NUR 209 Medical-Surgical Nursing II – Exam Review
/ High-Yield Notes / Practice Questions (2026) |
Exam 3: Complex Conditions & Multi-System
Dysfunction
Instructions: Choose the single best answer for each question.
Clinical scenarios require application of knowledge and
prioritization skills.
Cardiovascular Disorders (Questions 1-20)
1. A nurse is assessing a client with suspected left-sided heart failure. Which of the
following findings is the nurse most likely to encounter?
A. Jugular vein distention
B. Hepatomegaly
C. Bibasilar crackles
D. Peripheral edema
Answer: C. Bibasilar crackles
Rationale: Left-sided heart failure occurs when the left ventricle cannot effectively
pump blood out to the body, causing blood to back up into the pulmonary circulation.
This results in pulmonary congestion, leading to crackles (rales) in the lung bases. JVD,
hepatomegaly, and peripheral edema are classic signs of right-sided heart failure.
2. A client with an acute myocardial infarction (MI) receives thrombolytic therapy.
Which assessment finding would indicate to the nurse that the therapy is
effective?
A. Decreased creatine kinase-MB levels
B. Increase in troponin I levels
C. Resolution of chest pain
D. Presence of reperfusion dysrhythmias
Answer: D. Presence of reperfusion dysrhythmias
Rationale: Reperfusion dysrhythmias (e.g., accelerated idioventricular rhythm, PVCs) are
a clinical sign that blood flow is being restored to the ischemic myocardium. While
resolution of chest pain is a positive sign, it is subjective. The presence of reperfusion
dysrhythmias is an objective indicator of successful thrombolysis.
,3. The nurse is caring for a client 4 hours after a cardiac catheterization via the
right femoral artery. What is the priority nursing assessment?
A. Pain level in the chest
B. Capillary refill of the right toes
C. Auscultation of heart sounds
D. Intake and output since the procedure
Answer: B. Capillary refill of the right toes
Rationale: Following a femoral artery catheterization, the priority is to assess circulation
to the affected extremity (distal to the insertion site). This includes checking pedal
pulses, capillary refill, color, and sensation to detect arterial occlusion, hematoma, or
thrombus formation.
4. A client with chronic stable angina is prescribed nitroglycerin (Nitrostat)
sublingual tablets. Which instruction should the nurse include in the discharge
teaching?
A. "Swallow the tablet with a full glass of water for faster absorption."
B. "Take one tablet every 15 minutes until the chest pain subsides."
C. "Keep the tablets in a clear plastic pill box so you can see if they are still good."
D. "If pain is not relieved after one tablet, call 911, and take up to two more tablets while
waiting."
Answer: D. "If pain is not relieved after one tablet, call 911, and take up to two
more tablets while waiting
Rationale: The correct protocol for angina is to stop activity and take one tablet. If pain
is unrelieved after 5 minutes, call emergency services, and take a second tablet. If still
unrelieved after another 5 minutes, a third tablet is taken. Nitroglycerin should be stored
in a dark, airtight container, not plastic, and administered sublingually, not swallowed.
5. A client with infective endocarditis develops sudden onset of left-sided
hemiplegia and slurred speech. The nurse should suspect which complication?
A. Mycotic aneurysm
B. Pulmonary embolism
C. Embolic stroke
D. Hypoglycemic event
Answer: C. Embolic stroke
Rationale: Vegetation’s (clumps of platelets, fibrin, and microorganisms) from infective
endocarditis can dislodge and travel to the cerebral circulation, causing a stroke. This is
a common and serious complication of endocarditis.
,6. The nurse is reviewing lab results for a client with hypertension who is being
worked up for secondary hypertension. Which laboratory value requires
immediate follow-up?
A. Serum potassium of 3.0 mEq/L
B. Fasting blood glucose of 100 mg/dL
C. Serum creatinine of 1.0 mg/dL
D. Total cholesterol of 180 mg/dL
Answer: A. Serum potassium of 3.0 mEq/L
Rationale: A potassium level of 3.0 is low (hypokalemia). While this can be caused by
diuretics, it is also a classic finding in primary hyperaldosteronism (Conn’s syndrome), a
cause of secondary hypertension. Hypokalemia can lead to cardiac dysrhythmias and
muscle weakness and requires prompt correction.
7. A client in the ICU with a pulmonary artery catheter (Swan-Ganz) has a
pulmonary capillary wedge pressure (PCWP) of 25 mm Hg (normal 6-12 mm Hg).
The nurse correlates this finding with which condition?
A. Hypovolemia
B. Fluid volume overload
C. Severe dehydration
D. Arterial vasodilation
Answer: B. Fluid volume overload
Rationale: PCWP is an indirect measurement of left atrial pressure. An elevated PCWP
indicates increased pressure in the left side of the heart, usually due to fluid volume
overload or left ventricular failure (cardiogenic pulmonary edema).
