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 74-year-old male with a history of heart failure presents with worsening dyspnea,
orthopnea, and a 5-pound weight gain over 3 days. Lung auscultation reveals crackles bilaterally.
Which medication should the nurse anticipate administering first?
A. Enalapril 5 mg PO
B. Furosemide 40 mg IV push
C. Carvedilol 12.5 mg PO
D. Digoxin 0.125 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 weight gain, orthopnea, and
bilateral crackles indicate significant fluid retention 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 experiences chest pressure while mowing the lawn. The
patient has sublingual nitroglycerin prescribed. Which instruction should the nurse reinforce?
A. Swallow the tablet quickly with a full glass of water
B. Stop activity, sit down, and place the tablet under the tongue
C. Chew the tablet thoroughly before swallowing for faster onset
D. Take two tablets immediately if the pain is severe
Correct Answer: D
,Rationale: Correct because sublingual nitroglycerin must be placed under the tongue or in the
buccal pouch to dissolve completely, allowing rapid absorption through the highly vascular oral
mucosa directly into the systemic circulation without first-pass hepatic metabolism. The patient
must stop all activity, sit or lie down to prevent orthostatic hypotension, and take one dose every
5 minutes for up to three doses; if pain persists after three doses, emergency services must be
called immediately. Swallowing the tablet destroys its efficacy, chewing is inappropriate for
sublingual formulations, and taking more than one dose at a time increases the risk of severe
hypotension without additional therapeutic benefit.
Q3: A patient with new-onset atrial fibrillation has an irregularly irregular rhythm with a
ventricular rate of 128 bpm. The blood pressure is 92/58 mmHg and the patient is diaphoretic
and confused. Which is the priority nursing action?
A. Prepare for immediate synchronized cardioversion
B. Administer IV metoprolol 5 mg push
C. Give IV digoxin 0.25 mg for rate control
D. Initiate therapeutic hypothermia protocol
Correct Answer: A
Rationale: Correct because this patient has atrial fibrillation with rapid ventricular response
(RVR) and is hemodynamically unstable (hypotension 92/58 mmHg, altered mental status,
diaphoresis), which are indications for immediate synchronized cardioversion to restore sinus
rhythm and improve cardiac output. Rate-control medications such as metoprolol, diltiazem, or
digoxin are contraindicated in unstable patients as they can worsen hypotension and cause
cardiovascular collapse. The nurse must prepare the crash cart, ensure sedation is available,
verify synchronized mode on the defibrillator, and have airway management equipment ready
while continuously monitoring rhythm and blood pressure.
Q4: A patient with hypertension is prescribed captopril 25 mg twice daily. Two weeks later, the
patient reports a persistent dry cough and a potassium level of 5.4 mEq/L. Which nursing action
is most appropriate?
A. Discontinue the captopril and switch to a calcium channel blocker
B. Notify the provider to discuss switching to an ARB
C. Administer an antitussive and increase dietary potassium
D. Reduce the captopril dose to 12.5 mg twice daily
Correct Answer: C
, Rationale: Correct because a dry, persistent cough is a well-documented side effect of ACE
inhibitors such as captopril, caused by accumulation of bradykinin and substance P from ACE
inhibition, and while not dangerous, it often necessitates switching to an angiotensin receptor
blocker (ARB) such as losartan which does not affect bradykinin metabolism. The mild
hyperkalemia (5.4 mEq/L) also warrants monitoring and possible dietary modification. The nurse
must notify the provider to discuss switching to an ARB, as the cough rarely resolves with
continued ACE inhibitor use and significantly impacts quality of life and medication adherence.
Q5: A patient with peripheral artery disease reports calf pain after walking half a block that
resolves within 2 minutes of rest. The nurse notes shiny skin, absent hair growth, and cool feet
bilaterally. Which patient teaching is most important?
A. Elevate your legs above your heart when sitting to reduce swelling
B. Walk daily to the point of pain, rest, then resume to build collateral circulation
C. Apply warm compresses to your calves before walking to dilate vessels
D. Avoid all physical activity to prevent tissue damage
Correct Answer: D
Rationale: Correct because a supervised walking program to the point of claudication, followed
by rest until pain resolves, then resuming walking is the cornerstone of peripheral artery disease
management as it stimulates development of collateral circulation and improves walking distance
over time. Leg elevation worsens arterial perfusion and is appropriate for venous insufficiency,
not PAD; warm compresses are contraindicated due to decreased sensation and burn risk; and
complete activity avoidance leads to deconditioning and worsening functional status. The nurse
must also emphasize smoking cessation, diabetes and blood pressure control, statin therapy,
antiplatelet therapy, and meticulous foot care.
Q6: An RN is planning care for a patient with a stable tracheostomy. Which task may be
delegated to an experienced LPN?
A. Perform the initial comprehensive swallowing evaluation
B. Assess the stoma for signs of infection or granulation tissue
C. Perform routine sterile suctioning of the tracheostomy
D. Develop and implement the initial patient education plan
Correct Answer: A
Rationale: Correct because routine tracheostomy suctioning using sterile technique is within the
scope of practice for an experienced LPN/LVN under RN supervision, as it is a delegated skill-
based task that does not require complex clinical judgment or initial patient assessment. The
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Guide
Guaranteed Pass
Q1: A 74-year-old male with a history of heart failure presents with worsening dyspnea,
orthopnea, and a 5-pound weight gain over 3 days. Lung auscultation reveals crackles bilaterally.
