NUR 242 Medical-Surgical Nursing Exam 4 |
Questions And Answers With Explained Rationale
| 2026/2027 Update
Question 1.
A patient with dilated cardiomyopathy presents with severe dyspnea, orthopnea, and
an S3 gallop. An echocardiogram shows an ejection fraction of 25%. The nurse knows
that the primary problem in dilated cardiomyopathy is:
A. Hypertrophy of the left ventricular wall causing outflow obstruction.
B. Ventricular dilation and impaired systolic contractility leading to heart failure.
C. Restricted ventricular filling due to rigid myocardium.
D. Pericardial thickening preventing diastolic filling.
Correct Answer: B
Rationale: Dilated cardiomyopathy (DCM) is characterized by ventricular chamber
enlargement and impaired systolic function (reduced ejection fraction), leading to
progressive heart failure. It is the most common type of cardiomyopathy. Causes include:
genetic mutations, viral myocarditis, alcohol abuse, chemotherapy (doxorubicin), and
peripartum cardiomyopathy. Treatment includes: ACE inhibitors/ARBs/ARNIs, beta-
blockers, aldosterone antagonists, SGLT2 inhibitors, diuretics, ICD for primary prevention if
EF ≤35%, and cardiac resynchronization therapy (CRT) if QRS >150 ms. In contrast,
hypertrophic cardiomyopathy involves wall thickening and outflow obstruction; restrictive
cardiomyopathy involves rigid ventricles with impaired filling.
Question 2.
A patient with acute pericarditis presents with sharp, pleuritic chest pain that
worsens with inspiration and lying supine, and improves when sitting upright and
leaning forward. The nurse knows that the classic ECG finding in acute pericarditis is:
A. ST elevation in a single coronary territory with reciprocal ST depression.
B. Diffuse ST-segment elevation and PR-segment depression across most leads.
C. Peaked T waves and a widened QRS complex.
,D. Sinus bradycardia with first-degree AV block.
Correct Answer: B
Rationale: Acute pericarditis classically presents with diffuse, concave ST-segment
elevation in most leads (I, II, III, aVL, aVF, V2–V6) with PR-segment depression. Unlike
STEMI, there is NO reciprocal ST depression (except possibly in aVR and V1, which may
show PR elevation and ST depression). Other features include: pericardial friction rub,
tachycardia, and fever. Treatment includes: NSAIDs (high-dose ibuprofen or aspirin),
colchicine, and rest. Corticosteroids are reserved for refractory cases. Cardiac tamponade
(Beck's triad) is a complication.
Question 3.
A patient is 4 hours post-cardiac catheterization via the right femoral artery. The
nurse notes that the puncture site is expanding, and the patient complains of
increasing groin pain. The nurse suspects a pseudoaneurysm. The nurse's priority
action is to:
A. Apply firm manual pressure proximal to the puncture site and notify the provider
immediately.
B. Remove the pressure dressing to assess the wound more thoroughly.
C. Have the patient ambulate to the bathroom to promote circulation.
D. Administer aspirin and apply a warm compress.
Correct Answer: A
Rationale: A pseudoaneurysm (false aneurysm) is a collection of blood that forms between
the arterial wall and surrounding tissue due to inadequate sealing of the arterial puncture
after catheterization. It presents as a pulsatile, expanding mass at the puncture site with a
bruit. The priority is to apply firm manual pressure proximal to the site to control bleeding,
maintain bed rest with the leg straight, and notify the provider immediately. Diagnosis is
confirmed by ultrasound. Treatment includes: prolonged manual compression, ultrasound-
guided thrombin injection, or surgical repair. Removing the dressing, ambulating, or
applying heat worsens the situation.
Question 4.
A patient with a spontaneous pneumothorax develops sudden severe dyspnea,
hypotension, tachycardia, and tracheal deviation to the left. The nurse suspects a
tension pneumothorax. The nurse's priority action is to:
, A. Prepare the patient for immediate chest tube insertion in the second intercostal space,
midclavicular line, on the affected side.
