NSG 527 Medical-Surgical Nursing II Exam 1 Questions And Correct
Verified Answers With Rationales Graded A+ | (Latest Version)
1. A 61-year-old patient reports substernal chest pressure while climbing stairs. The
discomfort resolves within four minutes of resting and has occurred with a similar level of
exertion for several months. Which interpretation best explains these findings?
A. Pericarditis caused by inflammation of the pericardial sac
B. Stable angina caused by transient myocardial ischemia
C. Acute myocardial infarction caused by complete coronary artery occlusion
D. Unstable angina caused by acute coronary plaque disruption
Answer: B
Rationale: Stable angina occurs when myocardial oxygen demand exceeds the supply
available through narrowed coronary arteries, typically during exertion. Symptoms usually
resolve with rest or prescribed nitroglycerin. New, worsening, or rest-related chest pain raises
concern for acute coronary syndrome.
2. A patient arrives in the emergency department with persistent chest pressure, diaphoresis,
and nausea. The oxygen saturation is 96% on room air, and the patient is hemodynamically
stable. Which action should the nurse prioritize?
A. Administer oxygen at 4 L/min by nasal cannula
B. Encourage the patient to walk to determine exercise tolerance
C. Administer intravenous morphine before further assessment
D. Obtain a 12-lead electrocardiogram immediately
Answer: D
Rationale: A 12-lead ECG should be obtained promptly, ideally within 10 minutes of arrival,
to identify ischemic changes and determine whether emergency reperfusion is needed.
Supplemental oxygen is not routinely indicated when oxygenation is adequate. Analgesia and
other interventions should not delay ECG acquisition or reperfusion assessment.
1
,3. A patient experiencing suspected acute coronary syndrome receives an order for sublingual
nitroglycerin. Before administering the medication, the nurse obtains a blood pressure of
84/52 mmHg. What is the most appropriate response?
A. Withhold nitroglycerin and notify the provider promptly
B. Give half the prescribed dose to minimize hypotension
C. Administer the medication and reassess the pressure in five minutes
D. Administer nitroglycerin with a rapid intravenous fluid bolus without further assessment
Answer: A
Rationale: Nitroglycerin reduces preload through venous dilation and can cause profound
hypotension, particularly when blood pressure is already low. The medication should be
withheld, and the nurse should promptly escalate the finding and assess for impaired
perfusion. The nurse should not independently modify the dose or initiate an unprescribed
fluid bolus.
4. A patient prescribed sublingual nitroglycerin for angina reports taking tadalafil
approximately 18 hours earlier. The patient now has chest discomfort. Which action is most
appropriate?
A. Administer nitroglycerin after placing the patient in a supine position
B. Administer nitroglycerin because the medication was prescribed for angina
C. Withhold nitroglycerin and activate emergency evaluation for the chest pain
D. Substitute an additional dose of an oral antihypertensive medication
Answer: C
Rationale: Tadalafil and nitroglycerin can produce severe, potentially life-threatening
hypotension when used together. Tadalafil generally requires at least a 48-hour interval
before nitrates may be considered, and even then, administration requires clinical assessment
and monitoring. The patient needs emergency evaluation for chest pain and an alternative
treatment plan.
2
,5. A patient with suspected acute myocardial infarction has no aspirin allergy, active bleeding,
or other known contraindication. Which medication should the nurse anticipate administering
promptly to reduce further platelet aggregation?
A. Chewable aspirin
B. Intravenous vitamin K
C. Oral warfarin
D. Subcutaneous vitamin B12
Answer: A
Rationale: Chewable aspirin rapidly inhibits platelet aggregation and is a foundational early
treatment for suspected acute myocardial infarction when not contraindicated. Warfarin acts
more slowly and is not an appropriate substitute for immediate antiplatelet therapy. Vitamin
K reverses warfarin, while vitamin B12 has no role in acute coronary management.
6. A patient develops crushing chest pain while awaiting diagnostic testing. The ECG shows
ST-segment elevation in contiguous leads, and the cardiac catheterization team is being
activated. Which intervention most directly restores blood flow to the affected myocardium?
A. Scheduling an outpatient exercise stress test
B. Initiating long-term oral anticoagulation alone
C. Performing emergency percutaneous coronary intervention when promptly available
D. Administering a beta-blocker as the sole acute intervention
Answer: C
Rationale: Primary PCI can mechanically open the occluded coronary artery and restore
myocardial perfusion. It is the preferred reperfusion strategy for eligible patients with STEMI
when it can be delivered promptly. Medication alone or delayed outpatient testing does not
provide the necessary emergency reperfusion.
3
, 7. A patient with acute coronary syndrome is being evaluated for fibrinolytic therapy because
timely PCI is unavailable. Which finding represents a major contraindication to administering
alteplase?
A. Mild nausea accompanying chest discomfort
B. A history of controlled hypertension
C. A heart rate of 88 beats/min
D. A previous hemorrhagic stroke
Answer: D
Rationale: A previous hemorrhagic stroke is a major contraindication to fibrinolytic therapy
because of the risk of catastrophic intracranial bleeding. Other important contraindications
include active internal bleeding and certain recent intracranial procedures or injuries. The
nurse must verify eligibility using the applicable STEMI fibrinolysis protocol before
treatment.
8. A patient experiences chest pressure while climbing stairs that resolves with rest. What is
the most likely explanation?
A. Reduced cardiac workload
B. Myocardial oxygen demand exceeds supply
C. Pericardial inflammation
D. Complete coronary occlusion
Answer: B
Rationale: Exertion increases myocardial oxygen demand, which may exceed supply through
narrowed coronary arteries, causing stable angina.
