NUR 209 Medical Surgical Nursing II Exam 1 Prep
Document | 2026/2027 Edition | 250 Verified Questions
NUR 209 Exam 1 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100%
Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive test bank for NUR 209 Medical Surgical Nursing II Exam 1 contains 250 verified
questions covering critical content areas such as perioperative care, fluid and electrolyte balance, pain
management, and respiratory disorders. Each question includes correct answers and rationales to
reinforce understanding and clinical reasoning. Designed to mirror the actual exam format, this
resource is essential for achieving a high score. Updated for the 2026/2027 academic year, it reflects
the most current evidence-based practices.
Key Features:
Perioperative nursing care including preoperative assessment and postoperative complications
Fluid and electrolyte imbalances: identification and management
Pain management principles and pharmacological interventions
Respiratory disorders: COPD, pneumonia, and pulmonary embolism
Cardiovascular conditions: hypertension, heart failure, and coronary artery disease
Endocrine disorders: diabetes mellitus and thyroid dysfunction
Updates for 2026:
- Incorporated latest AHA guidelines for hypertension management
- Added new questions on COVID-19 respiratory complications
- Updated rationales to reflect 2026 nursing standards
- Enhanced distractor explanations for improved critical thinking
- Revised content on opioid pain management per current regulations
Abstract:
This meticulously curated test bank for NUR 209 Medical Surgical Nursing II Exam 1 comprises 250 verified
questions that comprehensively address the core competencies required for successful exam performance. The
content is organized into major clinical areas including perioperative care, fluid and electrolyte balance, pain
management, respiratory and cardiovascular disorders, and endocrine conditions. Each question is accompanied
by a correct answer and a detailed rationale that explains the underlying pathophysiology and nursing
interventions, facilitating deep learning and retention. The test bank has been updated to incorporate the latest
clinical guidelines and evidence-based practices for the 2026/2027 academic year. Distractors are carefully
crafted to challenge common misconceptions and promote clinical judgment. This resource is ideal for students
seeking to solidify their knowledge and achieve a top grade on the exam.
Keywords:
NUR 209, Medical Surgical Nursing II, Exam 1, Test Bank, Perioperative Care, Fluid and Electrolytes, Pain
Management, Respiratory Disorders
Answer Format:
Each question is followed by the correct answer and a comprehensive rationale explaining the reasoning. Distractor
options are analyzed to clarify why they are incorrect, enhancing critical thinking. Answers are formatted for easy
review and self-assessment.
Compliance Checklist:
All questions aligned with NUR 209 course objectives
Updated to reflect 2026/2027 clinical practice guidelines
Page 1
, Rationales cite evidence-based sources
Distractors designed to test common errors
Content reviewed by subject matter experts
Suitable for exam preparation and remediation
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-50 Preoperative assessment, intraoperative care, 20%
postoperative complications, wound healing
Fluid and Electrolyte Balance 51-90 Sodium and potassium imbalances, fluid 16%
volume deficits and excess, acid-base
disorders
Pain Management 91-130 Pharmacological interventions, 16%
non-pharmacological therapies, opioid and
non-opioid analgesics
Respiratory Disorders 131-170 COPD, pneumonia, pulmonary embolism, 16%
asthma, respiratory failure
Cardiovascular Disorders 171-210 Hypertension, heart failure, coronary artery 16%
disease, dysrhythmias, myocardial infarction
Endocrine Disorders 211-250 Diabetes mellitus, thyroid disorders, adrenal 16%
insufficiency, SIADH
Page 2
,Q1. A patient with acute pancreatitis develops hypocalcemia. Which assessment finding requires immediate
intervention?
A. Positive Trousseau sign
B. Muscle cramps
C. Prolonged QT interval on ECG
D. Chvostek sign
Correct Answer: C. Prolonged QT interval on ECG
Rationale: Prolonged QT interval indicates severe hypocalcemia that can lead to ventricular dysrhythmias and
cardiac arrest. Trousseau sign, Chvostek sign, and muscle cramps are earlier signs of hypocalcemia but do not
indicate an immediate life-threatening risk.
Why Wrong:
A - Positive Trousseau sign is a clinical sign of hypocalcemia but does not indicate immediate cardiac risk.
