NSG233 / NSG 233 Exam 1: Medical-Surgical
Nursing III – Herzing Actual Exam Questions &
Verified Answers | 100% Correct | Pass Guaranteed
- A+ Graded
Complex Cardiovascular & Respiratory Disorders
Q1: A 72-year-old man is admitted with acute decompensated heart failure. His BNP is
1,200 pg/mL, and he has crackles bilaterally, JVD, and 3+ pitting edema. Which nursing
assessment finding best indicates that his condition is improving after diuresis?
A. Weight gain of 2 pounds
B. BNP rising to 1,800 pg/mL
C. Decreased JVD and resolution of crackles [CORRECT]
D. Increased peripheral edema to 4+
Correct Answer: C
Rationale: The best answer is C. In Medical-Surgical Nursing III, we prioritize physical
assessment findings alongside labs, and decreasing JVD with clearer lung sounds tells
us the fluid is coming off. Remember that BNP can lag behind clinical improvement, and
weight gain or worsening edema would signal continued congestion.
Q2: A patient with chronic heart failure reports increasing shortness of breath and
wakes up gasping at night. Which symptom is most specific to left-sided heart failure?
A. Hepatomegaly and ascites
B. Jugular venous distension
C. Paroxysmal nocturnal dyspnea [CORRECT]
D. Peripheral edema
Correct Answer: C
Rationale: The best answer is C. Paroxysmal nocturnal dyspnea happens when fluid
shifts back into the pulmonary circulation after lying flat, which is classic for left-sided
,failure. Hepatomegaly, JVD, and peripheral edema are more indicative of right-sided
failure.
Q3: During postoperative care of a patient status post coronary artery bypass graft,
which assessment finding on day 2 requires immediate notification of the provider?
A. Chest tube drainage of 75 mL in the past hour
B. Sternal click with inspiration and new onset of chest pain [CORRECT]
C. Temperature of 99.2°F
D. Patient rating pain 4/10
Correct Answer: B
Rationale: The best answer is B. A sternal click with inspiratory chest pain suggests
sternal dehiscence, which is a surgical emergency. Remember that post-CABG patients
need close monitoring for mediastinal bleeding, dysrhythmias, and sternal wound
complications.
Q4: A patient recovering from aortic valve replacement develops a harsh systolic
murmur, hypotension, and muffled heart sounds. Which complication should the nurse
suspect?
A. Cardiac tamponade [CORRECT]
B. Pulmonary embolism
C. Acute graft rejection
D. Aortic dissection
Correct Answer: A
Rationale: The best answer is A. Beck's triad—hypotension, muffled heart sounds, and
JVD—points to cardiac tamponade from postoperative bleeding into the pericardium.
Remember this is a time-critical emergency requiring pericardiocentesis or return to the
OR.
Q5: A patient with a known thoracic aortic aneurysm reports sudden, tearing chest pain
radiating to his back. His blood pressure is 190/110, and his left radial pulse is absent.
Which is the priority nursing intervention?
A. Administer sublingual nitroglycerin
B. Insert a Foley catheter
C. Initiate IV beta-blockade to reduce shear stress and prepare for surgery [CORRECT]
D. Apply warm compresses to the chest
, Correct Answer: C
Rationale: The best answer is C. Aortic dissection requires immediate blood pressure
and heart rate control to reduce aortic wall stress, with beta-blockade being first-line.
Remember that tearing chest pain with pulse deficits is a surgical emergency, and we
never give vasodilators alone without beta-blockade because reflex tachycardia can
worsen the dissection.
Q6: A patient on telemetry suddenly develops a wide-complex tachycardia at a rate of
180 with no discernible P waves. The patient is alert but hypotensive with a BP of
78/52. Which intervention should the nurse prepare for first?
A. Adenosine 6 mg rapid IV push
B. Synchronized cardioversion [CORRECT]
C. Atropine 1 mg IV push
D. Defibrillation with 200 joules
Correct Answer: B
Rationale: The best answer is B. Unstable wide-complex tachycardia with hypotension
requires synchronized cardioversion. Remember that adenosine is for stable
narrow-complex SVT, atropine is for bradycardia, and defibrillation is for pulseless
rhythms.
Q7: A patient with new-onset atrial fibrillation and RVR has a blood pressure of 98/64
and is mildly diaphoretic. The provider orders diltiazem bolus and drip. Which action by
the nurse is most appropriate?
A. Administer the diltiazem as ordered
B. Hold the diltiazem and notify the provider due to hypotension [CORRECT]
C. Give the bolus but hold the drip
D. Administer atropine prior to diltiazem
Correct Answer: B
Rationale: The best answer is B. Diltiazem is a negative inotrope and vasodilator that
can worsen hypotension in an unstable patient. Remember that in AFib with RVR and
hemodynamic compromise, synchronized cardioversion is preferred over
rate-controlling agents that could further drop the blood pressure.
