NUR 204 MEDICAL-SURGICAL
NURSING – SUMMER FINAL
EXAM 2026 QUESTIONS AND
ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Section 1: Cardiovascular Disorders
1. A patient with heart failure has crackles in both lungs, jugular vein
distension, and 3+ pitting edema. Which medication does the nurse prepare to
administer first?
a) Metoprolol
b) Digoxin
c) Furosemide – Rationale: Furosemide is a loop diuretic that rapidly reduces preload,
relieving pulmonary congestion. Beta-blockers and digoxin are not for acute
decompensation.
d) Spironolactone
2. A patient post-MI develops sudden hypotension, muffled heart sounds, and
distended neck veins. What is the priority action?
a) Administer IV fluids rapidly
b) Prepare for pericardiocentesis – Rationale: These are signs of cardiac tamponade
(Beck’s triad). Pericardiocentesis removes fluid and relieves pressure.
c) Start dopamine drip
d) Give sublingual nitroglycerin
3. Which lab value is most concerning in a patient taking warfarin?
a) Platelets 150,000/mm³
, b) INR 5.2 – *Rationale: INR target is usually 2-3 for most indications. INR 5.2 greatly
increases bleeding risk.*
c) PTT 35 seconds
d) Hemoglobin 13 g/dL
4. A patient with unstable angina reports chest pain 6/10. The nurse gives
nitroglycerin 0.4 mg SL. Pain remains 5/10 after 5 minutes. What next?
a) Give aspirin 324 mg PO
b) Repeat nitroglycerin – Rationale: Up to 3 doses of SL nitroglycerin every 5 minutes
for ongoing chest pain.
c) Call rapid response
d) Administer morphine
Section 2: Respiratory Disorders
5. A patient with COPD has an SpO₂ of 88% on 2 L nasal cannula. ABG: pH 7.32,
PaCO₂ 65, HCO₃ 30. Which action is correct?
a) Increase O₂ to 4 L
b) Maintain current O₂ – *Rationale: Patient has chronic hypercapnia; high O₂ may
remove hypoxic drive. Target SpO₂ 88-92% in COPD.*
c) Prepare for intubation
d) Give sodium bicarbonate
6. Post-thoracentesis, a patient reports sudden sharp chest pain and dyspnea.
What does the nurse suspect?
a) Pulmonary edema
b) Bronchospasm
c) Tension pneumothorax – Rationale: Sudden pain + dyspnea post-procedure
suggests pneumothorax from lung puncture.
d) Hemothorax
7. Which finding indicates proper positioning for a chest tube to water seal?
a) Tidaling in the water seal chamber with inspiration/expiration
b) Continuous bubbling in suction chamber only – Rationale: Tidaling is normal.
Continuous bubbling in water seal chamber indicates air leak.
c) No drainage in collection chamber
d) Patient lying flat
8. A patient with pneumonia has a fever of 102.5°F, confusion, and BP 90/60.
What order should the nurse question?
a) IV ceftriaxone
NURSING – SUMMER FINAL
EXAM 2026 QUESTIONS AND
ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Section 1: Cardiovascular Disorders
1. A patient with heart failure has crackles in both lungs, jugular vein
distension, and 3+ pitting edema. Which medication does the nurse prepare to
administer first?
a) Metoprolol
b) Digoxin
c) Furosemide – Rationale: Furosemide is a loop diuretic that rapidly reduces preload,
relieving pulmonary congestion. Beta-blockers and digoxin are not for acute
decompensation.
d) Spironolactone
2. A patient post-MI develops sudden hypotension, muffled heart sounds, and
distended neck veins. What is the priority action?
a) Administer IV fluids rapidly
b) Prepare for pericardiocentesis – Rationale: These are signs of cardiac tamponade
(Beck’s triad). Pericardiocentesis removes fluid and relieves pressure.
c) Start dopamine drip
d) Give sublingual nitroglycerin
3. Which lab value is most concerning in a patient taking warfarin?
a) Platelets 150,000/mm³
, b) INR 5.2 – *Rationale: INR target is usually 2-3 for most indications. INR 5.2 greatly
increases bleeding risk.*
c) PTT 35 seconds
d) Hemoglobin 13 g/dL
4. A patient with unstable angina reports chest pain 6/10. The nurse gives
nitroglycerin 0.4 mg SL. Pain remains 5/10 after 5 minutes. What next?
a) Give aspirin 324 mg PO
b) Repeat nitroglycerin – Rationale: Up to 3 doses of SL nitroglycerin every 5 minutes
for ongoing chest pain.
c) Call rapid response
d) Administer morphine
Section 2: Respiratory Disorders
5. A patient with COPD has an SpO₂ of 88% on 2 L nasal cannula. ABG: pH 7.32,
PaCO₂ 65, HCO₃ 30. Which action is correct?
a) Increase O₂ to 4 L
b) Maintain current O₂ – *Rationale: Patient has chronic hypercapnia; high O₂ may
remove hypoxic drive. Target SpO₂ 88-92% in COPD.*
c) Prepare for intubation
d) Give sodium bicarbonate
6. Post-thoracentesis, a patient reports sudden sharp chest pain and dyspnea.
What does the nurse suspect?
a) Pulmonary edema
b) Bronchospasm
c) Tension pneumothorax – Rationale: Sudden pain + dyspnea post-procedure
suggests pneumothorax from lung puncture.
d) Hemothorax
7. Which finding indicates proper positioning for a chest tube to water seal?
a) Tidaling in the water seal chamber with inspiration/expiration
b) Continuous bubbling in suction chamber only – Rationale: Tidaling is normal.
Continuous bubbling in water seal chamber indicates air leak.
c) No drainage in collection chamber
d) Patient lying flat
8. A patient with pneumonia has a fever of 102.5°F, confusion, and BP 90/60.
What order should the nurse question?
a) IV ceftriaxone
