NSG 223 / NSG223
Exam 1 (Latest 2026/2027)
Medical-Surgical Nursing II Quiz Bank
Questions and Verified Answers with Rationales
100% Correct | Grade A
Herzing University
College of Nursing
75 Questions | Aligned with 2026-2027 Curriculum Standards
NSG 223 Medical-Surgical Nursing II Exam 1 | Herzing University | Page 1
,Section 1: Cardiovascular Disorders (Hypertension, Heart Failure, CAD,
Dysrhythmias)
Q1: A nurse is reviewing the blood pressure readings of a 55-year-old patient during a routine
clinic visit. The patient's readings over the past three visits are 134/84 mmHg, 132/82 mmHg, and
136/86 mmHg. The nurse understands that hypertension is diagnosed when which criterion is
met?
A. A. Systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg
B. B. Systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg [CORRECT]
C. C. Systolic blood pressure ≥ 120 mmHg or diastolic blood pressure ≥ 75 mmHg
D. D. Systolic blood pressure ≥ 150 mmHg or diastolic blood pressure ≥ 95 mmHg
Correct Answer: B
Rationale: According to the latest ACC/AHA guidelines, hypertension is defined as systolic blood pressure ≥ 130
mmHg or diastolic blood pressure ≥ 80 mmHg. This patient meets the criteria with all three readings above 130/80.
The previous JNC 7 threshold of 140/90 (Option A) is outdated. Options C and D do not reflect current guideline
definitions.
Q2: A nurse is caring for a patient with newly diagnosed primary hypertension. The patient asks,
'What caused my high blood pressure?' Which is the most accurate response by the nurse?
A. A. Primary hypertension is caused by a specific kidney disease
B. B. Primary hypertension has no identifiable cause and is related to multiple risk factors [CORRECT]
C. C. Primary hypertension is always caused by excessive salt intake alone
D. D. Primary hypertension is a direct result of medication side effects
Correct Answer: B
Rationale: Primary (essential) hypertension accounts for 90-95% of all hypertension cases and has no single
identifiable cause. It is associated with multiple risk factors including family history, age, obesity, high sodium intake,
physical inactivity, and excessive alcohol consumption. Options A and D describe secondary hypertension, which has
an identifiable cause. Option C is incorrect because while sodium is a risk factor, it is not the sole cause.
Q3: A patient with stage 2 hypertension is prescribed lisinopril, an ACE inhibitor. The nurse
educates the patient about which side effects that should be reported to the provider?
A. A. Dry, persistent cough
B. B. Bradycardia and fatigue
C. C. Hyperkalemia and a dry, persistent cough [CORRECT]
D. D. Weight gain and increased appetite
Correct Answer: C
Rationale: ACE inhibitors like lisinopril commonly cause a dry, persistent cough due to bradykinin accumulation, and
they can cause hyperkalemia because they reduce aldosterone production. Patients should report both effects.
Bradycardia (Option B) is more associated with beta-blockers. Weight gain (Option D) is not typical of ACE inhibitors.
Option A is incomplete as it omits hyperkalemia.
Q4: A nurse is assessing a patient with left-sided heart failure. Which of the following findings
would the nurse most likely observe?
A. A. Jugular venous distention and dependent edema
B. B. Dyspnea, crackles in the lungs, and an S3 gallop [CORRECT]
NSG 223 Medical-Surgical Nursing II Exam 1 | Herzing University | Page 2
, C. C. Hepatomegaly and ascites
D. D. Bradycardia and hypotension
Correct Answer: B
Rationale: Left-sided heart failure causes pulmonary congestion because the left ventricle cannot effectively pump
blood forward, leading to fluid backup into the lungs. Classic findings include dyspnea, orthopnea, paroxysmal
nocturnal dyspnea (PND), crackles from pulmonary edema, and an S3 gallop. JVD, dependent edema,
hepatomegaly, and ascites (Options A and C) are right-sided heart failure findings.
Q5: A patient with heart failure has a B-type natriuretic peptide (BNP) level of 85 pg/mL. The nurse
interprets this result as indicating which of the following?
