MD3 - FINAL EXAM | QUESTIONS AND ANSWERS | 2025/2026 UPDATE |
WITH COMPLETE SOLUTION!!
Question 1
A 65-year-old female presents to the emergency department with epigastric pain, nausea, and
profound fatigue. She denies chest pain. The nurse recognizes that these symptoms in a female
could represent an atypical presentation of which of the following conditions?
A) Acute cholecystitis
B) Aortic dissection
C) Acute coronary syndrome
D) Anemia
Correct Answer: C) Acute coronary syndrome
Rationale: While men often present with classic substernal chest pain, women, older adults,
and patients with diabetes frequently present with atypical symptoms of acute coronary
syndrome (ACS). These can include shortness of breath, nausea, dizziness, or epigastric
pain.
Question 2
A client's electrocardiogram (ECG) shows a new ST-segment elevation in two contiguous leads.
This finding, combined with an elevated troponin level, is a key diagnostic indicator for:
A) Atrial fibrillation
B) Pericarditis
C) ST-elevation myocardial infarction (STEMI)
D) Stable angina
Correct Answer: C) ST-elevation myocardial infarction (STEMI)
Rationale: ST-segment elevation on an ECG indicates transmural myocardial injury and is
a hallmark of a STEMI. When paired with a positive cardiac biomarker like troponin, it
confirms the diagnosis of an acute myocardial infarction.
Question 3
A client experiencing an acute myocardial infarction (MI) is prescribed MONA as a part of their
initial treatment. Which component of MONA should the nurse administer first?
A) Morphine
B) Oxygen
C) Nitroglycerin
D) Aspirin
Correct Answer: D) Aspirin
Rationale: While all components are important, early administration of aspirin is critical.
Having the patient chew an aspirin (162-325 mg) provides rapid antiplatelet effects, which
can help prevent the progression of the coronary thrombus and has been shown to reduce
mortality.
,[Type here]
Question 4
A client is diagnosed with a STEMI and is a candidate for reperfusion therapy. A contraindication
for administering a thrombolytic agent such as alteplase would be:
A) A blood pressure of 160/95 mmHg.
B) A history of a recent ischemic stroke or active bleeding.
C) The client is currently taking aspirin.
D) The onset of chest pain was 4 hours ago.
Correct Answer: B) A history of a recent ischemic stroke or active bleeding.
Rationale: Thrombolytics work by dissolving existing clots. They are contraindicated in any
situation where there is a high risk of life-threatening bleeding, such as a recent
hemorrhagic stroke, a known intracranial neoplasm, or current active internal bleeding.
Question 5
A nurse is assessing a client with severe anemia. Which of the following skin changes would be
an expected finding?
A) Flushed, warm skin
B) Jaundice and cyanosis
C) Pallor and cool skin
D) Petechiae and purpura
Correct Answer: C) Pallor and cool skin
Rationale: Anemia is a deficiency of red blood cells or hemoglobin. This leads to reduced
oxygen-carrying capacity and can cause peripheral vasoconstriction to shunt blood to vital
organs. The result is pale (pallor) and cool skin and mucous membranes.
Question 6
A client is diagnosed with iron-deficiency anemia and is prescribed an oral iron supplement.
Which of the following instructions should the nurse provide?
A) "Take the iron supplement with a large glass of milk to prevent stomach upset."
B) "It is normal for your stools to become black or tarry while taking this medication."
C) "You should stop taking the supplement if you experience constipation."
D) "Take the iron on an empty stomach and avoid orange juice."
Correct Answer: B) "It is normal for your stools to become black or tarry while taking this
medication."
Rationale: Oral iron supplements commonly turn the stool a dark green or black color. This
is a normal and harmless side effect, and educating the client about it can prevent
unnecessary anxiety. Iron should be taken with vitamin C (like orange juice) to enhance
absorption and should not be taken with milk, which can inhibit absorption.
