NUR242 Medical-Surgical Nursing Exam 4 2026/2027 –
Complete Exam- Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
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SECTION 1: CARDIOVASCULAR DISORDERS (Q1–Q14)
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Question 1
A nurse is reviewing the medication list for a patient with chronic heart failure. Which
medication classification works by blocking aldosterone to reduce fibrosis and
remodeling of the heart?
A. Angiotensin-converting enzyme (ACE) inhibitor
B. Beta-adrenergic blocker
C. Aldosterone antagonist ✓
D. Loop diuretic
Correct Answer: C
Rationale:
Aldosterone antagonists such as spironolactone and eplerenone block aldosterone at
receptor sites, which decreases myocardial fibrosis and adverse ventricular remodeling
in heart failure. ACE inhibitors block angiotensin II formation, beta blockers reduce
sympathetic stimulation, and loop diuretics promote fluid excretion without direct
anti-aldosterone cardiac effects.
Question 2
A patient presents to the emergency department with crushing substernal chest pain
radiating to the left arm. The nurse understands that myocardial tissue death occurs
because of which primary pathophysiological mechanism?
,A. Coronary artery vasospasm without occlusion
B. Prolonged ischemia leading to irreversible cellular damage ✓
C. Acute elevation of systemic blood pressure
D. Rapid ventricular dysrhythmia causing pump failure
Correct Answer: B
Rationale:
Myocardial infarction occurs when coronary blood flow is insufficient to meet oxygen
demands, resulting in prolonged ischemia that causes irreversible necrosis of cardiac
muscle cells. Coronary vasospasm may contribute but does not fully explain tissue
death, while acute hypertension and rapid dysrhythmias are complications rather than
primary mechanisms of infarction.
Question 3
A 68-year-old patient with a history of heart failure is admitted with increasing dyspnea
and 3+ pitting edema in the lower extremities. Which assessment finding requires the
most immediate nursing intervention?
A. Weight gain of 2 pounds over one week
B. Crackles audible at the lung bases bilaterally ✓
C. Mild fatigue with activity
D. Jugular venous distention at 30 degrees
Correct Answer: B
Rationale:
Bilateral crackles at the lung bases indicate acute pulmonary edema from worsening
left ventricular failure, which threatens oxygenation and requires immediate intervention
such as positioning, oxygen administration, and notification of the provider. While
weight gain, fatigue, and JVD are concerning findings in heart failure, pulmonary
crackles represent acute respiratory compromise and are the highest priority.
Question 4
,A patient on the telemetry unit suddenly develops a heart rate of 160 beats per minute
with a regular narrow-complex rhythm. The patient is alert with a blood pressure of
98/60 mmHg. Which is the nurse's priority action?
A. Prepare for immediate synchronized cardioversion
B. Administer adenosine 6 mg rapid IV push ✓
C. Apply supplemental oxygen at 4 L via nasal cannula
D. Insert a nasogastric tube for decompression
Correct Answer: B
Rationale:
Adenosine is the first-line medication for stable supraventricular tachycardia (SVT)
because it interrupts reentry pathways through the AV node and often restores normal
sinus rhythm. Synchronized cardioversion is reserved for unstable patients,
supplemental oxygen is not indicated without hypoxemia, and nasogastric insertion is
unrelated to the dysrhythmia.
Question 5
A 72-year-old patient with acute decompensated heart failure and a new diagnosis of
acute kidney injury is receiving furosemide 80 mg IV twice daily and metolazone 5 mg
daily. The nurse notes a serum potassium of 2.8 mEq/L and a serum creatinine of 2.4
mg/dL. Which collaborative intervention should the nurse anticipate as the priority?
A. Increase the furosemide dose to promote renal perfusion
B. Discontinue the metolazone and administer potassium replacement ✓
C. Add spironolactone to enhance diuresis
D. Initiate hemodialysis immediately
Correct Answer: B
Rationale:
The combination of a loop diuretic and a thiazide diuretic in a patient with acute kidney
injury places the patient at severe risk for hypokalemia and worsening renal function;
, discontinuing the metolazone and replacing potassium addresses life-threatening
electrolyte imbalance and nephrotoxic synergy. Increasing furosemide worsens renal
perfusion, adding spironolactone is inappropriate with acute kidney injury, and dialysis is
not yet indicated.
Question 6
A nurse is teaching a patient newly diagnosed with hypertension about lifestyle
modifications. Which statement by the patient indicates correct understanding of the
Dietary Approaches to Stop Hypertension (DASH) eating plan?
A. "I should increase my intake of processed meats and canned soups."
B. "I will limit my sodium intake to no more than 2,300 mg per day." ✓
C. "I need to eliminate all carbohydrates from my diet."
D. "I should avoid all dairy products because they contain too much salt."
Correct Answer: B
Rationale:
The DASH diet emphasizes fruits, vegetables, whole grains, low-fat dairy, and lean
proteins while limiting sodium to 2,300 mg per day (or 1,500 mg for greater effect).
Processed meats and canned soups are high in sodium, carbohydrates are not
eliminated, and low-fat dairy is encouraged as part of the plan.
Question 7
A patient with coronary artery disease who underwent percutaneous coronary
intervention (PCI) with stent placement yesterday reports sudden severe chest pain and
diaphoresis. The 12-lead ECG shows ST-segment elevation in leads V1 through V4.
Which complication should the nurse recognize as most likely?
