1
NUR209/ NUR 209 Medical Surgical Nursing II
Review Exam 1 Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
Section 1: Cardiovascular Disorders
Q1: The nurse is assessing a patient with heart failure. Which finding is most indicative of left-
sided heart failure?
A. Jugular venous distention and hepatomegaly.
B. Bilateral ankle edema.
C. Ascites and splenomegaly.
D. Crackles in the lungs and dyspnea. [CORRECT]
Correct Answer: D
Rationale: Left-sided heart failure causes a backup of blood into the left atrium and pulmonary
veins, leading to pulmonary congestion and edema (crackles, dyspnea). Options A, B, and C are
signs of right-sided heart failure, which causes systemic venous congestion.
Q2: A patient is admitted with an acute myocardial infarction (MI). Which intervention should
the nurse implement first upon admission to the cardiac catheterization lab?
A. Administer prescribed clopidogrel (Plavix).
B. Obtain a 12-lead ECG.
C. Administer sublingual nitroglycerin.
D. Ensure the patient has IV access. [CORRECT]
Correct Answer: D
Rationale: While all are important, establishing IV access is the priority to allow for immediate
administration of emergency medications (morphine, antiplatelets, vasoactive drugs) during the
percutaneous coronary intervention (PCI) procedure. ECG and nitroglycerin are usually done in
the ER prior to transport, but access is critical for the lab.
,2
Q3: The nurse is teaching a patient about lisinopril, an ACE inhibitor. Which instruction should
be included?
A. "Rise slowly from a sitting or lying position to prevent dizziness." [CORRECT]
B. "You may notice a dry, hacking cough that requires immediate discontinuation."
C. "Take this medication with food to prevent stomach upset."
D. "Weigh yourself weekly and call the doctor if you gain 5 pounds in a week."
Correct Answer: A
Rationale: ACE inhibitors cause vasodilation and can lead to orthostatic hypotension; therefore,
teaching the patient to rise slowly is a safety priority. A cough is a common side effect but is not
an emergency; the physician should be notified, not necessarily the patient stopping it
immediately. Weight gain of 3 lbs in a day (not 5 in a week) is the specific warning sign for heart
failure.
Q4: A patient with atrial fibrillation is prescribed warfarin (Coumadin). Which dietary instruction
is essential?
A. Increase intake of green leafy vegetables.
B. Maintain a consistent intake of Vitamin K-rich foods. [CORRECT]
C. Avoid all dairy products.
D. Limit citrus fruits.
Correct Answer: B
Rationale: Vitamin K decreases the effectiveness of warfarin. Sudden increases in intake (green
leafy vegetables) can lower the INR (clotting time), while decreases can raise the INR.
Consistency is key to maintaining therapeutic levels.
Q5: A patient with peripheral arterial disease (PAD) reports leg pain when walking that is
relieved by rest. The nurse recognizes this as:
A. Deep vein thrombosis (DVT).
B. Intermittent claudication. [CORRECT]
C. Rest pain.
D. Thromboangiitis obliterans (Buerger's disease).
,3
Correct Answer: B
Rationale: Intermittent claudication is the classic symptom of PAD, characterized by ischemic
muscle pain during exertion that subsides with rest. Rest pain (Option C) is a more advanced
sign indicating critical limb ischemia.
Q6: When assessing a patient for signs of deep vein thrombosis (DVT), the nurse will look for:
A. Unilateral leg swelling, redness, and tenderness. [CORRECT]
B. Bilateral pitting edema.
C. Cool, pale extremity with diminished pulses.
D. Presence of stasis dermatitis.
Correct Answer: A
Rationale: DVT typically affects one leg (unilateral). Signs include swelling (edema), redness,
warmth, and tenderness (Homan's sign is no longer relied upon). Bilateral edema is more
systemic (heart failure). Cool, pale extremity suggests arterial occlusion.
Q7: The nurse is caring for a patient receiving heparin infusion. Which laboratory test does the
nurse monitor to evaluate the therapeutic effect?
