NUR 265 EXAM 2 (GALEN) NEWEST 2025 TEST BANK|
NUR256 ADVANCED CONCEPTS OF MEDICAL
SURGICAL NURSING EXAM 2 REVIEW WITH 450 REAL
EXAM QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST RECENT!!)
1. A patient with acute decompensated heart failure (ADHF) has
crackles in all lung fields, S3 gallop, and SpO2 88% on 4 L
nasal cannula. Which intervention first?
A) Insert Foley catheter
B) Administer IV furosemide
C) Place patient in high Fowler's position
D) Draw BNP level
Answer: C
Rationale: High Fowler's position reduces preload and improves
V/Q matching, rapidly improving oxygenation before or with
diuretics.
2. A patient is in atrial fibrillation with ventricular rate 140 bpm,
BP 90/60 mm Hg. Which medication does the nurse anticipate?
A) Amiodarone IV
B) Metoprolol IV
C) Diltiazem IV
1
,D) Digoxin PO
Answer: C
Rationale: IV diltiazem provides rapid rate control in unstable
AF without severe hypotension. Amiodarone is for rhythm control.
3. Post-cardiac catheterization via femoral artery, patient
reports severe groin pain and rapidly expanding hematoma.
Priority action?
A) Apply sandbag to groin
B) Notify provider immediately
C) Check pedal pulses
D) Recheck PT/INR
Answer: B
Rationale: Expanding hematoma suggests retroperitoneal
bleeding or pseudoaneurysm – life-threatening. Immediate
provider notification is priority.
4. A patient with STEMI develops crackles in mid-lung fields,
SpO2 91%, BP 100/70 mm Hg. Suspected complication?
A) Cardiogenic shock
B) Acute heart failure (Killip class II)
C) Pulmonary embolism
D) Pericarditis
2
,Answer: B
Rationale: Crackles in >1/2 lung fields indicate pulmonary
congestion from LV dysfunction. Killip class II = heart failure with
rales.
5. Post-cardiac arrest with ROSC but unconscious. Which
targeted temperature management goal is appropriate?
A) 35-37°C for 12 hours
B) 32-36°C for 24 hours
C) 28-30°C for 48 hours
D) Normothermia only
Answer: B
Rationale: TTM at 32-36°C for 24 hours reduces cerebral
metabolic demand and inflammation after ROSC.
6. Heart failure patient with weight gain of 5 lbs in 3 days,
worsening dyspnea, JVD. Which medication first?
A) Oral metoprolol
B) IV furosemide
C) Oral spironolactone
D) IV dopamine
Answer: B
Rationale: Rapid diuresis reduces preload and relieves
3
, pulmonary congestion. Oral diuretics are too slow for acute
exacerbation.
7. Patient with Impella device has urine output 15 mL/hr over 2
hours. Most appropriate action?
A) Increase IV fluids
B) Notify provider and assess for hemolysis
C) Administer furosemide
D) Check blood glucose
Answer: B
Rationale: Impella can cause hemolysis leading to AKI. Low urine
output requires prompt evaluation of device function and kidney
perfusion.
8. Telemetry shows regular rhythm, no P waves, wide QRS (0.14
sec), rate 180 bpm, BP 80/50 mm Hg. Priority intervention?
A) Amiodarone IV push
B) Synchronized cardioversion
C) Defibrillation
D) Adenosine IV push
Answer: B
Rationale: Monomorphic VT with hypotension requires immediate
synchronized cardioversion. Defibrillation is for pulseless VT.
4
NUR256 ADVANCED CONCEPTS OF MEDICAL
SURGICAL NURSING EXAM 2 REVIEW WITH 450 REAL
EXAM QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST RECENT!!)
1. A patient with acute decompensated heart failure (ADHF) has
crackles in all lung fields, S3 gallop, and SpO2 88% on 4 L
nasal cannula. Which intervention first?
A) Insert Foley catheter
B) Administer IV furosemide
C) Place patient in high Fowler's position
D) Draw BNP level
Answer: C
Rationale: High Fowler's position reduces preload and improves
V/Q matching, rapidly improving oxygenation before or with
diuretics.
2. A patient is in atrial fibrillation with ventricular rate 140 bpm,
BP 90/60 mm Hg. Which medication does the nurse anticipate?
A) Amiodarone IV
B) Metoprolol IV
C) Diltiazem IV
1
,D) Digoxin PO
Answer: C
Rationale: IV diltiazem provides rapid rate control in unstable
AF without severe hypotension. Amiodarone is for rhythm control.
3. Post-cardiac catheterization via femoral artery, patient
reports severe groin pain and rapidly expanding hematoma.
Priority action?
A) Apply sandbag to groin
B) Notify provider immediately
C) Check pedal pulses
D) Recheck PT/INR
Answer: B
Rationale: Expanding hematoma suggests retroperitoneal
bleeding or pseudoaneurysm – life-threatening. Immediate
provider notification is priority.
4. A patient with STEMI develops crackles in mid-lung fields,
SpO2 91%, BP 100/70 mm Hg. Suspected complication?
A) Cardiogenic shock
B) Acute heart failure (Killip class II)
C) Pulmonary embolism
D) Pericarditis
2
,Answer: B
Rationale: Crackles in >1/2 lung fields indicate pulmonary
congestion from LV dysfunction. Killip class II = heart failure with
rales.
5. Post-cardiac arrest with ROSC but unconscious. Which
targeted temperature management goal is appropriate?
A) 35-37°C for 12 hours
B) 32-36°C for 24 hours
C) 28-30°C for 48 hours
D) Normothermia only
Answer: B
Rationale: TTM at 32-36°C for 24 hours reduces cerebral
metabolic demand and inflammation after ROSC.
6. Heart failure patient with weight gain of 5 lbs in 3 days,
worsening dyspnea, JVD. Which medication first?
A) Oral metoprolol
B) IV furosemide
C) Oral spironolactone
D) IV dopamine
Answer: B
Rationale: Rapid diuresis reduces preload and relieves
3
, pulmonary congestion. Oral diuretics are too slow for acute
exacerbation.
7. Patient with Impella device has urine output 15 mL/hr over 2
hours. Most appropriate action?
A) Increase IV fluids
B) Notify provider and assess for hemolysis
C) Administer furosemide
D) Check blood glucose
Answer: B
Rationale: Impella can cause hemolysis leading to AKI. Low urine
output requires prompt evaluation of device function and kidney
perfusion.
8. Telemetry shows regular rhythm, no P waves, wide QRS (0.14
sec), rate 180 bpm, BP 80/50 mm Hg. Priority intervention?
A) Amiodarone IV push
B) Synchronized cardioversion
C) Defibrillation
D) Adenosine IV push
Answer: B
Rationale: Monomorphic VT with hypotension requires immediate
synchronized cardioversion. Defibrillation is for pulseless VT.
4
