MDC4 Medical-Surgical Nursing IV Exam 1 –
Official Academic Board of Nursing –
2026/2027 Academic Year – Verified
Questions and Answers for Undergraduate
Nursing Students
Section 1: Cardiovascular Disorders
Question 1: A patient with heart failure is prescribed furosemide. Which laboratory value requires the
nurse to notify the healthcare provider?
A) Serum potassium of 3.2 mEq/L
B) Serum sodium of 138 mEq/L
C) Serum creatinine of 1.0 mg/dL
D) Blood glucose of 110 mg/dL
*Answer: A) Serum potassium of 3.2 mEq/L Rationale: Furosemide is a loop diuretic that causes
potassium wasting. Hypokalemia (normal 3.5-5.0 mEq/L) increases the risk of cardiac dysrhythmias,
especially in patients with heart failure who may also be taking digoxin. The nurse must notify the
provider immediately.
Question 2: Which assessment finding is most indicative of left-sided heart failure?
A) Peripheral edema
B) Jugular venous distention
C) Crackles in the lung bases
D) Hepatomegaly
*Answer: C) Crackles in the lung bases Rationale: Left-sided heart failure leads to pulmonary congestion
due to the inability of the left ventricle to pump blood effectively, causing fluid backup into the lungs.
Crackles are a hallmark sign of pulmonary edema. Peripheral edema, JVD, and hepatomegaly are signs
of right-sided heart failure.
Question 3: A patient is receiving digoxin for heart failure. Which finding indicates digoxin toxicity?
A) Heart rate of 68 beats per minute
B) Serum digoxin level of 1.2 ng/mL
C) Yellow-green halos around vision
D) Blood pressure of 130/80 mmHg
*Answer: C) Yellow-green halos around vision Rationale: Yellow-green halos (xanthopsia) are a classic
visual disturbance associated with digoxin toxicity. Normal digoxin levels are 0.8-2.0 ng/mL. A heart rate
of 68 is within normal limits, and the blood pressure is acceptable.
, Question 4: The nurse is caring for a patient with acute coronary syndrome. Which medication should
be administered first?
A) Nitroglycerin sublingual
B) Aspirin 324 mg chewed
C) Morphine sulfate IV
D) Oxygen at 2 L/min
*Answer: B) Aspirin 324 mg chewed Rationale: Aspirin is the priority intervention for acute coronary
syndrome because it reduces mortality by inhibiting platelet aggregation. It should be given immediately
upon recognition of symptoms, unless contraindicated. Nitroglycerin and morphine are also important
but follow aspirin administration.
Question 5: A patient with pericarditis is experiencing sharp chest pain that worsens with inspiration.
Which position provides the most relief?
A) Supine
B) Prone
C) Sitting upright and leaning forward
D) Left lateral recumbent
*Answer: C) Sitting upright and leaning forward Rationale: Pericarditis pain is typically relieved by
sitting upright and leaning forward, which reduces pressure on the pericardium by decreasing cardiac
movement against the inflamed pericardial sac. Supine and other positions often worsen the pain.
Question 6: The nurse is assessing a patient with an abdominal aortic aneurysm (AAA). Which finding is
most concerning?
A) Back pain
B) Pulsatile abdominal mass
C) Sudden, severe back or abdominal pain with hypotension
D) Bruit over the abdomen
*Answer: C) Sudden, severe back or abdominal pain with hypotension Rationale: Sudden, severe pain
with hypotension indicates a rupturing AAA, which is a life-threatening emergency requiring immediate
surgical intervention. While back pain, a pulsatile mass, and bruit are associated with AAA, they do not
indicate imminent rupture.
Question 7: Which ECG finding is characteristic of atrial fibrillation?
A) Absent P waves with irregularly irregular QRS complexes
B) Sawtooth P waves
C) Wide QRS complexes
D) ST-segment elevation
*Answer: A) Absent P waves with irregularly irregular QRS complexes Rationale: Atrial fibrillation is
characterized by the absence of distinct P waves (replaced by fibrillatory waves) and an irregularly
irregular ventricular response. Sawtooth P waves indicate atrial flutter. Wide QRS indicates bundle
branch block or ventricular origin, and ST elevation indicates myocardial injury.
Question 8: A patient post-cardiac catheterization has a groin site. Which assessment finding requires
immediate action?
