NUR209 EXAM 4 \NUR 209 MEDICAL SURGICAL NURSING II ACTUAL EXAM 4
LATEST 2026/2027 ACCURATE TEST COMPLETE APPROVED QUESTIONS AND
CORRECT DETAILED ANSWERS WITH RATIONALES (100% CORRECT
VERIFIED SOLUTIONS) CURRENTLY UPDATED VERSION |GUARANTEED PASS
A+ (BRAND NEW!) |FORTIS
A nurse notices gross hematuria in a patient who is receiving their third dose of Cyclophosphamide
(Cytoxan). What is the nurse's priority action?
A. Document the finding as an expected side effect.
B. Notify the provider and assess the patient's fluid intake.
C. Administer the next dose with a full glass of water.
D. Request an order for a vitamin K supplement.
Correct Answer: B. Notify the provider and assess the patient's fluid intake. Hematuria in a patient
taking Cyclophosphamide suggests hemorrhagic cystitis, a serious adverse effect. The nurse should
notify the provider and assess hydration status, as adequate fluid intake is crucial for prevention.
A patient with a history of COPD asks the nurse about taking dextromethorphan for a cough. What is the
nurse's best response?
A. "This medication is safe and effective for treating your cough."
B. "You should not take this because it can suppress the cough you need to clear your airways."
C. "Take this only at night so it doesn't interfere with your breathing during the day."
D. "This medication is combined with an expectorant, so it will help you cough up mucus."
Correct Answer: B. "You should not take this because it can suppress the cough you need to clear your
airways." Dextromethorphan is an antitussive for non-productive coughs. Patients with COPD often have
productive coughs to clear secretions, and suppressing this reflex can be harmful.
A patient asks the nurse why two different chemotherapy drugs are being used to treat their cancer. The
nurse's response is based on the understanding that combination chemotherapy is used to:
A. Minimize the adverse effects of each individual drug.
B. Allow for a shorter overall course of treatment.
C. Decrease drug resistance and increase destruction of cancer cells.
,D. Target only the cancer cells that are actively dividing.
Correct Answer: C. Decrease drug resistance and increase destruction of cancer cells. Combination
chemotherapy uses drugs with different mechanisms of action to target cancer cells at various points in
the cell cycle, which maximizes cell kill and reduces the likelihood of drug resistance.
A patient has been receiving an erythropoietin-stimulating agent (ESA) for 8 weeks. Their hemoglobin
level remains at 8 g/ld., the same as it was at week 3 of therapy. The nurse anticipates an order for:
A. A complete blood count and serum iron levels.
B. An increased dose of the ESA.
C. More frequent dosing of the ESA.
D. Packed red blood cell infusions.
Correct Answer: A. A complete blood count and serum iron levels. A poor response to ESA therapy is
often due to iron deficiency. Before changing the dose or considering transfusions, the nurse should
expect the provider to assess iron stores.
A patient is brought to the emergency department 16 hours after ingesting a large quantity of extra-
strength acetaminophen. The nurse will expect the provider to order:
A. Gastric lavage.
B. Activated charcoal.
C. Acetyl cysteine (Mucomyst).
D. Liver enzyme tests only.
Correct Answer: C. Acetyl cysteine (Mucomyst). Acetyl cysteine is the antidote for acetaminophen
overdose and is most effective if given within 12-24 hours of ingestion.
A client with heart failure reports a weight gain of 2 kg (4.4 lbs.) over 2 days. What should the nurse do
first?
A. Notify the healthcare provider.
B. Restrict oral fluids.
C. Administer a PRN dose of a diuretic.
,D. Assess for peripheral edema and lung sounds.
Correct Answer: D. Assess for peripheral edema and lung sounds. The nurse must first assess the client
to gather more data about the potential fluid retention before implementing any interventions or
notifying the provider.
Which electrolyte imbalance increases a patient's risk for developing digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Correct Answer: B. Hypokalemia. Low serum potassium levels make the myocardium more sensitive to
digoxin, significantly increasing the risk of toxicity.
