NUR 265 Medical-Surgical Nursing –
Comprehensive Practice Exam Galen College
Style | 150 Questions | Answers & Rationales
Cardiovascular (Questions 1-20)
1. A client with heart failure has an ejection fraction of 35%. Which
medication does the nurse expect to be prescribed to improve
survival?
A. Furosemide
B. Digoxin
C. Carvedilol
D. Dopamine
Answer: C. Carvedilol
Rationale: Beta-blockers (carvedilol, metoprolol succinate)
reduce mortality in HFrEF by decreasing cardiac remodeling
and workload.
2. A client with atrial fibrillation is prescribed warfarin. Which INR
indicates therapeutic effect?
A. 1.0
B. 1.5
C. 2.5
D. 4.0
Answer: C. 2.5
*Rationale: Therapeutic INR for atrial fibrillation is 2.0-3.0.
INR of 2.5 is within range.*
,3. A client receiving furosemide has a potassium level of 2.9 mEq/L.
What is the priority action?
A. Administer the furosemide as ordered
B. Notify the healthcare provider
C. Give potassium supplements
D. Recheck the level in 4 hours
Answer: B. Notify the healthcare provider
Rationale: Hypokalemia (K < 3.5) with furosemide requires
immediate notification. Furosemide should be held.
4. A client with angina reports chest pain 6/10. Nitroglycerin is
administered. After 5 minutes, pain is 4/10. What should the nurse
do?
A. Administer morphine
B. Administer a second nitroglycerin
C. Notify the provider
D. Apply oxygen
Answer: B. Administer a second nitroglycerin
Rationale: Nitroglycerin can be given every 5 minutes for up
to 3 doses. Pain reduction indicates effectiveness.
5. Which finding in a client with peripheral artery disease (PAD) is
most concerning?
A. Intermittent claudication
B. Cool, pale extremities
C. Non-healing ulcer on the toe
D. Diminished posterior tibial pulse
,Answer: C. Non-healing ulcer on the toe
Rationale: Non-healing ulcers indicate critical limb ischemia
and risk of amputation, requiring urgent intervention.
6. A client post-cardiac catheterization has a femoral sheath. The
nurse finds a large, expanding hematoma. What is the priority
action?
A. Apply a sandbag
B. Notify the provider
C. Apply firm pressure above the site
D. Check distal pulses
Answer: C. Apply firm pressure above the site
Rationale: Immediate pressure is needed to stop bleeding.
Then notify provider and assess pulses.
7. A client with DVT on heparin has a platelet count drop from
250,000 to 80,000. What does the nurse suspect?
A. Expected response
B. Heparin-induced thrombocytopenia (HIT)
C. Hemolytic anemia
D. Disseminated intravascular coagulation
Answer: B. Heparin-induced thrombocytopenia (HIT)
Rationale: A >50% drop in platelets on heparin suggests HIT.
Heparin must be stopped immediately.
8. A client with hypertension is started on lisinopril. Which adverse
effect requires immediate reporting?
A. Dry cough
B. Dizziness
, C. Swelling of the tongue
D. Headache
Answer: C. Swelling of the tongue
Rationale: Angioedema (tongue/lip swelling) is life-
threatening and requires immediate intervention.
9. A client with acute pulmonary edema has pink, frothy sputum.
What is the priority intervention?
A. Administer furosemide IV
B. Position in high-Fowler's
C. Apply oxygen via non-rebreather
D. Prepare for intubation
Answer: C. Apply oxygen via non-rebreather
Rationale: Oxygenation is the priority. High-Fowler's and
furosemide follow, but oxygen comes first.
10. A client with endocarditis has petechiae, splinter hemorrhages,
and a new murmur. Which complication should the nurse monitor
for?
A. Heart failure
B. Systemic embolization
C. Pericarditis
D. Myocarditis
Answer: B. Systemic embolization
Rationale: Vegetations on valves can embolize to brain,
kidneys, lungs, or extremities.
11. A client with an MI has ST elevation in leads II, III, and aVF.
Which area of the heart is affected?
