1
NUR 242 MED SURG EXAM 3 2026/2027 | Latest Actual
Exam | Complete 180 Questions & Correct Detailed
Answers with Rationales | Already Graded A+ | Galen
College of Nursing | Pass Guaranteed
Section 1: Cardiovascular Disorders (Questions 1-35)
Question 1 A 68-year-old male with a history of hypertension and type 2 diabetes
presents with progressive dyspnea on exertion, orthopnea, and bilateral lower
extremity edema. On examination, an S3 gallop is auscultated, and jugular venous
distension is noted. Echocardiogram reveals an ejection fraction of 35%. Which
classification best describes this patient's heart failure?
A. Heart failure with preserved ejection fraction (HFpEF)
B. Heart failure with reduced ejection fraction (HFrEF)
C. Right-sided heart failure only
D. Acute decompensated heart failure without structural remodeling
Correct Answer: B. Heart failure with reduced ejection fraction (HFrEF) [CORRECT]
Rationale: HFrEF is defined by an ejection fraction ≤40%, with typical manifestations
including S3 gallop, pulmonary congestion, and peripheral edema due to systolic
dysfunction and neurohormonal activation. HFpEF requires EF ≥50%, making A
incorrect; while right-sided failure can occur, the S3 and orthopnea indicate left-sided
involvement, making C incomplete; D is incorrect because EF 35% confirms structural
remodeling with reduced systolic function.
Correct Answer: B
Question 2 A nurse is caring for a patient with HFrEF who is prescribed
sacubitril/valsartan (Entresto). The patient asks how this medication differs from
previous ACE inhibitors. Which mechanism should the nurse explain?
,2
A. It inhibits angiotensin-converting enzyme and blocks aldosterone secretion
B. It inhibits neprilysin and blocks the angiotensin II receptor
C. It selectively blocks beta-1 adrenergic receptors to reduce cardiac workload
D. It inhibits the sodium-glucose cotransporter-2 in the proximal tubule
Correct Answer: B. It inhibits neprilysin and blocks the angiotensin II receptor
[CORRECT]
Rationale: Sacubitril/valsartan is an ARNI that combines neprilysin inhibition (which
increases natriuretic peptides) with angiotensin receptor blockade, reducing
vasoconstriction, sodium retention, and sympathetic tone without the ACE inhibitor
cough. A describes ACE inhibitors, C describes beta-blockers like metoprolol, and D
describes SGLT2 inhibitors such as dapagliflozin.
Correct Answer: B
Question 3 A patient with chronic HFrEF is being discharged on dapagliflozin 10 mg
daily. The nurse provides education about this medication. Which statement by the
patient indicates correct understanding?
A. "I should stop this medication if I develop a urinary tract infection."
B. "This medication will help my heart by removing excess glucose through my
urine."
C. "I need to hold this medication if I am vomiting or unable to eat for 24 hours."
D. "I should expect my blood sugar to drop dangerously low while taking this."
Correct Answer: C. "I need to hold this medication if I am vomiting or unable to eat
for 24 hours." [CORRECT]
Rationale: Per 2026 ADA and AHA/ACC/HFSA guidelines, SGLT2 inhibitors are now
Class I recommendations for all HF stages, but patients must practice sick-day
management—holding the drug during acute illness, surgery, or reduced oral intake
to prevent euglycemic DKA. A is incorrect because UTIs are not an automatic reason
to stop; B is partially true but incomplete as the cardiac benefits extend beyond
glucosuria; D is incorrect because SGLT2 inhibitors rarely cause hypoglycemia when
used without insulin or sulfonylureas.
,3
Correct Answer: C
Question 4 A 72-year-old African American male with HFrEF (EF 30%) remains
symptomatic despite optimal doses of lisinopril, metoprolol succinate, and
furosemide. According to current AHA/ACC/HFSA 2026 guidelines, which medication
combination should be added?
A. Hydralazine and isosorbide dinitrate
B. Digoxin and amiodarone
C. Spironolactone and eplerenone together
D. Amlodipine and atorvastatin
Correct Answer: A. Hydralazine and isosorbide dinitrate [CORRECT]
Rationale: The AHA/ACC/HFSA guidelines specifically recommend
hydralazine/isosorbide dinitrate as a fixed-dose combination (BiDil) for African
American patients with HFrEF who remain symptomatic on standard therapy,
improving outcomes and reducing mortality. B is incorrect because amiodarone is
not first-line for HF; C is incorrect because using both mineralocorticoid antagonists
together increases hyperkalemia risk; D is incorrect because amlodipine has no
mortality benefit in HF.