Official Academic Board of Nursing –
2026/2027 Academic Year – Verified
Questions and Answers for Undergraduate
Nursing Students
Section 1: Cardiovascular Disorders
Question 1: A patient with heart failure is prescribed furosemide. Which laboratory value requires the
nurse to notify the healthcare provider?
A) Serum potassium of 3.2 mEq/L
B) Serum sodium of 138 mEq/L
C) Serum creatinine of 1.0 mg/dL
D) Blood glucose of 110 mg/dL
*Answer: A) Serum potassium of 3.2 mEq/L Rationale: Furosemide is a loop diuretic that causes
potassium wasting. Hypokalemia (normal 3.5-5.0 mEq/L) increases the risk of cardiac dysrhythmias,
especially in patients with heart failure who may also be taking digoxin. The nurse must notify the
provider immediately.
Question 2: Which assessment finding is most indicative of left-sided heart failure?
A) Peripheral edema
B) Jugular venous distention
C) Crackles in the lung bases
D) Hepatomegaly
*Answer: C) Crackles in the lung bases Rationale: Left-sided heart failure leads to pulmonary congestion
due to the inability of the left ventricle to pump blood effectively, causing fluid backup into the lungs.
Crackles are a hallmark sign of pulmonary edema. Peripheral edema, JVD, and hepatomegaly are signs
of right-sided heart failure.
Question 3: A patient is receiving digoxin for heart failure. Which finding indicates digoxin toxicity?
A) Heart rate of 68 beats per minute
B) Serum digoxin level of 1.2 ng/mL
C) Yellow-green halos around vision
D) Blood pressure of 130/80 mmHg
*Answer: C) Yellow-green halos around vision Rationale: Yellow-green halos (xanthopsia) are a classic
visual disturbance associated with digoxin toxicity. Normal digoxin levels are 0.8-2.0 ng/mL. A heart rate
of 68 is within normal limits, and the blood pressure is acceptable.
, Question 4: The nurse is caring for a patient with acute coronary syndrome. Which medication should
be administered first?
A) Nitroglycerin sublingual
B) Aspirin 324 mg chewed
C) Morphine sulfate IV
D) Oxygen at 2 L/min
*Answer: B) Aspirin 324 mg chewed Rationale: Aspirin is the priority intervention for acute coronary
syndrome because it reduces mortality by inhibiting platelet aggregation. It should be given immediately
upon recognition of symptoms, unless contraindicated. Nitroglycerin and morphine are also important
but follow aspirin administration.
Question 5: A patient with pericarditis is experiencing sharp chest pain that worsens with inspiration.
Which position provides the most relief?
A) Supine
B) Prone
C) Sitting upright and leaning forward
D) Left lateral recumbent
*Answer: C) Sitting upright and leaning forward Rationale: Pericarditis pain is typically relieved by
sitting upright and leaning forward, which reduces pressure on the pericardium by decreasing cardiac
movement against the inflamed pericardial sac. Supine and other positions often worsen the pain.
Question 6: The nurse is assessing a patient with an abdominal aortic aneurysm (AAA). Which finding is
most concerning?
A) Back pain
B) Pulsatile abdominal mass
C) Sudden, severe back or abdominal pain with hypotension
D) Bruit over the abdomen
*Answer: C) Sudden, severe back or abdominal pain with hypotension Rationale: Sudden, severe pain
with hypotension indicates a rupturing AAA, which is a life-threatening emergency requiring immediate
surgical intervention. While back pain, a pulsatile mass, and bruit are associated with AAA, they do not
indicate imminent rupture.
Question 7: Which ECG finding is characteristic of atrial fibrillation?
A) Absent P waves with irregularly irregular QRS complexes
B) Sawtooth P waves
C) Wide QRS complexes
D) ST-segment elevation
*Answer: A) Absent P waves with irregularly irregular QRS complexes Rationale: Atrial fibrillation is
characterized by the absence of distinct P waves (replaced by fibrillatory waves) and an irregularly
irregular ventricular response. Sawtooth P waves indicate atrial flutter. Wide QRS indicates bundle
branch block or ventricular origin, and ST elevation indicates myocardial injury.
Question 8: A patient post-cardiac catheterization has a groin site. Which assessment finding requires
immediate action?
