1
NUR 221 Exam 2 Actual Exam 2026/2027 –
Complete Exam-Style Questions with
Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders (HF, CAD, MI, Hypertension) — Questions 1-18]
Q1: A patient with Heart Failure (HF) reports experiencing sudden shortness of breath that wakes
them up at night. The nurse recognizes this symptom as:
A. Orthopnea
B. Dyspnea on exertion
C. Paroxysmal nocturnal dyspnea (PND) [CORRECT]
D. Cheyne-Stokes respiration
Correct Answer: C
Rationale: Paroxysmal nocturnal dyspnea (PND) is defined as sudden shortness of breath that
occurs at night, usually waking the patient from sleep, often requiring the patient to sit up or
stand to relieve it. It is caused by the reabsorption of peripheral edema fluid into the vascular
system when lying down. Orthopnea (A) is dyspnea occurring when lying flat but relieved by
sitting up; PND is distinct as it wakes the patient from sleep. Dyspnea on exertion (B) occurs
during activity. Cheyne-Stokes (D) is a specific pattern of periodic breathing.
Q2: Which assessment finding is most indicative of left-sided heart failure?
A. Jugular venous distension (JVD)
B. Hepatomegaly
C. Ascites
D. Bilateral crackles (rales) in the lung bases [CORRECT]
Correct Answer: D
,2
Rationale: Left-sided heart failure causes backup of blood into the left atrium and pulmonary
circulation, leading to pulmonary congestion and edema. This manifests as crackles (rales) heard
upon auscultation of the lungs. Options A, B, and C (JVD, hepatomegaly, ascites) are signs of
right-sided heart failure, which causes systemic venous congestion.
Q3: A patient is prescribed Furosemide (Lasix) for heart failure. Which electrolyte imbalance
should the nurse monitor for most closely?
A. Hypernatremia
B. Hypocalcemia
C. Hypokalemia [CORRECT]
D. Hypermagnesemia
Correct Answer: C
Rationale: Furosemide is a loop diuretic that inhibits the reabsorption of sodium and chloride in
the loop of Henle. A significant side effect is the increased excretion of potassium, leading to
hypokalemia. Hypokalemia can cause cardiac arrhythmias, which is particularly dangerous in
heart failure patients. Loop diuretics can also cause hyponatremia and hypocalcemia, but
hypokalemia is the primary concern requiring immediate monitoring.
Q4: The nurse is administering Digoxin (Lanoxin) to a patient. Which finding would cause the
nurse to withhold the dose and notify the provider?
A. Heart rate of 68 bpm
B. Potassium level of 4.0 mEq/L
C. Heart rate of 55 bpm [CORRECT]
D. Complaint of mild headache
Correct Answer: C
Rationale: One of the classic signs of digoxin toxicity is bradycardia. The standard protocol is to
hold the dose if the apical heart rate is less than 60 bpm (or per specific facility protocol, often
<50 or <60). Options A and B are within normal limits. A headache (D) is non-specific and not a
strict contraindication unless accompanied by visual disturbances (halos).
,3
Q5: A patient is presenting to the Emergency Department with chest pain. The nurse administers
nitroglycerin sublingually. What is the primary mechanism of action of nitroglycerin?
A. It reduces cardiac contractility.
B. It prevents platelet aggregation.
C. It causes venous dilation to reduce preload. [CORRECT]
D. It dissolves the coronary clot.
Correct Answer: C
Rationale: Nitroglycerin is a vasodilator that primarily acts on the venous system. By dilating the
veins, it reduces venous return (preload) to the heart, which decreases myocardial oxygen
demand. It also dilates coronary arteries to improve blood flow. It does not dissolve clots (D),
that is the role of fibrinolytics, nor does it directly reduce contractility like beta-blockers.
Q6: Which laboratory marker is the most specific indicator of myocardial muscle injury?
A. Myoglobin
B. Creatine Kinase-MB (CK-MB)
C. Troponin I or T [CORRECT]
D. C-reactive protein (CRP)
Correct Answer: C
Rationale: Troponin I and Troponin T are proteins found exclusively in cardiac muscle. They are
the gold standard biomarkers for diagnosing myocardial infarction (MI) because of their high
specificity and sensitivity. Myoglobin (A) rises early but is not specific to the heart (also found in
skeletal muscle). CK-MB (B) is specific but less sensitive than troponin. CRP (D) is a marker of
inflammation.