4
Verified Answers With Rationales Graded A+ | (Latest Version)
1. A 61-year-old patient reports substernal chest pressure while climbing stairs. The
discomfort resolves within four minutes of resting and has occurred with a similar level of
exertion for several months. Which interpretation best explains these findings?
A. Pericarditis caused by inflammation of the pericardial sac
B. Stable angina caused by transient myocardial ischemia
C. Acute myocardial infarction caused by complete coronary artery occlusion
D. Unstable angina caused by acute coronary plaque disruption
Answer: B
Rationale: Stable angina occurs when myocardial oxygen demand exceeds the supply
available through narrowed coronary arteries, typically during exertion. Symptoms usually
resolve with rest or prescribed nitroglycerin. New, worsening, or rest-related chest pain raises
concern for acute coronary syndrome.
2. A patient arrives in the emergency department with persistent chest pressure, diaphoresis,
and nausea. The oxygen saturation is 96% on room air, and the patient is hemodynamically
stable. Which action should the nurse prioritize?
A. Administer oxygen at 4 L/min by nasal cannula
B. Encourage the patient to walk to determine exercise tolerance
C. Administer intravenous morphine before further assessment
D. Obtain a 12-lead electrocardiogram immediately
Answer: D
Rationale: A 12-lead ECG should be obtained promptly, ideally within 10 minutes of arrival,
to identify ischemic changes and determine whether emergency reperfusion is needed.
Supplemental oxygen is not routinely indicated when oxygenation is adequate. Analgesia and
other interventions should not delay ECG acquisition or reperfusion assessment.
1
,3. A patient experiencing suspected acute coronary syndrome receives an order for sublingual
nitroglycerin. Before administering the medication, the nurse obtains a blood pressure of
84/52 mmHg. What is the most appropriate response?
A. Withhold nitroglycerin and notify the provider promptly
B. Give half the prescribed dose to minimize hypotension
C. Administer the medication and reassess the pressure in five minutes
D. Administer nitroglycerin with a rapid intravenous fluid bolus without further assessment
Answer: A
Rationale: Nitroglycerin reduces preload through venous dilation and can cause profound
hypotension, particularly when blood pressure is already low. The medication should be
withheld, and the nurse should promptly escalate the finding and assess for impaired
perfusion. The nurse should not independently modify the dose or initiate an unprescribed
fluid bolus.
4. A patient prescribed sublingual nitroglycerin for angina reports taking tadalafil
approximately 18 hours earlier. The patient now has chest discomfort. Which action is most
appropriate?
A. Administer nitroglycerin after placing the patient in a supine position
B. Administer nitroglycerin because the medication was prescribed for angina
C. Withhold nitroglycerin and activate emergency evaluation for the chest pain
D. Substitute an additional dose of an oral antihypertensive medication
Answer: C
Rationale: Tadalafil and nitroglycerin can produce severe, potentially life-threatening
hypotension when used together. Tadalafil generally requires at least a 48-hour interval
before nitrates may be considered, and even then, administration requires clinical assessment
and monitoring. The patient needs emergency evaluation for chest pain and an alternative
treatment plan.
2
,5. A patient with suspected acute myocardial infarction has no aspirin allergy, active bleeding,
or other known contraindication. Which medication should the nurse anticipate administering
promptly to reduce further platelet aggregation?
A. Chewable aspirin
B. Intravenous vitamin K
C. Oral warfarin
D. Subcutaneous vitamin B12
Answer: A
Rationale: Chewable aspirin rapidly inhibits platelet aggregation and is a foundational early
treatment for suspected acute myocardial infarction when not contraindicated. Warfarin acts
more slowly and is not an appropriate substitute for immediate antiplatelet therapy. Vitamin
K reverses warfarin, while vitamin B12 has no role in acute coronary management.
6. A patient develops crushing chest pain while awaiting diagnostic testing. The ECG shows
ST-segment elevation in contiguous leads, and the cardiac catheterization team is being
activated. Which intervention most directly restores blood flow to the affected myocardium?
A. Scheduling an outpatient exercise stress test
B. Initiating long-term oral anticoagulation alone
C. Performing emergency percutaneous coronary intervention when promptly available
D. Administering a beta-blocker as the sole acute intervention
Answer: C
Rationale: Primary PCI can mechanically open the occluded coronary artery and restore
myocardial perfusion. It is the preferred reperfusion strategy for eligible patients with STEMI
when it can be delivered promptly. Medication alone or delayed outpatient testing does not
provide the necessary emergency reperfusion.
3
, 7. A patient with acute coronary syndrome is being evaluated for fibrinolytic therapy because
timely PCI is unavailable. Which finding represents a major contraindication to administering
alteplase?
A. Mild nausea accompanying chest discomfort
B. A history of controlled hypertension
C. A heart rate of 88 beats/min
D. A previous hemorrhagic stroke
Answer: D
Rationale: A previous hemorrhagic stroke is a major contraindication to fibrinolytic therapy
because of the risk of catastrophic intracranial bleeding. Other important contraindications
include active internal bleeding and certain recent intracranial procedures or injuries. The
nurse must verify eligibility using the applicable STEMI fibrinolysis protocol before
treatment.
8. A patient experiences chest pressure while climbing stairs that resolves with rest. What is
the most likely explanation?
A. Reduced cardiac workload
B. Myocardial oxygen demand exceeds supply
C. Pericardial inflammation
D. Complete coronary occlusion
Answer: B
Rationale: Exertion increases myocardial oxygen demand, which may exceed supply through
narrowed coronary arteries, causing stable angina.
4
