NUR 265 MEDICAL-SURGICAL NURSING EXAM 2 2026 |
Two Updated Versions A & B | 100% Correct | Med Surg
Test | Pass Guaranteed - A+ Graded
VERSION A: CARDIOVASCULAR DISORDERS & CARDIAC
MONITORING (40 Questions)
Section A1: Heart Failure - Systolic vs Diastolic, ADHF, GDMT (Q1-10)
Q1. A 68-year-old male is admitted with acute decompensated heart failure (ADHF).
Assessment reveals crackles bilaterally, jugular venous distention (JVD) at 45 degrees,
and 3+ pitting edema in the lower extremities. His ejection fraction is documented as
25%. Which type of heart failure is MOST likely present?
A. Diastolic heart failure with preserved ejection fraction
B. Systolic heart failure with reduced ejection fraction (HFrEF)
C. Right-sided heart failure only
D. Hypertrophic cardiomyopathy
Rationale: An ejection fraction of 25% (normal ≥55%) indicates systolic heart
failure with reduced ejection fraction (HFrEF). The JVD, crackles, and edema are
classic signs of fluid overload. Diastolic heart failure (Option A) typically has
preserved EF (≥50%). Right-sided failure alone (Option C) wouldn't explain bilateral
crackles. Hypertrophic cardiomyopathy (Option D) is a separate condition.
Correct Answer: B
,Q2. A nurse is caring for a patient with HFrEF who is prescribed lisinopril, metoprolol,
and spironolactone. The patient asks why three medications are needed. Which
response BEST explains the mechanism of guideline-directed medical therapy
(GDMT)?
A. "Each medication works on a different aspect of the heart failure pathway to
reduce mortality and symptoms."
B. "The doctor is unsure which one works best, so we are trying all three."
C. "These medications are only for symptom control and do not affect survival."
D. "You only need the diuretic; the others are optional."
Rationale: GDMT for HFrEF uses multiple agents targeting different mechanisms:
ACE inhibitors (lisinopril) reduce afterload and remodeling, beta-blockers
(metoprolol) reduce sympathetic drive, and MRAs (spironolactone) reduce fibrosis.
Together they improve survival and symptoms. Option B is false. Option C is false—
GDMT improves mortality. Option D is dangerous and incorrect.
Correct Answer: A
Q3. A patient with heart failure is prescribed furosemide 40 mg IV twice daily. Which
assessment finding BEST indicates the medication is achieving the desired
therapeutic effect?
A. Weight gain of 2 kg over 24 hours
B. Decreased JVD and reduction in peripheral edema
C. Increased blood pressure from 110/70 to 140/90 mmHg
D. Heart rate increase from 72 to 98 bpm
Rationale: Furosemide is a loop diuretic that reduces preload by promoting fluid
elimination. Successful therapy is evidenced by decreased JVD and reduced
peripheral edema (signs of decongestion). Weight gain (Option A) indicates
worsening fluid retention. Increased BP (Option C) and HR (Option D) are not
therapeutic goals of diuretic therapy.
Correct Answer: B
,Q4. A nurse is teaching a patient with heart failure about daily weight monitoring.
Which instruction is MOST accurate?
A. "Weigh yourself once weekly at the same time."
B. "Weigh yourself every morning after urinating, before eating, wearing similar
clothing, and call if you gain 2-3 pounds in one day or 5 pounds in a week."
C. "Weigh yourself before bed each night and record the highest weight."
D. "Daily weights are not necessary if you feel well."
Rationale: Heart failure patients should weigh themselves daily under consistent
conditions (morning, post-void, before eating, similar clothing) and report rapid
weight gain (2-3 lbs/day or 5 lbs/week), which indicates fluid retention. Weekly
weighing (Option A) misses acute changes. Evening weights (Option C) are
inconsistent. Option D is dangerous—silent fluid accumulation can occur before
symptoms.
Correct Answer: B
Q5. A patient with acute decompensated heart failure is receiving IV nitroglycerin.
