,NU 185 Exam 1 | Medical-Surgical II | Questions &
Verified Answers | 2026 Edition | Galen College
1. Which of the following best describes the pathophysiology of acute coronary syndrome?
A) Rupture of an atherosclerotic plaque with subsequent platelet aggregation and thrombus formation
B) Progressive fibrosis of the myocardium
C) Spasm of a coronary artery without underlying atherosclerosis
D) Acute inflammation of the pericardial sac
Correct Answer: Rupture of an atherosclerotic plaque with subsequent platelet aggregation and
thrombus formation
Rationale: Acute coronary syndrome is most often triggered by rupture of an unstable plaque, exposing
subendothelial collagen and tissue factor. This leads to platelet adhesion, activation, and thrombus
formation that partially or completely occludes the coronary artery, causing ischemia or infarction.
2. The nurse is caring for a patient with acute decompensated heart failure who develops severe
dyspnea and pink, frothy sputum. Which intervention is the priority?
A) Administer IV furosemide
B) Place the patient in high Fowler’s position and administer oxygen
C) Insert an indwelling urinary catheter
D) Administer digoxin
Correct Answer: Place the patient in high Fowler’s position and administer oxygen
Rationale: The patient is experiencing pulmonary edema. Immediate priorities are to improve
oxygenation and reduce venous return by sitting the patient upright with legs dangling. Oxygen is given
to relieve hypoxemia. Diuretics and other medications follow.
3. A patient is admitted with chest pain and ST-segment elevation in leads II, III, and aVF. The nurse
anticipates an infarction in which area of the heart?
,A) Anterior wall
B) Lateral wall
C) Inferior wall
D) Septal wall
Correct Answer: Inferior wall
Rationale: Leads II, III, and aVF reflect the inferior surface of the left ventricle. An inferior MI often
involves the right coronary artery and may be accompanied by bradycardia and hypotension due to
vagal stimulation. Anterior MI shows changes in V1-V4.
4. The nurse is teaching a patient about management of heart failure. Which statement indicates a need
for further teaching?
A) “I will weigh myself every morning and report a gain of 2 to 3 pounds.”
B) “I will take my furosemide as prescribed.”
C) “I should rest if I feel short of breath.”
D) “I can use salt substitutes freely to lower my sodium intake.”
Correct Answer: “I can use salt substitutes freely to lower my sodium intake.”
Rationale: Many salt substitutes contain potassium chloride, which can cause life-threatening
hyperkalemia in patients taking ACE inhibitors or potassium-sparing diuretics. Patients should be taught
to avoid salt substitutes unless approved by their provider. The other statements indicate correct
understanding.
5. Which of the following dysrhythmias is characterized by an irregularly irregular rhythm and absence
of distinct P waves?
A) Atrial fibrillation
B) Ventricular tachycardia
C) Atrial flutter
D) Sinus bradycardia
, Correct Answer: Atrial fibrillation
Rationale: Atrial fibrillation is a chaotic rhythm with no organized atrial depolarization, resulting in an
irregular ventricular response and no discernible P waves. It increases the risk of thromboembolic
stroke. Atrial flutter has a sawtooth pattern; VT is regular; sinus brady has P waves.
6. The nurse is monitoring a patient receiving IV heparin. Which laboratory value is used to evaluate
therapeutic effectiveness?
A) Prothrombin time (PT)
B) Activated partial thromboplastin time (aPTT)
C) International normalized ratio (INR)
D) Platelet count
Correct Answer: Activated partial thromboplastin time (aPTT)
Rationale: Heparin potentiates antithrombin III, inhibiting thrombin and factor Xa, primarily affecting the
intrinsic pathway. aPTT is the standard test for monitoring unfractionated heparin therapy, with a
therapeutic range of 1.5 to 2.5 times the control value. Warfarin is monitored by PT/INR.
7. The nurse is caring for a patient with chronic obstructive pulmonary disease. Which finding indicates
the patient is retaining carbon dioxide?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis
Correct Answer: Respiratory acidosis
Rationale: In COPD, impaired gas exchange leads to retention of CO₂, which combines with water to
form carbonic acid, lowering pH and causing respiratory acidosis. The kidneys compensate by retaining
bicarbonate. Signs include headache, confusion, and somnolence.
