NUR 242 MED SURG EXAM 3 LATEST ACTUAL 2026/2027 |
Galen College of Nursing | 180 Questions with Correct
Detailed Answers and Rationales | Already Graded A+ | Pass
Guaranteed
SECTION 1: CARDIOVASCULAR DISORDERS (40 Questions)
Q1
A 68-year-old male is admitted with acute decompensated heart failure. Vital signs: BP
162/94 mmHg, HR 118 bpm (irregular), RR 26/min, SpO2 88% on room air. Physical
assessment reveals bilateral crackles in lower lung fields, 3+ pitting edema in bilateral
lower extremities, and jugular venous distension at 45 degrees. Current medications
include furosemide 40 mg IV daily, metoprolol 25 mg PO BID, and lisinopril 10 mg PO
daily. Which nursing intervention should be prioritized?
A. Administer metoprolol immediately to control the rapid heart rate
B. Increase the furosemide dose to promote diuresis and reduce preload
C. Position the patient in high Fowler's position with legs dependent to reduce venous
return and improve oxygenation [CORRECT]
D. Administer lisinopril first to afterload reduction
Correct Answer: C
Rationale: This patient presents with classic signs of acute decompensated heart
failure with fluid overload (bilateral crackles, JVD, peripheral edema) and respiratory
compromise (SpO2 88%, tachypnea). The priority nursing intervention follows the ABC
principle—Airway, Breathing, Circulation. Positioning the patient in high Fowler's position
,(90 degrees) with legs dependent utilizes gravity to reduce venous return to the heart
(decreasing preload), which immediately reduces pulmonary congestion and improves
ventilation-perfusion matching. This non-pharmacological intervention provides
immediate symptomatic relief while pharmacological measures take effect.
Why A is incorrect: While metoprolol (beta-blocker) is appropriate for chronic heart
failure management, administering it during acute decompensation with significant fluid
overload and hypoxemia could worsen heart failure by further depressing myocardial
contractility and potentially causing acute decompensation. Beta-blockers should be
held or reduced during acute exacerbations until hemodynamic stability is achieved.
Why B is incorrect: Although increasing diuresis is important for this fluid-overloaded
patient, this requires a physician's order. The nurse cannot independently increase
medication dosages. Additionally, diuresis takes time to achieve effect (hours), whereas
positioning provides immediate benefit for respiratory distress.
Why D is incorrect: ACE inhibitors like lisinopril are beneficial for afterload reduction in
chronic heart failure, but during acute decompensation with borderline hypotension
potential and respiratory distress, immediate positioning takes precedence. Additionally,
the patient's blood pressure (162/94) while elevated, does not represent a hypertensive
emergency requiring immediate ACE inhibitor administration over respiratory support.
Q2 (SATA - Select All That Apply)
A nurse is caring for a patient 24 hours post-myocardial infarction (MI) who received
thrombolytic therapy. Which assessment findings require immediate notification of the
healthcare provider? (Select all that apply)
A. Blood pressure 98/62 mmHg with complaints of dizziness [CORRECT]
,B. Hematocrit decreased from 42% to 31% [CORRECT]
C. Heart rate 88 bpm with regular rhythm
D. Sudden onset of severe headache with visual changes [CORRECT]
E. Temperature 37.8°C (100.0°F)
Correct Answer: A, B, D
Rationale: Post-thrombolytic therapy patients are at high risk for bleeding
complications, making vigilant assessment for hemorrhage essential.
A is correct: Hypotension (98/62 mmHg) combined with dizziness represents
significant hemodynamic compromise, potentially indicating internal bleeding,
cardiogenic shock, or re-infarction. This requires immediate provider notification and
intervention, possibly including fluid resuscitation or hemodynamic support.
B is correct: A hematocrit drop of 11 percentage points (42% to 31%) indicates
significant blood loss (approximately 3-4 units of blood loss) or hemodilution from
aggressive fluid resuscitation. In the context of thrombolytic therapy, this strongly
suggests occult bleeding (gastrointestinal, retroperitoneal, or intracranial) and requires
immediate investigation.