8. The nurse is providing discharge teaching to a client with a new permanent
pacemaker. Which statement by the client indicates a need for further teaching?
A. "I will avoid lifting my left arm above my shoulder for a few weeks."
B. "I will keep my cell phone in my shirt pocket over my pacemaker."
C. "I will wear a medical alert bracelet at all times."
D. "I will inform airport security about my pacemaker before going through the metal
detector."
Answer: B. "I will keep my cell phone in my shirt pocket over my pacemaker."
Rationale: Cell phones and other electronic devices should be kept at least 6 inches
away from the pacemaker generator to prevent electromagnetic interference. Placing it
directly over the device in a shirt pocket is dangerous.
, 9. A client with an abdominal aortic aneurysm (AAA) reports sudden, severe back
pain and "feeling faint." The nurse notes the blood pressure is 82/40 mm Hg and
the heart rate is 124 bpm. What is the priority action?
A. Administer pain medication.
B. Prepare for immediate surgical intervention.
C. Recheck the blood pressure in 15 minutes.
D. Place the client in a high-Fowler's position.
Answer: B. Prepare for immediate surgical intervention
Rationale: These symptoms (severe back pain, hypotension, tachycardia) are classic
signs of a rupturing AAA. This is a surgical emergency. The nurse must prepare the client
for immediate surgery while maintaining IV access and oxygen.
10. A client is started on amiodarone (Cordarone) for ventricular tachycardia.
Which baseline assessment is most important for the nurse to complete?
A. Liver function tests
B. Pulmonary function tests
C. Visual acuity exam
D. Thyroid function tests
Answer: D. Thyroid function tests
Rationale: Amiodarone has a high iodine content and can cause both hypothyroidism
and hyperthyroidism. Baseline and periodic monitoring of thyroid function is essential.
While it also affects the lungs, liver, and eyes (corneal micro deposits), thyroid function is
a critical and unique baseline to establish.
11. The nurse is auscultating heart sounds on a client with mitral valve prolapse.
Which finding is most consistent with this diagnosis?
A. A loud, blowing holosystolic murmur
B. A mid-systolic click followed by a murmur
C. A fixed, split S2
D. An opening snap
Answer: B. A mid-systolic click followed by a murmur
Rationale: Mitral valve prolapse is characterized by a midsystolic click (due to the
snapping of the chordae tendineae) often followed by a late systolic murmur if
regurgitation is present.
/ High-Yield Notes / Practice Questions (2026) |
Exam 3: Complex Conditions & Multi-System
Dysfunction
Instructions: Choose the single best answer for each question.
Clinical scenarios require application of knowledge and
prioritization skills.
Cardiovascular Disorders (Questions 1-20)
1. A nurse is assessing a client with suspected left-sided heart failure. Which of the
following findings is the nurse most likely to encounter?
A. Jugular vein distention
B. Hepatomegaly
C. Bibasilar crackles
D. Peripheral edema
Answer: C. Bibasilar crackles
Rationale: Left-sided heart failure occurs when the left ventricle cannot effectively
pump blood out to the body, causing blood to back up into the pulmonary circulation.
This results in pulmonary congestion, leading to crackles (rales) in the lung bases. JVD,
hepatomegaly, and peripheral edema are classic signs of right-sided heart failure.
2. A client with an acute myocardial infarction (MI) receives thrombolytic therapy.
Which assessment finding would indicate to the nurse that the therapy is
effective?
A. Decreased creatine kinase-MB levels
B. Increase in troponin I levels
C. Resolution of chest pain
D. Presence of reperfusion dysrhythmias
Answer: D. Presence of reperfusion dysrhythmias
Rationale: Reperfusion dysrhythmias (e.g., accelerated idioventricular rhythm, PVCs) are
a clinical sign that blood flow is being restored to the ischemic myocardium. While
resolution of chest pain is a positive sign, it is subjective. The presence of reperfusion
dysrhythmias is an objective indicator of successful thrombolysis.
,3. The nurse is caring for a client 4 hours after a cardiac catheterization via the
right femoral artery. What is the priority nursing assessment?
A. Pain level in the chest
B. Capillary refill of the right toes
C. Auscultation of heart sounds
D. Intake and output since the procedure
Answer: B. Capillary refill of the right toes
Rationale: Following a femoral artery catheterization, the priority is to assess circulation
to the affected extremity (distal to the insertion site). This includes checking pedal
pulses, capillary refill, color, and sensation to detect arterial occlusion, hematoma, or
thrombus formation.
4. A client with chronic stable angina is prescribed nitroglycerin (Nitrostat)
sublingual tablets. Which instruction should the nurse include in the discharge
teaching?
