GALEN COLLEGE OF NURSING
NU 155: Medical-Surgical Nursing I — Exam 3
Student Name: Date: ________________________
________________________________
Student ID: __________________________________ Score: ________ /____ Points
EXAMINATION INSTRUCTIONS:
Question 1. A nurse is assessing a client presenting with chest pain. The client reports that the pain occurred
while walking upstairs, lasted 10 minutes, and subsided after sitting down and resting. How should the nurse
document this condition?
A. Unstable angina
B. Stable angina
C. Acute myocardial infarction
D. Prinzmetal's variant angina
✔ Correct Answer: Option B
Rationale: Stable angina occurs with physical activity or exercise, lasts less than 15 minutes, and usually subsides with
rest. Unstable angina occurs at rest or with minimal exertion, is unpredictable, lasts longer (>15-30 min), and is not
relieved by rest or nitroglycerin.
Question 2. A nurse is administering the first dose of sublingual nitroglycerin to a client experiencing acute
angina pectoris. Which priority nursing intervention must the nurse perform immediately following
administration?
A. Auscultate lung sounds for pulmonary edema
B. Obtain a 12-lead electrocardiogram
C. Assess peripheral pulses in lower extremities
D. Check the client's blood pressure
✔ Correct Answer: Option D
Rationale: The nurse must check the client's blood pressure immediately after administering nitroglycerin, especially
during the first dose, because nitroglycerin is a potent vasodilator that can cause severe hypotension.
Question 3. A client with coronary artery disease (CAD) is being discharged on a low-cholesterol diet. Which
dietary choice selected by the client indicates an understanding of the nurse's dietary teaching?
A. Preparing scrambled eggs daily using whole eggs and lard
B. Consuming salmon cooked with olive oil twice a week and drinking nonfat milk
C. Cooking vegetables using palm oil or hydrogenated shortening
D. Eating whole milk products and commercial bakery croissants for breakfast
✔ Correct Answer: Option B
Rationale: Teaching for a low-cholesterol diet includes consuming fish rich in omega-3 fatty acids (salmon, mackerel,
tuna) at least twice a week, using unsaturated fats like olive oil, and drinking nonfat milk. High-fat commercial baked
goods, lard, palm oil, and whole eggs must be limited or avoided.
, Question 4. A client arrives at the emergency department with severe, crushing substernal chest pain radiating
to the jaw and left arm, unrelieved by nitroglycerin. The physician initiates MONA protocol. Which nursing action
is essential during acute MI management?
A. Establish large-bore IV access and administer weight-based continuous Heparin drip as ordered
B. Administer oral antiplatelets only after cardiac catheterization is completed
C. Encourage immediate bed exercises to increase coronary collateral circulation
D. Place the client in a completely flat supine position
✔ Correct Answer: Option A
Rationale: Emergency medical management for an acute MI (MONA protocol) includes establishing large-bore IV
access and administering Heparin as a continuous weight-based drip (monitored via PTT). Antiplatelet therapy and low-
sodium/low-cholesterol restrictions are also maintained.
Question 5. A nurse is evaluating a client admitted with heart failure. Which group of clinical manifestations
indicates to the nurse that the client is experiencing left-sided heart failure?
A. Jugular vein distention (JVD), dependent ankle edema, and ascites
B. Hepatomegaly, splenomegaly, and abdominal engorgement
C. Dyspnea, orthopnea, crackles on lung auscultation, and cough with blood-tinged sputum
D. Weight gain, anorexia, and right upper quadrant abdominal tenderness
✔ Correct Answer: Option C
Rationale: Left-sided heart failure causes pulmonary congestion due to fluid backing up into the lungs, leading to
dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles, wheezes, cough with blood-tinged sputum, and elevated
pulmonary capillary wedge pressure. Right-sided HF causes systemic venous congestion (JVD, edema, ascites).
Question 6. A nurse assesses a client with chronic cor pulmonale. Which assessment finding specifically
reflects right-sided heart failure?
A. Paroxysmal nocturnal dyspnea and orthopnea
B. Distended jugular veins at a 45-degree angle, dependent edema, and weight gain
C. Bilateral crackles and wheezing in lower lung fields
D. Elevated pulmonary capillary wedge pressure
✔ Correct Answer: Option B
Rationale: Right-sided heart failure (cor pulmonale) leads to systemic venous congestion, resulting in jugular vein
distention (JVD) visible at 45 degrees, dependent edema in legs and ankles, ascites, hepatomegaly, splenomegaly, and
weight gain.
Question 7. A nurse is providing discharge instructions to a client prescribed Digoxin and Furosemide (Lasix)
for heart failure management. Which instruction is critical for the nurse to emphasize?
A. Contact the provider immediately if experiencing vision changes such as yellow-green halos
B. Take over-the-counter NSAIDs daily for mild joint pain management
C. Double the dose of Furosemide if lower extremity edema increases slightly
D. Restrict physical activity completely to strict prolonged bed rest
✔ Correct Answer: Option A
Rationale: Digoxin increases myocardial pumping strength. The client must report signs of digoxin toxicity immediately,
such as yellow-green halos around lights, visual disturbances, or bradycardia. Additionally, NSAIDs have dangerous
drug-drug interactions with heart failure medications and must be avoided.
