NUR 242 Medical-Surgical Nursing Exam 4 Actual
2023/2024 with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
SECTION 1: Cardiovascular Disorders
(Questions 1–12)
Q1: A patient admitted with acute myocardial infarction (MI) reports crushing chest
pain unrelieved by nitroglycerin. Which medication should the nurse prepare to
administer first?
A. Morphine sulfate IV
B. Aspirin 325 mg chewable
C. Sublingual nitroglycerin 0.4 mg
D. Metoprolol 25 mg PO [CORRECT]
Correct Answer: D
Rationale: Correct because beta-blockers like metoprolol reduce myocardial oxygen
demand, limit infarct size, and decrease mortality when administered early in acute
MI, provided no contraindications exist.
Q2: Which assessment finding in a patient with heart failure indicates worsening left
ventricular function and requires immediate intervention?
A. Weight gain of 1 lb in 24 hours
B. Bilateral crackles at lung bases with orthopnea and pink frothy sputum [CORRECT]
C. Mild peripheral edema in the ankles
D. Slight increase in heart rate from 72 to 84 bpm
Correct Answer: B
Rationale: Correct because pink frothy sputum with orthopnea and crackles
indicates acute pulmonary edema from severe left-sided heart failure, a
life-threatening emergency requiring immediate intervention.
Q3: A patient with atrial fibrillation is prescribed warfarin. Which laboratory value
indicates the patient is within the therapeutic range?
A. INR of 1.0
B. INR of 2.5 [CORRECT]
C. INR of 4.5
,D. aPTT of 40 seconds
Correct Answer: B
Rationale: Correct because the therapeutic INR range for warfarin therapy in atrial
fibrillation is typically 2.0–3.0, with 2.5 representing optimal anticoagulation.
Q4: Which dietary instruction is most important for a patient newly diagnosed with
hypertension?
A. Increase potassium intake by eating more bananas and oranges.
B. Limit sodium intake to less than 2,300 mg per day, ideally 1,500 mg. [CORRECT]
C. Eliminate all sources of dietary fat.
D. Increase fluid intake to at least 4 liters daily.
Correct Answer: B
Rationale: Correct because sodium restriction is a cornerstone of hypertension
management; the DASH diet recommends limiting sodium to 1,500–2,300 mg daily
to reduce blood pressure.
Q5: A patient with chronic heart failure is prescribed furosemide 40 mg PO daily.
Which assessment finding indicates the medication is effective?
A. Increased blood pressure from 140/90 to 160/100 mmHg
B. Decreased peripheral edema and weight loss of 2 lb in 24 hours [CORRECT]
C. Increased heart rate from 78 to 96 bpm
D. Decreased urine output from 1,200 mL to 800 mL daily
Correct Answer: B
Rationale: Correct because furosemide is a loop diuretic that promotes fluid
elimination; reduced edema and weight loss indicate effective diuresis and
decreased fluid overload.
Q6: Which ECG change is most characteristic of an acute ST-elevation myocardial
infarction (STEMI)?
A. ST-segment depression in leads V1–V3
B. T-wave inversion in leads II, III, and aVF
C. ST-segment elevation in two or more contiguous leads [CORRECT]
D. Presence of U waves in all leads
Correct Answer: C
Rationale: Correct because STEMI is defined by ST-segment elevation in at least two
anatomically contiguous leads, indicating acute transmural myocardial injury
requiring emergent reperfusion therapy.
, Q7: A patient with a history of hypertension presents with a blood pressure of
220/130 mmHg, headache, and blurred vision but no evidence of acute organ
damage. This presentation is consistent with:
A. Hypertensive emergency
B. Hypertensive urgency [CORRECT]
C. Malignant hypertension
D. Secondary hypertension
Correct Answer: B
Rationale: Correct because hypertensive urgency is defined as severe hypertension
(≥180/120 mmHg) without evidence of acute target organ damage; it requires
gradual BP reduction over 24–48 hours.
Q8: Which nursing intervention is the priority when caring for a patient immediately
after percutaneous coronary intervention (PCI) with stent placement?
A. Encourage ambulation within 30 minutes.
B. Maintain bed rest and assess the femoral or radial access site for bleeding.
[CORRECT]
C. Administer aspirin and clopidogrel only after 24 hours.
D. Discontinue all anticoagulant therapy immediately.
Correct Answer: B
Rationale: Correct because vascular access site complications including bleeding
and hematoma are the most common risks post-PCI; bed rest and site monitoring
are essential immediate priorities.
Q9: A patient with heart failure is receiving digoxin. Which finding requires the nurse
to withhold the dose and notify the provider?
A. Heart rate of 68 bpm
B. Heart rate of 52 bpm [CORRECT]
C. Blood pressure of 130/84 mmHg
D. Potassium level of 4.2 mEq/L
Correct Answer: B
Rationale: Correct because digoxin slows AV nodal conduction and can cause
bradycardia; a heart rate below 60 bpm warrants withholding the dose to prevent
severe bradycardia or heart block.
Q10: Which symptom is most indicative of right-sided heart failure?
