NSG 123 MED-SURG EXAM 3: (Latest 2026/2027 Update) Hypertension,
Heart Failure, Hematologic Disorders & PAD | Q&A | Grade A | 100% Correct
(Verified Answers) – Nursing Program
Subject: NSG 123 – Medical-Surgical Nursing / Cardiovascular & Hematology
Source: NSG 123 MED-SURG EXAM 3 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is the primary goal for treating a patient with hypertensive emergency (crisis)?
Correct Answer: Admit to ICU, continuous BP monitoring, IV antihypertensive. Reduce SBP by no
more than 25% within first hour, then to 160/100 mmHg within 2-6 hours, then normal BP within 24-48
hours. For aortic dissection: SBP <120 mmHg in 1 hour. For preeclampsia/eclampsia: SBP <140 mmHg
in 1 hour.
1. Too rapid BP reduction can cause cerebral ischemia, MI, or renal failure.
2. IV medications: nicardipine, labetalol, clevidipine, sodium nitroprusside.
3. Monitor for end-organ damage reversal.
2. What is the pathophysiology of heart failure (HF)?
Correct Answer: Clinical syndrome where structural or functional cardiac disorder impairs the heart's
ability to pump enough blood to meet metabolic demands. Systolic HF: impaired contraction; Diastolic
HF: impaired filling.
1. HFrEF (systolic) EF <40%; HFpEF (diastolic) EF ≥50%.
2. Compensatory mechanisms: RAAS activation, SNS activation, ventricular
hypertrophy/dilation.
3. Over time compensation fails → worsening symptoms.
3. What are the clinical manifestations of right-sided heart failure?
Correct Answer: Dependent edema (lower extremities), hepatomegaly (enlarged liver), ascites (fluid in
peritoneal cavity), weight gain (fluid retention), JVD, anorexia, nausea.
1. Right-sided HF causes systemic venous congestion. hepatomegaly can lead to right upper
quadrant pain.
2. Ascites may cause abdominal distention and early satiety.
3. Most common cause is left-sided HF.
4. What are the stages of HTN according to ACC/AHA guidelines?
Correct Answer: Normal: <120 & <80; Elevated: 120-129 & <80; Stage 1: 130-139 & 80-89; Stage 2:
140-159 & 90-99; Hypertensive crisis: ≥180 and/or ≥120 mmHg.
1. 2017 ACC/AHA guidelines lowered thresholds for earlier intervention.
2. Stage 1 HTN treated with lifestyle changes (10-year ASCVD risk <10%) or medication (risk
>10%).
3. Stage 2 HTN requires two-drug combination therapy.
, 5. What is the mechanism of action (MOA) of thiazide diuretics for hypertension?
Correct Answer: Decrease blood volume, renal blood flow, and cardiac output. Deplete extracellular
fluid and sodium, directly affect vascular smooth muscle.
1. Thiazides (HCTZ, chlorthalidone) are first-line for most patients with HTN.
2. Cause loss of sodium, potassium, magnesium; increase uric acid and calcium.
3. Monitor for electrolyte imbalance; encourage potassium-rich foods.
6. What is the DASH diet and how is it beneficial for hypertension?
Correct Answer: Dietary Approaches to Stop Hypertension. Combined with weight loss, lowers SBP
11-16 mmHg. Low sodium (<2 g/day), high potassium (3500-5000 mg/day), high fruits/vegetables/low-
fat dairy.
1. High potassium diet contraindicated in CKD (risk hyperkalemia).
2. DASH diet also lowers LDL cholesterol.
3. Educate on reading food labels, avoiding processed foods.
7. What are the laboratory findings that suggest target organ damage (TOD) from hypertension?
Correct Answer: LVH on echocardiogram; elevated BUN and creatinine (renal damage);
microalbuminuria or macroalbuminuria; elevated uric acid; abnormal urinalysis.
1. Screening labs: CBC, electrolytes (sodium, potassium), creatinine, fasting glucose, cholesterol,
urinalysis.
2. 12-lead ECG for LVH (strain pattern).
3. Eye exam for retinopathy (hemorrhages, exudates, papilledema).
8. What are common side effects of ACE inhibitors (lisinopril, enalapril)?
Correct Answer: Cough (10-20%), hyperkalemia, angioedema, hypotension, rash, dysgeusia, renal
impairment.
1. ACE inhibitor-induced cough is dry, persistent; stop medication (switch to ARB).
2. Angioedema (lip/tongue swelling) is emergency — discontinue permanently.
3. Monitor potassium; avoid potassium supplements and potassium-sparing diuretics.
9. What is the mechanism of action of ACE inhibitors?
Correct Answer: Inhibit conversion of angiotensin I to angiotensin II → lower total peripheral
resistance (relax veins and arteries) → lower BP.