Question 7
A client with a history of alcoholism presents with anemia. Laboratory tests reveal a macrocytic
,[Type here]
anemia. The nurse should anticipate that this client requires education on increasing their intake
of which of the following?
A) Iron
B) Vitamin B12
C) Folate
D) Vitamin K
Correct Answer: C) Folate
Rationale: Alcoholism is a major risk factor for folate deficiency due to poor dietary intake,
malabsorption, and altered folate metabolism. Folate deficiency is a common cause of
macrocytic (megaloblastic) anemia.
Question 8
A client is admitted to the emergency department with a suspected thoracic aortic dissection,
reporting a severe, "tearing" chest pain that radiates to their back. What is the priority nursing
action?
A) Administer a full-dose aspirin.
B) Prepare the client for immediate surgery.
C) Establish two large-bore IVs and rapidly infuse normal saline.
D) Administer medications to lower blood pressure and heart rate.
Correct Answer: D) Administer medications to lower blood pressure and heart rate.
Rationale: The immediate goal in managing an aortic dissection is to reduce aortic wall
stress to prevent the propagation of the dissection and potential rupture. This is achieved
by aggressively lowering the heart rate (to reduce shear stress) and blood pressure (target
systolic 100-120 mmHg) using IV beta-blockers and vasodilators.
Question 9
Which of the following is a major, modifiable risk factor for the development of atherosclerosis?
A) Age over 65
B) Male gender
C) Family history of heart disease
D) Hyperlipidemia
Correct Answer: D) Hyperlipidemia
Rationale: While age, gender, and genetics are non-modifiable risk factors, hyperlipidemia
(specifically high LDL cholesterol) is a key modifiable risk factor. Elevated LDL
contributes directly to the formation of atherosclerotic plaques. It can be managed with
diet, exercise, and medications like statins.
Question 10
A nurse is providing dietary education to a client with atherosclerosis. The nurse should
recommend the DASH diet, which emphasizes:
, [Type here]
A) High intake of red meat and full-fat dairy.
B) Increased consumption of fruits, vegetables, and whole grains.
C) A diet high in sodium and saturated fats.
D) Limiting intake of fish and poultry.
Correct Answer: B) Increased consumption of fruits, vegetables, and whole grains.
Rationale: The DASH (Dietary Approaches to Stop Hypertension) diet is a heart-healthy
eating plan. It is rich in fruits, vegetables, whole grains, and low-fat dairy, and low in
saturated fat, total fat, cholesterol, and sodium. It has been proven to lower blood pressure
and LDL cholesterol.
Question 11
A client is brought to the emergency department and is found to be in asystole. After confirming
the rhythm in two leads, what is the immediate priority action?
A) Deliver an unsynchronized shock (defibrillation).
B) Administer a dose of amiodarone.
C) Start high-quality CPR (compressions).
D) Administer a dose of epinephrine.
Correct Answer: C) Start high-quality CPR (compressions).
Rationale: Asystole is a non-shockable rhythm. The immediate priority according to ACLS
guidelines is to begin high-quality chest compressions to provide circulation, while also
managing the airway and preparing to administer epinephrine.
Question 12
A major complication of atrial fibrillation is the formation of thrombi in the left atrial appendage.
These clots can dislodge and travel to the brain, causing what type of event?
A) Hemorrhagic stroke
B) Embolic (ischemic) stroke
C) Transient ischemic attack (TIA)
D) Subdural hematoma
Correct Answer: B) Embolic (ischemic) stroke
Rationale: The quivering of the atria in atrial fibrillation leads to blood stasis, which
promotes clot formation. If a clot from the left atrium breaks off, it can travel through the
systemic circulation and lodge in a cerebral artery, blocking blood flow and causing an
embolic stroke.
Question 13
A client with atrial fibrillation has a heart rate of 140 bpm and is symptomatic. The initial goal of
pharmacologic management is to:
A) Convert the rhythm to normal sinus rhythm.
