Below are 25 Wolters Kluwer/Next Generation NCLEX (NGN)-style practice questions with
answers and rationales based on Lippincott CoursePoint Enhanced for Brunner & Suddarth’s
Textbook of Medical-Surgical Nursing, 15th Edition. These questions reflect the textbook’s
evidence-based content from Chapters 25–27 (Module 8) and incorporate various
NGN formats such as multiple-choice, multiple-response, case studies, and enhanced hotspot
questions. Each question includes a rationale aligned with the textbook.
Multiple-Choice Questions
1. Question: A 65-year-old male with a history of hypertension and smoking reports chest
pain during exertion that resolves with rest. What is the most likely physiological
explanation for this symptom?
a) Plaque rupture causing thrombus formation
b) Increased myocardial oxygen demand exceeding supply
c) Pulmonary congestion from left-sided heart failure
d) Vasospasm of the coronary arteries
Answer: b) Increased myocardial oxygen demand exceeding supply
Rationale: The textbook explains that stable angina, as described (pain with exertion,
relieved by rest), occurs when fixed atherosclerotic narrowing limits coronary blood
flow, causing a supply-demand mismatch during activity (Chapter 25). Plaque rupture (a)
is associated with unstable angina, pulmonary congestion (c) with heart failure, and
vasospasm (d) with Prinzmetal’s angina.
2. Question: A nurse is caring for a patient with left-sided heart failure who reports dyspnea
when lying flat. What is the best initial nursing action?
a) Administer a loop diuretic as prescribed
b) Position the patient in high Fowler’s position
c) Obtain a chest X-ray to confirm pulmonary edema
d) Increase the patient’s oxygen flow rate to 6 L/min
Answer: b) Position the patient in high Fowler’s position
Rationale: The textbook prioritizes positioning in high Fowler’s to reduce preload and
ease breathing in acute heart failure by promoting venous pooling in the lower
extremities (Chapter 25). Diuretics (a) and oxygen (d) are subsequent steps, while a chest
X-ray (c) is diagnostic, not an initial intervention.
3. Question: A patient with hypertension asks, “Why do I need an ACE inhibitor if my
blood pressure isn’t high today?” What is the nurse’s best response?
a) “It helps reduce strain on your heart even when your blood pressure is normal.”
b) “It only works when your blood pressure is high, so you can skip it today.”
c) “It prevents kidney damage by increasing blood flow.”
d) “It’s just a precaution in case your blood pressure rises suddenly.”
Answer: a) “It helps reduce strain on your heart even when your blood pressure is
normal.”
Rationale: The textbook states that ACE inhibitors reduce afterload and prevent cardiac
remodeling in heart failure, independent of daily BP readings (Chapter 25). Options b, c,
and d misrepresent their role.
, 4. Question: A patient with peripheral artery disease (PAD) has pale, cool feet that turn red
when dangled. What does this finding indicate?
a) Venous insufficiency
b) Dependent rubor
c) Lymphatic obstruction
d) Deep vein thrombosis
Answer: b) Dependent rubor
Rationale: The textbook describes dependent rubor as a sign of arterial insufficiency in
PAD, where elevation causes pallor due to poor inflow, and dependency leads to
sluggish, oxygen-poor blood pooling (Chapter 26). Other options do not match this
presentation.
5. Question: A patient with a BP of 210/120 mmHg denies symptoms. What is the
appropriate classification of this hypertensive crisis?
a) Hypertensive emergency
b) Hypertensive urgency
c) Stage 2 hypertension
d) White coat hypertension
Answer: b) Hypertensive urgency
Rationale: The textbook defines hypertensive urgency as BP >180/120 mmHg without
organ damage symptoms, managed with oral antihypertensives (Chapter 27). An
emergency (a) involves organ damage, while c and d do not apply to acute crises.
Multiple-Response Questions (Select All That Apply)
6. Question: A nurse is assessing a patient with suspected cardiogenic shock. Which
findings should the nurse expect? (Select all that apply.)
a) Hypotension
b) Warm, dry skin
c) Confusion
d) Tachycardia
e) Increased urine output
Answers: a) Hypotension, c) Confusion, d) Tachycardia
Rationale: The textbook lists hypotension, confusion (from hypoperfusion), and
tachycardia (compensatory response) as signs of cardiogenic shock (Chapter 25). Warm,
dry skin (b) and increased urine output (e) indicate adequate perfusion, not shock.