The nurse notes the blood pressure has dropped from 142/88 to 88/52 mmHg.
Which action should the nurse take FIRST?
A. Increase the nitroglycerin drip rate
B. Stop the nitroglycerin infusion and notify the provider
C. Administer a fluid bolus of 500 mL NS
D. Continue the infusion and recheck in 30 minutes
Rationale: Hypotension (SBP <90 mmHg) is a contraindication to continued
nitroglycerin, which causes venodilation and reduces preload. The nurse must stop
the infusion immediately to prevent cardiovascular collapse and notify the provider.
Increasing the rate (Option A) would worsen hypotension. Fluid bolus (Option C) may
be ordered later but stopping the offending agent is first. Option D delays critical
intervention.
Correct Answer: B
, Q6. A patient with chronic heart failure has a BNP level of 1,850 pg/mL (normal
<100). Which clinical finding would the nurse expect to correlate with this elevated
level?
A. Decreased pulmonary capillary wedge pressure
B. Increased ventricular wall stress and fluid overload
C. Decreased left ventricular end-diastolic pressure
D. Normal cardiac output with no symptoms
Rationale: BNP (B-type natriuretic peptide) is released in response to increased
ventricular wall stress from volume overload and stretching. Elevated BNP
correlates with severity of heart failure and fluid overload. Options A, C, and D
describe conditions inconsistent with severe heart failure.
Correct Answer: B
Q7. A nurse is reviewing medications for a patient with HFrEF. Which medication is
CONTRAINDICATED in this patient population?
A. Lisinopril
B. Metoprolol succinate
C. Diltiazem
D. Spironolactone
Rationale: Non-dihydropyridine calcium channel blockers (diltiazem, verapamil)
are contraindicated in HFrEF because they have negative inotropic effects,
worsening systolic function. ACE inhibitors (Option A), beta-blockers (Option B), and
MRAs (Option D) are core GDMT therapies that improve outcomes in HFrEF.
Correct Answer: C
Q8. A patient with heart failure is being discharged. Which dietary instruction is
MOST important for preventing readmission?
Two Updated Versions A & B | 100% Correct | Med Surg
Test | Pass Guaranteed - A+ Graded
VERSION A: CARDIOVASCULAR DISORDERS & CARDIAC
MONITORING (40 Questions)
Section A1: Heart Failure - Systolic vs Diastolic, ADHF, GDMT (Q1-10)
Q1. A 68-year-old male is admitted with acute decompensated heart failure (ADHF).
Assessment reveals crackles bilaterally, jugular venous distention (JVD) at 45 degrees,
and 3+ pitting edema in the lower extremities. His ejection fraction is documented as
25%. Which type of heart failure is MOST likely present?
A. Diastolic heart failure with preserved ejection fraction
B. Systolic heart failure with reduced ejection fraction (HFrEF)
C. Right-sided heart failure only
D. Hypertrophic cardiomyopathy
Rationale: An ejection fraction of 25% (normal ≥55%) indicates systolic heart
failure with reduced ejection fraction (HFrEF). The JVD, crackles, and edema are
classic signs of fluid overload. Diastolic heart failure (Option A) typically has
preserved EF (≥50%). Right-sided failure alone (Option C) wouldn't explain bilateral
crackles. Hypertrophic cardiomyopathy (Option D) is a separate condition.
Correct Answer: B
,Q2. A nurse is caring for a patient with HFrEF who is prescribed lisinopril, metoprolol,
and spironolactone. The patient asks why three medications are needed. Which
response BEST explains the mechanism of guideline-directed medical therapy
(GDMT)?
A. "Each medication works on a different aspect of the heart failure pathway to
reduce mortality and symptoms."
B. "The doctor is unsure which one works best, so we are trying all three."
C. "These medications are only for symptom control and do not affect survival."
D. "You only need the diuretic; the others are optional."
Rationale: GDMT for HFrEF uses multiple agents targeting different mechanisms:
ACE inhibitors (lisinopril) reduce afterload and remodeling, beta-blockers
(metoprolol) reduce sympathetic drive, and MRAs (spironolactone) reduce fibrosis.
