean and how does it differ from HFrEF?
Answer: HFpEF = Heart Failure with preserved Ejection Fraction (EF ≥50%). The heart
is stiff and cannot relax properly (diastolic dysfunction). HFrEF has reduced EF (<40%)
due to systolic dysfunction — the heart cannot contract effectively.
12. What is the significance of an S3 heart sound in a patient with heart failure?
Answer: An S3 (ventricular gallop) heard after S2 indicates ventricular volume overload
and is a classic sign of systolic heart failure and decreased cardiac output.
13. Why is daily weight monitoring important in heart failure patients?
Answer: Weight gain of more than 2 lbs in one day or 5 lbs in one week indicates fluid
retention and worsening heart failure. Patients should weigh each morning at the same
time after voiding.
14. What dietary teaching is essential for heart failure patients?
Answer: Restrict sodium to less than 2 g/day to reduce fluid retention. Limit fluid intake
as prescribed. Avoid alcohol and smoking. Eat small, frequent meals to reduce cardiac
workload.
15. What is cardiac output and how is it calculated?
Answer: Cardiac output (CO) = Heart Rate (HR) × Stroke Volume (SV). Normal CO is
4-8 L/min. Reduced CO leads to decreased organ perfusion.
16. What is the priority nursing action for ventricular fibrillation (VFib)?
,Answer: Immediate defibrillation (unsynchronized cardioversion) and initiation of CPR
per ACLS protocol. VFib is a shockable rhythm with no organized cardiac output.
17. What distinguishes atrial fibrillation (AFib) on an ECG?
Answer: Irregularly irregular rhythm, absent P waves (replaced by fibrillatory waves),
and irregular narrow QRS complexes. Ventricular rate may be fast or slow.
18. What is the major complication of untreated atrial fibrillation?
Answer: Thrombus formation in the left atrial appendage due to stasis of blood, leading
to stroke (cardioembolic). Anticoagulation (warfarin, apixaban, rivaroxaban) is required.
19. What does a prolonged PR interval indicate on ECG?
Answer: First-degree AV block — delayed conduction through the AV node. PR interval
>0.20 seconds (>5 small boxes). Usually benign and requires monitoring.
20. What is the treatment for symptomatic bradycardia (HR <50 with hypotension)?
Answer: Administer atropine IV (first-line). If ineffective, transcutaneous pacing or
dopamine/epinephrine infusion. Prepare for transvenous pacing if persistent.
21. What are the characteristics of ventricular tachycardia (VTach) on ECG?
Answer: Wide, bizarre QRS complexes (>0.12 sec), rate 100-250 bpm, regular rhythm.
Can be pulseless (treat like VFib) or with pulse (synchronized cardioversion or
amiodarone).
22. What is the difference between cardioversion and defibrillation?
Answer: Cardioversion is synchronized to the R wave and used for organized
tachyarrhythmias (AFib, VTach with pulse, SVT). Defibrillation is unsynchronized and
used for VFib or pulseless VTach.
23. What does the QRS complex represent on an ECG?
Answer: Ventricular depolarization — the electrical activation causing ventricular
contraction. Normal QRS duration is 0.06-0.10 seconds (1.5-2.5 small boxes).
24. What is a normal sinus rhythm?
Answer: Heart rate 60-100 bpm, regular rhythm, P wave before each QRS, PR interval
0.12-0.20 sec, QRS <0.10 sec, consistent P-wave morphology.
25. What nursing assessment should be done before administering digoxin?
Answer: Take apical pulse for one full minute before giving. Hold if HR is below 60
bpm (or per order). Monitor for toxicity signs: nausea, vomiting, visual disturbances
(yellow-green halos), bradycardia.
, 26. What are the BP classifications per JNC/ACC-AHA guidelines?
Answer: Normal: <120/80; Elevated: 120-129/<80; Stage 1 HTN: 130-139/80-89; Stage
2 HTN: ≥140/≥90; Hypertensive Crisis: >180/120.
27. What is hypertensive urgency vs. hypertensive emergency?
Answer: Urgency: severely elevated BP (>180/120) WITHOUT target organ damage.
Emergency: severely elevated BP WITH evidence of end-organ damage (MI, stroke,
AKI, dissection). Emergency requires ICU and IV antihypertensives.
28. What are the first-line antihypertensive medications?
Answer: Thiazide diuretics, ACE inhibitors (or ARBs), calcium channel blockers
(amlodipine), and beta-blockers. ACE inhibitors are preferred in diabetics and those with
CKD.
29. What lifestyle modifications are recommended for hypertension?
Answer: DASH diet (low sodium, high fruits/vegetables), weight loss, limit alcohol,
smoking cessation, regular aerobic exercise (150 min/week), and stress management.
30. What are signs of a hypertensive emergency?
Answer: Severe headache, blurred vision, chest pain, shortness of breath, altered mental
status, papilledema, hematuria, and seizures. Requires immediate IV treatment
(nicardipine, labetalol, sodium nitroprusside).
