Strayer University NUR 350 Med Surg II final exam (pdf) | 2026/2027
| Med-Surg II Q&A | Medical-Surgical Nursing
1. A nurse is caring for a client with an acute myocardial infarction (MI).
Which medication should the nurse administer first to reduce myocardial
oxygen demand and relieve pain?
A) Aspirin
B) Nitroglycerin
C) Morphine
D) Oxygen
Correct Answer: Morphine
Rationale: Morphine reduces preload and afterload, decreases myocardial
oxygen demand, and alleviates pain and anxiety associated with MI. Aspirin
inhibits platelet aggregation, nitroglycerin dilates coronary arteries, and
oxygen improves oxygenation—but morphine directly addresses pain and
oxygen demand simultaneously.
2. The nurse is assessing a client with right-sided heart failure. Which finding
is most consistent with this diagnosis?
A) Crackles in the lungs
B) Paroxysmal nocturnal dyspnea
C) Jugular venous distention
D) Orthopnea
Correct Answer: Jugular venous distention
Rationale: Right-sided heart failure results in systemic venous congestion,
leading to jugular venous distention, peripheral edema, hepatomegaly, and
,ascites. Crackles, paroxysmal nocturnal dyspnea, and orthopnea are signs of
left-sided heart failure (pulmonary congestion).
3. A client with heart failure is prescribed furosemide. Which potential
adverse effect should the nurse monitor for most closely?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
Correct Answer: Hypokalemia
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride
reabsorption in the ascending loop of Henle, leading to increased potassium
excretion. Hypokalemia is a common and potentially dangerous adverse
effect. Hyperkalemia is associated with potassium-sparing diuretics.
4. A client with angina is prescribed sublingual nitroglycerin. Which
instruction should the nurse include in teaching?
A) Swallow the tablet with a full glass of water
B) Place the tablet under the tongue and allow it to dissolve
C) Chew the tablet for faster absorption
D) Take the tablet with food to prevent stomach upset
Correct Answer: Place the tablet under the tongue and allow it to dissolve
Rationale: Sublingual nitroglycerin is placed under the tongue, where it
dissolves and is rapidly absorbed through the oral mucosa directly into
systemic circulation. It should not be swallowed, chewed, or taken with food.
,5. A client is 24 hours post-cardiac catheterization. Which finding requires
immediate notification of the healthcare provider?
A) Bruising at the insertion site
B) Pulse rate of 72 beats per minute
C) Numbness and pallor of the affected extremity
D) Blood pressure of 118/76 mm Hg
Correct Answer: Numbness and pallor of the affected extremity
Rationale: Numbness and pallor of the affected extremity indicate possible
arterial occlusion, a serious complication of cardiac catheterization requiring
immediate intervention. Bruising at the insertion site is common. Normal
vital signs are not concerning.
6. A client is prescribed digoxin for heart failure. Which assessment finding is
most indicative of digoxin toxicity?
A) Tachycardia
B) Bradycardia
C) Hyperglycemia
D) Hypertension
Correct Answer: Bradycardia
Rationale: Digoxin toxicity can cause bradycardia, nausea, vomiting, visual
disturbances (yellow-green halos), and cardiac dysrhythmias. The
therapeutic range is narrow. Tachycardia, hyperglycemia, and hypertension
are not typical signs of digoxin toxicity.
, 7. The nurse is caring for a client with infective endocarditis. Which
assessment finding is most consistent with this diagnosis?
A) Clubbing of the fingers
B) Peripheral edema
C) Splinter hemorrhages
D) Jugular venous distention
Correct Answer: Splinter hemorrhages
Rationale: Splinter hemorrhages (linear red-brown streaks under the nails)
are a classic sign of infective endocarditis, resulting from microemboli. Other
signs include Osler's nodes, Janeway lesions, and Roth's spots. Clubbing,
edema, and JVD are associated with chronic conditions.
8. A client with pericarditis reports sharp chest pain that worsens when lying
flat. Which position should the nurse encourage to relieve the pain?
A) Supine position
B) Prone position
C) Sitting upright and leaning forward
D) Left lateral recumbent position
Correct Answer: Sitting upright and leaning forward
Rationale: Pericarditis pain is often positional, worsening when the client lies
flat and improving when sitting upright and leaning forward. This position
reduces pressure on the pericardium. Supine and prone positions would
worsen the pain.
