NUR 205 Final Examination ACTUAL
EXAM 2026/2027 | Medical-Surgical
Nursing Adult Health | Verified Q&A |
Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (25 Questions)
Q1: A 72-year-old patient with a history of heart failure with reduced ejection fraction (HFrEF, EF 35%) is
admitted with worsening dyspnea, jugular venous distension, and 3+ pitting edema in both lower
extremities. Current medications include lisinopril 20 mg daily, carvedilol 25 mg BID, and furosemide 40
mg BID. Vital signs: BP 102/68, HR 78, RR 24, SpO₂ 91% on 2L nasal cannula. BNP is 1,200 pg/mL. Which
nursing action is the highest priority?
A. Administer a PRN dose of IV morphine for dyspnea and anxiety
B. Request an order for a beta-blocker dose increase to reduce cardiac workload
C. Assess lung sounds and prepare for potential non-invasive positive pressure ventilation (NIPPV)
[CORRECT]
D. Increase the furosemide to 80 mg IV push per standing protocol
Correct Answer: C
Rationale: The patient has acute decompensated HF with respiratory distress (RR 24, SpO₂ 91%). Priority
according to ABCs is airway/breathing. Assessing lung sounds (crackles/rales indicates pulmonary
edema) and preparing for NIPPV (BiPAP) can improve ventilation and reduce work of breathing.
Morphine (A) was historically used but has fallen out of favor due to potential respiratory depression
and worse outcomes; it is not first-line priority. Beta-blocker dose increase (B) is contraindicated in
acute decompensation. Increasing furosemide (D) requires an order and is important but not higher
priority than addressing hypoxemia and impending respiratory failure. NCLEX Client Needs: Physiological
Integrity – Physiological Adaptation – Illness Management
Q2: A patient with chronic atrial fibrillation (AFib) is prescribed apixaban (Eliquis) 5 mg BID. The nurse is
reviewing the CHA₂DS₂-VASc score. Which finding requires immediate provider notification?
A. History of hypertension and diabetes (score 3)
B. History of heart failure and age 74 (score 4)
,C. Female patient age 65 with no other risk factors (score 2)
D. History of stroke/TIA 6 months ago (score 5) [CORRECT]
Correct Answer: D
Rationale: CHA₂DS₂-VASc scores ≥2 indicate need for anticoagulation; score ≥4 indicates high risk for
stroke. A history of stroke/TIA (2 points) combined with age 65-74 (1 point) and and female sex (1 point)
yields score 5, indicating very high stroke risk requiring vigilant anticoagulation adherence and
monitoring. While all patients with AFib need education, the score 5 patient is at highest risk for
recurrent stroke. NCLEX Client Needs: Physiological Integrity – Reduction of Risk Potential
Q3: Which ECG finding indicates to the nurse that transcutaneous pacing (TCP) may be needed
immediately?
A. Second-degree AV block Type I (Wenckebach) with PR interval prolongation
B. Complete heart Block (Third-degree AV block) with wide QRS escape rhythm at 28 bpm [CORRECT]
C. Second-degree AV block Type II with 2:1 conduction
D. First-degree AV block with PR interval 0.24 seconds
Correct Answer: B
Rationale: Complete heart Block (Third-degree AV block) with a wide QRS escape rhythm at 28 bpm
indicates severe bradycardia with hemodynamic compromise. TCP provides immediate temporary
pacing for symptomatic bradycardia when the escape rhythm is unreliable or <40 bpm. Other blocks are
not immediate pacing indications unless symptomatic. NCLEX Client Needs: Physiological Integrity –
Physiological Adaptation – Illness Management
Q4: A patient with NSTEMI is receiving heparin infusion and scheduled for cardiac catheterization in 2
hours. The nurse notes the aPTT is 120 seconds (control 30-40 seconds). Which action is most
appropriate?
A. Continue infusion and recheck aPTT in 2 hours
B. Stop infusion immediately and notify provider [CORRECT]
C. Stop infusion and recheck aPTT in 1 hour
D. Continue infusion but delay catheterization
Correct Answer: B
Rationale: aPTT >100 seconds indicates supratherapeutic heparin levels with high bleeding risk. The
infusion must be stopped immediately to prevent bleeding complications during catheterization. The
provider must be notified for protamine sulfate orders if needed. NCLEX Client Needs: Safe and Effective
Care Environment – Safety and Infection Control
, Q5: A patient with severe aortic stenosis reports syncope during exertion. The nurse should anticipate
which intervention as priority?
