NUR 265 Exam 2 | two updated Versions | Questions and
Answers | 2025 Update | 100% Correct. - 217 Questions
This exam assesses advanced understanding of cardiovascular pathophysiology, pharmacotherapy, and clinical
management across a spectrum of acute and chronic cardiac conditions. Emphasis is on evidence-based
decision-making and interpretation of diagnostic data. It contains 217 multiple-choice questions, each with four
distractors and a fully worked rationale that explains why the keyed answer is correct. Content is organized into
10 focused sections: Cardiovascular Disorders, Respiratory Disorders, Fluids and Electrolytes, Acid-Base
Balance, Shock and Sepsis, Perioperative Nursing, Renal and Urinary Disorders, Endocrine Disorders (Diabetes
Mellitus), Pain Management, Inflammation and Infection. Targeted learning outcomes include: Analyze
hemodynamic changes in heart failure and shock states; Differentiate cardiac arrhythmias and select appropriate
interventions; Apply current guidelines for acute coronary syndrome and hypertension management. Every item
has been reviewed for clinical accuracy, current guidelines, and clarity so that students can study with confidence
and self-correct as they work through the bank. Use it as a high-yield review immediately before the exam, or as a
structured practice tool during the unit - the rationales double as concise teaching notes. The recommended
writing time is 3 hours, with a passing score of 80%. Aligned with Accredited by the Commission on Collegiate
Nursing Education (CCNE) and aligned with AACN Essentials. standards and reflects the question style
commonly seen on accredited program examinations. Students consistently achieving above the cut score on this
Section 1: Cardiovascular Disorders (Questions 1-23)
1 A patient with heart failure has an elevated left ventricular end-diastolic
pressure (LVEDP) but a normal left ventricular ejection fraction (LVEF
50%). Which pathophysiologic mechanism primarily explains this finding?
A) Reduced myocardial contractility due to beta-receptor downregulation
B) Impaired left ventricular relaxation and increased stiffness, leading to
diastolic dysfunction
C) Volume overload from renal sodium retention and neurohormonal
activation
D) Ventricular remodeling with eccentric hypertrophy and increased chamber
size
Answer: B
Rationale: In heart failure with preserved ejection fraction (HFpEF), diastolic
dysfunction is the primary mechanism. Impaired relaxation and increased
ventricular stiffness raise filling pressures despite normal systolic function.
Options A, C, and D are more characteristic of heart failure with reduced
ejection fraction (HFrEF).
2 A patient with acute decompensated heart failure presents with severe
dyspnea, pulmonary edema, and a systolic blood pressure of 88 mm Hg.
Which intervention is most appropriate?
,A) Initiate intravenous nitroprusside for afterload reduction
B) Administer intravenous furosemide and titrate dobutamine for inotropic
support
C) Start noninvasive positive pressure ventilation and intravenous metoprolol
D) Give sublingual nitroglycerin and arrange for urgent cardiac
catheterization
Answer: B
Rationale: The patient is in cardiogenic shock with hypotension; inotropes (e.g.,
dobutamine) are indicated to improve cardiac output while diuretics manage
pulmonary congestion. Vasodilators like nitroprusside (A) worsen hypotension.
Beta-blockers (C) are contraindicated acutely. Sublingual nitroglycerin (D) is
not first-line for hypotension.
3 A patient presents with acute chest pain, ST-segment elevation in leads II,
III, and aVF, and onset of symptoms 5 hours ago. The patient has a history of
peptic ulcer disease with a recent upper GI bleed. Which reperfusion strategy
is preferred?
A) Immediate fibrinolytic therapy with alteplase
B) Urgent percutaneous coronary intervention (PCI) with heparin and dual
antiplatelet therapy
C) Conservative management with aspirin and heparin alone
D) Emergent coronary artery bypass grafting (CABG)
Answer: B
Rationale: In STEMI, PCI is preferred over fibrinolysis when timely (<12
hours). Recent GI bleed is a contraindication to fibrinolysis (A). Conservative
management (C) is inadequate. CABG (D) is not the first-line reperfusion for
acute STEMI unless anatomy is unsuitable for PCI.
