NUR 265 Exam 3 Medical-Surgical Nursing
Official Practice Exam Actual Exam 2026/2027
with Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
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SECTION 1: ADVANCED CARDIOVASCULAR DISORDERS Q1 – Q10
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Question 1 of 50
A 68-year-old man with a history of systolic heart failure (EF 30%) arrives in the emergency
department with severe dyspnea, pink frothy sputum, and an oxygen saturation of 84% on
room air. His blood pressure is 198/110 mmHg, heart rate 122 beats/min, and respiratory rate
36 breaths/min. Bilateral crackles are audible to the mid-lung fields. After positioning him
upright and applying high-flow oxygen, which intervention should the nurse anticipate as the
next priority?
A. Initiate IV nitroglycerin at 10 mcg/min to reduce preload
B. Administer IV furosemide 80 mg to promote diuresis and reduce fluid overload ✓
CORRECT
C. Begin dobutamine at 5 mcg/kg/min to improve contractility
D. Insert a Foley catheter to monitor hourly urine output
Correct Answer: B
Rationale: In acute decompensated heart failure with pulmonary edema and hypertension, IV
loop diuretics are the priority to rapidly reduce intravascular volume and improve
oxygenation. Nitroglycerin reduces preload but does not address the fluid overload as directly
as diuresis in this hypertensive presentation. Dobutamine is reserved for low-output states
with hypotension, not hypertensive pulmonary edema.
Question 2 of 50
A 54-year-old woman presents to the cardiac unit 90 minutes after the sudden onset of
crushing substernal chest pain radiating to her left arm. Her 12-lead ECG shows 3 mm
ST-segment elevation in leads V1 through V4. Vital signs are BP 96/58 mmHg, HR 108 bpm,
RR 22, SpO2 93%. Labs reveal troponin I 0.8 ng/mL. Which action should the nurse prepare to
implement immediately?
,A. Administer sublingual nitroglycerin every 5 minutes for three doses
B. Initiate a heparin infusion and schedule a stress test for the morning
C. Prepare the patient for immediate synchronized cardioversion
D. Activate the cardiac catheterization lab for emergent percutaneous coronary intervention ✓
CORRECT
Correct Answer: D
Rationale: An anterior STEMI with active symptoms requires emergent reperfusion via PCI
within 90 minutes of first medical contact; this supersedes all other interventions.
Nitroglycerin may drop blood pressure further in this hypotensive patient, and stress testing
is contraindicated in acute STEMI. Synchronized cardioversion is not indicated without
unstable tachyarrhythmia.
Question 3 of 50
A 72-year-old man admitted for an inferior MI develops a wide-complex tachycardia at 190
beats/min. His blood pressure is 74/48 mmHg, and he is moaning but responsive. The
monitor shows monomorphic ventricular tachycardia. Which intervention should the nurse
perform first?
A. Defibrillate immediately with 200 joules biphasic ✓ CORRECT
B. Administer amiodarone 150 mg IV push over 10 minutes
C. Prepare for transcutaneous pacing at 80 beats/min
D. Give adenosine 6 mg rapid IV push followed by a saline flush
Correct Answer: A
Rationale: Pulseless or unstable ventricular tachycardia with hypotension and altered mental
status requires immediate unsynchronized defibrillation, not medication first. Amiodarone is
appropriate for stable VT or after defibrillation in pulseless arrest. Adenosine is
contraindicated in wide-complex tachycardia of unknown origin, and pacing is for bradycardia,
not tachycardia.
Question 4 of 50
A patient with cardiogenic shock has a pulmonary artery catheter in place. The current
readings show a pulmonary artery pressure of 48/28 mmHg, pulmonary capillary wedge
pressure of 26 mmHg, cardiac output of 4.2 L/min, and systemic vascular resistance of 1800
dynes/sec/cm. Which hemodynamic profile is most consistent with these findings?
A. Hypovolemic shock with decreased preload
B. Septic shock with vasodilation and capillary leak
C. Cardiogenic shock with elevated preload and afterload ✓ CORRECT
D. Anaphylactic shock with decreased systemic vascular resistance
, Correct Answer: C
Rationale: An elevated PCWP indicates increased left ventricular preload, while elevated SVR
indicates increased afterload; combined with low cardiac output, this confirms cardiogenic
shock. Hypovolemic shock would show low PCWP, septic shock would show low SVR with
normal or low PCWP, and anaphylactic shock would show profoundly decreased SVR.