A. Paroxysmal nocturnal dyspnea
B. Jugular venous distension and hepatomegaly [CORRECT]
C. Orthopnea
2023/2024 with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
SECTION 1: Cardiovascular Disorders
(Questions 1–12)
Q1: A patient admitted with acute myocardial infarction (MI) reports crushing chest
pain unrelieved by nitroglycerin. Which medication should the nurse prepare to
administer first?
A. Morphine sulfate IV
B. Aspirin 325 mg chewable
C. Sublingual nitroglycerin 0.4 mg
D. Metoprolol 25 mg PO [CORRECT]
Correct Answer: D
Rationale: Correct because beta-blockers like metoprolol reduce myocardial oxygen
demand, limit infarct size, and decrease mortality when administered early in acute
MI, provided no contraindications exist.
Q2: Which assessment finding in a patient with heart failure indicates worsening left
ventricular function and requires immediate intervention?
A. Weight gain of 1 lb in 24 hours
B. Bilateral crackles at lung bases with orthopnea and pink frothy sputum [CORRECT]
C. Mild peripheral edema in the ankles
D. Slight increase in heart rate from 72 to 84 bpm
Correct Answer: B
Rationale: Correct because pink frothy sputum with orthopnea and crackles
indicates acute pulmonary edema from severe left-sided heart failure, a
life-threatening emergency requiring immediate intervention.
Q3: A patient with atrial fibrillation is prescribed warfarin. Which laboratory value
indicates the patient is within the therapeutic range?
A. INR of 1.0
B. INR of 2.5 [CORRECT]
C. INR of 4.5
,D. aPTT of 40 seconds
Correct Answer: B
Rationale: Correct because the therapeutic INR range for warfarin therapy in atrial
fibrillation is typically 2.0–3.0, with 2.5 representing optimal anticoagulation.
Q4: Which dietary instruction is most important for a patient newly diagnosed with
hypertension?
A. Increase potassium intake by eating more bananas and oranges.
B. Limit sodium intake to less than 2,300 mg per day, ideally 1,500 mg. [CORRECT]
C. Eliminate all sources of dietary fat.
D. Increase fluid intake to at least 4 liters daily.
Correct Answer: B
Rationale: Correct because sodium restriction is a cornerstone of hypertension
management; the DASH diet recommends limiting sodium to 1,500–2,300 mg daily
to reduce blood pressure.
Q5: A patient with chronic heart failure is prescribed furosemide 40 mg PO daily.
Which assessment finding indicates the medication is effective?
A. Increased blood pressure from 140/90 to 160/100 mmHg
B. Decreased peripheral edema and weight loss of 2 lb in 24 hours [CORRECT]
C. Increased heart rate from 78 to 96 bpm
D. Decreased urine output from 1,200 mL to 800 mL daily
Correct Answer: B
Rationale: Correct because furosemide is a loop diuretic that promotes fluid
elimination; reduced edema and weight loss indicate effective diuresis and
decreased fluid overload.
Q6: Which ECG change is most characteristic of an acute ST-elevation myocardial
infarction (STEMI)?
A. ST-segment depression in leads V1–V3
B. T-wave inversion in leads II, III, and aVF
C. ST-segment elevation in two or more contiguous leads [CORRECT]
D. Presence of U waves in all leads
Correct Answer: C
Rationale: Correct because STEMI is defined by ST-segment elevation in at least two
anatomically contiguous leads, indicating acute transmural myocardial injury
requiring emergent reperfusion therapy.
, Q7: A patient with a history of hypertension presents with a blood pressure of
220/130 mmHg, headache, and blurred vision but no evidence of acute organ
damage. This presentation is consistent with:
A. Hypertensive emergency
B. Hypertensive urgency [CORRECT]
C. Malignant hypertension
D. Secondary hypertension
Correct Answer: B
Rationale: Correct because hypertensive urgency is defined as severe hypertension
(≥180/120 mmHg) without evidence of acute target organ damage; it requires
gradual BP reduction over 24–48 hours.
Q8: Which nursing intervention is the priority when caring for a patient immediately
after percutaneous coronary intervention (PCI) with stent placement?
A. Encourage ambulation within 30 minutes.
B. Maintain bed rest and assess the femoral or radial access site for bleeding.
[CORRECT]
C. Administer aspirin and clopidogrel only after 24 hours.
D. Discontinue all anticoagulant therapy immediately.
Correct Answer: B
Rationale: Correct because vascular access site complications including bleeding
and hematoma are the most common risks post-PCI; bed rest and site monitoring
are essential immediate priorities.
Q9: A patient with heart failure is receiving digoxin. Which finding requires the nurse
to withhold the dose and notify the provider?
A. Heart rate of 68 bpm
B. Heart rate of 52 bpm [CORRECT]
C. Blood pressure of 130/84 mmHg
D. Potassium level of 4.2 mEq/L
Correct Answer: B
Rationale: Correct because digoxin slows AV nodal conduction and can cause
bradycardia; a heart rate below 60 bpm warrants withholding the dose to prevent
severe bradycardia or heart block.
Q10: Which symptom is most indicative of right-sided heart failure?
A. Paroxysmal nocturnal dyspnea
B. Jugular venous distension and hepatomegaly [CORRECT]
C. Orthopnea
