Maryville NURS 620 Adult Exams Full Solution Pack Actual
Exam 2026/2027 – Complete Q&A with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section A: Cardiovascular Disorders — Assessment, Diagnostics, &
Management
Q1: A 68-year-old male presents with crushing substernal chest pain radiating to his left
arm, diaphoresis, and nausea. His ECG shows ST-segment elevation in leads II, III, and
aVF. His troponin I is 4.2 ng/mL (normal <0.04). Which diagnosis is most likely?
A. NSTEMI with anterior wall involvement
B. STEMI with inferior wall involvement [CORRECT]
C. Unstable angina without myocardial damage
D. Pericarditis with diffuse ST changes
Correct Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall STEMI; elevated
troponin confirms myocardial necrosis. NSTEMI (Option A) shows ST depression or
T-wave inversion without ST elevation. Unstable angina (Option C) has no troponin
elevation. Pericarditis (Option D) shows diffuse ST elevation and PR depression, not
localized inferior changes.
,Q2: A patient with acute STEMI is being prepared for reperfusion therapy. The
door-to-balloon time is 45 minutes, and the door-to-needle time for fibrinolysis would be
15 minutes. Which intervention is preferred?
A. Fibrinolytic therapy because it is faster
B. Primary PCI because it is the preferred reperfusion strategy when available within 90
minutes [CORRECT]
C. Conservative medical management with heparin only
D. Delayed PCI in 24 hours regardless of timing
Correct Answer: B
Rationale: Primary PCI is the preferred reperfusion strategy for STEMI when it can be
performed within 90 minutes of first medical contact, offering superior outcomes to
fibrinolysis. Option A is incorrect—while faster, fibrinolysis has lower reperfusion
success and higher bleeding risk. Option C denies necessary reperfusion. Option D
delays definitive therapy.
Q3: A patient with heart failure has an ejection fraction of 25% and presents with
dyspnea, orthopnea, S3 gallop, and bilateral crackles. Which medication class is
FIRST-LINE for this patient's condition?
A. Calcium channel blocker
B. ACE inhibitor or ARB [CORRECT]
C. Loop diuretic only without other agents
D. Beta-blocker initiated at maximum dose immediately
,Correct Answer: B
Rationale: ACE inhibitors/ARBs are first-line in HFrEF (systolic dysfunction) due to
mortality benefit, afterload reduction, and remodeling prevention. Option A is not
first-line and may worsen HF. Option C treats symptoms but does not improve mortality.
Option D requires careful titration from low doses once stable, not immediate maximum
dosing.
Q4: A patient with acute decompensated heart failure develops acute pulmonary edema
with severe dyspnea, pink frothy sputum, and oxygen saturation of 82% on room air.
Which intervention is the HIGHEST priority?
A. Administer furosemide 40 mg IV push
B. Apply noninvasive positive pressure ventilation (BiPAP) [CORRECT]
C. Administer digoxin loading dose
D. Insert a Foley catheter for strict I/O
Correct Answer: B
Rationale: In acute cardiogenic pulmonary edema with severe hypoxemia, noninvasive
ventilation (BiPAP/CPAP) is the highest priority to reduce work of breathing, improve
oxygenation, and decrease preload. While furosemide (Option A) is important, airway
and oxygenation take precedence per ABCs. Digoxin (Option C) is not first-line in acute
pulmonary edema. Foley insertion (Option D) is important but not emergent.
Q5: A patient in the ICU develops new-onset atrial fibrillation with a rapid ventricular
response (HR 160 bpm) and blood pressure of 88/52 mmHg. Which intervention is
most appropriate?
, A. Administer metoprolol 5 mg IV push
B. Administer diltiazem 0.25 mg/kg IV
C. Perform synchronized cardioversion [CORRECT]
D. Administer adenosine 6 mg rapid IV push
Correct Answer: C
Rationale: Unstable atrial fibrillation with hypotension (SBP <90) requires immediate
synchronized cardioversion. Options A and B are appropriate for stable patients but may
worsen hypotension. Option D is used for SVT/PSVT, not atrial fibrillation.
Q6: A patient with infective endocarditis presents with fever, a new harsh holosystolic
murmur at the apex, and acute dyspnea. Echocardiography shows a flail mitral valve
leaflet with severe regurgitation. Which complication has most likely occurred?
A. Aortic root abscess
B. Papillary muscle rupture with acute mitral regurgitation [CORRECT]
C. Pericardial tamponade
D. Ventricular septal defect
Correct Answer: B
Rationale: Papillary muscle rupture from infective endocarditis causes acute severe
mitral regurgitation, presenting with a new holosystolic murmur and acute pulmonary
edema. Option A would show aortic involvement. Option C presents with Beck's triad.
Option D produces a holosystolic murmur at the left sternal border with a step-up in
oxygen saturation.
