NURS202 Adult Medical-Surgical Nursing II 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 Students Success
Question 1: Which hemodynamic parameter is most indicative of left ventricular
preload?
A. Central venous pressure (CVP)
B. Systemic vascular resistance (SVR)
C. Pulmonary artery wedge pressure (PAWP)
D. Cardiac output (CO)
CORRECT ANSWER: C. Pulmonary artery wedge pressure (PAWP)
Rationale: Pulmonary artery wedge pressure (PAWP) reflects the pressure in the left
atrium and is used as a surrogate for left ventricular end-diastolic pressure, which
represents preload.
Question 2: A patient with acute decompensated heart failure is prescribed
intravenous furosemide. Which electrolyte imbalance should the nurse monitor
most closely?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
CORRECT ANSWER: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that promotes potassium excretion, placing the
patient at high risk for hypokalemia, which can lead to cardiac dysrhythmias.
Question 3: Which ECG finding is most characteristic of a myocardial infarction
involving the anterior wall?
A. ST-segment elevation in leads II, III, and aVF
B. ST-segment depression in leads V1–V3
C. ST-segment elevation in leads V1–V4
D. Inverted T waves in leads I and aVL
CORRECT ANSWER: C. ST-segment elevation in leads V1–V4
Rationale: Leads V1–V4 correspond to the anterior wall of the left ventricle; ST-segment
elevation in these leads indicates acute anterior myocardial infarction.
,Question 4: In managing a patient with cardiogenic shock, which intervention takes
priority?
A. Administering high-dose corticosteroids
B. Initiating vasopressor therapy to maintain perfusion
C. Providing oral fluids to increase preload
D. Encouraging ambulation to improve circulation
CORRECT ANSWER: B. Initiating vasopressor therapy to maintain perfusion
Rationale: Cardiogenic shock results from inadequate cardiac output; vasopressors or
inotropes are often required to support blood pressure and tissue perfusion until
cardiac function improves.
Question 5: Which medication class is contraindicated in a patient with heart
failure with reduced ejection fraction (HFrEF) and symptomatic bradycardia?
A. ACE inhibitors
B. Beta-blockers
C. Diuretics
D. Aldosterone antagonists
CORRECT ANSWER: B. Beta-blockers
Rationale: Beta-blockers can further reduce heart rate and are contraindicated in
patients with symptomatic bradycardia, despite their long-term benefits in stable
HFrEF.
Question 6: A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. What is
the most appropriate anticoagulation strategy?
A. No anticoagulation needed
B. Aspirin 81 mg daily
C. Direct oral anticoagulant (DOAC)
D. Unfractionated heparin infusion
CORRECT ANSWER: C. Direct oral anticoagulant (DOAC)
Rationale: A CHA₂DS₂-VASc score ≥2 in men (or ≥3 in women) indicates high stroke risk,
warranting therapeutic anticoagulation with a DOAC or warfarin; DOACs are preferred
due to safety and ease of use.
Question 7: Which assessment finding is most concerning in a patient 24 hours
post-op from coronary artery bypass graft (CABG) surgery?
A. Chest tube drainage of 100 mL/hr
B. Temperature of 37.8°C (100°F)
C. Sudden cessation of chest tube drainage with hypotension and jugular venous
distension
D. Incisional pain rated 5/10
, CORRECT ANSWER: C. Sudden cessation of chest tube drainage with hypotension
and jugular venous distension
Rationale: Sudden drop in chest tube output with signs of hypotension and JVD
suggests cardiac tamponade, a life-threatening postoperative complication requiring
immediate intervention.
Question 8: What is the primary purpose of administering nitroglycerin to a patient
experiencing acute angina?
A. To increase heart rate and contractility
B. To promote vasoconstriction of coronary arteries
C. To reduce preload and afterload, decreasing myocardial oxygen demand
D. To enhance platelet aggregation
CORRECT ANSWER: C. To reduce preload and afterload, decreasing myocardial
oxygen demand
Rationale: Nitroglycerin causes venous and arterial dilation, reducing both preload and
afterload, which lowers myocardial workload and oxygen consumption, relieving
ischemic chest pain.
Question 9: Which laboratory value is most critical to monitor in a patient receiving
intravenous heparin for deep vein thrombosis?
A. Hemoglobin
B. Platelet count
C. Activated partial thromboplastin time (aPTT)
D. Serum creatinine
CORRECT ANSWER: C. Activated partial thromboplastin time (aPTT)
Rationale: The aPTT is used to monitor the anticoagulant effect of unfractionated
heparin; it should be maintained within a therapeutic range (usually 1.5–2.5 times
control).
Question 10: A patient with chronic venous insufficiency should be taught to avoid
which of the following?
A. Wearing compression stockings
B. Elevating legs above heart level
C. Prolonged standing or sitting
D. Regular walking
CORRECT ANSWER: C. Prolonged standing or sitting
Rationale: Prolonged immobility increases venous stasis and worsens symptoms of
chronic venous insufficiency; frequent movement and leg elevation are recommended.
Question 11: Which sign is most indicative of right-sided heart failure?
