MDC4 Final Exam 2026/2027 Questions and Answers Actual Exam |
Detailed Rationales | Graded A+ | Pass Guaranteed – A+ Graded
Section 1: Cardiovascular Disorders
Question 1
A nurse is caring for a patient with acute decompensated heart failure. The patient is
receiving IV furosemide and oxygen. Which finding is most concerning?
A. Weight loss of 1 kg in 24 hours.
B. Development of pink, frothy sputum.
C. Urine output of 50 mL/hour.
D. Oxygen saturation of 92% on 2 L nasal cannula.
Correct Answer: B
Rationale: Pink, frothy sputum indicates acute pulmonary edema, a life-threatening
complication of decompensated heart failure requiring immediate intervention. Option A
is an expected finding with diuresis. Option C is adequate urine output. Option D is
acceptable, though not ideal, and does not indicate acute deterioration.
Question 2
A patient admitted with STEMI receives primary PCI. Two hours post-procedure, the
patient reports chest pressure and ST elevation returns on the monitor. Which is the
priority nursing action?
A. Administer sublingual nitroglycerin.
B. Notify the interventional cardiologist immediately.
C. Obtain a 12-lead ECG.
D. Assess vital signs.
Correct Answer: B
,Rationale: Return of chest pressure and ST elevation post-PCI suggests acute stent
thrombosis or reocclusion, a cardiac emergency requiring immediate physician
notification and possible emergent re-intervention. While Options C and D are important
assessments, Option B is the priority because "time is muscle." Option A may provide
temporary relief but does not address the emergent cause.
Question 3
A patient with newly diagnosed atrial fibrillation is started on apixaban. Which patient
statement indicates understanding of anticoagulation teaching?
A. "I will take aspirin instead on days I miss my apixaban dose."
B. "I should report any unusual bleeding or bruising immediately."
C. "I need to have my INR checked monthly."
D. "I can stop taking this medication if my heart rhythm returns to normal."
Correct Answer: B
Rationale: Apixaban is a direct oral anticoagulant (DOAC) that increases bleeding risk;
patients must report bleeding immediately. Option A is dangerous—DOACs should not
be substituted with aspirin. Option C is incorrect because INR monitoring is for warfarin,
not DOACs. Option D is incorrect because anticoagulation for AF is based on stroke risk
(CHA₂DS₂-VASc score), not rhythm status alone.
Question 4
A patient presents with blood pressure 220/130 mmHg, headache, and blurred vision.
The provider diagnoses hypertensive emergency. What is the priority nursing
intervention?
A. Administer oral antihypertensive medication immediately.
B. Obtain IV access and administer IV antihypertensive per protocol.
C. Place the patient in Trendelenburg position.
D. Encourage the patient to perform Valsalva maneuver.
, Correct Answer: B
Rationale: Hypertensive emergency requires controlled reduction of blood pressure with
IV antihypertensives (e.g., nicardipine, labetalol) to prevent end-organ damage. Oral
agents work too slowly (Option A). Trendelenburg position (Option C) increases cerebral
perfusion pressure and is contraindicated. Valsalva maneuver (Option D) is
contraindicated and may worsen hemodynamics.
Question 5
A patient in cardiogenic shock has a pulmonary artery catheter. Which hemodynamic
finding is consistent with this condition?
A. Elevated cardiac output, decreased systemic vascular resistance.
B. Decreased cardiac output, increased systemic vascular resistance.
C. Normal cardiac output, decreased pulmonary capillary wedge pressure.
D. Increased cardiac output, increased pulmonary capillary wedge pressure.
Correct Answer: B
Rationale: Cardiogenic shock is characterized by decreased cardiac output due to pump
failure, with compensatory increased systemic vascular resistance. Pulmonary capillary
wedge pressure is typically elevated due to left ventricular failure. Option A describes
distributive (septic) shock. Option C is inconsistent with cardiogenic shock. Option D
describes a high-output state, not cardiogenic shock.
Section 2: Respiratory Disorders
Question 6
A patient with COPD exacerbation arrives at the ED with SpO₂ 84% on room air. Which
oxygen delivery method is most appropriate initially?
