NUR 242 Medical-Surgical Nursing Exam 3 | Questions
With 100% Correct Answers And Detailed Rationale |
2026/2027 Updates
Question 1.
A patient with acute decompensated heart failure has a BNP level of 1,850 pg/mL.
The nurse knows that B-type natriuretic peptide (BNP) is elevated in heart failure
because:
A. The liver releases BNP in response to decreased albumin.
B. The cardiac ventricles release BNP in response to increased wall stretch and volume
overload.
C. The kidneys release BNP when perfusion decreases.
D. The adrenal glands release BNP as a compensatory mechanism for hypotension.
Correct Answer: B
Rationale: B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are
released primarily from the cardiac ventricles in response to increased myocardial wall
stretch from volume expansion and pressure overload. Elevated levels support the
diagnosis of heart failure and correlate with severity. BNP <100 pg/mL makes heart failure
unlikely; >400 pg/mL strongly suggests heart failure. BNP is also used to differentiate
cardiac from pulmonary causes of dyspnea. Treatment for acute decompensated HF
includes: diuretics, nitrates, inotropes (dobutamine, milrinone) if needed, and vasodilators.
Question 2.
A patient with cardiogenic shock after a massive myocardial infarction is being
prepared for intra-aortic balloon pump (IABP) insertion. The nurse knows that the
primary mechanism by which IABP improves coronary perfusion is:
A. It increases afterload during systole, strengthening cardiac contractions.
B. It inflates during diastole, increasing coronary artery perfusion, and deflates during
systole, decreasing afterload.
C. It continuously pumps blood throughout the cardiac cycle, replacing ventricular function.
D. It delivers thrombolytics directly to the coronary arteries.
Correct Answer: B
,Rationale: The intra-aortic balloon pump (IABP) is a mechanical circulatory support
device. The balloon inflates during diastole (after aortic valve closure), augmenting diastolic
pressure and improving coronary artery perfusion. It deflates just before systole, reducing
afterload (resistance against which the left ventricle must pump), thereby decreasing
myocardial oxygen demand. It is used for: cardiogenic shock, refractory angina, mechanical
complications of MI (papillary muscle rupture, VSD), and as a bridge to revascularization or
advanced therapies. Complications include: limb ischemia, balloon rupture,
thrombocytopenia, and infection.
Question 3.
A patient with a history of atrial fibrillation is started on amiodarone. The nurse
knows that amiodarone has a unique side effect profile. Which adverse effect
requires the most long-term monitoring?
A. Reversible skin rash.
B. Pulmonary fibrosis, thyroid dysfunction, and hepatotoxicity.
C. Mild gastrointestinal upset.
D. Transient hair loss.
Correct Answer: B
Rationale: Amiodarone is a class III antiarrhythmic with a complex side effect profile due to
its iodine content and lipophilic nature. Serious long-term adverse effects include:
pulmonary toxicity (pneumonitis, fibrosis—occurs in 1–17%), thyroid dysfunction (both
hyper- and hypothyroidism due to high iodine load), hepatotoxicity, corneal microdeposits,
peripheral neuropathy, and photosensitivity. Baseline and periodic monitoring includes:
pulmonary function tests, chest X-ray, thyroid function tests (TSH, free T4), liver function
tests, and slit-lamp eye examination. Despite these risks, it remains highly effective for
ventricular and atrial arrhythmias.
Question 4.
A patient recovering from cardiac surgery develops hypotension, muffled heart
sounds, and jugular venous distension. The nurse suspects cardiac tamponade. The
nurse knows that this triad is known as:
A. Cushing's triad.
B. Beck's triad.
, C. Charcot's triad.
D. Virchow's triad.
Correct Answer: B
Rationale: Beck's triad consists of: (1) hypotension (from decreased cardiac output), (2)
muffled or distant heart sounds (from fluid around the heart), and (3) jugular venous
distension (from impaired venous return). It is the classic presentation of cardiac
tamponade, a life-threatening condition caused by fluid accumulation in the pericardial sac
compressing the heart. Additional findings include: pulsus paradoxus (exaggerated drop in
systolic BP during inspiration), tachycardia, and dyspnea. Emergency treatment is
pericardiocentesis (needle aspiration) or surgical pericardial window. Cushing's triad is
increased ICP (hypertension, bradycardia, irregular respirations). Charcot's triad is
cholangitis (fever, jaundice, RUQ pain). Virchow's triad describes thrombosis risk factors.
Question 5.
A patient with a spontaneous pneumothorax has a chest tube inserted. The nurse
notes intermittent bubbling in the water seal chamber. The nurse knows that this
indicates:
A. An air leak from the lung that is being evacuated.
B. A disconnected tube requiring immediate reconnection.
C. That the suction is set too low.
D. A clot in the chest tube requiring irrigation.
Correct Answer: A
Rationale: Intermittent bubbling in the water seal chamber (not the suction control
chamber) is normal and indicates that air is being evacuated from the pleural space as the
lung re-expands. Bubbling typically occurs with inspiration or coughing. Continuous
bubbling suggests a persistent air leak. Tidaling (gentle rise and fall of fluid with
respiration) is also normal and indicates the system is patent. The nurse should document
the amount and character of drainage, ensure the system remains below chest level, check
for kinks, and monitor for signs of re-expansion.
Question 6.