A. Surgical valve replacement evaluation [CORRECT]
B. Cardiac catheterization with balloon valvuloplasty
C. Start beta-blocker therapy to reduce myocardial oxygen demand
D. Monitor with serial echocardiograms only
Correct Answer: A
Rationale: Syncope in aortic stenosis indicates severe obstruction (valve area <1.0 cm² or mean gradient
>40 mmHg). This is a Class I indication for aortic valve replacement. Balloon valvuloplasty (B) provides
temporary relief only and is reserved for patients who are not surgical candidates. Beta-blockers (C) are
contraindicated in severe AS due to negative inotropy. NCLEX Client Needs: Physiological Integrity –
Physiological Adaptation – Illness Management
Q6: Which medication combination requires the nurse to monitor for hyperkalemia most closely?
A. Lisinopril, spironolactone, and potassium supplements [CORRECT]
B. Furosemide, hydrochlorothiazide, and digoxin
C. Metoprolol, amLODIPine, and atamsiatin
D. Clopidogrel, aspirin, and atorvastatin
Correct Answer: A
Rationale: ACE inhibitor (lisinopril) + potassium-sparing diuretic (spironolactone) + potassium
supplements creates triple risk for hyperkalemia. This combination is common in heart failure treatment
and requires frequent potassium monitoring and ECG surveillance for peaked T waves. NCLEX Client
Needs: Physiological Integrity – Pharmacological and Parenteral Therapies
Q7: A patient with peripheral artery disease (PAD) has an ABI of 0.78. Which teaching point is priority?
A. Exercise to the point of pain, rest, then resume [CORRECT]
B. Walk 30 minutes daily regardless of pain
C. Stop all exercise if leg pain occurs
D. Use heating pads on legs to improve circulation
Correct Answer: A
Rationale: ABI <0.90 confirms PAD. Supervised exercise to the point of claudication (pain), followed by
rest, then resuming walking promotes collateral circulation development. Walking through severe pain
(B) causes tissue damage. Stopping all exercise (C) prevents conditioning. Heating pads (D) can cause
burns in patients with decreased sensation. NCLEX Client Needs: Health Promotion and Maintenance
EXAM 2026/2027 | Medical-Surgical
Nursing Adult Health | Verified Q&A |
Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (25 Questions)
Q1: A 72-year-old patient with a history of heart failure with reduced ejection fraction (HFrEF, EF 35%) is
admitted with worsening dyspnea, jugular venous distension, and 3+ pitting edema in both lower
extremities. Current medications include lisinopril 20 mg daily, carvedilol 25 mg BID, and furosemide 40
mg BID. Vital signs: BP 102/68, HR 78, RR 24, SpO₂ 91% on 2L nasal cannula. BNP is 1,200 pg/mL. Which
nursing action is the highest priority?
A. Administer a PRN dose of IV morphine for dyspnea and anxiety
B. Request an order for a beta-blocker dose increase to reduce cardiac workload
C. Assess lung sounds and prepare for potential non-invasive positive pressure ventilation (NIPPV)
[CORRECT]
D. Increase the furosemide to 80 mg IV push per standing protocol
Correct Answer: C
Rationale: The patient has acute decompensated HF with respiratory distress (RR 24, SpO₂ 91%). Priority
according to ABCs is airway/breathing. Assessing lung sounds (crackles/rales indicates pulmonary
edema) and preparing for NIPPV (BiPAP) can improve ventilation and reduce work of breathing.
Morphine (A) was historically used but has fallen out of favor due to potential respiratory depression
and worse outcomes; it is not first-line priority. Beta-blocker dose increase (B) is contraindicated in
acute decompensation. Increasing furosemide (D) requires an order and is important but not higher
priority than addressing hypoxemia and impending respiratory failure. NCLEX Client Needs: Physiological
Integrity – Physiological Adaptation – Illness Management
Q2: A patient with chronic atrial fibrillation (AFib) is prescribed apixaban (Eliquis) 5 mg BID. The nurse is
reviewing the CHA₂DS₂-VASc score. Which finding requires immediate provider notification?
