NUR 253 MEDICAL-SURGICAL NURSING EXAM 3
2026/2027 | Galen College of Nursing | 100% Correct
| Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Hypertension, CAD,
Heart Failure) (Q1-15)
Q1. A 68-year-old male presents to the clinic with a blood pressure of 158/96 mmHg
on three separate occasions. According to the 2017 ACC/AHA hypertension
guidelines, how is this patient's blood pressure classified?
A. Normal
B. Elevated
C. Stage 1 Hypertension
D. Stage 2 Hypertension
Correct Answer: C
C. Stage 1 Hypertension [CORRECT]
Rationale: The 2017 ACC/AHA guidelines classify BP 130-139/80-89 as Stage 1 and
140+/90+ as Stage 2; however, 158/96 falls in the Stage 2 range (≥140/≥90). Wait—
rechecking: 158/96 meets Stage 2 criteria (systolic ≥140 OR diastolic ≥90). Actually,
158/96 is Stage 2. But let me verify: Stage 1 is 130-139 OR 80-89. Stage 2 is ≥140 OR
≥90. This patient has both values in Stage 2 range. Correction needed.
Correct Answer: D
D. Stage 2 Hypertension [CORRECT]
Rationale: The 2017 ACC/AHA guidelines classify blood pressure ≥140 systolic OR
≥90 diastolic as Stage 2 Hypertension. This patient's 158/96 mmHg meets Stage 2
criteria. Stage 1 (C) is 130-139/80-89. Normal (A) is <120/<80. Elevated (B) is 120-129
and <80.
,Q2. A nurse is administering a first dose of lisinopril to a patient with newly
diagnosed hypertension. Which assessment is MOST important before giving this
medication?
A. Heart rate
B. Blood pressure and potassium level
C. Respiratory rate
D. Temperature
Correct Answer: B
B. Blood pressure and potassium level [CORRECT]
Rationale: ACE inhibitors like lisinopril can cause hypotension (first-dose syncope)
and hyperkalemia; baseline BP and potassium must be assessed. Heart rate (A) and
respiratory rate (C) are standard but not specific to ACE inhibitor risks. Temperature
(D) is irrelevant to lisinopril administration.
Q3. A patient with HFrEF (heart failure with reduced ejection fraction) is prescribed a
guideline-directed medical therapy (GDMT) regimen. Which combination represents
the CORRECT foundational quadruple therapy?
A. ACE inhibitor, beta-blocker, digoxin, and furosemide
B. ACE inhibitor/ARB/ARNI, evidence-based beta-blocker, MRA, and SGLT2 inhibitor
C. ACE inhibitor, calcium channel blocker, nitrate, and hydralazine
D. Beta-blocker, diuretic, anticoagulant, and statin
Correct Answer: B
B. ACE inhibitor/ARB/ARNI, evidence-based beta-blocker, MRA, and SGLT2 inhibitor
[CORRECT]
Rationale: The 2022 AHA/ACC/HFSA heart failure guidelines establish quadruple
therapy: ACEi/ARB/ARNI, beta-blocker (carvedilol, metoprolol succinate, or
bisoprolol), mineralocorticoid receptor antagonist (MRA), and SGLT2 inhibitor.
,Digoxin (A) is not foundational. Calcium channel blockers (C) are not first-line for
HFrEF. Anticoagulants (D) are not standard unless indicated for other conditions.
Q4. A patient with acute coronary syndrome (ACS) is receiving heparin infusion at
1,000 units/hour. The aPTT result is 28 seconds (control 30 seconds, therapeutic
range 60-80 seconds). What is the nurse's CORRECT action?
A. Continue the infusion at the current rate
B. Increase the infusion rate by 200 units/hour and recheck aPTT in 4 hours
C. Decrease the infusion rate by 200 units/hour and recheck aPTT in 4 hours
D. Stop the infusion immediately and notify the provider
Correct Answer: B
B. Increase the infusion rate by 200 units/hour and recheck aPTT in 4 hours
[CORRECT]
Rationale: An aPTT below therapeutic range (<60 seconds) indicates subtherapeutic
anticoagulation; the infusion rate should be increased per protocol (typically by 10-
20%). Continuing current rate (A) leaves patient at risk for clot progression.
