Exam 2: NUR 209 Medical-Surgical Nursing II
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Content Focus :
Advanced Renal Failure, Chronic Cardiovascular Management, Respiratory Failure,
GI/Hepatobiliary Emergencies, Endocrine Crises & Neurological Emergencies
Q1: A patient with end-stage renal disease has a left forearm radiocephalic arteriovenous fistula.
Which nursing action is contraindicated when caring for this vascular access?
A. Palpating the fistula site for a thrill every shift
B. Auscultating for a continuous bruit over the anastomosis
C. Drawing blood samples from the left arm
D. Monitoring the fistula site for warmth and erythema
Correct Answer: C
Rationale: The arteriovenous fistula extremity must be protected from all invasive procedures
including venipuncture, intravenous catheter insertion, and blood pressure measurement to
prevent trauma, venous stasis, and thrombosis. Drawing blood from the fistula arm can cause
hematoma formation, vessel injury, or clotting that permanently compromises the patient's
lifeline for hemodialysis. Correct because preserving fistula patency requires absolute avoidance
of needle sticks and constrictive devices in the affected extremity.
,Q2: A patient with heart failure with reduced ejection fraction is prescribed carvedilol. The nurse
understands that this medication improves long-term outcomes primarily through which
mechanism?
A. Reduction of sympathetic tone and adverse cardiac remodeling
B. Direct diuretic effect on the renal tubules
C. Positive inotropic stimulation of the myocardium
D. Pure arterial vasodilation without neurohormonal blockade
Correct Answer: A
Rationale: Carvedilol is a non-selective beta-blocker with alpha-1 blocking properties that
inhibits chronic sympathetic nervous system activation, which is a primary driver of pathologic
ventricular remodeling and disease progression in HFrEF. By antagonizing beta-adrenergic
receptors, carvedilol reduces heart rate, myocardial oxygen demand, and fibrotic remodeling,
thereby improving survival and reducing hospitalizations. Correct because neurohormonal
blockade with beta-adrenergic inhibition is the foundational mechanism by which carvedilol
reduces mortality in systolic heart failure.
Q3: A patient with acute stroke has non-contrast head computed tomography that demonstrates
an intraparenchymal hemorrhage. Which medication is absolutely contraindicated for this
patient?
A. Intravenous labetalol for blood pressure control
B. Intravenous mannitol for intracranial pressure reduction
C. Oral nimodipine for vasospasm prophylaxis
D. Intravenous alteplase for thrombolysis
Correct Answer: D
Rationale: Intravenous alteplase is a fibrinolytic agent that dissolves clots and restores perfusion
in ischemic stroke, but its administration in hemorrhagic stroke causes catastrophic expansion of
the hematoma and significantly increases mortality. The presence of blood on non-contrast head
CT is an absolute contraindication to thrombolytic therapy because there is no occlusive
thrombus to dissolve, only a bleeding vessel. Correct because thrombolytics are strictly limited
to ischemic stroke after hemorrhage has been excluded by neuroimaging.
, Q4: A patient with decompensated cirrhosis and ascites receives dietary counseling from the
nurse. Which instruction is most appropriate for this patient?
A. Increase dietary sodium to 4 grams per day
B. Restrict sodium intake to less than 2 grams per day
C. Consume an unrestricted high-protein diet
D. Restrict fluids only and maintain normal sodium intake
Correct Answer: B
Rationale: Ascites in cirrhosis results from portal hypertension and secondary
hyperaldosteronism, which causes avid renal sodium retention and expansion of extracellular
fluid volume. Sodium restriction to less than 2 grams per day is the cornerstone of non-surgical
management because it directly reduces the total body sodium load that drives ascites formation.
Correct because dietary sodium restriction is the first-line intervention for ascites and must be
implemented before or concurrently with diuretic therapy.
Q5: A patient with opioid-induced respiratory depression has the following arterial blood gas:
pH 7.22, PaCO2 68 mmHg, HCO3 28 mEq/L. Which acid-base disturbance is present?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Correct Answer: A
Rationale: Respiratory acidosis is characterized by a primary elevation in PaCO2 above 45
mmHg due to alveolar hypoventilation, which causes a decrease in pH below 7.35. The
bicarbonate level of 28 mEq/L represents mild metabolic compensation by the kidneys, but the
pH remains acidic because the respiratory component dominates. Correct because the elevated
PaCO2 with an acidemic pH defines respiratory acidosis resulting from central respiratory
depression.
Q6: A patient with Stage 5 chronic kidney disease exhibits manifestations of uremic syndrome.
Which assessment findings are consistent with this diagnosis? Select all that apply.
