NU 185 Exam 3: 200 NCLEX-Style
Questions with Rationales for
Medical-Surgical Nursing II
(2026/2027) Graded A+
Cardiovascular Disorders
Question 1
A nurse is assessing a client who is 2 hours post-cardiac
catheterization. Which finding requires immediate intervention?
A. Pulse rate of 88/min
B. Blood pressure 118/76 mmHg
C. Complaints of mild back pain
D. Pallor and coolness of the affected extremity
Answer: D
Rationale: Pallor and coolness indicate arterial occlusion or
compromised circulation to the extremity. This is a medical
emergency requiring immediate notification of the provider. Mild
back pain is expected from lying flat.
Question 2
A client with heart failure has an ejection fraction of 32%. Which
statement by the client indicates understanding of this finding?
A. "My heart is pumping blood more efficiently than normal."
B. "My heart is not pumping out as much blood as it should."
C. "This means I have too much fluid in my lungs."
D. "This test shows I have had a heart attack."
,Answer: B
Rationale: Normal EF is 55-70%. An EF of 32% indicates significantly
reduced pumping ability. The heart is not effectively ejecting blood
with each contraction.
Question 3
A nurse is administering furosemide (Lasix) to a client with
pulmonary edema. Which laboratory value should the nurse monitor
most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium
wasting. Hypokalemia can lead to cardiac arrhythmias. Monitor
serum potassium closely.
Question 4
A client with left-sided heart failure reports increasing shortness of
breath and awakens at night gasping for air. Which intervention
should the nurse implement first?
A. Administer supplemental oxygen
B. Place the client in high Fowler's position
C. Notify the healthcare provider
D. Assess oxygen saturation
Answer: B
Rationale: High Fowler's position uses gravity to reduce venous
,return and decrease pulmonary congestion. This is the immediate
priority intervention before oxygen or notification.
Question 5
A nurse is providing discharge teaching to a client with heart failure.
Which dietary instruction should the nurse include?
A. "Limit your daily sodium intake to 4 grams."
B. "Restrict fluids to 3 liters per day."
C. "Limit sodium to 2 grams per day and fluids to 2 liters."
D. "You may eat canned soups and frozen dinners."
Answer: C
Rationale: Sodium restriction to ≤2 g/day and fluid restriction to ≤2
L/day helps prevent fluid overload in heart failure. Canned soups and
frozen dinners are high in sodium.
Question 6
A client is in cardiogenic shock. The nurse expects which medication
to be prescribed to increase cardiac contractility?
A. Furosemide
B. Digoxin
C. Nitroglycerin
D. Metoprolol
Answer: B
Rationale: Digoxin increases the force of myocardial contraction
(positive inotrope), improving cardiac output in cardiogenic shock.
Furosemide removes fluid, nitroglycerin dilates vessels, and
metoprolol decreases heart rate.
, Question 7
A nurse is assessing a client with right-sided heart failure. Which
finding is most consistent with this diagnosis?
A. Crackles in the lung bases
B. Jugular venous distention
C. Orthopnea
D. Frothy sputum
Answer: B
Rationale: JVD is a classic sign of right-sided heart failure due to
increased systemic venous pressure. Crackles, orthopnea, and frothy
sputum indicate left-sided failure.
Question 8
A client has a permanent pacemaker inserted. Which statement by
the client indicates the need for further teaching?
A. "I will avoid contact sports like football."
B. "I can use my microwave as usual."
C. "I will check my pulse daily."
D. "I should keep my cell phone in my chest pocket."
Answer: D
Rationale: Cell phones should be kept at least 6 inches away from the
pacemaker. Keeping it in the chest pocket directly over the device is
contraindicated. Microwaves are safe.
Question 9
A nurse is caring for a client in hypovolemic shock. Which assessment
finding indicates adequate tissue perfusion?
A. Urine output 25 mL/hr
B. Capillary refill 4 seconds
Questions with Rationales for
Medical-Surgical Nursing II
(2026/2027) Graded A+
Cardiovascular Disorders
Question 1
A nurse is assessing a client who is 2 hours post-cardiac
catheterization. Which finding requires immediate intervention?
A. Pulse rate of 88/min
B. Blood pressure 118/76 mmHg
C. Complaints of mild back pain
D. Pallor and coolness of the affected extremity
Answer: D
Rationale: Pallor and coolness indicate arterial occlusion or
compromised circulation to the extremity. This is a medical
emergency requiring immediate notification of the provider. Mild
back pain is expected from lying flat.
Question 2
A client with heart failure has an ejection fraction of 32%. Which
statement by the client indicates understanding of this finding?
A. "My heart is pumping blood more efficiently than normal."
B. "My heart is not pumping out as much blood as it should."
C. "This means I have too much fluid in my lungs."
D. "This test shows I have had a heart attack."
,Answer: B
Rationale: Normal EF is 55-70%. An EF of 32% indicates significantly
reduced pumping ability. The heart is not effectively ejecting blood
with each contraction.
Question 3
A nurse is administering furosemide (Lasix) to a client with
pulmonary edema. Which laboratory value should the nurse monitor
most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium
wasting. Hypokalemia can lead to cardiac arrhythmias. Monitor
serum potassium closely.
Question 4
A client with left-sided heart failure reports increasing shortness of
breath and awakens at night gasping for air. Which intervention
should the nurse implement first?
A. Administer supplemental oxygen
B. Place the client in high Fowler's position
C. Notify the healthcare provider
D. Assess oxygen saturation
Answer: B
Rationale: High Fowler's position uses gravity to reduce venous
,return and decrease pulmonary congestion. This is the immediate
priority intervention before oxygen or notification.
Question 5
A nurse is providing discharge teaching to a client with heart failure.
Which dietary instruction should the nurse include?
A. "Limit your daily sodium intake to 4 grams."
B. "Restrict fluids to 3 liters per day."
C. "Limit sodium to 2 grams per day and fluids to 2 liters."
D. "You may eat canned soups and frozen dinners."
Answer: C
Rationale: Sodium restriction to ≤2 g/day and fluid restriction to ≤2
L/day helps prevent fluid overload in heart failure. Canned soups and
frozen dinners are high in sodium.
Question 6
A client is in cardiogenic shock. The nurse expects which medication
to be prescribed to increase cardiac contractility?
A. Furosemide
B. Digoxin
C. Nitroglycerin
D. Metoprolol
Answer: B
Rationale: Digoxin increases the force of myocardial contraction
(positive inotrope), improving cardiac output in cardiogenic shock.
Furosemide removes fluid, nitroglycerin dilates vessels, and
metoprolol decreases heart rate.
, Question 7
A nurse is assessing a client with right-sided heart failure. Which
finding is most consistent with this diagnosis?
A. Crackles in the lung bases
B. Jugular venous distention
C. Orthopnea
D. Frothy sputum
Answer: B
Rationale: JVD is a classic sign of right-sided heart failure due to
increased systemic venous pressure. Crackles, orthopnea, and frothy
sputum indicate left-sided failure.
Question 8
A client has a permanent pacemaker inserted. Which statement by
the client indicates the need for further teaching?
A. "I will avoid contact sports like football."
B. "I can use my microwave as usual."
C. "I will check my pulse daily."
D. "I should keep my cell phone in my chest pocket."
Answer: D
Rationale: Cell phones should be kept at least 6 inches away from the
pacemaker. Keeping it in the chest pocket directly over the device is
contraindicated. Microwaves are safe.
Question 9
A nurse is caring for a client in hypovolemic shock. Which assessment
finding indicates adequate tissue perfusion?
A. Urine output 25 mL/hr
B. Capillary refill 4 seconds