Question 5 of 50
Four days after an anterior wall MI, a 62-year-old man suddenly develops acute shortness of
breath, hypotension, and a new loud holosystolic murmur at the left sternal border. His
oxygen saturation drops from 96% to 78%. Which complication should the nurse suspect?
A. Acute pericardial tamponade from Dressler syndrome
B. Rupture of the ventricular septum with left-to-right shunting ✓ CORRECT
C. Papillary muscle rupture causing acute mitral regurgitation
D. Right ventricular infarction with decreased preload
Correct Answer: B
Rationale: A new holosystolic murmur at the left sternal border with sudden hypoxemia and
hypotension days post-MI is classic for ventricular septal rupture, creating a left-to-right
shunt. Papillary muscle rupture produces a murmur at the apex radiating to the axilla, not the
sternal border. Dressler syndrome presents with pericardial friction rub and fever, not an
acute murmur.
Question 6 of 50
A patient in the ICU with acute decompensated heart failure has the following hemodynamic
parameters: MAP 58 mmHg, CVP 14 mmHg, PCWP 24 mmHg, and cardiac index 1.8
L/min/m². The provider orders an IV vasopressor. Which agent should the nurse expect to
administer?
A. Nitroprusside to reduce afterload and improve cardiac output
B. Nitroglycerin to dilate coronary arteries and reduce preload
C. Dobutamine to increase contractility and reduce afterload
D. Norepinephrine to increase systemic vascular resistance and MAP ✓ CORRECT
Correct Answer: D
Rationale: With a low MAP and adequate preload (elevated CVP and PCWP), the priority is to
restore perfusion pressure with a vasopressor such as norepinephrine. Nitroprusside and
nitroglycerin would further drop blood pressure in this hypotensive patient. Dobutamine
improves contractility but can cause vasodilation and worsen hypotension without
concurrent vasopressor support.
Question 7 of 50
Official Practice Exam Actual Exam 2026/2027
with Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: ADVANCED CARDIOVASCULAR DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old man with a history of systolic heart failure (EF 30%) arrives in the emergency
department with severe dyspnea, pink frothy sputum, and an oxygen saturation of 84% on
room air. His blood pressure is 198/110 mmHg, heart rate 122 beats/min, and respiratory rate
36 breaths/min. Bilateral crackles are audible to the mid-lung fields. After positioning him
upright and applying high-flow oxygen, which intervention should the nurse anticipate as the
next priority?
A. Initiate IV nitroglycerin at 10 mcg/min to reduce preload
B. Administer IV furosemide 80 mg to promote diuresis and reduce fluid overload ✓
CORRECT
C. Begin dobutamine at 5 mcg/kg/min to improve contractility
D. Insert a Foley catheter to monitor hourly urine output
Correct Answer: B
Rationale: In acute decompensated heart failure with pulmonary edema and hypertension, IV
loop diuretics are the priority to rapidly reduce intravascular volume and improve
oxygenation. Nitroglycerin reduces preload but does not address the fluid overload as directly
as diuresis in this hypertensive presentation. Dobutamine is reserved for low-output states
with hypotension, not hypertensive pulmonary edema.
Question 2 of 50
A 54-year-old woman presents to the cardiac unit 90 minutes after the sudden onset of
crushing substernal chest pain radiating to her left arm. Her 12-lead ECG shows 3 mm
ST-segment elevation in leads V1 through V4. Vital signs are BP 96/58 mmHg, HR 108 bpm,
RR 22, SpO2 93%. Labs reveal troponin I 0.8 ng/mL. Which action should the nurse prepare to
implement immediately?
,A. Administer sublingual nitroglycerin every 5 minutes for three doses
B. Initiate a heparin infusion and schedule a stress test for the morning
C. Prepare the patient for immediate synchronized cardioversion
D. Activate the cardiac catheterization lab for emergent percutaneous coronary intervention ✓
CORRECT
Correct Answer: D
Rationale: An anterior STEMI with active symptoms requires emergent reperfusion via PCI
within 90 minutes of first medical contact; this supersedes all other interventions.