A. Hypocalcemia
B. Generalized pruritus
C. Hypertension
D. Bradycardia
E. Metallic taste
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Content Focus :
Advanced Renal Failure, Chronic Cardiovascular Management, Respiratory Failure,
GI/Hepatobiliary Emergencies, Endocrine Crises & Neurological Emergencies
Q1: A patient with end-stage renal disease has a left forearm radiocephalic arteriovenous fistula.
Which nursing action is contraindicated when caring for this vascular access?
A. Palpating the fistula site for a thrill every shift
B. Auscultating for a continuous bruit over the anastomosis
C. Drawing blood samples from the left arm
D. Monitoring the fistula site for warmth and erythema
Correct Answer: C
Rationale: The arteriovenous fistula extremity must be protected from all invasive procedures
including venipuncture, intravenous catheter insertion, and blood pressure measurement to
prevent trauma, venous stasis, and thrombosis. Drawing blood from the fistula arm can cause
hematoma formation, vessel injury, or clotting that permanently compromises the patient's
lifeline for hemodialysis. Correct because preserving fistula patency requires absolute avoidance
of needle sticks and constrictive devices in the affected extremity.
,Q2: A patient with heart failure with reduced ejection fraction is prescribed carvedilol. The nurse
understands that this medication improves long-term outcomes primarily through which
mechanism?
A. Reduction of sympathetic tone and adverse cardiac remodeling
B. Direct diuretic effect on the renal tubules
C. Positive inotropic stimulation of the myocardium
D. Pure arterial vasodilation without neurohormonal blockade
Correct Answer: A
Rationale: Carvedilol is a non-selective beta-blocker with alpha-1 blocking properties that
inhibits chronic sympathetic nervous system activation, which is a primary driver of pathologic
ventricular remodeling and disease progression in HFrEF. By antagonizing beta-adrenergic
receptors, carvedilol reduces heart rate, myocardial oxygen demand, and fibrotic remodeling,
thereby improving survival and reducing hospitalizations. Correct because neurohormonal
blockade with beta-adrenergic inhibition is the foundational mechanism by which carvedilol
reduces mortality in systolic heart failure.
Q3: A patient with acute stroke has non-contrast head computed tomography that demonstrates
an intraparenchymal hemorrhage. Which medication is absolutely contraindicated for this
patient?
A. Intravenous labetalol for blood pressure control
B. Intravenous mannitol for intracranial pressure reduction
C. Oral nimodipine for vasospasm prophylaxis
D. Intravenous alteplase for thrombolysis
Correct Answer: D
Rationale: Intravenous alteplase is a fibrinolytic agent that dissolves clots and restores perfusion
in ischemic stroke, but its administration in hemorrhagic stroke causes catastrophic expansion of
the hematoma and significantly increases mortality. The presence of blood on non-contrast head
CT is an absolute contraindication to thrombolytic therapy because there is no occlusive
thrombus to dissolve, only a bleeding vessel. Correct because thrombolytics are strictly limited
to ischemic stroke after hemorrhage has been excluded by neuroimaging.
, Q4: A patient with decompensated cirrhosis and ascites receives dietary counseling from the
nurse. Which instruction is most appropriate for this patient?
A. Increase dietary sodium to 4 grams per day
B. Restrict sodium intake to less than 2 grams per day
C. Consume an unrestricted high-protein diet
D. Restrict fluids only and maintain normal sodium intake
Correct Answer: B
Rationale: Ascites in cirrhosis results from portal hypertension and secondary
hyperaldosteronism, which causes avid renal sodium retention and expansion of extracellular
fluid volume. Sodium restriction to less than 2 grams per day is the cornerstone of non-surgical
management because it directly reduces the total body sodium load that drives ascites formation.
Correct because dietary sodium restriction is the first-line intervention for ascites and must be
implemented before or concurrently with diuretic therapy.
Q5: A patient with opioid-induced respiratory depression has the following arterial blood gas:
pH 7.22, PaCO2 68 mmHg, HCO3 28 mEq/L. Which acid-base disturbance is present?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Correct Answer: A
Rationale: Respiratory acidosis is characterized by a primary elevation in PaCO2 above 45
mmHg due to alveolar hypoventilation, which causes a decrease in pH below 7.35. The
bicarbonate level of 28 mEq/L represents mild metabolic compensation by the kidneys, but the
pH remains acidic because the respiratory component dominates. Correct because the elevated
PaCO2 with an acidemic pH defines respiratory acidosis resulting from central respiratory
depression.
Q6: A patient with Stage 5 chronic kidney disease exhibits manifestations of uremic syndrome.
Which assessment findings are consistent with this diagnosis? Select all that apply.
A. Hypocalcemia
B. Generalized pruritus
C. Hypertension
D. Bradycardia
E. Metallic taste
