NURS 201 – MEDICAL-SURGICAL
NURSING FINAL EXAM
QUESTIONS AND ANSWERS
WITH RATIONALES/GRADED
A+/2026 UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Section 1: Cardiovascular Disorders (Questions 1–12)
1. A patient with acute decompensated heart failure presents with severe
dyspnea, crackles in all lung fields, and an SpO₂ of 88% on room air. Which
intervention should the nurse implement first?
a. Administer IV furosemide
b. Apply continuous positive airway pressure (CPAP)
c. Place patient in high-Fowler’s position
d. Prepare for endotracheal intubation
Correct answer: c – Place patient in high-Fowler’s position
Rationale: Positioning is immediate and non-invasive, reducing preload and improving
lung expansion. CPAP (b) is next if positioning and oxygen fail.
2. A nurse is caring for a patient 6 hours after a myocardial infarction. Which
finding requires immediate intervention?
a. Sinus bradycardia at 54 bpm
b. Pain rated 3/10 at the sternum
c. New S3 gallop and jugular vein distention
d. Anxiety and restlessness
Correct answer: c – New S3 gallop and jugular vein distention
*Rationale: This indicates acute heart failure, a serious complication post-MI. S3 +
JVD suggests decreased contractility and fluid overload.*
3. Which beta-blocker is preferred for patients with chronic stable heart failure
with reduced ejection fraction (HFrEF) per 2026 guidelines?
,a. Atenolol
b. Propranolol
c. Carvedilol
d. Esmolol
Correct answer: c – Carvedilol
Rationale: Carvedilol, metoprolol succinate, and bisoprolol are evidence-based for
HFrEF. Atenolol and propranolol are not recommended.
4. A patient with atrial fibrillation on warfarin has an INR of 4.8. No bleeding is
present. What should the nurse do first?
a. Prepare vitamin K 10 mg IV
b. Hold warfarin and notify provider
c. Administer fresh frozen plasma
d. Give protamine sulfate
Correct answer: b – Hold warfarin and notify provider
Rationale: INR 4.8 without bleeding → hold warfarin, assess need for dose adjustment.
Vitamin K causes prolonged anticoagulation reversal if not bleeding.
5. Which symptom is most specific to infective endocarditis?
a. Splinter hemorrhages
b. Osler’s nodes
c. Clubbing of fingers
d. Pericardial friction rub
Correct answer: b – Osler’s nodes
Rationale: Osler’s nodes (painful, red nodules on fingertips) are highly specific for
endocarditis. Splinter hemorrhages can occur with trauma.
6. A patient post-cardiac catheterization via right femoral artery develops
sudden severe back pain and hypotension. The nurse suspects:
a. Retroperitoneal bleeding
b. Vagal reaction
c. Allergic contrast reaction
d. Pulmonary embolism
Correct answer: a – Retroperitoneal bleeding
Rationale: Back pain + hypotension after femoral access suggests bleeding behind
peritoneum. Requires immediate surgical evaluation.
7. Which lab value is most indicative of myocardial infarction?
a. Elevated CK-MB
b. High-sensitivity troponin I rise/fall
, c. Elevated BNP
d. Elevated CRP
Correct answer: b – High-sensitivity troponin I rise/fall
Rationale: Troponin is the most sensitive and specific cardiac biomarker. BNP (c)
suggests heart failure.
8. A patient with hypertension is prescribed a thiazide diuretic. Which
electrolyte imbalance is most concerning?
a. Hyperkalemia
b. Hypokalemia
c. Hypermagnesemia
d. Hypocalcemia
Correct answer: b – Hypokalemia
Rationale: Thiazides increase potassium excretion. Monitor for hypokalemia → risk of
dysrhythmias.
9. A patient with pericarditis reports pleuritic chest pain that worsens when
lying flat. The nurse should:
a. Administer morphine IV
b. Encourage reclining position
c. Have the patient sit up and lean forward
d. Apply oxygen at 2 L/min
Correct answer: c – Have the patient sit up and lean forward
Rationale: Leaning forward relieves pericardial friction and pain. Supine worsens
inflammation.
10. Which discharge instruction is critical for a patient with a new mechanical
heart valve on warfarin?
a. “Take aspirin daily for pain relief”
b. “Use a soft toothbrush and electric razor”
c. “Increase intake of leafy green vegetables daily”
d. “Stop warfarin if you see bruises”
Correct answer: b – Use a soft toothbrush and electric razor
Rationale: Reduces bleeding risk. Consistent vitamin K intake is important, not increase
(c).