Comprehensive Practice Exam Galen College
Style | 150 Questions | Answers & Rationales
Cardiovascular (Questions 1-20)
1. A client with heart failure has an ejection fraction of 35%. Which
medication does the nurse expect to be prescribed to improve
survival?
A. Furosemide
B. Digoxin
C. Carvedilol
D. Dopamine
Answer: C. Carvedilol
Rationale: Beta-blockers (carvedilol, metoprolol succinate)
reduce mortality in HFrEF by decreasing cardiac remodeling
and workload.
2. A client with atrial fibrillation is prescribed warfarin. Which INR
indicates therapeutic effect?
A. 1.0
B. 1.5
C. 2.5
D. 4.0
Answer: C. 2.5
*Rationale: Therapeutic INR for atrial fibrillation is 2.0-3.0.
INR of 2.5 is within range.*
,3. A client receiving furosemide has a potassium level of 2.9 mEq/L.
What is the priority action?
A. Administer the furosemide as ordered
B. Notify the healthcare provider
C. Give potassium supplements
D. Recheck the level in 4 hours
Answer: B. Notify the healthcare provider
Rationale: Hypokalemia (K < 3.5) with furosemide requires
immediate notification. Furosemide should be held.
4. A client with angina reports chest pain 6/10. Nitroglycerin is
administered. After 5 minutes, pain is 4/10. What should the nurse
do?
A. Administer morphine
B. Administer a second nitroglycerin
C. Notify the provider
D. Apply oxygen
Answer: B. Administer a second nitroglycerin
Rationale: Nitroglycerin can be given every 5 minutes for up
to 3 doses. Pain reduction indicates effectiveness.
5. Which finding in a client with peripheral artery disease (PAD) is
most concerning?
A. Intermittent claudication
B. Cool, pale extremities
C. Non-healing ulcer on the toe
D. Diminished posterior tibial pulse
,Answer: C. Non-healing ulcer on the toe
Rationale: Non-healing ulcers indicate critical limb ischemia
and risk of amputation, requiring urgent intervention.
6. A client post-cardiac catheterization has a femoral sheath. The
nurse finds a large, expanding hematoma. What is the priority
action?
A. Apply a sandbag
B. Notify the provider
C. Apply firm pressure above the site
D. Check distal pulses
Answer: C. Apply firm pressure above the site
Rationale: Immediate pressure is needed to stop bleeding.
Then notify provider and assess pulses.
7. A client with DVT on heparin has a platelet count drop from
250,000 to 80,000. What does the nurse suspect?
A. Expected response
B. Heparin-induced thrombocytopenia (HIT)
C. Hemolytic anemia
D. Disseminated intravascular coagulation
Answer: B. Heparin-induced thrombocytopenia (HIT)
Rationale: A >50% drop in platelets on heparin suggests HIT.
Heparin must be stopped immediately.
8. A client with hypertension is started on lisinopril. Which adverse
effect requires immediate reporting?
A. Dry cough
B. Dizziness
, C. Swelling of the tongue
D. Headache
Answer: C. Swelling of the tongue
Rationale: Angioedema (tongue/lip swelling) is life-
threatening and requires immediate intervention.
9. A client with acute pulmonary edema has pink, frothy sputum.
What is the priority intervention?
A. Administer furosemide IV
B. Position in high-Fowler's
C. Apply oxygen via non-rebreather
D. Prepare for intubation
Answer: C. Apply oxygen via non-rebreather
Rationale: Oxygenation is the priority. High-Fowler's and
furosemide follow, but oxygen comes first.
10. A client with endocarditis has petechiae, splinter hemorrhages,
and a new murmur. Which complication should the nurse monitor
for?
A. Heart failure
B. Systemic embolization
C. Pericarditis
D. Myocarditis
Answer: B. Systemic embolization
Rationale: Vegetations on valves can embolize to brain,
kidneys, lungs, or extremities.
11. A client with an MI has ST elevation in leads II, III, and aVF.
Which area of the heart is affected?