31. What is the difference between STEMI and NSTEMI?
Answer: STEMI shows ST elevation on ECG and complete coronary artery occlusion —
requires emergent PCI or thrombolytics. NSTEMI shows no ST elevation (may have ST
depression/T-wave changes) and partial occlusion.
32. What is the classic presentation of an acute MI?
Answer: Crushing, pressure-like chest pain radiating to left arm, jaw, or back;
diaphoresis; nausea/vomiting; dyspnea; anxiety. Women and diabetics may present
atypically with fatigue, indigestion, or jaw pain only.
33. What are the nursing priorities in caring for a patient with STEMI?
Answer: Activate catheterization lab (PCI goal within 90 min), administer aspirin 325
mg, oxygen if SpO2 <90%, nitroglycerin for chest pain (if BP allows), IV access,
continuous cardiac monitoring, 12-lead ECG.
34. What does the mnemonic MONA represent in ACS care?
Answer: Morphine (pain relief, preload reduction), Oxygen (if O2 sat <90%), Nitrates
(vasodilation, preload reduction), Aspirin (antiplatelet). Note: morphine use is now
controversial due to potential harm in NSTEMI.
QUESTIONS AND ANSWERS - CURRENT VERSION (2026/2027)
Cardiovascular | Respiratory | Renal | Neurological
1. What is the primary difference between left-sided and right-sided heart failure?
Answer: Left-sided heart failure causes pulmonary congestion (dyspnea, crackles, frothy
sputum), while right-sided heart failure causes systemic venous congestion (peripheral
edema, JVD, hepatomegaly).
2. What are the hallmark signs of left-sided heart failure?
Answer: Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND), crackles in lung
bases, S3 gallop, pulmonary edema, and decreased activity tolerance.
3. What are the hallmark signs of right-sided heart failure?
Answer: Jugular venous distension (JVD), dependent peripheral edema, ascites,
hepatomegaly, weight gain, and fatigue.
4. What does BNP (B-type natriuretic peptide) indicate in heart failure?
Answer: Elevated BNP indicates ventricular wall stress and volume overload; it is used
to diagnose and monitor heart failure severity. Levels above 100 pg/mL suggest heart
failure.
5. What is the nursing priority for a patient in acute pulmonary edema?
Answer: Place patient in high Fowler's position, administer supplemental oxygen,
prepare for possible intubation, administer prescribed diuretics (furosemide IV), and
monitor vital signs and O2 saturation continuously.
6. What is orthopnea and what does it indicate?
Answer: Orthopnea is shortness of breath when lying flat, relieved by sitting upright. It
indicates left-sided heart failure due to redistribution of fluid to the lungs.
7. What are the common medications used in heart failure management?
,Answer: ACE inhibitors (or ARBs), beta-blockers, diuretics (furosemide), digoxin, and
aldosterone antagonists (spironolactone). These reduce preload, afterload, and improve
cardiac output.
8. What is the mechanism of action of furosemide in heart failure?
Answer: Furosemide is a loop diuretic that inhibits sodium-potassium-chloride
reabsorption in the loop of Henle, promoting fluid excretion and reducing preload and
pulmonary congestion.
9. What electrolyte imbalance is a major concern with loop diuretic use?
Answer: Hypokalemia. Loop diuretics cause potassium wasting, which can lead to
dangerous cardiac arrhythmias, especially in patients taking digoxin.
10. What is ejection fraction and what value indicates systolic heart failure?
Answer: Ejection fraction (EF) is the percentage of blood pumped out of the left
ventricle with each beat. Normal is 55-70%. An EF below 40% indicates systolic
(HFrEF) heart failure.
11. What does HFpEF mean and how does it differ from HFrEF?
Answer: HFpEF = Heart Failure with preserved Ejection Fraction (EF ≥50%). The heart
is stiff and cannot relax properly (diastolic dysfunction). HFrEF has reduced EF (<40%)
due to systolic dysfunction — the heart cannot contract effectively.
12. What is the significance of an S3 heart sound in a patient with heart failure?
Answer: An S3 (ventricular gallop) heard after S2 indicates ventricular volume overload
and is a classic sign of systolic heart failure and decreased cardiac output.
13. Why is daily weight monitoring important in heart failure patients?
Answer: Weight gain of more than 2 lbs in one day or 5 lbs in one week indicates fluid
retention and worsening heart failure. Patients should weigh each morning at the same
time after voiding.
14. What dietary teaching is essential for heart failure patients?
Answer: Restrict sodium to less than 2 g/day to reduce fluid retention. Limit fluid intake
as prescribed. Avoid alcohol and smoking. Eat small, frequent meals to reduce cardiac
workload.
15. What is cardiac output and how is it calculated?
Answer: Cardiac output (CO) = Heart Rate (HR) × Stroke Volume (SV). Normal CO is
4-8 L/min. Reduced CO leads to decreased organ perfusion.
