NURS202 Adult Medical-Surgical Nursing II Nursing & Healthcare Practice Exam
Study Guide Updated 2026 | Verified Questions and Answers with Detailed
Rationales | Advanced Cardiovascular and Respiratory Disorders, Neurological and
Endocrine Conditions, Oncology Nursing, Critical Care Concepts, Multisystem
Disorders, Shock and Sepsis Management, Complex Pharmacology, ICU and
Emergency Interventions, Patient Safety and Prioritization, NCLEX-Style Clinical
Judgment Questions | Complete Exam Prep Resource for Nursing and Healthcare
Students Success
Question 1: Which of the following is the most common initial symptom of
pulmonary embolism?
A. Hemoptysis
B. Tachycardia
C. Sudden onset dyspnea
D. Pleuritic chest pain
CORRECT ANSWER: C. Sudden onset dyspnea
RATIONALE:Sudden onset dyspnea is the most frequent presenting symptom of
pulmonary embolism (PE). While other symptoms like pleuritic chest pain, hemoptysis,
and tachycardia may occur, dyspnea is reported in up to 80% of cases and often
appears abruptly due to impaired gas exchange and increased dead space ventilation.
Question 2: A patient with chronic kidney disease (CKD) is at highest risk for which
electrolyte imbalance?
A. Hypernatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypomagnesemia
CORRECT ANSWER: C. Hyperkalemia
RATIONALE:In CKD, the kidneys lose the ability to excrete potassium effectively, leading
to hyperkalemia. This is a life-threatening complication that can cause cardiac
arrhythmias. Monitoring serum potassium and dietary intake is critical in managing CKD
patients.
Question 3: Which medication class is contraindicated in a patient with acute
decompensated heart failure and severe pulmonary edema?
A. Loop diuretics
B. ACE inhibitors
C. Non-dihydropyridine calcium channel blockers
D. Beta-blockers
CORRECT ANSWER: C. Non-dihydropyridine calcium channel blockers
RATIONALE:Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem)
have negative inotropic effects and can worsen heart failure by reducing myocardial
,contractility. They are generally avoided in acute decompensated heart failure,
especially with reduced ejection fraction.
Question 4: What is the primary pathophysiologic mechanism in type 1 diabetes
mellitus?
A. Insulin resistance in peripheral tissues
B. Excessive hepatic glucose production
C. Autoimmune destruction of pancreatic beta cells
D. Defective insulin receptor signaling
CORRECT ANSWER: C. Autoimmune destruction of pancreatic beta cells
RATIONALE:Type 1 diabetes results from an autoimmune process that selectively
destroys insulin-producing beta cells in the pancreas, leading to absolute insulin
deficiency. This contrasts with type 2 diabetes, which involves insulin resistance and
relative insulin deficiency.
Question 5: Which clinical finding is most indicative of pericardial tamponade?
A. Bradycardia
B. Hypertension
C. Pulsus paradoxus
D. Bounding peripheral pulses
CORRECT ANSWER: C. Pulsus paradoxus
RATIONALE:Pulsus paradoxus—a drop in systolic blood pressure >10 mmHg during
inspiration—is a hallmark sign of pericardial tamponade. It occurs due to impaired
ventricular filling caused by increased intrapericardial pressure compressing the heart
chambers.
Question 6: A patient with cirrhosis develops asterixis. This finding is most likely
associated with which condition?
A. Hypoglycemia
B. Hepatic encephalopathy
C. Hyponatremia
D. Wernicke’s encephalopathy
CORRECT ANSWER: B. Hepatic encephalopathy
RATIONALE:Asterixis, or "flapping tremor," is a classic neurological sign of hepatic
encephalopathy, resulting from the accumulation of ammonia and other toxins that the
failing liver cannot clear. It reflects cerebral dysfunction due to metabolic
derangements in advanced liver disease.
Question 7: Which laboratory value is most critical to monitor in a patient receiving
heparin therapy?
, A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Platelet count alone
CORRECT ANSWER: B. Activated partial thromboplastin time (aPTT)
RATIONALE:aPTT is used to monitor unfractionated heparin therapy because it reflects
the intrinsic coagulation pathway that heparin affects. Therapeutic range is typically 1.5
to 2.5 times the control value. Platelet count must also be monitored for heparin-
induced thrombocytopenia (HIT), but aPTT is primary for dosing.
Question 8: Which of the following is a priority nursing intervention for a patient
with diabetic ketoacidosis (DKA)?
A. Administer oral hypoglycemic agents
B. Restrict fluid intake to prevent cerebral edema
C. Initiate intravenous insulin infusion
D. Encourage high-carbohydrate meals
CORRECT ANSWER: C. Initiate intravenous insulin infusion
RATIONALE:IV insulin is essential in DKA to reverse ketogenesis, lower blood glucose,
and restore normal metabolism. Oral agents are ineffective in DKA due to insulin
deficiency and acidosis. Fluid resuscitation is also critical, but insulin is the
cornerstone of treatment.
Question 9: What is the most appropriate position for a patient experiencing an
acute asthma exacerbation?
A. Supine with legs elevated
B. Prone with head turned
C. High Fowler’s position
D. Trendelenburg position
CORRECT ANSWER: C. High Fowler’s position
RATIONALE:High Fowler’s position (sitting upright at 60–90 degrees) maximizes lung
expansion, reduces work of breathing, and facilitates air exchange. It is the preferred
position during acute respiratory distress such as asthma attacks.
Question 10: Which assessment finding is most concerning in a patient with
suspected sepsis?
