NUR242 Medical-Surgical Nursing Exam 4 Question Bank
(Latest 2026/2027 Edition) – Questions, Answers &
Detailed Rationales 100% Correct| Grade A- Galen
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SECTION 1: CARDIOVASCULAR DISORDERS
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Question 1
A 68-year-old male patient with a history of hypertension presents to the emergency
department with crushing substernal chest pain radiating to the left arm, diaphoresis,
and nausea. Vital signs reveal BP 88/56 mmHg, HR 110 bpm, RR 24/min, and SpO2 91%
on room air. The 12-lead ECG shows ST-segment elevation in leads V1–V4. Which
intervention should the nurse prioritize?
A. Administer sublingual nitroglycerin 0.4 mg
B. Initiate aspirin 325 mg chewable
C. Prepare the patient for immediate percutaneous coronary intervention
D. Apply supplemental oxygen at 2 L/min via nasal cannula
Correct Answer:
C — Prepare the patient for immediate percutaneous coronary intervention
Rationale:
This patient presents with an acute anterior ST-elevation myocardial infarction (STEMI)
and cardiogenic shock (hypotension, tachycardia), which requires emergent reperfusion
therapy. PCI within 90 minutes is the gold standard. While aspirin and oxygen are
appropriate adjuncts, they do not address the primary pathology; nitroglycerin is
contraindicated due to hypotension.
Question 2
,A nurse is caring for a patient 24 hours post-coronary artery bypass graft (CABG)
surgery. The patient suddenly develops jugular venous distension, muffled heart sounds,
and hypotension. Which condition should the nurse suspect, and what is the priority
action?
A. Cardiac tamponade; notify the surgeon immediately
B. Pneumothorax; prepare for chest tube insertion
C. Myocardial infarction; administer thrombolytics
D. Pulmonary embolism; initiate heparin infusion
Correct Answer:
A — Cardiac tamponade; notify the surgeon immediately
Rationale:
The triad of jugular venous distension, muffled heart sounds, and hypotension (Beck's
triad) is pathognomonic for cardiac tamponade, a surgical emergency after CABG
requiring immediate pericardial drainage. Pneumothorax would present with absent
breath sounds and respiratory distress; MI would show ECG changes; PE would present
with dyspnea and tachypnea.
Question 3
A patient with chronic heart failure is prescribed lisinopril 10 mg daily, furosemide 40
mg daily, and carvedilol 12.5 mg twice daily. The patient reports dizziness upon
standing. Which assessment finding requires immediate nursing intervention?
A. Serum potassium of 3.6 mEq/L
B. Blood pressure of 92/58 mmHg after standing
C. Weight gain of 2 pounds over one week
D. Heart rate of 58 bpm at rest
Correct Answer:
B — Blood pressure of 92/58 mmHg after standing
,Rationale:
Orthostatic hypotension (BP <90/60 mmHg upon standing) in a patient on ACE
inhibitors, diuretics, and beta-blockers indicates significant hemodynamic compromise
and high fall risk requiring immediate intervention. Potassium of 3.6 is within
acceptable range; 2-pound weight gain is minimal; heart rate of 58 is expected with
beta-blocker therapy.
Question 4
A 55-year-old patient with atrial fibrillation is started on warfarin therapy. The nurse
provides discharge education. Which patient statement indicates correct understanding
of warfarin management?
A. "I will increase my intake of green leafy vegetables to boost my vitamin K."
B. "I should take aspirin daily in addition to warfarin for better stroke prevention."
C. "I need to have my INR checked regularly and report any unusual bleeding."
D. "I can stop taking warfarin once my heart rhythm returns to normal."
Correct Answer:
C — I need to have my INR checked regularly and report any unusual bleeding
Rationale:
Regular INR monitoring and bleeding surveillance are cornerstone safety measures for
warfarin therapy. Vitamin K-rich foods should be kept consistent, not increased;
combining aspirin increases bleeding risk without added stroke benefit; atrial fibrillation
often requires lifelong anticoagulation regardless of rhythm control.
Question 5
A patient with peripheral arterial disease (PAD) reports severe leg pain at rest that
worsens when the legs are elevated. The nurse notes non-healing ulcers on the toes and
absence of pedal pulses. Which nursing intervention is most appropriate?
, A. Apply warm compresses to the lower extremities for 20 minutes
B. Elevate the legs above heart level to promote venous return
C. Keep the legs in a dependent position and avoid pressure on heels
D. Encourage vigorous walking exercise to improve collateral circulation
Correct Answer:
C — Keep the legs in a dependent position and avoid pressure on heels
Rationale:
Dependent positioning utilizes gravity to improve arterial perfusion to ischemic tissues
in PAD; heel pressure must be avoided to prevent ulceration. Warm compresses can
cause thermal injury in insensate ischemic tissue; elevation worsens arterial
insufficiency; vigorous exercise is contraindicated with rest pain indicating critical limb
ischemia.
Question 6
A nurse is monitoring a patient with infective endocarditis who suddenly reports severe
headache, visual disturbances, and right-sided weakness. Which complication should
the nurse suspect?
A. Myocardial rupture
B. Septic emboli to the brain
C. Acute kidney injury
D. Pericardial effusion
Correct Answer:
B — Septic emboli to the brain
Rationale:
Infective endocarditis produces vegetations that embolize to major organs; neurological
deficits (headache, visual changes, weakness) strongly suggest septic cerebral emboli
or mycotic aneurysm rupture. Myocardial rupture presents with tamponade; AKI
presents with decreased urine output; pericardial effusion presents with Beck's triad.
