# VATI Med-Surg II (Medical-Surgical Nursing 2) –
Nursing Program – Exam-Style Questions with
Detailed Rationales (A Grade)
Length – 84 Questions
---
## Section 1: Cardiovascular Disorders (Questions 1–15)
**1.** A client with heart failure (HF) is receiving furosemide (Lasix) 40 mg IV twice daily. Which
assessment finding requires immediate intervention?
A) Weight loss of 1 kg in 24 hours
B) Serum potassium 3.1 mEq/L
C) Blood pressure 110/70 mmHg
D) Urine output 50 mL/hr
💡 **RATIONALE** – Furosemide is a loop diuretic that causes potassium wasting. A serum potassium of
3.1 mEq/L (normal 3.5–5.0) is hypokalemia, which increases the risk of digoxin toxicity and cardiac
arrhythmias, especially ventricular tachycardia and fibrillation.
✔️ **ANSWER** – B) Serum potassium 3.1 mEq/L
---
**2.** The nurse is caring for a client with acute decompensated heart failure (ADHF) who has crackles
in all lung fields, oxygen saturation 88% on room air, and +3 pitting edema in the lower extremities.
Which medication does the nurse prepare to administer first?
A) Metoprolol 25 mg PO
B) Furosemide 80 mg IV push
C) Digoxin 0.25 mg PO
,D) Spironolactone 25 mg PO
💡 **RATIONALE** – Furosemide (Lasix) is a loop diuretic that rapidly reduces preload by promoting
diuresis, relieving pulmonary congestion and improving oxygenation. IV administration provides
immediate onset (5 minutes). Beta-blockers (metoprolol) are not given in acute decompensation as they
can worsen HF.
✔️ **ANSWER** – B) Furosemide 80 mg IV push
---
**3.** A client with chronic heart failure (HF) has been prescribed carvedilol (Coreg). The client asks,
"Why do I need this medication? I thought beta-blockers are bad for the heart." Which response is
correct?
A) "Carvedilol increases your heart rate to improve cardiac output."
B) "Carvedilol blocks the harmful effects of chronic sympathetic stimulation, which reduces mortality in
heart failure."
C) "Carvedilol is a diuretic that helps remove excess fluid."
D) "Carvedilol is only given for high blood pressure, not heart failure."
💡 **RATIONALE** – Carvedilol is a non-selective beta-blocker with alpha-1 blocking activity. In chronic
HF, it reduces sympathetic overactivity, decreases afterload, prevents cardiac remodeling, and has been
shown to reduce mortality (CAPRICORN, COPERNICUS trials). Beta-blockers are contraindicated in acute
decompensated HF but are standard therapy for chronic HF with reduced ejection fraction (HFrEF).
✔️ **ANSWER** – B) "Carvedilol blocks the harmful effects of chronic sympathetic stimulation, which
reduces mortality in heart failure."
---
**4.** The nurse is monitoring a client receiving a continuous infusion of nitroglycerin for acute
coronary syndrome (ACS). Which finding indicates a therapeutic response?
A) Heart rate 55 bpm
B) Blood pressure 85/50 mmHg
,C) Chest pain decreases from 7/10 to 2/10 on the pain scale
D) Respiratory rate 28 breaths/min
💡 **RATIONALE** – Nitroglycerin is a vasodilator that reduces preload and afterload, decreasing
myocardial oxygen demand. Relief of chest pain (angina) is the primary therapeutic endpoint.
Hypotension (BP <90 systolic) and reflex tachycardia are potential adverse effects requiring dose
adjustment.
✔️ **ANSWER** – C) Chest pain decreases from 7/10 to 2/10 on the pain scale
---
**5.** A client with a mechanical heart valve who takes warfarin (Coumadin) presents with an INR of
4.8. The client denies bleeding but has a small bruise on the arm. Which action should the nurse take?
A) Administer vitamin K 10 mg IM immediately
B) Hold the next dose of warfarin and notify the provider
C) Increase the warfarin dose by 25%
D) Administer fresh frozen plasma (FFP)
💡 **RATIONALE** – For a mechanical heart valve, target INR is typically 2.5–3.5 (higher than standard
2–3). An INR of 4.8 is supratherapeutic but not critical (<5.0) in an asymptomatic client without bleeding.
