NUR 265 MEDICAL-SURGICAL NURSING I EXAM 1 2026/2027
| Galen College Complete Solutions | 100% Correct Answers
with Detailed Rationales | GRADED A | Pass Guaranteed
UNIT 1: CARDIOVASCULAR DISORDERS (20 Questions)
Question 1 (Multiple Choice)
A 68-year-old male patient is admitted with chest pain and is diagnosed with an
ST-elevation myocardial infarction (STEMI). The nurse notes the following vital signs: BP
88/56 mmHg, HR 110 bpm (regular), RR 24/min, SpO₂ 92% on room air. The patient
appears diaphoretic and anxious. Which nursing intervention is the priority?
A. Administer morphine sulfate 2 mg IV for pain relief
B. Apply supplemental oxygen at 2 L/min via nasal cannula
C. Initiate thrombolytic therapy per protocol
D. Establish IV access and prepare for primary PCI [CORRECT]
Correct Answer: D
Rationale: In STEMI management, the priority is reperfusion therapy to restore coronary
blood flow and limit myocardial damage. Primary percutaneous coronary intervention
,(PCI) is the gold standard when available within 90 minutes of first medical contact.
While pain management (A) and oxygen therapy (B) are important supportive measures,
they do not address the underlying pathophysiology of coronary artery occlusion.
Thrombolytics (C) are indicated only when PCI cannot be performed within 120
minutes. The patient's hypotension (BP 88/56) and tachycardia indicate cardiogenic
shock risk, making rapid reperfusion critical. Establishing IV access enables medication
administration and prepares the patient for emergent catheterization.
Question 2 (Multiple Choice)
A nurse is caring for a patient with heart failure who is prescribed furosemide (Lasix) 40
mg IV twice daily. Which assessment finding indicates the medication is effective?
A. Decreased potassium level from 4.2 to 3.1 mEq/L
B. Weight loss of 2 kg over 24 hours [CORRECT]
C. Increased blood urea nitrogen (BUN) from 18 to 28 mg/dL
D. Development of orthostatic hypotension
Correct Answer: B
Rationale: Furosemide is a loop diuretic that reduces fluid volume overload in heart
failure. Weight loss is the most reliable indicator of effective diuresis, as 1 kg equals
approximately 1 liter of fluid loss. While hypokalemia (A) is an expected side effect
,requiring monitoring, it does not indicate therapeutic effectiveness. Elevated BUN (C)
may indicate dehydration or reduced renal perfusion from excessive diuresis.
Orthostatic hypotension (D) suggests volume depletion and requires intervention rather
than indicating success.
Question 3 (Select-All-That-Apply)
The nurse is assessing a patient with suspected deep vein thrombosis (DVT). Which
findings support this diagnosis? (Select all that apply)
A. Unilateral calf swelling [CORRECT]
B. Homans' sign (calf pain on dorsiflexion) [CORRECT]
C. Bilateral pitting edema to the ankles
D. Warmth and erythema over affected area [CORRECT]
E. Palpable cord-like venous structure [CORRECT]
F. Bradycardia and hypotension
Correct Answer: A, B, D, E
Rationale: Classic DVT manifestations include unilateral (not bilateral) extremity
changes due to venous obstruction. Bilateral edema (C) typically indicates systemic
, causes (heart failure, renal disease, liver disease). The affected limb often
demonstrates swelling, warmth, erythema, tenderness, and a palpable thrombosed vein.
Homans' sign, while not diagnostic, supports clinical suspicion. Bradycardia and
hypotension (F) are not associated with uncomplicated DVT but may occur with
massive pulmonary embolism. Early recognition prevents embolization to pulmonary
circulation.
Question 4 (Multiple Choice)
A patient with atrial fibrillation is prescribed warfarin (Coumadin). The nurse notes an
INR of 4.8. Which action is most appropriate?