A. Non-rebreather mask at 15 L/min.
B. Nasal cannula at 2 L/min, titrated to SpO₂ 88-92%.
Detailed Rationales | Graded A+ | Pass Guaranteed – A+ Graded
Section 1: Cardiovascular Disorders
Question 1
A nurse is caring for a patient with acute decompensated heart failure. The patient is
receiving IV furosemide and oxygen. Which finding is most concerning?
A. Weight loss of 1 kg in 24 hours.
B. Development of pink, frothy sputum.
C. Urine output of 50 mL/hour.
D. Oxygen saturation of 92% on 2 L nasal cannula.
Correct Answer: B
Rationale: Pink, frothy sputum indicates acute pulmonary edema, a life-threatening
complication of decompensated heart failure requiring immediate intervention. Option A
is an expected finding with diuresis. Option C is adequate urine output. Option D is
acceptable, though not ideal, and does not indicate acute deterioration.
Question 2
A patient admitted with STEMI receives primary PCI. Two hours post-procedure, the
patient reports chest pressure and ST elevation returns on the monitor. Which is the
priority nursing action?
A. Administer sublingual nitroglycerin.
B. Notify the interventional cardiologist immediately.
C. Obtain a 12-lead ECG.
D. Assess vital signs.
Correct Answer: B
,Rationale: Return of chest pressure and ST elevation post-PCI suggests acute stent
thrombosis or reocclusion, a cardiac emergency requiring immediate physician
notification and possible emergent re-intervention. While Options C and D are important
assessments, Option B is the priority because "time is muscle." Option A may provide
temporary relief but does not address the emergent cause.
Question 3
A patient with newly diagnosed atrial fibrillation is started on apixaban. Which patient
statement indicates understanding of anticoagulation teaching?
A. "I will take aspirin instead on days I miss my apixaban dose."
B. "I should report any unusual bleeding or bruising immediately."
C. "I need to have my INR checked monthly."
D. "I can stop taking this medication if my heart rhythm returns to normal."
Correct Answer: B
Rationale: Apixaban is a direct oral anticoagulant (DOAC) that increases bleeding risk;
patients must report bleeding immediately. Option A is dangerous—DOACs should not
be substituted with aspirin. Option C is incorrect because INR monitoring is for warfarin,
not DOACs. Option D is incorrect because anticoagulation for AF is based on stroke risk
(CHA₂DS₂-VASc score), not rhythm status alone.
Question 4
A patient presents with blood pressure 220/130 mmHg, headache, and blurred vision.
The provider diagnoses hypertensive emergency. What is the priority nursing
intervention?
A. Administer oral antihypertensive medication immediately.
B. Obtain IV access and administer IV antihypertensive per protocol.
C. Place the patient in Trendelenburg position.
D. Encourage the patient to perform Valsalva maneuver.
, Correct Answer: B
Rationale: Hypertensive emergency requires controlled reduction of blood pressure with
IV antihypertensives (e.g., nicardipine, labetalol) to prevent end-organ damage. Oral
agents work too slowly (Option A). Trendelenburg position (Option C) increases cerebral
perfusion pressure and is contraindicated. Valsalva maneuver (Option D) is
contraindicated and may worsen hemodynamics.
Question 5
A patient in cardiogenic shock has a pulmonary artery catheter. Which hemodynamic
finding is consistent with this condition?
A. Elevated cardiac output, decreased systemic vascular resistance.
B. Decreased cardiac output, increased systemic vascular resistance.
C. Normal cardiac output, decreased pulmonary capillary wedge pressure.
D. Increased cardiac output, increased pulmonary capillary wedge pressure.
Correct Answer: B
Rationale: Cardiogenic shock is characterized by decreased cardiac output due to pump
failure, with compensatory increased systemic vascular resistance. Pulmonary capillary
wedge pressure is typically elevated due to left ventricular failure. Option A describes
distributive (septic) shock. Option C is inconsistent with cardiogenic shock. Option D
describes a high-output state, not cardiogenic shock.
Section 2: Respiratory Disorders
Question 6
A patient with COPD exacerbation arrives at the ED with SpO₂ 84% on room air. Which
oxygen delivery method is most appropriate initially?
A. Non-rebreather mask at 15 L/min.
B. Nasal cannula at 2 L/min, titrated to SpO₂ 88-92%.
