U 189 / NU189 EXAM 1
N
2026-2027 | Medical-Surgical
Nursing II Review | Galen
College | 100% Verified Q&A |
Grade A | Pass Guaranteed
* *Q1 (Cardiovascular – Heart Failure):** A 72-year-old male with HFrEF (EF 35%) presents with
worsening dyspnea, 3+ pitting edema, and weight gain of 4 lbs in 2 days. His current
medications include metoprolol, lisinopril, furosemide, and digoxin. Which medication class
should be added to his regimen per the 2026 GDMT guidelines?
) Hydralazine/isosorbide dinitrate
A
B) SGLT2 inhibitor
C) Ivabradine
D) Sacubitril/valsartan
* *[CORRECT]** B
*Rationale: The 2026 ACC/AHA/HFSA heart failure guidelines now recommend SGLT2
inhibitors (dapagliflozin or empagliflozin) as foundational GDMT for all HF patients regardless of
EF, including HFrEF and HFpEF. While sacubitril/valsartan (ARNI) is also GDMT, it typically
replaces ACEi/ARB rather than being "added." Hydralazine/isosorbide is reserved for Black
patients or ACEi-intolerant patients. Ivabradine is for stable HFrEF with HR ≥70 bpm on
maximally tolerated beta-blocker.*
---
* *Q2 (Cardiovascular – Heart Failure):** A nurse is assessing a patient with left-sided heart
failure. Which finding is most consistent with this condition?
) Jugular venous distension
A
B) Hepatomegaly
C) Crackles in lung bases
,D) Dependent edema
* *[CORRECT]** C
*Rationale: Left-sided heart failure causes pulmonary congestion, resulting in crackles in the
lung bases, orthopnea, and paroxysmal nocturnal dyspnea. Jugular venous distension,
hepatomegaly, and dependent edema are classic signs of right-sided heart failure due to
systemic venous congestion. The distinction between left and right HF signs is critical for
accurate assessment and intervention.*
---
* *Q3 (Cardiovascular – Heart Failure):** A patient on digoxin has a serum digoxin level of 2.8
ng/mL (therapeutic: 0.5–0.9 ng/mL). Which assessment finding would the nurse expect?
) Bradycardia and visual disturbances
A
B) Tachycardia and hypertension
C) Hyperkalemia and muscle weakness
D) Hypoglycemia and confusion
* *[CORRECT]** A
*Rationale: Digoxin toxicity (levels >2.0 ng/mL) manifests with cardiac effects (bradycardia,
various dysrhythmias) and non-cardiac effects including nausea, vomiting, and visual
disturbances (yellow-green halos, blurred vision). Hypokalemia increases digoxin toxicity risk.
Tachycardia is not typical; digoxin slows AV nodal conduction. The nurse should hold the next
dose and notify the provider.*
---
* *Q4 (Cardiovascular – CAD/MI):** A 58-year-old male reports chest pain described as
"pressure" radiating to the left arm, lasting 15 minutes, unrelieved by rest. His troponin I is 0.8
ng/mL (normal <0.04). Which diagnosis is most likely?
) Stable angina
A
B) Unstable angina
C) NSTEMI
D) STEMI
* *[CORRECT]** C
*Rationale: NSTEMI is characterized by elevated cardiac biomarkers (troponin) without
ST-segment elevation on ECG. The elevated troponin I (0.8 ng/mL) differentiates NSTEMI from
unstable angina (no biomarker elevation). Stable angina is relieved by rest or nitroglycerin.
STEMI requires ST-segment elevation; further ECG assessment would confirm. The 15-minute
duration and radiation pattern are consistent with acute coronary syndrome.*
,---
* *Q5 (Cardiovascular – CAD/MI):** During a STEMI, which ECG change indicates transmural
myocardial injury?
) T-wave inversion
A
B) ST-segment depression
C) ST-segment elevation
D) Pathologic Q waves
* *[CORRECT]** C
*Rationale: ST-segment elevation indicates acute transmural (full-thickness) myocardial injury
and is the hallmark of STEMI, requiring emergent reperfusion therapy within 90 minutes of first
medical contact. T-wave inversion and ST depression indicate ischemia. Pathologic Q waves
develop hours to days later and indicate completed necrosis (infarction), not acute injury. Time
is muscle in STEMI management.*
---
* *Q6 (Cardiovascular – CAD/MI):** A patient with an acute MI is receiving thrombolytic therapy.
Which finding during therapy requires immediate nursing intervention?
) Blood pressure 148/92 mmHg
A
B) Occasional premature ventricular contractions
C) Sudden severe headache with altered mental status
D) Mild nausea after eating
* *[CORRECT]** C
*Rationale: Sudden severe headache with altered mental status during thrombolytic therapy
suggests intracranial hemorrhage, the most serious complication of fibrinolytics. This requires
immediate discontinuation of the infusion and emergency neuroimaging. PVCs are common
post-MI. Hypertension and mild nausea do not require immediate intervention. The nurse must
monitor for bleeding at all sites during thrombolysis.*
---
* *Q7 (Cardiovascular – Dysrhythmias):** A patient in atrial fibrillation with rapid ventricular
response has a heart rate of 154 bpm and BP 88/52 mmHg. What is the priority intervention?