A patient with flail chest after a motor vehicle accident has paradoxical movement of
a segment of the chest wall. The nurse knows that the priority intervention is to:
With 100% Correct Answers And Detailed Rationale |
2026/2027 Updates
Question 1.
A patient with acute decompensated heart failure has a BNP level of 1,850 pg/mL.
The nurse knows that B-type natriuretic peptide (BNP) is elevated in heart failure
because:
A. The liver releases BNP in response to decreased albumin.
B. The cardiac ventricles release BNP in response to increased wall stretch and volume
overload.
C. The kidneys release BNP when perfusion decreases.
D. The adrenal glands release BNP as a compensatory mechanism for hypotension.
Correct Answer: B
Rationale: B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are
released primarily from the cardiac ventricles in response to increased myocardial wall
stretch from volume expansion and pressure overload. Elevated levels support the
diagnosis of heart failure and correlate with severity. BNP <100 pg/mL makes heart failure
unlikely; >400 pg/mL strongly suggests heart failure. BNP is also used to differentiate
cardiac from pulmonary causes of dyspnea. Treatment for acute decompensated HF
includes: diuretics, nitrates, inotropes (dobutamine, milrinone) if needed, and vasodilators.
Question 2.
A patient with cardiogenic shock after a massive myocardial infarction is being
prepared for intra-aortic balloon pump (IABP) insertion. The nurse knows that the
primary mechanism by which IABP improves coronary perfusion is:
A. It increases afterload during systole, strengthening cardiac contractions.
B. It inflates during diastole, increasing coronary artery perfusion, and deflates during
systole, decreasing afterload.
C. It continuously pumps blood throughout the cardiac cycle, replacing ventricular function.
D. It delivers thrombolytics directly to the coronary arteries.
Correct Answer: B
,Rationale: The intra-aortic balloon pump (IABP) is a mechanical circulatory support
device. The balloon inflates during diastole (after aortic valve closure), augmenting diastolic
pressure and improving coronary artery perfusion. It deflates just before systole, reducing
afterload (resistance against which the left ventricle must pump), thereby decreasing
myocardial oxygen demand. It is used for: cardiogenic shock, refractory angina, mechanical
complications of MI (papillary muscle rupture, VSD), and as a bridge to revascularization or
advanced therapies. Complications include: limb ischemia, balloon rupture,
thrombocytopenia, and infection.
Question 3.
A patient with a history of atrial fibrillation is started on amiodarone. The nurse
knows that amiodarone has a unique side effect profile. Which adverse effect
requires the most long-term monitoring?
A. Reversible skin rash.
B. Pulmonary fibrosis, thyroid dysfunction, and hepatotoxicity.
C. Mild gastrointestinal upset.
D. Transient hair loss.
Correct Answer: B
Rationale: Amiodarone is a class III antiarrhythmic with a complex side effect profile due to
its iodine content and lipophilic nature. Serious long-term adverse effects include:
pulmonary toxicity (pneumonitis, fibrosis—occurs in 1–17%), thyroid dysfunction (both
hyper- and hypothyroidism due to high iodine load), hepatotoxicity, corneal microdeposits,
peripheral neuropathy, and photosensitivity. Baseline and periodic monitoring includes:
pulmonary function tests, chest X-ray, thyroid function tests (TSH, free T4), liver function
tests, and slit-lamp eye examination. Despite these risks, it remains highly effective for
ventricular and atrial arrhythmias.
Question 4.
A patient recovering from cardiac surgery develops hypotension, muffled heart
sounds, and jugular venous distension. The nurse suspects cardiac tamponade. The
nurse knows that this triad is known as:
A. Cushing's triad.
B. Beck's triad.
, C. Charcot's triad.
D. Virchow's triad.
Correct Answer: B
Rationale: Beck's triad consists of: (1) hypotension (from decreased cardiac output), (2)
muffled or distant heart sounds (from fluid around the heart), and (3) jugular venous
distension (from impaired venous return). It is the classic presentation of cardiac
tamponade, a life-threatening condition caused by fluid accumulation in the pericardial sac
compressing the heart. Additional findings include: pulsus paradoxus (exaggerated drop in
systolic BP during inspiration), tachycardia, and dyspnea. Emergency treatment is
pericardiocentesis (needle aspiration) or surgical pericardial window. Cushing's triad is
increased ICP (hypertension, bradycardia, irregular respirations). Charcot's triad is
cholangitis (fever, jaundice, RUQ pain). Virchow's triad describes thrombosis risk factors.
Question 5.
A patient with a spontaneous pneumothorax has a chest tube inserted. The nurse
notes intermittent bubbling in the water seal chamber. The nurse knows that this
indicates:
A. An air leak from the lung that is being evacuated.
B. A disconnected tube requiring immediate reconnection.
C. That the suction is set too low.
D. A clot in the chest tube requiring irrigation.
Correct Answer: A
Rationale: Intermittent bubbling in the water seal chamber (not the suction control
chamber) is normal and indicates that air is being evacuated from the pleural space as the
lung re-expands. Bubbling typically occurs with inspiration or coughing. Continuous
bubbling suggests a persistent air leak. Tidaling (gentle rise and fall of fluid with
respiration) is also normal and indicates the system is patent. The nurse should document
the amount and character of drainage, ensure the system remains below chest level, check
for kinks, and monitor for signs of re-expansion.
Question 6.
A patient with flail chest after a motor vehicle accident has paradoxical movement of
a segment of the chest wall. The nurse knows that the priority intervention is to:
