NUR104 | NUR104 Medsurg 2 Exam 1 Version 1
Questions with Correct Answers and Expert
Explanation for Each Question
1. A patient is admitted with suspected left-sided heart failure. Which clinical
manifestation should the nurse expect to find during the assessment?
A. Jugular venous distention
B. Hepatomegaly
C. Peripheral edema
D. Crackles in the lung bases
Correct Answer: D
Expert Explanation: Left-sided heart failure primarily involves a decrease in the
left ventricle’s pumping ability, leading to fluid backup into the pulmonary
circulation. Crackles are a hallmark sign of pulmonary congestion caused by this
fluid shift into the alveoli. In contrast, peripheral edema and jugular venous
distention are classic signs of right-sided heart failure. The nurse must prioritize
respiratory assessment to monitor for signs of worsening pulmonary edema.
Prompt identification of these symptoms is critical for timely intervention and
preventing respiratory failure.
,2. Which laboratory value is most specific for diagnosing an acute myocardial
infarction?
A. Troponin I
B. Brain natriuretic peptide (BNP)
C. Creatine kinase (CK-MB)
D. Myoglobin
Correct Answer: A
Expert Explanation: Troponin I is a highly sensitive and specific biomarker for
cardiac muscle injury. It begins to rise within a few hours of an infarct and remains
elevated for several days. While CK-MB was used in the past, it is less specific than
troponin because it can be found in skeletal muscle. BNP is used to evaluate heart
failure rather than acute ischemia or infarction. The nurse should anticipate serial
troponin draws to track the progression of myocardial damage.
3. A nurse is teaching a patient about a new prescription for Lisinopril. Which side
effect should the patient be instructed to report immediately?
A. A persistent dry cough
B. Swelling of the lips or tongue
C. Increased urination
,D. Mild fatigue
Correct Answer: B
Expert Explanation: Angioedema is a rare but life-threatening adverse reaction
associated with ACE inhibitors like Lisinopril. Swelling of the lips, tongue, or face
indicates an airway emergency that requires immediate medical intervention. While
a dry cough is a common side effect of ACE inhibitors, it is not as urgent as
angioedema. Increased urination is typically seen with diuretics rather than ACE
inhibitors. The nurse must emphasize that the patient should stop the medication if
these symptoms occur.
4. What is the primary mechanism of action for Nitroglycerin in the treatment of
stable angina?
A. Increasing heart rate to improve output
B. Causing peripheral vasodilation to reduce preload
C. Directly thinning the blood to prevent clots
D. Inhibiting the sodium-potassium pump
Correct Answer: B
Expert Explanation: Nitroglycerin acts as a potent vasodilator that primarily
affects the venous system, thereby reducing the volume of blood returning to the
heart. This reduction in preload decreases the workload and oxygen demand of the
, myocardium. It also dilates the coronary arteries, although its effect on systemic
preload is more significant in relieving angina. Nurses must monitor blood pressure
closely because rapid vasodilation can lead to hypotension. Understanding this
mechanism helps in explaining why patients should sit down before taking the
medication.
5. An ECG shows a saw-tooth pattern of P-waves with a regular QRS rhythm. How
should the nurse document this rhythm?
A. Atrial fibrillation
B. Ventricular tachycardia
C. Sinus bradycardia
D. Atrial flutter
Correct Answer: D
Expert Explanation: Atrial flutter is characterized by rapid, regular atrial
depolarizations that appear as a saw-tooth pattern on an ECG. These are known as
flutter waves (F-waves) and usually occur at a rate of 250 to 350 beats per minute.
Atrial fibrillation would show an irregularly irregular rhythm without distinct P-
waves. Ventricular tachycardia would show wide, bizarre QRS complexes rather
than organized atrial activity. Identifying this rhythm is essential for determining
the appropriate anticoagulation and rate-control therapy.
Questions with Correct Answers and Expert
Explanation for Each Question
1. A patient is admitted with suspected left-sided heart failure. Which clinical
manifestation should the nurse expect to find during the assessment?
A. Jugular venous distention
B. Hepatomegaly
C. Peripheral edema
D. Crackles in the lung bases
Correct Answer: D
Expert Explanation: Left-sided heart failure primarily involves a decrease in the
left ventricle’s pumping ability, leading to fluid backup into the pulmonary
circulation. Crackles are a hallmark sign of pulmonary congestion caused by this
fluid shift into the alveoli. In contrast, peripheral edema and jugular venous
distention are classic signs of right-sided heart failure. The nurse must prioritize
respiratory assessment to monitor for signs of worsening pulmonary edema.
Prompt identification of these symptoms is critical for timely intervention and
preventing respiratory failure.
,2. Which laboratory value is most specific for diagnosing an acute myocardial
infarction?
A. Troponin I
B. Brain natriuretic peptide (BNP)
C. Creatine kinase (CK-MB)
D. Myoglobin
Correct Answer: A
Expert Explanation: Troponin I is a highly sensitive and specific biomarker for
cardiac muscle injury. It begins to rise within a few hours of an infarct and remains
elevated for several days. While CK-MB was used in the past, it is less specific than
troponin because it can be found in skeletal muscle. BNP is used to evaluate heart
failure rather than acute ischemia or infarction. The nurse should anticipate serial
troponin draws to track the progression of myocardial damage.
3. A nurse is teaching a patient about a new prescription for Lisinopril. Which side
effect should the patient be instructed to report immediately?
A. A persistent dry cough
B. Swelling of the lips or tongue
C. Increased urination
,D. Mild fatigue
Correct Answer: B
Expert Explanation: Angioedema is a rare but life-threatening adverse reaction
associated with ACE inhibitors like Lisinopril. Swelling of the lips, tongue, or face
indicates an airway emergency that requires immediate medical intervention. While
a dry cough is a common side effect of ACE inhibitors, it is not as urgent as
angioedema. Increased urination is typically seen with diuretics rather than ACE
inhibitors. The nurse must emphasize that the patient should stop the medication if
these symptoms occur.
4. What is the primary mechanism of action for Nitroglycerin in the treatment of
stable angina?
A. Increasing heart rate to improve output
B. Causing peripheral vasodilation to reduce preload
C. Directly thinning the blood to prevent clots
D. Inhibiting the sodium-potassium pump
Correct Answer: B
Expert Explanation: Nitroglycerin acts as a potent vasodilator that primarily
affects the venous system, thereby reducing the volume of blood returning to the
heart. This reduction in preload decreases the workload and oxygen demand of the
, myocardium. It also dilates the coronary arteries, although its effect on systemic
preload is more significant in relieving angina. Nurses must monitor blood pressure
closely because rapid vasodilation can lead to hypotension. Understanding this
mechanism helps in explaining why patients should sit down before taking the
medication.
5. An ECG shows a saw-tooth pattern of P-waves with a regular QRS rhythm. How
should the nurse document this rhythm?
A. Atrial fibrillation
B. Ventricular tachycardia
C. Sinus bradycardia
D. Atrial flutter
Correct Answer: D
Expert Explanation: Atrial flutter is characterized by rapid, regular atrial
depolarizations that appear as a saw-tooth pattern on an ECG. These are known as
flutter waves (F-waves) and usually occur at a rate of 250 to 350 beats per minute.
Atrial fibrillation would show an irregularly irregular rhythm without distinct P-
waves. Ventricular tachycardia would show wide, bizarre QRS complexes rather
than organized atrial activity. Identifying this rhythm is essential for determining
the appropriate anticoagulation and rate-control therapy.