4 On echocardiography, a patient with syncope has a left ventricular outflow
tract gradient of 40 mm Hg at rest that increases to 90 mm Hg with Valsalva
maneuver. Which finding distinguishes hypertrophic cardiomyopathy
(HCM) from aortic stenosis?
A) Calcified aortic valve leaflets with reduced systolic opening
B) Systolic anterior motion of the mitral valve and asymmetric septal
hypertrophy
C) Left atrial enlargement and pulmonary hypertension
,D) Preserved left ventricular ejection fraction with concentric remodeling
Answer: B
Rationale: Systolic anterior motion (SAM) of the mitral valve and asymmetric
septal hypertrophy are hallmarks of HCM, causing dynamic outflow
obstruction exacerbated by decreased preload (e.g., Valsalva). Aortic stenosis
(A) shows fixed valvular obstruction with calcified leaflets.
5 A patient with atrial fibrillation (AF) and a CHADS-VASc score of 3
requires rate control. The patient has chronic kidney disease stage 4 (eGFR
25 mL/min) and heart failure with reduced ejection fraction (LVEF 35%).
Which agent is most appropriate?
A) Verapamil
B) Amiodarone
C) Diltiazem
D) Metoprolol
Answer: D
Rationale: Beta-blockers (metoprolol) are first-line for rate control in AF with
HFrEF, as they improve outcomes. Verapamil and diltiazem
(non-dihydropyridine CCBs) are negative inotropes and contraindicated in
HFrEF. Amiodarone is used for rhythm control, not first-line rate control, and
has toxicity concerns.
6 A patient with claudication in both calves has an ankle-brachial index (ABI)
of 0.65 at rest, which drops to 0.40 after exercise. Duplex ultrasound shows a
focal stenosis in the right superficial femoral artery. Initial management
includes:
A) Percutaneous transluminal angioplasty with stent placement
B) Supervised exercise therapy and antiplatelet therapy
C) Bypass grafting with autologous vein
D) Endarterectomy of the common femoral artery
Answer: B
Rationale: For intermittent claudication due to focal disease, initial management
is exercise therapy and antiplatelet therapy (e.g., aspirin). Revascularization (A,
C, D) is reserved for limb-threatening ischemia or failure of conservative
therapy. The moderate reduction in ABI does not require immediate
intervention.
, 7 A patient with metastatic lung cancer presents with dyspnea, muffled heart
sounds, and a fall in systolic blood pressure of 15 mm Hg during inspiration.
Which intervention should be performed first?
A) Administer intravenous normal saline bolus
B) Perform emergency pericardiocentesis
C) Start intravenous inotropic support
D) Obtain urgent transesophageal echocardiogram
Answer: B
Rationale: The findings (Beck's triad: hypotension, muffled heart sounds,
jugular venous distention; plus pulsus paradoxus) suggest cardiac tamponade.
Pericardiocentesis is life-saving and should not be delayed. Fluid bolus (A)
may temporarily help but is not definitive. Inotropes (C) are supportive.
Imaging (D) should not delay drainage if instability is present.
8 A patient with poorly controlled hypertension presents with sudden tearing
chest pain radiating to the back, a blood pressure difference of 25 mm Hg
between arms, and a widened mediastinum on chest X-ray. Which blood
pressure management strategy is indicated while awaiting emergency
surgery?
A) Reduce systolic blood pressure to <120 mm Hg within 20 minutes using
intravenous nitroprusside and a beta-blocker
B) Maintain systolic blood pressure at 140-160 mm Hg to ensure adequate
perfusion to vital organs
C) Administer intravenous hydralazine and labetalol to achieve gradual
reduction over 24 hours
D) Start oral amlodipine and metoprolol for long-term control
Answer: A
Rationale: Acute aortic dissection requires aggressive blood pressure control
(systolic 100-120 mm Hg) to reduce shear stress. Intravenous beta-blockers
(e.g., esmolol) are first-line to decrease heart rate and dP/dt, combined with
vasodilators like nitroprusside. Gradual reduction (C, D) or higher targets (B)
increase risk of dissection propagation.
9 A patient presents with chest pain for 3 hours, ST elevation in leads V1-V4,
and elevated troponin. Time from symptom onset is 3 hours. Which
intervention is most appropriate immediately?