A. A. The patient has severe heart failure requiring immediate intervention
B. B. Heart failure is unlikely as the cause of the patient's symptoms [CORRECT]
C. C. The patient has moderate heart failure with a guarded prognosis
D. D. The result is inconclusive and a repeat test is needed
Correct Answer: B
Rationale: A BNP level less than 100 pg/mL makes heart failure an unlikely cause of the patient's symptoms. BNP is
released from the ventricles in response to volume expansion and pressure overload. Levels above 100 pg/mL
suggest heart failure, with higher levels correlating with greater severity. A level of 85 pg/mL falls below the diagnostic
threshold.
Q6: A nurse is caring for a patient with heart failure who is receiving digoxin. Before administering
the scheduled dose, the nurse assesses the apical pulse and finds it to be 56 bpm. Which action
should the nurse take?
A. A. Administer the dose as prescribed because the rate is within normal limits
B. B. Hold the dose and notify the healthcare provider [CORRECT]
C. C. Administer the dose and recheck the pulse in 30 minutes
D. D. Give half the prescribed dose and document the pulse rate
Correct Answer: B
Rationale: The nurse should hold the digoxin dose if the apical pulse is below 60 bpm. Digoxin slows AV node
conduction and can cause bradycardia. The therapeutic range is 0.8-2.0 ng/mL, and toxicity can cause
life-threatening dysrhythmias. The nurse must hold the dose, notify the provider, and obtain further orders.
Administering the dose (Options A and C) or giving half (Option D) could worsen bradycardia.
Q7: A patient with heart failure is being discharged home. The nurse provides dietary teaching.
Which instruction is most appropriate regarding sodium restriction?
A. A. Limit sodium intake to less than 4 grams per day
B. B. There are no specific sodium restrictions for heart failure
C. C. Limit sodium intake to 2 grams per day [CORRECT]
D. D. Avoid all sodium completely, including naturally occurring sodium in foods
Correct Answer: C
Rationale: Patients with heart failure are typically instructed to restrict sodium intake to 2 grams (2000 mg) per day to
prevent fluid retention and worsening of heart failure symptoms. Option A (4 g/day) is too permissive. Option B is
incorrect because sodium restriction is a cornerstone of HF management. Option D is unrealistic and unnecessary.
NSG 223 Medical-Surgical Nursing II Exam 1 | Herzing University | Page 3
Exam 1 (Latest 2026/2027)
Medical-Surgical Nursing II Quiz Bank
Questions and Verified Answers with Rationales
100% Correct | Grade A
Herzing University
College of Nursing
75 Questions | Aligned with 2026-2027 Curriculum Standards
NSG 223 Medical-Surgical Nursing II Exam 1 | Herzing University | Page 1
,Section 1: Cardiovascular Disorders (Hypertension, Heart Failure, CAD,
Dysrhythmias)
Q1: A nurse is reviewing the blood pressure readings of a 55-year-old patient during a routine
clinic visit. The patient's readings over the past three visits are 134/84 mmHg, 132/82 mmHg, and
136/86 mmHg. The nurse understands that hypertension is diagnosed when which criterion is
met?
A. A. Systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg
B. B. Systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg [CORRECT]
C. C. Systolic blood pressure ≥ 120 mmHg or diastolic blood pressure ≥ 75 mmHg
D. D. Systolic blood pressure ≥ 150 mmHg or diastolic blood pressure ≥ 95 mmHg
Correct Answer: B
Rationale: According to the latest ACC/AHA guidelines, hypertension is defined as systolic blood pressure ≥ 130
mmHg or diastolic blood pressure ≥ 80 mmHg. This patient meets the criteria with all three readings above 130/80.
The previous JNC 7 threshold of 140/90 (Option A) is outdated. Options C and D do not reflect current guideline
definitions.
Q2: A nurse is caring for a patient with newly diagnosed primary hypertension. The patient asks,
'What caused my high blood pressure?' Which is the most accurate response by the nurse?
A. A. Primary hypertension is caused by a specific kidney disease
B. B. Primary hypertension has no identifiable cause and is related to multiple risk factors [CORRECT]
C. C. Primary hypertension is always caused by excessive salt intake alone
D. D. Primary hypertension is a direct result of medication side effects
Correct Answer: B
Rationale: Primary (essential) hypertension accounts for 90-95% of all hypertension cases and has no single
identifiable cause. It is associated with multiple risk factors including family history, age, obesity, high sodium intake,
physical inactivity, and excessive alcohol consumption. Options A and D describe secondary hypertension, which has
an identifiable cause. Option C is incorrect because while sodium is a risk factor, it is not the sole cause.