7. Question: Which interventions should a nurse include in the care plan for a patient with
chronic venous insufficiency (CVI)? (Select all that apply.)
a) Encourage leg elevation
b) Apply compression stockings
c) Teach the patient to avoid prolonged standing
d) Administer anticoagulants prophylactically
e) Promote daily walking
Answers: a) Encourage leg elevation, b) Apply compression stockings, c) Teach the
patient to avoid prolonged standing
answers and rationales based on Lippincott CoursePoint Enhanced for Brunner & Suddarth’s
Textbook of Medical-Surgical Nursing, 15th Edition. These questions reflect the textbook’s
evidence-based content from Chapters 25–27 (Module 8) and incorporate various
NGN formats such as multiple-choice, multiple-response, case studies, and enhanced hotspot
questions. Each question includes a rationale aligned with the textbook.
Multiple-Choice Questions
1. Question: A 65-year-old male with a history of hypertension and smoking reports chest
pain during exertion that resolves with rest. What is the most likely physiological
explanation for this symptom?
a) Plaque rupture causing thrombus formation
b) Increased myocardial oxygen demand exceeding supply
c) Pulmonary congestion from left-sided heart failure
d) Vasospasm of the coronary arteries
Answer: b) Increased myocardial oxygen demand exceeding supply
Rationale: The textbook explains that stable angina, as described (pain with exertion,
relieved by rest), occurs when fixed atherosclerotic narrowing limits coronary blood
flow, causing a supply-demand mismatch during activity (Chapter 25). Plaque rupture (a)
is associated with unstable angina, pulmonary congestion (c) with heart failure, and
vasospasm (d) with Prinzmetal’s angina.
2. Question: A nurse is caring for a patient with left-sided heart failure who reports dyspnea
when lying flat. What is the best initial nursing action?
a) Administer a loop diuretic as prescribed
b) Position the patient in high Fowler’s position
c) Obtain a chest X-ray to confirm pulmonary edema
d) Increase the patient’s oxygen flow rate to 6 L/min
Answer: b) Position the patient in high Fowler’s position
Rationale: The textbook prioritizes positioning in high Fowler’s to reduce preload and
ease breathing in acute heart failure by promoting venous pooling in the lower
extremities (Chapter 25). Diuretics (a) and oxygen (d) are subsequent steps, while a chest
X-ray (c) is diagnostic, not an initial intervention.
3. Question: A patient with hypertension asks, “Why do I need an ACE inhibitor if my
blood pressure isn’t high today?” What is the nurse’s best response?
a) “It helps reduce strain on your heart even when your blood pressure is normal.”
b) “It only works when your blood pressure is high, so you can skip it today.”
c) “It prevents kidney damage by increasing blood flow.”
d) “It’s just a precaution in case your blood pressure rises suddenly.”
Answer: a) “It helps reduce strain on your heart even when your blood pressure is
normal.”
Rationale: The textbook states that ACE inhibitors reduce afterload and prevent cardiac
remodeling in heart failure, independent of daily BP readings (Chapter 25). Options b, c,
and d misrepresent their role.
, 4. Question: A patient with peripheral artery disease (PAD) has pale, cool feet that turn red
when dangled. What does this finding indicate?
a) Venous insufficiency
b) Dependent rubor
c) Lymphatic obstruction
d) Deep vein thrombosis
Answer: b) Dependent rubor
Rationale: The textbook describes dependent rubor as a sign of arterial insufficiency in
PAD, where elevation causes pallor due to poor inflow, and dependency leads to
sluggish, oxygen-poor blood pooling (Chapter 26). Other options do not match this
presentation.
5. Question: A patient with a BP of 210/120 mmHg denies symptoms. What is the
appropriate classification of this hypertensive crisis?
a) Hypertensive emergency
b) Hypertensive urgency
c) Stage 2 hypertension
d) White coat hypertension
Answer: b) Hypertensive urgency
Rationale: The textbook defines hypertensive urgency as BP >180/120 mmHg without
organ damage symptoms, managed with oral antihypertensives (Chapter 27). An
emergency (a) involves organ damage, while c and d do not apply to acute crises.
Multiple-Response Questions (Select All That Apply)
6. Question: A nurse is assessing a patient with suspected cardiogenic shock. Which
findings should the nurse expect? (Select all that apply.)
a) Hypotension
b) Warm, dry skin
c) Confusion
d) Tachycardia
e) Increased urine output
Answers: a) Hypotension, c) Confusion, d) Tachycardia
Rationale: The textbook lists hypotension, confusion (from hypoperfusion), and
tachycardia (compensatory response) as signs of cardiogenic shock (Chapter 25). Warm,
dry skin (b) and increased urine output (e) indicate adequate perfusion, not shock.
7. Question: Which interventions should a nurse include in the care plan for a patient with
chronic venous insufficiency (CVI)? (Select all that apply.)
a) Encourage leg elevation
b) Apply compression stockings
c) Teach the patient to avoid prolonged standing
d) Administer anticoagulants prophylactically
e) Promote daily walking
Answers: a) Encourage leg elevation, b) Apply compression stockings, c) Teach the
patient to avoid prolonged standing