Correct Answer: A
Question 5 A patient with chronic heart failure is prescribed digoxin 0.25 mg daily.
The nurse notes the patient's potassium level is 3.0 mEq/L. Which action is the
priority?
A. Administer the digoxin as ordered and recheck potassium in 24 hours
B. Hold the digoxin, notify the provider, and monitor for signs of toxicity
C. Administer potassium supplements and give the digoxin 2 hours later
D. Increase the patient's fluid restriction to prevent further potassium loss
, 4
Correct Answer: B. Hold the digoxin, notify the provider, and monitor for signs of
toxicity [CORRECT]
Rationale: Hypokalemia potentiates digoxin toxicity by increasing myocardial
binding of digoxin; with K+ at 3.0 mEq/L, the nurse must hold the dose and notify
the provider immediately to prevent life-threatening arrhythmias. A is unsafe
because hypokalemia significantly increases toxicity risk; C is inappropriate because
the nurse cannot independently delay cardiac medications without provider orders; D
does not address the immediate risk of digoxin toxicity.
Correct Answer: B
Question 6 A patient with heart failure reports seeing yellow-green halos around
lights and experiencing nausea. The nurse checks the digoxin level, which is 3.2
ng/mL. Which ECG finding would the nurse anticipate?
A. Peaked T waves and widened QRS complexes
B. Ventricular bigeminy or trigeminy with scooping of ST segments
C. Sine wave pattern and absent P waves
D. U waves and prolonged QT interval
Correct Answer: B. Ventricular bigeminy or trigeminy with scooping of ST segments
[CORRECT]
Rationale: Digoxin toxicity (level >2.0 ng/mL) commonly causes ventricular ectopy,
bigeminy, trigeminy, and the characteristic "digoxin effect" of scooped ST segments;
yellow-green halos and GI symptoms are classic extracardiac manifestations. A
describes hyperkalemia, C describes severe hyperkalemia progression, and D
describes hypokalemia.
Correct Answer: B
Question 7 A nurse is educating a patient with HFrEF about daily self-monitoring.
Which patient statement indicates a need for further teaching?
NUR 242 MED SURG EXAM 3 2026/2027 | Latest Actual
Exam | Complete 180 Questions & Correct Detailed
Answers with Rationales | Already Graded A+ | Galen
College of Nursing | Pass Guaranteed
Section 1: Cardiovascular Disorders (Questions 1-35)
Question 1 A 68-year-old male with a history of hypertension and type 2 diabetes
presents with progressive dyspnea on exertion, orthopnea, and bilateral lower
extremity edema. On examination, an S3 gallop is auscultated, and jugular venous
distension is noted. Echocardiogram reveals an ejection fraction of 35%. Which
classification best describes this patient's heart failure?
A. Heart failure with preserved ejection fraction (HFpEF)
B. Heart failure with reduced ejection fraction (HFrEF)
C. Right-sided heart failure only
D. Acute decompensated heart failure without structural remodeling
Correct Answer: B. Heart failure with reduced ejection fraction (HFrEF) [CORRECT]
Rationale: HFrEF is defined by an ejection fraction ≤40%, with typical manifestations
including S3 gallop, pulmonary congestion, and peripheral edema due to systolic
dysfunction and neurohormonal activation. HFpEF requires EF ≥50%, making A
incorrect; while right-sided failure can occur, the S3 and orthopnea indicate left-sided
involvement, making C incomplete; D is incorrect because EF 35% confirms structural
remodeling with reduced systolic function.
Correct Answer: B
Question 2 A nurse is caring for a patient with HFrEF who is prescribed
sacubitril/valsartan (Entresto). The patient asks how this medication differs from
previous ACE inhibitors. Which mechanism should the nurse explain?
,2
A. It inhibits angiotensin-converting enzyme and blocks aldosterone secretion
B. It inhibits neprilysin and blocks the angiotensin II receptor
C. It selectively blocks beta-1 adrenergic receptors to reduce cardiac workload
D. It inhibits the sodium-glucose cotransporter-2 in the proximal tubule
Correct Answer: B. It inhibits neprilysin and blocks the angiotensin II receptor
[CORRECT]
Rationale: Sacubitril/valsartan is an ARNI that combines neprilysin inhibition (which
increases natriuretic peptides) with angiotensin receptor blockade, reducing
vasoconstriction, sodium retention, and sympathetic tone without the ACE inhibitor
cough. A describes ACE inhibitors, C describes beta-blockers like metoprolol, and D
describes SGLT2 inhibitors such as dapagliflozin.
