NUR 242: MEDICAL-SURGICAL NURSING I
EXAM 3 Actual Questions and Verified
Answers (2026/2027) Galen College A+
Preparation
Section 1: Cardiovascular Disorders
Q1: A 58-year-old patient has a blood pressure of 142/92 mmHg on three separate
occasions. According to current JNC guidelines, how should the nurse classify this
blood pressure reading?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage 1 hypertension [CORRECT]
D. Stage 2 hypertension
Correct Answer: C
Rationale: According to the ACC/AHA and JNC 8 guidelines, Stage 1 hypertension is
defined as systolic blood pressure 130-139 mmHg or diastolic 80-89 mmHg (or
140-159/90-99 depending on specific guideline version). A reading of 142/92 mmHg
meets criteria for Stage 1 or Stage 2 depending on the specific classification system
used; however, most current guidelines classify 140-159/90-99 as Stage 1. Stage 2
requires ≥160/100 mmHg. Elevated is 120-129/<80, and normal is <120/<80.
Q2: A patient prescribed lisinopril (Prinivil) calls the clinic complaining of a persistent
dry cough. Which explanation by the nurse is most accurate regarding this side effect?
A. "This indicates an allergic reaction and you must stop the medication immediately"
B. "This is a common side effect of ACE inhibitors caused by bradykinin accumulation
[CORRECT]"
,C. "This means the medication is working to lower your blood pressure"
D. "You should take an over-the-counter cough suppressant without consulting your
provider"
Correct Answer: B
Rationale: A dry, nonproductive cough is a well-documented class effect of ACE
inhibitors due to inhibition of bradykinin breakdown, which causes irritation of the cough
reflex. While bothersome, it is not an allergic reaction (angioedema would indicate
allergy). If intolerable, the provider may switch to an ARB. Patients should not stop
antihypertensives abruptly or self-medicate without consultation.
Q3: The nurse is caring for a patient with variant (Prinzmetal's) angina. Which
assessment finding would the nurse expect that differentiates this from stable angina?
A. Pain occurs predictably with exertion and resolves with rest
B. Pain occurs at rest due to coronary artery spasm [CORRECT]
C. Pain is relieved immediately by nitroglycerin but not rest
D. Pain is always associated with STEMI on ECG
Correct Answer: B
Rationale: Variant angina is caused by transient coronary artery vasospasm, typically
occurring at rest rather than with exertion, often between midnight and early morning.
ST-segment elevation may be seen during episodes but resolves when the spasm
subsides. Stable angina (A) is exertion-related. Both types typically respond to nitrates
(C), and variant angina does not necessarily cause permanent STEMI (D).
Q4: The nurse is reviewing an ECG rhythm strip showing: regular rhythm, rate 72 bpm, P
waves present before each QRS complex, PR interval 0.16 seconds, QRS duration 0.08
seconds. How should the nurse interpret this rhythm?
A. Sinus bradycardia
B. Normal sinus rhythm [CORRECT]
C. First-degree AV block
D. Sinus tachycardia
Correct Answer: B
,Rationale: Normal sinus rhythm is characterized by a regular rhythm, rate 60-100 bpm,
upright P waves preceding each QRS complex, PR interval 0.12-0.20 seconds, and
narrow QRS complexes (<0.12 seconds). This strip meets all criteria. Bradycardia (A)
requires rate <60, tachycardia (D) requires >100, and first-degree block (C) requires PR
interval >0.20 seconds.
Q5: A patient presents with crushing substernal chest pain. The ECG shows ST-segment
elevation in leads II, III, and aVF. Which complication should the nurse monitor for
specifically with this type of myocardial infarction?
A. Papillary muscle rupture causing mitral regurgitation (common in inferior MI)
B. Bundle branch blocks (more common in anterior MI)
C. Bradydysrhythmias and heart blocks due to RCA occlusion [CORRECT]
D. Ventricular aneurysm formation (more common in anterior MI)
Correct Answer: C
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall MI, typically
resulting from right coronary artery (RCA) occlusion. The RCA supplies the SA and AV
nodes in most people, making bradydysrhythmias (sinus bradycardia, heart blocks)
common complications. Papillary muscle rupture (A) and ventricular aneurysms (D) are
more common with anterior/apical MIs (LAD territory).
Q6: The nurse is reviewing laboratory results for a patient 4 hours post-chest pain onset.
Which cardiac biomarker combination is most indicative of an acute NSTEMI?