A. Prothrombin time (PT/INR).
B. Partial thromboplastin time (aPTT). [CORRECT]
C. Platelet count.
D. Bleeding time.
Correct Answer: B
Rationale: Heparin affects the intrinsic pathway, so aPTT is monitored. PT/INR is monitored for
warfarin. Platelets are monitored for heparin-induced thrombocytopenia (HIT), but aPTT
determines the efficacy of the anticoagulation.
Q8: A patient with heart failure is prescribed digoxin. The nurse instructs the patient to report
which sign of toxicity?
A. Dry cough.
B. Constipation.
, 4
C. Nausea, vomiting, and visual changes (yellow/green halos). [CORRECT]
D. Hypokalemia.
Correct Answer: C
Rationale: Gastrointestinal upset (nausea, vomiting, anorexia) and visual disturbances (halos) are
early signs of digoxin toxicity. Hypokalemia increases the risk of digoxin toxicity but is not a
sign of toxicity itself.
Q9: The nurse is monitoring a patient with chest pain in the emergency department. The ECG
shows ST-segment depression in leads V1-V4. The nurse identifies this as:
A. Anterior wall MI.
B. Anterolateral wall MI.
C. Posterior wall MI.
D. Septal wall MI. [CORRECT]
Correct Answer: D
Rationale: ST depression in leads V1-V4 (especially V1 and V2) is a "mirror image"
representation of a Posterior Wall MI (ST elevation usually seen in posterior leads V7-V9, which
aren't standard in 12-lead ECGs). ST elevation in V1-V4 indicates Anterior MI.
Q10: A patient with hypertension is prescribed hydrochlorothiazide. The nurse should monitor
the patient for:
A. Hypokalemia. [CORRECT]
B. Hyponatremia.
C. Hyperglycemia.
D. Thrombocytopenia.
Correct Answer: A
Rationale: Thiazide diuretics cause potassium and sodium loss, leading to hypokalemia and
hyponatremia. While hyponatremia can occur, hypokalemia is a more critical concern due to
cardiac arrhythmia risk.
NUR209/ NUR 209 Medical Surgical Nursing II
Review Exam 1 Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
Section 1: Cardiovascular Disorders
Q1: The nurse is assessing a patient with heart failure. Which finding is most indicative of left-
sided heart failure?
A. Jugular venous distention and hepatomegaly.
B. Bilateral ankle edema.
C. Ascites and splenomegaly.
D. Crackles in the lungs and dyspnea. [CORRECT]
Correct Answer: D
Rationale: Left-sided heart failure causes a backup of blood into the left atrium and pulmonary
veins, leading to pulmonary congestion and edema (crackles, dyspnea). Options A, B, and C are
signs of right-sided heart failure, which causes systemic venous congestion.
Q2: A patient is admitted with an acute myocardial infarction (MI). Which intervention should
the nurse implement first upon admission to the cardiac catheterization lab?
A. Administer prescribed clopidogrel (Plavix).
B. Obtain a 12-lead ECG.
C. Administer sublingual nitroglycerin.
D. Ensure the patient has IV access. [CORRECT]
Correct Answer: D
Rationale: While all are important, establishing IV access is the priority to allow for immediate
administration of emergency medications (morphine, antiplatelets, vasoactive drugs) during the
percutaneous coronary intervention (PCI) procedure. ECG and nitroglycerin are usually done in
the ER prior to transport, but access is critical for the lab.
,2
Q3: The nurse is teaching a patient about lisinopril, an ACE inhibitor. Which instruction should
be included?
A. "Rise slowly from a sitting or lying position to prevent dizziness." [CORRECT]
B. "You may notice a dry, hacking cough that requires immediate discontinuation."
C. "Take this medication with food to prevent stomach upset."
D. "Weigh yourself weekly and call the doctor if you gain 5 pounds in a week."
Correct Answer: A
Rationale: ACE inhibitors cause vasodilation and can lead to orthostatic hypotension; therefore,
teaching the patient to rise slowly is a safety priority. A cough is a common side effect but is not
an emergency; the physician should be notified, not necessarily the patient stopping it
immediately. Weight gain of 3 lbs in a day (not 5 in a week) is the specific warning sign for heart
failure.