B) Control the ventricular rate.
WITH COMPLETE SOLUTION!!
Question 1
A 65-year-old female presents to the emergency department with epigastric pain, nausea, and
profound fatigue. She denies chest pain. The nurse recognizes that these symptoms in a female
could represent an atypical presentation of which of the following conditions?
A) Acute cholecystitis
B) Aortic dissection
C) Acute coronary syndrome
D) Anemia
Correct Answer: C) Acute coronary syndrome
Rationale: While men often present with classic substernal chest pain, women, older adults,
and patients with diabetes frequently present with atypical symptoms of acute coronary
syndrome (ACS). These can include shortness of breath, nausea, dizziness, or epigastric
pain.
Question 2
A client's electrocardiogram (ECG) shows a new ST-segment elevation in two contiguous leads.
This finding, combined with an elevated troponin level, is a key diagnostic indicator for:
A) Atrial fibrillation
B) Pericarditis
C) ST-elevation myocardial infarction (STEMI)
D) Stable angina
Correct Answer: C) ST-elevation myocardial infarction (STEMI)
Rationale: ST-segment elevation on an ECG indicates transmural myocardial injury and is
a hallmark of a STEMI. When paired with a positive cardiac biomarker like troponin, it
confirms the diagnosis of an acute myocardial infarction.
Question 3
A client experiencing an acute myocardial infarction (MI) is prescribed MONA as a part of their
initial treatment. Which component of MONA should the nurse administer first?
A) Morphine
B) Oxygen
C) Nitroglycerin
D) Aspirin
Correct Answer: D) Aspirin
Rationale: While all components are important, early administration of aspirin is critical.
Having the patient chew an aspirin (162-325 mg) provides rapid antiplatelet effects, which
can help prevent the progression of the coronary thrombus and has been shown to reduce
mortality.
,[Type here]
Question 4
A client is diagnosed with a STEMI and is a candidate for reperfusion therapy. A contraindication
for administering a thrombolytic agent such as alteplase would be:
A) A blood pressure of 160/95 mmHg.
B) A history of a recent ischemic stroke or active bleeding.
C) The client is currently taking aspirin.
D) The onset of chest pain was 4 hours ago.
Correct Answer: B) A history of a recent ischemic stroke or active bleeding.
Rationale: Thrombolytics work by dissolving existing clots. They are contraindicated in any
situation where there is a high risk of life-threatening bleeding, such as a recent
hemorrhagic stroke, a known intracranial neoplasm, or current active internal bleeding.
Question 5
A nurse is assessing a client with severe anemia. Which of the following skin changes would be
an expected finding?
A) Flushed, warm skin
B) Jaundice and cyanosis
C) Pallor and cool skin
D) Petechiae and purpura
Correct Answer: C) Pallor and cool skin
Rationale: Anemia is a deficiency of red blood cells or hemoglobin. This leads to reduced
oxygen-carrying capacity and can cause peripheral vasoconstriction to shunt blood to vital
organs. The result is pale (pallor) and cool skin and mucous membranes.
Question 6
A client is diagnosed with iron-deficiency anemia and is prescribed an oral iron supplement.
Which of the following instructions should the nurse provide?
A) "Take the iron supplement with a large glass of milk to prevent stomach upset."
B) "It is normal for your stools to become black or tarry while taking this medication."
C) "You should stop taking the supplement if you experience constipation."
D) "Take the iron on an empty stomach and avoid orange juice."
Correct Answer: B) "It is normal for your stools to become black or tarry while taking this
medication."
Rationale: Oral iron supplements commonly turn the stool a dark green or black color. This
is a normal and harmless side effect, and educating the client about it can prevent
unnecessary anxiety. Iron should be taken with vitamin C (like orange juice) to enhance
absorption and should not be taken with milk, which can inhibit absorption.