A client with an acute myocardial infarction reports crushing chest pain rated 9/10. Which medication
should the nurse administer first?
A. Morphine sulfate
B. Sublingual nitroglycerin
C. Chewed aspirin
D. Supplemental oxygen
Correct Answer: C. Chewed aspirin. Aspirin is a priority in MI management because it rapidly inhibits
platelet aggregation, reducing mortality. While the other interventions are important, aspirin should be
given immediately, often before the ECG is obtained.
Which assessment finding in a client with heart failure indicates worsening of their condition and
requires immediate follow-up?
A. Decreased urine output
B. New onset of crackles in the lung bases
C. Increase in blood pressure from 120/80 to 130/85
, D. Report of fatigue after ambulating in the hall
Correct Answer: B. New onset of crackles in the lung bases. Crackles indicate pulmonary congestion due
to fluid overload, a classic sign of worsening heart failure.
A nurse teaches a patient about using sublingual nitroglycerin for angina. Which statement by the
patient indicates correct understanding?
A. "I should swallow the tablet with a full glass of water for faster effect."
B. "I can store the pills in a pillbox in my bathroom medicine cabinet."
C. "I will place the tablet under my tongue and let it dissolve."
D. "I should chew the tablet to break it up for faster absorption."
Correct Answer: C. "I will place the tablet under my tongue and let it dissolve." Nitroglycerin must be
absorbed through the sublingual mucosa to avoid first-pass metabolism in the liver and achieve rapid
effect.
Which position is most effective for improving breathing in a patient experiencing an acute exacerbation
of COPD?
A. Supine with legs elevated
B. High Fowler's
C. Trendelenburg
D. Left lateral recumbent
Correct Answer: B. High Fowler's. Sitting upright (High Fowler's) allows for maximum lung expansion by
decreasing the pressure of abdominal contents on the diaphragm.
A patient with diabetes reports feeling shaky, sweaty, and confused. What is the nurse's priority action?
A. Administer 10 units of regular insulin.
B. Give the patient 4 ounces of orange juice.
C. Reassure the patient and have them lie down.
D. Check the patient's blood glucose level.
LATEST 2026/2027 ACCURATE TEST COMPLETE APPROVED QUESTIONS AND
CORRECT DETAILED ANSWERS WITH RATIONALES (100% CORRECT
VERIFIED SOLUTIONS) CURRENTLY UPDATED VERSION |GUARANTEED PASS
A+ (BRAND NEW!) |FORTIS
A nurse notices gross hematuria in a patient who is receiving their third dose of Cyclophosphamide
(Cytoxan). What is the nurse's priority action?
A. Document the finding as an expected side effect.
B. Notify the provider and assess the patient's fluid intake.
C. Administer the next dose with a full glass of water.
D. Request an order for a vitamin K supplement.
Correct Answer: B. Notify the provider and assess the patient's fluid intake. Hematuria in a patient
taking Cyclophosphamide suggests hemorrhagic cystitis, a serious adverse effect. The nurse should
notify the provider and assess hydration status, as adequate fluid intake is crucial for prevention.
A patient with a history of COPD asks the nurse about taking dextromethorphan for a cough. What is the
nurse's best response?
A. "This medication is safe and effective for treating your cough."
B. "You should not take this because it can suppress the cough you need to clear your airways."
C. "Take this only at night so it doesn't interfere with your breathing during the day."
D. "This medication is combined with an expectorant, so it will help you cough up mucus."
Correct Answer: B. "You should not take this because it can suppress the cough you need to clear your
airways." Dextromethorphan is an antitussive for non-productive coughs. Patients with COPD often have
productive coughs to clear secretions, and suppressing this reflex can be harmful.
A patient asks the nurse why two different chemotherapy drugs are being used to treat their cancer. The
nurse's response is based on the understanding that combination chemotherapy is used to:
A. Minimize the adverse effects of each individual drug.
B. Allow for a shorter overall course of treatment.
C. Decrease drug resistance and increase destruction of cancer cells.
,D. Target only the cancer cells that are actively dividing.
