NUR 170: MEDICAL-SURGICAL
NURSING
EXAM 4 REVIEW
Advanced Systems Integration & Complex Clinical Judgment
65 Questions with Correct Answers and Rationales
2026/2027 Academic Year
Institutional Course Assessment | Practice Review Guide
, TABLE OF CONTENTS
Section 1: Cardiovascular Nursing Management (Q1–Q12) (12 questions)
Section 2: Respiratory Nursing Management (Q13–Q22) (10 questions)
Section 3: Gastrointestinal & Hepatobiliary Nursing (Q23–Q30) (8 questions)
Section 4: Endocrine & Metabolic Nursing (Q31–Q40) (10 questions)
Section 5: Renal & Electrolyte Management (Q41–Q47) (7 questions)
Section 6: Medication Safety, Prioritization & Patient Education (Q48–Q57) (10 questions)
Section 7: Legal/Ethical, Clinical Judgment & NGN Strategies (Q58–Q65) (8 questions)
,Section 1: Cardiovascular Nursing Management (Q1–Q12)
This section covers acute coronary syndromes, heart failure management, arrhythmia recognition
and intervention, anticoagulation therapy, and post-procedural cardiac care. Aligned with
AHA/ACC Guidelines and NCSBN Physiological Integrity: Reduction of Risk Potential and
Physiological Adaptation domains.
Q1. A patient presents to the emergency department with substernal chest pain radiating to the
left arm, diaphoresis, and nausea. The 12-lead ECG reveals ST-segment elevation in leads II, III,
and aVF. The nurse recognizes this finding as indicative of which condition?
A) Non-ST-elevation myocardial infarction (NSTEMI)
B) ST-elevation myocardial infarction (STEMI) involving the inferior wall
C) Unstable angina with reciprocal changes
D) Pericarditis with diffuse ST elevation
Rationale: ST elevation in leads II, III, and aVF localizes the injury to the inferior wall of the left
ventricle, supplied by the right coronary artery (RCA). This is a classic STEMI presentation
requiring immediate reperfusion therapy (PCI or fibrinolytics) per AHA/ACC guidelines.
NSTEMI and unstable angina present with ST depression or T-wave inversions, not ST elevation.
Pericarditis causes diffuse ST elevation across multiple leads, not localized to inferior leads.
Q2. Following a percutaneous coronary intervention (PCI) with stent placement, the patient
receives a dual antiplatelet therapy (DAPT) prescription of aspirin and clopidogrel. Which
statement by the patient indicates a need for further teaching?
A) I will take both aspirin and clopidogrel every day as prescribed.
B) I should report any unusual bleeding, bruising, or dark stools to my provider.
C) I can stop taking clopidogrel after 2 weeks since the stent is already placed.
D) I will avoid NSAIDs like ibuprofen while on this medication regimen.
Rationale: DAPT is essential for preventing stent thrombosis. Current AHA/ACC guidelines
recommend a minimum of 6–12 months of DAPT (aspirin plus a P2Y12 inhibitor such as
clopidogrel) after PCI with stent placement, depending on stent type and bleeding risk. Premature
discontinuation significantly increases the risk of stent thrombosis, which can be fatal. The other
statements reflect appropriate understanding of DAPT therapy.
Q3. A patient with heart failure with reduced ejection fraction (HFrEF, EF 30%) is prescribed
furosemide 40 mg IV twice daily, enalapril 10 mg PO daily, and carvedilol 6.25 mg PO twice
daily. Which assessment finding is most concerning and requires immediate nursing intervention?
