NUR242 Medical-Surgical Nursing Exam 3 Question
Bank (Latest 2026/2027 Edition) – Questions,
Answers & Detailed Rationales
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SECTION 1: CARDIOVASCULAR AND RESPIRATORY DISORDERS
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Question 1
A 68-year-old male is admitted with acute myocardial infarction. Twelve hours
post-admission, he develops sudden onset dyspnea, tachypnea, and oxygen saturation
drops to 84% on room air. Physical examination reveals bilateral crackles and an S3
gallop. Which pathophysiological process is most likely responsible for his acute
deterioration?
A. Papillary muscle rupture causing acute mitral regurgitation
B. Acute left ventricular failure leading to pulmonary edema
C. Ventricular septal rupture causing left-to-right shunt
D. Right ventricular infarction causing acute right heart failure
Correct Answer:
B — Acute left ventricular failure leading to pulmonary edema
Rationale:
The presentation of acute dyspnea, hypoxemia, bilateral crackles, and S3 gallop
following MI is classic for acute left ventricular failure with cardiogenic pulmonary
edema due to extensive myocardial damage and reduced contractility. Papillary muscle
rupture (A) would present with a new holosystolic murmur and acute severe mitral
regurgitation. Ventricular septal rupture (C) would show a harsh systolic murmur with a
,thrill. Right ventricular infarction (D) would present with hypotension, clear lungs, and
elevated jugular venous pressure.
Question 2
A 54-year-old female with a history of heart failure is prescribed furosemide 40 mg
twice daily. During morning assessment, the nurse notes muscle weakness, fatigue, and
irregular pulse. Laboratory results reveal potassium 2.8 mEq/L. Which cardiac rhythm is
most likely to develop if this electrolyte imbalance is not corrected?
A. Atrial fibrillation with rapid ventricular response
B. Ventricular tachycardia
C. Sinus bradycardia with first-degree AV block
D. Ventricular fibrillation
Correct Answer:
B — Ventricular tachycardia
Rationale:
Hypokalemia (potassium 2.8 mEq/L) increases myocardial irritability and predisposes
to ventricular arrhythmias, particularly ventricular tachycardia, due to delayed ventricular
repolarization and increased automaticity. Atrial fibrillation (A) is more associated with
structural heart disease. Sinus bradycardia (C) is associated with hyperkalemia, not
hypokalemia. While ventricular fibrillation (D) can occur, ventricular tachycardia is the
more direct and common rhythm disturbance from hypokalemia.
Question 3
A 72-year-old male with chronic obstructive pulmonary disease (COPD) presents with
increased dyspnea, sputum purulence, and volume. Arterial blood gas on room air
shows pH 7.28, PaCO2 72 mmHg, PaO2 58 mmHg, and HCO3 34 mEq/L. Which
acid-base disorder is present?
, A. Acute respiratory acidosis with metabolic compensation
B. Chronic respiratory acidosis with renal compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer:
B — Chronic respiratory acidosis with renal compensation
Rationale:
The pH of 7.28 with markedly elevated PaCO2 (72 mmHg) and elevated bicarbonate (34
mEq/L) indicates chronic respiratory acidosis with adequate renal compensation. In
acute respiratory acidosis, bicarbonate would increase only 1 mEq/L per 10 mmHg rise
in PaCO2, whereas here the bicarbonate has risen appropriately for chronic
compensation. Metabolic alkalosis (C) would show elevated pH. Mixed acidosis (D)
would show decreased bicarbonate.
Question 4
A 45-year-old male is admitted with community-acquired pneumonia. His chest X-ray
shows a right lower lobe infiltrate. He is started on ceftriaxone and azithromycin. Twelve
hours later, his temperature is 39.2°C, heart rate 118 bpm, respiratory rate 28, and blood
pressure 88/52 mmHg. Which intervention is the priority?