Q4: A patient with atrial fibrillation is prescribed warfarin (Coumadin). Which dietary instruction
is essential?
A. Increase intake of green leafy vegetables.
B. Maintain a consistent intake of Vitamin K-rich foods. [CORRECT]
C. Avoid all dairy products.
D. Limit citrus fruits.
Correct Answer: B
Rationale: Vitamin K decreases the effectiveness of warfarin. Sudden increases in intake (green
leafy vegetables) can lower the INR (clotting time), while decreases can raise the INR.
Consistency is key to maintaining therapeutic levels.
Q5: A patient with peripheral arterial disease (PAD) reports leg pain when walking that is
relieved by rest. The nurse recognizes this as:
A. Deep vein thrombosis (DVT).
B. Intermittent claudication. [CORRECT]
C. Rest pain.
D. Thromboangiitis obliterans (Buerger's disease).
,3
Correct Answer: B
Rationale: Intermittent claudication is the classic symptom of PAD, characterized by ischemic
muscle pain during exertion that subsides with rest. Rest pain (Option C) is a more advanced
sign indicating critical limb ischemia.
Q6: When assessing a patient for signs of deep vein thrombosis (DVT), the nurse will look for:
A. Unilateral leg swelling, redness, and tenderness. [CORRECT]
B. Bilateral pitting edema.
C. Cool, pale extremity with diminished pulses.
D. Presence of stasis dermatitis.
Correct Answer: A
Rationale: DVT typically affects one leg (unilateral). Signs include swelling (edema), redness,
warmth, and tenderness (Homan's sign is no longer relied upon). Bilateral edema is more
systemic (heart failure). Cool, pale extremity suggests arterial occlusion.
Q7: The nurse is caring for a patient receiving heparin infusion. Which laboratory test does the
nurse monitor to evaluate the therapeutic effect?
A. Prothrombin time (PT/INR).
B. Partial thromboplastin time (aPTT). [CORRECT]
C. Platelet count.
D. Bleeding time.
Correct Answer: B
Rationale: Heparin affects the intrinsic pathway, so aPTT is monitored. PT/INR is monitored for
warfarin. Platelets are monitored for heparin-induced thrombocytopenia (HIT), but aPTT
determines the efficacy of the anticoagulation.
Q8: A patient with heart failure is prescribed digoxin. The nurse instructs the patient to report
which sign of toxicity?
A. Dry cough.
B. Constipation.
, 4
C. Nausea, vomiting, and visual changes (yellow/green halos). [CORRECT]
D. Hypokalemia.
Correct Answer: C
Rationale: Gastrointestinal upset (nausea, vomiting, anorexia) and visual disturbances (halos) are
early signs of digoxin toxicity. Hypokalemia increases the risk of digoxin toxicity but is not a
sign of toxicity itself.
Q9: The nurse is monitoring a patient with chest pain in the emergency department. The ECG
shows ST-segment depression in leads V1-V4. The nurse identifies this as:
A. Anterior wall MI.
B. Anterolateral wall MI.
C. Posterior wall MI.
D. Septal wall MI. [CORRECT]
Correct Answer: D
Rationale: ST depression in leads V1-V4 (especially V1 and V2) is a "mirror image"
representation of a Posterior Wall MI (ST elevation usually seen in posterior leads V7-V9, which
aren't standard in 12-lead ECGs). ST elevation in V1-V4 indicates Anterior MI.
Q10: A patient with hypertension is prescribed hydrochlorothiazide. The nurse should monitor
the patient for:
A. Hypokalemia. [CORRECT]
B. Hyponatremia.
C. Hyperglycemia.
D. Thrombocytopenia.
Correct Answer: A
Rationale: Thiazide diuretics cause potassium and sodium loss, leading to hypokalemia and
hyponatremia. While hyponatremia can occur, hypokalemia is a more critical concern due to
cardiac arrhythmia risk.
