NUR 170 / NUR170 Concepts of Medical-Surgical
Nursing Exam 4 Review 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 crackles bilaterally, jugular
venous distention, and peripheral edema. Which medication should the nurse
anticipate administering first?
A. Digoxin to increase cardiac contractility
B. Furosemide to reduce preload through diuresis
C. Dobutamine to increase cardiac output
D. Metoprolol to reduce myocardial oxygen demand
Correct Answer: B
Rationale: Correct because furosemide is a loop diuretic that reduces fluid overload
and pulmonary congestion by promoting diuresis; addressing volume overload is the
priority in acute decompensated heart failure.
Q2: A patient with ST-elevation myocardial infarction (STEMI) is receiving
thrombolytic therapy. Which assessment finding requires immediate intervention?
A. Blood pressure of 148/92 mmHg
B. Bleeding from the IV insertion site with a 2 cm hematoma
C. Sudden onset of severe headache and altered mental status
D. Heart rate of 88 beats per minute
Correct Answer: C
Rationale: Correct because sudden severe headache and altered mental status
during thrombolytic therapy may indicate intracranial hemorrhage, a life-threatening
,complication requiring immediate discontinuation of therapy and emergency
evaluation.
Q3: A patient with atrial fibrillation is prescribed warfarin. Which laboratory value
indicates therapeutic anticoagulation?
A. PT of 12 seconds
B. INR of 2.5
C. aPTT of 45 seconds
D. Platelet count of 250,000/mm³
Correct Answer: B
Rationale: Correct because the therapeutic INR range for atrial fibrillation is typically
2.0-3.0; an INR of 2.5 indicates adequate anticoagulation to prevent
thromboembolism while minimizing bleeding risk.
Q4: A patient with aortic stenosis reports dyspnea on exertion, chest pain, and
syncope. Which pathophysiologic mechanism explains these symptoms?
A. Decreased preload causing reduced stroke volume
B. Fixed obstruction to left ventricular outflow leading to decreased cardiac output
C. Increased venous return causing right heart failure
D. Aortic regurgitation causing volume overload
Correct Answer: B
Rationale: Correct because aortic stenosis creates a fixed obstruction to left
ventricular outflow; the heart cannot increase cardiac output with exertion, causing
dyspnea, angina from subendocardial ischemia, and syncope from cerebral
hypoperfusion.
Q5: A patient with an abdominal aortic aneurysm (AAA) measuring 5.8 cm is being
monitored. Which instruction is most important for the nurse to provide?
A. "You may resume heavy lifting and straining activities."
B. "Report immediately any sudden severe back or abdominal pain."
C. "Aneurysms smaller than 6 cm do not require surgical intervention."
D. "You should avoid all blood pressure medications."
Correct Answer: B
, Rationale: Correct because sudden severe back or abdominal pain in a patient with
AAA may indicate impending rupture, a surgical emergency; prompt recognition and
intervention are critical for survival.
Q6: A patient with infective endocarditis has a new onset of hematuria. Which
complication should the nurse suspect?
A. Acute kidney injury from nephrotoxic antibiotics
B. Septic emboli to the kidneys causing glomerulonephritis
C. Dehydration causing prerenal azotemia
D. Urinary tract infection
Correct Answer: B
Rationale: Correct because septic emboli from infective endocarditis commonly
lodge in the kidneys, causing immune complex-mediated glomerulonephritis and
hematuria; this is a recognized complication of endocarditis.
Q7: A patient with hypertensive emergency has a blood pressure of 220/130 mmHg
and altered mental status. Which is the nurse's priority intervention?
A. Administering oral antihypertensives and monitoring for 24 hours
B. Initiating IV antihypertensive therapy with close hemodynamic monitoring
C. Placing the patient in Trendelenburg position to improve cerebral perfusion
D. Administering diuretics to reduce fluid volume
Correct Answer: B
Rationale: Correct because hypertensive emergency with end-organ damage requires
immediate controlled reduction of blood pressure using IV antihypertensives with
continuous monitoring to prevent further organ injury.
Q8: A patient with a permanent pacemaker reports dizziness and fatigue. Telemetry
shows failure to capture. Which action should the nurse take first?
A. Increase the pacemaker rate setting
B. Place the patient on supplemental oxygen and assess vital signs
C. Apply transcutaneous pacing pads and prepare for temporary pacing
D. Administer atropine to increase the intrinsic heart rate
Correct Answer: B
Nursing Exam 4 Review 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 crackles bilaterally, jugular
venous distention, and peripheral edema. Which medication should the nurse
anticipate administering first?
