NUR 242 MED SURG EXAM 3 COMPLETE STUDY GUIDE |
Galen College of Nursing | MS Exam 3 Verified Q&A | Pass
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Section 1: Cardiovascular Disorders – Exam 3 Emphasis
(Questions 1-35)
Question 1
A 68-year-old patient with a history of hypertension and myocardial infarction is
diagnosed with heart failure. The nurse notes an S3 gallop on auscultation, bilateral
crackles, and orthopnea. Which type of heart failure is most likely present?
A. Right-sided systolic heart failure
B. Left-sided diastolic heart failure
C. Left-sided systolic heart failure
D. Right-sided diastolic heart failure
Correct Answer: C
Rationale: Left-sided systolic heart failure presents with S3 gallop (ventricular gallop
due to rapid ventricular filling), pulmonary congestion (crackles, orthopnea,
paroxysmal nocturnal dyspnea), and forward failure symptoms (fatigue, decreased
exercise tolerance). Right-sided failure (A, D) presents with JVD, peripheral edema,
hepatomegaly, and ascites. Diastolic failure (B) presents with preserved ejection
fraction and signs of impaired relaxation without S3 gallop. Galen NUR 242
emphasis: left HF manifests with pulmonary symptoms; systolic failure involves
impaired contractility with characteristic S3.
,Question 2
A patient with heart failure is being discharged home. The nurse is teaching about
daily weights. Which instruction is most important?
A. "Weigh yourself at the same time each day, wearing similar clothing, and report a
gain of more than 2–3 pounds in 24 hours or 5 pounds in a week."
B. "Weigh yourself once weekly in the morning after urinating."
C. "A weight gain of 5–10 pounds in a week is expected with heart failure."
D. "Only weigh yourself if you notice increased swelling in your legs."
Correct Answer: A
Rationale: Daily weights at the same time with similar clothing provide consistent
data for fluid status monitoring. A gain >2–3 lbs/24 hr or >5 lbs/week indicates fluid
retention requiring provider notification and possible diuretic adjustment. Weekly
weights (B) miss acute changes. Weight gain of 5–10 lbs (C) is abnormal and
indicates worsening failure. Waiting for edema (D) delays intervention. Galen NUR
242 principle: daily weights are a cornerstone of HF self-management; early
detection of fluid retention prevents hospitalization.
Question 3
A patient with heart failure is prescribed furosemide 40 mg PO daily, lisinopril 10 mg
PO daily, and carvedilol 6.25 mg PO twice daily. The patient asks why three
medications are necessary. Which response by the nurse is most accurate?
A. "Each medication treats a different symptom of heart failure."
B. "These medications work together to reduce fluid overload, afterload, and cardiac
remodeling."
C. "The doctor prescribed all three to ensure at least one works."
D. "You only need to take the diuretic; the others are optional."
Correct Answer: B
Rationale: Furosemide (loop diuretic) reduces fluid overload and preload. Lisinopril
(ACE inhibitor) reduces afterload, prevents cardiac remodeling, and improves survival.
Carvedilol (beta-blocker) reduces heart rate, myocardial oxygen demand, and
,reverses remodeling. Together they address multiple pathophysiologic mechanisms.
They do not merely treat symptoms (A). Polypharmacy is evidence-based (C), not
redundant. All medications are essential (D); beta-blockers and ACE inhibitors are
mortality-reducing therapies. Galen NUR 242 pharmacology principle: HF
management requires neurohormonal blockade (ACEi/ARB, beta-blocker, MRA) plus
diuresis.
Question 4
A patient with heart failure has the following vital signs: BP 92/58 mmHg, HR 110
bpm, RR 24, SpO₂ 88% on room air. The patient is confused and oliguric. Which
action is the nurse's priority?
A. Administer the scheduled oral furosemide
B. Apply supplemental oxygen and prepare for possible intubation
C. Increase the patient's oral fluid intake
D. Administer the scheduled beta-blocker
Correct Answer: B
Rationale: This patient presents with acute decompensated heart failure with
hypoxemia (SpO₂ 88%), tachycardia, hypotension, and altered mental status—
indications of cardiogenic shock and respiratory failure. Oxygen is the immediate
priority to address hypoxemia; intubation may be needed for respiratory failure.