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 Students Success
Question 1: Which hemodynamic parameter is most indicative of left ventricular
preload?
A. Central venous pressure (CVP)
B. Systemic vascular resistance (SVR)
C. Pulmonary artery wedge pressure (PAWP)
D. Cardiac output (CO)
CORRECT ANSWER: C. Pulmonary artery wedge pressure (PAWP)
Rationale: Pulmonary artery wedge pressure (PAWP) reflects the pressure in the left
atrium and is used as a surrogate for left ventricular end-diastolic pressure, which
represents preload.
Question 2: A patient with acute decompensated heart failure is prescribed
intravenous furosemide. Which electrolyte imbalance should the nurse monitor
most closely?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
CORRECT ANSWER: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that promotes potassium excretion, placing the
patient at high risk for hypokalemia, which can lead to cardiac dysrhythmias.
Question 3: Which ECG finding is most characteristic of a myocardial infarction
involving the anterior wall?
A. ST-segment elevation in leads II, III, and aVF
B. ST-segment depression in leads V1–V3
C. ST-segment elevation in leads V1–V4
D. Inverted T waves in leads I and aVL
CORRECT ANSWER: C. ST-segment elevation in leads V1–V4
Rationale: Leads V1–V4 correspond to the anterior wall of the left ventricle; ST-segment
elevation in these leads indicates acute anterior myocardial infarction.
,Question 4: In managing a patient with cardiogenic shock, which intervention takes
priority?
A. Administering high-dose corticosteroids
B. Initiating vasopressor therapy to maintain perfusion
C. Providing oral fluids to increase preload
D. Encouraging ambulation to improve circulation
CORRECT ANSWER: B. Initiating vasopressor therapy to maintain perfusion
Rationale: Cardiogenic shock results from inadequate cardiac output; vasopressors or
inotropes are often required to support blood pressure and tissue perfusion until
cardiac function improves.
Question 5: Which medication class is contraindicated in a patient with heart
failure with reduced ejection fraction (HFrEF) and symptomatic bradycardia?
A. ACE inhibitors
B. Beta-blockers
C. Diuretics
D. Aldosterone antagonists
CORRECT ANSWER: B. Beta-blockers
Rationale: Beta-blockers can further reduce heart rate and are contraindicated in
patients with symptomatic bradycardia, despite their long-term benefits in stable
HFrEF.
Question 6: A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. What is
the most appropriate anticoagulation strategy?
A. No anticoagulation needed
B. Aspirin 81 mg daily
C. Direct oral anticoagulant (DOAC)
D. Unfractionated heparin infusion
CORRECT ANSWER: C. Direct oral anticoagulant (DOAC)
Rationale: A CHA₂DS₂-VASc score ≥2 in men (or ≥3 in women) indicates high stroke risk,
warranting therapeutic anticoagulation with a DOAC or warfarin; DOACs are preferred
due to safety and ease of use.
Question 7: Which assessment finding is most concerning in a patient 24 hours
post-op from coronary artery bypass graft (CABG) surgery?
A. Chest tube drainage of 100 mL/hr
B. Temperature of 37.8°C (100°F)
C. Sudden cessation of chest tube drainage with hypotension and jugular venous
distension
D. Incisional pain rated 5/10
, CORRECT ANSWER: C. Sudden cessation of chest tube drainage with hypotension
and jugular venous distension
Rationale: Sudden drop in chest tube output with signs of hypotension and JVD
suggests cardiac tamponade, a life-threatening postoperative complication requiring
immediate intervention.
Question 8: What is the primary purpose of administering nitroglycerin to a patient
experiencing acute angina?
A. To increase heart rate and contractility
B. To promote vasoconstriction of coronary arteries
C. To reduce preload and afterload, decreasing myocardial oxygen demand
D. To enhance platelet aggregation
CORRECT ANSWER: C. To reduce preload and afterload, decreasing myocardial
oxygen demand
Rationale: Nitroglycerin causes venous and arterial dilation, reducing both preload and
afterload, which lowers myocardial workload and oxygen consumption, relieving
ischemic chest pain.
Question 9: Which laboratory value is most critical to monitor in a patient receiving
intravenous heparin for deep vein thrombosis?
A. Hemoglobin
B. Platelet count
C. Activated partial thromboplastin time (aPTT)
D. Serum creatinine
CORRECT ANSWER: C. Activated partial thromboplastin time (aPTT)
Rationale: The aPTT is used to monitor the anticoagulant effect of unfractionated
heparin; it should be maintained within a therapeutic range (usually 1.5–2.5 times
control).
Question 10: A patient with chronic venous insufficiency should be taught to avoid
which of the following?
A. Wearing compression stockings
B. Elevating legs above heart level
C. Prolonged standing or sitting
D. Regular walking
CORRECT ANSWER: C. Prolonged standing or sitting
Rationale: Prolonged immobility increases venous stasis and worsens symptoms of
chronic venous insufficiency; frequent movement and leg elevation are recommended.
Question 11: Which sign is most indicative of right-sided heart failure?