9. The nurse is assessing a client with an abdominal aortic aneurysm (AAA).
Which finding is most concerning and indicates possible rupture?
| Med-Surg II Q&A | Medical-Surgical Nursing
1. A nurse is caring for a client with an acute myocardial infarction (MI).
Which medication should the nurse administer first to reduce myocardial
oxygen demand and relieve pain?
A) Aspirin
B) Nitroglycerin
C) Morphine
D) Oxygen
Correct Answer: Morphine
Rationale: Morphine reduces preload and afterload, decreases myocardial
oxygen demand, and alleviates pain and anxiety associated with MI. Aspirin
inhibits platelet aggregation, nitroglycerin dilates coronary arteries, and
oxygen improves oxygenation—but morphine directly addresses pain and
oxygen demand simultaneously.
2. The nurse is assessing a client with right-sided heart failure. Which finding
is most consistent with this diagnosis?
A) Crackles in the lungs
B) Paroxysmal nocturnal dyspnea
C) Jugular venous distention
D) Orthopnea
Correct Answer: Jugular venous distention
Rationale: Right-sided heart failure results in systemic venous congestion,
leading to jugular venous distention, peripheral edema, hepatomegaly, and
,ascites. Crackles, paroxysmal nocturnal dyspnea, and orthopnea are signs of
left-sided heart failure (pulmonary congestion).
3. A client with heart failure is prescribed furosemide. Which potential
adverse effect should the nurse monitor for most closely?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
Correct Answer: Hypokalemia
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride
reabsorption in the ascending loop of Henle, leading to increased potassium
excretion. Hypokalemia is a common and potentially dangerous adverse
effect. Hyperkalemia is associated with potassium-sparing diuretics.
4. A client with angina is prescribed sublingual nitroglycerin. Which
instruction should the nurse include in teaching?
A) Swallow the tablet with a full glass of water
B) Place the tablet under the tongue and allow it to dissolve
C) Chew the tablet for faster absorption
D) Take the tablet with food to prevent stomach upset
Correct Answer: Place the tablet under the tongue and allow it to dissolve
Rationale: Sublingual nitroglycerin is placed under the tongue, where it
dissolves and is rapidly absorbed through the oral mucosa directly into
systemic circulation. It should not be swallowed, chewed, or taken with food.
,5. A client is 24 hours post-cardiac catheterization. Which finding requires
immediate notification of the healthcare provider?
A) Bruising at the insertion site
B) Pulse rate of 72 beats per minute
C) Numbness and pallor of the affected extremity
D) Blood pressure of 118/76 mm Hg
Correct Answer: Numbness and pallor of the affected extremity
Rationale: Numbness and pallor of the affected extremity indicate possible
arterial occlusion, a serious complication of cardiac catheterization requiring
immediate intervention. Bruising at the insertion site is common. Normal
vital signs are not concerning.
6. A client is prescribed digoxin for heart failure. Which assessment finding is
most indicative of digoxin toxicity?
A) Tachycardia
B) Bradycardia
C) Hyperglycemia
D) Hypertension
Correct Answer: Bradycardia
Rationale: Digoxin toxicity can cause bradycardia, nausea, vomiting, visual
disturbances (yellow-green halos), and cardiac dysrhythmias. The
therapeutic range is narrow. Tachycardia, hyperglycemia, and hypertension
are not typical signs of digoxin toxicity.
, 7. The nurse is caring for a client with infective endocarditis. Which
assessment finding is most consistent with this diagnosis?
A) Clubbing of the fingers
B) Peripheral edema
C) Splinter hemorrhages
D) Jugular venous distention
Correct Answer: Splinter hemorrhages
Rationale: Splinter hemorrhages (linear red-brown streaks under the nails)
are a classic sign of infective endocarditis, resulting from microemboli. Other
signs include Osler's nodes, Janeway lesions, and Roth's spots. Clubbing,
edema, and JVD are associated with chronic conditions.
8. A client with pericarditis reports sharp chest pain that worsens when lying
flat. Which position should the nurse encourage to relieve the pain?
A) Supine position
B) Prone position
C) Sitting upright and leaning forward
D) Left lateral recumbent position
Correct Answer: Sitting upright and leaning forward
Rationale: Pericarditis pain is often positional, worsening when the client lies
flat and improving when sitting upright and leaning forward. This position
reduces pressure on the pericardium. Supine and prone positions would
worsen the pain.
9. The nurse is assessing a client with an abdominal aortic aneurysm (AAA).
Which finding is most concerning and indicates possible rupture?