The standard approach is to hold the next dose, monitor for bleeding, and notify the provider for dose
adjustment. Vitamin K and FFP are reserved for major bleeding or INR >10.
✔️ **ANSWER** – B) Hold the next dose of warfarin and notify the provider
---
**6.** The nurse is assessing a client with infective endocarditis. Which finding is most concerning?
A) Fever of 100.8°F (38.2°C)
B) Splinter hemorrhages under the fingernails
C) New onset of confusion and right-sided weakness
D) Heart murmur auscultated at the apex
, 💡 **RATIONALE** – New onset confusion and right-sided weakness indicate a possible embolic stroke,
a life-threatening complication of infective endocarditis. Vegetations on heart valves can embolize to
the brain, causing neurological deficits. This requires immediate notification of the provider and likely
neuroimaging (CT/MRI).
✔️ **ANSWER** – C) New onset of confusion and right-sided weakness
---
**7.** A client with hypertensive crisis is admitted with a blood pressure of 230/130 mmHg. The
provider orders IV sodium nitroprusside (Nipride). Which nursing action is essential during
administration?
A) Monitor the client's urine output every 4 hours
B) Protect the IV bag from light with an opaque covering
C) Administer the medication as an IV push over 1 minute
D) Increase the infusion rate until the client's blood pressure is 110/70 mmHg
💡 **RATIONALE** – Sodium nitroprusside is light-sensitive and degrades when exposed to light,
requiring the IV bag and tubing to be covered with an opaque material (aluminum foil or commercial
cover). It is given by continuous IV infusion with a pump, never as an IV push. Blood pressure should be
lowered gradually (not below 160–170 systolic) to avoid cerebral ischemia.
✔️ **ANSWER** – B) Protect the IV bag from light with an opaque covering
---
**8.** The nurse is teaching a client with newly diagnosed atrial fibrillation (AF) about the prescribed
apixaban (Eliquis). Which statement indicates correct understanding?
A) "I will need to get my INR checked every week at the lab."
B) "I can stop this medication if I feel better and my symptoms go away."
C) "If I miss a dose, I should take it as soon as I remember, but never double the next dose."
D) "I should take this medication with orange juice to help absorption."
Nursing Program – Exam-Style Questions with
Detailed Rationales (A Grade)
Length – 84 Questions
---
## Section 1: Cardiovascular Disorders (Questions 1–15)
**1.** A client with heart failure (HF) is receiving furosemide (Lasix) 40 mg IV twice daily. Which
assessment finding requires immediate intervention?
A) Weight loss of 1 kg in 24 hours
B) Serum potassium 3.1 mEq/L
C) Blood pressure 110/70 mmHg
D) Urine output 50 mL/hr
💡 **RATIONALE** – Furosemide is a loop diuretic that causes potassium wasting. A serum potassium of
3.1 mEq/L (normal 3.5–5.0) is hypokalemia, which increases the risk of digoxin toxicity and cardiac
arrhythmias, especially ventricular tachycardia and fibrillation.
✔️ **ANSWER** – B) Serum potassium 3.1 mEq/L
---
**2.** The nurse is caring for a client with acute decompensated heart failure (ADHF) who has crackles
in all lung fields, oxygen saturation 88% on room air, and +3 pitting edema in the lower extremities.
Which medication does the nurse prepare to administer first?
A) Metoprolol 25 mg PO
B) Furosemide 80 mg IV push
C) Digoxin 0.25 mg PO
,D) Spironolactone 25 mg PO
💡 **RATIONALE** – Furosemide (Lasix) is a loop diuretic that rapidly reduces preload by promoting
diuresis, relieving pulmonary congestion and improving oxygenation. IV administration provides
immediate onset (5 minutes). Beta-blockers (metoprolol) are not given in acute decompensation as they
can worsen HF.
✔️ **ANSWER** – B) Furosemide 80 mg IV push
---
**3.** A client with chronic heart failure (HF) has been prescribed carvedilol (Coreg). The client asks,
"Why do I need this medication? I thought beta-blockers are bad for the heart." Which response is
correct?
A) "Carvedilol increases your heart rate to improve cardiac output."
B) "Carvedilol blocks the harmful effects of chronic sympathetic stimulation, which reduces mortality in
heart failure."
