NUR 254 Exam 2 | (2026/2027 Update) Questions &
Answers (Verified Answers) - Galen College Of
Nursing || Complete A+ Guide
Section 1: Cardiovascular Disorders (Questions 1–50)
1. A client with acute decompensated heart failure (ADHF) presents with severe
dyspnea, crackles throughout lung fields, and oxygen saturation 82% on room air.
Which intervention should the nurse implement first?
A. Administer IV furosemide
B. Place the client in high-Fowler’s position
C. Start a dopamine infusion
D. Draw a troponin level
Answer: B
Rationale: High-Fowler’s position reduces preload and improves ventilation; this is
immediate priority before medication.
2. A client with heart failure has a prescription for metoprolol succinate. The nurse
knows the primary purpose of this medication is to:
A. Increase contractility
B. Reduce mortality by blocking sympathetic overstimulation
C. Promote diuresis
D. Vasodilate arteries
Answer: B
Rationale: Beta-blockers (carvedilol, metoprolol succinate) reduce sympathetic
remodeling and mortality in HFrEF.
3. A client with an ST-elevation myocardial infarction (STEMI) is being transferred for
percutaneous coronary intervention (PCI). Which medication should be given
immediately if not contraindicated?
A. Aspirin 324 mg chewed
B. Warfarin 5 mg PO
,C. Clopidogrel 75 mg daily
D. Enoxaparin 1 mg/kg
Answer: A
Rationale: Aspirin reduces mortality in acute MI; given immediately.
4. A client is admitted with acute pericarditis. Which finding is most characteristic?
A. Pleuritic chest pain relieved by leaning forward
B. Pain radiating to left arm
C. Pain worse with leaning forward
D. ST-segment depression in all leads
Answer: A
Rationale: Pericarditis pain is sharp, pleuritic, relieved by sitting/leaning forward.
5. A client with hypertension has a new prescription for hydrochlorothiazide. The nurse
should monitor for:
A. Hypokalemia, hyperglycemia, hyperuricemia
B. Hyperkalemia, hyponatremia
C. Bradycardia
D. Cough
Answer: A
Rationale: Thiazides cause hypokalemia, increased glucose, increased uric acid.
6. A client with heart failure has a jugular venous pressure (JVP) of 12 cm H₂O and 3+
pitting edema. The nurse anticipates which medication?
A. IV furosemide
B. Metoprolol
C. Spironolactone
D. Digoxin
Answer: A
Rationale: Loop diuretics (furosemide) for volume overload.
7. A client with atrial fibrillation (AF) and a CHA₂DS₂-VASc score of 4 is prescribed
apixaban. The nurse teaches that the purpose of anticoagulation is to:
A. Convert AF to sinus rhythm
B. Prevent stroke (thrombus from left atrium)
,C. Lower blood pressure
D. Reduce chest pain
Answer: B
Rationale: AF increases stroke risk; anticoagulation reduces it.
8. A client with heart failure has an ejection fraction of 25%. The nurse classifies this as:
A. HF with preserved ejection fraction (HFpEF)
B. HF with reduced ejection fraction (HFrEF)
C. Diastolic heart failure
D. Normal cardiac function
Answer: B
Rationale: HFrEF = EF ≤ 40%; HFpEF = EF ≥ 50%.
9. Which laboratory finding supports the diagnosis of heart failure?
A. Elevated B-type natriuretic peptide (BNP)
B. Elevated troponin
C. Low potassium
D. Low hemoglobin
Answer: A
Rationale: BNP > 100 pg/mL suggests heart failure.
10. A client with an acute MI develops crackles in both lungs and an S3 gallop. The
nurse suspects:
A. Pericarditis
B. Acute mitral regurgitation
C. Cardiogenic shock
D. Left ventricular failure (pulmonary edema)
Answer: D
Rationale: S3 and crackles indicate left ventricular failure.
11. A client is receiving IV nitroglycerin for acute coronary syndrome. The nurse should
monitor primarily for:
A. Hypotension and headache
B. Hyperkalemia
, C. Bradycardia
D. Hyperglycemia
Answer: A
Rationale: Nitroglycerin causes vasodilation → hypotension, reflex tachycardia,
headache.
12. A client with a permanent pacemaker for complete heart block should be taught to:
A. Avoid MRI unless device is MRI-compatible
B. Use a microwave
C. Hold cell phone over the generator
D. Not check pulse
Answer: A
Rationale: MRI may interfere with pacemaker unless MRI-safe.
13. A client with endocarditis has petechiae, splinter hemorrhages, and Osler nodes.
The nurse anticipates which diagnostic test?
A. Blood cultures (x3) and echocardiogram
B. Cardiac catheterization
C. ECG
D. Chest x-ray
Answer: A
Rationale: Blood cultures and echo (TTE/TEE) diagnose endocarditis.
14. A client with a deep vein thrombosis (DVT) is started on heparin infusion. The nurse
should monitor:
A. aPTT (goal 1.5–2.5 times control)
B. INR
C. Platelet count (HIT risk)
D. Both A and C
Answer: D
Rationale: Heparin monitored by aPTT; also monitor platelets for heparin-induced
thrombocytopenia (HIT).
15. A client with pulmonary embolism (PE) has hypotension and tachycardia. Which
intervention is priority?