B - Muscle cramps are a common early symptom of hypocalcemia, not a sign of impending cardiac arrest.
D - Chvostek sign is a facial twitch response that can occur in hypocalcemia but is not a priority over ECG
changes.
Reference: Ignatavicius, D.D., Workman, M.L., & Rebar, C.R. (2021). Medical-Surgical Nursing: Concepts for
Interprofessional Collaborative Care, 10th Ed., Ch. 17.
Q2. A patient in the intensive care unit has a pulmonary artery catheter. The nurse notes a pulmonary artery
wedge pressure (PAWP) of 4 mm Hg (normal 6-12 mm Hg) and a cardiac index (CI) of 1.8 L/min/m² (normal
2.5-4.0 L/min/m²). Which intervention should the nurse anticipate?
A. Administer a vasopressor such as norepinephrine
B. Administer a diuretic such as furosemide
C. Administer a fluid bolus of 0.9% normal saline
D. Administer a beta-blocker such as metoprolol
Correct Answer: C. Administer a fluid bolus of 0.9% normal saline
Rationale: Low PAWP (preload) and low CI indicate hypovolemic shock. Fluid resuscitation is the priority to
increase preload and improve cardiac output. Vasopressors are used if fluid resuscitation is inadequate; diuretics
and beta-blockers would worsen the condition.
Why Wrong:
A - Vasopressors are indicated after adequate fluid resuscitation if hypotension persists.
B - Diuretics would further decrease preload and worsen hypovolemic shock.
D - Beta-blockers decrease heart rate and contractility, which would further reduce cardiac output.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2022). Critical Care Nursing: Diagnosis and Management,
9th Ed., Ch. 22.
Q3. A patient with septic shock is receiving norepinephrine and has a mean arterial pressure (MAP) of 65
mm Hg. The nurse reviews the most recent laboratory results: lactate 4.2 mmol/L (normal <2), pH 7.30,
PaCO2 35 mm Hg, HCO3- 16 mEq/L. Which additional therapy should the nurse question if prescribed?
A. Crystalloid fluid bolus 500 mL
B. Sodium bicarbonate 50 mEq IV
C. Hydrocortisone 50 mg IV every 6 hours
D. Broad-spectrum antibiotics
Correct Answer: B. Sodium bicarbonate 50 mEq IV
Rationale: Sodium bicarbonate is not recommended for lactic acidosis in septic shock unless pH is less than 7.15,
as it can worsen intracellular acidosis and impair oxygen delivery. The current pH of 7.30 does not meet the
threshold. Fluid resuscitation, corticosteroids for vasopressor-dependent shock, and antibiotics are all appropriate.
Why Wrong:
A - Fluid bolus is appropriate as the patient likely has ongoing fluid deficits.
Page 3
, C - Hydrocortisone is recommended for septic shock patients who remain hypotensive despite adequate fluid
and vasopressor therapy.
D - Broad-spectrum antibiotics are a cornerstone of sepsis management.
Reference: Rhodes, A., et al. (2017). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and
Septic Shock: 2016. Intensive Care Medicine, 43(3), 304-377.
Q4. A patient is 2 hours post-operative following a total hip arthroplasty under spinal anesthesia. The nurse
assesses the patient and finds the following: heart rate 110 bpm, blood pressure 90/60 mm Hg, respiratory
rate 22 breaths/min, temperature 36.8°C, oxygen saturation 95% on room air. The patient reports severe
incisional pain (8/10) and nausea. What is the nurse's priority action?
A. Administer ondansetron 4 mg IV for nausea
B. Administer morphine 2 mg IV for pain
C. Assess the surgical dressing and check for bleeding
D. Increase IV fluid rate and elevate legs
Correct Answer: D. Increase IV fluid rate and elevate legs
Rationale: The patient's tachycardia and hypotension suggest hypovolemia, possibly due to vasodilation from
spinal anesthesia or blood loss. Increasing IV fluids and elevating legs can improve venous return and cardiac
output. Pain and nausea are secondary concerns; however, administering morphine could worsen hypotension.
Assessing for bleeding is important but not the first priority if fluid resuscitation is needed immediately.