) Administer IV diltiazem
A
B) Administer IV metoprolol
C) Perform synchronized cardioversion
D) Administer IV heparin bolus
, * *[CORRECT]** C
*Rationale: Unstable atrial fibrillation with hypotension (SBP <90 mmHg) and signs of poor
perfusion requires immediate synchronized cardioversion (100–200 J biphasic) rather than rate
control medications, which could worsen hypotension. Diltiazem and metoprolol are
contraindicated in unstable patients. Heparin is important for stroke prevention but does not
address the immediate hemodynamic instability. The ACLS protocol prioritizes cardioversion for
unstable tachyarrhythmias.*
---
* *Q8 (Cardiovascular – Dysrhythmias):** A patient on telemetry develops ventricular tachycardia
with a pulse and BP 78/40 mmHg. What is the nurse's first action?
) Defibrillate immediately
A
B) Administer IV amiodarone 300 mg push
C) Prepare for synchronized cardioversion
D) Start CPR
* *[CORRECT]** C
*Rationale: Pulseless VT requires defibrillation and CPR, but VT with a pulse and hemodynamic
compromise (SBP <90 mmHg, altered mental status, signs of shock) requires synchronized
cardioversion (100 J initially). Amiodarone is used for stable VT or after cardioversion if the
rhythm persists. The presence of a pulse eliminates the need for CPR. Synchronized
cardioversion avoids the vulnerable period of the T-wave.*
---
* *Q9 (Cardiovascular – Dysrhythmias):** A patient with a new permanent pacemaker asks when
they can resume driving. What is the nurse's best response?
) "You can drive immediately as long as you feel well."
A
B) "You should not drive for at least 1 week and must avoid raising your left arm above shoulder
level for 4–6 weeks."
C) "You can drive short distances after 48 hours."
D) "You must wait 3 months before driving again."
* *[CORRECT]** B
*Rationale: After pacemaker insertion, patients should avoid driving for at least 1 week and must
not raise the ipsilateral arm above shoulder level for 4–6 weeks to prevent lead dislodgement.
The incision site must heal, and lead stability must be confirmed. Driving restrictions may be
longer if the patient experienced syncope prior to implantation. The nurse should also advise
against MRI compatibility checks and carrying cell phones in the breast pocket on the
pacemaker side.*
N
2026-2027 | Medical-Surgical
Nursing II Review | Galen
College | 100% Verified Q&A |
Grade A | Pass Guaranteed
* *Q1 (Cardiovascular – Heart Failure):** A 72-year-old male with HFrEF (EF 35%) presents with
worsening dyspnea, 3+ pitting edema, and weight gain of 4 lbs in 2 days. His current
medications include metoprolol, lisinopril, furosemide, and digoxin. Which medication class
should be added to his regimen per the 2026 GDMT guidelines?
) Hydralazine/isosorbide dinitrate
A
B) SGLT2 inhibitor
C) Ivabradine
D) Sacubitril/valsartan
* *[CORRECT]** B
*Rationale: The 2026 ACC/AHA/HFSA heart failure guidelines now recommend SGLT2
inhibitors (dapagliflozin or empagliflozin) as foundational GDMT for all HF patients regardless of
EF, including HFrEF and HFpEF. While sacubitril/valsartan (ARNI) is also GDMT, it typically
replaces ACEi/ARB rather than being "added." Hydralazine/isosorbide is reserved for Black
patients or ACEi-intolerant patients. Ivabradine is for stable HFrEF with HR ≥70 bpm on
maximally tolerated beta-blocker.*
---
* *Q2 (Cardiovascular – Heart Failure):** A nurse is assessing a patient with left-sided heart
failure. Which finding is most consistent with this condition?
) Jugular venous distension
A
B) Hepatomegaly
C) Crackles in lung bases
,D) Dependent edema
* *[CORRECT]** C
*Rationale: Left-sided heart failure causes pulmonary congestion, resulting in crackles in the
lung bases, orthopnea, and paroxysmal nocturnal dyspnea. Jugular venous distension,
hepatomegaly, and dependent edema are classic signs of right-sided heart failure due to
systemic venous congestion. The distinction between left and right HF signs is critical for
accurate assessment and intervention.*
---
* *Q3 (Cardiovascular – Heart Failure):** A patient on digoxin has a serum digoxin level of 2.8
ng/mL (therapeutic: 0.5–0.9 ng/mL). Which assessment finding would the nurse expect?
) Bradycardia and visual disturbances
A
B) Tachycardia and hypertension
C) Hyperkalemia and muscle weakness
D) Hypoglycemia and confusion
* *[CORRECT]** A
*Rationale: Digoxin toxicity (levels >2.0 ng/mL) manifests with cardiac effects (bradycardia,
various dysrhythmias) and non-cardiac effects including nausea, vomiting, and visual
disturbances (yellow-green halos, blurred vision). Hypokalemia increases digoxin toxicity risk.
