NUR 209 Medical-Surgical Nursing II Exam 1 Practice
Test Actual 2024/2025 with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
SECTION 1: Cardiovascular Disorders (Questions 1–12)
Q1: A patient with heart failure is prescribed furosemide (Lasix) 40 mg IV. The nurse
understands that the primary therapeutic effect of this medication is to:
A. Increase myocardial contractility
B. Reduce preload by promoting venous and arteriolar dilation
C. Increase afterload to improve cardiac output
D. Slow the heart rate
Correct Answer: B
Rationale: Furosemide is a loop diuretic that reduces preload by promoting diuresis
and venous dilation, decreasing fluid volume and ventricular filling pressure, which
reduces symptoms of pulmonary congestion in heart failure.
Q2: A patient with a myocardial infarction (MI) reports crushing substernal chest
pain radiating to the left arm. The nurse administers sublingual nitroglycerin. The
primary mechanism of action of nitroglycerin in acute MI is:
A. Increasing heart rate and contractility
B. Dilating coronary arteries and reducing myocardial oxygen demand through
venous and arterial dilation
,C. Preventing platelet aggregation
D. Dissolving the coronary thrombus
Correct Answer: B
Rationale: Nitroglycerin dilates coronary arteries to improve myocardial perfusion
and reduces myocardial oxygen demand through venodilation (decreasing preload)
and arterial dilation (decreasing afterload), relieving ischemic chest pain.
Q3: A patient with atrial fibrillation is prescribed warfarin (Coumadin). The nurse
monitors which laboratory value to assess therapeutic anticoagulation?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Prothrombin time (PT) alone
D. Platelet count
Correct Answer: B
Rationale: Warfarin therapy is monitored using the INR, which standardizes PT
results across laboratories; the therapeutic range for most indications is 2.0–3.0,
with higher ranges (2.5–3.5) for mechanical heart valves.
Q4: A patient with peripheral arterial disease (PAD) complains of leg pain when
walking that is relieved by rest. The nurse documents this as:
A. Rest pain
B. Intermittent claudication
C. Arterial ulceration
,D. Deep vein thrombosis
Correct Answer: B
Rationale: Intermittent claudication is cramping pain in the lower extremities induced
by exercise and relieved by rest, caused by inadequate blood flow through stenosed
or occluded arteries; it is the hallmark symptom of PAD.
Q5: A patient with heart failure has a blood pressure of 92/58 mmHg and reports
dizziness. The nurse is administering lisinopril. The nurse's priority action is to:
A. Administer the medication as prescribed
B. Hold the medication and notify the provider due to hypotension
C. Administer the medication with food
D. Increase the IV fluid rate
Correct Answer: B
Rationale: ACE inhibitors like lisinopril can cause hypotension, particularly after the
first dose or with volume depletion; holding the medication and notifying the provider
prevents further blood pressure reduction and potential syncope or renal
hypoperfusion.
Q6: A patient with aortic stenosis is being prepared for valve replacement surgery.
The nurse understands that a critical hemodynamic concern in aortic stenosis is:
A. Excessive afterload reduction
B. Fixed obstruction to left ventricular outflow, making the patient dependent on
adequate preload and sinus rhythm
C. Increased venous return
, D. Rapid heart rates
Correct Answer: B
Rationale: Aortic stenosis creates a fixed obstruction to left ventricular outflow;
patients are preload-dependent and require maintenance of sinus rhythm for atrial
kick, as hypovolemia or atrial fibrillation can precipitate acute hypotension and
syncope.
Q7: A patient with hypertension is prescribed a beta-blocker. The nurse teaches the
patient to monitor for which potential adverse effect?
A. Tachycardia
B. Bradycardia and fatigue
C. Hyperglycemia
D. Increased urine output
Correct Answer: B
Rationale: Beta-blockers block beta-1 adrenergic receptors, slowing heart rate
(bradycardia), reducing contractility, and causing fatigue; they can also mask
hypoglycemia symptoms in diabetic patients and cause bronchospasm in
asthmatics.
