1
NUR 265 Exam 1 | V1, V2 & V3 Question Bank
Advanced Concepts of Medical-Surgical Nursing |
2026 Update.
A 62-year-old male presents to the emergency department with crushing substernal chest
pain radiating to the left arm, diaphoresis, and nausea. His vital signs are: BP 98/62 mmHg,
HR 108 bpm, RR 22/min, SpO₂ 92% on room air. The 12-lead ECG shows ST-segment elevation
in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. The cardiac
catheterization lab is currently occupied with another emergent case. Based on current
evidence-based guidelines, what is the priority nursing intervention?
A. Administer aspirin 325 mg chewable and prepare for immediate thrombolytic therapy
B. Initiate IV nitroglycerin infusion and obtain serial troponin levels every 6 hours
C. Administer aspirin 325 mg chewable, establish IV access, and prepare for immediate
transfer to the cardiac catheterization lab for primary PCI
D. Give morphine sulfate 2 mg IV and schedule the patient for elective cardiac catheterization
in the morning
[CORRECT: C]
Rationale: This patient presents with an inferior wall STEMI (ST elevation in II, III, aVF with
reciprocal changes in I and aVL), meeting criteria for emergent reperfusion. Current ACC/AHA
guidelines mandate primary PCI within 90 minutes of first medical contact (door-to-balloon
time ≤90 minutes). Even if the cath lab is occupied, the priority is to prepare for immediate
transfer because primary PCI remains the gold standard. Aspirin 325 mg chewable should be
administered immediately to inhibit platelet aggregation and reduce mortality. Option A is
incorrect because thrombolytics are reserved for when PCI cannot be performed within 120
minutes of first medical contact, not merely because the lab is occupied. Option B delays
definitive reperfusion. Option D is dangerous—elective scheduling would result in
unacceptable mortality.
V1-Q2 | SATA | Acute Coronary Syndrome & STEMI
, 2
A nurse is caring for a patient diagnosed with NSTEMI. Which of the following clinical findings
and management principles are consistent with NSTEMI pathophysiology and evidence-based
care? Select all that apply.
A. ST-segment depression or T-wave inversion on 12-lead ECG without ST elevation
B. Elevated cardiac troponin levels indicating myocardial necrosis
C. Immediate thrombolytic therapy is the standard of care for all NSTEMI patients
D. Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (clopidogrel or ticagrelor) is
indicated
E. Emergent PCI is required within 90 minutes for all patients regardless of risk stratification
F. Glycoprotein IIb/IIIa inhibitors may be considered for high-risk patients undergoing PCI
G. The patient may present with unstable angina symptoms without detectable troponin
elevation
[CORRECT: A, B, D, F, G]
Rationale: NSTEMI is characterized by myocardial necrosis with elevated cardiac biomarkers
(troponin) in the absence of ST-segment elevation on ECG, typically manifesting as ST
depression or T-wave inversion (A, B). Unlike STEMI, NSTEMI management focuses on risk
stratification, antiplatelet therapy, and timing of intervention rather than emergent
reperfusion. Dual antiplatelet therapy (D) is cornerstone treatment to prevent further
thrombosis. Glycoprotein IIb/IIIa inhibitors (F) remain useful adjuncts for high-risk PCI cases.
Option C is incorrect—thrombolytics are contraindicated in NSTEMI as they increase mortality
without benefit. Option E is incorrect—while high-risk NSTEMI patients require early invasive
strategy (typically within 24-72 hours), it is not the same 90-minute window mandated for
STEMI. Option G describes unstable angina, which exists on the same ACS spectrum as
NSTEMI but without biomarker elevation.
V1-Q3 | Multiple-Choice | Heart Failure
A 74-year-old female with a history of chronic heart failure presents with acute dyspnea,
orthopnea, and bilateral crackles on auscultation. Her vital signs are: BP 156/94 mmHg, HR
112 bpm, RR 28/min, SpO₂ 88% on 2L NC. A BNP level is drawn and returns at 680 pg/mL.
