U 189 / NU189 EXAM 1
N
2026-2027 | Medical-Surgical
Nursing II Guide | Galen College |
100% Verified Q&A | Grade A |
Pass Guaranteed
## Part A: Multiple Choice (Q1‑55)
* *Q1 (Cardiovascular – Heart Failure):** A 72‑year‑old male with heart failure (HFrEF) reports
shortness of breath when lying flat and awakens at night gasping for air. He has 2+ pitting
edema in both lower extremities and an S3 gallop. Which medication is most likely to be ordered
as first‑line therapy to reduce mortality?
A. Furosemide
B. Digoxin
C. Metoprolol succinate
D. Spironolactone
**[CORRECT]** C
*Rationale: Beta‑blockers (metoprolol succinate, carvedilol, bisoprolol) are first‑line for HFrEF to
reduce mortality and hospitalizations per 2022 AHA/ACC/HFSA guidelines. Furosemide (A)
relieves symptoms but does not improve survival. Digoxin (B) is for symptom control in
refractory HF. Spironolactone (D) is used in advanced HF but not first‑line before beta‑blockers.
Test tip: "GDMT" for HFrEF includes beta‑blockers, ACEi/ARB/ARNI, and SGLT2i – remember
the mortality benefit.*
* *Q2 (Cardiovascular – Heart Failure):** A patient with chronic heart failure is instructed to
monitor daily weights. The nurse should teach the patient to report a weight gain of how many
pounds in one day?
A. 1 pound
B. 2 pounds
C. 3 pounds
D. 5 pounds
**[CORRECT]** C
,* Rationale: A weight gain of 3 pounds in one day or 5 pounds in one week indicates fluid
retention and requires provider notification per heart failure management protocols. This early
intervention prevents acute decompensation. One pound (A) is too sensitive, while 5 pounds in
one day (D) represents significant overload that should have been caught earlier.*
* *Q3 (Cardiovascular – CAD/Angina):** A 58‑year‑old male with stable angina experiences
chest pain while climbing stairs. He stops and takes a sublingual nitroglycerin tablet. After 5
minutes, the pain persists. What is the nurse's priority action?
A. Call 911 immediately
B. Administer a second nitroglycerin tablet
C. Have the patient lie down and rest
D. Administer aspirin 325 mg
**[CORRECT]** B
*Rationale: Per AHA guidelines, if angina persists after 5 minutes, a second nitroglycerin tablet
may be taken. If pain persists after a third tablet (15 minutes total), emergency services should
be called. Calling 911 (A) is premature at 5 minutes for stable angina. Resting (C) was already
attempted. Aspirin (D) is appropriate for suspected MI but not routine angina management.*
* *Q4 (Cardiovascular – MI):** A patient with suspected acute MI presents with ST‑segment
elevation in leads V1‑V4. Which intervention has the highest priority?
A. Administer morphine sulfate
B. Obtain cardiac biomarkers
C. Initiate reperfusion therapy (PCI)
D. Administer supplemental oxygen
**[CORRECT]** C
*Rationale: STEMI requires immediate reperfusion therapy – PCI within 90 minutes of first
medical contact is the gold standard per ACC/AHA guidelines. "Time is muscle" – every minute
of delay increases myocardial damage. While oxygen (D), morphine (A), and biomarkers (B) are
important, they are secondary to restoring coronary blood flow.*
* *Q5 (Cardiovascular – Dysrhythmias):** A patient with atrial fibrillation has a heart rate of 150
bpm and blood pressure of 88/52 mmHg. Which intervention should the nurse anticipate?
A. Administer IV metoprolol
B. Perform synchronized cardioversion
C. Administer IV digoxin
D. Start IV heparin infusion
**[CORRECT]** B
*Rationale: Unstable atrial fibrillation with hypotension (SBP <90 mmHg) requires immediate
synchronized cardioversion per ACLS protocols. Rate control agents like metoprolol (A) or
digoxin (C) are contraindicated in unstable patients as they may worsen hypotension. Heparin
(D) is for stroke prevention but does not address the immediate hemodynamic instability.*
* *Q6 (Cardiovascular – Hypertension):** According to current ACC/AHA guidelines, which blood
pressure reading meets the threshold for Stage 2 hypertension?