C) "Carvedilol is a diuretic that helps remove excess fluid."
D) "Carvedilol is only given for high blood pressure, not heart failure."
💡 **RATIONALE** – Carvedilol is a non-selective beta-blocker with alpha-1 blocking activity. In chronic
HF, it reduces sympathetic overactivity, decreases afterload, prevents cardiac remodeling, and has been
shown to reduce mortality (CAPRICORN, COPERNICUS trials). Beta-blockers are contraindicated in acute
decompensated HF but are standard therapy for chronic HF with reduced ejection fraction (HFrEF).
✔️ **ANSWER** – B) "Carvedilol blocks the harmful effects of chronic sympathetic stimulation, which
reduces mortality in heart failure."
---
**4.** The nurse is monitoring a client receiving a continuous infusion of nitroglycerin for acute
coronary syndrome (ACS). Which finding indicates a therapeutic response?
A) Heart rate 55 bpm
B) Blood pressure 85/50 mmHg
,C) Chest pain decreases from 7/10 to 2/10 on the pain scale
D) Respiratory rate 28 breaths/min
💡 **RATIONALE** – Nitroglycerin is a vasodilator that reduces preload and afterload, decreasing
myocardial oxygen demand. Relief of chest pain (angina) is the primary therapeutic endpoint.
Hypotension (BP <90 systolic) and reflex tachycardia are potential adverse effects requiring dose
adjustment.
✔️ **ANSWER** – C) Chest pain decreases from 7/10 to 2/10 on the pain scale
---
**5.** A client with a mechanical heart valve who takes warfarin (Coumadin) presents with an INR of
4.8. The client denies bleeding but has a small bruise on the arm. Which action should the nurse take?
A) Administer vitamin K 10 mg IM immediately
B) Hold the next dose of warfarin and notify the provider
C) Increase the warfarin dose by 25%
D) Administer fresh frozen plasma (FFP)
💡 **RATIONALE** – For a mechanical heart valve, target INR is typically 2.5–3.5 (higher than standard
2–3). An INR of 4.8 is supratherapeutic but not critical (<5.0) in an asymptomatic client without bleeding.
The standard approach is to hold the next dose, monitor for bleeding, and notify the provider for dose
adjustment. Vitamin K and FFP are reserved for major bleeding or INR >10.
✔️ **ANSWER** – B) Hold the next dose of warfarin and notify the provider
---
**6.** The nurse is assessing a client with infective endocarditis. Which finding is most concerning?
A) Fever of 100.8°F (38.2°C)
B) Splinter hemorrhages under the fingernails
C) New onset of confusion and right-sided weakness
D) Heart murmur auscultated at the apex
, 💡 **RATIONALE** – New onset confusion and right-sided weakness indicate a possible embolic stroke,
a life-threatening complication of infective endocarditis. Vegetations on heart valves can embolize to
the brain, causing neurological deficits. This requires immediate notification of the provider and likely
neuroimaging (CT/MRI).
✔️ **ANSWER** – C) New onset of confusion and right-sided weakness
---
**7.** A client with hypertensive crisis is admitted with a blood pressure of 230/130 mmHg. The
provider orders IV sodium nitroprusside (Nipride). Which nursing action is essential during
administration?
A) Monitor the client's urine output every 4 hours
B) Protect the IV bag from light with an opaque covering
C) Administer the medication as an IV push over 1 minute
D) Increase the infusion rate until the client's blood pressure is 110/70 mmHg
💡 **RATIONALE** – Sodium nitroprusside is light-sensitive and degrades when exposed to light,
requiring the IV bag and tubing to be covered with an opaque material (aluminum foil or commercial
cover). It is given by continuous IV infusion with a pump, never as an IV push. Blood pressure should be
lowered gradually (not below 160–170 systolic) to avoid cerebral ischemia.
✔️ **ANSWER** – B) Protect the IV bag from light with an opaque covering
---
**8.** The nurse is teaching a client with newly diagnosed atrial fibrillation (AF) about the prescribed
apixaban (Eliquis). Which statement indicates correct understanding?
A) "I will need to get my INR checked every week at the lab."
B) "I can stop this medication if I feel better and my symptoms go away."
C) "If I miss a dose, I should take it as soon as I remember, but never double the next dose."
D) "I should take this medication with orange juice to help absorption."
