NURS 201 Intermediate Med-Surge Midterm
Exam|QUESTIONS AND ANSWERS| 2026
UPDATE| 100% CORRECT-WCU.
SECTION 1: CARDIOVASCULAR DISORDERS
(Questions 1-12)
Question 1
A patient with heart failure is prescribed furosemide (Lasix). Which
laboratory value should the nurse monitor most closely?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Correct Answer: B. Potassium
Rationale: Furosemide is a loop diuretic that causes increased excretion of
potassium, leading to hypokalemia. Hypokalemia increases the risk of
cardiac arrhythmias, especially in patients taking digoxin. Serum potassium
should be monitored closely, and potassium supplementation may be
required. Hypokalemia also increases the risk of digoxin toxicity.
Subtopic: Heart Failure – Diuretic Therapy
Question 2
A patient is prescribed warfarin (Coumadin). The nurse teaches the patient to
avoid which food?
,A. Apples
B. Bananas
C. Green leafy vegetables
D. Rice
Correct Answer: C. Green leafy vegetables
Rationale: Green leafy vegetables (spinach, kale, broccoli, Brussels sprouts)
are high in vitamin K, which antagonizes the effects of warfarin. Patients
should maintain a consistent intake of vitamin K, not avoid it entirely, but
large fluctuations can alter INR. Consistency is key; patients should not
abruptly increase or decrease vitamin K intake.
Subtopic: Anticoagulants – Warfarin Teaching
Question 3
A patient with angina is prescribed nitroglycerin sublingual tablets. Which
instruction is correct?
A. "Swallow the tablet with a full glass of water."
B. "Take a tablet every 5 minutes until pain is relieved, up to 3 tablets."
C. "Store the tablets in the refrigerator."
D. "Take the tablet with food to prevent stomach upset."
Correct Answer: B. "Take a tablet every 5 minutes until pain is relieved, up
to 3 tablets."
Rationale: Nitroglycerin sublingual tablets are taken at the onset of chest
pain: one tablet under the tongue every 5 minutes, up to three tablets. If
pain is not relieved after three tablets, the patient should seek emergency
medical attention. Nitroglycerin should not be swallowed; it is absorbed
sublingually. Tablets should be stored in their original container, away from
light and moisture, and replaced every 6-12 months.
Subtopic: Angina – Nitroglycerin Administration
Question 4
A patient with hypertension is prescribed lisinopril (an ACE inhibitor). The
, patient develops a persistent, dry, non-productive cough. What is the nurse's
best response?
A. "This is a normal side effect that will go away with continued use."
B. "You should stop taking the medication immediately."
C. "Report this to your provider; they may switch you to an ARB."
D. "Take the medication with food to reduce the cough."
Correct Answer: C. "Report this to your provider; they may switch you to an
ARB."
Rationale: A persistent dry cough is a common side effect of ACE inhibitors
(due to increased bradykinin). It occurs in about 10-20% of patients and is
the most common reason for discontinuation. The provider may switch the
patient to an angiotensin II receptor blocker (ARB), which has a lower
incidence of cough. The patient should not stop the medication without
consulting the provider.
Subtopic: ACE Inhibitors – Cough Side Effect
Question 5
A patient is receiving a continuous heparin infusion. The aPTT is 120 seconds
(therapeutic range 60-80 seconds). What is the priority nursing action?
A. Increase the infusion rate
B. Decrease the infusion rate
C. Hold the infusion and notify the provider
D. Continue the infusion as ordered
Correct Answer: C. Hold the infusion and notify the provider
Rationale: An aPTT of 120 seconds is significantly supratherapeutic, placing
the patient at high risk for bleeding. The nurse should hold the heparin
infusion and notify the provider immediately. Continuing or increasing the
infusion would increase bleeding risk. The provider may order a dose
reduction or restart at a lower rate after reassessment.
Subtopic: Anticoagulants – Heparin Monitoring
Exam|QUESTIONS AND ANSWERS| 2026
UPDATE| 100% CORRECT-WCU.
SECTION 1: CARDIOVASCULAR DISORDERS
(Questions 1-12)
Question 1
A patient with heart failure is prescribed furosemide (Lasix). Which
laboratory value should the nurse monitor most closely?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Correct Answer: B. Potassium
Rationale: Furosemide is a loop diuretic that causes increased excretion of
potassium, leading to hypokalemia. Hypokalemia increases the risk of
cardiac arrhythmias, especially in patients taking digoxin. Serum potassium
should be monitored closely, and potassium supplementation may be
required. Hypokalemia also increases the risk of digoxin toxicity.
Subtopic: Heart Failure – Diuretic Therapy
Question 2
A patient is prescribed warfarin (Coumadin). The nurse teaches the patient to
avoid which food?
,A. Apples
B. Bananas
C. Green leafy vegetables
D. Rice
Correct Answer: C. Green leafy vegetables
Rationale: Green leafy vegetables (spinach, kale, broccoli, Brussels sprouts)
are high in vitamin K, which antagonizes the effects of warfarin. Patients
should maintain a consistent intake of vitamin K, not avoid it entirely, but
large fluctuations can alter INR. Consistency is key; patients should not
abruptly increase or decrease vitamin K intake.
Subtopic: Anticoagulants – Warfarin Teaching
Question 3
A patient with angina is prescribed nitroglycerin sublingual tablets. Which
instruction is correct?
A. "Swallow the tablet with a full glass of water."
B. "Take a tablet every 5 minutes until pain is relieved, up to 3 tablets."
C. "Store the tablets in the refrigerator."
D. "Take the tablet with food to prevent stomach upset."
Correct Answer: B. "Take a tablet every 5 minutes until pain is relieved, up
to 3 tablets."
Rationale: Nitroglycerin sublingual tablets are taken at the onset of chest
pain: one tablet under the tongue every 5 minutes, up to three tablets. If
pain is not relieved after three tablets, the patient should seek emergency
medical attention. Nitroglycerin should not be swallowed; it is absorbed
sublingually. Tablets should be stored in their original container, away from
light and moisture, and replaced every 6-12 months.
Subtopic: Angina – Nitroglycerin Administration
Question 4
A patient with hypertension is prescribed lisinopril (an ACE inhibitor). The
, patient develops a persistent, dry, non-productive cough. What is the nurse's
best response?
A. "This is a normal side effect that will go away with continued use."
B. "You should stop taking the medication immediately."
C. "Report this to your provider; they may switch you to an ARB."
D. "Take the medication with food to reduce the cough."
Correct Answer: C. "Report this to your provider; they may switch you to an
ARB."
Rationale: A persistent dry cough is a common side effect of ACE inhibitors
(due to increased bradykinin). It occurs in about 10-20% of patients and is
the most common reason for discontinuation. The provider may switch the
patient to an angiotensin II receptor blocker (ARB), which has a lower
incidence of cough. The patient should not stop the medication without
consulting the provider.
Subtopic: ACE Inhibitors – Cough Side Effect
Question 5
A patient is receiving a continuous heparin infusion. The aPTT is 120 seconds
(therapeutic range 60-80 seconds). What is the priority nursing action?
A. Increase the infusion rate
B. Decrease the infusion rate
C. Hold the infusion and notify the provider
D. Continue the infusion as ordered
Correct Answer: C. Hold the infusion and notify the provider
Rationale: An aPTT of 120 seconds is significantly supratherapeutic, placing
the patient at high risk for bleeding. The nurse should hold the heparin
infusion and notify the provider immediately. Continuing or increasing the
infusion would increase bleeding risk. The provider may order a dose
reduction or restart at a lower rate after reassessment.
Subtopic: Anticoagulants – Heparin Monitoring
