NSG 223 Medical-Surgical Nursing II
Final Exam.
Section 1: Cardiovascular Disorders (25 Questions)
Q1: A nurse is assessing a patient with heart failure who reports sudden onset of
dyspnea and coughing up pink, frothy sputum. Which action should the nurse
take FIRST?
A. Administer furosemide IV push
B. Place the patient in high-Fowler's position
C. Apply a non-rebreather mask at 100% oxygen
D. Morphine sulfate 2 mg IV
Correct Answer: D
Rationale: Correct because morphine reduces preload, decreases anxiety, and
reduces respiratory drive, which is the priority in acute pulmonary edema before
other interventions. This matches the ACLS protocol for acute cardiogenic
pulmonary edema where morphine addresses the primary pathophysiologic
mechanisms.
Q2: A patient with acute myocardial infarction develops ventricular tachycardia
with a pulse and blood pressure 88/52 mmHg. What is the nurse's priority
intervention?
A. Administer amiodarone 150 mg IV over 10 minutes
B. Prepare for synchronized cardioversion
C. Begin CPR immediately
D. Administer lidocaine 1 mg/kg IV bolus
Correct Answer: B
Rationale: Correct because the patient is unstable with hypotension and a pulse;
synchronized cardioversion is the priority intervention for unstable ventricular
tachycardia per ACLS algorithms. This matches the standard that unstable
tachyarrhythmias require immediate electrical therapy.
,Q3: A nurse is caring for a patient post-cardiac catheterization with a femoral
approach. The patient reports sudden severe back pain and has a dropping blood
pressure. Which action should the nurse take FIRST?
A. Apply manual pressure to the groin site
B. Notify the physician immediately
C. Assess distal pulses
D. Check the activated clotting time
Correct Answer: A
Rationale: Correct because sudden severe back pain with hypotension post-
catheterization indicates retroperitoneal hemorrhage; applying manual pressure
to the groin site is the immediate priority to control bleeding. This matches the
emergency management protocol for vascular access site complications.
Q4: A patient with heart failure is prescribed digoxin 0.25 mg daily. The nurse
notes the apical pulse is 52 beats/minute. What is the appropriate nursing action?
A. Administer the dose and notify the physician
B. Hold the dose and notify the physician
C. Administer half the dose and monitor
D. Check the potassium level before administering
Correct Answer: B
Rationale: Correct because digoxin should be held when the apical pulse is below
60 beats/minute due to risk of bradycardia and heart block. This matches the
established safety parameter for cardiac glycoside administration.
Q5: A patient with atrial fibrillation is receiving warfarin therapy. The nurse notes
an INR of 4.8. Which intervention is most appropriate?
A. Administer vitamin K 10 mg subcutaneously
B. Hold the next dose and notify the physician
C. Continue the current dose and monitor
D. Administer fresh frozen plasma
Correct Answer: B
,Rationale: Correct because an INR of 4.8 indicates supratherapeutic
anticoagulation; holding the next dose and notifying the physician is the priority
to prevent bleeding complications. This matches the therapeutic INR range of 2.0-
3.0 for atrial fibrillation.
Q6: A patient with acute coronary syndrome is receiving nitroglycerin IV infusion.
The blood pressure drops from 142/88 to 96/58 mmHg. What is the nurse's priority
action?
A. Increase the nitroglycerin infusion rate
B. Stop the nitroglycerin infusion immediately
C. Administer normal saline bolus 500 mL
D. Place the patient in Trendelenburg position
Correct Answer: B
Rationale: Correct because hypotension is a serious adverse effect of
nitroglycerin; stopping the infusion immediately is the priority to prevent further
cardiovascular compromise. This matches the pharmacologic principle that
vasodilator therapy requires immediate discontinuation when hypotension
develops.
Q7: A patient with heart failure is prescribed spironolactone. The nurse should
monitor for which potential adverse effect?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Correct Answer: A
Rationale: Correct because spironolactone is a potassium-sparing diuretic that
can cause hyperkalemia, particularly in patients with renal impairment or those
taking ACE inhibitors. This matches the pharmacologic profile of aldosterone
antagonists.
Q8: A patient with peripheral arterial disease reports severe pain in the left foot
even at rest. The foot is cool, pale, and has diminished pulses. Which nursing
diagnosis is the priority?
A. Ineffective tissue perfusion
, B. Acute pain
C. Risk for infection
D. Impaired physical mobility
Correct Answer: A
Rationale: Correct because the assessment findings indicate critical limb
ischemia with compromised arterial blood flow; ineffective tissue perfusion is the
priority nursing diagnosis as it threatens tissue viability. This matches the
pathophysiology of advanced peripheral arterial disease.
Q9: A patient with a permanent pacemaker is being discharged. Which patient
statement indicates correct understanding of self-care?
A. "I should avoid using a microwave oven"
B. "I can lift weights up to 25 pounds with my left arm"
C. "I need to check my pulse daily and report rates below 60"
D. "I should avoid cell phone use entirely"
Correct Answer: C
Rationale: Correct because daily pulse monitoring with reporting of bradycardia
or irregular rhythms is essential for patients with pacemakers to detect device
malfunction. This matches the standard discharge teaching for permanent
pacemaker patients.
Q10: A patient with infective endocarditis is receiving IV antibiotics. The nurse
notes a new onset of petechiae on the conjunctiva and splinter hemorrhages
under the nails. Which complication should the nurse suspect?
A. Septic emboli
B. Digitalis toxicity
C. Thrombocytopenia
D. Allergic reaction
Correct Answer: A
Rationale: Correct because petechiae and splinter hemorrhages are classic
peripheral signs of infective endocarditis resulting from septic emboli to small
vessels. This matches the peripheral manifestations of embolic phenomena in
endocarditis.
