NUR 2063 / NUR2063: Essentials of
Pathophysiology Exam 2 (Latest Updated)
Rasmussen. 2026/2027
1. A nurse is caring for a client admitted with acute heart failure. Which
assessment finding requires immediate intervention?
A. Bilateral 2+ pitting edema in the ankles
B. Blood pressure of 150/90 mm Hg
C. Crackles throughout both lung fields and oxygen saturation of 84%
D. Weight gain of 2 lb (0.9 kg) over 24 hours
Correct Answer: C
Rationale: This client is experiencing severe pulmonary edema, resulting in impaired gas
exchange and hypoxemia. An oxygen saturation of 84% indicates inadequate
oxygenation requiring immediate intervention. Peripheral edema indicates fluid overload
but is not immediately life-threatening. Mild hypertension is common in heart failure
and is less urgent. Rapid weight gain signals worsening fluid retention but is not as
immediately dangerous as hypoxia.
2. A client with left-sided heart failure is being assessed. Which finding should the
nurse identify as a manifestation of left-sided heart failure?
A. Dependent edema in the lower extremities
B. Pink-tinged frothy sputum
C. Jugular vein distention
D. Hepatomegaly
Correct Answer: B
Rationale: Pink-tinged frothy sputum indicates pulmonary edema, a key manifestation
of left-sided heart failure due to backup of blood into the pulmonary circulation.
Dependent edema, JVD, and hepatomegaly are signs of right-sided heart failure.
3. A client receiving packed red blood cells suddenly develops chills, fever, and
flank pain. What should the nurse do first?
,A. Notify the provider
B. Slow the infusion
C. Stop the transfusion
D. Administer acetaminophen
Correct Answer: C
Rationale: These findings suggest an acute hemolytic transfusion reaction. Immediate
actions include stopping the transfusion, maintaining IV access with normal saline using
new tubing, notifying the provider and blood bank, monitoring vital signs, and
obtaining blood and urine specimens as ordered. Stopping the transfusion prevents
further exposure to incompatible blood.
4. A client with atrial fibrillation is prescribed warfarin. The nurse educates the
client that they must avoid eating large amounts of which foods?
A. Bananas and oranges
B. Green leafy vegetables (spinach, kale)
C. Grapefruit juice
D. Dairy products
Correct Answer: B
Rationale: Green leafy vegetables are high in Vitamin K, which antagonizes the effect of
warfarin. Patients should maintain consistent Vitamin K intake rather than avoid it
completely. Grapefruit juice is a concern with statins and calcium channel blockers, not
warfarin.
5. A client with deep vein thrombosis is started on IV heparin. Which laboratory
value should the nurse monitor to evaluate the therapeutic efficacy of heparin?
A. PT/INR
B. aPTT
C. Platelet count
D. D-dimer
Correct Answer: B
Rationale: Heparin is monitored using the aPTT. The goal is typically 1.5-2.5 times the
control value. PT/INR is used to monitor warfarin. Platelet count is monitored to detect
HIT. D-dimer is a diagnostic test for DVT/PE.
,6. A client on warfarin has an INR of 4.5 without bleeding. Which action is most
appropriate?
A. Administer vitamin K 10 mg subcutaneously
B. Withhold warfarin and recheck INR in 24-48 hours
C. Give fresh frozen plasma immediately
D. Increase warfarin dose
Correct Answer: B
Rationale: For an asymptomatic patient with INR 4.5-10, guidelines recommend
withholding warfarin (no vitamin K unless high bleeding risk). Recheck INR in 1-2 days.
Vitamin K is for INR >10 or active bleeding.
7. A patient on clopidogrel is scheduled for elective surgery. When should
clopidogrel be stopped?
A. 2 days before surgery
B. 5 days before surgery
C. 10 days before surgery
D. 14 days before surgery
Correct Answer: B
Rationale: Clopidogrel irreversibly inhibits P2Y12; platelet function recovers in 5-7 days
(new platelets). Guidelines recommend stopping 5 days pre-op for most non-cardiac
surgeries.