1. Also decrease aldosterone secretion (reduces sodium/water retention).
2. Prevent degradation of bradykinin (contributes to cough).
3. Contraindicated in pregnancy (fetal renal agenesis), bilateral renal artery stenosis.
Heart Failure, Hematologic Disorders & PAD | Q&A | Grade A | 100% Correct
(Verified Answers) – Nursing Program
Subject: NSG 123 – Medical-Surgical Nursing / Cardiovascular & Hematology
Source: NSG 123 MED-SURG EXAM 3 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is the primary goal for treating a patient with hypertensive emergency (crisis)?
Correct Answer: Admit to ICU, continuous BP monitoring, IV antihypertensive. Reduce SBP by no
more than 25% within first hour, then to 160/100 mmHg within 2-6 hours, then normal BP within 24-48
hours. For aortic dissection: SBP <120 mmHg in 1 hour. For preeclampsia/eclampsia: SBP <140 mmHg
in 1 hour.
1. Too rapid BP reduction can cause cerebral ischemia, MI, or renal failure.
2. IV medications: nicardipine, labetalol, clevidipine, sodium nitroprusside.
3. Monitor for end-organ damage reversal.
2. What is the pathophysiology of heart failure (HF)?
Correct Answer: Clinical syndrome where structural or functional cardiac disorder impairs the heart's
ability to pump enough blood to meet metabolic demands. Systolic HF: impaired contraction; Diastolic
HF: impaired filling.
1. HFrEF (systolic) EF <40%; HFpEF (diastolic) EF ≥50%.
2. Compensatory mechanisms: RAAS activation, SNS activation, ventricular
hypertrophy/dilation.
3. Over time compensation fails → worsening symptoms.
3. What are the clinical manifestations of right-sided heart failure?
Correct Answer: Dependent edema (lower extremities), hepatomegaly (enlarged liver), ascites (fluid in
peritoneal cavity), weight gain (fluid retention), JVD, anorexia, nausea.
1. Right-sided HF causes systemic venous congestion. hepatomegaly can lead to right upper
quadrant pain.
2. Ascites may cause abdominal distention and early satiety.
3. Most common cause is left-sided HF.
4. What are the stages of HTN according to ACC/AHA guidelines?
Correct Answer: Normal: <120 & <80; Elevated: 120-129 & <80; Stage 1: 130-139 & 80-89; Stage 2:
140-159 & 90-99; Hypertensive crisis: ≥180 and/or ≥120 mmHg.
1. 2017 ACC/AHA guidelines lowered thresholds for earlier intervention.
2. Stage 1 HTN treated with lifestyle changes (10-year ASCVD risk <10%) or medication (risk
>10%).
3. Stage 2 HTN requires two-drug combination therapy.
, 5. What is the mechanism of action (MOA) of thiazide diuretics for hypertension?
Correct Answer: Decrease blood volume, renal blood flow, and cardiac output. Deplete extracellular
fluid and sodium, directly affect vascular smooth muscle.
1. Thiazides (HCTZ, chlorthalidone) are first-line for most patients with HTN.
2. Cause loss of sodium, potassium, magnesium; increase uric acid and calcium.
3. Monitor for electrolyte imbalance; encourage potassium-rich foods.
6. What is the DASH diet and how is it beneficial for hypertension?
Correct Answer: Dietary Approaches to Stop Hypertension. Combined with weight loss, lowers SBP
11-16 mmHg. Low sodium (<2 g/day), high potassium (3500-5000 mg/day), high fruits/vegetables/low-
fat dairy.
1. High potassium diet contraindicated in CKD (risk hyperkalemia).
2. DASH diet also lowers LDL cholesterol.
3. Educate on reading food labels, avoiding processed foods.
7. What are the laboratory findings that suggest target organ damage (TOD) from hypertension?
Correct Answer: LVH on echocardiogram; elevated BUN and creatinine (renal damage);
microalbuminuria or macroalbuminuria; elevated uric acid; abnormal urinalysis.
1. Screening labs: CBC, electrolytes (sodium, potassium), creatinine, fasting glucose, cholesterol,
urinalysis.
2. 12-lead ECG for LVH (strain pattern).
3. Eye exam for retinopathy (hemorrhages, exudates, papilledema).
8. What are common side effects of ACE inhibitors (lisinopril, enalapril)?
Correct Answer: Cough (10-20%), hyperkalemia, angioedema, hypotension, rash, dysgeusia, renal
impairment.
1. ACE inhibitor-induced cough is dry, persistent; stop medication (switch to ARB).
2. Angioedema (lip/tongue swelling) is emergency — discontinue permanently.
3. Monitor potassium; avoid potassium supplements and potassium-sparing diuretics.
9. What is the mechanism of action of ACE inhibitors?
Correct Answer: Inhibit conversion of angiotensin I to angiotensin II → lower total peripheral
resistance (relax veins and arteries) → lower BP.
1. Also decrease aldosterone secretion (reduces sodium/water retention).
2. Prevent degradation of bradykinin (contributes to cough).
3. Contraindicated in pregnancy (fetal renal agenesis), bilateral renal artery stenosis.