B. Wait for a chest X-ray to confirm the diagnosis before intervening.
C. Administer high-flow oxygen and observe for 30 minutes.
D. Perform a needle thoracostomy in the fourth intercostal space, midaxillary line.
Correct Answer: A
Rationale: Tension pneumothorax is a life-threatening emergency in which air enters the
pleural space but cannot escape, causing increasing intrapleural pressure that collapses the
lung, shifts the mediastinum, and compresses the contralateral lung and great vessels.
Clinical signs include: severe dyspnea, hypotension, tachycardia, tracheal deviation away
from the affected side, absent breath sounds, and distended neck veins. It is a clinical
diagnosis—do NOT wait for imaging. The immediate treatment is needle decompression
(14-gauge needle, 5 cm long) in the second intercostal space at the midclavicular line on the
affected side, followed by chest tube insertion. The fourth intercostal space midaxillary line
is used for standard chest tubes, not emergency needle decompression.
Question 5.
A patient with lung cancer is found to have syndrome of inappropriate antidiuretic
hormone (SIADH) as a paraneoplastic syndrome. The nurse expects to find:
A. Hypernatremia, hyperosmolar serum, and dilute urine.
B. Hyponatremia, hypo-osmolar serum, and concentrated urine with high sodium.
C. Hyperkalemia and metabolic acidosis.
D. Hypercalcemia and polyuria.
Correct Answer: B
Rationale: SIADH is commonly associated with small cell lung cancer (SCLC) as a
paraneoplastic syndrome. It causes water retention and dilutional hyponatremia.
Laboratory findings include: serum sodium <135 mEq/L, serum osmolality <275 mOsm/kg,
urine osmolality >100 mOsm/kg (inappropriately concentrated), and urine sodium >20
mEq/L (indicating sodium excretion despite hyponatremia). Treatment includes: fluid
restriction (800–1,200 mL/day), slow sodium correction, demeclocycline, and vasopressin
receptor antagonists (tolvaptan, conivaptan) for severe cases. Hypernatremia and
hypercalcemia are not features of SIADH.
Questions And Answers With Explained Rationale
| 2026/2027 Update
Question 1.
A patient with dilated cardiomyopathy presents with severe dyspnea, orthopnea, and
an S3 gallop. An echocardiogram shows an ejection fraction of 25%. The nurse knows
that the primary problem in dilated cardiomyopathy is:
A. Hypertrophy of the left ventricular wall causing outflow obstruction.
B. Ventricular dilation and impaired systolic contractility leading to heart failure.
C. Restricted ventricular filling due to rigid myocardium.
D. Pericardial thickening preventing diastolic filling.
Correct Answer: B
Rationale: Dilated cardiomyopathy (DCM) is characterized by ventricular chamber
enlargement and impaired systolic function (reduced ejection fraction), leading to
progressive heart failure. It is the most common type of cardiomyopathy. Causes include:
genetic mutations, viral myocarditis, alcohol abuse, chemotherapy (doxorubicin), and
peripartum cardiomyopathy. Treatment includes: ACE inhibitors/ARBs/ARNIs, beta-
blockers, aldosterone antagonists, SGLT2 inhibitors, diuretics, ICD for primary prevention if
EF ≤35%, and cardiac resynchronization therapy (CRT) if QRS >150 ms. In contrast,
hypertrophic cardiomyopathy involves wall thickening and outflow obstruction; restrictive
cardiomyopathy involves rigid ventricles with impaired filling.
Question 2.
A patient with acute pericarditis presents with sharp, pleuritic chest pain that
worsens with inspiration and lying supine, and improves when sitting upright and
leaning forward. The nurse knows that the classic ECG finding in acute pericarditis is:
A. ST elevation in a single coronary territory with reciprocal ST depression.
B. Diffuse ST-segment elevation and PR-segment depression across most leads.
C. Peaked T waves and a widened QRS complex.
,D. Sinus bradycardia with first-degree AV block.