Verified Answers | 2026 Edition | Galen College
1. Which of the following best describes the pathophysiology of acute coronary syndrome?
A) Rupture of an atherosclerotic plaque with subsequent platelet aggregation and thrombus formation
B) Progressive fibrosis of the myocardium
C) Spasm of a coronary artery without underlying atherosclerosis
D) Acute inflammation of the pericardial sac
Correct Answer: Rupture of an atherosclerotic plaque with subsequent platelet aggregation and
thrombus formation
Rationale: Acute coronary syndrome is most often triggered by rupture of an unstable plaque, exposing
subendothelial collagen and tissue factor. This leads to platelet adhesion, activation, and thrombus
formation that partially or completely occludes the coronary artery, causing ischemia or infarction.
2. The nurse is caring for a patient with acute decompensated heart failure who develops severe
dyspnea and pink, frothy sputum. Which intervention is the priority?
A) Administer IV furosemide
B) Place the patient in high Fowler’s position and administer oxygen
C) Insert an indwelling urinary catheter
D) Administer digoxin
Correct Answer: Place the patient in high Fowler’s position and administer oxygen
Rationale: The patient is experiencing pulmonary edema. Immediate priorities are to improve
oxygenation and reduce venous return by sitting the patient upright with legs dangling. Oxygen is given
to relieve hypoxemia. Diuretics and other medications follow.
3. A patient is admitted with chest pain and ST-segment elevation in leads II, III, and aVF. The nurse
anticipates an infarction in which area of the heart?
,A) Anterior wall
B) Lateral wall
C) Inferior wall
D) Septal wall
Correct Answer: Inferior wall
Rationale: Leads II, III, and aVF reflect the inferior surface of the left ventricle. An inferior MI often
involves the right coronary artery and may be accompanied by bradycardia and hypotension due to
vagal stimulation. Anterior MI shows changes in V1-V4.
4. The nurse is teaching a patient about management of heart failure. Which statement indicates a need
for further teaching?
A) “I will weigh myself every morning and report a gain of 2 to 3 pounds.”
B) “I will take my furosemide as prescribed.”
C) “I should rest if I feel short of breath.”
D) “I can use salt substitutes freely to lower my sodium intake.”
Correct Answer: “I can use salt substitutes freely to lower my sodium intake.”
Rationale: Many salt substitutes contain potassium chloride, which can cause life-threatening
hyperkalemia in patients taking ACE inhibitors or potassium-sparing diuretics. Patients should be taught
to avoid salt substitutes unless approved by their provider. The other statements indicate correct
understanding.
5. Which of the following dysrhythmias is characterized by an irregularly irregular rhythm and absence
of distinct P waves?
A) Atrial fibrillation
B) Ventricular tachycardia
C) Atrial flutter
D) Sinus bradycardia
, Correct Answer: Atrial fibrillation
Rationale: Atrial fibrillation is a chaotic rhythm with no organized atrial depolarization, resulting in an
irregular ventricular response and no discernible P waves. It increases the risk of thromboembolic
stroke. Atrial flutter has a sawtooth pattern; VT is regular; sinus brady has P waves.
6. The nurse is monitoring a patient receiving IV heparin. Which laboratory value is used to evaluate
therapeutic effectiveness?
A) Prothrombin time (PT)
B) Activated partial thromboplastin time (aPTT)
C) International normalized ratio (INR)
D) Platelet count
Correct Answer: Activated partial thromboplastin time (aPTT)
Rationale: Heparin potentiates antithrombin III, inhibiting thrombin and factor Xa, primarily affecting the
intrinsic pathway. aPTT is the standard test for monitoring unfractionated heparin therapy, with a
therapeutic range of 1.5 to 2.5 times the control value. Warfarin is monitored by PT/INR.
7. The nurse is caring for a patient with chronic obstructive pulmonary disease. Which finding indicates
the patient is retaining carbon dioxide?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis
Correct Answer: Respiratory acidosis
Rationale: In COPD, impaired gas exchange leads to retention of CO₂, which combines with water to
form carbonic acid, lowering pH and causing respiratory acidosis. The kidneys compensate by retaining
bicarbonate. Signs include headache, confusion, and somnolence.
