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Bank category: Nursing Exit Exam Topics (HESI / NCLEX)
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1 Question 1
A nurse is assessing a patient with a new onset of a loud, harsh systolic murmur
heard best at the second intercostal space, right sternal border, radiating to the
carotid arteries. This finding is most consistent with:
☐ A. Mitral regurgitation.
☐ B. Aortic insufficiency.
☑ C. Aortic stenosis.
☐ D. Pulmonic stenosis.
RATIONALE
Aortic stenosis classically presents with a harsh systolic ejection murmur best heard at the right
second intercostal space with radiation to the carotid arteries. It results from narrowing of the
aortic valve opening.
,2 Question 2
A patient is admitted with acute myocardial infarction. The nurse understands that
the most common cause of MI is:
☐ A. Vasospasm of the coronary arteries.
☑ B. Atherosclerosis with plaque rupture and thrombus formation.
☐ C. Coronary artery dissection.
☐ D. Embolism from a distant source.
RATIONALE
The most common cause of myocardial infarction is rupture of an atherosclerotic plaque in a
coronary artery, followed by thrombus formation that blocks blood flow and causes myocardial
ischemia and necrosis.
,3 Question 3
A patient with heart failure is prescribed sacubitril/valsartan (Entresto). The nurse
should instruct the patient to avoid concurrent use of which medication class due
to the risk of angioedema?
☐ A. Beta-blockers.
☐ B. Calcium channel blockers.
☑ C. ACE inhibitors.
☐ D. Diuretics.
RATIONALE
Sacubitril/valsartan should not be taken with ACE inhibitors because the combination
significantly increases the risk of angioedema. A washout period is required when switching from
an ACE inhibitor.
,4 Question 4
A nurse is caring for a patient with a suspected pulmonary embolism. Which of the
following assessment findings would be most indicative?
☐ A. Bradycardia and hypotension.
☑ B. Sudden onset of dyspnea, pleuritic chest pain, and tachypnea.
☐ C. Peripheral edema and warm, reddened extremity.
☐ D. Muffled heart sounds and JVD.
RATIONALE
Pulmonary embolism commonly presents with sudden dyspnea, sharp pleuritic chest pain,
tachypnea, tachycardia, anxiety, and sometimes hemoptysis. It occurs when a clot blocks
pulmonary blood flow, creating an acute respiratory emergency.
,5 Question 5
A patient with chronic heart failure is admitted with increasing peripheral edema,
jugular venous distension (JVD), and hepatomegaly. Reviewing the provided
information on heart failure, which side of the heart is primarily affected, and what
is the underlying reason for these manifestations?
☐ A. Left side; decreased cardiac output leading to systemic hypoperfusion.
☑ B. Right side; inability of the right ventricle to effectively pump blood to the
pulmonary circulation, causing blood to back up into the systemic venous
system.
☐ C. Both sides; global cardiac dysfunction leading to both pulmonary and
systemic symptoms.
, ☐ D. Acute heart failure; sudden onset of symptoms due to an acute
myocardial event.
RATIONALE
Peripheral edema, JVD, and hepatomegaly are hallmark findings of right-sided heart failure. The
right ventricle fails to pump blood effectively into the pulmonary circulation, causing venous
blood to back up into the systemic circulation.