Correct Answer: B
Rationale: Acute pericarditis classically presents with diffuse, concave ST-segment
elevation in most leads (I, II, III, aVL, aVF, V2–V6) with PR-segment depression. Unlike
STEMI, there is NO reciprocal ST depression (except possibly in aVR and V1, which may
show PR elevation and ST depression). Other features include: pericardial friction rub,
tachycardia, and fever. Treatment includes: NSAIDs (high-dose ibuprofen or aspirin),
colchicine, and rest. Corticosteroids are reserved for refractory cases. Cardiac tamponade
(Beck's triad) is a complication.
Question 3.
A patient is 4 hours post-cardiac catheterization via the right femoral artery. The
nurse notes that the puncture site is expanding, and the patient complains of
increasing groin pain. The nurse suspects a pseudoaneurysm. The nurse's priority
action is to:
A. Apply firm manual pressure proximal to the puncture site and notify the provider
immediately.
B. Remove the pressure dressing to assess the wound more thoroughly.
C. Have the patient ambulate to the bathroom to promote circulation.
D. Administer aspirin and apply a warm compress.
Correct Answer: A
Rationale: A pseudoaneurysm (false aneurysm) is a collection of blood that forms between
the arterial wall and surrounding tissue due to inadequate sealing of the arterial puncture
after catheterization. It presents as a pulsatile, expanding mass at the puncture site with a
bruit. The priority is to apply firm manual pressure proximal to the site to control bleeding,
maintain bed rest with the leg straight, and notify the provider immediately. Diagnosis is
confirmed by ultrasound. Treatment includes: prolonged manual compression, ultrasound-
guided thrombin injection, or surgical repair. Removing the dressing, ambulating, or
applying heat worsens the situation.
Question 4.
A patient with a spontaneous pneumothorax develops sudden severe dyspnea,
hypotension, tachycardia, and tracheal deviation to the left. The nurse suspects a
tension pneumothorax. The nurse's priority action is to:
, A. Prepare the patient for immediate chest tube insertion in the second intercostal space,
midclavicular line, on the affected side.
B. Wait for a chest X-ray to confirm the diagnosis before intervening.
C. Administer high-flow oxygen and observe for 30 minutes.
D. Perform a needle thoracostomy in the fourth intercostal space, midaxillary line.
Correct Answer: A
Rationale: Tension pneumothorax is a life-threatening emergency in which air enters the
pleural space but cannot escape, causing increasing intrapleural pressure that collapses the
lung, shifts the mediastinum, and compresses the contralateral lung and great vessels.
Clinical signs include: severe dyspnea, hypotension, tachycardia, tracheal deviation away
from the affected side, absent breath sounds, and distended neck veins. It is a clinical
diagnosis—do NOT wait for imaging. The immediate treatment is needle decompression
(14-gauge needle, 5 cm long) in the second intercostal space at the midclavicular line on the
affected side, followed by chest tube insertion. The fourth intercostal space midaxillary line
is used for standard chest tubes, not emergency needle decompression.
Question 5.
A patient with lung cancer is found to have syndrome of inappropriate antidiuretic
hormone (SIADH) as a paraneoplastic syndrome. The nurse expects to find:
A. Hypernatremia, hyperosmolar serum, and dilute urine.
B. Hyponatremia, hypo-osmolar serum, and concentrated urine with high sodium.
C. Hyperkalemia and metabolic acidosis.
D. Hypercalcemia and polyuria.
Correct Answer: B
Rationale: SIADH is commonly associated with small cell lung cancer (SCLC) as a
paraneoplastic syndrome. It causes water retention and dilutional hyponatremia.
Laboratory findings include: serum sodium <135 mEq/L, serum osmolality <275 mOsm/kg,
urine osmolality >100 mOsm/kg (inappropriately concentrated), and urine sodium >20
mEq/L (indicating sodium excretion despite hyponatremia). Treatment includes: fluid
restriction (800–1,200 mL/day), slow sodium correction, demeclocycline, and vasopressin
receptor antagonists (tolvaptan, conivaptan) for severe cases. Hypernatremia and
hypercalcemia are not features of SIADH.
