Galen College of Nursing
NSG 3800: Advanced Medical-Surgical Nursing
Exam 2 Practice Evaluation | 2026/2027
75 Questions | Select the BEST answer for each question. Correct answers are highlighted in teal
.
Section I: Cardiac — ACS, Heart Failure, Arrhythmias
1. A 68-year-old patient presents to the emergency department with substernal chest pain rated 8/10,
diaphoresis, and ST-segment elevation in leads II, III, and aVF on the 12-lead ECG. Which intervention
should the nurse implement FIRST?
A. Administer aspirin B. Obtain a portable C. Schedule a stress test D. Apply oxygen via
325 mg chewable chest x-ray non-rebreather mask
Correct Answer: A. Administer aspirin 325 mg chewable
Rationale: The priority for a patient with suspected acute coronary syndrome (ACS) and ST elevation is to initiate the
MONA protocol: Morphine, Oxygen (if SpO2 < 94%), Nitroglycerin, and Aspirin. Aspirin 325 mg chewable should be
given immediately to inhibit platelet aggregation and reduce mortality. Time is muscle, and delaying antiplatelet
therapy increases infarct size.
2. A patient with chronic heart failure presents with bilateral crackles in the lung bases, jugular venous
distention (JVD), and +3 pitting edema in the lower extremities. Which finding would indicate
WORSENING of the patient's condition?
A. Weight gain of 2 kg B. Blood pressure of C. Occasional dry cough D. Mild fatigue with
(4.4 lbs) in 2 days 110/70 mmHg at night activity
Correct Answer: A. Weight gain of 2 kg (4.4 lbs) in 2 days
Rationale: A weight gain of 2 kg in 2 days is a hallmark sign of fluid retention indicative of worsening heart failure.
The heart's inability to maintain adequate cardiac output leads to sodium and water retention. Patients should be
instructed to weigh themselves daily and report gains exceeding 1–2 kg per day, as this often precedes overt symptoms
of decompensation.
3. A patient with atrial fibrillation has a ventricular rate of 148 bpm on the cardiac monitor. The patient
reports palpitations and mild shortness of breath but is hemodynamically stable. Which medication does the
nurse anticipate administering?
A. Atropine sulfate B. Adenosine IV push C. Diltiazem or D. Epinephrine 1 mg IV
amiodarone for rate push
control
Correct Answer: C. Diltiazem or amiodarone for rate control
Rationale: For hemodynamically stable atrial fibrillation, the priority is rate control. Diltiazem (a calcium channel
blocker) or amiodarone are commonly used to slow the ventricular response rate. Adenosine is used for
1
,supraventricular tachycardia (SVT) diagnosis and treatment, and atropine is for symptomatic bradycardia. Epinephrine
is used in cardiac arrest or severe anaphylaxis.
4. A patient with heart failure is being discharged home on lisinopril (an ACE inhibitor) and furosemide (a
loop diuretic). Which laboratory value and clinical finding should the nurse instruct the patient to monitor?
A. Sodium level and B. Potassium level and C. Calcium level and D. Magnesium level and
confusion signs of hypokalemia muscle cramps tremors
Correct Answer: B. Potassium level and signs of hypokalemia
Rationale: Lisinopril can cause hyperkalemia (it is a potassium-sparing ACE inhibitor), while furosemide causes
potassium loss (hypokalemia). The opposing effects require careful monitoring of serum potassium levels. Signs of
hypokalemia include muscle weakness, fatigue, arrhythmias, and leg cramps. Potassium supplementation or dietary
adjustments may be needed.
5. A patient who had a myocardial infarction 5 days ago is being discharged on clopidogrel (Plavix). Which
statement by the patient indicates an understanding of the teaching?
A. "I will take ibuprofen for my occasional B. "I should report any unusual bleeding or
headaches." bruising to my provider."
C. "I can stop taking this medication after 2 weeks." D. "I will take the medication only when I have
chest pain."
Correct Answer: B. "I should report any unusual bleeding or bruising to my provider."
Rationale: Clopidogrel is an antiplatelet agent that inhibits platelet aggregation, putting the patient at risk for
bleeding. The patient should report any unusual bleeding, bruising, or blood in stool or urine. NSAIDs like ibuprofen
increase bleeding risk and should be avoided. Clopidogrel must be taken daily as prescribed and is typically continued
long-term, not as needed.