, 3
Based on this finding and clinical presentation, which type of heart failure is most likely
present, and what is the priority intervention?
A. Systolic heart failure; initiate IV furosemide and continuous positive airway pressure (CPAP)
B. Diastolic heart failure with preserved ejection fraction; administer IV nitroglycerin for
afterload reduction
C. Acute decompensated heart failure; begin high-dose IV loop diuretic therapy and assess for
cardiogenic shock
D. Right-sided heart failure; administer IV fluids to improve preload and cardiac output
[CORRECT: C]
Rationale: A BNP level >400 pg/mL strongly suggests heart failure (values >400 have high
positive predictive value for HF decompensation), and this patient's presentation with acute
dyspnea, orthopnea, tachypnea, hypoxemia, and crackles indicates acute decompensated
heart failure (ADHF). The priority intervention is high-dose IV loop diuretic therapy
(furosemide) to reduce pulmonary congestion, combined with continuous assessment for
progression to cardiogenic shock given the tachycardia and elevated BP. CPAP may be
indicated for respiratory distress but diuresis is foundational. Option A incorrectly assumes
systolic failure without echocardiographic confirmation. Option B incorrectly assumes
diastolic failure; while possible, the immediate priority is decongestion regardless of EF.
Option D is dangerous—IV fluids would worsen pulmonary edema in ADHF.
V1-Q4 | Multiple-Choice | Heart Failure
A nurse is reviewing BNP results for four patients in the cardiac unit. Which BNP value and
clinical correlation requires immediate nursing intervention?
A. BNP 45 pg/mL in a patient with chronic stable heart failure on optimal medical therapy
B. BNP 220 pg/mL in a patient with new-onset atrial fibrillation and mild dyspnea on exertion
C. BNP 890 pg/mL in a patient with acute pulmonary edema, hypotension (BP 78/52), and
cool clammy extremities
D. BNP 350 pg/mL in a patient with chronic kidney disease stage 3 and stable baseline
symptoms
, 4
[CORRECT: C]
Rationale: A BNP of 890 pg/mL in a patient with acute pulmonary edema and hypotension
with cool clammy extremities indicates cardiogenic shock complicating acute decompensated
heart failure. This requires immediate intervention including vasopressors, inotropic support,
possible mechanical circulatory support, and emergent cardiology consultation. BNP <100
pg/mL effectively rules out heart failure (A is reassuring). BNP 220 pg/mL (B) is elevated but
consistent with mild decompensation or cardiac strain from AF. BNP can be falsely elevated in
renal dysfunction (D), making clinical correlation essential; this patient is stable.
V1-Q5 | SATA | Heart Failure
A nurse is educating a patient newly diagnosed with heart failure about BNP monitoring.
Which statements by the nurse are accurate? Select all that apply.
A. "A BNP level below 100 pg/mL makes acute heart failure unlikely."
B. "Your BNP level will likely decrease as your heart failure treatment becomes effective."
C. "BNP levels are not affected by obesity, age, or kidney function."
D. "A BNP above 400 pg/mL strongly supports a diagnosis of heart failure."
E. "We will use trending BNP levels to monitor your response to therapy and detect early
decompensation."
F. "BNP is released by the ventricles in response to myocardial stretching and wall tension."
[CORRECT: A, B, D, E, F]
Rationale: BNP (B-type natriuretic peptide) is released from ventricular myocardium in
response to increased wall tension and stretching (F), making it a valuable biomarker for HF
diagnosis and monitoring. A cutoff of <100 pg/mL has excellent negative predictive value to
rule out acute HF (A). Levels >400 pg/mL strongly suggest HF (D). Serial BNP monitoring
guides therapy effectiveness and predicts readmission risk (B, E). Option C is incorrect—BNP is
inversely correlated with BMI (lower in obesity), increases with age, and is elevated in renal
dysfunction due to reduced clearance, requiring clinical interpretation.
