NUR209 EXAM 1 Actual Exam 2026/2027
Complete Questions and Verified Answers
with Detailed Rationales Medical Surgical
Nursing II 100% Correct Grade A Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
Q1: A nurse is caring for a patient with heart failure who has been receiving furosemide 40 mg
IV daily. Which laboratory value requires immediate intervention?
A. Sodium 135 mEq/L
B. Potassium 2.8 mEq/L. [CORRECT]
C. Creatinine 1.0 mg/dL
D. Hemoglobin 12.5 g/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that can cause significant potassium loss, leading to
hypokalemia. A potassium level of 2.8 mEq/L is critically low and increases the risk of life-
threatening dysrhythmias (B). Sodium 135 mEq/L (A) is within normal range. Creatinine 1.0
mg/dL (C) is normal. Hemoglobin 12.5 g/dL (D) is within normal range for some populations.
Q2: A patient with hypertension presents with blood pressure 220/130 mmHg, headache, and
blurred vision but denies chest pain or neurological deficits. The nurse recognizes this as:
A. Hypertensive emergency requiring immediate IV antihypertensives
B. Hypertensive urgency requiring gradual BP reduction over 24-48 hours. [CORRECT]
C. Primary hypertension requiring lifestyle modifications only
D. White coat hypertension requiring no treatment
Correct Answer: B
Rationale: Hypertensive urgency is defined as severe hypertension (≥180/120 mmHg) without
evidence of acute target organ damage (no papilledema, encephalopathy, acute kidney injury, or
cardiac ischemia). Treatment involves gradual reduction over 24-48 hours using oral agents (B).
,Hypertensive emergency (A) requires immediate IV therapy. This is not primary hypertension
(C) or white coat phenomenon (D).
Q3: A patient with stable angina reports chest pain while climbing stairs. The nurse understands
that this pain:
A. Indicates an acute myocardial infarction is occurring
B. Is predictable, occurs with exertion, and relieved by rest or nitroglycerin. [CORRECT]
C. Occurs at rest and indicates unstable angina
D. Requires immediate thrombolytic therapy
Correct Answer: B
Rationale: Stable angina is characterized by predictable chest pain that occurs with exertion or
stress and is relieved by rest or nitroglycerin within 5 minutes (B). It indicates reversible
myocardial ischemia without cell death. Unstable angina (C) occurs at rest or with increasing
frequency/severity. MI (A) involves prolonged pain with biomarker elevation. Thrombolytics (D)
are for STEMI, not stable angina.
Q4: A patient with acute chest pain is diagnosed with STEMI. The nurse understands that the
priority reperfusion goal is:
A. Administration of fibrinolytics within 6 hours of symptom onset
B. Percutaneous coronary intervention within 90 minutes of first medical contact. [CORRECT]
C. Administration of aspirin within 24 hours
D. Transfer to a cardiac rehabilitation program
Correct Answer: B
Rationale: For STEMI, primary PCI (percutaneous coronary intervention) is the preferred
reperfusion strategy with a goal of door-to-balloon time within 90 minutes of first medical
contact (B). Fibrinolytics (A) are used if PCI cannot be performed within 120 minutes, with goal
of door-to-needle within 30 minutes. Aspirin (C) should be given immediately, not within 24
hours. Cardiac rehab (D) occurs after stabilization.
Q5: A patient with heart failure has crackles bilaterally, orthopnea, paroxysmal nocturnal
dyspnea, and an S3 gallop. The nurse recognizes these as findings of:
A. Right-sided heart failure
B. Left-sided heart failure. [CORRECT]
, C. Cardiogenic shock
D. Pericardial tamponade
Correct Answer: B
Rationale: Left-sided heart failure causes pulmonary congestion manifesting as crackles
(pulmonary edema), orthopnea (dyspnea when supine), PND (sudden dyspnea awakening patient
from sleep), and S3 gallop (ventricular filling sound) (B). Right-sided failure (A) shows systemic
congestion (JVD, peripheral edema, hepatomegaly). Cardiogenic shock (C) involves hypotension
and organ hypoperfusion. Tamponade (D) shows Beck's triad.
Q6: A patient with atrial fibrillation has an irregularly irregular pulse with no discernible P
waves on ECG. The nurse understands the primary risk associated with this rhythm is:
A. Bradycardia leading to syncope
B. Thrombus formation and embolic stroke. [CORRECT]
C. Ventricular fibrillation
D. Complete heart block
Correct Answer: B
Rationale: In atrial fibrillation, ineffective atrial contraction causes blood stasis, particularly in
the left atrial appendage, leading to thrombus formation. Embolization causes ischemic stroke
(risk increased 5-fold) (B). Rate control and anticoagulation are essential. While bradycardia (A)
can occur, stroke prevention is the priority. AF can precipitate V-fib (C) rarely, and heart block
(D) is not typical.
Q7: A patient with a mechanical heart valve is taking warfarin. The nurse understands the
therapeutic INR range for this patient is:
A. 1.5-2.0
B. 2.0-3.0
C. 2.5-3.5. [CORRECT]
D. 3.5-4.5
Correct Answer: C
Rationale: Mechanical heart valves, particularly in the mitral position or with older valve types,
require higher anticoagulation intensity due to thrombogenicity. The target INR is 2.5-3.5 (C).
Bioprosthetic valves or valves in aortic position may use 2.0-3.0 (B). Standard DVT/AF
treatment is 2.0-3.0. Higher ranges increase bleeding risk without additional benefit.