6. A patient with systolic heart failure has a left ventricular ejection fraction (LVEF) of 30%. Which
discharge instruction is the PRIORITY for the nurse to provide?
A. Limit sodium intake to less than 2 g per day B. Perform daily weight monitoring and report
gain > 2 lbs/day
C. Exercise vigorously for 60 minutes daily D. Drink at least 3 liters of fluid per day
Correct Answer: B. Perform daily weight monitoring and report gain > 2 lbs/day
Rationale: Daily weight monitoring is the most sensitive indicator of fluid retention in heart failure and is the highest
priority discharge instruction. A weight gain of more than 1–2 kg (2–2.2 lbs) in 24 hours signals fluid accumulation
before symptoms appear, allowing early intervention. While sodium restriction is also important, weight monitoring
provides the earliest warning of decompensation.
7. A patient on the cardiac telemetry unit has a 3rd degree (complete) heart block noted on the monitor. The
patient's heart rate is 35 bpm and blood pressure is 82/50 mmHg. What is the nurse's PRIORITY action?
A. Administer atropine 0.5 mg IV B. Prepare for temporary transvenous
pacemaker insertion
C. Encourage the patient to cough forcefully D. Apply transcutaneous pacing patches and
document
Correct Answer: B. Prepare for temporary transvenous pacemaker insertion
2
, Rationale: Third-degree heart block is a complete dissociation between atrial and ventricular conduction, resulting in
a slow ventricular escape rhythm. When the patient is symptomatic (hypotensive, bradycardic), the priority is to
prepare for temporary pacemaker insertion. Transcutaneous pacing can be used as a bridge, but the definitive
treatment is a temporary transvenous pacemaker followed by evaluation for a permanent pacemaker.
8. A patient presents with chest discomfort, fatigue, and diaphoresis. Laboratory results show elevated
troponin I levels and the ECG reveals ST-segment depression in multiple leads. Which diagnosis is MOST
consistent with these findings?
A. ST-elevation myocardial infarction (STEMI) B. Non-ST-elevation myocardial infarction
(NSTEMI)
C. Unstable angina D. Pericarditis
Correct Answer: B. Non-ST-elevation myocardial infarction (NSTEMI)
Rationale: Elevated cardiac troponin combined with ST-segment depression (rather than elevation) is characteristic of
a Non-ST-elevation myocardial infarction (NSTEMI). NSTEMI indicates myocardial necrosis with partial or
intermittent coronary occlusion. STEMI shows ST elevation and typically requires immediate reperfusion. Unstable
angina presents similarly but without troponin elevation.
9. A patient with known heart failure has a BNP (B-type natriuretic peptide) level of 900 pg/mL. Which
interpretation of this result is MOST accurate?
A. Normal finding for an older adult B. Mild fluid overload requiring diuretic adjustment
C. Severe heart failure requiring immediate D. Laboratory error; BNP does not correlate with
intervention heart failure
Correct Answer: C. Severe heart failure requiring immediate intervention
Rationale: BNP is a hormone released by the ventricles in response to volume expansion and pressure overload. Levels
< 100 pg/mL are considered normal, 100–300 suggest mild heart failure, 300–700 suggest moderate heart failure, and
levels > 700–900 pg/mL indicate severe heart failure requiring urgent evaluation and intervention. This patient needs
immediate clinical assessment and treatment adjustment.
10. A patient with a pulmonary embolism is receiving a continuous heparin infusion. Which laboratory test
should the nurse monitor to evaluate the THERAPEUTIC effect of heparin?
A. Prothrombin time (PT/INR) B. Activated partial thromboplastin time (aPTT)
C. International Normalized Ratio (INR) D. Platelet count
Correct Answer: B. Activated partial thromboplastin time (aPTT)
Rationale: Heparin's therapeutic effect is monitored using the activated partial thromboplastin time (aPTT). The target
aPTT for heparin therapy is typically 1.5–2.5 times the control value (approximately 60–80 seconds). PT/INR is used to
monitor warfarin therapy. While platelet counts should be monitored every 2–3 days to detect heparin-induced
thrombocytopenia (HIT), aPTT is the primary test for heparin efficacy.