A. Temperature of 38.1°C (100.6°F)
B. Heart rate of 98 bpm
C. Lactate level of 4.5 mmol/L
D. Respiratory rate of 18 breaths/min
CORRECT ANSWER: C. Lactate level of 4.5 mmol/L
Study Guide Updated 2026 | Verified Questions and Answers with Detailed
Rationales | Advanced Cardiovascular and Respiratory Disorders, Neurological and
Endocrine Conditions, Oncology Nursing, Critical Care Concepts, Multisystem
Disorders, Shock and Sepsis Management, Complex Pharmacology, ICU and
Emergency Interventions, Patient Safety and Prioritization, NCLEX-Style Clinical
Judgment Questions | Complete Exam Prep Resource for Nursing and Healthcare
Students Success
Question 1: Which of the following is the most common initial symptom of
pulmonary embolism?
A. Hemoptysis
B. Tachycardia
C. Sudden onset dyspnea
D. Pleuritic chest pain
CORRECT ANSWER: C. Sudden onset dyspnea
RATIONALE:Sudden onset dyspnea is the most frequent presenting symptom of
pulmonary embolism (PE). While other symptoms like pleuritic chest pain, hemoptysis,
and tachycardia may occur, dyspnea is reported in up to 80% of cases and often
appears abruptly due to impaired gas exchange and increased dead space ventilation.
Question 2: A patient with chronic kidney disease (CKD) is at highest risk for which
electrolyte imbalance?
A. Hypernatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypomagnesemia
CORRECT ANSWER: C. Hyperkalemia
RATIONALE:In CKD, the kidneys lose the ability to excrete potassium effectively, leading
to hyperkalemia. This is a life-threatening complication that can cause cardiac
arrhythmias. Monitoring serum potassium and dietary intake is critical in managing CKD
patients.
Question 3: Which medication class is contraindicated in a patient with acute
decompensated heart failure and severe pulmonary edema?
A. Loop diuretics
B. ACE inhibitors
C. Non-dihydropyridine calcium channel blockers
D. Beta-blockers
CORRECT ANSWER: C. Non-dihydropyridine calcium channel blockers
RATIONALE:Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem)
have negative inotropic effects and can worsen heart failure by reducing myocardial
,contractility. They are generally avoided in acute decompensated heart failure,
especially with reduced ejection fraction.
Question 4: What is the primary pathophysiologic mechanism in type 1 diabetes
mellitus?
A. Insulin resistance in peripheral tissues
B. Excessive hepatic glucose production
C. Autoimmune destruction of pancreatic beta cells
D. Defective insulin receptor signaling
CORRECT ANSWER: C. Autoimmune destruction of pancreatic beta cells
RATIONALE:Type 1 diabetes results from an autoimmune process that selectively
destroys insulin-producing beta cells in the pancreas, leading to absolute insulin
deficiency. This contrasts with type 2 diabetes, which involves insulin resistance and
relative insulin deficiency.
Question 5: Which clinical finding is most indicative of pericardial tamponade?
A. Bradycardia
B. Hypertension
C. Pulsus paradoxus
D. Bounding peripheral pulses
CORRECT ANSWER: C. Pulsus paradoxus
RATIONALE:Pulsus paradoxus—a drop in systolic blood pressure >10 mmHg during
inspiration—is a hallmark sign of pericardial tamponade. It occurs due to impaired
ventricular filling caused by increased intrapericardial pressure compressing the heart
chambers.
Question 6: A patient with cirrhosis develops asterixis. This finding is most likely
associated with which condition?
A. Hypoglycemia
B. Hepatic encephalopathy
C. Hyponatremia
D. Wernicke’s encephalopathy
CORRECT ANSWER: B. Hepatic encephalopathy
RATIONALE:Asterixis, or "flapping tremor," is a classic neurological sign of hepatic
encephalopathy, resulting from the accumulation of ammonia and other toxins that the
failing liver cannot clear. It reflects cerebral dysfunction due to metabolic
derangements in advanced liver disease.
Question 7: Which laboratory value is most critical to monitor in a patient receiving
heparin therapy?
, A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Platelet count alone
CORRECT ANSWER: B. Activated partial thromboplastin time (aPTT)
RATIONALE:aPTT is used to monitor unfractionated heparin therapy because it reflects
the intrinsic coagulation pathway that heparin affects. Therapeutic range is typically 1.5
to 2.5 times the control value. Platelet count must also be monitored for heparin-
induced thrombocytopenia (HIT), but aPTT is primary for dosing.
Question 8: Which of the following is a priority nursing intervention for a patient
with diabetic ketoacidosis (DKA)?
A. Administer oral hypoglycemic agents
B. Restrict fluid intake to prevent cerebral edema
C. Initiate intravenous insulin infusion
D. Encourage high-carbohydrate meals
CORRECT ANSWER: C. Initiate intravenous insulin infusion
RATIONALE:IV insulin is essential in DKA to reverse ketogenesis, lower blood glucose,
and restore normal metabolism. Oral agents are ineffective in DKA due to insulin
deficiency and acidosis. Fluid resuscitation is also critical, but insulin is the
cornerstone of treatment.
Question 9: What is the most appropriate position for a patient experiencing an
acute asthma exacerbation?
A. Supine with legs elevated
B. Prone with head turned
C. High Fowler’s position
D. Trendelenburg position
CORRECT ANSWER: C. High Fowler’s position
RATIONALE:High Fowler’s position (sitting upright at 60–90 degrees) maximizes lung
expansion, reduces work of breathing, and facilitates air exchange. It is the preferred
position during acute respiratory distress such as asthma attacks.
Question 10: Which assessment finding is most concerning in a patient with
suspected sepsis?
A. Temperature of 38.1°C (100.6°F)
B. Heart rate of 98 bpm
C. Lactate level of 4.5 mmol/L
D. Respiratory rate of 18 breaths/min
CORRECT ANSWER: C. Lactate level of 4.5 mmol/L