Why Wrong:
A - Antiemetics are not the priority; the nausea may be from hypotension.
B - Morphine can cause vasodilation and worsen hypotension; pain management should be addressed after
hemodynamic stabilization.
C - While bleeding is a concern, initial management of hypotension should be fluid resuscitation.
Reference: Lewis, S.L., et al. (2023). Medical-Surgical Nursing: Assessment and Management of Clinical
Problems, 11th Ed., Ch. 16.
Q5. A patient with chronic kidney disease stage 4 is admitted with hyperkalemia (potassium 6.2 mEq/L). The
ECG shows peaked T waves. The nurse prepares to administer intravenous calcium gluconate. Which
statement best explains the rationale for this therapy?
A. Calcium gluconate lowers serum potassium by shifting it into cells.
B. Calcium gluconate antagonizes the cardiac effects of hyperkalemia.
C. Calcium gluconate increases potassium excretion via the kidneys.
D. Calcium gluconate binds to potassium and removes it from the circulation.
Correct Answer: B. Calcium gluconate antagonizes the cardiac effects of hyperkalemia.
Rationale: Calcium gluconate does not lower serum potassium but stabilizes the cardiac cell membrane, protecting
against life-threatening dysrhythmias. It is a temporary measure while other treatments (e.g., insulin and glucose,
albuterol) are used to shift potassium into cells or remove it.
Why Wrong:
A - Shifting potassium into cells is achieved by insulin and glucose or albuterol, not calcium gluconate.
C - Potassium excretion is enhanced by loop diuretics or dialysis, not calcium gluconate.
D - Calcium does not bind potassium; it works on the myocardium.
Reference: Lehne, R.A. (2022). Pharmacology for Nursing Care, 11th Ed., Ch. 49.
Q6. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled mechanical
ventilation with a tidal volume of 6 mL/kg ideal body weight, PEEP of 10 cm H2O, and FiO2 of 0.7. The
nurse reviews the arterial blood gas: pH 7.25, PaCO2 50 mm Hg, PaO2 60 mm Hg, HCO3- 22 mEq/L. Which
intervention should the nurse question?
A. Increase PEEP to 15 cm H2O
Page 4
Document | 2026/2027 Edition | 250 Verified Questions
NUR 209 Exam 1 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100%
Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive test bank for NUR 209 Medical Surgical Nursing II Exam 1 contains 250 verified
questions covering critical content areas such as perioperative care, fluid and electrolyte balance, pain
management, and respiratory disorders. Each question includes correct answers and rationales to
reinforce understanding and clinical reasoning. Designed to mirror the actual exam format, this
resource is essential for achieving a high score. Updated for the 2026/2027 academic year, it reflects
the most current evidence-based practices.
Key Features:
Perioperative nursing care including preoperative assessment and postoperative complications
Fluid and electrolyte imbalances: identification and management
Pain management principles and pharmacological interventions
Respiratory disorders: COPD, pneumonia, and pulmonary embolism
Cardiovascular conditions: hypertension, heart failure, and coronary artery disease
Endocrine disorders: diabetes mellitus and thyroid dysfunction
Updates for 2026:
- Incorporated latest AHA guidelines for hypertension management
- Added new questions on COVID-19 respiratory complications
- Updated rationales to reflect 2026 nursing standards
- Enhanced distractor explanations for improved critical thinking
- Revised content on opioid pain management per current regulations
Abstract:
This meticulously curated test bank for NUR 209 Medical Surgical Nursing II Exam 1 comprises 250 verified
questions that comprehensively address the core competencies required for successful exam performance. The
content is organized into major clinical areas including perioperative care, fluid and electrolyte balance, pain
management, respiratory and cardiovascular disorders, and endocrine conditions. Each question is accompanied
by a correct answer and a detailed rationale that explains the underlying pathophysiology and nursing
interventions, facilitating deep learning and retention. The test bank has been updated to incorporate the latest
clinical guidelines and evidence-based practices for the 2026/2027 academic year. Distractors are carefully
crafted to challenge common misconceptions and promote clinical judgment. This resource is ideal for students
seeking to solidify their knowledge and achieve a top grade on the exam.
