NUR 265 Advanced Concepts Medical-Surgical Nursing
Exam 2 Actual 2025/2026 with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
SECTION 1: Complex Cardiovascular Disorders
(Questions 1–12)
Q1: A patient with acute coronary syndrome presents with ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery [CORRECT]
D. Posterior descending artery
Correct Answer: C
Rationale: Correct because ST elevation in leads II, III, and aVF indicates an inferior
wall MI, which is most commonly caused by occlusion of the right coronary artery.
Q2: A patient with heart failure has a blood pressure of 82/50 mmHg, heart rate of
118 bpm, and cool clammy skin. Which type of shock is most likely developing?
A. Anaphylactic shock
B. Septic shock
C. Cardiogenic shock [CORRECT]
D. Neurogenic shock
Correct Answer: C
Rationale: Correct because hypotension, tachycardia, and cool clammy skin in a
patient with heart failure indicate cardiogenic shock from inadequate cardiac output
and tissue perfusion.
Q3: Which ECG finding is most characteristic of cardiac tamponade?
A. ST-segment elevation in all leads
B. Electrical alternans with tachycardia and low voltage QRS complexes [CORRECT]
C. Wide QRS complexes with absent P waves
,D. Prolonged PR interval
Correct Answer: B
Rationale: Correct because electrical alternans (alternating amplitude of QRS
complexes) combined with tachycardia and low voltage is highly suggestive of
pericardial effusion causing cardiac tamponade.
Q4: A patient with aortic dissection presents with tearing chest pain radiating to the
back. Which blood pressure management is the priority?
A. Rapidly lowering systolic BP to <100 mmHg using IV beta-blockade [CORRECT]
B. Maintaining systolic BP >160 mmHg to preserve perfusion
C. Administering vasopressors to increase afterload
D. Allowing BP to remain elevated to prevent end-organ ischemia
Correct Answer: A
Rationale: Correct because reducing shear force on the aortic wall through
beta-blockade and controlled BP reduction is essential to prevent dissection
extension and rupture.
Q5: Which assessment finding in a patient with acute decompensated heart failure
indicates the need for immediate intervention?
A. Mild peripheral edema
B. Pink frothy sputum with orthopnea and bilateral crackles [CORRECT]
C. Slight weight gain of 1 lb in 24 hours
D. Mild dyspnea on exertion
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.
Q6: A patient with atrial fibrillation is prescribed amiodarone. Which adverse effect
requires the most frequent monitoring?
A. Hyperthyroidism
B. Pulmonary fibrosis and liver toxicity [CORRECT]
C. Hypoglycemia
D. Hypertension
Correct Answer: B
Rationale: Correct because amiodarone can cause life-threatening pulmonary
fibrosis and hepatotoxicity; baseline and periodic monitoring of liver function tests
and chest imaging are essential.
, Q7: Which hemodynamic parameter is most indicative of left ventricular preload?
A. Central venous pressure (CVP)
B. Pulmonary artery wedge pressure (PAWP) [CORRECT]
C. Systemic vascular resistance (SVR)
D. Cardiac output (CO)
Correct Answer: B
Rationale: Correct because PAWP reflects left atrial pressure and left ventricular
end-diastolic pressure, providing the best assessment of left ventricular preload.
Q8: A patient with an acute MI develops a new holosystolic murmur at the apex
radiating to the axilla. Which complication is most likely?
A. Papillary muscle rupture causing mitral regurgitation [CORRECT]
B. Ventricular septal defect
C. Aortic valve stenosis
D. Tricuspid regurgitation
Correct Answer: A
Rationale: Correct because a new apical holosystolic murmur after MI suggests
papillary muscle dysfunction or rupture, causing acute severe mitral regurgitation.
Q9: Which intervention is the priority for a patient with pulseless ventricular
tachycardia?
A. Administering atropine
B. Defibrillation with 120–200 joules biphasic [CORRECT]
C. Administering adenosine
D. Performing synchronized cardioversion
Correct Answer: B
Rationale: Correct because pulseless VT is a shockable rhythm; immediate
defibrillation is the priority intervention per ACLS guidelines, followed by CPR and
epinephrine.
Q10: A patient with hypertrophic cardiomyopathy develops syncope during exertion.
Which nursing instruction is most important?