Complete Questions and Verified Answers
with Detailed Rationales Medical Surgical
Nursing II 100% Correct Grade A Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
Q1: A nurse is caring for a patient with heart failure who has been receiving furosemide 40 mg
IV daily. Which laboratory value requires immediate intervention?
A. Sodium 135 mEq/L
B. Potassium 2.8 mEq/L. [CORRECT]
C. Creatinine 1.0 mg/dL
D. Hemoglobin 12.5 g/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that can cause significant potassium loss, leading to
hypokalemia. A potassium level of 2.8 mEq/L is critically low and increases the risk of life-
threatening dysrhythmias (B). Sodium 135 mEq/L (A) is within normal range. Creatinine 1.0
mg/dL (C) is normal. Hemoglobin 12.5 g/dL (D) is within normal range for some populations.
Q2: A patient with hypertension presents with blood pressure 220/130 mmHg, headache, and
blurred vision but denies chest pain or neurological deficits. The nurse recognizes this as:
A. Hypertensive emergency requiring immediate IV antihypertensives
B. Hypertensive urgency requiring gradual BP reduction over 24-48 hours. [CORRECT]
C. Primary hypertension requiring lifestyle modifications only
D. White coat hypertension requiring no treatment
Correct Answer: B
Rationale: Hypertensive urgency is defined as severe hypertension (≥180/120 mmHg) without
evidence of acute target organ damage (no papilledema, encephalopathy, acute kidney injury, or
cardiac ischemia). Treatment involves gradual reduction over 24-48 hours using oral agents (B).
,Hypertensive emergency (A) requires immediate IV therapy. This is not primary hypertension
(C) or white coat phenomenon (D).
Q3: A patient with stable angina reports chest pain while climbing stairs. The nurse understands
that this pain:
A. Indicates an acute myocardial infarction is occurring
B. Is predictable, occurs with exertion, and relieved by rest or nitroglycerin. [CORRECT]
C. Occurs at rest and indicates unstable angina
D. Requires immediate thrombolytic therapy
Correct Answer: B
Rationale: Stable angina is characterized by predictable chest pain that occurs with exertion or
stress and is relieved by rest or nitroglycerin within 5 minutes (B). It indicates reversible
myocardial ischemia without cell death. Unstable angina (C) occurs at rest or with increasing
frequency/severity. MI (A) involves prolonged pain with biomarker elevation. Thrombolytics (D)
are for STEMI, not stable angina.
Q4: A patient with acute chest pain is diagnosed with STEMI. The nurse understands that the
priority reperfusion goal is:
A. Administration of fibrinolytics within 6 hours of symptom onset
B. Percutaneous coronary intervention within 90 minutes of first medical contact. [CORRECT]
C. Administration of aspirin within 24 hours
D. Transfer to a cardiac rehabilitation program
Correct Answer: B
Rationale: For STEMI, primary PCI (percutaneous coronary intervention) is the preferred
reperfusion strategy with a goal of door-to-balloon time within 90 minutes of first medical
contact (B). Fibrinolytics (A) are used if PCI cannot be performed within 120 minutes, with goal
of door-to-needle within 30 minutes. Aspirin (C) should be given immediately, not within 24
hours. Cardiac rehab (D) occurs after stabilization.
Q5: A patient with heart failure has crackles bilaterally, orthopnea, paroxysmal nocturnal
dyspnea, and an S3 gallop. The nurse recognizes these as findings of:
A. Right-sided heart failure
B. Left-sided heart failure. [CORRECT]
, C. Cardiogenic shock
D. Pericardial tamponade
Correct Answer: B
Rationale: Left-sided heart failure causes pulmonary congestion manifesting as crackles
(pulmonary edema), orthopnea (dyspnea when supine), PND (sudden dyspnea awakening patient
from sleep), and S3 gallop (ventricular filling sound) (B). Right-sided failure (A) shows systemic
congestion (JVD, peripheral edema, hepatomegaly). Cardiogenic shock (C) involves hypotension
and organ hypoperfusion. Tamponade (D) shows Beck's triad.
Q6: A patient with atrial fibrillation has an irregularly irregular pulse with no discernible P
waves on ECG. The nurse understands the primary risk associated with this rhythm is:
A. Bradycardia leading to syncope
B. Thrombus formation and embolic stroke. [CORRECT]
C. Ventricular fibrillation
D. Complete heart block
Correct Answer: B
Rationale: In atrial fibrillation, ineffective atrial contraction causes blood stasis, particularly in
the left atrial appendage, leading to thrombus formation. Embolization causes ischemic stroke
(risk increased 5-fold) (B). Rate control and anticoagulation are essential. While bradycardia (A)
can occur, stroke prevention is the priority. AF can precipitate V-fib (C) rarely, and heart block
(D) is not typical.
Q7: A patient with a mechanical heart valve is taking warfarin. The nurse understands the
therapeutic INR range for this patient is:
A. 1.5-2.0
B. 2.0-3.0
C. 2.5-3.5. [CORRECT]
D. 3.5-4.5
Correct Answer: C
Rationale: Mechanical heart valves, particularly in the mitral position or with older valve types,
require higher anticoagulation intensity due to thrombogenicity. The target INR is 2.5-3.5 (C).
Bioprosthetic valves or valves in aortic position may use 2.0-3.0 (B). Standard DVT/AF
treatment is 2.0-3.0. Higher ranges increase bleeding risk without additional benefit.