Keywords:
NUR 209, Medical Surgical Nursing II, Exam 1, Test Bank, Perioperative Care, Fluid and Electrolytes, Pain
Management, Respiratory Disorders
Answer Format:
Each question is followed by the correct answer and a comprehensive rationale explaining the reasoning. Distractor
options are analyzed to clarify why they are incorrect, enhancing critical thinking. Answers are formatted for easy
review and self-assessment.
Compliance Checklist:
All questions aligned with NUR 209 course objectives
Updated to reflect 2026/2027 clinical practice guidelines
Page 1
, Rationales cite evidence-based sources
Distractors designed to test common errors
Content reviewed by subject matter experts
Suitable for exam preparation and remediation
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-50 Preoperative assessment, intraoperative care, 20%
postoperative complications, wound healing
Fluid and Electrolyte Balance 51-90 Sodium and potassium imbalances, fluid 16%
volume deficits and excess, acid-base
disorders
Pain Management 91-130 Pharmacological interventions, 16%
non-pharmacological therapies, opioid and
non-opioid analgesics
Respiratory Disorders 131-170 COPD, pneumonia, pulmonary embolism, 16%
asthma, respiratory failure
Cardiovascular Disorders 171-210 Hypertension, heart failure, coronary artery 16%
disease, dysrhythmias, myocardial infarction
Endocrine Disorders 211-250 Diabetes mellitus, thyroid disorders, adrenal 16%
insufficiency, SIADH
Page 2
,Q1. A patient with acute pancreatitis develops hypocalcemia. Which assessment finding requires immediate
intervention?
A. Positive Trousseau sign
B. Muscle cramps
C. Prolonged QT interval on ECG
D. Chvostek sign
Correct Answer: C. Prolonged QT interval on ECG
Rationale: Prolonged QT interval indicates severe hypocalcemia that can lead to ventricular dysrhythmias and
cardiac arrest. Trousseau sign, Chvostek sign, and muscle cramps are earlier signs of hypocalcemia but do not
indicate an immediate life-threatening risk.
Why Wrong:
A - Positive Trousseau sign is a clinical sign of hypocalcemia but does not indicate immediate cardiac risk.
B - Muscle cramps are a common early symptom of hypocalcemia, not a sign of impending cardiac arrest.
D - Chvostek sign is a facial twitch response that can occur in hypocalcemia but is not a priority over ECG
changes.
Reference: Ignatavicius, D.D., Workman, M.L., & Rebar, C.R. (2021). Medical-Surgical Nursing: Concepts for
Interprofessional Collaborative Care, 10th Ed., Ch. 17.
Q2. A patient in the intensive care unit has a pulmonary artery catheter. The nurse notes a pulmonary artery
wedge pressure (PAWP) of 4 mm Hg (normal 6-12 mm Hg) and a cardiac index (CI) of 1.8 L/min/m² (normal
2.5-4.0 L/min/m²). Which intervention should the nurse anticipate?
A. Administer a vasopressor such as norepinephrine
B. Administer a diuretic such as furosemide
C. Administer a fluid bolus of 0.9% normal saline
D. Administer a beta-blocker such as metoprolol
Correct Answer: C. Administer a fluid bolus of 0.9% normal saline
Rationale: Low PAWP (preload) and low CI indicate hypovolemic shock. Fluid resuscitation is the priority to
increase preload and improve cardiac output. Vasopressors are used if fluid resuscitation is inadequate; diuretics
and beta-blockers would worsen the condition.
Why Wrong:
A - Vasopressors are indicated after adequate fluid resuscitation if hypotension persists.
B - Diuretics would further decrease preload and worsen hypovolemic shock.
D - Beta-blockers decrease heart rate and contractility, which would further reduce cardiac output.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2022). Critical Care Nursing: Diagnosis and Management,
9th Ed., Ch. 22.
Q3. A patient with septic shock is receiving norepinephrine and has a mean arterial pressure (MAP) of 65
mm Hg. The nurse reviews the most recent laboratory results: lactate 4.2 mmol/L (normal <2), pH 7.30,
PaCO2 35 mm Hg, HCO3- 16 mEq/L. Which additional therapy should the nurse question if prescribed?