A. Administer vitamin K 2.5 mg orally [CORRECT]
B. Hold the next dose of warfarin and recheck INR in 1 week
C. Transfuse fresh frozen plasma immediately
D. Increase warfarin dose to achieve therapeutic anticoagulation
Correct Answer: A
Rationale: Therapeutic INR for atrial fibrillation is typically 2.0-3.0. An INR of 4.8
represents supratherapeutic anticoagulation with bleeding risk. The American College
of Chest Physicians recommends low-dose oral vitamin K (1-2.5 mg) for INR 4.5-10
without serious bleeding. Simply holding warfarin (B) results in slow INR reduction.
| Galen College Complete Solutions | 100% Correct Answers
with Detailed Rationales | GRADED A | Pass Guaranteed
UNIT 1: CARDIOVASCULAR DISORDERS (20 Questions)
Question 1 (Multiple Choice)
A 68-year-old male patient is admitted with chest pain and is diagnosed with an
ST-elevation myocardial infarction (STEMI). The nurse notes the following vital signs: BP
88/56 mmHg, HR 110 bpm (regular), RR 24/min, SpO₂ 92% on room air. The patient
appears diaphoretic and anxious. Which nursing intervention is the priority?
A. Administer morphine sulfate 2 mg IV for pain relief
B. Apply supplemental oxygen at 2 L/min via nasal cannula
C. Initiate thrombolytic therapy per protocol
D. Establish IV access and prepare for primary PCI [CORRECT]
Correct Answer: D
Rationale: In STEMI management, the priority is reperfusion therapy to restore coronary
blood flow and limit myocardial damage. Primary percutaneous coronary intervention
,(PCI) is the gold standard when available within 90 minutes of first medical contact.
While pain management (A) and oxygen therapy (B) are important supportive measures,
they do not address the underlying pathophysiology of coronary artery occlusion.
Thrombolytics (C) are indicated only when PCI cannot be performed within 120
minutes. The patient's hypotension (BP 88/56) and tachycardia indicate cardiogenic
shock risk, making rapid reperfusion critical. Establishing IV access enables medication
administration and prepares the patient for emergent catheterization.
Question 2 (Multiple Choice)
A nurse is caring for a patient with heart failure who is prescribed furosemide (Lasix) 40
mg IV twice daily. Which assessment finding indicates the medication is effective?
A. Decreased potassium level from 4.2 to 3.1 mEq/L
B. Weight loss of 2 kg over 24 hours [CORRECT]
C. Increased blood urea nitrogen (BUN) from 18 to 28 mg/dL
D. Development of orthostatic hypotension
Correct Answer: B
Rationale: Furosemide is a loop diuretic that reduces fluid volume overload in heart
failure. Weight loss is the most reliable indicator of effective diuresis, as 1 kg equals
approximately 1 liter of fluid loss. While hypokalemia (A) is an expected side effect
,requiring monitoring, it does not indicate therapeutic effectiveness. Elevated BUN (C)
may indicate dehydration or reduced renal perfusion from excessive diuresis.
Orthostatic hypotension (D) suggests volume depletion and requires intervention rather
than indicating success.
Question 3 (Select-All-That-Apply)
The nurse is assessing a patient with suspected deep vein thrombosis (DVT). Which
findings support this diagnosis? (Select all that apply)
A. Unilateral calf swelling [CORRECT]
B. Homans' sign (calf pain on dorsiflexion) [CORRECT]
C. Bilateral pitting edema to the ankles
D. Warmth and erythema over affected area [CORRECT]
E. Palpable cord-like venous structure [CORRECT]
F. Bradycardia and hypotension
Correct Answer: A, B, D, E
Rationale: Classic DVT manifestations include unilateral (not bilateral) extremity
changes due to venous obstruction. Bilateral edema (C) typically indicates systemic
, causes (heart failure, renal disease, liver disease). The affected limb often
demonstrates swelling, warmth, erythema, tenderness, and a palpable thrombosed vein.
Homans' sign, while not diagnostic, supports clinical suspicion. Bradycardia and
hypotension (F) are not associated with uncomplicated DVT but may occur with
massive pulmonary embolism. Early recognition prevents embolization to pulmonary
circulation.
Question 4 (Multiple Choice)
A patient with atrial fibrillation is prescribed warfarin (Coumadin). The nurse notes an
INR of 4.8. Which action is most appropriate?
A. Administer vitamin K 2.5 mg orally [CORRECT]
B. Hold the next dose of warfarin and recheck INR in 1 week
C. Transfuse fresh frozen plasma immediately
D. Increase warfarin dose to achieve therapeutic anticoagulation
Correct Answer: A
Rationale: Therapeutic INR for atrial fibrillation is typically 2.0-3.0. An INR of 4.8
represents supratherapeutic anticoagulation with bleeding risk. The American College
of Chest Physicians recommends low-dose oral vitamin K (1-2.5 mg) for INR 4.5-10
without serious bleeding. Simply holding warfarin (B) results in slow INR reduction.