Answers | 2025 Update | 100% Correct. - 217 Questions
This exam assesses advanced understanding of cardiovascular pathophysiology, pharmacotherapy, and clinical
management across a spectrum of acute and chronic cardiac conditions. Emphasis is on evidence-based
decision-making and interpretation of diagnostic data. It contains 217 multiple-choice questions, each with four
distractors and a fully worked rationale that explains why the keyed answer is correct. Content is organized into
10 focused sections: Cardiovascular Disorders, Respiratory Disorders, Fluids and Electrolytes, Acid-Base
Balance, Shock and Sepsis, Perioperative Nursing, Renal and Urinary Disorders, Endocrine Disorders (Diabetes
Mellitus), Pain Management, Inflammation and Infection. Targeted learning outcomes include: Analyze
hemodynamic changes in heart failure and shock states; Differentiate cardiac arrhythmias and select appropriate
interventions; Apply current guidelines for acute coronary syndrome and hypertension management. Every item
has been reviewed for clinical accuracy, current guidelines, and clarity so that students can study with confidence
and self-correct as they work through the bank. Use it as a high-yield review immediately before the exam, or as a
structured practice tool during the unit - the rationales double as concise teaching notes. The recommended
writing time is 3 hours, with a passing score of 80%. Aligned with Accredited by the Commission on Collegiate
Nursing Education (CCNE) and aligned with AACN Essentials. standards and reflects the question style
commonly seen on accredited program examinations. Students consistently achieving above the cut score on this
Section 1: Cardiovascular Disorders (Questions 1-23)
1 A patient with heart failure has an elevated left ventricular end-diastolic
pressure (LVEDP) but a normal left ventricular ejection fraction (LVEF
50%). Which pathophysiologic mechanism primarily explains this finding?
A) Reduced myocardial contractility due to beta-receptor downregulation
B) Impaired left ventricular relaxation and increased stiffness, leading to
diastolic dysfunction
C) Volume overload from renal sodium retention and neurohormonal
activation
D) Ventricular remodeling with eccentric hypertrophy and increased chamber
size
Answer: B
Rationale: In heart failure with preserved ejection fraction (HFpEF), diastolic
dysfunction is the primary mechanism. Impaired relaxation and increased
ventricular stiffness raise filling pressures despite normal systolic function.
Options A, C, and D are more characteristic of heart failure with reduced
ejection fraction (HFrEF).
2 A patient with acute decompensated heart failure presents with severe
dyspnea, pulmonary edema, and a systolic blood pressure of 88 mm Hg.
Which intervention is most appropriate?
,A) Initiate intravenous nitroprusside for afterload reduction
B) Administer intravenous furosemide and titrate dobutamine for inotropic
support
C) Start noninvasive positive pressure ventilation and intravenous metoprolol
D) Give sublingual nitroglycerin and arrange for urgent cardiac
catheterization
Answer: B
Rationale: The patient is in cardiogenic shock with hypotension; inotropes (e.g.,
dobutamine) are indicated to improve cardiac output while diuretics manage
pulmonary congestion. Vasodilators like nitroprusside (A) worsen hypotension.
Beta-blockers (C) are contraindicated acutely. Sublingual nitroglycerin (D) is
not first-line for hypotension.
3 A patient presents with acute chest pain, ST-segment elevation in leads II,
III, and aVF, and onset of symptoms 5 hours ago. The patient has a history of
peptic ulcer disease with a recent upper GI bleed. Which reperfusion strategy
is preferred?
A) Immediate fibrinolytic therapy with alteplase
B) Urgent percutaneous coronary intervention (PCI) with heparin and dual
antiplatelet therapy
C) Conservative management with aspirin and heparin alone
D) Emergent coronary artery bypass grafting (CABG)
Answer: B
Rationale: In STEMI, PCI is preferred over fibrinolysis when timely (<12
hours). Recent GI bleed is a contraindication to fibrinolysis (A). Conservative
management (C) is inadequate. CABG (D) is not the first-line reperfusion for
acute STEMI unless anatomy is unsuitable for PCI.
