NUR 254 Exam 4 | Questions and Answers
NUR 254 Exam 4 Actual Exam 2026/2027 – Comprehensive
Q&A with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Section A: Cardiovascular Disorders - Assessment & Management (10
Questions)
Q1: A 68-year-old patient with heart failure presents with dyspnea, fatigue, and
peripheral edema. An echocardiogram reveals an ejection fraction of 25%. Which type of
heart failure does this patient have?
A. Diastolic heart failure with preserved ejection fraction
B. Systolic heart failure with reduced ejection fraction [CORRECT]
C. Right-sided heart failure only
D. Hypertrophic cardiomyopathy
Correct Answer: B
Rationale: An ejection fraction of 25% (normal ≥55%) indicates systolic heart failure with
reduced ejection fraction (HFrEF), characterized by impaired ventricular contraction.
Diastolic heart failure (A) has preserved ejection fraction (≥50%) with impaired
relaxation. Right-sided failure (C) is a hemodynamic description, not a classification by
,ejection fraction. Hypertrophic cardiomyopathy (D) typically has preserved or
hyperdynamic EF.
Q2: A patient with acute myocardial infarction presents with crushing chest pain,
ST-segment elevation in leads V1-V4, and troponin I of 8.5 ng/mL (normal <0.04). Which
intervention should the nurse prioritize FIRST?
A. Administer morphine IV
B. Administer aspirin 325 mg chewable [CORRECT]
C. Prepare for immediate defibrillation
D. Insert a Foley catheter
Correct Answer: B
Rationale: Aspirin (antiplatelet) is the FIRST priority in acute MI per the MONA protocol
(Morphine, Oxygen, Nitroglycerin, Aspirin), as it reduces mortality by preventing further
thrombus formation. Morphine (A) addresses pain but is not first. Defibrillation (C) is for
lethal arrhythmias, not indicated here. Foley insertion (D) is not an acute MI priority.
Q3: A patient with heart failure is prescribed lisinopril. The nurse understands that the
PRIMARY mechanism of action of ACE inhibitors in heart failure is:
A. Increasing heart rate and contractility
B. Reducing afterload and preload through vasodilation and decreasing aldosterone
[CORRECT]
C. Blocking beta-adrenergic receptors
, D. Increasing urine output through loop diuresis
Correct Answer: B
Rationale: ACE inhibitors reduce afterload (arterial vasodilation) and preload (venous
vasodilation) by inhibiting angiotensin II formation and decreasing aldosterone,
reducing fluid retention and cardiac workload. Increasing heart rate (A) describes
positive inotropes. Beta-blockade (C) describes beta-blockers. Loop diuresis (D)
describes furosemide.
Q4: A patient with acute MI develops ventricular tachycardia with a pulse rate of 180
bpm and blood pressure 78/50 mmHg. Which intervention should the nurse anticipate?
A. Administer atropine 0.5 mg IV
B. Prepare for synchronized cardioversion [CORRECT]
C. Administer adenosine 6 mg rapid IV push
D. Perform immediate defibrillation
Correct Answer: B
Rationale: Unstable ventricular tachycardia (hypotension, altered perfusion) requires
synchronized cardioversion. Atropine (A) is for symptomatic bradycardia. Adenosine (C)
is for supraventricular tachycardia. Defibrillation (D) is for pulseless VT/VF; this patient
has a pulse.
Q5: A patient with hypertension has a blood pressure of 198/118 mmHg with evidence
of acute kidney injury. This is classified as:
A. Stage 1 hypertension
NUR 254 Exam 4 Actual Exam 2026/2027 – Comprehensive
Q&A with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Section A: Cardiovascular Disorders - Assessment & Management (10
Questions)
Q1: A 68-year-old patient with heart failure presents with dyspnea, fatigue, and
peripheral edema. An echocardiogram reveals an ejection fraction of 25%. Which type of
heart failure does this patient have?
A. Diastolic heart failure with preserved ejection fraction
B. Systolic heart failure with reduced ejection fraction [CORRECT]
C. Right-sided heart failure only
D. Hypertrophic cardiomyopathy
Correct Answer: B
Rationale: An ejection fraction of 25% (normal ≥55%) indicates systolic heart failure with
reduced ejection fraction (HFrEF), characterized by impaired ventricular contraction.
Diastolic heart failure (A) has preserved ejection fraction (≥50%) with impaired
relaxation. Right-sided failure (C) is a hemodynamic description, not a classification by
,ejection fraction. Hypertrophic cardiomyopathy (D) typically has preserved or
hyperdynamic EF.
Q2: A patient with acute myocardial infarction presents with crushing chest pain,
ST-segment elevation in leads V1-V4, and troponin I of 8.5 ng/mL (normal <0.04). Which
intervention should the nurse prioritize FIRST?
A. Administer morphine IV
B. Administer aspirin 325 mg chewable [CORRECT]
C. Prepare for immediate defibrillation
D. Insert a Foley catheter
Correct Answer: B
Rationale: Aspirin (antiplatelet) is the FIRST priority in acute MI per the MONA protocol
(Morphine, Oxygen, Nitroglycerin, Aspirin), as it reduces mortality by preventing further
thrombus formation. Morphine (A) addresses pain but is not first. Defibrillation (C) is for
lethal arrhythmias, not indicated here. Foley insertion (D) is not an acute MI priority.
Q3: A patient with heart failure is prescribed lisinopril. The nurse understands that the
PRIMARY mechanism of action of ACE inhibitors in heart failure is:
A. Increasing heart rate and contractility
B. Reducing afterload and preload through vasodilation and decreasing aldosterone
[CORRECT]
C. Blocking beta-adrenergic receptors
, D. Increasing urine output through loop diuresis
Correct Answer: B
Rationale: ACE inhibitors reduce afterload (arterial vasodilation) and preload (venous
vasodilation) by inhibiting angiotensin II formation and decreasing aldosterone,
reducing fluid retention and cardiac workload. Increasing heart rate (A) describes
positive inotropes. Beta-blockade (C) describes beta-blockers. Loop diuresis (D)
describes furosemide.
Q4: A patient with acute MI develops ventricular tachycardia with a pulse rate of 180
bpm and blood pressure 78/50 mmHg. Which intervention should the nurse anticipate?
A. Administer atropine 0.5 mg IV
B. Prepare for synchronized cardioversion [CORRECT]
C. Administer adenosine 6 mg rapid IV push
D. Perform immediate defibrillation
Correct Answer: B
Rationale: Unstable ventricular tachycardia (hypotension, altered perfusion) requires
synchronized cardioversion. Atropine (A) is for symptomatic bradycardia. Adenosine (C)
is for supraventricular tachycardia. Defibrillation (D) is for pulseless VT/VF; this patient
has a pulse.
Q5: A patient with hypertension has a blood pressure of 198/118 mmHg with evidence
of acute kidney injury. This is classified as:
A. Stage 1 hypertension
