NUR 2420 – Medical-Surgical
Nursing II Exam 2025/2026 Verified
Question and Answers
Question 1: Cardiovascular
A 68-year-old male with HFrEF (EF 32%) presents with dyspnea and 3+ pitting edema. BNP 450 pg/mL.
On lisinopril 20 mg and metoprolol 50 mg BID. Next pharmacologic adjustment per 2025 AHA
guidelines?
A. Increase lisinopril to 40 mg
B. Add spironolactone 25 mg
C. Initiate empagliflozin 10 mg daily
D. Switch to carvedilol
Rationale: In HFrEF, SGLT2 inhibitors like empagliflozin reduce HF hospitalizations by 25% via
natriuresis, reduced preload, and cardiac remodeling independent of glucose effects (EMPEROR-Reduced
trial, AHA 2025). Lisinopril max (A) risks AKI; spironolactone (B) for NYHA III-IV; carvedilol (D) if
not titrated yet. Nursing implication: Monitor for euglycemic DKA, educate on genital mycotic infections
(risk 10%).
Question 2: Cardiovascular
A 55-year-old female post-CABG day 3 develops atrial fibrillation with HR 140 bpm. BP 110/70.
First-line rate control?
A. Digoxin 0.25 mg IV
B. Amiodarone 150 mg IV
C. Metoprolol 5 mg IV q5min x3
D. Synchronized cardioversion
Rationale: Beta-blockers are first-line for postoperative AF rate control, reducing HR via AV node
blockade without proarrhythmic effects (AHA 2025). Digoxin (A) slower onset; amiodarone (B) for
,refractory; cardioversion (D) if unstable. Implication: Monitor for hypotension (5-10% risk), titrate to HR
<110 bpm.
Question 3: Cardiovascular
A 72-year-old with PAD (ABI 0.6) reports intermittent claudication. Cilostazol 100 mg BID initiated.
Expected outcome in 4 weeks?
A. Complete resolution of pain
B. Wound healing acceleration
C. 50% increase in pain-free walking distance
D. Blood pressure reduction
Rationale: Cilostazol, a PDE3 inhibitor, promotes vasodilation and inhibits platelet aggregation,
improving claudication distance by 40-60% via enhanced skeletal muscle perfusion (AHA 2025). Not for
wounds (B) or BP (D). Implication: Contraindicated in HF; monitor for headache (20%).
Question 4: Cardiovascular
A 60-year-old male with ACS receives ticagrelor 180 mg load. Concomitant therapy?
A. Aspirin 325 mg daily
B. Aspirin 81 mg daily
C. Clopidogrel 600 mg load
D. Heparin only
Rationale: Dual antiplatelet therapy (DAPT) with ticagrelor + low-dose aspirin reduces stent thrombosis
by 16% (PLATO trial, ACC 2025); high-dose aspirin (A) increases bleeding. Implication: PPI for GI
protection, duration 12 months.
Question 5: Cardiovascular
A 65-year-old with IE on vancomycin develops AKI (Cr 2.1 mg/dL). Alternative?
A. Continue vancomycin, dose adjust
B. Add gentamicin
C. Switch to daptomycin 8 mg/kg IV
, D. Oral linezolid
Rationale: Daptomycin is bactericidal against MRSA in endocarditis, with renal clearance <6%, avoiding
nephrotoxicity (IDSA 2025). Vancomycin (A) nephrotoxic at trough >15 mcg/mL. Implication: Monitor
CPK weekly (myopathy risk 5%).
Question 6: Cardiovascular
A 58-year-old post-MI on statins develops myalgia. Next step?
A. Stop statin
B. Add ezetimibe
C. Switch to rosuvastatin 20 mg
D. Increase dose
Rationale: Hydrophilic statins like rosuvastatin have lower muscle penetration, resolving myalgia in 70%
(AHA 2025). Abrupt stop (A) risks rebound. Implication: Check CK if severe, coQ10 adjunct unproven.
Question 7: Cardiovascular
A 70-year-old with aortic stenosis (valve area 0.8 cm²) reports syncope. Surgical risk high. Intervention?
A. Balloon valvuloplasty
B. TAVR
C. Medical management
D. Watchful waiting
Rationale: Transcatheter aortic valve replacement improves survival by 20% in inoperable patients via
retrograde femoral access (ACC 2025). Valvuloplasty (A) temporary. Implication: Pre-procedure CT
angio, monitor for stroke (2%).
Question 8: Cardiovascular
A 62-year-old with DVT on rivaroxaban develops bleeding. Reversal agent?