Which medication should the nurse anticipate administering first?
A. Enalapril 5 mg PO
B. Furosemide 40 mg IV push
C. Carvedilol 12.5 mg PO
D. Digoxin 0.125 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 weight gain, orthopnea, and
bilateral crackles indicate significant fluid retention 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 experiences chest pressure while mowing the lawn. The
patient has sublingual nitroglycerin prescribed. Which instruction should the nurse reinforce?
A. Swallow the tablet quickly with a full glass of water
B. Stop activity, sit down, and place the tablet under the tongue
C. Chew the tablet thoroughly before swallowing for faster onset
D. Take two tablets immediately if the pain is severe
Correct Answer: D
,Rationale: Correct because sublingual nitroglycerin must be placed under the tongue or in the
buccal pouch to dissolve completely, allowing rapid absorption through the highly vascular oral
mucosa directly into the systemic circulation without first-pass hepatic metabolism. The patient
must stop all activity, sit or lie down to prevent orthostatic hypotension, and take one dose every
5 minutes for up to three doses; if pain persists after three doses, emergency services must be
called immediately. Swallowing the tablet destroys its efficacy, chewing is inappropriate for
sublingual formulations, and taking more than one dose at a time increases the risk of severe
hypotension without additional therapeutic benefit.
Q3: A patient with new-onset atrial fibrillation has an irregularly irregular rhythm with a
ventricular rate of 128 bpm. The blood pressure is 92/58 mmHg and the patient is diaphoretic
and confused. Which is the priority nursing action?
A. Prepare for immediate synchronized cardioversion
B. Administer IV metoprolol 5 mg push
C. Give IV digoxin 0.25 mg for rate control
D. Initiate therapeutic hypothermia protocol
Correct Answer: A
Rationale: Correct because this patient has atrial fibrillation with rapid ventricular response
(RVR) and is hemodynamically unstable (hypotension 92/58 mmHg, altered mental status,
diaphoresis), which are indications for immediate synchronized cardioversion to restore sinus
rhythm and improve cardiac output. Rate-control medications such as metoprolol, diltiazem, or
digoxin are contraindicated in unstable patients as they can worsen hypotension and cause
cardiovascular collapse. The nurse must prepare the crash cart, ensure sedation is available,
verify synchronized mode on the defibrillator, and have airway management equipment ready
while continuously monitoring rhythm and blood pressure.
Q4: A patient with hypertension is prescribed captopril 25 mg twice daily. Two weeks later, the
patient reports a persistent dry cough and a potassium level of 5.4 mEq/L. Which nursing action
is most appropriate?
A. Discontinue the captopril and switch to a calcium channel blocker
B. Notify the provider to discuss switching to an ARB
C. Administer an antitussive and increase dietary potassium
D. Reduce the captopril dose to 12.5 mg twice daily
Correct Answer: C
, Rationale: Correct because a dry, persistent cough is a well-documented side effect of ACE
inhibitors such as captopril, caused by accumulation of bradykinin and substance P from ACE
inhibition, and while not dangerous, it often necessitates switching to an angiotensin receptor
blocker (ARB) such as losartan which does not affect bradykinin metabolism. The mild
hyperkalemia (5.4 mEq/L) also warrants monitoring and possible dietary modification. The nurse
must notify the provider to discuss switching to an ARB, as the cough rarely resolves with
continued ACE inhibitor use and significantly impacts quality of life and medication adherence.
Q5: A patient with peripheral artery disease reports calf pain after walking half a block that
resolves within 2 minutes of rest. The nurse notes shiny skin, absent hair growth, and cool feet
bilaterally. Which patient teaching is most important?
A. Elevate your legs above your heart when sitting to reduce swelling
B. Walk daily to the point of pain, rest, then resume to build collateral circulation
C. Apply warm compresses to your calves before walking to dilate vessels
D. Avoid all physical activity to prevent tissue damage
Correct Answer: D
Rationale: Correct because a supervised walking program to the point of claudication, followed
by rest until pain resolves, then resuming walking is the cornerstone of peripheral artery disease
management as it stimulates development of collateral circulation and improves walking distance
over time. Leg elevation worsens arterial perfusion and is appropriate for venous insufficiency,
not PAD; warm compresses are contraindicated due to decreased sensation and burn risk; and
complete activity avoidance leads to deconditioning and worsening functional status. The nurse
must also emphasize smoking cessation, diabetes and blood pressure control, statin therapy,
antiplatelet therapy, and meticulous foot care.
Q6: An RN is planning care for a patient with a stable tracheostomy. Which task may be
delegated to an experienced LPN?
A. Perform the initial comprehensive swallowing evaluation
B. Assess the stoma for signs of infection or granulation tissue
C. Perform routine sterile suctioning of the tracheostomy
D. Develop and implement the initial patient education plan
Correct Answer: A
Rationale: Correct because routine tracheostomy suctioning using sterile technique is within the
scope of practice for an experienced LPN/LVN under RN supervision, as it is a delegated skill-
based task that does not require complex clinical judgment or initial patient assessment. The
