NUR 242 MEDICAL-SURGICAL NURSING EXAM 2 2026/2027 |
Questions and Verified Answers | 100% Correct Grade A |
Galen College | Pass Guaranteed
Cardiovascular Disorders (Hypertension, CAD, Heart Failure,
Dysrhythmias, Valvular, Pericarditis, Endocarditis)
Q1: A 68-year-old male presents with chest pressure radiating to his left jaw,
diaphoresis, and nausea for the past 45 minutes. His ECG shows ST-segment elevation
in leads II, III, and aVF. Which priority intervention should the nurse anticipate?
A. Immediate administration of thrombolytics without further testing
B. Emergent cardiac catheterization for primary PCI [CORRECT]
C. Administration of warfarin for anticoagulation
D. Scheduled elective stress test in 48 hours
Correct Answer: B
Rationale: Inferior wall STEMI (ST elevation in II, III, aVF) requires emergent
reperfusion—primary PCI is preferred within 90 minutes. Thrombolytics (A) are
alternative if PCI unavailable within 120 minutes. Warfarin (C) is not emergent therapy.
Stress testing (D) is contraindicated in acute MI.
,Q2: A patient with heart failure weighs 2.5 kg more than yesterday, reports increased
shortness of breath, and has crackles bilaterally. The nurse notes jugular venous
distension at 45 degrees. These findings indicate:
A. Decompensated left-sided heart failure with fluid overload [CORRECT]
B. Stable compensated heart failure
C. Right-sided heart failure only
D. Acute myocardial infarction
Correct Answer: A
Rationale: Weight gain, dyspnea, crackles (left-sided), and JVD (right-sided) indicate
acute decompensated heart failure with fluid overload. Both left and right signs are
present. This is not stable (B) or isolated right-sided failure (C). No MI symptoms
described (D).
Q3: Which medication class for hypertension works by blocking angiotensin II receptors,
preventing vasoconstriction and aldosterone secretion?
A. ACE inhibitors
B. Angiotensin receptor blockers (ARBs) [CORRECT]
C. Calcium channel blockers
D. Thiazide diuretics
Correct Answer: B
,Rationale: ARBs (losartan, valsartan) specifically block AT1 receptors for angiotensin II.
ACE inhibitors (A) block conversion of angiotensin I to II. CCBs (C) block calcium
channels. Thiazides (D) work on distal tubule sodium excretion.
Q4: A patient with atrial fibrillation is prescribed warfarin. The nurse knows the
therapeutic INR target for AFib stroke prevention is typically:
A. 1.0-1.5
B. 1.5-2.0
C. 2.0-3.0 [CORRECT]
D. 3.0-4.0
Correct Answer: C
Rationale: AFib warfarin target is INR 2.0-3.0 for stroke prevention. Below 2.0 (A, B)
increases stroke risk. Above 3.0 (D) increases bleeding risk without additional benefit.
DOACs (apixaban, rivaroxaban) don't require INR monitoring.
Q5: A patient with pericarditis reports chest pain that worsens when lying flat and
improves when sitting up and leaning forward. The nurse auscultates a scratching,
grating sound at the left lower sternal border. This sound is:
A. S3 gallop
B. Pericardial friction rub [CORRECT]
C. Mitral regurgitation murmur
D. Pleural friction rub
, Correct Answer: B
Rationale: Pericardial friction rub is pathognomonic for pericarditis—scratching/grating
sound from inflamed pericardial layers. Pain worsens supine, improves leaning forward.
S3 (A) indicates heart failure. Mitral murmur (C) is systolic at apex. Pleural rub (D) is
respiratory.
Q6: The nurse is caring for a patient post-CABG who develops chest pain, ST elevation,
and hypotension 4 hours after surgery. Priority nursing actions include:
A. Administering aspirin and preparing for emergent angiography [CORRECT]
B. Providing reassurance that this is normal post-op pain
C. Administering prophylactic antibiotics
D. Increasing the rate of IV fluids only
Correct Answer: A
Rationale: Post-CABG chest pain with ST elevation suggests graft occlusion—acute
coronary syndrome requiring emergent reperfusion. Never dismiss post-CABG chest
pain as normal (B). Antibiotics (C) are for infection, not acute ischemia. Fluids alone (D)
won't address coronary occlusion.