, A) Weight gain of 1 kg over 2 days with bilateral ankle edema
B) Potassium level of 3.0 mEq/L with muscle cramping
C) Blood pressure of 96/62 mmHg with dizziness on standing
D) Heart rate of 58 bpm with occasional premature ventricular contractions
Rationale: A potassium level of 3.0 mEq/L (hypokalemia) in a patient receiving furosemide (a
loop diuretic that causes potassium wasting) is the most concerning finding. Hypokalemia
increases the risk of lethal cardiac arrhythmias, especially in HFrEF patients also taking ACE
inhibitors and beta-blockers. This requires immediate potassium replacement. While weight gain,
hypotension, and bradycardia are notable, hypokalemia poses the greatest acute life threat and
must be corrected before cardiac complications develop.
Q4. A patient with chronic heart failure asks the nurse why daily weights are more important than
blood pressure monitoring at home. What is the best nursing response?
A) Daily weights are easier to perform and require no special equipment.
B) Weight changes can detect fluid retention 2–3 days before symptoms of
decompensation appear.
C) Blood pressure fluctuations in heart failure are unreliable and not clinically useful.
D) Insurance companies require weight monitoring for medication approval.
Rationale: Daily weight measurement is the gold standard for monitoring fluid status in heart
failure. A weight gain of 1–2 kg over 2–3 days indicates fluid retention and may signal impending
decompensation before symptoms such as dyspnea or edema become apparent. This allows for
early intervention (e.g., diuretic dose adjustment) to prevent hospitalization. Blood pressure
monitoring remains important but does not provide the same early warning for volume overload as
daily weights per AHA/HFSA guidelines.
Q5. A patient with new-onset atrial fibrillation has a rapid ventricular rate of 156 bpm. The
patient reports chest discomfort and shortness of breath. Which intervention should the nurse
anticipate first?
A) Administer diltiazem IV for rate control
B) Prepare for immediate synchronized electrical cardioversion
C) Initiate anticoagulation with heparin infusion
D) Obtain a transesophageal echocardiogram (TEE)
Rationale: This patient is hemodynamically unstable (rapid rate with chest discomfort and
dyspnea), which is the key criterion for emergent synchronized cardioversion. AHA/ACC/HRS
guidelines state that unstable atrial fibrillation requires immediate electrical cardioversion rather
NURSING
EXAM 4 REVIEW
Advanced Systems Integration & Complex Clinical Judgment
65 Questions with Correct Answers and Rationales
2026/2027 Academic Year
Institutional Course Assessment | Practice Review Guide
, TABLE OF CONTENTS
Section 1: Cardiovascular Nursing Management (Q1–Q12) (12 questions)
Section 2: Respiratory Nursing Management (Q13–Q22) (10 questions)
Section 3: Gastrointestinal & Hepatobiliary Nursing (Q23–Q30) (8 questions)
Section 4: Endocrine & Metabolic Nursing (Q31–Q40) (10 questions)
Section 5: Renal & Electrolyte Management (Q41–Q47) (7 questions)
Section 6: Medication Safety, Prioritization & Patient Education (Q48–Q57) (10 questions)
Section 7: Legal/Ethical, Clinical Judgment & NGN Strategies (Q58–Q65) (8 questions)
,Section 1: Cardiovascular Nursing Management (Q1–Q12)
This section covers acute coronary syndromes, heart failure management, arrhythmia recognition
and intervention, anticoagulation therapy, and post-procedural cardiac care. Aligned with
AHA/ACC Guidelines and NCSBN Physiological Integrity: Reduction of Risk Potential and
Physiological Adaptation domains.
Q1. A patient presents to the emergency department with substernal chest pain radiating to the
left arm, diaphoresis, and nausea. The 12-lead ECG reveals ST-segment elevation in leads II, III,
and aVF. The nurse recognizes this finding as indicative of which condition?
A) Non-ST-elevation myocardial infarction (NSTEMI)
B) ST-elevation myocardial infarction (STEMI) involving the inferior wall
C) Unstable angina with reciprocal changes
D) Pericarditis with diffuse ST elevation
Rationale: ST elevation in leads II, III, and aVF localizes the injury to the inferior wall of the left
ventricle, supplied by the right coronary artery (RCA). This is a classic STEMI presentation
requiring immediate reperfusion therapy (PCI or fibrinolytics) per AHA/ACC guidelines.