V1-Q6 | ABG/Case Study Interpretation | Dysrhythmia Interpretation
NUR 265 Exam 1 | V1, V2 & V3 Question Bank
Advanced Concepts of Medical-Surgical Nursing |
2026 Update.
A 62-year-old male presents to the emergency department with crushing substernal chest
pain radiating to the left arm, diaphoresis, and nausea. His vital signs are: BP 98/62 mmHg,
HR 108 bpm, RR 22/min, SpO₂ 92% on room air. The 12-lead ECG shows ST-segment elevation
in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. The cardiac
catheterization lab is currently occupied with another emergent case. Based on current
evidence-based guidelines, what is the priority nursing intervention?
A. Administer aspirin 325 mg chewable and prepare for immediate thrombolytic therapy
B. Initiate IV nitroglycerin infusion and obtain serial troponin levels every 6 hours
C. Administer aspirin 325 mg chewable, establish IV access, and prepare for immediate
transfer to the cardiac catheterization lab for primary PCI
D. Give morphine sulfate 2 mg IV and schedule the patient for elective cardiac catheterization
in the morning
[CORRECT: C]
Rationale: This patient presents with an inferior wall STEMI (ST elevation in II, III, aVF with
reciprocal changes in I and aVL), meeting criteria for emergent reperfusion. Current ACC/AHA
guidelines mandate primary PCI within 90 minutes of first medical contact (door-to-balloon
time ≤90 minutes). Even if the cath lab is occupied, the priority is to prepare for immediate
transfer because primary PCI remains the gold standard. Aspirin 325 mg chewable should be
administered immediately to inhibit platelet aggregation and reduce mortality. Option A is
incorrect because thrombolytics are reserved for when PCI cannot be performed within 120
minutes of first medical contact, not merely because the lab is occupied. Option B delays
definitive reperfusion. Option D is dangerous—elective scheduling would result in
unacceptable mortality.
V1-Q2 | SATA | Acute Coronary Syndrome & STEMI
, 2
A nurse is caring for a patient diagnosed with NSTEMI. Which of the following clinical findings
and management principles are consistent with NSTEMI pathophysiology and evidence-based
care? Select all that apply.
A. ST-segment depression or T-wave inversion on 12-lead ECG without ST elevation
B. Elevated cardiac troponin levels indicating myocardial necrosis
C. Immediate thrombolytic therapy is the standard of care for all NSTEMI patients
D. Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (clopidogrel or ticagrelor) is
indicated
E. Emergent PCI is required within 90 minutes for all patients regardless of risk stratification
F. Glycoprotein IIb/IIIa inhibitors may be considered for high-risk patients undergoing PCI
G. The patient may present with unstable angina symptoms without detectable troponin
elevation
[CORRECT: A, B, D, F, G]
Rationale: NSTEMI is characterized by myocardial necrosis with elevated cardiac biomarkers
(troponin) in the absence of ST-segment elevation on ECG, typically manifesting as ST
depression or T-wave inversion (A, B). Unlike STEMI, NSTEMI management focuses on risk
stratification, antiplatelet therapy, and timing of intervention rather than emergent
reperfusion. Dual antiplatelet therapy (D) is cornerstone treatment to prevent further
thrombosis. Glycoprotein IIb/IIIa inhibitors (F) remain useful adjuncts for high-risk PCI cases.
Option C is incorrect—thrombolytics are contraindicated in NSTEMI as they increase mortality
without benefit. Option E is incorrect—while high-risk NSTEMI patients require early invasive
strategy (typically within 24-72 hours), it is not the same 90-minute window mandated for
STEMI. Option G describes unstable angina, which exists on the same ACS spectrum as
NSTEMI but without biomarker elevation.
V1-Q3 | Multiple-Choice | Heart Failure
A 74-year-old female with a history of chronic heart failure presents with acute dyspnea,
orthopnea, and bilateral crackles on auscultation. Her vital signs are: BP 156/94 mmHg, HR
112 bpm, RR 28/min, SpO₂ 88% on 2L NC. A BNP level is drawn and returns at 680 pg/mL.