Q8: A patient is admitted with acute decompensated heart failure and has crackles
bilaterally, jugular venous distention, and 3+ pitting edema. The nurse positions the
patient:
A. Flat in bed
B. In high Fowler's position with legs dependent
Test Actual 2024/2025 with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
SECTION 1: Cardiovascular Disorders (Questions 1–12)
Q1: A patient with heart failure is prescribed furosemide (Lasix) 40 mg IV. The nurse
understands that the primary therapeutic effect of this medication is to:
A. Increase myocardial contractility
B. Reduce preload by promoting venous and arteriolar dilation
C. Increase afterload to improve cardiac output
D. Slow the heart rate
Correct Answer: B
Rationale: Furosemide is a loop diuretic that reduces preload by promoting diuresis
and venous dilation, decreasing fluid volume and ventricular filling pressure, which
reduces symptoms of pulmonary congestion in heart failure.
Q2: A patient with a myocardial infarction (MI) reports crushing substernal chest
pain radiating to the left arm. The nurse administers sublingual nitroglycerin. The
primary mechanism of action of nitroglycerin in acute MI is:
A. Increasing heart rate and contractility
B. Dilating coronary arteries and reducing myocardial oxygen demand through
venous and arterial dilation
,C. Preventing platelet aggregation
D. Dissolving the coronary thrombus
Correct Answer: B
Rationale: Nitroglycerin dilates coronary arteries to improve myocardial perfusion
and reduces myocardial oxygen demand through venodilation (decreasing preload)
and arterial dilation (decreasing afterload), relieving ischemic chest pain.
Q3: A patient with atrial fibrillation is prescribed warfarin (Coumadin). The nurse
monitors which laboratory value to assess therapeutic anticoagulation?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Prothrombin time (PT) alone
D. Platelet count
Correct Answer: B
Rationale: Warfarin therapy is monitored using the INR, which standardizes PT
results across laboratories; the therapeutic range for most indications is 2.0–3.0,
with higher ranges (2.5–3.5) for mechanical heart valves.
Q4: A patient with peripheral arterial disease (PAD) complains of leg pain when
walking that is relieved by rest. The nurse documents this as:
A. Rest pain
B. Intermittent claudication
C. Arterial ulceration
,D. Deep vein thrombosis
Correct Answer: B
Rationale: Intermittent claudication is cramping pain in the lower extremities induced
by exercise and relieved by rest, caused by inadequate blood flow through stenosed
or occluded arteries; it is the hallmark symptom of PAD.
Q5: A patient with heart failure has a blood pressure of 92/58 mmHg and reports
dizziness. The nurse is administering lisinopril. The nurse's priority action is to:
A. Administer the medication as prescribed
B. Hold the medication and notify the provider due to hypotension
C. Administer the medication with food
D. Increase the IV fluid rate
Correct Answer: B
Rationale: ACE inhibitors like lisinopril can cause hypotension, particularly after the
first dose or with volume depletion; holding the medication and notifying the provider
prevents further blood pressure reduction and potential syncope or renal
hypoperfusion.
Q6: A patient with aortic stenosis is being prepared for valve replacement surgery.
The nurse understands that a critical hemodynamic concern in aortic stenosis is:
A. Excessive afterload reduction
B. Fixed obstruction to left ventricular outflow, making the patient dependent on
adequate preload and sinus rhythm
C. Increased venous return
, D. Rapid heart rates
Correct Answer: B
Rationale: Aortic stenosis creates a fixed obstruction to left ventricular outflow;
patients are preload-dependent and require maintenance of sinus rhythm for atrial
kick, as hypovolemia or atrial fibrillation can precipitate acute hypotension and
syncope.
Q7: A patient with hypertension is prescribed a beta-blocker. The nurse teaches the
patient to monitor for which potential adverse effect?
A. Tachycardia
B. Bradycardia and fatigue
C. Hyperglycemia
D. Increased urine output
Correct Answer: B
Rationale: Beta-blockers block beta-1 adrenergic receptors, slowing heart rate
(bradycardia), reducing contractility, and causing fatigue; they can also mask
hypoglycemia symptoms in diabetic patients and cause bronchospasm in
asthmatics.
Q8: A patient is admitted with acute decompensated heart failure and has crackles
bilaterally, jugular venous distention, and 3+ pitting edema. The nurse positions the
patient:
A. Flat in bed
B. In high Fowler's position with legs dependent
