NUR 209 / NUR209 Medical-Surgical Nursing II Exam 3
Practice Test Actual 2026/2027 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: Complex Cardiovascular & Peripheral Vascular
Disorders (Questions 1–12)
Q1: A 68-year-old client with a history of heart failure presents with acute dyspnea,
orthopnea, and pink frothy sputum. Vital signs: BP 162/94, HR 118, RR 32, SpO₂ 84%
on room air. Which nursing intervention is the priority?
A. Administer furosemide 40 mg IV push rapidly
B. Apply supplemental oxygen via nasal cannula at 4 L/min
C. Position the client in high Fowler's with legs dependent
D. Obtain a 12-lead ECG before initiating any treatment
Correct Answer: C
Rationale: Positioning the client in high Fowler's with legs dependent reduces venous
return to the heart, decreasing preload and pulmonary congestion, which is the
immediate priority before pharmacological interventions.
Q2: A client with acute coronary syndrome is receiving nitroglycerin infusion. The
nurse notes BP has dropped from 142/88 to 94/58 mmHg. Which action is most
appropriate?
,A. Increase the nitroglycerin infusion rate to improve coronary perfusion
B. Stop the infusion immediately and notify the provider
C. Slow the infusion rate and administer a 250 mL NS bolus
D. Continue the infusion and document the finding as expected
Correct Answer: C
Rationale: Hypotension from nitroglycerin requires slowing the infusion and
administering a fluid bolus to restore perfusion pressure while maintaining coronary
vasodilation benefits.
Q3: A client with atrial fibrillation is prescribed dabigatran. Which instruction is
essential for the nurse to provide?
A. "Take this medication with food to enhance absorption"
B. "You will need monthly INR blood tests while on this medication"
C. "Avoid NSAIDs and aspirin unless approved by your provider"
D. "This medication can be safely stopped 24 hours before any dental procedure"
Correct Answer: C
Rationale: Dabigatran is a direct thrombin inhibitor that increases bleeding risk;
concurrent NSAID or aspirin use further elevates this risk and requires provider
approval.
Q4: A client with peripheral arterial disease reports severe leg pain at rest that wakes
them at night. The nurse notes the foot is cool, pale, and hairless with diminished
pedal pulses. Which finding requires immediate reporting?
,A. Client reports pain is relieved by dangling legs over bedside
B. New onset of numbness and tingling in the affected foot
C. Capillary refill time of 4 seconds in the affected extremity
D. Client states pain is 8/10 despite scheduled analgesics
Correct Answer: B
Rationale: Numbness and tingling indicate progression from ischemic rest pain to
critical limb ischemia with nerve involvement, representing an emergent threat to
limb viability.
Q5: A client with a descending thoracic aortic aneurysm (5.2 cm) asks when surgery
will be scheduled. Which response by the nurse is most accurate?
A. "Surgery is typically indicated when the aneurysm reaches 6 cm in diameter"
B. "Your aneurysm is large enough that surgery should be performed within the
week"
C. "Descending thoracic aneurysms are managed medically regardless of size"
D. "Surgical repair is only indicated if you develop symptoms of rupture"
Correct Answer: A
Rationale: Elective surgical repair of descending thoracic aortic aneurysms is
generally recommended at 5.5–6.0 cm diameter, as the risk of rupture increases
significantly beyond this threshold.
Q6: A client post-cardiac catheterization via the femoral artery develops a hematoma
at the insertion site. The nurse notes the pedal pulse is weak and the foot is cool and
pale. What is the priority nursing action?
, A. Apply a pressure dressing and elevate the extremity
B. Assess the contralateral extremity for comparison
C. Notify the provider immediately and prepare for possible intervention
D. Document the finding and continue routine post-procedure monitoring
Correct Answer: C
Rationale: Diminished pulse with cool, pale skin indicates compromised distal
perfusion from arterial obstruction or compartment syndrome, requiring immediate
provider notification and intervention.
Q7: A client with heart failure is prescribed sacubitril/valsartan (Entresto). Which
assessment finding requires the nurse to hold the dose and notify the provider?
A. Serum potassium level of 4.8 mEq/L
B. Blood pressure of 98/62 mmHg
C. Heart rate of 56 beats per minute
D. Serum creatinine of 1.4 mg/dL
Correct Answer: B
Rationale: Sacubitril/valsartan can cause significant hypotension; holding the dose
and notifying the provider is indicated when systolic BP falls below 100 mmHg to
prevent syncope and renal hypoperfusion.
Q8: A client with infective endocarditis is receiving IV antibiotics. The nurse notes
new petechiae on the conjunctiva and splinter hemorrhages under the fingernails.