16. What is the priority nursing action for ventricular fibrillation (VFib)?
,Answer: Immediate defibrillation (unsynchronized cardioversion) and initiation of CPR
per ACLS protocol. VFib is a shockable rhythm with no organized cardiac output.
17. What distinguishes atrial fibrillation (AFib) on an ECG?
Answer: Irregularly irregular rhythm, absent P waves (replaced by fibrillatory waves),
and irregular narrow QRS complexes. Ventricular rate may be fast or slow.
18. What is the major complication of untreated atrial fibrillation?
Answer: Thrombus formation in the left atrial appendage due to stasis of blood, leading
to stroke (cardioembolic). Anticoagulation (warfarin, apixaban, rivaroxaban) is required.
19. What does a prolonged PR interval indicate on ECG?
Answer: First-degree AV block — delayed conduction through the AV node. PR interval
>0.20 seconds (>5 small boxes). Usually benign and requires monitoring.
20. What is the treatment for symptomatic bradycardia (HR <50 with hypotension)?
Answer: Administer atropine IV (first-line). If ineffective, transcutaneous pacing or
dopamine/epinephrine infusion. Prepare for transvenous pacing if persistent.
21. What are the characteristics of ventricular tachycardia (VTach) on ECG?
Answer: Wide, bizarre QRS complexes (>0.12 sec), rate 100-250 bpm, regular rhythm.
Can be pulseless (treat like VFib) or with pulse (synchronized cardioversion or
amiodarone).
22. What is the difference between cardioversion and defibrillation?
Answer: Cardioversion is synchronized to the R wave and used for organized
tachyarrhythmias (AFib, VTach with pulse, SVT). Defibrillation is unsynchronized and
used for VFib or pulseless VTach.
23. What does the QRS complex represent on an ECG?
Answer: Ventricular depolarization — the electrical activation causing ventricular
contraction. Normal QRS duration is 0.06-0.10 seconds (1.5-2.5 small boxes).
24. What is a normal sinus rhythm?
Answer: Heart rate 60-100 bpm, regular rhythm, P wave before each QRS, PR interval
0.12-0.20 sec, QRS <0.10 sec, consistent P-wave morphology.
25. What nursing assessment should be done before administering digoxin?
Answer: Take apical pulse for one full minute before giving. Hold if HR is below 60
bpm (or per order). Monitor for toxicity signs: nausea, vomiting, visual disturbances
(yellow-green halos), bradycardia.
, 26. What are the BP classifications per JNC/ACC-AHA guidelines?
Answer: Normal: <120/80; Elevated: 120-129/<80; Stage 1 HTN: 130-139/80-89; Stage
2 HTN: ≥140/≥90; Hypertensive Crisis: >180/120.
27. What is hypertensive urgency vs. hypertensive emergency?
Answer: Urgency: severely elevated BP (>180/120) WITHOUT target organ damage.
Emergency: severely elevated BP WITH evidence of end-organ damage (MI, stroke,
AKI, dissection). Emergency requires ICU and IV antihypertensives.
28. What are the first-line antihypertensive medications?
Answer: Thiazide diuretics, ACE inhibitors (or ARBs), calcium channel blockers
(amlodipine), and beta-blockers. ACE inhibitors are preferred in diabetics and those with
CKD.
29. What lifestyle modifications are recommended for hypertension?
Answer: DASH diet (low sodium, high fruits/vegetables), weight loss, limit alcohol,
smoking cessation, regular aerobic exercise (150 min/week), and stress management.
30. What are signs of a hypertensive emergency?
Answer: Severe headache, blurred vision, chest pain, shortness of breath, altered mental
status, papilledema, hematuria, and seizures. Requires immediate IV treatment
(nicardipine, labetalol, sodium nitroprusside).
31. What is the difference between STEMI and NSTEMI?
Answer: STEMI shows ST elevation on ECG and complete coronary artery occlusion —
requires emergent PCI or thrombolytics. NSTEMI shows no ST elevation (may have ST
depression/T-wave changes) and partial occlusion.
32. What is the classic presentation of an acute MI?
Answer: Crushing, pressure-like chest pain radiating to left arm, jaw, or back;
diaphoresis; nausea/vomiting; dyspnea; anxiety. Women and diabetics may present
atypically with fatigue, indigestion, or jaw pain only.
33. What are the nursing priorities in caring for a patient with STEMI?
Answer: Activate catheterization lab (PCI goal within 90 min), administer aspirin 325
mg, oxygen if SpO2 <90%, nitroglycerin for chest pain (if BP allows), IV access,
continuous cardiac monitoring, 12-lead ECG.
34. What does the mnemonic MONA represent in ACS care?
Answer: Morphine (pain relief, preload reduction), Oxygen (if O2 sat <90%), Nitrates
(vasodilation, preload reduction), Aspirin (antiplatelet). Note: morphine use is now
controversial due to potential harm in NSTEMI.