Exam 2026/2027 – Complete Q&A with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section A: Cardiovascular Disorders — Assessment, Diagnostics, &
Management
Q1: A 68-year-old male presents with crushing substernal chest pain radiating to his left
arm, diaphoresis, and nausea. His ECG shows ST-segment elevation in leads II, III, and
aVF. His troponin I is 4.2 ng/mL (normal <0.04). Which diagnosis is most likely?
A. NSTEMI with anterior wall involvement
B. STEMI with inferior wall involvement [CORRECT]
C. Unstable angina without myocardial damage
D. Pericarditis with diffuse ST changes
Correct Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall STEMI; elevated
troponin confirms myocardial necrosis. NSTEMI (Option A) shows ST depression or
T-wave inversion without ST elevation. Unstable angina (Option C) has no troponin
elevation. Pericarditis (Option D) shows diffuse ST elevation and PR depression, not
localized inferior changes.
,Q2: A patient with acute STEMI is being prepared for reperfusion therapy. The
door-to-balloon time is 45 minutes, and the door-to-needle time for fibrinolysis would be
15 minutes. Which intervention is preferred?
A. Fibrinolytic therapy because it is faster
B. Primary PCI because it is the preferred reperfusion strategy when available within 90
minutes [CORRECT]
C. Conservative medical management with heparin only
D. Delayed PCI in 24 hours regardless of timing
Correct Answer: B
Rationale: Primary PCI is the preferred reperfusion strategy for STEMI when it can be
performed within 90 minutes of first medical contact, offering superior outcomes to
fibrinolysis. Option A is incorrect—while faster, fibrinolysis has lower reperfusion
success and higher bleeding risk. Option C denies necessary reperfusion. Option D
delays definitive therapy.
Q3: A patient with heart failure has an ejection fraction of 25% and presents with
dyspnea, orthopnea, S3 gallop, and bilateral crackles. Which medication class is
FIRST-LINE for this patient's condition?
A. Calcium channel blocker
B. ACE inhibitor or ARB [CORRECT]
C. Loop diuretic only without other agents
D. Beta-blocker initiated at maximum dose immediately
,Correct Answer: B
Rationale: ACE inhibitors/ARBs are first-line in HFrEF (systolic dysfunction) due to
mortality benefit, afterload reduction, and remodeling prevention. Option A is not
first-line and may worsen HF. Option C treats symptoms but does not improve mortality.
Option D requires careful titration from low doses once stable, not immediate maximum
dosing.
Q4: A patient with acute decompensated heart failure develops acute pulmonary edema
with severe dyspnea, pink frothy sputum, and oxygen saturation of 82% on room air.
Which intervention is the HIGHEST priority?
A. Administer furosemide 40 mg IV push
B. Apply noninvasive positive pressure ventilation (BiPAP) [CORRECT]
C. Administer digoxin loading dose
D. Insert a Foley catheter for strict I/O
Correct Answer: B
Rationale: In acute cardiogenic pulmonary edema with severe hypoxemia, noninvasive
ventilation (BiPAP/CPAP) is the highest priority to reduce work of breathing, improve
oxygenation, and decrease preload. While furosemide (Option A) is important, airway
and oxygenation take precedence per ABCs. Digoxin (Option C) is not first-line in acute
pulmonary edema. Foley insertion (Option D) is important but not emergent.
Q5: A patient in the ICU develops new-onset atrial fibrillation with a rapid ventricular
response (HR 160 bpm) and blood pressure of 88/52 mmHg. Which intervention is
most appropriate?
, A. Administer metoprolol 5 mg IV push
B. Administer diltiazem 0.25 mg/kg IV
C. Perform synchronized cardioversion [CORRECT]
D. Administer adenosine 6 mg rapid IV push
Correct Answer: C
Rationale: Unstable atrial fibrillation with hypotension (SBP <90) requires immediate
synchronized cardioversion. Options A and B are appropriate for stable patients but may
worsen hypotension. Option D is used for SVT/PSVT, not atrial fibrillation.
Q6: A patient with infective endocarditis presents with fever, a new harsh holosystolic
murmur at the apex, and acute dyspnea. Echocardiography shows a flail mitral valve
leaflet with severe regurgitation. Which complication has most likely occurred?
A. Aortic root abscess
B. Papillary muscle rupture with acute mitral regurgitation [CORRECT]
C. Pericardial tamponade
D. Ventricular septal defect
Correct Answer: B
Rationale: Papillary muscle rupture from infective endocarditis causes acute severe
mitral regurgitation, presenting with a new holosystolic murmur and acute pulmonary
edema. Option A would show aortic involvement. Option C presents with Beck's triad.
Option D produces a holosystolic murmur at the left sternal border with a step-up in
oxygen saturation.