A. Vitamin K
B. Protamine
C. Andexanet alfa
Nursing II Exam 2025/2026 Verified
Question and Answers
Question 1: Cardiovascular
A 68-year-old male with HFrEF (EF 32%) presents with dyspnea and 3+ pitting edema. BNP 450 pg/mL.
On lisinopril 20 mg and metoprolol 50 mg BID. Next pharmacologic adjustment per 2025 AHA
guidelines?
A. Increase lisinopril to 40 mg
B. Add spironolactone 25 mg
C. Initiate empagliflozin 10 mg daily
D. Switch to carvedilol
Rationale: In HFrEF, SGLT2 inhibitors like empagliflozin reduce HF hospitalizations by 25% via
natriuresis, reduced preload, and cardiac remodeling independent of glucose effects (EMPEROR-Reduced
trial, AHA 2025). Lisinopril max (A) risks AKI; spironolactone (B) for NYHA III-IV; carvedilol (D) if
not titrated yet. Nursing implication: Monitor for euglycemic DKA, educate on genital mycotic infections
(risk 10%).
Question 2: Cardiovascular
A 55-year-old female post-CABG day 3 develops atrial fibrillation with HR 140 bpm. BP 110/70.
First-line rate control?
A. Digoxin 0.25 mg IV
B. Amiodarone 150 mg IV
C. Metoprolol 5 mg IV q5min x3
D. Synchronized cardioversion
Rationale: Beta-blockers are first-line for postoperative AF rate control, reducing HR via AV node
blockade without proarrhythmic effects (AHA 2025). Digoxin (A) slower onset; amiodarone (B) for
,refractory; cardioversion (D) if unstable. Implication: Monitor for hypotension (5-10% risk), titrate to HR
<110 bpm.
Question 3: Cardiovascular
A 72-year-old with PAD (ABI 0.6) reports intermittent claudication. Cilostazol 100 mg BID initiated.
Expected outcome in 4 weeks?
A. Complete resolution of pain
B. Wound healing acceleration
C. 50% increase in pain-free walking distance
D. Blood pressure reduction
Rationale: Cilostazol, a PDE3 inhibitor, promotes vasodilation and inhibits platelet aggregation,
improving claudication distance by 40-60% via enhanced skeletal muscle perfusion (AHA 2025). Not for
wounds (B) or BP (D). Implication: Contraindicated in HF; monitor for headache (20%).
Question 4: Cardiovascular
A 60-year-old male with ACS receives ticagrelor 180 mg load. Concomitant therapy?
A. Aspirin 325 mg daily
B. Aspirin 81 mg daily
C. Clopidogrel 600 mg load
D. Heparin only
Rationale: Dual antiplatelet therapy (DAPT) with ticagrelor + low-dose aspirin reduces stent thrombosis
by 16% (PLATO trial, ACC 2025); high-dose aspirin (A) increases bleeding. Implication: PPI for GI
protection, duration 12 months.
Question 5: Cardiovascular
A 65-year-old with IE on vancomycin develops AKI (Cr 2.1 mg/dL). Alternative?
A. Continue vancomycin, dose adjust
B. Add gentamicin
C. Switch to daptomycin 8 mg/kg IV
, D. Oral linezolid
Rationale: Daptomycin is bactericidal against MRSA in endocarditis, with renal clearance <6%, avoiding
nephrotoxicity (IDSA 2025). Vancomycin (A) nephrotoxic at trough >15 mcg/mL. Implication: Monitor
CPK weekly (myopathy risk 5%).
Question 6: Cardiovascular
A 58-year-old post-MI on statins develops myalgia. Next step?
A. Stop statin
B. Add ezetimibe
C. Switch to rosuvastatin 20 mg
D. Increase dose
Rationale: Hydrophilic statins like rosuvastatin have lower muscle penetration, resolving myalgia in 70%
(AHA 2025). Abrupt stop (A) risks rebound. Implication: Check CK if severe, coQ10 adjunct unproven.
Question 7: Cardiovascular
A 70-year-old with aortic stenosis (valve area 0.8 cm²) reports syncope. Surgical risk high. Intervention?
A. Balloon valvuloplasty
B. TAVR
C. Medical management
D. Watchful waiting
Rationale: Transcatheter aortic valve replacement improves survival by 20% in inoperable patients via
retrograde femoral access (ACC 2025). Valvuloplasty (A) temporary. Implication: Pre-procedure CT
angio, monitor for stroke (2%).
Question 8: Cardiovascular
A 62-year-old with DVT on rivaroxaban develops bleeding. Reversal agent?
A. Vitamin K
B. Protamine
C. Andexanet alfa