D is correct: Sudden severe headache with visual changes in a post-thrombolytic patient
is the hallmark presentation of intracranial hemorrhage, the most feared complication
of thrombolytic therapy. This represents a medical emergency requiring immediate CT
imaging, neurological consultation, and potential neurosurgical intervention.
Why C is incorrect: A heart rate of 88 bpm with regular rhythm is within normal limits
and expected post-MI. This represents therapeutic success rather than a complication
requiring notification.
, Why E is incorrect: A low-grade temperature (37.8°C/100.0°F) is common post-MI due
to the inflammatory response to myocardial necrosis (Dressler's syndrome or post-MI
pericarditis may develop days to weeks later). Unless the temperature exceeds 38.3°C
(101°F) or is accompanied by other signs of infection, this does not require immediate
provider notification.
Q3
A patient with chronic atrial fibrillation is prescribed warfarin 5 mg daily. The nurse
reviews the patient's laboratory values: INR 3.8, PT 28 seconds (control 12 seconds),
aPTT 35 seconds, platelet count 180,000/mm³. Which nursing action is most
appropriate?
A. Hold the warfarin dose and administer vitamin K 10 mg subcutaneously
B. Hold the next warfarin dose and notify the healthcare provider [CORRECT]
C. Continue the warfarin as prescribed and recheck INR in one week
D. Administer fresh frozen plasma immediately
Correct Answer: B
Rationale: The therapeutic INR range for atrial fibrillation anticoagulation is typically
2.0-3.0. This patient's INR of 3.8 represents supratherapeutic anticoagulation with
increased bleeding risk. The appropriate nursing action is to hold the next scheduled
warfarin dose and notify the healthcare provider for further orders. This collaborative
approach ensures the provider can assess bleeding risk, determine if vitamin K
administration is necessary (usually reserved for INR >4.0 or active bleeding), and
establish a revised dosing protocol.
Galen College of Nursing | 180 Questions with Correct
Detailed Answers and Rationales | Already Graded A+ | Pass
Guaranteed
SECTION 1: CARDIOVASCULAR DISORDERS (40 Questions)
Q1
A 68-year-old male is admitted with acute decompensated heart failure. Vital signs: BP
162/94 mmHg, HR 118 bpm (irregular), RR 26/min, SpO2 88% on room air. Physical
assessment reveals bilateral crackles in lower lung fields, 3+ pitting edema in bilateral
lower extremities, and jugular venous distension at 45 degrees. Current medications
include furosemide 40 mg IV daily, metoprolol 25 mg PO BID, and lisinopril 10 mg PO
daily. Which nursing intervention should be prioritized?
A. Administer metoprolol immediately to control the rapid heart rate
B. Increase the furosemide dose to promote diuresis and reduce preload
C. Position the patient in high Fowler's position with legs dependent to reduce venous
return and improve oxygenation [CORRECT]
D. Administer lisinopril first to afterload reduction
Correct Answer: C
Rationale: This patient presents with classic signs of acute decompensated heart
failure with fluid overload (bilateral crackles, JVD, peripheral edema) and respiratory
compromise (SpO2 88%, tachypnea). The priority nursing intervention follows the ABC
principle—Airway, Breathing, Circulation. Positioning the patient in high Fowler's position
,(90 degrees) with legs dependent utilizes gravity to reduce venous return to the heart
(decreasing preload), which immediately reduces pulmonary congestion and improves
ventilation-perfusion matching. This non-pharmacological intervention provides
immediate symptomatic relief while pharmacological measures take effect.
Why A is incorrect: While metoprolol (beta-blocker) is appropriate for chronic heart
failure management, administering it during acute decompensation with significant fluid
overload and hypoxemia could worsen heart failure by further depressing myocardial
contractility and potentially causing acute decompensation. Beta-blockers should be
held or reduced during acute exacerbations until hemodynamic stability is achieved.