Nitroglycerin may drop blood pressure further in this hypotensive patient, and stress testing
is contraindicated in acute STEMI. Synchronized cardioversion is not indicated without
unstable tachyarrhythmia.
Question 3 of 50
A 72-year-old man admitted for an inferior MI develops a wide-complex tachycardia at 190
beats/min. His blood pressure is 74/48 mmHg, and he is moaning but responsive. The
monitor shows monomorphic ventricular tachycardia. Which intervention should the nurse
perform first?
A. Defibrillate immediately with 200 joules biphasic ✓ CORRECT
B. Administer amiodarone 150 mg IV push over 10 minutes
C. Prepare for transcutaneous pacing at 80 beats/min
D. Give adenosine 6 mg rapid IV push followed by a saline flush
Correct Answer: A
Rationale: Pulseless or unstable ventricular tachycardia with hypotension and altered mental
status requires immediate unsynchronized defibrillation, not medication first. Amiodarone is
appropriate for stable VT or after defibrillation in pulseless arrest. Adenosine is
contraindicated in wide-complex tachycardia of unknown origin, and pacing is for bradycardia,
not tachycardia.
Question 4 of 50
A patient with cardiogenic shock has a pulmonary artery catheter in place. The current
readings show a pulmonary artery pressure of 48/28 mmHg, pulmonary capillary wedge
pressure of 26 mmHg, cardiac output of 4.2 L/min, and systemic vascular resistance of 1800
dynes/sec/cm. Which hemodynamic profile is most consistent with these findings?
A. Hypovolemic shock with decreased preload
B. Septic shock with vasodilation and capillary leak
C. Cardiogenic shock with elevated preload and afterload ✓ CORRECT
D. Anaphylactic shock with decreased systemic vascular resistance
, Correct Answer: C
Rationale: An elevated PCWP indicates increased left ventricular preload, while elevated SVR
indicates increased afterload; combined with low cardiac output, this confirms cardiogenic
shock. Hypovolemic shock would show low PCWP, septic shock would show low SVR with
normal or low PCWP, and anaphylactic shock would show profoundly decreased SVR.
Question 5 of 50
Four days after an anterior wall MI, a 62-year-old man suddenly develops acute shortness of
breath, hypotension, and a new loud holosystolic murmur at the left sternal border. His
oxygen saturation drops from 96% to 78%. Which complication should the nurse suspect?
A. Acute pericardial tamponade from Dressler syndrome
B. Rupture of the ventricular septum with left-to-right shunting ✓ CORRECT
C. Papillary muscle rupture causing acute mitral regurgitation
D. Right ventricular infarction with decreased preload
Correct Answer: B
Rationale: A new holosystolic murmur at the left sternal border with sudden hypoxemia and
hypotension days post-MI is classic for ventricular septal rupture, creating a left-to-right
shunt. Papillary muscle rupture produces a murmur at the apex radiating to the axilla, not the
sternal border. Dressler syndrome presents with pericardial friction rub and fever, not an
acute murmur.
Question 6 of 50
A patient in the ICU with acute decompensated heart failure has the following hemodynamic
parameters: MAP 58 mmHg, CVP 14 mmHg, PCWP 24 mmHg, and cardiac index 1.8
L/min/m². The provider orders an IV vasopressor. Which agent should the nurse expect to
administer?
A. Nitroprusside to reduce afterload and improve cardiac output
B. Nitroglycerin to dilate coronary arteries and reduce preload
C. Dobutamine to increase contractility and reduce afterload
D. Norepinephrine to increase systemic vascular resistance and MAP ✓ CORRECT
Correct Answer: D
Rationale: With a low MAP and adequate preload (elevated CVP and PCWP), the priority is to
restore perfusion pressure with a vasopressor such as norepinephrine. Nitroprusside and
nitroglycerin would further drop blood pressure in this hypotensive patient. Dobutamine
improves contractility but can cause vasodilation and worsen hypotension without
concurrent vasopressor support.
Question 7 of 50