4 On echocardiography, a patient with syncope has a left ventricular outflow
tract gradient of 40 mm Hg at rest that increases to 90 mm Hg with Valsalva
maneuver. Which finding distinguishes hypertrophic cardiomyopathy
(HCM) from aortic stenosis?
A) Calcified aortic valve leaflets with reduced systolic opening
B) Systolic anterior motion of the mitral valve and asymmetric septal
hypertrophy
C) Left atrial enlargement and pulmonary hypertension
,D) Preserved left ventricular ejection fraction with concentric remodeling
Answer: B
Rationale: Systolic anterior motion (SAM) of the mitral valve and asymmetric
septal hypertrophy are hallmarks of HCM, causing dynamic outflow
obstruction exacerbated by decreased preload (e.g., Valsalva). Aortic stenosis
(A) shows fixed valvular obstruction with calcified leaflets.
5 A patient with atrial fibrillation (AF) and a CHADS-VASc score of 3
requires rate control. The patient has chronic kidney disease stage 4 (eGFR
25 mL/min) and heart failure with reduced ejection fraction (LVEF 35%).
Which agent is most appropriate?
A) Verapamil
B) Amiodarone
C) Diltiazem
D) Metoprolol
Answer: D
Rationale: Beta-blockers (metoprolol) are first-line for rate control in AF with
HFrEF, as they improve outcomes. Verapamil and diltiazem
(non-dihydropyridine CCBs) are negative inotropes and contraindicated in
HFrEF. Amiodarone is used for rhythm control, not first-line rate control, and
has toxicity concerns.
6 A patient with claudication in both calves has an ankle-brachial index (ABI)
of 0.65 at rest, which drops to 0.40 after exercise. Duplex ultrasound shows a
focal stenosis in the right superficial femoral artery. Initial management
includes:
A) Percutaneous transluminal angioplasty with stent placement
B) Supervised exercise therapy and antiplatelet therapy
C) Bypass grafting with autologous vein
D) Endarterectomy of the common femoral artery
Answer: B
Rationale: For intermittent claudication due to focal disease, initial management
is exercise therapy and antiplatelet therapy (e.g., aspirin). Revascularization (A,
C, D) is reserved for limb-threatening ischemia or failure of conservative
therapy. The moderate reduction in ABI does not require immediate
intervention.
, 7 A patient with metastatic lung cancer presents with dyspnea, muffled heart
sounds, and a fall in systolic blood pressure of 15 mm Hg during inspiration.
Which intervention should be performed first?
A) Administer intravenous normal saline bolus
B) Perform emergency pericardiocentesis
C) Start intravenous inotropic support
D) Obtain urgent transesophageal echocardiogram
Answer: B
Rationale: The findings (Beck's triad: hypotension, muffled heart sounds,
jugular venous distention; plus pulsus paradoxus) suggest cardiac tamponade.
Pericardiocentesis is life-saving and should not be delayed. Fluid bolus (A)
may temporarily help but is not definitive. Inotropes (C) are supportive.
Imaging (D) should not delay drainage if instability is present.
8 A patient with poorly controlled hypertension presents with sudden tearing
chest pain radiating to the back, a blood pressure difference of 25 mm Hg
between arms, and a widened mediastinum on chest X-ray. Which blood
pressure management strategy is indicated while awaiting emergency
surgery?
A) Reduce systolic blood pressure to <120 mm Hg within 20 minutes using
intravenous nitroprusside and a beta-blocker
B) Maintain systolic blood pressure at 140-160 mm Hg to ensure adequate
perfusion to vital organs
C) Administer intravenous hydralazine and labetalol to achieve gradual
reduction over 24 hours
D) Start oral amlodipine and metoprolol for long-term control
Answer: A
Rationale: Acute aortic dissection requires aggressive blood pressure control
(systolic 100-120 mm Hg) to reduce shear stress. Intravenous beta-blockers
(e.g., esmolol) are first-line to decrease heart rate and dP/dt, combined with
vasodilators like nitroprusside. Gradual reduction (C, D) or higher targets (B)
increase risk of dissection propagation.
9 A patient presents with chest pain for 3 hours, ST elevation in leads V1-V4,
and elevated troponin. Time from symptom onset is 3 hours. Which
intervention is most appropriate immediately?