Tachycardia is not typical; digoxin slows AV nodal conduction. The nurse should hold the next
dose and notify the provider.*
---
* *Q4 (Cardiovascular – CAD/MI):** A 58-year-old male reports chest pain described as
"pressure" radiating to the left arm, lasting 15 minutes, unrelieved by rest. His troponin I is 0.8
ng/mL (normal <0.04). Which diagnosis is most likely?
) Stable angina
A
B) Unstable angina
C) NSTEMI
D) STEMI
* *[CORRECT]** C
*Rationale: NSTEMI is characterized by elevated cardiac biomarkers (troponin) without
ST-segment elevation on ECG. The elevated troponin I (0.8 ng/mL) differentiates NSTEMI from
unstable angina (no biomarker elevation). Stable angina is relieved by rest or nitroglycerin.
STEMI requires ST-segment elevation; further ECG assessment would confirm. The 15-minute
duration and radiation pattern are consistent with acute coronary syndrome.*
,---
* *Q5 (Cardiovascular – CAD/MI):** During a STEMI, which ECG change indicates transmural
myocardial injury?
) T-wave inversion
A
B) ST-segment depression
C) ST-segment elevation
D) Pathologic Q waves
* *[CORRECT]** C
*Rationale: ST-segment elevation indicates acute transmural (full-thickness) myocardial injury
and is the hallmark of STEMI, requiring emergent reperfusion therapy within 90 minutes of first
medical contact. T-wave inversion and ST depression indicate ischemia. Pathologic Q waves
develop hours to days later and indicate completed necrosis (infarction), not acute injury. Time
is muscle in STEMI management.*
---
* *Q6 (Cardiovascular – CAD/MI):** A patient with an acute MI is receiving thrombolytic therapy.
Which finding during therapy requires immediate nursing intervention?
) Blood pressure 148/92 mmHg
A
B) Occasional premature ventricular contractions
C) Sudden severe headache with altered mental status
D) Mild nausea after eating
* *[CORRECT]** C
*Rationale: Sudden severe headache with altered mental status during thrombolytic therapy
suggests intracranial hemorrhage, the most serious complication of fibrinolytics. This requires
immediate discontinuation of the infusion and emergency neuroimaging. PVCs are common
post-MI. Hypertension and mild nausea do not require immediate intervention. The nurse must
monitor for bleeding at all sites during thrombolysis.*
---
* *Q7 (Cardiovascular – Dysrhythmias):** A patient in atrial fibrillation with rapid ventricular
response has a heart rate of 154 bpm and BP 88/52 mmHg. What is the priority intervention?
) Administer IV diltiazem
A
B) Administer IV metoprolol
C) Perform synchronized cardioversion
D) Administer IV heparin bolus
, * *[CORRECT]** C
*Rationale: Unstable atrial fibrillation with hypotension (SBP <90 mmHg) and signs of poor
perfusion requires immediate synchronized cardioversion (100–200 J biphasic) rather than rate
control medications, which could worsen hypotension. Diltiazem and metoprolol are
contraindicated in unstable patients. Heparin is important for stroke prevention but does not
address the immediate hemodynamic instability. The ACLS protocol prioritizes cardioversion for
unstable tachyarrhythmias.*
---
* *Q8 (Cardiovascular – Dysrhythmias):** A patient on telemetry develops ventricular tachycardia
with a pulse and BP 78/40 mmHg. What is the nurse's first action?
) Defibrillate immediately
A
B) Administer IV amiodarone 300 mg push
C) Prepare for synchronized cardioversion
D) Start CPR
* *[CORRECT]** C
*Rationale: Pulseless VT requires defibrillation and CPR, but VT with a pulse and hemodynamic
compromise (SBP <90 mmHg, altered mental status, signs of shock) requires synchronized
cardioversion (100 J initially). Amiodarone is used for stable VT or after cardioversion if the
rhythm persists. The presence of a pulse eliminates the need for CPR. Synchronized
cardioversion avoids the vulnerable period of the T-wave.*
---
* *Q9 (Cardiovascular – Dysrhythmias):** A patient with a new permanent pacemaker asks when
they can resume driving. What is the nurse's best response?
) "You can drive immediately as long as you feel well."
A
B) "You should not drive for at least 1 week and must avoid raising your left arm above shoulder
level for 4–6 weeks."
C) "You can drive short distances after 48 hours."
D) "You must wait 3 months before driving again."
* *[CORRECT]** B
*Rationale: After pacemaker insertion, patients should avoid driving for at least 1 week and must
not raise the ipsilateral arm above shoulder level for 4–6 weeks to prevent lead dislodgement.
The incision site must heal, and lead stability must be confirmed. Driving restrictions may be
longer if the patient experienced syncope prior to implantation. The nurse should also advise
against MRI compatibility checks and carrying cell phones in the breast pocket on the
pacemaker side.*