Q7: The nurse is caring for a patient with Myocardial Infarction (MI). The provider orders the
"MONA" protocol. What does the "O" stand for?
A. Observation
, 4
B. Operations
C. Oxazepam
D. Oxygen [CORRECT]
Correct Answer: D
Rationale: In the MONA protocol (Morphine, Oxygen, Nitroglycerin, Aspirin) for acute MI,
Oxygen is administered if the patient is hypoxic (SpO2 < 90%) or experiencing dyspnea. The
goal is to increase oxygen delivery to the ischemic myocardium. Current guidelines suggest
supplemental oxygen is not necessary if the patient is not hypoxic, but it remains a standard
mnemonic component.
Q8: A patient is diagnosed with Unstable Angina. How does this differ from Stable Angina?
A. Stable angina occurs at rest; unstable angina occurs with exertion.
B. Unstable angina is relieved by rest or nitroglycerin; stable angina is not.
C. Unstable angina occurs at rest, is more severe, and is not relieved by rest or nitroglycerin.
[CORRECT]
D. Stable angina is caused by plaque rupture; unstable angina is caused by fixed stenosis.
Correct Answer: C
Rationale: Unstable Angina is a form of acute coronary syndrome characterized by chest pain
that occurs at rest, is of new onset, or is severe/crescendo. It usually results from plaque rupture
with thrombosis that is not fully occlusive. Stable Angina is predictable with exertion and
relieved by rest/nitroglycerin, caused by fixed atherosclerotic stenosis. Unstable angina is a
medical emergency.
Q9: A patient with Heart Failure with reduced Ejection Fraction (HFrEF) is prescribed an ARNI
(Angiotensin Receptor-Neprilysin Inhibitor). Which medication is an example of this drug class?
A. Lisinopril
B. Losartan
C. Sacubitril/valsartan (Entresto) [CORRECT]
NUR 221 Exam 2 Actual Exam 2026/2027 –
Complete Exam-Style Questions with
Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders (HF, CAD, MI, Hypertension) — Questions 1-18]
Q1: A patient with Heart Failure (HF) reports experiencing sudden shortness of breath that wakes
them up at night. The nurse recognizes this symptom as:
A. Orthopnea
B. Dyspnea on exertion
C. Paroxysmal nocturnal dyspnea (PND) [CORRECT]
D. Cheyne-Stokes respiration
Correct Answer: C
Rationale: Paroxysmal nocturnal dyspnea (PND) is defined as sudden shortness of breath that
occurs at night, usually waking the patient from sleep, often requiring the patient to sit up or
stand to relieve it. It is caused by the reabsorption of peripheral edema fluid into the vascular
system when lying down. Orthopnea (A) is dyspnea occurring when lying flat but relieved by
sitting up; PND is distinct as it wakes the patient from sleep. Dyspnea on exertion (B) occurs
during activity. Cheyne-Stokes (D) is a specific pattern of periodic breathing.
Q2: Which assessment finding is most indicative of left-sided heart failure?
A. Jugular venous distension (JVD)
B. Hepatomegaly
C. Ascites
D. Bilateral crackles (rales) in the lung bases [CORRECT]
Correct Answer: D
,2
Rationale: Left-sided heart failure causes backup of blood into the left atrium and pulmonary
circulation, leading to pulmonary congestion and edema. This manifests as crackles (rales) heard
upon auscultation of the lungs. Options A, B, and C (JVD, hepatomegaly, ascites) are signs of
right-sided heart failure, which causes systemic venous congestion.
Q3: A patient is prescribed Furosemide (Lasix) for heart failure. Which electrolyte imbalance
should the nurse monitor for most closely?
A. Hypernatremia
B. Hypocalcemia
C. Hypokalemia [CORRECT]
D. Hypermagnesemia
Correct Answer: C
Rationale: Furosemide is a loop diuretic that inhibits the reabsorption of sodium and chloride in
the loop of Henle. A significant side effect is the increased excretion of potassium, leading to
hypokalemia. Hypokalemia can cause cardiac arrhythmias, which is particularly dangerous in
heart failure patients. Loop diuretics can also cause hyponatremia and hypocalcemia, but
hypokalemia is the primary concern requiring immediate monitoring.