A. Digoxin to increase cardiac contractility
B. Furosemide to reduce preload through diuresis
C. Dobutamine to increase cardiac output
D. Metoprolol to reduce myocardial oxygen demand
Correct Answer: B
Rationale: Correct because furosemide is a loop diuretic that reduces fluid overload
and pulmonary congestion by promoting diuresis; addressing volume overload is the
priority in acute decompensated heart failure.
Q2: A patient with ST-elevation myocardial infarction (STEMI) is receiving
thrombolytic therapy. Which assessment finding requires immediate intervention?
A. Blood pressure of 148/92 mmHg
B. Bleeding from the IV insertion site with a 2 cm hematoma
C. Sudden onset of severe headache and altered mental status
D. Heart rate of 88 beats per minute
Correct Answer: C
Rationale: Correct because sudden severe headache and altered mental status
during thrombolytic therapy may indicate intracranial hemorrhage, a life-threatening
,complication requiring immediate discontinuation of therapy and emergency
evaluation.
Q3: A patient with atrial fibrillation is prescribed warfarin. Which laboratory value
indicates therapeutic anticoagulation?
A. PT of 12 seconds
B. INR of 2.5
C. aPTT of 45 seconds
D. Platelet count of 250,000/mm³
Correct Answer: B
Rationale: Correct because the therapeutic INR range for atrial fibrillation is typically
2.0-3.0; an INR of 2.5 indicates adequate anticoagulation to prevent
thromboembolism while minimizing bleeding risk.
Q4: A patient with aortic stenosis reports dyspnea on exertion, chest pain, and
syncope. Which pathophysiologic mechanism explains these symptoms?
A. Decreased preload causing reduced stroke volume
B. Fixed obstruction to left ventricular outflow leading to decreased cardiac output
C. Increased venous return causing right heart failure
D. Aortic regurgitation causing volume overload
Correct Answer: B
Rationale: Correct because aortic stenosis creates a fixed obstruction to left
ventricular outflow; the heart cannot increase cardiac output with exertion, causing
dyspnea, angina from subendocardial ischemia, and syncope from cerebral
hypoperfusion.
Q5: A patient with an abdominal aortic aneurysm (AAA) measuring 5.8 cm is being
monitored. Which instruction is most important for the nurse to provide?
A. "You may resume heavy lifting and straining activities."
B. "Report immediately any sudden severe back or abdominal pain."
C. "Aneurysms smaller than 6 cm do not require surgical intervention."
D. "You should avoid all blood pressure medications."
Correct Answer: B
, Rationale: Correct because sudden severe back or abdominal pain in a patient with
AAA may indicate impending rupture, a surgical emergency; prompt recognition and
intervention are critical for survival.
Q6: A patient with infective endocarditis has a new onset of hematuria. Which
complication should the nurse suspect?
A. Acute kidney injury from nephrotoxic antibiotics
B. Septic emboli to the kidneys causing glomerulonephritis
C. Dehydration causing prerenal azotemia
D. Urinary tract infection
Correct Answer: B
Rationale: Correct because septic emboli from infective endocarditis commonly
lodge in the kidneys, causing immune complex-mediated glomerulonephritis and
hematuria; this is a recognized complication of endocarditis.
Q7: A patient with hypertensive emergency has a blood pressure of 220/130 mmHg
and altered mental status. Which is the nurse's priority intervention?
A. Administering oral antihypertensives and monitoring for 24 hours
B. Initiating IV antihypertensive therapy with close hemodynamic monitoring
C. Placing the patient in Trendelenburg position to improve cerebral perfusion
D. Administering diuretics to reduce fluid volume
Correct Answer: B
Rationale: Correct because hypertensive emergency with end-organ damage requires
immediate controlled reduction of blood pressure using IV antihypertensives with
continuous monitoring to prevent further organ injury.
Q8: A patient with a permanent pacemaker reports dizziness and fatigue. Telemetry
shows failure to capture. Which action should the nurse take first?
A. Increase the pacemaker rate setting
B. Place the patient on supplemental oxygen and assess vital signs
C. Apply transcutaneous pacing pads and prepare for temporary pacing
D. Administer atropine to increase the intrinsic heart rate
Correct Answer: B