Which complication is the nurse most concerned about?
Practice Test Actual 2026/2027 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: Complex Cardiovascular & Peripheral Vascular
Disorders (Questions 1–12)
Q1: A 68-year-old client with a history of heart failure presents with acute dyspnea,
orthopnea, and pink frothy sputum. Vital signs: BP 162/94, HR 118, RR 32, SpO₂ 84%
on room air. Which nursing intervention is the priority?
A. Administer furosemide 40 mg IV push rapidly
B. Apply supplemental oxygen via nasal cannula at 4 L/min
C. Position the client in high Fowler's with legs dependent
D. Obtain a 12-lead ECG before initiating any treatment
Correct Answer: C
Rationale: Positioning the client in high Fowler's with legs dependent reduces venous
return to the heart, decreasing preload and pulmonary congestion, which is the
immediate priority before pharmacological interventions.
Q2: A client with acute coronary syndrome is receiving nitroglycerin infusion. The
nurse notes BP has dropped from 142/88 to 94/58 mmHg. Which action is most
appropriate?
,A. Increase the nitroglycerin infusion rate to improve coronary perfusion
B. Stop the infusion immediately and notify the provider
C. Slow the infusion rate and administer a 250 mL NS bolus
D. Continue the infusion and document the finding as expected
Correct Answer: C
Rationale: Hypotension from nitroglycerin requires slowing the infusion and
administering a fluid bolus to restore perfusion pressure while maintaining coronary
vasodilation benefits.
Q3: A client with atrial fibrillation is prescribed dabigatran. Which instruction is
essential for the nurse to provide?
A. "Take this medication with food to enhance absorption"
B. "You will need monthly INR blood tests while on this medication"
C. "Avoid NSAIDs and aspirin unless approved by your provider"
D. "This medication can be safely stopped 24 hours before any dental procedure"
Correct Answer: C
Rationale: Dabigatran is a direct thrombin inhibitor that increases bleeding risk;
concurrent NSAID or aspirin use further elevates this risk and requires provider
approval.
Q4: A client with peripheral arterial disease reports severe leg pain at rest that wakes
them at night. The nurse notes the foot is cool, pale, and hairless with diminished
pedal pulses. Which finding requires immediate reporting?
,A. Client reports pain is relieved by dangling legs over bedside
B. New onset of numbness and tingling in the affected foot
C. Capillary refill time of 4 seconds in the affected extremity
D. Client states pain is 8/10 despite scheduled analgesics
Correct Answer: B
Rationale: Numbness and tingling indicate progression from ischemic rest pain to
critical limb ischemia with nerve involvement, representing an emergent threat to
limb viability.
Q5: A client with a descending thoracic aortic aneurysm (5.2 cm) asks when surgery
will be scheduled. Which response by the nurse is most accurate?
A. "Surgery is typically indicated when the aneurysm reaches 6 cm in diameter"
B. "Your aneurysm is large enough that surgery should be performed within the
week"
C. "Descending thoracic aneurysms are managed medically regardless of size"
D. "Surgical repair is only indicated if you develop symptoms of rupture"
Correct Answer: A
Rationale: Elective surgical repair of descending thoracic aortic aneurysms is
generally recommended at 5.5–6.0 cm diameter, as the risk of rupture increases
significantly beyond this threshold.
Q6: A client post-cardiac catheterization via the femoral artery develops a hematoma
at the insertion site. The nurse notes the pedal pulse is weak and the foot is cool and
pale. What is the priority nursing action?
, A. Apply a pressure dressing and elevate the extremity
B. Assess the contralateral extremity for comparison
C. Notify the provider immediately and prepare for possible intervention
D. Document the finding and continue routine post-procedure monitoring
Correct Answer: C
Rationale: Diminished pulse with cool, pale skin indicates compromised distal
perfusion from arterial obstruction or compartment syndrome, requiring immediate
provider notification and intervention.
Q7: A client with heart failure is prescribed sacubitril/valsartan (Entresto). Which
assessment finding requires the nurse to hold the dose and notify the provider?
A. Serum potassium level of 4.8 mEq/L
B. Blood pressure of 98/62 mmHg
C. Heart rate of 56 beats per minute
D. Serum creatinine of 1.4 mg/dL
Correct Answer: B
Rationale: Sacubitril/valsartan can cause significant hypotension; holding the dose
and notifying the provider is indicated when systolic BP falls below 100 mmHg to
prevent syncope and renal hypoperfusion.
Q8: A client with infective endocarditis is receiving IV antibiotics. The nurse notes
new petechiae on the conjunctiva and splinter hemorrhages under the fingernails.
Which complication is the nurse most concerned about?