Why B is incorrect: Although increasing diuresis is important for this fluid-overloaded
patient, this requires a physician's order. The nurse cannot independently increase
medication dosages. Additionally, diuresis takes time to achieve effect (hours), whereas
positioning provides immediate benefit for respiratory distress.
Why D is incorrect: ACE inhibitors like lisinopril are beneficial for afterload reduction in
chronic heart failure, but during acute decompensation with borderline hypotension
potential and respiratory distress, immediate positioning takes precedence. Additionally,
the patient's blood pressure (162/94) while elevated, does not represent a hypertensive
emergency requiring immediate ACE inhibitor administration over respiratory support.
Q2 (SATA - Select All That Apply)
A nurse is caring for a patient 24 hours post-myocardial infarction (MI) who received
thrombolytic therapy. Which assessment findings require immediate notification of the
healthcare provider? (Select all that apply)
A. Blood pressure 98/62 mmHg with complaints of dizziness [CORRECT]
,B. Hematocrit decreased from 42% to 31% [CORRECT]
C. Heart rate 88 bpm with regular rhythm
D. Sudden onset of severe headache with visual changes [CORRECT]
E. Temperature 37.8°C (100.0°F)
Correct Answer: A, B, D
Rationale: Post-thrombolytic therapy patients are at high risk for bleeding
complications, making vigilant assessment for hemorrhage essential.
A is correct: Hypotension (98/62 mmHg) combined with dizziness represents
significant hemodynamic compromise, potentially indicating internal bleeding,
cardiogenic shock, or re-infarction. This requires immediate provider notification and
intervention, possibly including fluid resuscitation or hemodynamic support.
B is correct: A hematocrit drop of 11 percentage points (42% to 31%) indicates
significant blood loss (approximately 3-4 units of blood loss) or hemodilution from
aggressive fluid resuscitation. In the context of thrombolytic therapy, this strongly
suggests occult bleeding (gastrointestinal, retroperitoneal, or intracranial) and requires
immediate investigation.
D is correct: Sudden severe headache with visual changes in a post-thrombolytic patient
is the hallmark presentation of intracranial hemorrhage, the most feared complication
of thrombolytic therapy. This represents a medical emergency requiring immediate CT
imaging, neurological consultation, and potential neurosurgical intervention.
Why C is incorrect: A heart rate of 88 bpm with regular rhythm is within normal limits
and expected post-MI. This represents therapeutic success rather than a complication
requiring notification.
, Why E is incorrect: A low-grade temperature (37.8°C/100.0°F) is common post-MI due
to the inflammatory response to myocardial necrosis (Dressler's syndrome or post-MI
pericarditis may develop days to weeks later). Unless the temperature exceeds 38.3°C
(101°F) or is accompanied by other signs of infection, this does not require immediate
provider notification.
Q3
A patient with chronic atrial fibrillation is prescribed warfarin 5 mg daily. The nurse
reviews the patient's laboratory values: INR 3.8, PT 28 seconds (control 12 seconds),
aPTT 35 seconds, platelet count 180,000/mm³. Which nursing action is most
appropriate?
A. Hold the warfarin dose and administer vitamin K 10 mg subcutaneously
B. Hold the next warfarin dose and notify the healthcare provider [CORRECT]
C. Continue the warfarin as prescribed and recheck INR in one week
D. Administer fresh frozen plasma immediately
Correct Answer: B
Rationale: The therapeutic INR range for atrial fibrillation anticoagulation is typically
2.0-3.0. This patient's INR of 3.8 represents supratherapeutic anticoagulation with
increased bleeding risk. The appropriate nursing action is to hold the next scheduled
warfarin dose and notify the healthcare provider for further orders. This collaborative
approach ensures the provider can assess bleeding risk, determine if vitamin K
administration is necessary (usually reserved for INR >4.0 or active bleeding), and
establish a revised dosing protocol.