NSTEMI and unstable angina present with ST depression or T-wave inversions, not ST elevation.
Pericarditis causes diffuse ST elevation across multiple leads, not localized to inferior leads.
Q2. Following a percutaneous coronary intervention (PCI) with stent placement, the patient
receives a dual antiplatelet therapy (DAPT) prescription of aspirin and clopidogrel. Which
statement by the patient indicates a need for further teaching?
A) I will take both aspirin and clopidogrel every day as prescribed.
B) I should report any unusual bleeding, bruising, or dark stools to my provider.
C) I can stop taking clopidogrel after 2 weeks since the stent is already placed.
D) I will avoid NSAIDs like ibuprofen while on this medication regimen.
Rationale: DAPT is essential for preventing stent thrombosis. Current AHA/ACC guidelines
recommend a minimum of 6–12 months of DAPT (aspirin plus a P2Y12 inhibitor such as
clopidogrel) after PCI with stent placement, depending on stent type and bleeding risk. Premature
discontinuation significantly increases the risk of stent thrombosis, which can be fatal. The other
statements reflect appropriate understanding of DAPT therapy.
Q3. A patient with heart failure with reduced ejection fraction (HFrEF, EF 30%) is prescribed
furosemide 40 mg IV twice daily, enalapril 10 mg PO daily, and carvedilol 6.25 mg PO twice
daily. Which assessment finding is most concerning and requires immediate nursing intervention?
, A) Weight gain of 1 kg over 2 days with bilateral ankle edema
B) Potassium level of 3.0 mEq/L with muscle cramping
C) Blood pressure of 96/62 mmHg with dizziness on standing
D) Heart rate of 58 bpm with occasional premature ventricular contractions
Rationale: A potassium level of 3.0 mEq/L (hypokalemia) in a patient receiving furosemide (a
loop diuretic that causes potassium wasting) is the most concerning finding. Hypokalemia
increases the risk of lethal cardiac arrhythmias, especially in HFrEF patients also taking ACE
inhibitors and beta-blockers. This requires immediate potassium replacement. While weight gain,
hypotension, and bradycardia are notable, hypokalemia poses the greatest acute life threat and
must be corrected before cardiac complications develop.
Q4. A patient with chronic heart failure asks the nurse why daily weights are more important than
blood pressure monitoring at home. What is the best nursing response?
A) Daily weights are easier to perform and require no special equipment.
B) Weight changes can detect fluid retention 2–3 days before symptoms of
decompensation appear.
C) Blood pressure fluctuations in heart failure are unreliable and not clinically useful.
D) Insurance companies require weight monitoring for medication approval.
Rationale: Daily weight measurement is the gold standard for monitoring fluid status in heart
failure. A weight gain of 1–2 kg over 2–3 days indicates fluid retention and may signal impending
decompensation before symptoms such as dyspnea or edema become apparent. This allows for
early intervention (e.g., diuretic dose adjustment) to prevent hospitalization. Blood pressure
monitoring remains important but does not provide the same early warning for volume overload as
daily weights per AHA/HFSA guidelines.
Q5. A patient with new-onset atrial fibrillation has a rapid ventricular rate of 156 bpm. The
patient reports chest discomfort and shortness of breath. Which intervention should the nurse
anticipate first?
A) Administer diltiazem IV for rate control
B) Prepare for immediate synchronized electrical cardioversion
C) Initiate anticoagulation with heparin infusion
D) Obtain a transesophageal echocardiogram (TEE)
Rationale: This patient is hemodynamically unstable (rapid rate with chest discomfort and
dyspnea), which is the key criterion for emergent synchronized cardioversion. AHA/ACC/HRS
guidelines state that unstable atrial fibrillation requires immediate electrical cardioversion rather