A. History of hypertension and diabetes (score 3)
B. History of heart failure and age 74 (score 4)
,C. Female patient age 65 with no other risk factors (score 2)
D. History of stroke/TIA 6 months ago (score 5) [CORRECT]
Correct Answer: D
Rationale: CHA₂DS₂-VASc scores ≥2 indicate need for anticoagulation; score ≥4 indicates high risk for
stroke. A history of stroke/TIA (2 points) combined with age 65-74 (1 point) and and female sex (1 point)
yields score 5, indicating very high stroke risk requiring vigilant anticoagulation adherence and
monitoring. While all patients with AFib need education, the score 5 patient is at highest risk for
recurrent stroke. NCLEX Client Needs: Physiological Integrity – Reduction of Risk Potential
Q3: Which ECG finding indicates to the nurse that transcutaneous pacing (TCP) may be needed
immediately?
A. Second-degree AV block Type I (Wenckebach) with PR interval prolongation
B. Complete heart Block (Third-degree AV block) with wide QRS escape rhythm at 28 bpm [CORRECT]
C. Second-degree AV block Type II with 2:1 conduction
D. First-degree AV block with PR interval 0.24 seconds
Correct Answer: B
Rationale: Complete heart Block (Third-degree AV block) with a wide QRS escape rhythm at 28 bpm
indicates severe bradycardia with hemodynamic compromise. TCP provides immediate temporary
pacing for symptomatic bradycardia when the escape rhythm is unreliable or <40 bpm. Other blocks are
not immediate pacing indications unless symptomatic. NCLEX Client Needs: Physiological Integrity –
Physiological Adaptation – Illness Management
Q4: A patient with NSTEMI is receiving heparin infusion and scheduled for cardiac catheterization in 2
hours. The nurse notes the aPTT is 120 seconds (control 30-40 seconds). Which action is most
appropriate?
A. Continue infusion and recheck aPTT in 2 hours
B. Stop infusion immediately and notify provider [CORRECT]
C. Stop infusion and recheck aPTT in 1 hour
D. Continue infusion but delay catheterization
Correct Answer: B
Rationale: aPTT >100 seconds indicates supratherapeutic heparin levels with high bleeding risk. The
infusion must be stopped immediately to prevent bleeding complications during catheterization. The
provider must be notified for protamine sulfate orders if needed. NCLEX Client Needs: Safe and Effective
Care Environment – Safety and Infection Control
, Q5: A patient with severe aortic stenosis reports syncope during exertion. The nurse should anticipate
which intervention as priority?
A. Surgical valve replacement evaluation [CORRECT]
B. Cardiac catheterization with balloon valvuloplasty
C. Start beta-blocker therapy to reduce myocardial oxygen demand
D. Monitor with serial echocardiograms only
Correct Answer: A
Rationale: Syncope in aortic stenosis indicates severe obstruction (valve area <1.0 cm² or mean gradient
>40 mmHg). This is a Class I indication for aortic valve replacement. Balloon valvuloplasty (B) provides
temporary relief only and is reserved for patients who are not surgical candidates. Beta-blockers (C) are
contraindicated in severe AS due to negative inotropy. NCLEX Client Needs: Physiological Integrity –
Physiological Adaptation – Illness Management
Q6: Which medication combination requires the nurse to monitor for hyperkalemia most closely?
A. Lisinopril, spironolactone, and potassium supplements [CORRECT]
B. Furosemide, hydrochlorothiazide, and digoxin
C. Metoprolol, amLODIPine, and atamsiatin
D. Clopidogrel, aspirin, and atorvastatin
Correct Answer: A
Rationale: ACE inhibitor (lisinopril) + potassium-sparing diuretic (spironolactone) + potassium
supplements creates triple risk for hyperkalemia. This combination is common in heart failure treatment
and requires frequent potassium monitoring and ECG surveillance for peaked T waves. NCLEX Client
Needs: Physiological Integrity – Pharmacological and Parenteral Therapies
Q7: A patient with peripheral artery disease (PAD) has an ABI of 0.78. Which teaching point is priority?
A. Exercise to the point of pain, rest, then resume [CORRECT]
B. Walk 30 minutes daily regardless of pain
C. Stop all exercise if leg pain occurs
D. Use heating pads on legs to improve circulation
Correct Answer: A
Rationale: ABI <0.90 confirms PAD. Supervised exercise to the point of claudication (pain), followed by
rest, then resuming walking promotes collateral circulation development. Walking through severe pain
(B) causes tissue damage. Stopping all exercise (C) prevents conditioning. Heating pads (D) can cause
burns in patients with decreased sensation. NCLEX Client Needs: Health Promotion and Maintenance