Answers (Verified Answers) - Galen College Of
Nursing || Complete A+ Guide
Section 1: Cardiovascular Disorders (Questions 1–50)
1. A client with acute decompensated heart failure (ADHF) presents with severe
dyspnea, crackles throughout lung fields, and oxygen saturation 82% on room air.
Which intervention should the nurse implement first?
A. Administer IV furosemide
B. Place the client in high-Fowler’s position
C. Start a dopamine infusion
D. Draw a troponin level
Answer: B
Rationale: High-Fowler’s position reduces preload and improves ventilation; this is
immediate priority before medication.
2. A client with heart failure has a prescription for metoprolol succinate. The nurse
knows the primary purpose of this medication is to:
A. Increase contractility
B. Reduce mortality by blocking sympathetic overstimulation
C. Promote diuresis
D. Vasodilate arteries
Answer: B
Rationale: Beta-blockers (carvedilol, metoprolol succinate) reduce sympathetic
remodeling and mortality in HFrEF.
3. A client with an ST-elevation myocardial infarction (STEMI) is being transferred for
percutaneous coronary intervention (PCI). Which medication should be given
immediately if not contraindicated?
A. Aspirin 324 mg chewed
B. Warfarin 5 mg PO
,C. Clopidogrel 75 mg daily
D. Enoxaparin 1 mg/kg
Answer: A
Rationale: Aspirin reduces mortality in acute MI; given immediately.
4. A client is admitted with acute pericarditis. Which finding is most characteristic?
A. Pleuritic chest pain relieved by leaning forward
B. Pain radiating to left arm
C. Pain worse with leaning forward
D. ST-segment depression in all leads
Answer: A
Rationale: Pericarditis pain is sharp, pleuritic, relieved by sitting/leaning forward.
5. A client with hypertension has a new prescription for hydrochlorothiazide. The nurse
should monitor for:
A. Hypokalemia, hyperglycemia, hyperuricemia
B. Hyperkalemia, hyponatremia
C. Bradycardia
D. Cough
Answer: A
Rationale: Thiazides cause hypokalemia, increased glucose, increased uric acid.
6. A client with heart failure has a jugular venous pressure (JVP) of 12 cm H₂O and 3+
pitting edema. The nurse anticipates which medication?
A. IV furosemide
B. Metoprolol
C. Spironolactone
D. Digoxin
Answer: A
Rationale: Loop diuretics (furosemide) for volume overload.
7. A client with atrial fibrillation (AF) and a CHA₂DS₂-VASc score of 4 is prescribed
apixaban. The nurse teaches that the purpose of anticoagulation is to:
A. Convert AF to sinus rhythm
B. Prevent stroke (thrombus from left atrium)
,C. Lower blood pressure
D. Reduce chest pain
Answer: B
Rationale: AF increases stroke risk; anticoagulation reduces it.
8. A client with heart failure has an ejection fraction of 25%. The nurse classifies this as:
A. HF with preserved ejection fraction (HFpEF)
B. HF with reduced ejection fraction (HFrEF)
C. Diastolic heart failure
D. Normal cardiac function
Answer: B
Rationale: HFrEF = EF ≤ 40%; HFpEF = EF ≥ 50%.
9. Which laboratory finding supports the diagnosis of heart failure?
A. Elevated B-type natriuretic peptide (BNP)
B. Elevated troponin
C. Low potassium
D. Low hemoglobin
Answer: A
Rationale: BNP > 100 pg/mL suggests heart failure.
10. A client with an acute MI develops crackles in both lungs and an S3 gallop. The
nurse suspects:
A. Pericarditis
B. Acute mitral regurgitation
C. Cardiogenic shock
D. Left ventricular failure (pulmonary edema)
Answer: D
Rationale: S3 and crackles indicate left ventricular failure.
11. A client is receiving IV nitroglycerin for acute coronary syndrome. The nurse should
monitor primarily for:
A. Hypotension and headache
B. Hyperkalemia
, C. Bradycardia
D. Hyperglycemia
Answer: A
Rationale: Nitroglycerin causes vasodilation → hypotension, reflex tachycardia,
headache.
12. A client with a permanent pacemaker for complete heart block should be taught to:
A. Avoid MRI unless device is MRI-compatible
B. Use a microwave
C. Hold cell phone over the generator
D. Not check pulse
Answer: A
Rationale: MRI may interfere with pacemaker unless MRI-safe.
13. A client with endocarditis has petechiae, splinter hemorrhages, and Osler nodes.
The nurse anticipates which diagnostic test?
A. Blood cultures (x3) and echocardiogram
B. Cardiac catheterization
C. ECG
D. Chest x-ray
Answer: A
Rationale: Blood cultures and echo (TTE/TEE) diagnose endocarditis.
14. A client with a deep vein thrombosis (DVT) is started on heparin infusion. The nurse
should monitor:
A. aPTT (goal 1.5–2.5 times control)
B. INR
C. Platelet count (HIT risk)
D. Both A and C
Answer: D
Rationale: Heparin monitored by aPTT; also monitor platelets for heparin-induced
thrombocytopenia (HIT).
15. A client with pulmonary embolism (PE) has hypotension and tachycardia. Which
intervention is priority?
