NURS 280 Final Exam: 200 Evidence-
Based Questions with Rationales |
2026/2027 Comprehensive Review
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-35)
Q1. A patient with a history of myocardial infarction and stent
placement presents with palpitations. An ECG reveals atrial flutter.
Which patient is at highest risk for developing this dysrhythmia?
A) A client with hypertension controlled on medication
B) A client who had a myocardial infarction and required stent placement
C) A client with a history of diabetes mellitus
D) A client with hyperlipidemia
Answer: B
Rationale: Atrial flutter is a reentrant tachycardia that commonly occurs in
clients with underlying heart disease, including coronary artery disease and
myocardial infarction. Clients with structural heart disease are at higher risk
for atrial flutter due to scar tissue formation and altered conduction
pathways. While hypertension, diabetes, and hyperlipidemia are risk factors
for CAD, they do not directly create the reentrant circuits characteristic of
atrial flutter .
Q2. A client with heart failure has an ejection fraction of 35%. Which
medication is a first-line therapy for this client?
,A) Digoxin
B) Furosemide
C) Lisinopril (ACE inhibitor)
D) Metoprolol
Answer: C
Rationale: ACE inhibitors are first-line therapy for heart failure with
reduced ejection fraction (HFrEF). They reduce afterload, decrease preload,
and improve survival by blocking the renin-angiotensin-aldosterone
system. Digoxin is used for symptom control but not as first-line.
Furosemide manages fluid overload symptoms. Metoprolol is beneficial but
typically added after ACE inhibitor therapy .
Q3. Which ECG finding is characteristic of acute ST-elevation
myocardial infarction (STEMI)?
A) T-wave inversion
B) ST-segment depression
C) ST-segment elevation in two contiguous leads
D) Pathologic Q waves
Answer: C
Rationale: ST-segment elevation in two or more contiguous leads is the
hallmark of acute STEMI, indicating transmural ischemia. T-wave inversions
may indicate ischemia but are less specific. ST-segment depression
suggests subendocardial ischemia or reciprocal changes. Pathologic Q
waves indicate prior infarction, not acute injury .
Q4. A client with atrial fibrillation is at highest risk for which
complication?
,A) Heart failure
B) Stroke (thromboembolism)
C) Myocardial infarction
D) Cardiogenic shock
Answer: B
Rationale: Atrial fibrillation causes stasis of blood in the left atrium, leading
to thrombus formation and a five-fold increased risk of stroke due to
embolization. Anticoagulation is essential for stroke prevention. While AF
can contribute to heart failure, the most significant and preventable
complication is thromboembolic stroke .
Q5. A patient is prescribed warfarin for atrial fibrillation. Which
laboratory value is used to monitor therapy?
A) INR
B) aPTT
C) PT
D) Platelet count
Answer: A
Rationale: Warfarin is monitored by the International Normalized Ratio
(INR), with a therapeutic range typically 2.0-3.0 for atrial fibrillation. aPTT
monitors heparin therapy. PT is the raw prothrombin time value. Platelet
count monitors for heparin-induced thrombocytopenia (HIT) .
Q6. A patient with heart failure is prescribed digoxin. Which finding
indicates digoxin toxicity?
A) Bradycardia
B) Nausea
, C) Visual disturbances
D) All of the above
Answer: D
Rationale: Digoxin toxicity presents with multiple symptoms including
bradycardia (cardiac effect), nausea and anorexia (GI effects), and visual
disturbances such as yellow-green halos around lights. All are classic signs
of digoxin toxicity that require immediate assessment and serum digoxin
level measurement .
Q7. A client is diagnosed with hypertensive crisis. Which is the priority
intervention?
A) Administer oral antihypertensives
B) Administer IV antihypertensives
C) Restrict sodium intake
D) Encourage deep breathing
Answer: B
Rationale: Hypertensive crisis requires immediate blood pressure reduction
with IV antihypertensives to prevent end-organ damage. Oral agents are
not appropriate for emergent treatment as onset is too slow and dosing
less controllable. Sodium restriction is a chronic management strategy .
Q8. A patient with pericarditis is expected to exhibit which classic sign
on auscultation?
