NUR 253 Exam 3 Actual Exam 2026/2027 – Complete Q&A
with Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
Section A: Cardiovascular System - Pathophysiology & Pharmacology
(10 questions)
Q1: A patient with heart failure is prescribed digoxin 0.25 mg daily. Which laboratory
value must be monitored closely to prevent toxicity?
A. Serum potassium
B. Serum digoxin level (therapeutic range 0.5-2.0 ng/mL) [CORRECT]
C. Serum sodium
D. Blood urea nitrogen (BUN)
Correct Answer: B
Rationale: Digoxin has a narrow therapeutic index (0.5-2.0 ng/mL), and levels above 2.0
ng/mL significantly increase toxicity risk. While hypokalemia (A) potentiates digoxin
toxicity, the direct monitoring of serum digoxin levels is essential. Sodium (C) and BUN
(D) are not primary monitoring parameters for digoxin therapy.
Q2: A patient with atrial fibrillation is started on warfarin (Coumadin). The nurse
understands that the target INR (International Normalized Ratio) for most patients with
AF is:
A. 1.0-1.5
B. 1.5-2.0
C. 2.0-3.0 [CORRECT]
D. 3.0-4.0
,Correct Answer: C
Rationale: The target INR for warfarin therapy in atrial fibrillation is 2.0-3.0, which
provides adequate anticoagulation while minimizing bleeding risk. INR <2.0 (A, B)
provides insufficient stroke prevention; INR >3.0 (D) significantly increases bleeding risk
without additional therapeutic benefit for standard AF management.
Q3: A patient receiving intravenous nitroglycerin for acute angina develops severe
hypotension (BP 70/40). The nurse's priority intervention is:
A. Increase the nitroglycerin infusion rate
B. Stop the infusion immediately and place the patient in Trendelenburg position
[CORRECT]
C. Administer a beta-blocker
D. Continue the infusion and notify the provider
Correct Answer: B
Rationale: Nitroglycerin causes venous and arterial dilation; severe hypotension is a
life-threatening adverse effect requiring immediate discontinuation and positioning to
improve cerebral perfusion. Increasing the rate (A) worsens hypotension; beta-blockers
(C) further lower BP; continuing the infusion (D) is dangerous.
Q4: Which finding in a patient taking an angiotensin-converting enzyme (ACE) inhibitor
(lisinopril) requires immediate nursing intervention?
A. Dry cough
B. Angioedema (swelling of lips, tongue, or face) [CORRECT]
C. Mild dizziness
D. Hyperkalemia (K+ 5.2 mEq/L)
Correct Answer: B
, Rationale: Angioedema is a rare but life-threatening adverse effect of ACE inhibitors that
can rapidly progress to airway obstruction. It requires immediate discontinuation of the
drug and emergency intervention. Dry cough (A) is common but not emergent; mild
dizziness (C) is expected; hyperkalemia (D) requires monitoring but angioedema takes
priority.
Q5: A patient with acute coronary syndrome (ACS) is prescribed clopidogrel (Plavix) 75
mg daily. The nurse understands this medication works by:
A. Inhibiting thrombin formation
B. Inhibiting platelet aggregation by blocking ADP receptors [CORRECT]
C. Dissolving existing clots
D. Increasing fibrinogen levels
Correct Answer: B
Rationale: Clopidogrel is a P2Y12 ADP receptor antagonist that inhibits platelet
aggregation, preventing clot formation in ACS and post-stent placement. It does not
inhibit thrombin (A—that's heparin/direct thrombin inhibitors), dissolve clots (C—that's
thrombolytics), or increase fibrinogen (D).
Q6: A patient with heart failure has the following vital signs: BP 90/60, HR 110, RR 24,
SpO2 88% on room air. The patient reports severe dyspnea and has crackles throughout
both lung fields. The nurse recognizes this as:
A. Right-sided heart failure
B. Acute pulmonary edema from left-sided heart failure [CORRECT]
C. Stable chronic heart failure
D. Cardiogenic shock
Correct Answer: B
with Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
Section A: Cardiovascular System - Pathophysiology & Pharmacology
(10 questions)
Q1: A patient with heart failure is prescribed digoxin 0.25 mg daily. Which laboratory
value must be monitored closely to prevent toxicity?