(Latest 2026/2027 Edition) – Questions, Answers &
Detailed Rationales 100% Correct| Grade A- Galen
──────────────────────────────
SECTION 1: CARDIOVASCULAR DISORDERS
──────────────────────────────
Question 1
A 68-year-old male patient with a history of hypertension presents to the emergency
department with crushing substernal chest pain radiating to the left arm, diaphoresis,
and nausea. Vital signs reveal BP 88/56 mmHg, HR 110 bpm, RR 24/min, and SpO2 91%
on room air. The 12-lead ECG shows ST-segment elevation in leads V1–V4. Which
intervention should the nurse prioritize?
A. Administer sublingual nitroglycerin 0.4 mg
B. Initiate aspirin 325 mg chewable
C. Prepare the patient for immediate percutaneous coronary intervention
D. Apply supplemental oxygen at 2 L/min via nasal cannula
Correct Answer:
C — Prepare the patient for immediate percutaneous coronary intervention
Rationale:
This patient presents with an acute anterior ST-elevation myocardial infarction (STEMI)
and cardiogenic shock (hypotension, tachycardia), which requires emergent reperfusion
therapy. PCI within 90 minutes is the gold standard. While aspirin and oxygen are
appropriate adjuncts, they do not address the primary pathology; nitroglycerin is
contraindicated due to hypotension.
Question 2
,A nurse is caring for a patient 24 hours post-coronary artery bypass graft (CABG)
surgery. The patient suddenly develops jugular venous distension, muffled heart sounds,
and hypotension. Which condition should the nurse suspect, and what is the priority
action?
A. Cardiac tamponade; notify the surgeon immediately
B. Pneumothorax; prepare for chest tube insertion
C. Myocardial infarction; administer thrombolytics
D. Pulmonary embolism; initiate heparin infusion
Correct Answer:
A — Cardiac tamponade; notify the surgeon immediately
Rationale:
The triad of jugular venous distension, muffled heart sounds, and hypotension (Beck's
triad) is pathognomonic for cardiac tamponade, a surgical emergency after CABG
requiring immediate pericardial drainage. Pneumothorax would present with absent
breath sounds and respiratory distress; MI would show ECG changes; PE would present
with dyspnea and tachypnea.
Question 3
A patient with chronic heart failure is prescribed lisinopril 10 mg daily, furosemide 40
mg daily, and carvedilol 12.5 mg twice daily. The patient reports dizziness upon
standing. Which assessment finding requires immediate nursing intervention?
A. Serum potassium of 3.6 mEq/L
B. Blood pressure of 92/58 mmHg after standing
C. Weight gain of 2 pounds over one week
D. Heart rate of 58 bpm at rest
Correct Answer:
B — Blood pressure of 92/58 mmHg after standing
,Rationale:
Orthostatic hypotension (BP <90/60 mmHg upon standing) in a patient on ACE
inhibitors, diuretics, and beta-blockers indicates significant hemodynamic compromise
and high fall risk requiring immediate intervention. Potassium of 3.6 is within
acceptable range; 2-pound weight gain is minimal; heart rate of 58 is expected with
beta-blocker therapy.
Question 4
A 55-year-old patient with atrial fibrillation is started on warfarin therapy. The nurse
provides discharge education. Which patient statement indicates correct understanding
of warfarin management?
A. "I will increase my intake of green leafy vegetables to boost my vitamin K."
B. "I should take aspirin daily in addition to warfarin for better stroke prevention."
C. "I need to have my INR checked regularly and report any unusual bleeding."
D. "I can stop taking warfarin once my heart rhythm returns to normal."
Correct Answer:
C — I need to have my INR checked regularly and report any unusual bleeding
Rationale:
Regular INR monitoring and bleeding surveillance are cornerstone safety measures for
warfarin therapy. Vitamin K-rich foods should be kept consistent, not increased;
combining aspirin increases bleeding risk without added stroke benefit; atrial fibrillation
often requires lifelong anticoagulation regardless of rhythm control.
Question 5
A patient with peripheral arterial disease (PAD) reports severe leg pain at rest that
worsens when the legs are elevated. The nurse notes non-healing ulcers on the toes and
absence of pedal pulses. Which nursing intervention is most appropriate?
, A. Apply warm compresses to the lower extremities for 20 minutes
B. Elevate the legs above heart level to promote venous return
C. Keep the legs in a dependent position and avoid pressure on heels
D. Encourage vigorous walking exercise to improve collateral circulation
Correct Answer:
C — Keep the legs in a dependent position and avoid pressure on heels
Rationale:
Dependent positioning utilizes gravity to improve arterial perfusion to ischemic tissues
in PAD; heel pressure must be avoided to prevent ulceration. Warm compresses can
cause thermal injury in insensate ischemic tissue; elevation worsens arterial
insufficiency; vigorous exercise is contraindicated with rest pain indicating critical limb
ischemia.
Question 6
A nurse is monitoring a patient with infective endocarditis who suddenly reports severe
headache, visual disturbances, and right-sided weakness. Which complication should
the nurse suspect?
A. Myocardial rupture
B. Septic emboli to the brain
C. Acute kidney injury
D. Pericardial effusion
Correct Answer:
B — Septic emboli to the brain
Rationale:
Infective endocarditis produces vegetations that embolize to major organs; neurological
deficits (headache, visual changes, weakness) strongly suggest septic cerebral emboli
or mycotic aneurysm rupture. Myocardial rupture presents with tamponade; AKI
presents with decreased urine output; pericardial effusion presents with Beck's triad.