Question 7
A client with a history of alcoholism presents with anemia. Laboratory tests reveal a macrocytic
,[Type here]
anemia. The nurse should anticipate that this client requires education on increasing their intake
of which of the following?
A) Iron
B) Vitamin B12
C) Folate
D) Vitamin K
Correct Answer: C) Folate
Rationale: Alcoholism is a major risk factor for folate deficiency due to poor dietary intake,
malabsorption, and altered folate metabolism. Folate deficiency is a common cause of
macrocytic (megaloblastic) anemia.
Question 8
A client is admitted to the emergency department with a suspected thoracic aortic dissection,
reporting a severe, "tearing" chest pain that radiates to their back. What is the priority nursing
action?
A) Administer a full-dose aspirin.
B) Prepare the client for immediate surgery.
C) Establish two large-bore IVs and rapidly infuse normal saline.
D) Administer medications to lower blood pressure and heart rate.
Correct Answer: D) Administer medications to lower blood pressure and heart rate.
Rationale: The immediate goal in managing an aortic dissection is to reduce aortic wall
stress to prevent the propagation of the dissection and potential rupture. This is achieved
by aggressively lowering the heart rate (to reduce shear stress) and blood pressure (target
systolic 100-120 mmHg) using IV beta-blockers and vasodilators.
Question 9
Which of the following is a major, modifiable risk factor for the development of atherosclerosis?
A) Age over 65
B) Male gender
C) Family history of heart disease
D) Hyperlipidemia
Correct Answer: D) Hyperlipidemia
Rationale: While age, gender, and genetics are non-modifiable risk factors, hyperlipidemia
(specifically high LDL cholesterol) is a key modifiable risk factor. Elevated LDL
contributes directly to the formation of atherosclerotic plaques. It can be managed with
diet, exercise, and medications like statins.
Question 10
A nurse is providing dietary education to a client with atherosclerosis. The nurse should
recommend the DASH diet, which emphasizes:
, [Type here]
A) High intake of red meat and full-fat dairy.
B) Increased consumption of fruits, vegetables, and whole grains.
C) A diet high in sodium and saturated fats.
D) Limiting intake of fish and poultry.
Correct Answer: B) Increased consumption of fruits, vegetables, and whole grains.
Rationale: The DASH (Dietary Approaches to Stop Hypertension) diet is a heart-healthy
eating plan. It is rich in fruits, vegetables, whole grains, and low-fat dairy, and low in
saturated fat, total fat, cholesterol, and sodium. It has been proven to lower blood pressure
and LDL cholesterol.
Question 11
A client is brought to the emergency department and is found to be in asystole. After confirming
the rhythm in two leads, what is the immediate priority action?
A) Deliver an unsynchronized shock (defibrillation).
B) Administer a dose of amiodarone.
C) Start high-quality CPR (compressions).
D) Administer a dose of epinephrine.
Correct Answer: C) Start high-quality CPR (compressions).
Rationale: Asystole is a non-shockable rhythm. The immediate priority according to ACLS
guidelines is to begin high-quality chest compressions to provide circulation, while also
managing the airway and preparing to administer epinephrine.
Question 12
A major complication of atrial fibrillation is the formation of thrombi in the left atrial appendage.
These clots can dislodge and travel to the brain, causing what type of event?
A) Hemorrhagic stroke
B) Embolic (ischemic) stroke
C) Transient ischemic attack (TIA)
D) Subdural hematoma
Correct Answer: B) Embolic (ischemic) stroke
Rationale: The quivering of the atria in atrial fibrillation leads to blood stasis, which
promotes clot formation. If a clot from the left atrium breaks off, it can travel through the
systemic circulation and lodge in a cerebral artery, blocking blood flow and causing an
embolic stroke.
Question 13
A client with atrial fibrillation has a heart rate of 140 bpm and is symptomatic. The initial goal of
pharmacologic management is to:
A) Convert the rhythm to normal sinus rhythm.
B) Control the ventricular rate.
