Exam 3: NUR 201 Medical-Surgical Nursing I
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Guide
Guaranteed Pass
Q1: A 72-year-old male is admitted with acute heart failure exacerbation. He has bilateral lung
crackles, 3+ pitting edema in both lower extremities, and orthopnea. Which medication should
the nurse prepare to administer first?
A. Digoxin 0.25 mg PO
B. Furosemide 40 mg IV push
C. Metoprolol 25 mg PO
D. Enalapril 5 mg PO
Correct Answer: B
Rationale: Correct because furosemide is a loop diuretic that acts rapidly to reduce fluid volume
overload in acute heart failure exacerbation by promoting diuresis and decreasing preload, which
improves breathing and reduces pulmonary congestion. The patient's bilateral crackles, severe
pitting edema, and orthopnea indicate significant fluid overload requiring immediate
intervention. The nurse must position the patient in high Fowler's to maximize lung expansion,
monitor blood pressure for hypotension, and assess electrolytes (especially potassium) following
diuretic administration to prevent hypokalemia and associated dysrhythmias.
Q2: A patient with chronic stable angina reports chest pain while walking to the bathroom. The
nurse administers sublingual nitroglycerin 0.4 mg. Which instruction is most important?
A. Swallow the tablet with water for faster absorption
B. Place the tablet under the tongue and allow it to dissolve completely
C. Chew the tablet thoroughly before swallowing
D. Take the tablet with food to prevent stomach upset
Correct Answer: D
,Rationale: Correct because sublingual nitroglycerin must be placed under the tongue or in the
buccal pouch (between cheek and gum) and allowed to dissolve completely for rapid absorption
through the oral mucosa into the systemic circulation, bypassing first-pass hepatic metabolism.
Swallowing the tablet significantly delays and reduces absorption, chewing destroys the
sublingual formulation, and food interferes with absorption. The nurse must instruct the patient
to sit or lie down before taking nitroglycerin to prevent orthostatic hypotension, and to call
emergency services if pain is not relieved after three doses taken 5 minutes apart.
Q3: A patient with atrial fibrillation has an irregularly irregular pulse, absent P waves on
telemetry, and a ventricular rate of 140 bpm. The blood pressure is 88/52 mmHg. Which is the
priority nursing action?
A. Administer digoxin 0.25 mg IV for rate control
B. Prepare for immediate synchronized cardioversion
C. Give metoprolol 5 mg IV to slow the heart rate
D. Initiate anticoagulation with heparin infusion
Correct Answer: A
Rationale: Correct because this patient has atrial fibrillation with rapid ventricular response
(RVR) and is hemodynamically unstable (SBP 88/52 mmHg), which is an indication for
immediate synchronized cardioversion to restore sinus rhythm and improve cardiac output.
Hemodynamic instability in afib is defined by hypotension, altered mental status, chest pain, or
signs of poor perfusion, and rate-control medications such as digoxin, beta-blockers, or calcium
channel blockers are contraindicated in unstable patients as they can worsen hypotension. The
nurse must prepare the crash cart, ensure sedation is available, and have the defibrillator ready
for synchronized cardioversion while continuing to monitor rhythm and blood pressure.
Q4: A patient with heart failure is taking lisinopril 10 mg daily. The nurse notes a potassium of
5.6 mEq/L and the patient reports swelling of the lips and tongue. Which complication is most
likely?
A. Hypokalemia from ACE inhibitor therapy
B. Angioedema from ACE inhibitor therapy
C. Hypernatremia from ACE inhibitor therapy
D. Anaphylaxis from digoxin toxicity
Correct Answer: C
, Rationale: Correct because angioedema (swelling of the lips, tongue, face, and airway) is a
serious and potentially life-threatening side effect of ACE inhibitors such as lisinopril, caused by
increased bradykinin levels from ACE inhibition. The hyperkalemia (5.6 mEq/L) is also
consistent with ACE inhibitor therapy, as these medications decrease aldosterone secretion and
reduce renal potassium excretion. The nurse must discontinue the ACE inhibitor immediately,
maintain airway patency, prepare for emergency intubation if airway compromise develops, and
notify the provider for alternative antihypertensive therapy such as an ARB (if angioedema was
not severe) or calcium channel blocker.
Q5: A patient with peripheral artery disease (PAD) reports severe cramping pain in the calves
after walking two blocks, which resolves with rest. The nurse notes shiny, hairless skin on the
lower legs and absent pedal pulses. Which nursing instruction is most appropriate?
A. Elevate the legs above the heart to promote venous return
B. Keep the legs dependent and avoid direct heat application
C. Apply warm compresses to the calves to improve circulation
D. Encourage prolonged bed rest to reduce oxygen demand
Correct Answer: D
Rationale: Correct because patients with peripheral artery disease (PAD) have decreased arterial
blood flow to the lower extremities, and keeping the legs dependent (down) maximizes arterial
perfusion through gravity-assisted blood flow. Direct heat application is absolutely
contraindicated due to decreased sensation and high burn risk from ischemic tissue. Elevating the
legs above the heart worsens arterial perfusion and is appropriate for chronic venous
insufficiency, not PAD. The nurse should also instruct the patient on a supervised walking
program to improve collateral circulation, daily foot inspection, proper footwear, and smoking
cessation to slow disease progression.
Q6: A patient with a tracheostomy is being cared for by an LPN under RN supervision. Which
task is appropriate for the LPN to perform?