A) Pericardial friction rub
B) S3 gallop
C) Systolic murmur
D) Jugular venous distention
Based Questions with Rationales |
2026/2027 Comprehensive Review
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-35)
Q1. A patient with a history of myocardial infarction and stent
placement presents with palpitations. An ECG reveals atrial flutter.
Which patient is at highest risk for developing this dysrhythmia?
A) A client with hypertension controlled on medication
B) A client who had a myocardial infarction and required stent placement
C) A client with a history of diabetes mellitus
D) A client with hyperlipidemia
Answer: B
Rationale: Atrial flutter is a reentrant tachycardia that commonly occurs in
clients with underlying heart disease, including coronary artery disease and
myocardial infarction. Clients with structural heart disease are at higher risk
for atrial flutter due to scar tissue formation and altered conduction
pathways. While hypertension, diabetes, and hyperlipidemia are risk factors
for CAD, they do not directly create the reentrant circuits characteristic of
atrial flutter .
Q2. A client with heart failure has an ejection fraction of 35%. Which
medication is a first-line therapy for this client?
,A) Digoxin
B) Furosemide
C) Lisinopril (ACE inhibitor)
D) Metoprolol
Answer: C
Rationale: ACE inhibitors are first-line therapy for heart failure with
reduced ejection fraction (HFrEF). They reduce afterload, decrease preload,
and improve survival by blocking the renin-angiotensin-aldosterone
system. Digoxin is used for symptom control but not as first-line.
Furosemide manages fluid overload symptoms. Metoprolol is beneficial but
typically added after ACE inhibitor therapy .
Q3. Which ECG finding is characteristic of acute ST-elevation
myocardial infarction (STEMI)?
A) T-wave inversion
B) ST-segment depression
C) ST-segment elevation in two contiguous leads
D) Pathologic Q waves
Answer: C
Rationale: ST-segment elevation in two or more contiguous leads is the
hallmark of acute STEMI, indicating transmural ischemia. T-wave inversions
may indicate ischemia but are less specific. ST-segment depression
suggests subendocardial ischemia or reciprocal changes. Pathologic Q
waves indicate prior infarction, not acute injury .
Q4. A client with atrial fibrillation is at highest risk for which
complication?
,A) Heart failure
B) Stroke (thromboembolism)
C) Myocardial infarction
D) Cardiogenic shock
Answer: B
Rationale: Atrial fibrillation causes stasis of blood in the left atrium, leading
to thrombus formation and a five-fold increased risk of stroke due to
embolization. Anticoagulation is essential for stroke prevention. While AF
can contribute to heart failure, the most significant and preventable
complication is thromboembolic stroke .
Q5. A patient is prescribed warfarin for atrial fibrillation. Which
laboratory value is used to monitor therapy?
A) INR
B) aPTT
C) PT
D) Platelet count
Answer: A
Rationale: Warfarin is monitored by the International Normalized Ratio
(INR), with a therapeutic range typically 2.0-3.0 for atrial fibrillation. aPTT
monitors heparin therapy. PT is the raw prothrombin time value. Platelet
count monitors for heparin-induced thrombocytopenia (HIT) .
Q6. A patient with heart failure is prescribed digoxin. Which finding
indicates digoxin toxicity?
A) Bradycardia
B) Nausea
, C) Visual disturbances
D) All of the above
Answer: D
Rationale: Digoxin toxicity presents with multiple symptoms including
bradycardia (cardiac effect), nausea and anorexia (GI effects), and visual
disturbances such as yellow-green halos around lights. All are classic signs
of digoxin toxicity that require immediate assessment and serum digoxin
level measurement .
Q7. A client is diagnosed with hypertensive crisis. Which is the priority
intervention?
A) Administer oral antihypertensives
B) Administer IV antihypertensives
C) Restrict sodium intake
D) Encourage deep breathing
Answer: B
Rationale: Hypertensive crisis requires immediate blood pressure reduction
with IV antihypertensives to prevent end-organ damage. Oral agents are
not appropriate for emergent treatment as onset is too slow and dosing
less controllable. Sodium restriction is a chronic management strategy .
Q8. A patient with pericarditis is expected to exhibit which classic sign
on auscultation?
A) Pericardial friction rub
B) S3 gallop
C) Systolic murmur
D) Jugular venous distention
