1
NUR 355 Exam 4 (MedSurg 1) Upto date Questions
anNUR 355 Exam 4 (MedSurg 1) Upto date Questions
and Detailed Answers | Easy to Read | Grade +d
Detailed Answers | Easy to Read | Grade +
This practice exam is designed to help you prepare for Exam 4 in NUR 355 (Med-Surg 1). It covers key
topics including cardiovascular disorders (hypertension, heart failure, coronary artery disease,
myocardial infarction), respiratory disorders (COPD, pneumonia, pulmonary embolism), renal disorders,
endocrine disorders (diabetes, thyroid), and common complications. Each question includes the correct
answer and a rationale to reinforce your understanding. Use this as a self-assessment tool to identify
areas for further review.
Section 1: Cardiovascular Disorders
1. A patient with hypertension is prescribed hydrochlorothiazide. Which of the following adverse effects
should the nurse monitor?
• A) Hyperkalemia
• B) Hypokalemia
• C) Hyponatremia
• D) Hypocalcemia
✔✔ Answer✔✔ B
Rationale: Hydrochlorothiazide is a thiazide diuretic that causes potassium wasting, leading to
hypokalemia. It can also cause hyponatremia, hypercalcemia, and hyperglycemia. Potassium levels
should be monitored regularly.
2. A patient with chronic heart failure is receiving furosemide. Which assessment finding is most
important to report to the provider?
• A) Weight loss of 1 kg in 24 hours
• B) Serum potassium level of 3.2 mEq/L
• C) Blood pressure of 110/70 mmHg
• D) Urine output of 50 mL/hour
,2
✔✔ Answer✔✔ B
*Rationale: A potassium level of 3.2 mEq/L is critically low (normal 3.5-5.0) and increases the risk of
cardiac dysrhythmias, especially if the patient is on digoxin. This finding requires immediate
intervention. Weight loss of 1 kg/day is expected with diuresis; BP 110/70 is acceptable; urine output 50
mL/hour is adequate.*
3. A patient is admitted with acute decompensated heart failure. The nurse assesses jugular venous
distention (JVD), crackles in the lungs, and peripheral edema. Which of the following interventions
should the nurse implement first?
• A) Administer furosemide IV.
• B) Place the patient in high-Fowler’s position.
• C) Initiate a low-sodium diet.
• D) Obtain a chest X-ray.
✔✔ Answer✔✔ B
Rationale: Positioning the patient in high-Fowler’s position facilitates breathing and reduces preload by
pooling blood in the lower extremities. This is an immediate intervention to improve oxygenation.
Furosemide and other interventions follow.
4. A patient with heart failure is prescribed carvedilol. Which of the following is a priority teaching
point?
• A) “Take this medication with food to prevent stomach upset.”
• B) “Monitor your weight daily and report a gain of 2-3 pounds in a day.”
• C) “This medication may cause a dry cough.”
• D) “You may stop this medication if you feel dizzy.”
✔✔ Answer✔✔ B
Rationale: Daily weight monitoring is crucial for heart failure patients to detect fluid retention early.
Carvedilol is a beta-blocker that should not be stopped abruptly; it can cause rebound tachycardia and
worsening heart failure. Dry cough is associated with ACE inhibitors, not carvedilol.
5. A patient with stable angina reports chest pain that occurs with exertion and is relieved by rest. The
nurse knows that this type of angina is most likely:
• A) Unstable angina
• B) Variant (Prinzmetal) angina
,3
• C) Stable angina
• D) Microvascular angina
✔✔ Answer✔✔ C
Rationale: Stable angina is predictable, occurs with exertion or stress, and is relieved by rest or
nitroglycerin. Unstable angina occurs at rest or with minimal exertion and is a medical emergency.
Variant angina is caused by coronary artery spasm.
6. A patient is prescribed nitroglycerin sublingual tablets for angina. Which of the following instructions
should the nurse include?
• A) “Swallow the tablet with a full glass of water.”
• B) “Take a tablet every 5 minutes until pain subsides, up to three doses.”
• C) “Store the tablets in a plastic container.”
• D) “Expect a burning sensation when the tablet dissolves.”
✔✔ Answer✔✔ B
Rationale: Standard instructions: take one tablet at onset of pain; if no relief in 5 minutes, call 911 and
take a second; a third may be taken while awaiting emergency care. Tablets should be kept in the
original glass container, not plastic. A burning sensation may occur but is not a reliable indicator of
effectiveness.
7. A patient with a myocardial infarction (MI) is receiving thrombolytic therapy. Which of the following
findings would indicate a complication of this therapy?