A. Perform the initial tracheostomy tube change
B. Conduct a comprehensive swallowing assessment
C. Perform routine tracheostomy suctioning
D. Develop the initial patient education plan for stoma care
Correct Answer: A
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Guide
Guaranteed Pass
Q1: A 72-year-old male is admitted with acute heart failure exacerbation. He has bilateral lung
crackles, 3+ pitting edema in both lower extremities, and orthopnea. Which medication should
the nurse prepare to administer first?
A. Digoxin 0.25 mg PO
B. Furosemide 40 mg IV push
C. Metoprolol 25 mg PO
D. Enalapril 5 mg PO
Correct Answer: B
Rationale: Correct because furosemide is a loop diuretic that acts rapidly to reduce fluid volume
overload in acute heart failure exacerbation by promoting diuresis and decreasing preload, which
improves breathing and reduces pulmonary congestion. The patient's bilateral crackles, severe
pitting edema, and orthopnea indicate significant fluid overload requiring immediate
intervention. The nurse must position the patient in high Fowler's to maximize lung expansion,
monitor blood pressure for hypotension, and assess electrolytes (especially potassium) following
diuretic administration to prevent hypokalemia and associated dysrhythmias.
Q2: A patient with chronic stable angina reports chest pain while walking to the bathroom. The
nurse administers sublingual nitroglycerin 0.4 mg. Which instruction is most important?
A. Swallow the tablet with water for faster absorption
B. Place the tablet under the tongue and allow it to dissolve completely
C. Chew the tablet thoroughly before swallowing
D. Take the tablet with food to prevent stomach upset
Correct Answer: D
,Rationale: Correct because sublingual nitroglycerin must be placed under the tongue or in the
buccal pouch (between cheek and gum) and allowed to dissolve completely for rapid absorption
through the oral mucosa into the systemic circulation, bypassing first-pass hepatic metabolism.
Swallowing the tablet significantly delays and reduces absorption, chewing destroys the
sublingual formulation, and food interferes with absorption. The nurse must instruct the patient
to sit or lie down before taking nitroglycerin to prevent orthostatic hypotension, and to call
emergency services if pain is not relieved after three doses taken 5 minutes apart.
Q3: A patient with atrial fibrillation has an irregularly irregular pulse, absent P waves on
telemetry, and a ventricular rate of 140 bpm. The blood pressure is 88/52 mmHg. Which is the
priority nursing action?
A. Administer digoxin 0.25 mg IV for rate control
B. Prepare for immediate synchronized cardioversion
C. Give metoprolol 5 mg IV to slow the heart rate
D. Initiate anticoagulation with heparin infusion
Correct Answer: A
Rationale: Correct because this patient has atrial fibrillation with rapid ventricular response
(RVR) and is hemodynamically unstable (SBP 88/52 mmHg), which is an indication for
immediate synchronized cardioversion to restore sinus rhythm and improve cardiac output.
Hemodynamic instability in afib is defined by hypotension, altered mental status, chest pain, or
signs of poor perfusion, and rate-control medications such as digoxin, beta-blockers, or calcium
channel blockers are contraindicated in unstable patients as they can worsen hypotension. The
nurse must prepare the crash cart, ensure sedation is available, and have the defibrillator ready
for synchronized cardioversion while continuing to monitor rhythm and blood pressure.
Q4: A patient with heart failure is taking lisinopril 10 mg daily. The nurse notes a potassium of
5.6 mEq/L and the patient reports swelling of the lips and tongue. Which complication is most
likely?
A. Hypokalemia from ACE inhibitor therapy
B. Angioedema from ACE inhibitor therapy
C. Hypernatremia from ACE inhibitor therapy
D. Anaphylaxis from digoxin toxicity
Correct Answer: C
, Rationale: Correct because angioedema (swelling of the lips, tongue, face, and airway) is a
serious and potentially life-threatening side effect of ACE inhibitors such as lisinopril, caused by
increased bradykinin levels from ACE inhibition. The hyperkalemia (5.6 mEq/L) is also
consistent with ACE inhibitor therapy, as these medications decrease aldosterone secretion and
reduce renal potassium excretion. The nurse must discontinue the ACE inhibitor immediately,
maintain airway patency, prepare for emergency intubation if airway compromise develops, and
notify the provider for alternative antihypertensive therapy such as an ARB (if angioedema was
not severe) or calcium channel blocker.
Q5: A patient with peripheral artery disease (PAD) reports severe cramping pain in the calves
after walking two blocks, which resolves with rest. The nurse notes shiny, hairless skin on the
lower legs and absent pedal pulses. Which nursing instruction is most appropriate?
A. Elevate the legs above the heart to promote venous return
B. Keep the legs dependent and avoid direct heat application
C. Apply warm compresses to the calves to improve circulation
D. Encourage prolonged bed rest to reduce oxygen demand
Correct Answer: D
Rationale: Correct because patients with peripheral artery disease (PAD) have decreased arterial
blood flow to the lower extremities, and keeping the legs dependent (down) maximizes arterial
perfusion through gravity-assisted blood flow. Direct heat application is absolutely
contraindicated due to decreased sensation and high burn risk from ischemic tissue. Elevating the
legs above the heart worsens arterial perfusion and is appropriate for chronic venous
insufficiency, not PAD. The nurse should also instruct the patient on a supervised walking
program to improve collateral circulation, daily foot inspection, proper footwear, and smoking
cessation to slow disease progression.
Q6: A patient with a tracheostomy is being cared for by an LPN under RN supervision. Which
task is appropriate for the LPN to perform?
A. Perform the initial tracheostomy tube change
B. Conduct a comprehensive swallowing assessment
C. Perform routine tracheostomy suctioning
D. Develop the initial patient education plan for stoma care
Correct Answer: A