Section II: Respiratory — COPD, Asthma, PE, ARDS
3
NSG 3800: Advanced Medical-Surgical Nursing
Exam 2 Practice Evaluation | 2026/2027
75 Questions | Select the BEST answer for each question. Correct answers are highlighted in teal
.
Section I: Cardiac — ACS, Heart Failure, Arrhythmias
1. A 68-year-old patient presents to the emergency department with substernal chest pain rated 8/10,
diaphoresis, and ST-segment elevation in leads II, III, and aVF on the 12-lead ECG. Which intervention
should the nurse implement FIRST?
A. Administer aspirin B. Obtain a portable C. Schedule a stress test D. Apply oxygen via
325 mg chewable chest x-ray non-rebreather mask
Correct Answer: A. Administer aspirin 325 mg chewable
Rationale: The priority for a patient with suspected acute coronary syndrome (ACS) and ST elevation is to initiate the
MONA protocol: Morphine, Oxygen (if SpO2 < 94%), Nitroglycerin, and Aspirin. Aspirin 325 mg chewable should be
given immediately to inhibit platelet aggregation and reduce mortality. Time is muscle, and delaying antiplatelet
therapy increases infarct size.
2. A patient with chronic heart failure presents with bilateral crackles in the lung bases, jugular venous
distention (JVD), and +3 pitting edema in the lower extremities. Which finding would indicate
WORSENING of the patient's condition?
A. Weight gain of 2 kg B. Blood pressure of C. Occasional dry cough D. Mild fatigue with
(4.4 lbs) in 2 days 110/70 mmHg at night activity
Correct Answer: A. Weight gain of 2 kg (4.4 lbs) in 2 days
Rationale: A weight gain of 2 kg in 2 days is a hallmark sign of fluid retention indicative of worsening heart failure.
The heart's inability to maintain adequate cardiac output leads to sodium and water retention. Patients should be
instructed to weigh themselves daily and report gains exceeding 1–2 kg per day, as this often precedes overt symptoms
of decompensation.
3. A patient with atrial fibrillation has a ventricular rate of 148 bpm on the cardiac monitor. The patient
reports palpitations and mild shortness of breath but is hemodynamically stable. Which medication does the
nurse anticipate administering?
A. Atropine sulfate B. Adenosine IV push C. Diltiazem or D. Epinephrine 1 mg IV
amiodarone for rate push
control
Correct Answer: C. Diltiazem or amiodarone for rate control
Rationale: For hemodynamically stable atrial fibrillation, the priority is rate control. Diltiazem (a calcium channel
blocker) or amiodarone are commonly used to slow the ventricular response rate. Adenosine is used for
1
,supraventricular tachycardia (SVT) diagnosis and treatment, and atropine is for symptomatic bradycardia. Epinephrine
is used in cardiac arrest or severe anaphylaxis.
4. A patient with heart failure is being discharged home on lisinopril (an ACE inhibitor) and furosemide (a
loop diuretic). Which laboratory value and clinical finding should the nurse instruct the patient to monitor?
A. Sodium level and B. Potassium level and C. Calcium level and D. Magnesium level and
confusion signs of hypokalemia muscle cramps tremors
Correct Answer: B. Potassium level and signs of hypokalemia
Rationale: Lisinopril can cause hyperkalemia (it is a potassium-sparing ACE inhibitor), while furosemide causes
potassium loss (hypokalemia). The opposing effects require careful monitoring of serum potassium levels. Signs of
hypokalemia include muscle weakness, fatigue, arrhythmias, and leg cramps. Potassium supplementation or dietary
adjustments may be needed.
5. A patient who had a myocardial infarction 5 days ago is being discharged on clopidogrel (Plavix). Which
statement by the patient indicates an understanding of the teaching?
A. "I will take ibuprofen for my occasional B. "I should report any unusual bleeding or
headaches." bruising to my provider."
C. "I can stop taking this medication after 2 weeks." D. "I will take the medication only when I have
chest pain."
Correct Answer: B. "I should report any unusual bleeding or bruising to my provider."
Rationale: Clopidogrel is an antiplatelet agent that inhibits platelet aggregation, putting the patient at risk for
bleeding. The patient should report any unusual bleeding, bruising, or blood in stool or urine. NSAIDs like ibuprofen
increase bleeding risk and should be avoided. Clopidogrel must be taken daily as prescribed and is typically continued
long-term, not as needed.
