Page 1 of 182
Medical-Surgical II Final Exam Newest
complete questions and correct verified
answers (detailed answers) already graded
A+
1. A nurse is assessing a client with heart failure. Which finding
is an early sign of decreased cardiac output?
A. Jugular vein distention
B. Crackles in lung bases
C. Decreased urine output
D. Peripheral edema
Correct Answer: C. Decreased urine output
Rationale: Early decreased cardiac output reduces renal
,Page 2 of 182
perfusion, activating RAAS and decreasing urine output. JVD,
crackles, and edema are later signs of fluid overload.
2. A client with unstable angina is prescribed nitroglycerin
sublingual. Which instruction is correct?
A. Swallow the tablet with water
B. Take up to 3 tablets 5 minutes apart for chest pain
C. Store tablets in a clear glass bottle
D. Take the tablet at the first sign of dizziness
Correct Answer: B. Take up to 3 tablets 5 minutes apart for
chest pain
Rationale: Nitroglycerin SL is taken q5min up to 3 doses for
chest pain unrelieved by rest. It should not be swallowed,
stored in original dark glass bottle, and not used for dizziness.
3. A post-cardiac arrest client has a serum potassium of 2.8
mEq/L. The nurse should monitor for which dysrhythmia?
A. Atrial fibrillation
B. Ventricular fibrillation
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C. Premature ventricular contractions (PVCs)
D. Sinus bradycardia
Correct Answer: C. Premature ventricular contractions (PVCs)
Rationale: Hypokalemia increases myocardial irritability →
PVCs, VT, VFib. Hyperkalemia causes peaked T waves and
bradycardia.
4. A client with acute decompensated heart failure has
crackles, S3 gallop, and BP 90/50. Which medication should
the nurse administer first?
A. Furosemide IV
B. Metoprolol PO
C. Digoxin PO
D. Spironolactone PO
Correct Answer: A. Furosemide IV
Rationale: Immediate diuresis reduces preload, relieving
pulmonary congestion. Beta-blockers (metoprolol) are not
given in acute decompensation.
, Page 4 of 182
5. A nurse is caring for a client post–coronary artery bypass
graft (CABG). Which assessment finding requires immediate
action?
A. Chest tube drainage of 75 mL/hr
B. Temperature 99.2°F (37.3°C)
C. Jugular vein distention with hypotension
D. Serous drainage on sternal dressing
Correct Answer: C. Jugular vein distention with hypotension
Rationale: JVD + hypotension suggests cardiac tamponade
(pericardial fluid compressing heart). Requires immediate
pericardiocentesis.
6. A client with atrial fibrillation is started on warfarin. Which
lab value indicates therapeutic effect?
A. aPTT 60–80 seconds
B. INR 2.0–3.0
C. Platelets >150,000
D. PT 12–15 seconds
Medical-Surgical II Final Exam Newest
complete questions and correct verified
answers (detailed answers) already graded
A+
1. A nurse is assessing a client with heart failure. Which finding
is an early sign of decreased cardiac output?
A. Jugular vein distention
B. Crackles in lung bases
C. Decreased urine output
D. Peripheral edema
Correct Answer: C. Decreased urine output
Rationale: Early decreased cardiac output reduces renal
,Page 2 of 182
perfusion, activating RAAS and decreasing urine output. JVD,
crackles, and edema are later signs of fluid overload.
2. A client with unstable angina is prescribed nitroglycerin
sublingual. Which instruction is correct?
A. Swallow the tablet with water
B. Take up to 3 tablets 5 minutes apart for chest pain
C. Store tablets in a clear glass bottle
D. Take the tablet at the first sign of dizziness
Correct Answer: B. Take up to 3 tablets 5 minutes apart for
chest pain
Rationale: Nitroglycerin SL is taken q5min up to 3 doses for
chest pain unrelieved by rest. It should not be swallowed,
stored in original dark glass bottle, and not used for dizziness.
3. A post-cardiac arrest client has a serum potassium of 2.8
mEq/L. The nurse should monitor for which dysrhythmia?
A. Atrial fibrillation
B. Ventricular fibrillation
,Page 3 of 182
C. Premature ventricular contractions (PVCs)
D. Sinus bradycardia
Correct Answer: C. Premature ventricular contractions (PVCs)
Rationale: Hypokalemia increases myocardial irritability →
PVCs, VT, VFib. Hyperkalemia causes peaked T waves and
bradycardia.
4. A client with acute decompensated heart failure has
crackles, S3 gallop, and BP 90/50. Which medication should
the nurse administer first?
A. Furosemide IV
B. Metoprolol PO
C. Digoxin PO
D. Spironolactone PO
Correct Answer: A. Furosemide IV
Rationale: Immediate diuresis reduces preload, relieving
pulmonary congestion. Beta-blockers (metoprolol) are not
given in acute decompensation.
, Page 4 of 182
5. A nurse is caring for a client post–coronary artery bypass
graft (CABG). Which assessment finding requires immediate
action?
A. Chest tube drainage of 75 mL/hr
B. Temperature 99.2°F (37.3°C)
C. Jugular vein distention with hypotension
D. Serous drainage on sternal dressing
Correct Answer: C. Jugular vein distention with hypotension
Rationale: JVD + hypotension suggests cardiac tamponade
(pericardial fluid compressing heart). Requires immediate
pericardiocentesis.
6. A client with atrial fibrillation is started on warfarin. Which
lab value indicates therapeutic effect?
A. aPTT 60–80 seconds
B. INR 2.0–3.0
C. Platelets >150,000
D. PT 12–15 seconds
