NUR 242 Medical-Surgical Nursing Exam
3: Ultimate 150-Question Practice Test
with Rationales
**Question 1**
An older client with a history of congestive heart failure expresses
concern about potential exposure to tuberculosis (TB) from their
roommate at the extended care facility. The roommate coughs a great
deal and sometimes spits up blood. Which is the primary reason the
nurse pursues more information about the roommate?
A. TB is highly contagious in all populations
B. TB adversely affects older adults with chronic illness
C. The roommate should be isolated immediately
D. The client is at risk for developing pneumonia
**Answer: B**
**Rationale:** Older adults with chronic illnesses such as heart failure
are at increased risk for severe complications from TB due to age-
related immune system decline and underlying comorbidities. While TB
is contagious, the primary concern is the increased vulnerability of this
patient population .
---
,**Question 2**
The clinic nurse is teaching a group of clients with heart failure (HF)
about dietary interventions to prevent fluid overload. Which topic
should be included?
A. Use of canned vegetables for convenience
B. Use of fresh or frozen vegetables instead of canned ones
C. Limiting fluid intake to 1 liter per day for all clients
D. Increasing salt intake to maintain blood pressure
**Answer: B**
**Rationale:** Clients with heart failure should follow a low-sodium
diet to prevent fluid overload. Fresh or frozen vegetables are lower in
sodium than canned vegetables, which often contain added salt for
preservation. Sodium restriction is the primary dietary intervention .
---
**Question 3**
A client with heart failure has an episode of paroxysmal nocturnal
dyspnea (PND). Which action should the nurse take first?
A. Administer oxygen via nasal cannula
B. Assist the client to sit on the edge of the bed
C. Notify the healthcare provider
D. Administer furosemide IV push
,**Answer: B**
**Rationale:** PND occurs when fluid shifts from the legs to the lungs
during sleep, causing sudden shortness of breath. The priority action is
to assist the client to sit upright to use gravity to reduce venous return
and improve oxygenation. Oxygen may be needed next, and then the
provider should be notified .
---
**Question 4**
When caring for a client with right ventricular heart failure, which
assessment findings would the nurse expect? (Select all that apply)
A. Dependent edema
B. Swollen hands and fingers
C. Right upper quadrant discomfort
D. Crackles in the lung bases
E. Jugular venous distention
**Answer: A, B, C, E**
**Rationale:** Right-sided heart failure causes systemic venous
congestion, leading to dependent edema, swollen extremities, right
upper quadrant discomfort (hepatomegaly), and jugular venous
distention. Crackles in lung bases are characteristic of left-sided heart
failure, not right-sided .
, ---
**Question 5**
A client with left-sided heart failure is experiencing dyspnea and
orthopnea. Which pathophysiologic mechanism is the primary cause of
these symptoms?
A. Decreased cardiac output to the systemic circulation
B. Fluid backup into the pulmonary circulation
C. Decreased renal perfusion
D. Increased venous return to the heart
**Answer: B**
**Rationale:** Left-sided heart failure causes fluid to back up into the
pulmonary circulation because the left ventricle cannot pump blood
forward effectively. This leads to pulmonary congestion, which
manifests as dyspnea, orthopnea, and crackles .
---
**Question 6**
A client with heart failure is prescribed furosemide (Lasix). Which
electrolyte imbalance should the nurse monitor for most closely?
A. Hyperkalemia
3: Ultimate 150-Question Practice Test
with Rationales
**Question 1**
An older client with a history of congestive heart failure expresses
concern about potential exposure to tuberculosis (TB) from their
roommate at the extended care facility. The roommate coughs a great
deal and sometimes spits up blood. Which is the primary reason the
nurse pursues more information about the roommate?
A. TB is highly contagious in all populations
B. TB adversely affects older adults with chronic illness
C. The roommate should be isolated immediately
D. The client is at risk for developing pneumonia
**Answer: B**
**Rationale:** Older adults with chronic illnesses such as heart failure
are at increased risk for severe complications from TB due to age-
related immune system decline and underlying comorbidities. While TB
is contagious, the primary concern is the increased vulnerability of this
patient population .
---
,**Question 2**
The clinic nurse is teaching a group of clients with heart failure (HF)
about dietary interventions to prevent fluid overload. Which topic
should be included?
A. Use of canned vegetables for convenience
B. Use of fresh or frozen vegetables instead of canned ones
C. Limiting fluid intake to 1 liter per day for all clients
D. Increasing salt intake to maintain blood pressure
**Answer: B**
**Rationale:** Clients with heart failure should follow a low-sodium
diet to prevent fluid overload. Fresh or frozen vegetables are lower in
sodium than canned vegetables, which often contain added salt for
preservation. Sodium restriction is the primary dietary intervention .
---
**Question 3**
A client with heart failure has an episode of paroxysmal nocturnal
dyspnea (PND). Which action should the nurse take first?
A. Administer oxygen via nasal cannula
B. Assist the client to sit on the edge of the bed
C. Notify the healthcare provider
D. Administer furosemide IV push
,**Answer: B**
**Rationale:** PND occurs when fluid shifts from the legs to the lungs
during sleep, causing sudden shortness of breath. The priority action is
to assist the client to sit upright to use gravity to reduce venous return
and improve oxygenation. Oxygen may be needed next, and then the
provider should be notified .
---
**Question 4**
When caring for a client with right ventricular heart failure, which
assessment findings would the nurse expect? (Select all that apply)
A. Dependent edema
B. Swollen hands and fingers
C. Right upper quadrant discomfort
D. Crackles in the lung bases
E. Jugular venous distention
**Answer: A, B, C, E**
**Rationale:** Right-sided heart failure causes systemic venous
congestion, leading to dependent edema, swollen extremities, right
upper quadrant discomfort (hepatomegaly), and jugular venous
distention. Crackles in lung bases are characteristic of left-sided heart
failure, not right-sided .
, ---
**Question 5**
A client with left-sided heart failure is experiencing dyspnea and
orthopnea. Which pathophysiologic mechanism is the primary cause of
these symptoms?
A. Decreased cardiac output to the systemic circulation
B. Fluid backup into the pulmonary circulation
C. Decreased renal perfusion
D. Increased venous return to the heart
**Answer: B**
**Rationale:** Left-sided heart failure causes fluid to back up into the
pulmonary circulation because the left ventricle cannot pump blood
forward effectively. This leads to pulmonary congestion, which
manifests as dyspnea, orthopnea, and crackles .
---
**Question 6**
A client with heart failure is prescribed furosemide (Lasix). Which
electrolyte imbalance should the nurse monitor for most closely?
A. Hyperkalemia