A. Serum potassium
B. Serum digoxin level (therapeutic range 0.5-2.0 ng/mL) [CORRECT]
C. Serum sodium
D. Blood urea nitrogen (BUN)
Correct Answer: B
Rationale: Digoxin has a narrow therapeutic index (0.5-2.0 ng/mL), and levels above 2.0
ng/mL significantly increase toxicity risk. While hypokalemia (A) potentiates digoxin
toxicity, the direct monitoring of serum digoxin levels is essential. Sodium (C) and BUN
(D) are not primary monitoring parameters for digoxin therapy.
Q2: A patient with atrial fibrillation is started on warfarin (Coumadin). The nurse
understands that the target INR (International Normalized Ratio) for most patients with
AF is:
A. 1.0-1.5
B. 1.5-2.0
C. 2.0-3.0 [CORRECT]
D. 3.0-4.0
,Correct Answer: C
Rationale: The target INR for warfarin therapy in atrial fibrillation is 2.0-3.0, which
provides adequate anticoagulation while minimizing bleeding risk. INR <2.0 (A, B)
provides insufficient stroke prevention; INR >3.0 (D) significantly increases bleeding risk
without additional therapeutic benefit for standard AF management.
Q3: A patient receiving intravenous nitroglycerin for acute angina develops severe
hypotension (BP 70/40). The nurse's priority intervention is:
A. Increase the nitroglycerin infusion rate
B. Stop the infusion immediately and place the patient in Trendelenburg position
[CORRECT]
C. Administer a beta-blocker
D. Continue the infusion and notify the provider
Correct Answer: B
Rationale: Nitroglycerin causes venous and arterial dilation; severe hypotension is a
life-threatening adverse effect requiring immediate discontinuation and positioning to
improve cerebral perfusion. Increasing the rate (A) worsens hypotension; beta-blockers
(C) further lower BP; continuing the infusion (D) is dangerous.
Q4: Which finding in a patient taking an angiotensin-converting enzyme (ACE) inhibitor
(lisinopril) requires immediate nursing intervention?
A. Dry cough
B. Angioedema (swelling of lips, tongue, or face) [CORRECT]
C. Mild dizziness
D. Hyperkalemia (K+ 5.2 mEq/L)
Correct Answer: B
, Rationale: Angioedema is a rare but life-threatening adverse effect of ACE inhibitors that
can rapidly progress to airway obstruction. It requires immediate discontinuation of the
drug and emergency intervention. Dry cough (A) is common but not emergent; mild
dizziness (C) is expected; hyperkalemia (D) requires monitoring but angioedema takes
priority.
Q5: A patient with acute coronary syndrome (ACS) is prescribed clopidogrel (Plavix) 75
mg daily. The nurse understands this medication works by:
A. Inhibiting thrombin formation
B. Inhibiting platelet aggregation by blocking ADP receptors [CORRECT]
C. Dissolving existing clots
D. Increasing fibrinogen levels
Correct Answer: B
Rationale: Clopidogrel is a P2Y12 ADP receptor antagonist that inhibits platelet
aggregation, preventing clot formation in ACS and post-stent placement. It does not
inhibit thrombin (A—that's heparin/direct thrombin inhibitors), dissolve clots (C—that's
thrombolytics), or increase fibrinogen (D).
Q6: A patient with heart failure has the following vital signs: BP 90/60, HR 110, RR 24,
SpO2 88% on room air. The patient reports severe dyspnea and has crackles throughout
both lung fields. The nurse recognizes this as:
A. Right-sided heart failure
B. Acute pulmonary edema from left-sided heart failure [CORRECT]
C. Stable chronic heart failure
D. Cardiogenic shock
Correct Answer: B