8. A nurse is assessing a client who is 12 hours postoperative following a total hip
arthroplasty. Which finding requires immediate intervention?
A. Pain rated 6 on a 0-10 scale
B. Temperature of 100.2°F (37.9°C)
C. Sudden shortness of breath and chest pain
D. Drainage of 50 mL of serosanguineous fluid from the surgical drain
Correct Answer: C
Rationale: Sudden dyspnea and chest pain in a postoperative orthopedic client strongly
suggest a pulmonary embolism (PE), a life-threatening complication requiring
immediate intervention. Moderate postoperative pain is expected; slight temperature
, elevation during the first 24 hours may occur due to inflammation; moderate
serosanguineous drainage is expected after surgery.
9. A patient on heparin for deep vein thrombosis develops new thrombocytopenia
(platelet count 45,000/L) and a skin lesion at the injection site. Which diagnostic
test would confirm the suspected condition?
A. Platelet factor 4 antibody assay (ELISA)
B. Bleeding time
C. Partial thromboplastin time (aPTT)
D. D-dimer
Correct Answer: A
Rationale: Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder caused
by antibodies against platelet factor 4/heparin complexes. ELISA detects these
antibodies and is the confirmatory test. Bleeding time, aPTT, and D-dimer are not
specific for HIT.
10. A client with heart failure has a prescription for digoxin. Which finding
indicates digoxin toxicity?
A. Heart rate of 72 bpm
B. Nausea and yellow vision
C. Blood pressure of 140/90 mm Hg
D. Dry cough
Correct Answer: B
Rationale: Classic signs of digoxin toxicity include GI symptoms (nausea, vomiting,
anorexia) and visual disturbances (yellow or green halos, blurred vision).
11. A client with new-onset atrial fibrillation has a heart rate of 140 bpm and
blood pressure 100/60 mmHg. The nurse should prepare for which intervention?
A. Synchronized electrical cardioversion
B. Defibrillation
C. Pacemaker insertion
D. Adenosine administration
Pathophysiology Exam 2 (Latest Updated)
Rasmussen. 2026/2027
1. A nurse is caring for a client admitted with acute heart failure. Which
assessment finding requires immediate intervention?
A. Bilateral 2+ pitting edema in the ankles
B. Blood pressure of 150/90 mm Hg
C. Crackles throughout both lung fields and oxygen saturation of 84%
D. Weight gain of 2 lb (0.9 kg) over 24 hours
Correct Answer: C
Rationale: This client is experiencing severe pulmonary edema, resulting in impaired gas
exchange and hypoxemia. An oxygen saturation of 84% indicates inadequate
oxygenation requiring immediate intervention. Peripheral edema indicates fluid overload
but is not immediately life-threatening. Mild hypertension is common in heart failure
and is less urgent. Rapid weight gain signals worsening fluid retention but is not as
immediately dangerous as hypoxia.
2. A client with left-sided heart failure is being assessed. Which finding should the
nurse identify as a manifestation of left-sided heart failure?
A. Dependent edema in the lower extremities
B. Pink-tinged frothy sputum
C. Jugular vein distention
D. Hepatomegaly
Correct Answer: B
Rationale: Pink-tinged frothy sputum indicates pulmonary edema, a key manifestation
of left-sided heart failure due to backup of blood into the pulmonary circulation.
Dependent edema, JVD, and hepatomegaly are signs of right-sided heart failure.
3. A client receiving packed red blood cells suddenly develops chills, fever, and
flank pain. What should the nurse do first?
,A. Notify the provider
B. Slow the infusion
C. Stop the transfusion
D. Administer acetaminophen
Correct Answer: C
Rationale: These findings suggest an acute hemolytic transfusion reaction. Immediate
actions include stopping the transfusion, maintaining IV access with normal saline using
new tubing, notifying the provider and blood bank, monitoring vital signs, and
obtaining blood and urine specimens as ordered. Stopping the transfusion prevents
further exposure to incompatible blood.
