Galen NUR 265 Medical-Surgical Nursing (TESTED
QUESTIONS, CLINICALLY RELEVANT
SCENARIOS & APPLICATION-LEVEL ITEMS)
Exam 1
1. A patient receiving high-dose loop diuretics develops frequent premature ventricular contractions. Which laboratory
value should the nurse review first?
A. Serum bilirubin.
B. Serum potassium.
C. Serum amylase.
D. Serum phosphate only.
Correct Answer: B. Serum potassium.
Rationale: Loop diuretics can cause potassium and magnesium losses, both of which increase ventricular ectopy risk. Potassium is an
immediate priority to evaluate, with magnesium also commonly assessed.
2. A stable adult has a regular narrow-complex tachycardia at 188/min. Vagal maneuvers do not terminate the rhythm.
Which intervention is expected next?
A. Give atropine and prepare for transcutaneous pacing.
B. Deliver an unsynchronized defibrillation shock.
C. Administer oral warfarin and discharge the patient.
D. Administer adenosine by rapid IV push followed immediately by a saline flush.
Correct Answer: D. Administer adenosine by rapid IV push followed immediately by a saline flush.
Rationale: For stable regular narrow-complex SVT that persists after vagal maneuvers, rapid IV adenosine is a standard next intervention.
Unstable patients require synchronized cardioversion.
3. A patient in cardiogenic shock has a cardiac output of 2.6 L/min, pulmonary artery occlusion pressure of 24 mm Hg,
and cool clammy skin. Which interpretation is most accurate?
A. Systemic vascular tone is absent while cardiac function is normal.
B. The findings indicate uncomplicated distributive shock with low preload.
C. The patient is primarily volume depleted and needs unrestricted rapid fluid loading.
D. Left ventricular pump failure is causing elevated filling pressure and reduced forward flow.
Correct Answer: D. Left ventricular pump failure is causing elevated filling pressure and reduced forward flow.
Rationale: Cardiogenic shock typically produces low cardiac output with elevated left-sided filling pressures due to pump failure. Fluid
should be individualized because indiscriminate loading can worsen pulmonary edema.
, 4. Which assessment pattern is most characteristic of severe symptomatic aortic stenosis?
A. Bounding pulses with a continuous machinery murmur.
B. Exertional syncope, angina, dyspnea, and a systolic murmur radiating to the carotids.
C. Sudden unilateral absent breath sounds with tracheal deviation.
D. Pleuritic chest pain relieved by leaning forward with diffuse ST elevation.
Correct Answer: B. Exertional syncope, angina, dyspnea, and a systolic murmur radiating to the carotids.
Rationale: Severe aortic stenosis causes fixed left ventricular outflow obstruction. The classic symptom triad is exertional angina, syncope,
and dyspnea, often with a harsh systolic murmur radiating to the neck.
5. A patient with persistent atrial fibrillation asks why an anticoagulant is prescribed even though the heart rate is
controlled. Which response is best?
A. "Rate control does not remove the risk of atrial thrombus formation and embolic stroke."
B. "The medication permanently converts atrial fibrillation to sinus rhythm."
C. "Anticoagulants are used mainly to slow the ventricular rate."
D. "Stroke risk is eliminated once palpitations stop."
Correct Answer: A. "Rate control does not remove the risk of atrial thrombus formation and embolic stroke."
Rationale: Atrial fibrillation can produce blood stasis in the atria, especially the left atrial appendage, allowing thrombus formation. Stroke
prevention is considered separately from rate or rhythm symptom control.
6. Which laboratory test is most useful for detecting myocardial injury in a patient with suspected acute coronary
syndrome?
A. Serum lipase.
B. Serial high-sensitivity cardiac troponin.
C. D-dimer as the sole cardiac test.
D. Serum ammonia.
Correct Answer: B. Serial high-sensitivity cardiac troponin.
Rationale: Cardiac troponin is the preferred biomarker for myocardial injury. Serial values are interpreted with symptoms and ECG findings
because an elevated troponin indicates injury but not automatically the cause.
7. Two hours after femoral artery PCI, a patient reports new back pain and feels faint. BP is 84/50 mm Hg and the groin
dressing is dry. What should the nurse suspect?
A. Acute pericarditis from positioning.
B. Expected post-procedure soreness.
C. Retroperitoneal bleeding.
D. Simple anxiety without a physiologic cause.
Correct Answer: C. Retroperitoneal bleeding.
Rationale: Retroperitoneal hemorrhage after femoral access may produce hypotension, tachycardia, flank or back pain, and little visible
bleeding at the puncture site. This is an emergency.
QUESTIONS, CLINICALLY RELEVANT
SCENARIOS & APPLICATION-LEVEL ITEMS)
Exam 1
1. A patient receiving high-dose loop diuretics develops frequent premature ventricular contractions. Which laboratory
value should the nurse review first?
A. Serum bilirubin.
B. Serum potassium.
C. Serum amylase.
D. Serum phosphate only.
Correct Answer: B. Serum potassium.
Rationale: Loop diuretics can cause potassium and magnesium losses, both of which increase ventricular ectopy risk. Potassium is an
immediate priority to evaluate, with magnesium also commonly assessed.
2. A stable adult has a regular narrow-complex tachycardia at 188/min. Vagal maneuvers do not terminate the rhythm.
Which intervention is expected next?
A. Give atropine and prepare for transcutaneous pacing.
B. Deliver an unsynchronized defibrillation shock.
C. Administer oral warfarin and discharge the patient.
D. Administer adenosine by rapid IV push followed immediately by a saline flush.
Correct Answer: D. Administer adenosine by rapid IV push followed immediately by a saline flush.
Rationale: For stable regular narrow-complex SVT that persists after vagal maneuvers, rapid IV adenosine is a standard next intervention.
Unstable patients require synchronized cardioversion.
3. A patient in cardiogenic shock has a cardiac output of 2.6 L/min, pulmonary artery occlusion pressure of 24 mm Hg,
and cool clammy skin. Which interpretation is most accurate?
A. Systemic vascular tone is absent while cardiac function is normal.
B. The findings indicate uncomplicated distributive shock with low preload.
C. The patient is primarily volume depleted and needs unrestricted rapid fluid loading.
D. Left ventricular pump failure is causing elevated filling pressure and reduced forward flow.
Correct Answer: D. Left ventricular pump failure is causing elevated filling pressure and reduced forward flow.
Rationale: Cardiogenic shock typically produces low cardiac output with elevated left-sided filling pressures due to pump failure. Fluid
should be individualized because indiscriminate loading can worsen pulmonary edema.
, 4. Which assessment pattern is most characteristic of severe symptomatic aortic stenosis?
A. Bounding pulses with a continuous machinery murmur.
B. Exertional syncope, angina, dyspnea, and a systolic murmur radiating to the carotids.
C. Sudden unilateral absent breath sounds with tracheal deviation.
D. Pleuritic chest pain relieved by leaning forward with diffuse ST elevation.
Correct Answer: B. Exertional syncope, angina, dyspnea, and a systolic murmur radiating to the carotids.
Rationale: Severe aortic stenosis causes fixed left ventricular outflow obstruction. The classic symptom triad is exertional angina, syncope,
and dyspnea, often with a harsh systolic murmur radiating to the neck.
5. A patient with persistent atrial fibrillation asks why an anticoagulant is prescribed even though the heart rate is
controlled. Which response is best?
A. "Rate control does not remove the risk of atrial thrombus formation and embolic stroke."
B. "The medication permanently converts atrial fibrillation to sinus rhythm."
C. "Anticoagulants are used mainly to slow the ventricular rate."
D. "Stroke risk is eliminated once palpitations stop."
Correct Answer: A. "Rate control does not remove the risk of atrial thrombus formation and embolic stroke."
Rationale: Atrial fibrillation can produce blood stasis in the atria, especially the left atrial appendage, allowing thrombus formation. Stroke
prevention is considered separately from rate or rhythm symptom control.
6. Which laboratory test is most useful for detecting myocardial injury in a patient with suspected acute coronary
syndrome?
A. Serum lipase.
B. Serial high-sensitivity cardiac troponin.
C. D-dimer as the sole cardiac test.
D. Serum ammonia.
Correct Answer: B. Serial high-sensitivity cardiac troponin.
Rationale: Cardiac troponin is the preferred biomarker for myocardial injury. Serial values are interpreted with symptoms and ECG findings
because an elevated troponin indicates injury but not automatically the cause.
7. Two hours after femoral artery PCI, a patient reports new back pain and feels faint. BP is 84/50 mm Hg and the groin
dressing is dry. What should the nurse suspect?
A. Acute pericarditis from positioning.
B. Expected post-procedure soreness.
C. Retroperitoneal bleeding.
D. Simple anxiety without a physiologic cause.
Correct Answer: C. Retroperitoneal bleeding.
Rationale: Retroperitoneal hemorrhage after femoral access may produce hypotension, tachycardia, flank or back pain, and little visible
bleeding at the puncture site. This is an emergency.
