NUR 265 EXAM 1 (GALEN) NEWEST 2025 TEST BANK|
NUR256 ADVANCED CONCEPTS OF MEDICAL-
SURGICAL NURSING EXAM 1 REVIEW WITH 350 REAL
EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED A+ (MOST
RECENT!!)
1. A patient with acute decompensated heart failure has crackles
in both lungs, an S3 gallop, and oxygen saturation of 88% on
room air. Which intervention should the nurse implement first?
a) Administer IV furosemide
b) Place the patient in high-Fowler’s position
c) Start a dopamine infusion
d) Obtain a stat chest x-ray
Answer: b) Place the patient in high-Fowler’s position
Rationale: High-Fowler’s position reduces preload and improves
ventilation, providing immediate relief of dyspnea. Airway and
breathing come before medications or diagnostics.
2. A patient with cardiogenic shock has a pulmonary artery
catheter. Which finding indicates improvement?
1
,a) Cardiac index (CI) increased from 1.6 to 2.8 L/min/m²
b) Systemic vascular resistance (SVR) increased from 800 to
1200 dynes/sec/cm⁻⁵
c) Pulmonary artery wedge pressure (PAWP) increased from 18
to 24 mmHg
d) Mixed venous oxygen saturation (SvO₂) decreased from 70%
to 55%
Answer: a) Cardiac index increased from 1.6 to 2.8 L/min/m²
Rationale: Normal CI is 2.5–4.0 L/min/m². An increase indicates
improved cardiac output. Elevated SVR and PAWP suggest
worsening failure. Decreased SvO₂ indicates increased oxygen
extraction (worse).
3. A patient with new-onset atrial fibrillation with rapid
ventricular response (heart rate 150 bpm) has a blood pressure
of 85/50 mmHg and reports chest pain. What is the priority
action?
a) Administer oral metoprolol
b) Prepare for synchronized cardioversion
c) Start a heparin drip
d) Give IV digoxin
2
,Answer: b) Prepare for synchronized cardioversion
Rationale: Unstable atrial fibrillation (hypotension, chest pain)
requires immediate synchronized cardioversion. Medications are
for stable patients.
4. The nurse is caring for a patient receiving IV norepinephrine.
The IV site in the right forearm appears pale and cold. What
should the nurse do first?
a) Apply a warm compress
b) Stop the infusion immediately
c) Slow the infusion rate
d) Notify the provider
Answer: b) Stop the infusion immediately
Rationale: Pallor and coldness indicate possible extravasation or
severe vasoconstriction, risking tissue necrosis. Stop infusion first,
then notify provider and consider phentolamine.
5. A patient with an anterior wall myocardial infarction develops
new-onset hypotension and a murmur. Which complication should
the nurse suspect?
a) Pericarditis
3
, b) Ventricular septal rupture
c) Pulmonary embolism
d) Aortic stenosis
Answer: b) Ventricular septal rupture
Rationale: Ventricular septal rupture causes a harsh holosystolic
murmur and sudden hemodynamic compromise, often 3–7 days
post-AMI, especially with anterior MI.
6. The nurse notes a widened QRS complex on the monitor of a
patient with hyperkalemia. Which medication should be
prepared?
a) Calcium gluconate
b) Sodium polystyrene sulfonate
c) Insulin and dextrose
d) Furosemide
Answer: a) Calcium gluconate
Rationale: Calcium gluconate stabilizes cardiac membranes to
prevent ventricular dysrhythmias in severe hyperkalemia. It does
not lower potassium but buys time.
4
NUR256 ADVANCED CONCEPTS OF MEDICAL-
SURGICAL NURSING EXAM 1 REVIEW WITH 350 REAL
EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED A+ (MOST
RECENT!!)
1. A patient with acute decompensated heart failure has crackles
in both lungs, an S3 gallop, and oxygen saturation of 88% on
room air. Which intervention should the nurse implement first?
a) Administer IV furosemide
b) Place the patient in high-Fowler’s position
c) Start a dopamine infusion
d) Obtain a stat chest x-ray
Answer: b) Place the patient in high-Fowler’s position
Rationale: High-Fowler’s position reduces preload and improves
ventilation, providing immediate relief of dyspnea. Airway and
breathing come before medications or diagnostics.
2. A patient with cardiogenic shock has a pulmonary artery
catheter. Which finding indicates improvement?
1
,a) Cardiac index (CI) increased from 1.6 to 2.8 L/min/m²
b) Systemic vascular resistance (SVR) increased from 800 to
1200 dynes/sec/cm⁻⁵
c) Pulmonary artery wedge pressure (PAWP) increased from 18
to 24 mmHg
d) Mixed venous oxygen saturation (SvO₂) decreased from 70%
to 55%
Answer: a) Cardiac index increased from 1.6 to 2.8 L/min/m²
Rationale: Normal CI is 2.5–4.0 L/min/m². An increase indicates
improved cardiac output. Elevated SVR and PAWP suggest
worsening failure. Decreased SvO₂ indicates increased oxygen
extraction (worse).
3. A patient with new-onset atrial fibrillation with rapid
ventricular response (heart rate 150 bpm) has a blood pressure
of 85/50 mmHg and reports chest pain. What is the priority
action?
a) Administer oral metoprolol
b) Prepare for synchronized cardioversion
c) Start a heparin drip
d) Give IV digoxin
2
,Answer: b) Prepare for synchronized cardioversion
Rationale: Unstable atrial fibrillation (hypotension, chest pain)
requires immediate synchronized cardioversion. Medications are
for stable patients.
4. The nurse is caring for a patient receiving IV norepinephrine.
The IV site in the right forearm appears pale and cold. What
should the nurse do first?
a) Apply a warm compress
b) Stop the infusion immediately
c) Slow the infusion rate
d) Notify the provider
Answer: b) Stop the infusion immediately
Rationale: Pallor and coldness indicate possible extravasation or
severe vasoconstriction, risking tissue necrosis. Stop infusion first,
then notify provider and consider phentolamine.
5. A patient with an anterior wall myocardial infarction develops
new-onset hypotension and a murmur. Which complication should
the nurse suspect?
a) Pericarditis
3
, b) Ventricular septal rupture
c) Pulmonary embolism
d) Aortic stenosis
Answer: b) Ventricular septal rupture
Rationale: Ventricular septal rupture causes a harsh holosystolic
murmur and sudden hemodynamic compromise, often 3–7 days
post-AMI, especially with anterior MI.
6. The nurse notes a widened QRS complex on the monitor of a
patient with hyperkalemia. Which medication should be
prepared?
a) Calcium gluconate
b) Sodium polystyrene sulfonate
c) Insulin and dextrose
d) Furosemide
Answer: a) Calcium gluconate
Rationale: Calcium gluconate stabilizes cardiac membranes to
prevent ventricular dysrhythmias in severe hyperkalemia. It does
not lower potassium but buys time.
4