4. A client with atrial fibrillation is prescribed warfarin. The nurse educates the
client that they must avoid eating large amounts of which foods?
A. Bananas and oranges
B. Green leafy vegetables (spinach, kale)
C. Grapefruit juice
D. Dairy products
Correct Answer: B
Rationale: Green leafy vegetables are high in Vitamin K, which antagonizes the effect of
warfarin. Patients should maintain consistent Vitamin K intake rather than avoid it
completely. Grapefruit juice is a concern with statins and calcium channel blockers, not
warfarin.
5. A client with deep vein thrombosis is started on IV heparin. Which laboratory
value should the nurse monitor to evaluate the therapeutic efficacy of heparin?
A. PT/INR
B. aPTT
C. Platelet count
D. D-dimer
Correct Answer: B
Rationale: Heparin is monitored using the aPTT. The goal is typically 1.5-2.5 times the
control value. PT/INR is used to monitor warfarin. Platelet count is monitored to detect
HIT. D-dimer is a diagnostic test for DVT/PE.
,6. A client on warfarin has an INR of 4.5 without bleeding. Which action is most
appropriate?
A. Administer vitamin K 10 mg subcutaneously
B. Withhold warfarin and recheck INR in 24-48 hours
C. Give fresh frozen plasma immediately
D. Increase warfarin dose
Correct Answer: B
Rationale: For an asymptomatic patient with INR 4.5-10, guidelines recommend
withholding warfarin (no vitamin K unless high bleeding risk). Recheck INR in 1-2 days.
Vitamin K is for INR >10 or active bleeding.
7. A patient on clopidogrel is scheduled for elective surgery. When should
clopidogrel be stopped?
A. 2 days before surgery
B. 5 days before surgery
C. 10 days before surgery
D. 14 days before surgery
Correct Answer: B
Rationale: Clopidogrel irreversibly inhibits P2Y12; platelet function recovers in 5-7 days
(new platelets). Guidelines recommend stopping 5 days pre-op for most non-cardiac
surgeries.
8. A nurse is assessing a client who is 12 hours postoperative following a total hip
arthroplasty. Which finding requires immediate intervention?
A. Pain rated 6 on a 0-10 scale
B. Temperature of 100.2°F (37.9°C)
C. Sudden shortness of breath and chest pain
D. Drainage of 50 mL of serosanguineous fluid from the surgical drain
Correct Answer: C
Rationale: Sudden dyspnea and chest pain in a postoperative orthopedic client strongly
suggest a pulmonary embolism (PE), a life-threatening complication requiring
immediate intervention. Moderate postoperative pain is expected; slight temperature
, elevation during the first 24 hours may occur due to inflammation; moderate
serosanguineous drainage is expected after surgery.
9. A patient on heparin for deep vein thrombosis develops new thrombocytopenia
(platelet count 45,000/L) and a skin lesion at the injection site. Which diagnostic
test would confirm the suspected condition?
A. Platelet factor 4 antibody assay (ELISA)
B. Bleeding time
C. Partial thromboplastin time (aPTT)
D. D-dimer
Correct Answer: A
Rationale: Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder caused
by antibodies against platelet factor 4/heparin complexes. ELISA detects these
antibodies and is the confirmatory test. Bleeding time, aPTT, and D-dimer are not
specific for HIT.
10. A client with heart failure has a prescription for digoxin. Which finding
indicates digoxin toxicity?
A. Heart rate of 72 bpm
B. Nausea and yellow vision
C. Blood pressure of 140/90 mm Hg
D. Dry cough
Correct Answer: B
Rationale: Classic signs of digoxin toxicity include GI symptoms (nausea, vomiting,
anorexia) and visual disturbances (yellow or green halos, blurred vision).
11. A client with new-onset atrial fibrillation has a heart rate of 140 bpm and
blood pressure 100/60 mmHg. The nurse should prepare for which intervention?
A. Synchronized electrical cardioversion
B. Defibrillation
C. Pacemaker insertion
D. Adenosine administration