Decreasing (C) is appropriate for supratherapeutic aPTT. Stopping (D) is for critical
bleeding or extreme supratherapeutic values.
Q5. A patient with heart failure reports increasing dyspnea on exertion, weight gain
of 3 lbs in 2 days, and ankle edema. Which assessment finding would indicate the
need for IMMEDIATE provider notification?
A. Bilateral crackles at lung bases
B. Jugular venous distension at 45 degrees
C. Oxygen saturation of 88% on room air
D. 2+ pitting edema in lower extremities
Correct Answer: C
C. Oxygen saturation of 88% on room air [CORRECT]
, Rationale: SpO2 88% indicates severe hypoxemia requiring immediate intervention
(oxygen, possible escalation of care). Crackles (A), JVD (B), and 2+ edema (D) are
expected findings in decompensated heart failure but do not require immediate
notification unless accompanied by hypoxemia or hemodynamic instability.
Q6. A nurse is caring for a patient 24 hours post-MI who suddenly develops
ventricular tachycardia with a pulse and BP 78/50. Which medication should the
nurse prepare to administer FIRST?
A. Atropine 0.5 mg IV
B. Amiodarone 150 mg IV push
C. Epinephrine 1 mg IV push
D. Adenosine 6 mg rapid IV push
Correct Answer: B
B. Amiodarone 150 mg IV push [CORRECT]
Rationale: Pulseless VT/VF and unstable VT with pulse are treated with amiodarone
per ACLS. Atropine (A) is for symptomatic bradycardia. Epinephrine (C) is for
pulseless arrest. Adenosine (D) is for stable SVT, not VT.
Q7. A patient with stable angina is prescribed sublingual nitroglycerin. Which patient
teaching is MOST important?
A. "Take the medication with food to prevent stomach upset"
B. "Sit or lie down before taking the tablet to prevent hypotension and falls"
C. "Chew the tablet thoroughly before swallowing for faster absorption"
D. "Store the tablets in the bathroom medicine cabinet for easy access"
Correct Answer: B
B. "Sit or lie down before taking the tablet to prevent hypotension and falls"
[CORRECT]
2026/2027 | Galen College of Nursing | 100% Correct
| Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Hypertension, CAD,
Heart Failure) (Q1-15)
Q1. A 68-year-old male presents to the clinic with a blood pressure of 158/96 mmHg
on three separate occasions. According to the 2017 ACC/AHA hypertension
guidelines, how is this patient's blood pressure classified?
A. Normal
B. Elevated
C. Stage 1 Hypertension
D. Stage 2 Hypertension
Correct Answer: C
C. Stage 1 Hypertension [CORRECT]
Rationale: The 2017 ACC/AHA guidelines classify BP 130-139/80-89 as Stage 1 and
140+/90+ as Stage 2; however, 158/96 falls in the Stage 2 range (≥140/≥90). Wait—
rechecking: 158/96 meets Stage 2 criteria (systolic ≥140 OR diastolic ≥90). Actually,
158/96 is Stage 2. But let me verify: Stage 1 is 130-139 OR 80-89. Stage 2 is ≥140 OR
≥90. This patient has both values in Stage 2 range. Correction needed.
Correct Answer: D
D. Stage 2 Hypertension [CORRECT]
Rationale: The 2017 ACC/AHA guidelines classify blood pressure ≥140 systolic OR
≥90 diastolic as Stage 2 Hypertension. This patient's 158/96 mmHg meets Stage 2
criteria. Stage 1 (C) is 130-139/80-89. Normal (A) is <120/<80. Elevated (B) is 120-129
and <80.
,Q2. A nurse is administering a first dose of lisinopril to a patient with newly
diagnosed hypertension. Which assessment is MOST important before giving this
medication?
A. Heart rate
B. Blood pressure and potassium level
C. Respiratory rate
D. Temperature
Correct Answer: B
B. Blood pressure and potassium level [CORRECT]
Rationale: ACE inhibitors like lisinopril can cause hypotension (first-dose syncope)
and hyperkalemia; baseline BP and potassium must be assessed. Heart rate (A) and
respiratory rate (C) are standard but not specific to ACE inhibitor risks. Temperature
(D) is irrelevant to lisinopril administration.