6. A patient with systolic heart failure has a left ventricular ejection fraction (LVEF) of 30%. Which
discharge instruction is the PRIORITY for the nurse to provide?
A. Limit sodium intake to less than 2 g per day B. Perform daily weight monitoring and report
gain > 2 lbs/day
C. Exercise vigorously for 60 minutes daily D. Drink at least 3 liters of fluid per day
Correct Answer: B. Perform daily weight monitoring and report gain > 2 lbs/day
Rationale: Daily weight monitoring is the most sensitive indicator of fluid retention in heart failure and is the highest
priority discharge instruction. A weight gain of more than 1–2 kg (2–2.2 lbs) in 24 hours signals fluid accumulation
before symptoms appear, allowing early intervention. While sodium restriction is also important, weight monitoring
provides the earliest warning of decompensation.
7. A patient on the cardiac telemetry unit has a 3rd degree (complete) heart block noted on the monitor. The
patient's heart rate is 35 bpm and blood pressure is 82/50 mmHg. What is the nurse's PRIORITY action?
A. Administer atropine 0.5 mg IV B. Prepare for temporary transvenous
pacemaker insertion
C. Encourage the patient to cough forcefully D. Apply transcutaneous pacing patches and
document
Correct Answer: B. Prepare for temporary transvenous pacemaker insertion
2
, Rationale: Third-degree heart block is a complete dissociation between atrial and ventricular conduction, resulting in
a slow ventricular escape rhythm. When the patient is symptomatic (hypotensive, bradycardic), the priority is to
prepare for temporary pacemaker insertion. Transcutaneous pacing can be used as a bridge, but the definitive
treatment is a temporary transvenous pacemaker followed by evaluation for a permanent pacemaker.
8. A patient presents with chest discomfort, fatigue, and diaphoresis. Laboratory results show elevated
troponin I levels and the ECG reveals ST-segment depression in multiple leads. Which diagnosis is MOST
consistent with these findings?
A. ST-elevation myocardial infarction (STEMI) B. Non-ST-elevation myocardial infarction
(NSTEMI)
C. Unstable angina D. Pericarditis
Correct Answer: B. Non-ST-elevation myocardial infarction (NSTEMI)
Rationale: Elevated cardiac troponin combined with ST-segment depression (rather than elevation) is characteristic of
a Non-ST-elevation myocardial infarction (NSTEMI). NSTEMI indicates myocardial necrosis with partial or
intermittent coronary occlusion. STEMI shows ST elevation and typically requires immediate reperfusion. Unstable
angina presents similarly but without troponin elevation.
9. A patient with known heart failure has a BNP (B-type natriuretic peptide) level of 900 pg/mL. Which
interpretation of this result is MOST accurate?
A. Normal finding for an older adult B. Mild fluid overload requiring diuretic adjustment
C. Severe heart failure requiring immediate D. Laboratory error; BNP does not correlate with
intervention heart failure
Correct Answer: C. Severe heart failure requiring immediate intervention
Rationale: BNP is a hormone released by the ventricles in response to volume expansion and pressure overload. Levels
< 100 pg/mL are considered normal, 100–300 suggest mild heart failure, 300–700 suggest moderate heart failure, and
levels > 700–900 pg/mL indicate severe heart failure requiring urgent evaluation and intervention. This patient needs
immediate clinical assessment and treatment adjustment.
10. A patient with a pulmonary embolism is receiving a continuous heparin infusion. Which laboratory test
should the nurse monitor to evaluate the THERAPEUTIC effect of heparin?
A. Prothrombin time (PT/INR) B. Activated partial thromboplastin time (aPTT)
C. International Normalized Ratio (INR) D. Platelet count
Correct Answer: B. Activated partial thromboplastin time (aPTT)
Rationale: Heparin's therapeutic effect is monitored using the activated partial thromboplastin time (aPTT). The target
aPTT for heparin therapy is typically 1.5–2.5 times the control value (approximately 60–80 seconds). PT/INR is used to
monitor warfarin therapy. While platelet counts should be monitored every 2–3 days to detect heparin-induced
thrombocytopenia (HIT), aPTT is the primary test for heparin efficacy.
Section II: Respiratory — COPD, Asthma, PE, ARDS
3