A. Crystalloid fluid bolus 500 mL
B. Sodium bicarbonate 50 mEq IV
C. Hydrocortisone 50 mg IV every 6 hours
D. Broad-spectrum antibiotics
Correct Answer: B. Sodium bicarbonate 50 mEq IV
Rationale: Sodium bicarbonate is not recommended for lactic acidosis in septic shock unless pH is less than 7.15,
as it can worsen intracellular acidosis and impair oxygen delivery. The current pH of 7.30 does not meet the
threshold. Fluid resuscitation, corticosteroids for vasopressor-dependent shock, and antibiotics are all appropriate.
Why Wrong:
A - Fluid bolus is appropriate as the patient likely has ongoing fluid deficits.
Page 3
, C - Hydrocortisone is recommended for septic shock patients who remain hypotensive despite adequate fluid
and vasopressor therapy.
D - Broad-spectrum antibiotics are a cornerstone of sepsis management.
Reference: Rhodes, A., et al. (2017). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and
Septic Shock: 2016. Intensive Care Medicine, 43(3), 304-377.
Q4. A patient is 2 hours post-operative following a total hip arthroplasty under spinal anesthesia. The nurse
assesses the patient and finds the following: heart rate 110 bpm, blood pressure 90/60 mm Hg, respiratory
rate 22 breaths/min, temperature 36.8°C, oxygen saturation 95% on room air. The patient reports severe
incisional pain (8/10) and nausea. What is the nurse's priority action?
A. Administer ondansetron 4 mg IV for nausea
B. Administer morphine 2 mg IV for pain
C. Assess the surgical dressing and check for bleeding
D. Increase IV fluid rate and elevate legs
Correct Answer: D. Increase IV fluid rate and elevate legs
Rationale: The patient's tachycardia and hypotension suggest hypovolemia, possibly due to vasodilation from
spinal anesthesia or blood loss. Increasing IV fluids and elevating legs can improve venous return and cardiac
output. Pain and nausea are secondary concerns; however, administering morphine could worsen hypotension.
Assessing for bleeding is important but not the first priority if fluid resuscitation is needed immediately.
Why Wrong:
A - Antiemetics are not the priority; the nausea may be from hypotension.
B - Morphine can cause vasodilation and worsen hypotension; pain management should be addressed after
hemodynamic stabilization.
C - While bleeding is a concern, initial management of hypotension should be fluid resuscitation.
Reference: Lewis, S.L., et al. (2023). Medical-Surgical Nursing: Assessment and Management of Clinical
Problems, 11th Ed., Ch. 16.
Q5. A patient with chronic kidney disease stage 4 is admitted with hyperkalemia (potassium 6.2 mEq/L). The
ECG shows peaked T waves. The nurse prepares to administer intravenous calcium gluconate. Which
statement best explains the rationale for this therapy?
A. Calcium gluconate lowers serum potassium by shifting it into cells.
B. Calcium gluconate antagonizes the cardiac effects of hyperkalemia.
C. Calcium gluconate increases potassium excretion via the kidneys.
D. Calcium gluconate binds to potassium and removes it from the circulation.
Correct Answer: B. Calcium gluconate antagonizes the cardiac effects of hyperkalemia.
Rationale: Calcium gluconate does not lower serum potassium but stabilizes the cardiac cell membrane, protecting
against life-threatening dysrhythmias. It is a temporary measure while other treatments (e.g., insulin and glucose,
albuterol) are used to shift potassium into cells or remove it.
Why Wrong:
A - Shifting potassium into cells is achieved by insulin and glucose or albuterol, not calcium gluconate.
C - Potassium excretion is enhanced by loop diuretics or dialysis, not calcium gluconate.
D - Calcium does not bind potassium; it works on the myocardium.
Reference: Lehne, R.A. (2022). Pharmacology for Nursing Care, 11th Ed., Ch. 49.
Q6. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled mechanical
ventilation with a tidal volume of 6 mL/kg ideal body weight, PEEP of 10 cm H2O, and FiO2 of 0.7. The
nurse reviews the arterial blood gas: pH 7.25, PaCO2 50 mm Hg, PaO2 60 mm Hg, HCO3- 22 mEq/L. Which
intervention should the nurse question?
A. Increase PEEP to 15 cm H2O
Page 4