, . 128/82 mmHg
A
B. 135/88 mmHg
C. 142/92 mmHg
D. 118/78 mmHg
**[CORRECT]** C
*Rationale: Stage 2 hypertension is defined as SBP ≥140 mmHg or DBP ≥90 mmHg per 2017
ACC/AHA guidelines. Option C (142/92) meets this threshold. Option A is elevated, B is Stage
1, and D is normal. First‑line treatment for Stage 2 includes thiazide diuretics, ACE inhibitors,
ARBs, or calcium channel blockers.*
* *Q7 (Cardiovascular – Valvular Disease):** A 68‑year‑old patient reports syncope, angina, and
dyspnea on exertion. On auscultation, a harsh systolic ejection murmur is heard at the right
upper sternal border radiating to the carotids. Which valvular disorder is most likely?
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral stenosis
D. Aortic regurgitation
**[CORRECT]** B
*Rationale: The triad of syncope, angina, and dyspnea (SAD) is classic for aortic stenosis. The
harsh systolic ejection murmur at the right upper sternal border radiating to the carotids confirms
this diagnosis. Mitral regurgitation (A) produces a holosystolic murmur at the apex. Mitral
stenosis (C) causes a diastolic rumble. Aortic regurgitation (D) produces a diastolic blowing
murmur.*
* *Q8 (Cardiovascular – Heart Failure):** A patient with HFrEF is prescribed sacubitril/valsartan
(Entresto). Which previous medication must be discontinued before starting this therapy?
A. Furosemide
B. Metoprolol
C. Lisinopril
D. Digoxin
**[CORRECT]** C
*Rationale: Sacubitril/valsartan is an ARNI that replaces ACE inhibitors or ARBs. ACE inhibitors
like lisinopril must be discontinued 36 hours before starting Entresto to prevent angioedema.
Furosemide (A), metoprolol (B), and digoxin (D) can be continued as part of GDMT. Test tip:
"ACE to ARNI = 36‑hour washout."*
* *Q9 (Cardiovascular – MI Complications):** Three days post‑MI, a patient develops a
pericardial friction rub, fever, and pleuritic chest pain relieved by sitting forward. Which
complication is most likely?
A. Papillary muscle rupture
B. Dressler's syndrome
C. Ventricular free wall rupture
D. Cardiogenic shock
**[CORRECT]** B
N
2026-2027 | Medical-Surgical
Nursing II Guide | Galen College |
100% Verified Q&A | Grade A |
Pass Guaranteed
## Part A: Multiple Choice (Q1‑55)
* *Q1 (Cardiovascular – Heart Failure):** A 72‑year‑old male with heart failure (HFrEF) reports
shortness of breath when lying flat and awakens at night gasping for air. He has 2+ pitting
edema in both lower extremities and an S3 gallop. Which medication is most likely to be ordered
as first‑line therapy to reduce mortality?
A. Furosemide
B. Digoxin
C. Metoprolol succinate
D. Spironolactone
**[CORRECT]** C
*Rationale: Beta‑blockers (metoprolol succinate, carvedilol, bisoprolol) are first‑line for HFrEF to
reduce mortality and hospitalizations per 2022 AHA/ACC/HFSA guidelines. Furosemide (A)
relieves symptoms but does not improve survival. Digoxin (B) is for symptom control in
refractory HF. Spironolactone (D) is used in advanced HF but not first‑line before beta‑blockers.
Test tip: "GDMT" for HFrEF includes beta‑blockers, ACEi/ARB/ARNI, and SGLT2i – remember
the mortality benefit.*
* *Q2 (Cardiovascular – Heart Failure):** A patient with chronic heart failure is instructed to
monitor daily weights. The nurse should teach the patient to report a weight gain of how many
pounds in one day?
A. 1 pound
B. 2 pounds
C. 3 pounds
D. 5 pounds
**[CORRECT]** C
,* Rationale: A weight gain of 3 pounds in one day or 5 pounds in one week indicates fluid
retention and requires provider notification per heart failure management protocols. This early
intervention prevents acute decompensation. One pound (A) is too sensitive, while 5 pounds in
one day (D) represents significant overload that should have been caught earlier.*
* *Q3 (Cardiovascular – CAD/Angina):** A 58‑year‑old male with stable angina experiences
chest pain while climbing stairs. He stops and takes a sublingual nitroglycerin tablet. After 5
minutes, the pain persists. What is the nurse's priority action?