, 3
Based on this finding and clinical presentation, which type of heart failure is most likely
present, and what is the priority intervention?
A. Systolic heart failure; initiate IV furosemide and continuous positive airway pressure (CPAP)
B. Diastolic heart failure with preserved ejection fraction; administer IV nitroglycerin for
afterload reduction
C. Acute decompensated heart failure; begin high-dose IV loop diuretic therapy and assess for
cardiogenic shock
D. Right-sided heart failure; administer IV fluids to improve preload and cardiac output
[CORRECT: C]
Rationale: A BNP level >400 pg/mL strongly suggests heart failure (values >400 have high
positive predictive value for HF decompensation), and this patient's presentation with acute
dyspnea, orthopnea, tachypnea, hypoxemia, and crackles indicates acute decompensated
heart failure (ADHF). The priority intervention is high-dose IV loop diuretic therapy
(furosemide) to reduce pulmonary congestion, combined with continuous assessment for
progression to cardiogenic shock given the tachycardia and elevated BP. CPAP may be
indicated for respiratory distress but diuresis is foundational. Option A incorrectly assumes
systolic failure without echocardiographic confirmation. Option B incorrectly assumes
diastolic failure; while possible, the immediate priority is decongestion regardless of EF.
Option D is dangerous—IV fluids would worsen pulmonary edema in ADHF.
V1-Q4 | Multiple-Choice | Heart Failure
A nurse is reviewing BNP results for four patients in the cardiac unit. Which BNP value and
clinical correlation requires immediate nursing intervention?
A. BNP 45 pg/mL in a patient with chronic stable heart failure on optimal medical therapy
B. BNP 220 pg/mL in a patient with new-onset atrial fibrillation and mild dyspnea on exertion
C. BNP 890 pg/mL in a patient with acute pulmonary edema, hypotension (BP 78/52), and
cool clammy extremities
D. BNP 350 pg/mL in a patient with chronic kidney disease stage 3 and stable baseline
symptoms
, 4
[CORRECT: C]
Rationale: A BNP of 890 pg/mL in a patient with acute pulmonary edema and hypotension
with cool clammy extremities indicates cardiogenic shock complicating acute decompensated
heart failure. This requires immediate intervention including vasopressors, inotropic support,
possible mechanical circulatory support, and emergent cardiology consultation. BNP <100
pg/mL effectively rules out heart failure (A is reassuring). BNP 220 pg/mL (B) is elevated but
consistent with mild decompensation or cardiac strain from AF. BNP can be falsely elevated in
renal dysfunction (D), making clinical correlation essential; this patient is stable.
V1-Q5 | SATA | Heart Failure
A nurse is educating a patient newly diagnosed with heart failure about BNP monitoring.
Which statements by the nurse are accurate? Select all that apply.
A. "A BNP level below 100 pg/mL makes acute heart failure unlikely."
B. "Your BNP level will likely decrease as your heart failure treatment becomes effective."
C. "BNP levels are not affected by obesity, age, or kidney function."
D. "A BNP above 400 pg/mL strongly supports a diagnosis of heart failure."
E. "We will use trending BNP levels to monitor your response to therapy and detect early
decompensation."
F. "BNP is released by the ventricles in response to myocardial stretching and wall tension."
[CORRECT: A, B, D, E, F]
Rationale: BNP (B-type natriuretic peptide) is released from ventricular myocardium in
response to increased wall tension and stretching (F), making it a valuable biomarker for HF
diagnosis and monitoring. A cutoff of <100 pg/mL has excellent negative predictive value to
rule out acute HF (A). Levels >400 pg/mL strongly suggest HF (D). Serial BNP monitoring
guides therapy effectiveness and predicts readmission risk (B, E). Option C is incorrect—BNP is
inversely correlated with BMI (lower in obesity), increases with age, and is elevated in renal
dysfunction due to reduced clearance, requiring clinical interpretation.
V1-Q6 | ABG/Case Study Interpretation | Dysrhythmia Interpretation