Together they improve survival and symptoms. Option B is false. Option C is false—
GDMT improves mortality. Option D is dangerous and incorrect.
Correct Answer: A
Q3. A patient with heart failure is prescribed furosemide 40 mg IV twice daily. Which
assessment finding BEST indicates the medication is achieving the desired
therapeutic effect?
A. Weight gain of 2 kg over 24 hours
B. Decreased JVD and reduction in peripheral edema
C. Increased blood pressure from 110/70 to 140/90 mmHg
D. Heart rate increase from 72 to 98 bpm
Rationale: Furosemide is a loop diuretic that reduces preload by promoting fluid
elimination. Successful therapy is evidenced by decreased JVD and reduced
peripheral edema (signs of decongestion). Weight gain (Option A) indicates
worsening fluid retention. Increased BP (Option C) and HR (Option D) are not
therapeutic goals of diuretic therapy.
Correct Answer: B
,Q4. A nurse is teaching a patient with heart failure about daily weight monitoring.
Which instruction is MOST accurate?
A. "Weigh yourself once weekly at the same time."
B. "Weigh yourself every morning after urinating, before eating, wearing similar
clothing, and call if you gain 2-3 pounds in one day or 5 pounds in a week."
C. "Weigh yourself before bed each night and record the highest weight."
D. "Daily weights are not necessary if you feel well."
Rationale: Heart failure patients should weigh themselves daily under consistent
conditions (morning, post-void, before eating, similar clothing) and report rapid
weight gain (2-3 lbs/day or 5 lbs/week), which indicates fluid retention. Weekly
weighing (Option A) misses acute changes. Evening weights (Option C) are
inconsistent. Option D is dangerous—silent fluid accumulation can occur before
symptoms.
Correct Answer: B
Q5. A patient with acute decompensated heart failure is receiving IV nitroglycerin.
The nurse notes the blood pressure has dropped from 142/88 to 88/52 mmHg.
Which action should the nurse take FIRST?
A. Increase the nitroglycerin drip rate
B. Stop the nitroglycerin infusion and notify the provider
C. Administer a fluid bolus of 500 mL NS
D. Continue the infusion and recheck in 30 minutes
Rationale: Hypotension (SBP <90 mmHg) is a contraindication to continued
nitroglycerin, which causes venodilation and reduces preload. The nurse must stop
the infusion immediately to prevent cardiovascular collapse and notify the provider.
Increasing the rate (Option A) would worsen hypotension. Fluid bolus (Option C) may
be ordered later but stopping the offending agent is first. Option D delays critical
intervention.
Correct Answer: B
, Q6. A patient with chronic heart failure has a BNP level of 1,850 pg/mL (normal
<100). Which clinical finding would the nurse expect to correlate with this elevated
level?
A. Decreased pulmonary capillary wedge pressure
B. Increased ventricular wall stress and fluid overload
C. Decreased left ventricular end-diastolic pressure
D. Normal cardiac output with no symptoms
Rationale: BNP (B-type natriuretic peptide) is released in response to increased
ventricular wall stress from volume overload and stretching. Elevated BNP
correlates with severity of heart failure and fluid overload. Options A, C, and D
describe conditions inconsistent with severe heart failure.
Correct Answer: B
Q7. A nurse is reviewing medications for a patient with HFrEF. Which medication is
CONTRAINDICATED in this patient population?
A. Lisinopril
B. Metoprolol succinate
C. Diltiazem
D. Spironolactone
Rationale: Non-dihydropyridine calcium channel blockers (diltiazem, verapamil)
are contraindicated in HFrEF because they have negative inotropic effects,
worsening systolic function. ACE inhibitors (Option A), beta-blockers (Option B), and
MRAs (Option D) are core GDMT therapies that improve outcomes in HFrEF.
Correct Answer: C
Q8. A patient with heart failure is being discharged. Which dietary instruction is
MOST important for preventing readmission?