A. "Swallow the tablet with a full glass of water for faster absorption."
B. "Take one tablet every 15 minutes until the chest pain subsides."
C. "Keep the tablets in a clear plastic pill box so you can see if they are still good."
D. "If pain is not relieved after one tablet, call 911, and take up to two more tablets while
waiting."
Answer: D. "If pain is not relieved after one tablet, call 911, and take up to two
more tablets while waiting
Rationale: The correct protocol for angina is to stop activity and take one tablet. If pain
is unrelieved after 5 minutes, call emergency services, and take a second tablet. If still
unrelieved after another 5 minutes, a third tablet is taken. Nitroglycerin should be stored
in a dark, airtight container, not plastic, and administered sublingually, not swallowed.
5. A client with infective endocarditis develops sudden onset of left-sided
hemiplegia and slurred speech. The nurse should suspect which complication?
A. Mycotic aneurysm
B. Pulmonary embolism
C. Embolic stroke
D. Hypoglycemic event
Answer: C. Embolic stroke
Rationale: Vegetation’s (clumps of platelets, fibrin, and microorganisms) from infective
endocarditis can dislodge and travel to the cerebral circulation, causing a stroke. This is
a common and serious complication of endocarditis.
,6. The nurse is reviewing lab results for a client with hypertension who is being
worked up for secondary hypertension. Which laboratory value requires
immediate follow-up?
A. Serum potassium of 3.0 mEq/L
B. Fasting blood glucose of 100 mg/dL
C. Serum creatinine of 1.0 mg/dL
D. Total cholesterol of 180 mg/dL
Answer: A. Serum potassium of 3.0 mEq/L
Rationale: A potassium level of 3.0 is low (hypokalemia). While this can be caused by
diuretics, it is also a classic finding in primary hyperaldosteronism (Conn’s syndrome), a
cause of secondary hypertension. Hypokalemia can lead to cardiac dysrhythmias and
muscle weakness and requires prompt correction.
7. A client in the ICU with a pulmonary artery catheter (Swan-Ganz) has a
pulmonary capillary wedge pressure (PCWP) of 25 mm Hg (normal 6-12 mm Hg).
The nurse correlates this finding with which condition?
A. Hypovolemia
B. Fluid volume overload
C. Severe dehydration
D. Arterial vasodilation
Answer: B. Fluid volume overload
Rationale: PCWP is an indirect measurement of left atrial pressure. An elevated PCWP
indicates increased pressure in the left side of the heart, usually due to fluid volume
overload or left ventricular failure (cardiogenic pulmonary edema).
8. The nurse is providing discharge teaching to a client with a new permanent
pacemaker. Which statement by the client indicates a need for further teaching?
A. "I will avoid lifting my left arm above my shoulder for a few weeks."
B. "I will keep my cell phone in my shirt pocket over my pacemaker."
C. "I will wear a medical alert bracelet at all times."
D. "I will inform airport security about my pacemaker before going through the metal
detector."
Answer: B. "I will keep my cell phone in my shirt pocket over my pacemaker."
Rationale: Cell phones and other electronic devices should be kept at least 6 inches
away from the pacemaker generator to prevent electromagnetic interference. Placing it
directly over the device in a shirt pocket is dangerous.
, 9. A client with an abdominal aortic aneurysm (AAA) reports sudden, severe back
pain and "feeling faint." The nurse notes the blood pressure is 82/40 mm Hg and
the heart rate is 124 bpm. What is the priority action?
A. Administer pain medication.
B. Prepare for immediate surgical intervention.
C. Recheck the blood pressure in 15 minutes.
D. Place the client in a high-Fowler's position.
Answer: B. Prepare for immediate surgical intervention
Rationale: These symptoms (severe back pain, hypotension, tachycardia) are classic
signs of a rupturing AAA. This is a surgical emergency. The nurse must prepare the client
for immediate surgery while maintaining IV access and oxygen.
10. A client is started on amiodarone (Cordarone) for ventricular tachycardia.
Which baseline assessment is most important for the nurse to complete?
A. Liver function tests
B. Pulmonary function tests
C. Visual acuity exam
D. Thyroid function tests
Answer: D. Thyroid function tests
Rationale: Amiodarone has a high iodine content and can cause both hypothyroidism
and hyperthyroidism. Baseline and periodic monitoring of thyroid function is essential.
While it also affects the lungs, liver, and eyes (corneal micro deposits), thyroid function is
a critical and unique baseline to establish.
11. The nurse is auscultating heart sounds on a client with mitral valve prolapse.
Which finding is most consistent with this diagnosis?
A. A loud, blowing holosystolic murmur
B. A mid-systolic click followed by a murmur
C. A fixed, split S2
D. An opening snap
Answer: B. A mid-systolic click followed by a murmur
Rationale: Mitral valve prolapse is characterized by a midsystolic click (due to the
snapping of the chordae tendineae) often followed by a late systolic murmur if
regurgitation is present.