A. Post-pericardiotomy syndrome
B. Acute stent thrombosis with recurrent myocardial infarction ✓
C. Stable angina pectoris
D. Costochondritis
Complete Exam- Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
──────────────────────────────
SECTION 1: CARDIOVASCULAR DISORDERS (Q1–Q14)
──────────────────────────────
Question 1
A nurse is reviewing the medication list for a patient with chronic heart failure. Which
medication classification works by blocking aldosterone to reduce fibrosis and
remodeling of the heart?
A. Angiotensin-converting enzyme (ACE) inhibitor
B. Beta-adrenergic blocker
C. Aldosterone antagonist ✓
D. Loop diuretic
Correct Answer: C
Rationale:
Aldosterone antagonists such as spironolactone and eplerenone block aldosterone at
receptor sites, which decreases myocardial fibrosis and adverse ventricular remodeling
in heart failure. ACE inhibitors block angiotensin II formation, beta blockers reduce
sympathetic stimulation, and loop diuretics promote fluid excretion without direct
anti-aldosterone cardiac effects.
Question 2
A patient presents to the emergency department with crushing substernal chest pain
radiating to the left arm. The nurse understands that myocardial tissue death occurs
because of which primary pathophysiological mechanism?
,A. Coronary artery vasospasm without occlusion
B. Prolonged ischemia leading to irreversible cellular damage ✓
C. Acute elevation of systemic blood pressure
D. Rapid ventricular dysrhythmia causing pump failure
Correct Answer: B
Rationale:
Myocardial infarction occurs when coronary blood flow is insufficient to meet oxygen
demands, resulting in prolonged ischemia that causes irreversible necrosis of cardiac
muscle cells. Coronary vasospasm may contribute but does not fully explain tissue
death, while acute hypertension and rapid dysrhythmias are complications rather than
primary mechanisms of infarction.
Question 3
A 68-year-old patient with a history of heart failure is admitted with increasing dyspnea
and 3+ pitting edema in the lower extremities. Which assessment finding requires the
most immediate nursing intervention?
A. Weight gain of 2 pounds over one week
B. Crackles audible at the lung bases bilaterally ✓
C. Mild fatigue with activity
D. Jugular venous distention at 30 degrees
Correct Answer: B
Rationale:
Bilateral crackles at the lung bases indicate acute pulmonary edema from worsening
left ventricular failure, which threatens oxygenation and requires immediate intervention
such as positioning, oxygen administration, and notification of the provider. While
weight gain, fatigue, and JVD are concerning findings in heart failure, pulmonary
crackles represent acute respiratory compromise and are the highest priority.
Question 4
,A patient on the telemetry unit suddenly develops a heart rate of 160 beats per minute
with a regular narrow-complex rhythm. The patient is alert with a blood pressure of
98/60 mmHg. Which is the nurse's priority action?
A. Prepare for immediate synchronized cardioversion
B. Administer adenosine 6 mg rapid IV push ✓
C. Apply supplemental oxygen at 4 L via nasal cannula
D. Insert a nasogastric tube for decompression
Correct Answer: B
Rationale:
Adenosine is the first-line medication for stable supraventricular tachycardia (SVT)
because it interrupts reentry pathways through the AV node and often restores normal
sinus rhythm. Synchronized cardioversion is reserved for unstable patients,
supplemental oxygen is not indicated without hypoxemia, and nasogastric insertion is
unrelated to the dysrhythmia.
Question 5
A 72-year-old patient with acute decompensated heart failure and a new diagnosis of
acute kidney injury is receiving furosemide 80 mg IV twice daily and metolazone 5 mg
daily. The nurse notes a serum potassium of 2.8 mEq/L and a serum creatinine of 2.4
mg/dL. Which collaborative intervention should the nurse anticipate as the priority?
A. Increase the furosemide dose to promote renal perfusion
B. Discontinue the metolazone and administer potassium replacement ✓
C. Add spironolactone to enhance diuresis
D. Initiate hemodialysis immediately
Correct Answer: B
Rationale:
The combination of a loop diuretic and a thiazide diuretic in a patient with acute kidney
injury places the patient at severe risk for hypokalemia and worsening renal function;
, discontinuing the metolazone and replacing potassium addresses life-threatening
electrolyte imbalance and nephrotoxic synergy. Increasing furosemide worsens renal
perfusion, adding spironolactone is inappropriate with acute kidney injury, and dialysis is
not yet indicated.
Question 6
A nurse is teaching a patient newly diagnosed with hypertension about lifestyle
modifications. Which statement by the patient indicates correct understanding of the
Dietary Approaches to Stop Hypertension (DASH) eating plan?
A. "I should increase my intake of processed meats and canned soups."
B. "I will limit my sodium intake to no more than 2,300 mg per day." ✓
C. "I need to eliminate all carbohydrates from my diet."
D. "I should avoid all dairy products because they contain too much salt."
Correct Answer: B
Rationale:
The DASH diet emphasizes fruits, vegetables, whole grains, low-fat dairy, and lean
proteins while limiting sodium to 2,300 mg per day (or 1,500 mg for greater effect).
Processed meats and canned soups are high in sodium, carbohydrates are not
eliminated, and low-fat dairy is encouraged as part of the plan.
Question 7
A patient with coronary artery disease who underwent percutaneous coronary
intervention (PCI) with stent placement yesterday reports sudden severe chest pain and
diaphoresis. The 12-lead ECG shows ST-segment elevation in leads V1 through V4.
Which complication should the nurse recognize as most likely?
A. Post-pericardiotomy syndrome
B. Acute stent thrombosis with recurrent myocardial infarction ✓
C. Stable angina pectoris
D. Costochondritis