• A) Chest pain relieved
• B) ST-segment elevation resolution
• C) Reperfusion dysrhythmias
• D) Bleeding from the IV site
✔✔ Answer✔✔ D
Rationale: Bleeding is a major complication of thrombolytics. Minor bleeding (IV site) may be
manageable, but any bleeding should be reported. Reperfusion dysrhythmias are expected and may
indicate successful reperfusion. Chest pain relief and ST-segment resolution are desired outcomes.
8. A patient is 6 hours post-MI and has a heart rate of 110 bpm, blood pressure 90/60 mmHg, and
crackles in the lungs. Which of the following complications is most likely?
• A) Cardiogenic shock
, 4
• B) Pericarditis
• C) Ventricular aneurysm
• D) Heart failure
✔✔ Answer✔✔ A
Rationale: Cardiogenic shock is characterized by hypotension, tachycardia, and signs of end-organ
hypoperfusion (e.g., crackles from pulmonary congestion). It occurs in about 10-15% of MI patients and
has high mortality. Heart failure is possible but cardiogenic shock is the more acute presentation with
hypotension.
9. A patient with coronary artery disease is prescribed aspirin 81 mg daily. What is the primary purpose
of this medication?
• A) Reduce cholesterol levels
• B) Prevent platelet aggregation
• C) Dilate coronary arteries
• D) Decrease myocardial oxygen demand
✔✔ Answer✔✔ B
Rationale: Low-dose aspirin irreversibly inhibits cyclooxygenase-1 (COX-1) in platelets, reducing
thromboxane A2 production and preventing platelet aggregation. This reduces the risk of thrombotic
events.
10. A patient with a history of deep vein thrombosis (DVT) is prescribed warfarin. Which of the following
laboratory tests is used to monitor therapy?
• A) aPTT
• B) INR
• C) Platelet count
• D) D-dimer
✔✔ Answer✔✔ B
Rationale: Warfarin is monitored using the International Normalized Ratio (INR), with a target typically
of 2-3 for DVT treatment. aPTT is used for heparin. Platelet count monitors for heparin-induced
thrombocytopenia; D-dimer is used to diagnose DVT.
11. A patient on warfarin has an INR of 4.5 with no signs of bleeding. Which of the following is the
appropriate nursing action?
NUR 355 Exam 4 (MedSurg 1) Upto date Questions
anNUR 355 Exam 4 (MedSurg 1) Upto date Questions
and Detailed Answers | Easy to Read | Grade +d
Detailed Answers | Easy to Read | Grade +
This practice exam is designed to help you prepare for Exam 4 in NUR 355 (Med-Surg 1). It covers key
topics including cardiovascular disorders (hypertension, heart failure, coronary artery disease,
myocardial infarction), respiratory disorders (COPD, pneumonia, pulmonary embolism), renal disorders,
endocrine disorders (diabetes, thyroid), and common complications. Each question includes the correct
answer and a rationale to reinforce your understanding. Use this as a self-assessment tool to identify
areas for further review.
Section 1: Cardiovascular Disorders
1. A patient with hypertension is prescribed hydrochlorothiazide. Which of the following adverse effects
should the nurse monitor?
• A) Hyperkalemia
• B) Hypokalemia
• C) Hyponatremia
• D) Hypocalcemia
✔✔ Answer✔✔ B
Rationale: Hydrochlorothiazide is a thiazide diuretic that causes potassium wasting, leading to
hypokalemia. It can also cause hyponatremia, hypercalcemia, and hyperglycemia. Potassium levels
should be monitored regularly.
2. A patient with chronic heart failure is receiving furosemide. Which assessment finding is most
important to report to the provider?
• A) Weight loss of 1 kg in 24 hours
• B) Serum potassium level of 3.2 mEq/L
• C) Blood pressure of 110/70 mmHg
• D) Urine output of 50 mL/hour
,2
✔✔ Answer✔✔ B
*Rationale: A potassium level of 3.2 mEq/L is critically low (normal 3.5-5.0) and increases the risk of
cardiac dysrhythmias, especially if the patient is on digoxin. This finding requires immediate
intervention. Weight loss of 1 kg/day is expected with diuresis; BP 110/70 is acceptable; urine output 50
mL/hour is adequate.*
3. A patient is admitted with acute decompensated heart failure. The nurse assesses jugular venous
distention (JVD), crackles in the lungs, and peripheral edema. Which of the following interventions
should the nurse implement first?
• A) Administer furosemide IV.
• B) Place the patient in high-Fowler’s position.
• C) Initiate a low-sodium diet.