11. A nurse is assessing a patient with peripheral artery disease (PAD). Which
finding is expected?
a. Warm, erythematous lower legs
b. Diminished posterior tibial pulse
NURSING FINAL EXAM
QUESTIONS AND ANSWERS
WITH RATIONALES/GRADED
A+/2026 UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Section 1: Cardiovascular Disorders (Questions 1–12)
1. A patient with acute decompensated heart failure presents with severe
dyspnea, crackles in all lung fields, and an SpO₂ of 88% on room air. Which
intervention should the nurse implement first?
a. Administer IV furosemide
b. Apply continuous positive airway pressure (CPAP)
c. Place patient in high-Fowler’s position
d. Prepare for endotracheal intubation
Correct answer: c – Place patient in high-Fowler’s position
Rationale: Positioning is immediate and non-invasive, reducing preload and improving
lung expansion. CPAP (b) is next if positioning and oxygen fail.
2. A nurse is caring for a patient 6 hours after a myocardial infarction. Which
finding requires immediate intervention?
a. Sinus bradycardia at 54 bpm
b. Pain rated 3/10 at the sternum
c. New S3 gallop and jugular vein distention
d. Anxiety and restlessness
Correct answer: c – New S3 gallop and jugular vein distention
*Rationale: This indicates acute heart failure, a serious complication post-MI. S3 +
JVD suggests decreased contractility and fluid overload.*
3. Which beta-blocker is preferred for patients with chronic stable heart failure
with reduced ejection fraction (HFrEF) per 2026 guidelines?
,a. Atenolol
b. Propranolol
c. Carvedilol
d. Esmolol
Correct answer: c – Carvedilol
Rationale: Carvedilol, metoprolol succinate, and bisoprolol are evidence-based for
HFrEF. Atenolol and propranolol are not recommended.
4. A patient with atrial fibrillation on warfarin has an INR of 4.8. No bleeding is
present. What should the nurse do first?
a. Prepare vitamin K 10 mg IV
b. Hold warfarin and notify provider
c. Administer fresh frozen plasma
d. Give protamine sulfate
Correct answer: b – Hold warfarin and notify provider
Rationale: INR 4.8 without bleeding → hold warfarin, assess need for dose adjustment.
Vitamin K causes prolonged anticoagulation reversal if not bleeding.
5. Which symptom is most specific to infective endocarditis?
a. Splinter hemorrhages
b. Osler’s nodes
c. Clubbing of fingers
d. Pericardial friction rub
Correct answer: b – Osler’s nodes
Rationale: Osler’s nodes (painful, red nodules on fingertips) are highly specific for
endocarditis. Splinter hemorrhages can occur with trauma.
6. A patient post-cardiac catheterization via right femoral artery develops
sudden severe back pain and hypotension. The nurse suspects:
a. Retroperitoneal bleeding
b. Vagal reaction
c. Allergic contrast reaction
d. Pulmonary embolism
Correct answer: a – Retroperitoneal bleeding
Rationale: Back pain + hypotension after femoral access suggests bleeding behind
peritoneum. Requires immediate surgical evaluation.
7. Which lab value is most indicative of myocardial infarction?
a. Elevated CK-MB
b. High-sensitivity troponin I rise/fall
, c. Elevated BNP
d. Elevated CRP
Correct answer: b – High-sensitivity troponin I rise/fall
Rationale: Troponin is the most sensitive and specific cardiac biomarker. BNP (c)
suggests heart failure.
8. A patient with hypertension is prescribed a thiazide diuretic. Which
electrolyte imbalance is most concerning?
a. Hyperkalemia
b. Hypokalemia
c. Hypermagnesemia
d. Hypocalcemia
Correct answer: b – Hypokalemia
Rationale: Thiazides increase potassium excretion. Monitor for hypokalemia → risk of
dysrhythmias.
9. A patient with pericarditis reports pleuritic chest pain that worsens when
lying flat. The nurse should:
a. Administer morphine IV
b. Encourage reclining position
c. Have the patient sit up and lean forward
d. Apply oxygen at 2 L/min
Correct answer: c – Have the patient sit up and lean forward
Rationale: Leaning forward relieves pericardial friction and pain. Supine worsens
inflammation.
10. Which discharge instruction is critical for a patient with a new mechanical
heart valve on warfarin?
a. “Take aspirin daily for pain relief”
b. “Use a soft toothbrush and electric razor”
c. “Increase intake of leafy green vegetables daily”
d. “Stop warfarin if you see bruises”
Correct answer: b – Use a soft toothbrush and electric razor
Rationale: Reduces bleeding risk. Consistent vitamin K intake is important, not increase
(c).
11. A nurse is assessing a patient with peripheral artery disease (PAD). Which
finding is expected?
a. Warm, erythematous lower legs
b. Diminished posterior tibial pulse
