Herzing University Med-Surg Final Exam 2026 Questions & Verified
Answers Comprehensive Nursing Review
EXAM 1: CARDIAC & CARDIOVASCULAR DISORDERS (Questions 1-35)
Question 1
A client with acute decompensated heart failure presents with severe dyspnea,
pink frothy sputum, and crackles in all lung fields. Which intervention should the
nurse implement FIRST?
A) Administer morphine sulfate IV
B) Place the client in high-Fowler's position
C) Give furosemide IV push
D) Start a nitroglycerin drip
Answer: B
Rationale: High-Fowler's position uses gravity to reduce preload and improve gas
exchange. Positioning comes before medications unless the patient is pulseless.
This immediate action helps redistribute fluid from the lungs to dependent areas.
Morphine, diuretics, and vasodilators follow quickly, but position is the priority
first action.
,Question 2
A patient with acute myocardial infarction (STEMI) is receiving thrombolytic
therapy. Which finding requires immediate intervention?
A) Mild headache
B) Facial droop and slurred speech
C) Nausea
D) Sinus tachycardia at 102 bpm
Answer: B
Rationale: Thrombolytics (e.g., alteplase) increase the risk of intracranial
hemorrhage (ICH). Facial droop and slurred speech are signs of stroke, a life-
threatening complication. Immediate neurologic assessment and CT scan are
required. Mild headache may be benign, but new focal neurologic deficits are red
flags per AHA/ACC STEMI guidelines.
Question 3
The nurse is caring for a patient with acute decompensated heart failure (ADHF)
and crackles in all lung fields. Which medication should the nurse anticipate
administering first?
,A) Metoprolol
B) Furosemide
C) Lisinopril
D) Spironolactone
Answer: B
Rationale: Furosemide (loop diuretic) is first-line for acute pulmonary edema in
ADHF to reduce preload and fluid overload. Beta-blockers (metoprolol) and ACE
inhibitors (lisinopril) are contraindicated in acute decompensation due to negative
inotropy and hypotension risk. Spironolactone is a potassium-sparing diuretic
used for chronic management, not acute rescue.
Question 4
A client returns to the surgical unit after an open cholecystectomy. Six hours later,
the nurse notes a heart rate of 122 bpm, BP 98/62 mmHg, and cool, clammy skin.
What is the priority action?
A) Increase the IV fluid rate
B) Assess the surgical dressing for bleeding
, C) Notify the provider immediately
D) Recheck vital signs in 15 minutes
Answer: B
Rationale: Tachycardia, hypotension, and cool skin suggest hypovolemic shock
from possible postoperative bleeding. The nurse must first assess the dressing
and surgical site for visible blood loss, then notify the provider, increase fluids,
and possibly prepare for a return to the OR.
Question 5
A client with infective endocarditis is admitted. What is the priority nursing
intervention?
A) Administer antipyretics as ordered
B) Obtain at least two sets of blood cultures before initiating antibiotics
C) Place the client on fluid restrictions
D) Monitor for signs of heart failure
Answer: B
Answers Comprehensive Nursing Review
EXAM 1: CARDIAC & CARDIOVASCULAR DISORDERS (Questions 1-35)
Question 1
A client with acute decompensated heart failure presents with severe dyspnea,
pink frothy sputum, and crackles in all lung fields. Which intervention should the
nurse implement FIRST?
A) Administer morphine sulfate IV
B) Place the client in high-Fowler's position
C) Give furosemide IV push
D) Start a nitroglycerin drip
Answer: B
Rationale: High-Fowler's position uses gravity to reduce preload and improve gas
exchange. Positioning comes before medications unless the patient is pulseless.
This immediate action helps redistribute fluid from the lungs to dependent areas.
Morphine, diuretics, and vasodilators follow quickly, but position is the priority
first action.
,Question 2
A patient with acute myocardial infarction (STEMI) is receiving thrombolytic
therapy. Which finding requires immediate intervention?
A) Mild headache
B) Facial droop and slurred speech
C) Nausea
D) Sinus tachycardia at 102 bpm
Answer: B
Rationale: Thrombolytics (e.g., alteplase) increase the risk of intracranial
hemorrhage (ICH). Facial droop and slurred speech are signs of stroke, a life-
threatening complication. Immediate neurologic assessment and CT scan are
required. Mild headache may be benign, but new focal neurologic deficits are red
flags per AHA/ACC STEMI guidelines.
Question 3
The nurse is caring for a patient with acute decompensated heart failure (ADHF)
and crackles in all lung fields. Which medication should the nurse anticipate
administering first?
,A) Metoprolol
B) Furosemide
C) Lisinopril
D) Spironolactone
Answer: B
Rationale: Furosemide (loop diuretic) is first-line for acute pulmonary edema in
ADHF to reduce preload and fluid overload. Beta-blockers (metoprolol) and ACE
inhibitors (lisinopril) are contraindicated in acute decompensation due to negative
inotropy and hypotension risk. Spironolactone is a potassium-sparing diuretic
used for chronic management, not acute rescue.
Question 4
A client returns to the surgical unit after an open cholecystectomy. Six hours later,
the nurse notes a heart rate of 122 bpm, BP 98/62 mmHg, and cool, clammy skin.
What is the priority action?
A) Increase the IV fluid rate
B) Assess the surgical dressing for bleeding
, C) Notify the provider immediately
D) Recheck vital signs in 15 minutes
Answer: B
Rationale: Tachycardia, hypotension, and cool skin suggest hypovolemic shock
from possible postoperative bleeding. The nurse must first assess the dressing
and surgical site for visible blood loss, then notify the provider, increase fluids,
and possibly prepare for a return to the OR.
Question 5
A client with infective endocarditis is admitted. What is the priority nursing
intervention?
A) Administer antipyretics as ordered
B) Obtain at least two sets of blood cultures before initiating antibiotics
C) Place the client on fluid restrictions
D) Monitor for signs of heart failure
Answer: B