Final Exam.
Section 1: Cardiovascular Disorders (25 Questions)
Q1: A nurse is assessing a patient with heart failure who reports sudden onset of
dyspnea and coughing up pink, frothy sputum. Which action should the nurse
take FIRST?
A. Administer furosemide IV push
B. Place the patient in high-Fowler's position
C. Apply a non-rebreather mask at 100% oxygen
D. Morphine sulfate 2 mg IV
Correct Answer: D
Rationale: Correct because morphine reduces preload, decreases anxiety, and
reduces respiratory drive, which is the priority in acute pulmonary edema before
other interventions. This matches the ACLS protocol for acute cardiogenic
pulmonary edema where morphine addresses the primary pathophysiologic
mechanisms.
Q2: A patient with acute myocardial infarction develops ventricular tachycardia
with a pulse and blood pressure 88/52 mmHg. What is the nurse's priority
intervention?
A. Administer amiodarone 150 mg IV over 10 minutes
B. Prepare for synchronized cardioversion
C. Begin CPR immediately
D. Administer lidocaine 1 mg/kg IV bolus
Correct Answer: B
Rationale: Correct because the patient is unstable with hypotension and a pulse;
synchronized cardioversion is the priority intervention for unstable ventricular
tachycardia per ACLS algorithms. This matches the standard that unstable
tachyarrhythmias require immediate electrical therapy.
,Q3: A nurse is caring for a patient post-cardiac catheterization with a femoral
approach. The patient reports sudden severe back pain and has a dropping blood
pressure. Which action should the nurse take FIRST?
A. Apply manual pressure to the groin site
B. Notify the physician immediately
C. Assess distal pulses
D. Check the activated clotting time
Correct Answer: A
Rationale: Correct because sudden severe back pain with hypotension post-
catheterization indicates retroperitoneal hemorrhage; applying manual pressure
to the groin site is the immediate priority to control bleeding. This matches the
emergency management protocol for vascular access site complications.
Q4: A patient with heart failure is prescribed digoxin 0.25 mg daily. The nurse
notes the apical pulse is 52 beats/minute. What is the appropriate nursing action?
A. Administer the dose and notify the physician
B. Hold the dose and notify the physician
C. Administer half the dose and monitor
D. Check the potassium level before administering
Correct Answer: B
Rationale: Correct because digoxin should be held when the apical pulse is below
60 beats/minute due to risk of bradycardia and heart block. This matches the
established safety parameter for cardiac glycoside administration.
Q5: A patient with atrial fibrillation is receiving warfarin therapy. The nurse notes
an INR of 4.8. Which intervention is most appropriate?
A. Administer vitamin K 10 mg subcutaneously
B. Hold the next dose and notify the physician
C. Continue the current dose and monitor
D. Administer fresh frozen plasma
Correct Answer: B
,Rationale: Correct because an INR of 4.8 indicates supratherapeutic
anticoagulation; holding the next dose and notifying the physician is the priority
to prevent bleeding complications. This matches the therapeutic INR range of 2.0-
3.0 for atrial fibrillation.
Q6: A patient with acute coronary syndrome is receiving nitroglycerin IV infusion.
The blood pressure drops from 142/88 to 96/58 mmHg. What is the nurse's priority
action?
A. Increase the nitroglycerin infusion rate
B. Stop the nitroglycerin infusion immediately
C. Administer normal saline bolus 500 mL
D. Place the patient in Trendelenburg position
Correct Answer: B
Rationale: Correct because hypotension is a serious adverse effect of
nitroglycerin; stopping the infusion immediately is the priority to prevent further
cardiovascular compromise. This matches the pharmacologic principle that
vasodilator therapy requires immediate discontinuation when hypotension
develops.
Q7: A patient with heart failure is prescribed spironolactone. The nurse should
monitor for which potential adverse effect?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Correct Answer: A
Rationale: Correct because spironolactone is a potassium-sparing diuretic that
can cause hyperkalemia, particularly in patients with renal impairment or those
taking ACE inhibitors. This matches the pharmacologic profile of aldosterone
antagonists.
Q8: A patient with peripheral arterial disease reports severe pain in the left foot
even at rest. The foot is cool, pale, and has diminished pulses. Which nursing
diagnosis is the priority?
A. Ineffective tissue perfusion
, B. Acute pain
C. Risk for infection
D. Impaired physical mobility
Correct Answer: A
Rationale: Correct because the assessment findings indicate critical limb
ischemia with compromised arterial blood flow; ineffective tissue perfusion is the
priority nursing diagnosis as it threatens tissue viability. This matches the
pathophysiology of advanced peripheral arterial disease.
Q9: A patient with a permanent pacemaker is being discharged. Which patient
statement indicates correct understanding of self-care?
A. "I should avoid using a microwave oven"
B. "I can lift weights up to 25 pounds with my left arm"
C. "I need to check my pulse daily and report rates below 60"
D. "I should avoid cell phone use entirely"
Correct Answer: C
Rationale: Correct because daily pulse monitoring with reporting of bradycardia
or irregular rhythms is essential for patients with pacemakers to detect device
malfunction. This matches the standard discharge teaching for permanent
pacemaker patients.
Q10: A patient with infective endocarditis is receiving IV antibiotics. The nurse
notes a new onset of petechiae on the conjunctiva and splinter hemorrhages
under the nails. Which complication should the nurse suspect?
A. Septic emboli
B. Digitalis toxicity
C. Thrombocytopenia
D. Allergic reaction
Correct Answer: A
Rationale: Correct because petechiae and splinter hemorrhages are classic
peripheral signs of infective endocarditis resulting from septic emboli to small
vessels. This matches the peripheral manifestations of embolic phenomena in
endocarditis.