Q7: A patient with systolic heart failure is prescribed lisinopril, metoprolol, furosemide,
and spironolactone. The nurse understands that spironolactone is added primarily to:
A. Reduce preload through rapid diuresis
B. Block aldosterone effects and reduce mortality in HFrEF [CORRECT]
Questions and Verified Answers | 100% Correct Grade A |
Galen College | Pass Guaranteed
Cardiovascular Disorders (Hypertension, CAD, Heart Failure,
Dysrhythmias, Valvular, Pericarditis, Endocarditis)
Q1: A 68-year-old male presents with chest pressure radiating to his left jaw,
diaphoresis, and nausea for the past 45 minutes. His ECG shows ST-segment elevation
in leads II, III, and aVF. Which priority intervention should the nurse anticipate?
A. Immediate administration of thrombolytics without further testing
B. Emergent cardiac catheterization for primary PCI [CORRECT]
C. Administration of warfarin for anticoagulation
D. Scheduled elective stress test in 48 hours
Correct Answer: B
Rationale: Inferior wall STEMI (ST elevation in II, III, aVF) requires emergent
reperfusion—primary PCI is preferred within 90 minutes. Thrombolytics (A) are
alternative if PCI unavailable within 120 minutes. Warfarin (C) is not emergent therapy.
Stress testing (D) is contraindicated in acute MI.
,Q2: A patient with heart failure weighs 2.5 kg more than yesterday, reports increased
shortness of breath, and has crackles bilaterally. The nurse notes jugular venous
distension at 45 degrees. These findings indicate:
A. Decompensated left-sided heart failure with fluid overload [CORRECT]
B. Stable compensated heart failure
C. Right-sided heart failure only
D. Acute myocardial infarction
Correct Answer: A
Rationale: Weight gain, dyspnea, crackles (left-sided), and JVD (right-sided) indicate
acute decompensated heart failure with fluid overload. Both left and right signs are
present. This is not stable (B) or isolated right-sided failure (C). No MI symptoms
described (D).
Q3: Which medication class for hypertension works by blocking angiotensin II receptors,
preventing vasoconstriction and aldosterone secretion?
A. ACE inhibitors
B. Angiotensin receptor blockers (ARBs) [CORRECT]
C. Calcium channel blockers
D. Thiazide diuretics
Correct Answer: B
,Rationale: ARBs (losartan, valsartan) specifically block AT1 receptors for angiotensin II.
ACE inhibitors (A) block conversion of angiotensin I to II. CCBs (C) block calcium
channels. Thiazides (D) work on distal tubule sodium excretion.
Q4: A patient with atrial fibrillation is prescribed warfarin. The nurse knows the
therapeutic INR target for AFib stroke prevention is typically:
A. 1.0-1.5
B. 1.5-2.0
C. 2.0-3.0 [CORRECT]
D. 3.0-4.0
Correct Answer: C
Rationale: AFib warfarin target is INR 2.0-3.0 for stroke prevention. Below 2.0 (A, B)
increases stroke risk. Above 3.0 (D) increases bleeding risk without additional benefit.
DOACs (apixaban, rivaroxaban) don't require INR monitoring.
Q5: A patient with pericarditis reports chest pain that worsens when lying flat and
improves when sitting up and leaning forward. The nurse auscultates a scratching,
grating sound at the left lower sternal border. This sound is:
A. S3 gallop
B. Pericardial friction rub [CORRECT]
C. Mitral regurgitation murmur
D. Pleural friction rub
, Correct Answer: B
Rationale: Pericardial friction rub is pathognomonic for pericarditis—scratching/grating
sound from inflamed pericardial layers. Pain worsens supine, improves leaning forward.
S3 (A) indicates heart failure. Mitral murmur (C) is systolic at apex. Pleural rub (D) is
respiratory.
Q6: The nurse is caring for a patient post-CABG who develops chest pain, ST elevation,
and hypotension 4 hours after surgery. Priority nursing actions include:
A. Administering aspirin and preparing for emergent angiography [CORRECT]
B. Providing reassurance that this is normal post-op pain
C. Administering prophylactic antibiotics
D. Increasing the rate of IV fluids only
Correct Answer: A
Rationale: Post-CABG chest pain with ST elevation suggests graft occlusion—acute
coronary syndrome requiring emergent reperfusion. Never dismiss post-CABG chest
pain as normal (B). Antibiotics (C) are for infection, not acute ischemia. Fluids alone (D)
won't address coronary occlusion.
Q7: A patient with systolic heart failure is prescribed lisinopril, metoprolol, furosemide,
and spironolactone. The nurse understands that spironolactone is added primarily to:
A. Reduce preload through rapid diuresis
B. Block aldosterone effects and reduce mortality in HFrEF [CORRECT]
