NUR 265 MEDICAL-SURGICAL NURSING EXAM 3 2026/2027 |
Galen College | 100% Correct | Med Surg Test | Pass
Guaranteed - A+ Graded
Section 1: Cardiac Disorders - Heart Failure, Valvular Disease & CAD (Questions 1-15)
Question 1
A 72-year-old male with a history of chronic systolic heart failure (EF 35%) is admitted
with worsening dyspnea, orthopnea, and 3+ pitting edema in bilateral lower extremities.
His current medications include furosemide 40 mg PO daily, lisinopril 10 mg PO daily,
and carvedilol 12.5 mg PO BID. His vital signs are: BP 168/94 mmHg, HR 102 bpm, RR
26/min, SpO₂ 88% on room air. Which intervention addresses the primary hemodynamic
problem?
A. Increase carvedilol to 25 mg BID to reduce afterload
B. Administer IV furosemide and apply supplemental oxygen
C. Start an ACE inhibitor to prevent ventricular remodeling
D. Initiate a dopamine infusion at 5 mcg/kg/min to improve contractility
B. Administer IV furosemide and apply supplemental oxygen [CORRECT]
Rationale: The patient presents with acute decompensated heart failure with fluid
overload (orthopnea, pitting edema) and hypoxemia. The primary hemodynamic
problem is increased preload (volume overload) and pulmonary congestion. IV
furosemide rapidly reduces preload by promoting diuresis, and supplemental oxygen
corrects hypoxemia. Option A is incorrect because increasing beta-blocker dose during
acute decompensation can worsen heart failure. Option C is incorrect because the
patient is already on an ACE inhibitor (lisinopril). Option D is incorrect because
,dopamine is not first-line for volume overload; it is reserved for cardiogenic shock with
low output.
Correct Answer: B
Question 2
A nurse is caring for a patient receiving nitroprusside for afterload reduction in acute
decompensated heart failure. Which assessment finding requires the most immediate
intervention?
A. Blood pressure of 92/58 mmHg
B. Heart rate of 88 bpm
C. Urine output of 40 mL/hr
D. Respiratory rate of 18/min
A. Blood pressure of 92/58 mmHg [CORRECT]
Rationale: Nitroprusside is a potent arterial and venous vasodilator that can cause
profound hypotension. A BP of 92/58 mmHg indicates excessive afterload reduction
and requires immediate intervention (titration down or discontinuation of the infusion).
Option B is a normal finding. Option C is adequate urine output. Option D is a normal
respiratory rate.
Correct Answer: A
Question 3
A 68-year-old female with severe aortic stenosis develops acute chest pain and syncope
while ambulating to the bathroom. Her vital signs are: BP 84/50 mmHg, HR 110 bpm, RR
24/min. Which pathophysiologic mechanism best explains this presentation?
,A. Left ventricular outflow obstruction causing decreased cardiac output and coronary
perfusion
B. Mitral regurgitation causing pulmonary congestion and right heart failure
C. Aortic regurgitation causing volume overload and widened pulse pressure
D. Tricuspid stenosis causing decreased right ventricular filling and systemic venous
congestion
A. Left ventricular outflow obstruction causing decreased cardiac output and coronary
perfusion [CORRECT]
Rationale: Severe aortic stenosis narrows the aortic valve opening, creating a fixed
obstruction to left ventricular outflow. During exertion, the heart cannot increase cardiac
output to meet metabolic demands, leading to hypotension, syncope, and decreased
coronary perfusion (angina). Option B describes mitral regurgitation, not aortic stenosis.
Option C describes aortic regurgitation. Option D describes tricuspid stenosis.
Correct Answer: A
Question 4
A patient with chronic heart failure is prescribed digoxin 0.25 mg PO daily. Before
administering the dose, the nurse notes the patient's apical pulse is 52 bpm. Which is
the nurse's priority action?
A. Administer the digoxin and notify the provider
B. Hold the digoxin and notify the provider
C. Give the digoxin with a glass of orange juice
D. Check the potassium level and then administer
B. Hold the digoxin and notify the provider [CORRECT]
Rationale: Digoxin slows the heart rate through its vagotonic effect. The standard
protocol is to hold digoxin if the apical pulse is below 60 bpm (or per institutional policy,
, often <50-60 bpm) to prevent severe bradycardia or heart block. Option A is unsafe.
Option C is irrelevant to bradycardia management. Option D delays necessary
intervention; the dose must be held first.
Correct Answer: B
Question 5
A patient with heart failure is receiving milrinone at 0.5 mcg/kg/min via continuous IV
infusion. Which assessment finding indicates a positive therapeutic response?
A. Decreased urine output and increased heart rate
B. Increased cardiac output and decreased pulmonary capillary wedge pressure
C. Increased systemic vascular resistance and decreased stroke volume
D. Decreased ejection fraction and increased afterload
B. Increased cardiac output and decreased pulmonary capillary wedge pressure
[CORRECT]
Rationale: Milrinone is a phosphodiesterase-3 inhibitor with inotropic and vasodilatory
properties. It increases cardiac contractility (positive inotrope) and causes vasodilation,
reducing afterload and preload. A positive response includes improved cardiac output
and reduced pulmonary capillary wedge pressure (a measure of preload/left ventricular
filling pressure). Option A describes worsening function. Option C and D describe
negative or opposite effects.