A. Encourage vigorous aerobic exercise to strengthen the heart.
B. Avoid strenuous exercise and dehydration; report syncope immediately.
[CORRECT]
C. Increase salt intake to maintain blood pressure.
D. Discontinue all cardiac medications.
Correct Answer: B
Exam 2 Actual 2025/2026 with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
SECTION 1: Complex Cardiovascular Disorders
(Questions 1–12)
Q1: A patient with acute coronary syndrome presents with ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery [CORRECT]
D. Posterior descending artery
Correct Answer: C
Rationale: Correct because ST elevation in leads II, III, and aVF indicates an inferior
wall MI, which is most commonly caused by occlusion of the right coronary artery.
Q2: A patient with heart failure has a blood pressure of 82/50 mmHg, heart rate of
118 bpm, and cool clammy skin. Which type of shock is most likely developing?
A. Anaphylactic shock
B. Septic shock
C. Cardiogenic shock [CORRECT]
D. Neurogenic shock
Correct Answer: C
Rationale: Correct because hypotension, tachycardia, and cool clammy skin in a
patient with heart failure indicate cardiogenic shock from inadequate cardiac output
and tissue perfusion.
Q3: Which ECG finding is most characteristic of cardiac tamponade?
A. ST-segment elevation in all leads
B. Electrical alternans with tachycardia and low voltage QRS complexes [CORRECT]
C. Wide QRS complexes with absent P waves
,D. Prolonged PR interval
Correct Answer: B
Rationale: Correct because electrical alternans (alternating amplitude of QRS
complexes) combined with tachycardia and low voltage is highly suggestive of
pericardial effusion causing cardiac tamponade.
Q4: A patient with aortic dissection presents with tearing chest pain radiating to the
back. Which blood pressure management is the priority?
A. Rapidly lowering systolic BP to <100 mmHg using IV beta-blockade [CORRECT]
B. Maintaining systolic BP >160 mmHg to preserve perfusion
C. Administering vasopressors to increase afterload
D. Allowing BP to remain elevated to prevent end-organ ischemia
Correct Answer: A
Rationale: Correct because reducing shear force on the aortic wall through
beta-blockade and controlled BP reduction is essential to prevent dissection
extension and rupture.
Q5: Which assessment finding in a patient with acute decompensated heart failure
indicates the need for immediate intervention?
A. Mild peripheral edema
B. Pink frothy sputum with orthopnea and bilateral crackles [CORRECT]
C. Slight weight gain of 1 lb in 24 hours
D. Mild dyspnea on exertion
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.
Q6: A patient with atrial fibrillation is prescribed amiodarone. Which adverse effect
requires the most frequent monitoring?
A. Hyperthyroidism
B. Pulmonary fibrosis and liver toxicity [CORRECT]
C. Hypoglycemia
D. Hypertension
Correct Answer: B
Rationale: Correct because amiodarone can cause life-threatening pulmonary
fibrosis and hepatotoxicity; baseline and periodic monitoring of liver function tests
and chest imaging are essential.
, Q7: Which hemodynamic parameter is most indicative of left ventricular preload?
A. Central venous pressure (CVP)
B. Pulmonary artery wedge pressure (PAWP) [CORRECT]
C. Systemic vascular resistance (SVR)
D. Cardiac output (CO)
Correct Answer: B
Rationale: Correct because PAWP reflects left atrial pressure and left ventricular
end-diastolic pressure, providing the best assessment of left ventricular preload.
Q8: A patient with an acute MI develops a new holosystolic murmur at the apex
radiating to the axilla. Which complication is most likely?
A. Papillary muscle rupture causing mitral regurgitation [CORRECT]
B. Ventricular septal defect
C. Aortic valve stenosis
D. Tricuspid regurgitation
Correct Answer: A
Rationale: Correct because a new apical holosystolic murmur after MI suggests
papillary muscle dysfunction or rupture, causing acute severe mitral regurgitation.
Q9: Which intervention is the priority for a patient with pulseless ventricular
tachycardia?
A. Administering atropine
B. Defibrillation with 120–200 joules biphasic [CORRECT]
C. Administering adenosine
D. Performing synchronized cardioversion
Correct Answer: B
Rationale: Correct because pulseless VT is a shockable rhythm; immediate
defibrillation is the priority intervention per ACLS guidelines, followed by CPR and
epinephrine.
Q10: A patient with hypertrophic cardiomyopathy develops syncope during exertion.
Which nursing instruction is most important?
A. Encourage vigorous aerobic exercise to strengthen the heart.
B. Avoid strenuous exercise and dehydration; report syncope immediately.
[CORRECT]
C. Increase salt intake to maintain blood pressure.
D. Discontinue all cardiac medications.
Correct Answer: B