Correct Answer: C. Decrease drug resistance and increase destruction of cancer cells. Combination
chemotherapy uses drugs with different mechanisms of action to target cancer cells at various points in
the cell cycle, which maximizes cell kill and reduces the likelihood of drug resistance.
A patient has been receiving an erythropoietin-stimulating agent (ESA) for 8 weeks. Their hemoglobin
level remains at 8 g/ld., the same as it was at week 3 of therapy. The nurse anticipates an order for:
A. A complete blood count and serum iron levels.
B. An increased dose of the ESA.
C. More frequent dosing of the ESA.
D. Packed red blood cell infusions.
Correct Answer: A. A complete blood count and serum iron levels. A poor response to ESA therapy is
often due to iron deficiency. Before changing the dose or considering transfusions, the nurse should
expect the provider to assess iron stores.
A patient is brought to the emergency department 16 hours after ingesting a large quantity of extra-
strength acetaminophen. The nurse will expect the provider to order:
A. Gastric lavage.
B. Activated charcoal.
C. Acetyl cysteine (Mucomyst).
D. Liver enzyme tests only.
Correct Answer: C. Acetyl cysteine (Mucomyst). Acetyl cysteine is the antidote for acetaminophen
overdose and is most effective if given within 12-24 hours of ingestion.
A client with heart failure reports a weight gain of 2 kg (4.4 lbs.) over 2 days. What should the nurse do
first?
A. Notify the healthcare provider.
B. Restrict oral fluids.
C. Administer a PRN dose of a diuretic.
,D. Assess for peripheral edema and lung sounds.
Correct Answer: D. Assess for peripheral edema and lung sounds. The nurse must first assess the client
to gather more data about the potential fluid retention before implementing any interventions or
notifying the provider.
Which electrolyte imbalance increases a patient's risk for developing digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Correct Answer: B. Hypokalemia. Low serum potassium levels make the myocardium more sensitive to
digoxin, significantly increasing the risk of toxicity.
A client with an acute myocardial infarction reports crushing chest pain rated 9/10. Which medication
should the nurse administer first?
A. Morphine sulfate
B. Sublingual nitroglycerin
C. Chewed aspirin
D. Supplemental oxygen
Correct Answer: C. Chewed aspirin. Aspirin is a priority in MI management because it rapidly inhibits
platelet aggregation, reducing mortality. While the other interventions are important, aspirin should be
given immediately, often before the ECG is obtained.
Which assessment finding in a client with heart failure indicates worsening of their condition and
requires immediate follow-up?
A. Decreased urine output
B. New onset of crackles in the lung bases
C. Increase in blood pressure from 120/80 to 130/85
, D. Report of fatigue after ambulating in the hall
Correct Answer: B. New onset of crackles in the lung bases. Crackles indicate pulmonary congestion due
to fluid overload, a classic sign of worsening heart failure.
A nurse teaches a patient about using sublingual nitroglycerin for angina. Which statement by the
patient indicates correct understanding?
A. "I should swallow the tablet with a full glass of water for faster effect."
B. "I can store the pills in a pillbox in my bathroom medicine cabinet."
C. "I will place the tablet under my tongue and let it dissolve."
D. "I should chew the tablet to break it up for faster absorption."
Correct Answer: C. "I will place the tablet under my tongue and let it dissolve." Nitroglycerin must be
absorbed through the sublingual mucosa to avoid first-pass metabolism in the liver and achieve rapid
effect.
Which position is most effective for improving breathing in a patient experiencing an acute exacerbation
of COPD?
A. Supine with legs elevated
B. High Fowler's
C. Trendelenburg
D. Left lateral recumbent
Correct Answer: B. High Fowler's. Sitting upright (High Fowler's) allows for maximum lung expansion by
decreasing the pressure of abdominal contents on the diaphragm.
A patient with diabetes reports feeling shaky, sweaty, and confused. What is the nurse's priority action?
A. Administer 10 units of regular insulin.
B. Give the patient 4 ounces of orange juice.
C. Reassure the patient and have them lie down.
D. Check the patient's blood glucose level.