Correct Answer: B
Question 6
Galen College | 100% Correct | Med Surg Test | Pass
Guaranteed - A+ Graded
Section 1: Cardiac Disorders - Heart Failure, Valvular Disease & CAD (Questions 1-15)
Question 1
A 72-year-old male with a history of chronic systolic heart failure (EF 35%) is admitted
with worsening dyspnea, orthopnea, and 3+ pitting edema in bilateral lower extremities.
His current medications include furosemide 40 mg PO daily, lisinopril 10 mg PO daily,
and carvedilol 12.5 mg PO BID. His vital signs are: BP 168/94 mmHg, HR 102 bpm, RR
26/min, SpO₂ 88% on room air. Which intervention addresses the primary hemodynamic
problem?
A. Increase carvedilol to 25 mg BID to reduce afterload
B. Administer IV furosemide and apply supplemental oxygen
C. Start an ACE inhibitor to prevent ventricular remodeling
D. Initiate a dopamine infusion at 5 mcg/kg/min to improve contractility
B. Administer IV furosemide and apply supplemental oxygen [CORRECT]
Rationale: The patient presents with acute decompensated heart failure with fluid
overload (orthopnea, pitting edema) and hypoxemia. The primary hemodynamic
problem is increased preload (volume overload) and pulmonary congestion. IV
furosemide rapidly reduces preload by promoting diuresis, and supplemental oxygen
corrects hypoxemia. Option A is incorrect because increasing beta-blocker dose during
acute decompensation can worsen heart failure. Option C is incorrect because the
patient is already on an ACE inhibitor (lisinopril). Option D is incorrect because
,dopamine is not first-line for volume overload; it is reserved for cardiogenic shock with
low output.
Correct Answer: B
Question 2
A nurse is caring for a patient receiving nitroprusside for afterload reduction in acute
decompensated heart failure. Which assessment finding requires the most immediate
intervention?
A. Blood pressure of 92/58 mmHg
B. Heart rate of 88 bpm
C. Urine output of 40 mL/hr
D. Respiratory rate of 18/min
A. Blood pressure of 92/58 mmHg [CORRECT]
Rationale: Nitroprusside is a potent arterial and venous vasodilator that can cause
profound hypotension. A BP of 92/58 mmHg indicates excessive afterload reduction
and requires immediate intervention (titration down or discontinuation of the infusion).
Option B is a normal finding. Option C is adequate urine output. Option D is a normal
respiratory rate.
Correct Answer: A
Question 3
A 68-year-old female with severe aortic stenosis develops acute chest pain and syncope
while ambulating to the bathroom. Her vital signs are: BP 84/50 mmHg, HR 110 bpm, RR
24/min. Which pathophysiologic mechanism best explains this presentation?
,A. Left ventricular outflow obstruction causing decreased cardiac output and coronary
perfusion
B. Mitral regurgitation causing pulmonary congestion and right heart failure
C. Aortic regurgitation causing volume overload and widened pulse pressure
D. Tricuspid stenosis causing decreased right ventricular filling and systemic venous
congestion
A. Left ventricular outflow obstruction causing decreased cardiac output and coronary
perfusion [CORRECT]
Rationale: Severe aortic stenosis narrows the aortic valve opening, creating a fixed
obstruction to left ventricular outflow. During exertion, the heart cannot increase cardiac
output to meet metabolic demands, leading to hypotension, syncope, and decreased
coronary perfusion (angina). Option B describes mitral regurgitation, not aortic stenosis.
Option C describes aortic regurgitation. Option D describes tricuspid stenosis.
Correct Answer: A
Question 4
A patient with chronic heart failure is prescribed digoxin 0.25 mg PO daily. Before
administering the dose, the nurse notes the patient's apical pulse is 52 bpm. Which is
the nurse's priority action?
A. Administer the digoxin and notify the provider
B. Hold the digoxin and notify the provider
C. Give the digoxin with a glass of orange juice
D. Check the potassium level and then administer
B. Hold the digoxin and notify the provider [CORRECT]
Rationale: Digoxin slows the heart rate through its vagotonic effect. The standard
protocol is to hold digoxin if the apical pulse is below 60 bpm (or per institutional policy,
, often <50-60 bpm) to prevent severe bradycardia or heart block. Option A is unsafe.
Option C is irrelevant to bradycardia management. Option D delays necessary
intervention; the dose must be held first.
Correct Answer: B
Question 5
A patient with heart failure is receiving milrinone at 0.5 mcg/kg/min via continuous IV
infusion. Which assessment finding indicates a positive therapeutic response?
A. Decreased urine output and increased heart rate
B. Increased cardiac output and decreased pulmonary capillary wedge pressure
C. Increased systemic vascular resistance and decreased stroke volume
D. Decreased ejection fraction and increased afterload
B. Increased cardiac output and decreased pulmonary capillary wedge pressure
[CORRECT]
Rationale: Milrinone is a phosphodiesterase-3 inhibitor with inotropic and vasodilatory
properties. It increases cardiac contractility (positive inotrope) and causes vasodilation,
reducing afterload and preload. A positive response includes improved cardiac output
and reduced pulmonary capillary wedge pressure (a measure of preload/left ventricular
filling pressure). Option A describes worsening function. Option C and D describe
negative or opposite effects.
Correct Answer: B
Question 6