Q3: A patient with stage 2 hypertension is prescribed lisinopril, an ACE inhibitor. The nurse
educates the patient about which side effects that should be reported to the provider?
A. A. Dry, persistent cough
B. B. Bradycardia and fatigue
C. C. Hyperkalemia and a dry, persistent cough [CORRECT]
D. D. Weight gain and increased appetite
Correct Answer: C
Rationale: ACE inhibitors like lisinopril commonly cause a dry, persistent cough due to bradykinin accumulation, and
they can cause hyperkalemia because they reduce aldosterone production. Patients should report both effects.
Bradycardia (Option B) is more associated with beta-blockers. Weight gain (Option D) is not typical of ACE inhibitors.
Option A is incomplete as it omits hyperkalemia.
Q4: A nurse is assessing a patient with left-sided heart failure. Which of the following findings
would the nurse most likely observe?
A. A. Jugular venous distention and dependent edema
B. B. Dyspnea, crackles in the lungs, and an S3 gallop [CORRECT]
NSG 223 Medical-Surgical Nursing II Exam 1 | Herzing University | Page 2
, C. C. Hepatomegaly and ascites
D. D. Bradycardia and hypotension
Correct Answer: B
Rationale: Left-sided heart failure causes pulmonary congestion because the left ventricle cannot effectively pump
blood forward, leading to fluid backup into the lungs. Classic findings include dyspnea, orthopnea, paroxysmal
nocturnal dyspnea (PND), crackles from pulmonary edema, and an S3 gallop. JVD, dependent edema,
hepatomegaly, and ascites (Options A and C) are right-sided heart failure findings.
Q5: A patient with heart failure has a B-type natriuretic peptide (BNP) level of 85 pg/mL. The nurse
interprets this result as indicating which of the following?
A. A. The patient has severe heart failure requiring immediate intervention
B. B. Heart failure is unlikely as the cause of the patient's symptoms [CORRECT]
C. C. The patient has moderate heart failure with a guarded prognosis
D. D. The result is inconclusive and a repeat test is needed
Correct Answer: B
Rationale: A BNP level less than 100 pg/mL makes heart failure an unlikely cause of the patient's symptoms. BNP is
released from the ventricles in response to volume expansion and pressure overload. Levels above 100 pg/mL
suggest heart failure, with higher levels correlating with greater severity. A level of 85 pg/mL falls below the diagnostic
threshold.
Q6: A nurse is caring for a patient with heart failure who is receiving digoxin. Before administering
the scheduled dose, the nurse assesses the apical pulse and finds it to be 56 bpm. Which action
should the nurse take?
A. A. Administer the dose as prescribed because the rate is within normal limits
B. B. Hold the dose and notify the healthcare provider [CORRECT]
C. C. Administer the dose and recheck the pulse in 30 minutes
D. D. Give half the prescribed dose and document the pulse rate
Correct Answer: B
Rationale: The nurse should hold the digoxin dose if the apical pulse is below 60 bpm. Digoxin slows AV node
conduction and can cause bradycardia. The therapeutic range is 0.8-2.0 ng/mL, and toxicity can cause
life-threatening dysrhythmias. The nurse must hold the dose, notify the provider, and obtain further orders.
Administering the dose (Options A and C) or giving half (Option D) could worsen bradycardia.
Q7: A patient with heart failure is being discharged home. The nurse provides dietary teaching.
Which instruction is most appropriate regarding sodium restriction?
A. A. Limit sodium intake to less than 4 grams per day
B. B. There are no specific sodium restrictions for heart failure
C. C. Limit sodium intake to 2 grams per day [CORRECT]
D. D. Avoid all sodium completely, including naturally occurring sodium in foods
Correct Answer: C
Rationale: Patients with heart failure are typically instructed to restrict sodium intake to 2 grams (2000 mg) per day to
prevent fluid retention and worsening of heart failure symptoms. Option A (4 g/day) is too permissive. Option B is
incorrect because sodium restriction is a cornerstone of HF management. Option D is unrealistic and unnecessary.
NSG 223 Medical-Surgical Nursing II Exam 1 | Herzing University | Page 3