Furosemide (A) worsens hypotension in shock. Increasing fluids (C) worsens fluid
overload. Beta-blockers (D) are contraindicated in acute decompensated HF and
hypotension. Galen NUR 242 priority framework: ABCs take precedence; hypoxemia
with altered mental status requires immediate oxygenation.
Question 5
A patient with heart failure is prescribed spironolactone 25 mg daily. Which
laboratory value requires the most frequent monitoring?
, A. Serum sodium
B. Serum potassium
C. Blood urea nitrogen
D. Hemoglobin
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist
that can cause life-threatening hyperkalemia, especially when combined with ACE
inhibitors or in patients with renal impairment. Potassium must be monitored closely
(typically every 1–2 weeks after initiation, then periodically). While sodium (A) and
BUN (C) are monitored in HF, potassium is the most critical with spironolactone.
Hemoglobin (D) is not directly affected. Galen NUR 242 medication safety principle:
aldosterone antagonists require vigilant potassium monitoring; hyperkalemia >5.5
mEq/L requires dose reduction or discontinuation.
Question 6
A patient with heart failure is prescribed empagliflozin 10 mg daily. The nurse
understands this medication benefits the patient by:
A. Increasing cardiac contractility and ejection fraction
B. Reducing glucose reabsorption in the kidneys and decreasing afterload
C. Blocking beta-adrenergic receptors to reduce heart rate
D. Inhibiting angiotensin-converting enzyme to reduce afterload
Correct Answer: B
Rationale: Empagliflozin is an SGLT2 inhibitor that reduces glucose reabsorption in
the proximal tubule (causing glucosuria), promotes osmotic diuresis, reduces preload
and afterload, and improves cardiac metabolism. It does not increase contractility
(A)—that's digoxin or inotropes. Beta-blockade (C) is carvedilol/metoprolol. ACE
inhibition (D) is lisinopril/enalapril. Galen NUR 242 pharmacology principle: SGLT2
inhibitors are now first-line in HFrEF regardless of diabetes status due to mortality
and hospitalization reduction (DAPA-HF, EMPEROR-Reduced trials).
Galen College of Nursing | MS Exam 3 Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders – Exam 3 Emphasis
(Questions 1-35)
Question 1
A 68-year-old patient with a history of hypertension and myocardial infarction is
diagnosed with heart failure. The nurse notes an S3 gallop on auscultation, bilateral
crackles, and orthopnea. Which type of heart failure is most likely present?
A. Right-sided systolic heart failure
B. Left-sided diastolic heart failure
C. Left-sided systolic heart failure
D. Right-sided diastolic heart failure
Correct Answer: C
Rationale: Left-sided systolic heart failure presents with S3 gallop (ventricular gallop
due to rapid ventricular filling), pulmonary congestion (crackles, orthopnea,
paroxysmal nocturnal dyspnea), and forward failure symptoms (fatigue, decreased
exercise tolerance). Right-sided failure (A, D) presents with JVD, peripheral edema,
hepatomegaly, and ascites. Diastolic failure (B) presents with preserved ejection
fraction and signs of impaired relaxation without S3 gallop. Galen NUR 242
emphasis: left HF manifests with pulmonary symptoms; systolic failure involves
impaired contractility with characteristic S3.
,Question 2
A patient with heart failure is being discharged home. The nurse is teaching about
daily weights. Which instruction is most important?
A. "Weigh yourself at the same time each day, wearing similar clothing, and report a
gain of more than 2–3 pounds in 24 hours or 5 pounds in a week."
B. "Weigh yourself once weekly in the morning after urinating."
C. "A weight gain of 5–10 pounds in a week is expected with heart failure."
D. "Only weigh yourself if you notice increased swelling in your legs."
Correct Answer: A
Rationale: Daily weights at the same time with similar clothing provide consistent
data for fluid status monitoring. A gain >2–3 lbs/24 hr or >5 lbs/week indicates fluid
retention requiring provider notification and possible diuretic adjustment. Weekly
weights (B) miss acute changes. Weight gain of 5–10 lbs (C) is abnormal and
indicates worsening failure. Waiting for edema (D) delays intervention. Galen NUR
242 principle: daily weights are a cornerstone of HF self-management; early
detection of fluid retention prevents hospitalization.
