NUR 265 Exam 3 | NUR 265 Advanced Medical-Surgical
Nursing | Questions and Answers with Rationales
2026/2027 Update
QUESTION 1
A client is admitted to the emergency department following an acute myocardial
infarction. Which cardiac biomarker begins to rise earliest within 1 to 3 hours
after myocardial injury?
A. Creatine kinase MB
B. Myoglobin
C. Troponin T
D. Lactate dehydrogenase
ANSWER: B
RATIONALE: Myoglobin is an oxygen-binding protein found in cardiac and skeletal
muscle that rises earliest, within 1 to 3 hours following myocardial injury,
although it lacks cardiac specificity compared to troponins.
QUESTION 2
Which diagnostic test is considered the gold standard for confirming coronary
artery disease and evaluating coronary anatomy?
A. Transthoracic echocardiogram
B. Exercise stress electrocardiography
C. Cardiac catheterization and coronary angiography
D. Myocardial perfusion imaging scan
ANSWER: C
,RATIONALE: Cardiac catheterization with coronary angiography provides direct
visualization of the coronary arteries, allowing accurate assessment of luminal
narrowing, occlusion sites, and suitability for revascularization procedures.
QUESTION 3
A client with stable angina is prescribed sublingual nitroglycerin tablets. Which
patient instruction regarding medication storage and administration is correct?
A. Store tablets in a clear plastic container exposed to room light
B. Take one tablet every 15 minutes for a maximum of four doses
C. Keep tablets in their original dark glass container and replace every 6 months
D. Swallow the tablet whole with a full glass of water
ANSWER: C
RATIONALE: Nitroglycerin is unstable when exposed to light, heat, and moisture.
It must be stored in its original dark glass, airtight container and replaced every 6
months to maintain potency. It is placed sublingually, not swallowed.
QUESTION 4
Which ECG finding is characteristic of an acute ST-elevation myocardial infarction?
A. Prolonged PR interval with flattened T waves
B. ST-segment elevation in contiguous leads reflecting myocardial injury
C. Persistent T-wave inversion without ST changes
D. Shortened QT interval and prominent U waves
ANSWER: B
RATIONALE: Acute transmural myocardial injury is characterized on the 12-lead
ECG by significant ST-segment elevation in two or more contiguous leads,
indicating full-thickness ischemia and impending necrosis.
QUESTION 5
,A client undergoes percutaneous transluminal coronary angioplasty with stent
placement. Which antiplatelet medication combination is routinely prescribed
post-procedure to prevent stent thrombosis?
A. Aspirin and clopidogrel
B. Warfarin and dabigatran
C. Heparin and rivaroxaban
D. Aspirin and ibuprofen
ANSWER: A
RATIONALE: Dual antiplatelet therapy consisting of aspirin and a P2Y12 inhibitor
such as clopidogrel is standard post-percutaneous coronary intervention to inhibit
platelet aggregation and prevent acute stent thrombosis.
QUESTION 6
Which clinical manifestation is a hallmark sign of right-sided heart failure?
A. Bilateral crackles in lung bases and orthopnea
B. Jugular venous distension, hepatomegaly, and dependent pitting edema
C. Paroxysmal nocturnal dyspnea and dry hacking cough
D. S3 gallop sound and frothy pink-tinged sputum
ANSWER: B
RATIONALE: Right-sided heart failure causes systemic venous congestion, leading
to hallmark physical findings of jugular venous distension, hepatomegaly,
splenomegaly, ascites, and dependent peripheral pitting edema.
QUESTION 7
A client with heart failure is prescribed furosemide. Which laboratory parameter
must be closely monitored during therapy with this loop diuretic?
A. Serum sodium and potassium levels
B. Serum glucose and hemoglobin A1c
, C. Total serum protein and albumin
D. Serum uric acid and bilirubin
ANSWER: A
RATIONALE: Loop diuretics such as furosemide inhibit sodium and chloride
reabsorption in the loop of Henle, leading to significant urinary excretion of
water, sodium, potassium, and chloride. Hypokalemia and hyponatremia are
major risks requiring close monitoring.
QUESTION 8
Which medication class is considered first-line therapy for chronic heart failure
with reduced ejection fraction to inhibit the renin-angiotensin-aldosterone
system and reduce mortality?
A. Calcium channel blockers
B. Angiotensin-converting enzyme inhibitors
C. Direct-acting vasodilators
D. Loop diuretics alone
ANSWER: B
RATIONALE: Angiotensin-converting enzyme inhibitors block the conversion of
angiotensin I to angiotensin II, leading to vasodilation, decreased afterload, and
reduced ventricular remodeling, significantly improving survival in heart failure.
QUESTION 9
A client with infective endocarditis develops splinter hemorrhages under the
fingernails and painful red nodules on the pads of the fingers. What are these
finger nodules called?