Q3. A patient with HFrEF (heart failure with reduced ejection fraction) is prescribed a
guideline-directed medical therapy (GDMT) regimen. Which combination represents
the CORRECT foundational quadruple therapy?
A. ACE inhibitor, beta-blocker, digoxin, and furosemide
B. ACE inhibitor/ARB/ARNI, evidence-based beta-blocker, MRA, and SGLT2 inhibitor
C. ACE inhibitor, calcium channel blocker, nitrate, and hydralazine
D. Beta-blocker, diuretic, anticoagulant, and statin
Correct Answer: B
B. ACE inhibitor/ARB/ARNI, evidence-based beta-blocker, MRA, and SGLT2 inhibitor
[CORRECT]
Rationale: The 2022 AHA/ACC/HFSA heart failure guidelines establish quadruple
therapy: ACEi/ARB/ARNI, beta-blocker (carvedilol, metoprolol succinate, or
bisoprolol), mineralocorticoid receptor antagonist (MRA), and SGLT2 inhibitor.
,Digoxin (A) is not foundational. Calcium channel blockers (C) are not first-line for
HFrEF. Anticoagulants (D) are not standard unless indicated for other conditions.
Q4. A patient with acute coronary syndrome (ACS) is receiving heparin infusion at
1,000 units/hour. The aPTT result is 28 seconds (control 30 seconds, therapeutic
range 60-80 seconds). What is the nurse's CORRECT action?
A. Continue the infusion at the current rate
B. Increase the infusion rate by 200 units/hour and recheck aPTT in 4 hours
C. Decrease the infusion rate by 200 units/hour and recheck aPTT in 4 hours
D. Stop the infusion immediately and notify the provider
Correct Answer: B
B. Increase the infusion rate by 200 units/hour and recheck aPTT in 4 hours
[CORRECT]
Rationale: An aPTT below therapeutic range (<60 seconds) indicates subtherapeutic
anticoagulation; the infusion rate should be increased per protocol (typically by 10-
20%). Continuing current rate (A) leaves patient at risk for clot progression.
Decreasing (C) is appropriate for supratherapeutic aPTT. Stopping (D) is for critical
bleeding or extreme supratherapeutic values.
Q5. A patient with heart failure reports increasing dyspnea on exertion, weight gain
of 3 lbs in 2 days, and ankle edema. Which assessment finding would indicate the
need for IMMEDIATE provider notification?
A. Bilateral crackles at lung bases
B. Jugular venous distension at 45 degrees
C. Oxygen saturation of 88% on room air
D. 2+ pitting edema in lower extremities
Correct Answer: C
C. Oxygen saturation of 88% on room air [CORRECT]
, Rationale: SpO2 88% indicates severe hypoxemia requiring immediate intervention
(oxygen, possible escalation of care). Crackles (A), JVD (B), and 2+ edema (D) are
expected findings in decompensated heart failure but do not require immediate
notification unless accompanied by hypoxemia or hemodynamic instability.
Q6. A nurse is caring for a patient 24 hours post-MI who suddenly develops
ventricular tachycardia with a pulse and BP 78/50. Which medication should the
nurse prepare to administer FIRST?
A. Atropine 0.5 mg IV
B. Amiodarone 150 mg IV push
C. Epinephrine 1 mg IV push
D. Adenosine 6 mg rapid IV push
Correct Answer: B
B. Amiodarone 150 mg IV push [CORRECT]
Rationale: Pulseless VT/VF and unstable VT with pulse are treated with amiodarone
per ACLS. Atropine (A) is for symptomatic bradycardia. Epinephrine (C) is for
pulseless arrest. Adenosine (D) is for stable SVT, not VT.
Q7. A patient with stable angina is prescribed sublingual nitroglycerin. Which patient
teaching is MOST important?
A. "Take the medication with food to prevent stomach upset"
B. "Sit or lie down before taking the tablet to prevent hypotension and falls"
C. "Chew the tablet thoroughly before swallowing for faster absorption"
D. "Store the tablets in the bathroom medicine cabinet for easy access"
Correct Answer: B
B. "Sit or lie down before taking the tablet to prevent hypotension and falls"
[CORRECT]