Question 3
A patient with heart failure is prescribed furosemide 40 mg PO daily, lisinopril 10 mg
PO daily, and carvedilol 6.25 mg PO twice daily. The patient asks why three
medications are necessary. Which response by the nurse is most accurate?
A. "Each medication treats a different symptom of heart failure."
B. "These medications work together to reduce fluid overload, afterload, and cardiac
remodeling."
C. "The doctor prescribed all three to ensure at least one works."
D. "You only need to take the diuretic; the others are optional."
Correct Answer: B
Rationale: Furosemide (loop diuretic) reduces fluid overload and preload. Lisinopril
(ACE inhibitor) reduces afterload, prevents cardiac remodeling, and improves survival.
Carvedilol (beta-blocker) reduces heart rate, myocardial oxygen demand, and
,reverses remodeling. Together they address multiple pathophysiologic mechanisms.
They do not merely treat symptoms (A). Polypharmacy is evidence-based (C), not
redundant. All medications are essential (D); beta-blockers and ACE inhibitors are
mortality-reducing therapies. Galen NUR 242 pharmacology principle: HF
management requires neurohormonal blockade (ACEi/ARB, beta-blocker, MRA) plus
diuresis.
Question 4
A patient with heart failure has the following vital signs: BP 92/58 mmHg, HR 110
bpm, RR 24, SpO₂ 88% on room air. The patient is confused and oliguric. Which
action is the nurse's priority?
A. Administer the scheduled oral furosemide
B. Apply supplemental oxygen and prepare for possible intubation
C. Increase the patient's oral fluid intake
D. Administer the scheduled beta-blocker
Correct Answer: B
Rationale: This patient presents with acute decompensated heart failure with
hypoxemia (SpO₂ 88%), tachycardia, hypotension, and altered mental status—
indications of cardiogenic shock and respiratory failure. Oxygen is the immediate
priority to address hypoxemia; intubation may be needed for respiratory failure.
Furosemide (A) worsens hypotension in shock. Increasing fluids (C) worsens fluid
overload. Beta-blockers (D) are contraindicated in acute decompensated HF and
hypotension. Galen NUR 242 priority framework: ABCs take precedence; hypoxemia
with altered mental status requires immediate oxygenation.
Question 5
A patient with heart failure is prescribed spironolactone 25 mg daily. Which
laboratory value requires the most frequent monitoring?
, A. Serum sodium
B. Serum potassium
C. Blood urea nitrogen
D. Hemoglobin
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist
that can cause life-threatening hyperkalemia, especially when combined with ACE
inhibitors or in patients with renal impairment. Potassium must be monitored closely
(typically every 1–2 weeks after initiation, then periodically). While sodium (A) and
BUN (C) are monitored in HF, potassium is the most critical with spironolactone.
Hemoglobin (D) is not directly affected. Galen NUR 242 medication safety principle:
aldosterone antagonists require vigilant potassium monitoring; hyperkalemia >5.5
mEq/L requires dose reduction or discontinuation.
Question 6
A patient with heart failure is prescribed empagliflozin 10 mg daily. The nurse
understands this medication benefits the patient by:
A. Increasing cardiac contractility and ejection fraction
B. Reducing glucose reabsorption in the kidneys and decreasing afterload
C. Blocking beta-adrenergic receptors to reduce heart rate
D. Inhibiting angiotensin-converting enzyme to reduce afterload
Correct Answer: B
Rationale: Empagliflozin is an SGLT2 inhibitor that reduces glucose reabsorption in
the proximal tubule (causing glucosuria), promotes osmotic diuresis, reduces preload
and afterload, and improves cardiac metabolism. It does not increase contractility
(A)—that's digoxin or inotropes. Beta-blockade (C) is carvedilol/metoprolol. ACE
inhibition (D) is lisinopril/enalapril. Galen NUR 242 pharmacology principle: SGLT2
inhibitors are now first-line in HFrEF regardless of diabetes status due to mortality
and hospitalization reduction (DAPA-HF, EMPEROR-Reduced trials).