A. Call 911 immediately
B. Administer a second nitroglycerin tablet
C. Have the patient lie down and rest
D. Administer aspirin 325 mg
**[CORRECT]** B
*Rationale: Per AHA guidelines, if angina persists after 5 minutes, a second nitroglycerin tablet
may be taken. If pain persists after a third tablet (15 minutes total), emergency services should
be called. Calling 911 (A) is premature at 5 minutes for stable angina. Resting (C) was already
attempted. Aspirin (D) is appropriate for suspected MI but not routine angina management.*
* *Q4 (Cardiovascular – MI):** A patient with suspected acute MI presents with ST‑segment
elevation in leads V1‑V4. Which intervention has the highest priority?
A. Administer morphine sulfate
B. Obtain cardiac biomarkers
C. Initiate reperfusion therapy (PCI)
D. Administer supplemental oxygen
**[CORRECT]** C
*Rationale: STEMI requires immediate reperfusion therapy – PCI within 90 minutes of first
medical contact is the gold standard per ACC/AHA guidelines. "Time is muscle" – every minute
of delay increases myocardial damage. While oxygen (D), morphine (A), and biomarkers (B) are
important, they are secondary to restoring coronary blood flow.*
* *Q5 (Cardiovascular – Dysrhythmias):** A patient with atrial fibrillation has a heart rate of 150
bpm and blood pressure of 88/52 mmHg. Which intervention should the nurse anticipate?
A. Administer IV metoprolol
B. Perform synchronized cardioversion
C. Administer IV digoxin
D. Start IV heparin infusion
**[CORRECT]** B
*Rationale: Unstable atrial fibrillation with hypotension (SBP <90 mmHg) requires immediate
synchronized cardioversion per ACLS protocols. Rate control agents like metoprolol (A) or
digoxin (C) are contraindicated in unstable patients as they may worsen hypotension. Heparin
(D) is for stroke prevention but does not address the immediate hemodynamic instability.*
* *Q6 (Cardiovascular – Hypertension):** According to current ACC/AHA guidelines, which blood
pressure reading meets the threshold for Stage 2 hypertension?
, . 128/82 mmHg
A
B. 135/88 mmHg
C. 142/92 mmHg
D. 118/78 mmHg
**[CORRECT]** C
*Rationale: Stage 2 hypertension is defined as SBP ≥140 mmHg or DBP ≥90 mmHg per 2017
ACC/AHA guidelines. Option C (142/92) meets this threshold. Option A is elevated, B is Stage
1, and D is normal. First‑line treatment for Stage 2 includes thiazide diuretics, ACE inhibitors,
ARBs, or calcium channel blockers.*
* *Q7 (Cardiovascular – Valvular Disease):** A 68‑year‑old patient reports syncope, angina, and
dyspnea on exertion. On auscultation, a harsh systolic ejection murmur is heard at the right
upper sternal border radiating to the carotids. Which valvular disorder is most likely?
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral stenosis
D. Aortic regurgitation
**[CORRECT]** B
*Rationale: The triad of syncope, angina, and dyspnea (SAD) is classic for aortic stenosis. The
harsh systolic ejection murmur at the right upper sternal border radiating to the carotids confirms
this diagnosis. Mitral regurgitation (A) produces a holosystolic murmur at the apex. Mitral
stenosis (C) causes a diastolic rumble. Aortic regurgitation (D) produces a diastolic blowing
murmur.*
* *Q8 (Cardiovascular – Heart Failure):** A patient with HFrEF is prescribed sacubitril/valsartan
(Entresto). Which previous medication must be discontinued before starting this therapy?
A. Furosemide
B. Metoprolol
C. Lisinopril
D. Digoxin
**[CORRECT]** C
*Rationale: Sacubitril/valsartan is an ARNI that replaces ACE inhibitors or ARBs. ACE inhibitors
like lisinopril must be discontinued 36 hours before starting Entresto to prevent angioedema.
Furosemide (A), metoprolol (B), and digoxin (D) can be continued as part of GDMT. Test tip:
"ACE to ARNI = 36‑hour washout."*
* *Q9 (Cardiovascular – MI Complications):** Three days post‑MI, a patient develops a
pericardial friction rub, fever, and pleuritic chest pain relieved by sitting forward. Which
complication is most likely?
A. Papillary muscle rupture
B. Dressler's syndrome
C. Ventricular free wall rupture
D. Cardiogenic shock
**[CORRECT]** B