NU 155: Medical-Surgical Nursing I — Exam 3
Student Name: Date: ________________________
________________________________
Student ID: __________________________________ Score: ________ /____ Points
EXAMINATION INSTRUCTIONS:
Question 1. A nurse is assessing a client presenting with chest pain. The client reports that the pain occurred
while walking upstairs, lasted 10 minutes, and subsided after sitting down and resting. How should the nurse
document this condition?
A. Unstable angina
B. Stable angina
C. Acute myocardial infarction
D. Prinzmetal's variant angina
✔ Correct Answer: Option B
Rationale: Stable angina occurs with physical activity or exercise, lasts less than 15 minutes, and usually subsides with
rest. Unstable angina occurs at rest or with minimal exertion, is unpredictable, lasts longer (>15-30 min), and is not
relieved by rest or nitroglycerin.
Question 2. A nurse is administering the first dose of sublingual nitroglycerin to a client experiencing acute
angina pectoris. Which priority nursing intervention must the nurse perform immediately following
administration?
A. Auscultate lung sounds for pulmonary edema
B. Obtain a 12-lead electrocardiogram
C. Assess peripheral pulses in lower extremities
D. Check the client's blood pressure
✔ Correct Answer: Option D
Rationale: The nurse must check the client's blood pressure immediately after administering nitroglycerin, especially
during the first dose, because nitroglycerin is a potent vasodilator that can cause severe hypotension.
Question 3. A client with coronary artery disease (CAD) is being discharged on a low-cholesterol diet. Which
dietary choice selected by the client indicates an understanding of the nurse's dietary teaching?
A. Preparing scrambled eggs daily using whole eggs and lard
B. Consuming salmon cooked with olive oil twice a week and drinking nonfat milk
C. Cooking vegetables using palm oil or hydrogenated shortening
D. Eating whole milk products and commercial bakery croissants for breakfast
✔ Correct Answer: Option B
Rationale: Teaching for a low-cholesterol diet includes consuming fish rich in omega-3 fatty acids (salmon, mackerel,
tuna) at least twice a week, using unsaturated fats like olive oil, and drinking nonfat milk. High-fat commercial baked
goods, lard, palm oil, and whole eggs must be limited or avoided.
, Question 4. A client arrives at the emergency department with severe, crushing substernal chest pain radiating
to the jaw and left arm, unrelieved by nitroglycerin. The physician initiates MONA protocol. Which nursing action
is essential during acute MI management?
A. Establish large-bore IV access and administer weight-based continuous Heparin drip as ordered
B. Administer oral antiplatelets only after cardiac catheterization is completed
C. Encourage immediate bed exercises to increase coronary collateral circulation
D. Place the client in a completely flat supine position
✔ Correct Answer: Option A
Rationale: Emergency medical management for an acute MI (MONA protocol) includes establishing large-bore IV
access and administering Heparin as a continuous weight-based drip (monitored via PTT). Antiplatelet therapy and low-
sodium/low-cholesterol restrictions are also maintained.
Question 5. A nurse is evaluating a client admitted with heart failure. Which group of clinical manifestations
indicates to the nurse that the client is experiencing left-sided heart failure?
A. Jugular vein distention (JVD), dependent ankle edema, and ascites
B. Hepatomegaly, splenomegaly, and abdominal engorgement
C. Dyspnea, orthopnea, crackles on lung auscultation, and cough with blood-tinged sputum
D. Weight gain, anorexia, and right upper quadrant abdominal tenderness
✔ Correct Answer: Option C
Rationale: Left-sided heart failure causes pulmonary congestion due to fluid backing up into the lungs, leading to
dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles, wheezes, cough with blood-tinged sputum, and elevated
pulmonary capillary wedge pressure. Right-sided HF causes systemic venous congestion (JVD, edema, ascites).
Question 6. A nurse assesses a client with chronic cor pulmonale. Which assessment finding specifically
reflects right-sided heart failure?
A. Paroxysmal nocturnal dyspnea and orthopnea
B. Distended jugular veins at a 45-degree angle, dependent edema, and weight gain
C. Bilateral crackles and wheezing in lower lung fields
D. Elevated pulmonary capillary wedge pressure
✔ Correct Answer: Option B
Rationale: Right-sided heart failure (cor pulmonale) leads to systemic venous congestion, resulting in jugular vein
distention (JVD) visible at 45 degrees, dependent edema in legs and ankles, ascites, hepatomegaly, splenomegaly, and
weight gain.
Question 7. A nurse is providing discharge instructions to a client prescribed Digoxin and Furosemide (Lasix)
for heart failure management. Which instruction is critical for the nurse to emphasize?
A. Contact the provider immediately if experiencing vision changes such as yellow-green halos
B. Take over-the-counter NSAIDs daily for mild joint pain management
C. Double the dose of Furosemide if lower extremity edema increases slightly
D. Restrict physical activity completely to strict prolonged bed rest
✔ Correct Answer: Option A
Rationale: Digoxin increases myocardial pumping strength. The client must report signs of digoxin toxicity immediately,
such as yellow-green halos around lights, visual disturbances, or bradycardia. Additionally, NSAIDs have dangerous
drug-drug interactions with heart failure medications and must be avoided.