• D) Obtain a chest X-ray.
✔✔ Answer✔✔ B
Rationale: Positioning the patient in high-Fowler’s position facilitates breathing and reduces preload by
pooling blood in the lower extremities. This is an immediate intervention to improve oxygenation.
Furosemide and other interventions follow.
4. A patient with heart failure is prescribed carvedilol. Which of the following is a priority teaching
point?
• A) “Take this medication with food to prevent stomach upset.”
• B) “Monitor your weight daily and report a gain of 2-3 pounds in a day.”
• C) “This medication may cause a dry cough.”
• D) “You may stop this medication if you feel dizzy.”
✔✔ Answer✔✔ B
Rationale: Daily weight monitoring is crucial for heart failure patients to detect fluid retention early.
Carvedilol is a beta-blocker that should not be stopped abruptly; it can cause rebound tachycardia and
worsening heart failure. Dry cough is associated with ACE inhibitors, not carvedilol.
5. A patient with stable angina reports chest pain that occurs with exertion and is relieved by rest. The
nurse knows that this type of angina is most likely:
• A) Unstable angina
• B) Variant (Prinzmetal) angina
,3
• C) Stable angina
• D) Microvascular angina
✔✔ Answer✔✔ C
Rationale: Stable angina is predictable, occurs with exertion or stress, and is relieved by rest or
nitroglycerin. Unstable angina occurs at rest or with minimal exertion and is a medical emergency.
Variant angina is caused by coronary artery spasm.
6. A patient is prescribed nitroglycerin sublingual tablets for angina. Which of the following instructions
should the nurse include?
• A) “Swallow the tablet with a full glass of water.”
• B) “Take a tablet every 5 minutes until pain subsides, up to three doses.”
• C) “Store the tablets in a plastic container.”
• D) “Expect a burning sensation when the tablet dissolves.”
✔✔ Answer✔✔ B
Rationale: Standard instructions: take one tablet at onset of pain; if no relief in 5 minutes, call 911 and
take a second; a third may be taken while awaiting emergency care. Tablets should be kept in the
original glass container, not plastic. A burning sensation may occur but is not a reliable indicator of
effectiveness.
7. A patient with a myocardial infarction (MI) is receiving thrombolytic therapy. Which of the following
findings would indicate a complication of this therapy?
• A) Chest pain relieved
• B) ST-segment elevation resolution
• C) Reperfusion dysrhythmias
• D) Bleeding from the IV site
✔✔ Answer✔✔ D
Rationale: Bleeding is a major complication of thrombolytics. Minor bleeding (IV site) may be
manageable, but any bleeding should be reported. Reperfusion dysrhythmias are expected and may
indicate successful reperfusion. Chest pain relief and ST-segment resolution are desired outcomes.
8. A patient is 6 hours post-MI and has a heart rate of 110 bpm, blood pressure 90/60 mmHg, and
crackles in the lungs. Which of the following complications is most likely?
• A) Cardiogenic shock
, 4
• B) Pericarditis
• C) Ventricular aneurysm
• D) Heart failure
✔✔ Answer✔✔ A
Rationale: Cardiogenic shock is characterized by hypotension, tachycardia, and signs of end-organ
hypoperfusion (e.g., crackles from pulmonary congestion). It occurs in about 10-15% of MI patients and
has high mortality. Heart failure is possible but cardiogenic shock is the more acute presentation with
hypotension.
9. A patient with coronary artery disease is prescribed aspirin 81 mg daily. What is the primary purpose
of this medication?
• A) Reduce cholesterol levels
• B) Prevent platelet aggregation
• C) Dilate coronary arteries
• D) Decrease myocardial oxygen demand
✔✔ Answer✔✔ B
Rationale: Low-dose aspirin irreversibly inhibits cyclooxygenase-1 (COX-1) in platelets, reducing
thromboxane A2 production and preventing platelet aggregation. This reduces the risk of thrombotic
events.
10. A patient with a history of deep vein thrombosis (DVT) is prescribed warfarin. Which of the following
laboratory tests is used to monitor therapy?
• A) aPTT
• B) INR
• C) Platelet count
• D) D-dimer
✔✔ Answer✔✔ B
Rationale: Warfarin is monitored using the International Normalized Ratio (INR), with a target typically
of 2-3 for DVT treatment. aPTT is used for heparin. Platelet count monitors for heparin-induced
thrombocytopenia; D-dimer is used to diagnose DVT.
11. A patient on warfarin has an INR of 4.5 with no signs of bleeding. Which of the following is the
appropriate nursing action?