A. Add vancomycin to cover methicillin-resistant Staphylococcus aureus
B. Administer aggressive intravenous fluid resuscitation and vasopressors
C. Obtain CT scan of the chest to evaluate for abscess formation
D. Increase the dose of azithromycin to achieve higher tissue concentrations
Correct Answer:
B — Administer aggressive intravenous fluid resuscitation and vasopressors
Rationale:
The patient has developed septic shock (hypotension, tachycardia, tachypnea, fever)
requiring immediate hemodynamic support with fluid resuscitation and vasopressors
Bank (Latest 2026/2027 Edition) – Questions,
Answers & Detailed Rationales
──────────────────────────────
SECTION 1: CARDIOVASCULAR AND RESPIRATORY DISORDERS
──────────────────────────────
Question 1
A 68-year-old male is admitted with acute myocardial infarction. Twelve hours
post-admission, he develops sudden onset dyspnea, tachypnea, and oxygen saturation
drops to 84% on room air. Physical examination reveals bilateral crackles and an S3
gallop. Which pathophysiological process is most likely responsible for his acute
deterioration?
A. Papillary muscle rupture causing acute mitral regurgitation
B. Acute left ventricular failure leading to pulmonary edema
C. Ventricular septal rupture causing left-to-right shunt
D. Right ventricular infarction causing acute right heart failure
Correct Answer:
B — Acute left ventricular failure leading to pulmonary edema
Rationale:
The presentation of acute dyspnea, hypoxemia, bilateral crackles, and S3 gallop
following MI is classic for acute left ventricular failure with cardiogenic pulmonary
edema due to extensive myocardial damage and reduced contractility. Papillary muscle
rupture (A) would present with a new holosystolic murmur and acute severe mitral
regurgitation. Ventricular septal rupture (C) would show a harsh systolic murmur with a
,thrill. Right ventricular infarction (D) would present with hypotension, clear lungs, and
elevated jugular venous pressure.
Question 2
A 54-year-old female with a history of heart failure is prescribed furosemide 40 mg
twice daily. During morning assessment, the nurse notes muscle weakness, fatigue, and
irregular pulse. Laboratory results reveal potassium 2.8 mEq/L. Which cardiac rhythm is
most likely to develop if this electrolyte imbalance is not corrected?
A. Atrial fibrillation with rapid ventricular response
B. Ventricular tachycardia
C. Sinus bradycardia with first-degree AV block
D. Ventricular fibrillation
Correct Answer:
B — Ventricular tachycardia
Rationale:
Hypokalemia (potassium 2.8 mEq/L) increases myocardial irritability and predisposes
to ventricular arrhythmias, particularly ventricular tachycardia, due to delayed ventricular
repolarization and increased automaticity. Atrial fibrillation (A) is more associated with
structural heart disease. Sinus bradycardia (C) is associated with hyperkalemia, not
hypokalemia. While ventricular fibrillation (D) can occur, ventricular tachycardia is the
more direct and common rhythm disturbance from hypokalemia.
Question 3
A 72-year-old male with chronic obstructive pulmonary disease (COPD) presents with
increased dyspnea, sputum purulence, and volume. Arterial blood gas on room air
shows pH 7.28, PaCO2 72 mmHg, PaO2 58 mmHg, and HCO3 34 mEq/L. Which
acid-base disorder is present?
, A. Acute respiratory acidosis with metabolic compensation
B. Chronic respiratory acidosis with renal compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer:
B — Chronic respiratory acidosis with renal compensation
Rationale:
The pH of 7.28 with markedly elevated PaCO2 (72 mmHg) and elevated bicarbonate (34
mEq/L) indicates chronic respiratory acidosis with adequate renal compensation. In
acute respiratory acidosis, bicarbonate would increase only 1 mEq/L per 10 mmHg rise
in PaCO2, whereas here the bicarbonate has risen appropriately for chronic
compensation. Metabolic alkalosis (C) would show elevated pH. Mixed acidosis (D)
would show decreased bicarbonate.
Question 4
A 45-year-old male is admitted with community-acquired pneumonia. His chest X-ray
shows a right lower lobe infiltrate. He is started on ceftriaxone and azithromycin. Twelve
hours later, his temperature is 39.2°C, heart rate 118 bpm, respiratory rate 28, and blood
pressure 88/52 mmHg. Which intervention is the priority?
A. Add vancomycin to cover methicillin-resistant Staphylococcus aureus
B. Administer aggressive intravenous fluid resuscitation and vasopressors
C. Obtain CT scan of the chest to evaluate for abscess formation
D. Increase the dose of azithromycin to achieve higher tissue concentrations
Correct Answer:
B — Administer aggressive intravenous fluid resuscitation and vasopressors
Rationale:
The patient has developed septic shock (hypotension, tachycardia, tachypnea, fever)
requiring immediate hemodynamic support with fluid resuscitation and vasopressors