A. Normal troponin I, elevated CK-MB
B. Elevated troponin I, normal CK-MB [CORRECT]
C. Elevated myoglobin only
D. Elevated BNP, normal troponin
Correct Answer: B
Rationale: Troponin I is the most sensitive and specific biomarker for myocardial
necrosis, rising within 3-6 hours and remaining elevated for 7-14 days. In NSTEMI,
troponin is elevated indicating myocardial damage, while CK-MB may remain normal in
smaller infarctions or rise later. Myoglobin (C) is nonspecific and rises rapidly in any
, muscle injury. BNP (D) indicates ventricular stretch/heart failure, not acute MI
specifically.
Q7: A patient in the emergency department develops ventricular tachycardia with a
pulse but is unstable with a blood pressure of 70/40 mmHg. Which intervention is the
priority?
A. Administer amiodarone 300 mg IV push immediately
B. Perform immediate synchronized cardioversion [CORRECT]
C. Begin CPR and prepare for defibrillation
D. Administer epinephrine 1 mg IV push
Correct Answer: B
Rationale: Per ACLS guidelines, patients with pulse-sustained VT who are unstable
(hypotension, acute altered mental status, signs of shock, ischemic chest discomfort, or
acute heart failure) require immediate synchronized cardioversion. Unsynchronized
defibrillation (C) is for pulseless VT. Amiodarone (A) is used for stable VT or after
cardioversion if needed. Epinephrine (D) is for pulseless arrest algorithms.
Q8: The telemetry monitor shows an irregularly irregular rhythm with no discernible P
waves and fibrillatory waves between QRS complexes. The ventricular rate is 110 bpm.
Which rhythm is described?
A. Sinus tachycardia with PACs
B. Atrial flutter with variable block
C. Atrial fibrillation with rapid ventricular response [CORRECT]
D. Ventricular fibrillation
Correct Answer: C
Rationale: The absence of P waves with an irregularly irregular rhythm and fibrillatory
baseline waves is pathognomonic for atrial fibrillation. The rate of 110 bpm classifies
this as AFib with rapid ventricular response (RVR). Sinus tachycardia (A) would show
regular P waves. Atrial flutter (B) shows characteristic sawtooth flutter waves.
Ventricular fibrillation (D) shows chaotic, coarse or fine waves without organized QRS
complexes.
EXAM 3 Actual Questions and Verified
Answers (2026/2027) Galen College A+
Preparation
Section 1: Cardiovascular Disorders
Q1: A 58-year-old patient has a blood pressure of 142/92 mmHg on three separate
occasions. According to current JNC guidelines, how should the nurse classify this
blood pressure reading?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage 1 hypertension [CORRECT]
D. Stage 2 hypertension
Correct Answer: C
Rationale: According to the ACC/AHA and JNC 8 guidelines, Stage 1 hypertension is
defined as systolic blood pressure 130-139 mmHg or diastolic 80-89 mmHg (or
140-159/90-99 depending on specific guideline version). A reading of 142/92 mmHg
meets criteria for Stage 1 or Stage 2 depending on the specific classification system
used; however, most current guidelines classify 140-159/90-99 as Stage 1. Stage 2
requires ≥160/100 mmHg. Elevated is 120-129/<80, and normal is <120/<80.
Q2: A patient prescribed lisinopril (Prinivil) calls the clinic complaining of a persistent
dry cough. Which explanation by the nurse is most accurate regarding this side effect?
A. "This indicates an allergic reaction and you must stop the medication immediately"
B. "This is a common side effect of ACE inhibitors caused by bradykinin accumulation
[CORRECT]"
,C. "This means the medication is working to lower your blood pressure"
D. "You should take an over-the-counter cough suppressant without consulting your
provider"
Correct Answer: B
Rationale: A dry, nonproductive cough is a well-documented class effect of ACE
inhibitors due to inhibition of bradykinin breakdown, which causes irritation of the cough
reflex. While bothersome, it is not an allergic reaction (angioedema would indicate
allergy). If intolerable, the provider may switch to an ARB. Patients should not stop
antihypertensives abruptly or self-medicate without consultation.
Q3: The nurse is caring for a patient with variant (Prinzmetal's) angina. Which
assessment finding would the nurse expect that differentiates this from stable angina?
A. Pain occurs predictably with exertion and resolves with rest
B. Pain occurs at rest due to coronary artery spasm [CORRECT]
C. Pain is relieved immediately by nitroglycerin but not rest
D. Pain is always associated with STEMI on ECG
Correct Answer: B
Rationale: Variant angina is caused by transient coronary artery vasospasm, typically
occurring at rest rather than with exertion, often between midnight and early morning.