Correct Answer: B
Question 3 A patient with chronic HFrEF is being discharged on dapagliflozin 10 mg
daily. The nurse provides education about this medication. Which statement by the
patient indicates correct understanding?
A. "I should stop this medication if I develop a urinary tract infection."
B. "This medication will help my heart by removing excess glucose through my
urine."
C. "I need to hold this medication if I am vomiting or unable to eat for 24 hours."
D. "I should expect my blood sugar to drop dangerously low while taking this."
Correct Answer: C. "I need to hold this medication if I am vomiting or unable to eat
for 24 hours." [CORRECT]
Rationale: Per 2026 ADA and AHA/ACC/HFSA guidelines, SGLT2 inhibitors are now
Class I recommendations for all HF stages, but patients must practice sick-day
management—holding the drug during acute illness, surgery, or reduced oral intake
to prevent euglycemic DKA. A is incorrect because UTIs are not an automatic reason
to stop; B is partially true but incomplete as the cardiac benefits extend beyond
glucosuria; D is incorrect because SGLT2 inhibitors rarely cause hypoglycemia when
used without insulin or sulfonylureas.
,3
Correct Answer: C
Question 4 A 72-year-old African American male with HFrEF (EF 30%) remains
symptomatic despite optimal doses of lisinopril, metoprolol succinate, and
furosemide. According to current AHA/ACC/HFSA 2026 guidelines, which medication
combination should be added?
A. Hydralazine and isosorbide dinitrate
B. Digoxin and amiodarone
C. Spironolactone and eplerenone together
D. Amlodipine and atorvastatin
Correct Answer: A. Hydralazine and isosorbide dinitrate [CORRECT]
Rationale: The AHA/ACC/HFSA guidelines specifically recommend
hydralazine/isosorbide dinitrate as a fixed-dose combination (BiDil) for African
American patients with HFrEF who remain symptomatic on standard therapy,
improving outcomes and reducing mortality. B is incorrect because amiodarone is
not first-line for HF; C is incorrect because using both mineralocorticoid antagonists
together increases hyperkalemia risk; D is incorrect because amlodipine has no
mortality benefit in HF.
Correct Answer: A
Question 5 A patient with chronic heart failure is prescribed digoxin 0.25 mg daily.
The nurse notes the patient's potassium level is 3.0 mEq/L. Which action is the
priority?
A. Administer the digoxin as ordered and recheck potassium in 24 hours
B. Hold the digoxin, notify the provider, and monitor for signs of toxicity
C. Administer potassium supplements and give the digoxin 2 hours later
D. Increase the patient's fluid restriction to prevent further potassium loss
, 4
Correct Answer: B. Hold the digoxin, notify the provider, and monitor for signs of
toxicity [CORRECT]
Rationale: Hypokalemia potentiates digoxin toxicity by increasing myocardial
binding of digoxin; with K+ at 3.0 mEq/L, the nurse must hold the dose and notify
the provider immediately to prevent life-threatening arrhythmias. A is unsafe
because hypokalemia significantly increases toxicity risk; C is inappropriate because
the nurse cannot independently delay cardiac medications without provider orders; D
does not address the immediate risk of digoxin toxicity.
Correct Answer: B
Question 6 A patient with heart failure reports seeing yellow-green halos around
lights and experiencing nausea. The nurse checks the digoxin level, which is 3.2
ng/mL. Which ECG finding would the nurse anticipate?
A. Peaked T waves and widened QRS complexes
B. Ventricular bigeminy or trigeminy with scooping of ST segments
C. Sine wave pattern and absent P waves
D. U waves and prolonged QT interval
Correct Answer: B. Ventricular bigeminy or trigeminy with scooping of ST segments
[CORRECT]
Rationale: Digoxin toxicity (level >2.0 ng/mL) commonly causes ventricular ectopy,
bigeminy, trigeminy, and the characteristic "digoxin effect" of scooped ST segments;
yellow-green halos and GI symptoms are classic extracardiac manifestations. A
describes hyperkalemia, C describes severe hyperkalemia progression, and D
describes hypokalemia.
Correct Answer: B
Question 7 A nurse is educating a patient with HFrEF about daily self-monitoring.
Which patient statement indicates a need for further teaching?