Q4: The nurse is administering Digoxin (Lanoxin) to a patient. Which finding would cause the
nurse to withhold the dose and notify the provider?
A. Heart rate of 68 bpm
B. Potassium level of 4.0 mEq/L
C. Heart rate of 55 bpm [CORRECT]
D. Complaint of mild headache
Correct Answer: C
Rationale: One of the classic signs of digoxin toxicity is bradycardia. The standard protocol is to
hold the dose if the apical heart rate is less than 60 bpm (or per specific facility protocol, often
<50 or <60). Options A and B are within normal limits. A headache (D) is non-specific and not a
strict contraindication unless accompanied by visual disturbances (halos).
,3
Q5: A patient is presenting to the Emergency Department with chest pain. The nurse administers
nitroglycerin sublingually. What is the primary mechanism of action of nitroglycerin?
A. It reduces cardiac contractility.
B. It prevents platelet aggregation.
C. It causes venous dilation to reduce preload. [CORRECT]
D. It dissolves the coronary clot.
Correct Answer: C
Rationale: Nitroglycerin is a vasodilator that primarily acts on the venous system. By dilating the
veins, it reduces venous return (preload) to the heart, which decreases myocardial oxygen
demand. It also dilates coronary arteries to improve blood flow. It does not dissolve clots (D),
that is the role of fibrinolytics, nor does it directly reduce contractility like beta-blockers.
Q6: Which laboratory marker is the most specific indicator of myocardial muscle injury?
A. Myoglobin
B. Creatine Kinase-MB (CK-MB)
C. Troponin I or T [CORRECT]
D. C-reactive protein (CRP)
Correct Answer: C
Rationale: Troponin I and Troponin T are proteins found exclusively in cardiac muscle. They are
the gold standard biomarkers for diagnosing myocardial infarction (MI) because of their high
specificity and sensitivity. Myoglobin (A) rises early but is not specific to the heart (also found in
skeletal muscle). CK-MB (B) is specific but less sensitive than troponin. CRP (D) is a marker of
inflammation.
Q7: The nurse is caring for a patient with Myocardial Infarction (MI). The provider orders the
"MONA" protocol. What does the "O" stand for?
A. Observation
, 4
B. Operations
C. Oxazepam
D. Oxygen [CORRECT]
Correct Answer: D
Rationale: In the MONA protocol (Morphine, Oxygen, Nitroglycerin, Aspirin) for acute MI,
Oxygen is administered if the patient is hypoxic (SpO2 < 90%) or experiencing dyspnea. The
goal is to increase oxygen delivery to the ischemic myocardium. Current guidelines suggest
supplemental oxygen is not necessary if the patient is not hypoxic, but it remains a standard
mnemonic component.
Q8: A patient is diagnosed with Unstable Angina. How does this differ from Stable Angina?
A. Stable angina occurs at rest; unstable angina occurs with exertion.
B. Unstable angina is relieved by rest or nitroglycerin; stable angina is not.
C. Unstable angina occurs at rest, is more severe, and is not relieved by rest or nitroglycerin.
[CORRECT]
D. Stable angina is caused by plaque rupture; unstable angina is caused by fixed stenosis.
Correct Answer: C
Rationale: Unstable Angina is a form of acute coronary syndrome characterized by chest pain
that occurs at rest, is of new onset, or is severe/crescendo. It usually results from plaque rupture
with thrombosis that is not fully occlusive. Stable Angina is predictable with exertion and
relieved by rest/nitroglycerin, caused by fixed atherosclerotic stenosis. Unstable angina is a
medical emergency.
Q9: A patient with Heart Failure with reduced Ejection Fraction (HFrEF) is prescribed an ARNI
(Angiotensin Receptor-Neprilysin Inhibitor). Which medication is an example of this drug class?
A. Lisinopril
B. Losartan
C. Sacubitril/valsartan (Entresto) [CORRECT]