ST-segment elevation may be seen during episodes but resolves when the spasm
subsides. Stable angina (A) is exertion-related. Both types typically respond to nitrates
(C), and variant angina does not necessarily cause permanent STEMI (D).
Q4: The nurse is reviewing an ECG rhythm strip showing: regular rhythm, rate 72 bpm, P
waves present before each QRS complex, PR interval 0.16 seconds, QRS duration 0.08
seconds. How should the nurse interpret this rhythm?
A. Sinus bradycardia
B. Normal sinus rhythm [CORRECT]
C. First-degree AV block
D. Sinus tachycardia
Correct Answer: B
,Rationale: Normal sinus rhythm is characterized by a regular rhythm, rate 60-100 bpm,
upright P waves preceding each QRS complex, PR interval 0.12-0.20 seconds, and
narrow QRS complexes (<0.12 seconds). This strip meets all criteria. Bradycardia (A)
requires rate <60, tachycardia (D) requires >100, and first-degree block (C) requires PR
interval >0.20 seconds.
Q5: A patient presents with crushing substernal chest pain. The ECG shows ST-segment
elevation in leads II, III, and aVF. Which complication should the nurse monitor for
specifically with this type of myocardial infarction?
A. Papillary muscle rupture causing mitral regurgitation (common in inferior MI)
B. Bundle branch blocks (more common in anterior MI)
C. Bradydysrhythmias and heart blocks due to RCA occlusion [CORRECT]
D. Ventricular aneurysm formation (more common in anterior MI)
Correct Answer: C
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall MI, typically
resulting from right coronary artery (RCA) occlusion. The RCA supplies the SA and AV
nodes in most people, making bradydysrhythmias (sinus bradycardia, heart blocks)
common complications. Papillary muscle rupture (A) and ventricular aneurysms (D) are
more common with anterior/apical MIs (LAD territory).
Q6: The nurse is reviewing laboratory results for a patient 4 hours post-chest pain onset.
Which cardiac biomarker combination is most indicative of an acute NSTEMI?
A. Normal troponin I, elevated CK-MB
B. Elevated troponin I, normal CK-MB [CORRECT]
C. Elevated myoglobin only
D. Elevated BNP, normal troponin
Correct Answer: B
Rationale: Troponin I is the most sensitive and specific biomarker for myocardial
necrosis, rising within 3-6 hours and remaining elevated for 7-14 days. In NSTEMI,
troponin is elevated indicating myocardial damage, while CK-MB may remain normal in
smaller infarctions or rise later. Myoglobin (C) is nonspecific and rises rapidly in any
, muscle injury. BNP (D) indicates ventricular stretch/heart failure, not acute MI
specifically.
Q7: A patient in the emergency department develops ventricular tachycardia with a
pulse but is unstable with a blood pressure of 70/40 mmHg. Which intervention is the
priority?
A. Administer amiodarone 300 mg IV push immediately
B. Perform immediate synchronized cardioversion [CORRECT]
C. Begin CPR and prepare for defibrillation
D. Administer epinephrine 1 mg IV push
Correct Answer: B
Rationale: Per ACLS guidelines, patients with pulse-sustained VT who are unstable
(hypotension, acute altered mental status, signs of shock, ischemic chest discomfort, or
acute heart failure) require immediate synchronized cardioversion. Unsynchronized
defibrillation (C) is for pulseless VT. Amiodarone (A) is used for stable VT or after
cardioversion if needed. Epinephrine (D) is for pulseless arrest algorithms.
Q8: The telemetry monitor shows an irregularly irregular rhythm with no discernible P
waves and fibrillatory waves between QRS complexes. The ventricular rate is 110 bpm.
Which rhythm is described?
A. Sinus tachycardia with PACs
B. Atrial flutter with variable block
C. Atrial fibrillation with rapid ventricular response [CORRECT]
D. Ventricular fibrillation
Correct Answer: C
Rationale: The absence of P waves with an irregularly irregular rhythm and fibrillatory
baseline waves is pathognomonic for atrial fibrillation. The rate of 110 bpm classifies
this as AFib with rapid ventricular response (RVR). Sinus tachycardia (A) would show
regular P waves. Atrial flutter (B) shows characteristic sawtooth flutter waves.
Ventricular fibrillation (D) shows chaotic, coarse or fine waves without organized QRS
complexes.