Nursing III – Herzing Actual Exam Questions &
Verified Answers | 100% Correct | Pass Guaranteed
- A+ Graded
Complex Cardiovascular & Respiratory Disorders
Q1: A 72-year-old man is admitted with acute decompensated heart failure. His BNP is
1,200 pg/mL, and he has crackles bilaterally, JVD, and 3+ pitting edema. Which nursing
assessment finding best indicates that his condition is improving after diuresis?
A. Weight gain of 2 pounds
B. BNP rising to 1,800 pg/mL
C. Decreased JVD and resolution of crackles [CORRECT]
D. Increased peripheral edema to 4+
Correct Answer: C
Rationale: The best answer is C. In Medical-Surgical Nursing III, we prioritize physical
assessment findings alongside labs, and decreasing JVD with clearer lung sounds tells
us the fluid is coming off. Remember that BNP can lag behind clinical improvement, and
weight gain or worsening edema would signal continued congestion.
Q2: A patient with chronic heart failure reports increasing shortness of breath and
wakes up gasping at night. Which symptom is most specific to left-sided heart failure?
A. Hepatomegaly and ascites
B. Jugular venous distension
C. Paroxysmal nocturnal dyspnea [CORRECT]
D. Peripheral edema
Correct Answer: C
Rationale: The best answer is C. Paroxysmal nocturnal dyspnea happens when fluid
shifts back into the pulmonary circulation after lying flat, which is classic for left-sided
,failure. Hepatomegaly, JVD, and peripheral edema are more indicative of right-sided
failure.
Q3: During postoperative care of a patient status post coronary artery bypass graft,
which assessment finding on day 2 requires immediate notification of the provider?
A. Chest tube drainage of 75 mL in the past hour
B. Sternal click with inspiration and new onset of chest pain [CORRECT]
C. Temperature of 99.2°F
D. Patient rating pain 4/10
Correct Answer: B
Rationale: The best answer is B. A sternal click with inspiratory chest pain suggests
sternal dehiscence, which is a surgical emergency. Remember that post-CABG patients
need close monitoring for mediastinal bleeding, dysrhythmias, and sternal wound
complications.
Q4: A patient recovering from aortic valve replacement develops a harsh systolic
murmur, hypotension, and muffled heart sounds. Which complication should the nurse
suspect?
A. Cardiac tamponade [CORRECT]
B. Pulmonary embolism
C. Acute graft rejection
D. Aortic dissection
Correct Answer: A
Rationale: The best answer is A. Beck's triad—hypotension, muffled heart sounds, and
JVD—points to cardiac tamponade from postoperative bleeding into the pericardium.
Remember this is a time-critical emergency requiring pericardiocentesis or return to the
OR.
Q5: A patient with a known thoracic aortic aneurysm reports sudden, tearing chest pain
radiating to his back. His blood pressure is 190/110, and his left radial pulse is absent.
Which is the priority nursing intervention?
A. Administer sublingual nitroglycerin
B. Insert a Foley catheter
C. Initiate IV beta-blockade to reduce shear stress and prepare for surgery [CORRECT]
D. Apply warm compresses to the chest
, Correct Answer: C
Rationale: The best answer is C. Aortic dissection requires immediate blood pressure
and heart rate control to reduce aortic wall stress, with beta-blockade being first-line.
Remember that tearing chest pain with pulse deficits is a surgical emergency, and we
never give vasodilators alone without beta-blockade because reflex tachycardia can
worsen the dissection.
Q6: A patient on telemetry suddenly develops a wide-complex tachycardia at a rate of
180 with no discernible P waves. The patient is alert but hypotensive with a BP of
78/52. Which intervention should the nurse prepare for first?
A. Adenosine 6 mg rapid IV push
B. Synchronized cardioversion [CORRECT]
C. Atropine 1 mg IV push
D. Defibrillation with 200 joules
Correct Answer: B
Rationale: The best answer is B. Unstable wide-complex tachycardia with hypotension
requires synchronized cardioversion. Remember that adenosine is for stable
narrow-complex SVT, atropine is for bradycardia, and defibrillation is for pulseless
rhythms.
Q7: A patient with new-onset atrial fibrillation and RVR has a blood pressure of 98/64
and is mildly diaphoretic. The provider orders diltiazem bolus and drip. Which action by
the nurse is most appropriate?
A. Administer the diltiazem as ordered
B. Hold the diltiazem and notify the provider due to hypotension [CORRECT]
C. Give the bolus but hold the drip
D. Administer atropine prior to diltiazem
Correct Answer: B
Rationale: The best answer is B. Diltiazem is a negative inotrope and vasodilator that
can worsen hypotension in an unstable patient. Remember that in AFib with RVR and
hemodynamic compromise, synchronized cardioversion is preferred over
rate-controlling agents that could further drop the blood pressure.
