NUR 170 / NUR170 Concepts of Medical-Surgical
Nursing Exam 4 Version B Guide Actual 2026/2027 with
Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
SECTION 1: COMPLEX CARDIOVASCULAR DISORDERS (12
Questions)
Q1: A patient with acute decompensated heart failure has a BNP of 1,850 pg/mL and
reports orthopnea. Which nursing assessment finding indicates worsening left
ventricular function?
A. Decreased jugular venous pressure
B. Bibasilar crackles and an S3 heart sound
C. Clear lung fields on auscultation
D. Bradycardia with regular rhythm
Correct Answer: B
Rationale: Correct because bibasilar crackles result from pulmonary edema due to
increased left atrial pressure, and an S3 gallop indicates rapid ventricular filling from
volume overload—both are classic signs of decompensated left heart failure.
Q2: A patient with unstable angina has ST-segment depression on ECG. Which
pathophysiologic process is occurring?
A. Complete coronary artery occlusion with myocardial necrosis
B. Subendocardial ischemia from partially obstructed coronary flow
C. Pericardial inflammation causing diffuse ST elevation
D. Electrolyte imbalance affecting cardiac conduction
Correct Answer: B
,Rationale: Correct because ST-segment depression in unstable angina indicates
subendocardial ischemia from a partially occluded coronary artery with reduced
blood flow, without complete occlusion or myocardial necrosis.
Q3: A patient with atrial flutter has a ventricular rate of 150 beats/min with a
sawtooth pattern on ECG. Which nursing intervention is the priority?
A. Administering adenosine to convert the rhythm
B. Assessing hemodynamic stability and preparing for synchronized cardioversion if
unstable
C. Administering atropine to increase the heart rate
D. Encouraging the patient to perform Valsalva maneuver
Correct Answer: B
Rationale: Correct because atrial flutter with rapid ventricular response can cause
hemodynamic compromise; the nurse must first assess stability and prepare for
synchronized cardioversion if the patient is unstable, per ACLS guidelines.
Q4: A patient with a mechanical heart valve is prescribed lifelong anticoagulation.
Which INR target range is most appropriate?
A. 1.5-2.0
B. 2.0-3.0
C. 2.5-3.5
D. 3.5-4.5
Correct Answer: C
Rationale: Correct because mechanical heart valves require a higher INR target
(2.5-3.5 for aortic valves, 3.0-3.5 for mitral valves) compared to other indications due
to the high thrombogenicity of prosthetic materials.
Q5: A patient with a thoracic aortic aneurysm reports sudden tearing chest pain
radiating to the back. Which complication should the nurse suspect?
A. Stable angina pectoris
B. Aortic dissection
C. Pulmonary embolism
D. Acute pericarditis
, Correct Answer: B
Rationale: Correct because sudden tearing or ripping chest pain radiating to the back
is the classic presentation of aortic dissection, a life-threatening complication of
thoracic aortic aneurysm requiring immediate surgical evaluation.
Q6: A patient with infective endocarditis has splinter hemorrhages and Osler nodes.
Which embolic complication is the nurse most concerned about?
A. Peripheral arterial emboli to the extremities
B. Septic emboli to the brain causing stroke or mycotic aneurysm
C. Pulmonary emboli from venous thrombosis
D. Splenic infarction causing abdominal pain
Correct Answer: B
Rationale: Correct because septic emboli from left-sided endocarditis commonly
travel to the brain, causing ischemic stroke, intracranial hemorrhage from mycotic
aneurysm rupture, or brain abscess—the most feared complications.
Q7: A patient with hypertensive urgency has a blood pressure of 190/110 mmHg
without end-organ damage. Which nursing intervention is most appropriate?
A. Administering IV nitroprusside for rapid blood pressure reduction
B. Administering oral antihypertensives with gradual reduction over 24-48 hours
C. Administering sublingual nifedipine for immediate effect
D. Placing the patient in Trendelenburg position
Correct Answer: B
Rationale: Correct because hypertensive urgency without end-organ damage
requires gradual blood pressure reduction over 24-48 hours with oral medications;
rapid reduction can cause cerebral, coronary, or renal hypoperfusion.
Q8: A patient with a biventricular pacemaker reports palpitations. Telemetry shows
pacemaker spikes without subsequent QRS complexes. Which term describes this
finding?
A. Pacemaker oversensing
B. Failure to capture
C. Pacemaker-mediated tachycardia
D. Normal pacemaker function
Nursing Exam 4 Version B Guide Actual 2026/2027 with
Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
SECTION 1: COMPLEX CARDIOVASCULAR DISORDERS (12
Questions)
Q1: A patient with acute decompensated heart failure has a BNP of 1,850 pg/mL and
reports orthopnea. Which nursing assessment finding indicates worsening left
ventricular function?
A. Decreased jugular venous pressure
B. Bibasilar crackles and an S3 heart sound
C. Clear lung fields on auscultation
D. Bradycardia with regular rhythm
Correct Answer: B
Rationale: Correct because bibasilar crackles result from pulmonary edema due to
increased left atrial pressure, and an S3 gallop indicates rapid ventricular filling from
volume overload—both are classic signs of decompensated left heart failure.
Q2: A patient with unstable angina has ST-segment depression on ECG. Which
pathophysiologic process is occurring?
A. Complete coronary artery occlusion with myocardial necrosis
B. Subendocardial ischemia from partially obstructed coronary flow
C. Pericardial inflammation causing diffuse ST elevation
D. Electrolyte imbalance affecting cardiac conduction
Correct Answer: B
,Rationale: Correct because ST-segment depression in unstable angina indicates
subendocardial ischemia from a partially occluded coronary artery with reduced
blood flow, without complete occlusion or myocardial necrosis.
Q3: A patient with atrial flutter has a ventricular rate of 150 beats/min with a
sawtooth pattern on ECG. Which nursing intervention is the priority?
A. Administering adenosine to convert the rhythm
B. Assessing hemodynamic stability and preparing for synchronized cardioversion if
unstable
C. Administering atropine to increase the heart rate
D. Encouraging the patient to perform Valsalva maneuver
Correct Answer: B
Rationale: Correct because atrial flutter with rapid ventricular response can cause
hemodynamic compromise; the nurse must first assess stability and prepare for
synchronized cardioversion if the patient is unstable, per ACLS guidelines.
Q4: A patient with a mechanical heart valve is prescribed lifelong anticoagulation.
Which INR target range is most appropriate?
A. 1.5-2.0
B. 2.0-3.0
C. 2.5-3.5
D. 3.5-4.5
Correct Answer: C
Rationale: Correct because mechanical heart valves require a higher INR target
(2.5-3.5 for aortic valves, 3.0-3.5 for mitral valves) compared to other indications due
to the high thrombogenicity of prosthetic materials.
Q5: A patient with a thoracic aortic aneurysm reports sudden tearing chest pain
radiating to the back. Which complication should the nurse suspect?
A. Stable angina pectoris
B. Aortic dissection
C. Pulmonary embolism
D. Acute pericarditis
, Correct Answer: B
Rationale: Correct because sudden tearing or ripping chest pain radiating to the back
is the classic presentation of aortic dissection, a life-threatening complication of
thoracic aortic aneurysm requiring immediate surgical evaluation.
Q6: A patient with infective endocarditis has splinter hemorrhages and Osler nodes.
Which embolic complication is the nurse most concerned about?
A. Peripheral arterial emboli to the extremities
B. Septic emboli to the brain causing stroke or mycotic aneurysm
C. Pulmonary emboli from venous thrombosis
D. Splenic infarction causing abdominal pain
Correct Answer: B
Rationale: Correct because septic emboli from left-sided endocarditis commonly
travel to the brain, causing ischemic stroke, intracranial hemorrhage from mycotic
aneurysm rupture, or brain abscess—the most feared complications.
Q7: A patient with hypertensive urgency has a blood pressure of 190/110 mmHg
without end-organ damage. Which nursing intervention is most appropriate?
A. Administering IV nitroprusside for rapid blood pressure reduction
B. Administering oral antihypertensives with gradual reduction over 24-48 hours
C. Administering sublingual nifedipine for immediate effect
D. Placing the patient in Trendelenburg position
Correct Answer: B
Rationale: Correct because hypertensive urgency without end-organ damage
requires gradual blood pressure reduction over 24-48 hours with oral medications;
rapid reduction can cause cerebral, coronary, or renal hypoperfusion.
Q8: A patient with a biventricular pacemaker reports palpitations. Telemetry shows
pacemaker spikes without subsequent QRS complexes. Which term describes this
finding?
A. Pacemaker oversensing
B. Failure to capture
C. Pacemaker-mediated tachycardia
D. Normal pacemaker function