A. Janeway lesions
B. Osler nodes
C. Roth spots
D. Petrova spots
Nursing | Questions and Answers with Rationales
2026/2027 Update
QUESTION 1
A client is admitted to the emergency department following an acute myocardial
infarction. Which cardiac biomarker begins to rise earliest within 1 to 3 hours
after myocardial injury?
A. Creatine kinase MB
B. Myoglobin
C. Troponin T
D. Lactate dehydrogenase
ANSWER: B
RATIONALE: Myoglobin is an oxygen-binding protein found in cardiac and skeletal
muscle that rises earliest, within 1 to 3 hours following myocardial injury,
although it lacks cardiac specificity compared to troponins.
QUESTION 2
Which diagnostic test is considered the gold standard for confirming coronary
artery disease and evaluating coronary anatomy?
A. Transthoracic echocardiogram
B. Exercise stress electrocardiography
C. Cardiac catheterization and coronary angiography
D. Myocardial perfusion imaging scan
ANSWER: C
,RATIONALE: Cardiac catheterization with coronary angiography provides direct
visualization of the coronary arteries, allowing accurate assessment of luminal
narrowing, occlusion sites, and suitability for revascularization procedures.
QUESTION 3
A client with stable angina is prescribed sublingual nitroglycerin tablets. Which
patient instruction regarding medication storage and administration is correct?
A. Store tablets in a clear plastic container exposed to room light
B. Take one tablet every 15 minutes for a maximum of four doses
C. Keep tablets in their original dark glass container and replace every 6 months
D. Swallow the tablet whole with a full glass of water
ANSWER: C
RATIONALE: Nitroglycerin is unstable when exposed to light, heat, and moisture.
It must be stored in its original dark glass, airtight container and replaced every 6
months to maintain potency. It is placed sublingually, not swallowed.
QUESTION 4
Which ECG finding is characteristic of an acute ST-elevation myocardial infarction?
A. Prolonged PR interval with flattened T waves
B. ST-segment elevation in contiguous leads reflecting myocardial injury
C. Persistent T-wave inversion without ST changes
D. Shortened QT interval and prominent U waves
ANSWER: B
RATIONALE: Acute transmural myocardial injury is characterized on the 12-lead
ECG by significant ST-segment elevation in two or more contiguous leads,
indicating full-thickness ischemia and impending necrosis.
QUESTION 5
,A client undergoes percutaneous transluminal coronary angioplasty with stent
placement. Which antiplatelet medication combination is routinely prescribed
post-procedure to prevent stent thrombosis?
A. Aspirin and clopidogrel
B. Warfarin and dabigatran
C. Heparin and rivaroxaban
D. Aspirin and ibuprofen
ANSWER: A
RATIONALE: Dual antiplatelet therapy consisting of aspirin and a P2Y12 inhibitor
such as clopidogrel is standard post-percutaneous coronary intervention to inhibit
platelet aggregation and prevent acute stent thrombosis.
QUESTION 6
Which clinical manifestation is a hallmark sign of right-sided heart failure?
A. Bilateral crackles in lung bases and orthopnea
B. Jugular venous distension, hepatomegaly, and dependent pitting edema
C. Paroxysmal nocturnal dyspnea and dry hacking cough
D. S3 gallop sound and frothy pink-tinged sputum
ANSWER: B
RATIONALE: Right-sided heart failure causes systemic venous congestion, leading
to hallmark physical findings of jugular venous distension, hepatomegaly,
splenomegaly, ascites, and dependent peripheral pitting edema.
QUESTION 7
A client with heart failure is prescribed furosemide. Which laboratory parameter
must be closely monitored during therapy with this loop diuretic?
A. Serum sodium and potassium levels
B. Serum glucose and hemoglobin A1c
, C. Total serum protein and albumin
D. Serum uric acid and bilirubin
ANSWER: A
RATIONALE: Loop diuretics such as furosemide inhibit sodium and chloride
reabsorption in the loop of Henle, leading to significant urinary excretion of
water, sodium, potassium, and chloride. Hypokalemia and hyponatremia are
major risks requiring close monitoring.
QUESTION 8
Which medication class is considered first-line therapy for chronic heart failure
with reduced ejection fraction to inhibit the renin-angiotensin-aldosterone
system and reduce mortality?
A. Calcium channel blockers
B. Angiotensin-converting enzyme inhibitors
C. Direct-acting vasodilators
D. Loop diuretics alone
ANSWER: B
RATIONALE: Angiotensin-converting enzyme inhibitors block the conversion of
angiotensin I to angiotensin II, leading to vasodilation, decreased afterload, and
reduced ventricular remodeling, significantly improving survival in heart failure.
QUESTION 9
A client with infective endocarditis develops splinter hemorrhages under the
fingernails and painful red nodules on the pads of the fingers. What are these
finger nodules called?
A. Janeway lesions
B. Osler nodes
C. Roth spots
D. Petrova spots
