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MED SURG 2 MIDTERM Complete Original Study Guide &
Exam Questions with Answers and Rationales
Section 1: Cardiovascular Disorders (Questions)
1. A nurse is assessing a client with heart failure. Which
finding indicates left-sided heart failure?
A. Peripheral edema
B. Jugular vein distention
C. Crackles in the lung bases
D. Hepatomegaly
Answer: C
Rationale: Left-sided heart failure causes pulmonary
congestion, leading to crackles, dyspnea, and orthopnea.
Peripheral edema, JVD, and hepatomegaly are signs of
right-sided heart failure.
2. A client is receiving nitroglycerin sublingual for chest pain.
The nurse should instruct the client to:
A. Swallow the tablet with water
B. Take one tablet every 5 minutes, up to 3 tablets, and call
911 if pain persists
C. Lie flat after taking the medication
D. Expect a rapid heart rate and headache, which are signs
of allergy
Answer: B
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Rationale: Sublingual nitroglycerin is given every 5
minutes up to 3 doses; if pain is unrelieved, emergency
services are needed. Headache and hypotension are
common side effects, not allergy.
3. Which laboratory value is most specific for myocardial
infarction?
A. CK-MB
B. Troponin I
C. Myoglobin
D. BNP
Answer: B
Rationale: Troponin I and T are highly specific to cardiac
muscle and rise 3-12 hours after MI, remaining elevated
for up to 2 weeks. CK-MB is less specific; BNP is for heart
failure.
4. A client with atrial fibrillation is at highest risk for which
complication?
A. Myocardial infarction
B. Stroke
C. Pulmonary embolism
D. Pericarditis
Answer: B
Rationale: Atrial fibrillation causes ineffective atrial
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contraction, leading to blood stasis in the atria and clot
formation. Emboli can travel to the brain causing stroke.
5. The nurse is auscultating heart sounds. An S3 heart sound
is most likely indicative of:
A. Hypertension
B. Heart failure
C. Aortic stenosis
D. Mitral valve prolapse
Answer: B
Rationale: An S3 (ventricular gallop) is an early diastolic
sound associated with volume overload and decreased
ventricular compliance, commonly heard in heart failure.
6. Which client should the nurse see first?
A. A client with stable angina who reports pain 4/10 after
walking
B. A client with heart failure who has gained 2 lb in 2 days
C. A client with new onset of chest pain unrelieved by rest
D. A client with hypertension whose BP is 150/90
Answer: C
Rationale: Unstable angina or possible MI is an
emergency. The client with new chest pain unrelieved by
rest needs immediate assessment and intervention.
7. A client is prescribed warfarin. The nurse should monitor
which laboratory value?
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A. aPTT
B. INR
C. Platelet count
D. Bleeding time
Answer: B
Rationale: Warfarin is monitored by INR (target usually 2-
3 for most indications). Heparin is monitored by aPTT.
8. The nurse is caring for a client with peripheral arterial
disease. Which assessment finding is expected?
A. Warm, reddened extremities
B. Edema and brown pigmentation
C. Cool, pale extremities with diminished pulses
D. Irregular, painful ulcers with drainage
Answer: C
Rationale: PAD is due to arterial insufficiency, causing
cool, pale, shiny skin, diminished/absent pulses, and
intermittent claudication. Venous disease causes edema
and brown discoloration.
9. A client is scheduled for a cardiac catheterization. Which
nursing action is most important before the procedure?
A. Administer a sedative
B. Assess for allergies to iodine or shellfish
C. Ensure the client has a full bladder
D. Remove all jewelry and dentures
MED SURG 2 MIDTERM Complete Original Study Guide &
Exam Questions with Answers and Rationales
Section 1: Cardiovascular Disorders (Questions)
1. A nurse is assessing a client with heart failure. Which
finding indicates left-sided heart failure?
A. Peripheral edema
B. Jugular vein distention
C. Crackles in the lung bases
D. Hepatomegaly
Answer: C
Rationale: Left-sided heart failure causes pulmonary
congestion, leading to crackles, dyspnea, and orthopnea.
Peripheral edema, JVD, and hepatomegaly are signs of
right-sided heart failure.
2. A client is receiving nitroglycerin sublingual for chest pain.
The nurse should instruct the client to:
A. Swallow the tablet with water
B. Take one tablet every 5 minutes, up to 3 tablets, and call
911 if pain persists
C. Lie flat after taking the medication
D. Expect a rapid heart rate and headache, which are signs
of allergy
Answer: B
,https://www.stuvia.com/user/performance
Rationale: Sublingual nitroglycerin is given every 5
minutes up to 3 doses; if pain is unrelieved, emergency
services are needed. Headache and hypotension are
common side effects, not allergy.
3. Which laboratory value is most specific for myocardial
infarction?
A. CK-MB
B. Troponin I
C. Myoglobin
D. BNP
Answer: B
Rationale: Troponin I and T are highly specific to cardiac
muscle and rise 3-12 hours after MI, remaining elevated
for up to 2 weeks. CK-MB is less specific; BNP is for heart
failure.
4. A client with atrial fibrillation is at highest risk for which
complication?
A. Myocardial infarction
B. Stroke
C. Pulmonary embolism
D. Pericarditis
Answer: B
Rationale: Atrial fibrillation causes ineffective atrial
,https://www.stuvia.com/user/performance
contraction, leading to blood stasis in the atria and clot
formation. Emboli can travel to the brain causing stroke.
5. The nurse is auscultating heart sounds. An S3 heart sound
is most likely indicative of:
A. Hypertension
B. Heart failure
C. Aortic stenosis
D. Mitral valve prolapse
Answer: B
Rationale: An S3 (ventricular gallop) is an early diastolic
sound associated with volume overload and decreased
ventricular compliance, commonly heard in heart failure.
6. Which client should the nurse see first?
A. A client with stable angina who reports pain 4/10 after
walking
B. A client with heart failure who has gained 2 lb in 2 days
C. A client with new onset of chest pain unrelieved by rest
D. A client with hypertension whose BP is 150/90
Answer: C
Rationale: Unstable angina or possible MI is an
emergency. The client with new chest pain unrelieved by
rest needs immediate assessment and intervention.
7. A client is prescribed warfarin. The nurse should monitor
which laboratory value?
, https://www.stuvia.com/user/performance
A. aPTT
B. INR
C. Platelet count
D. Bleeding time
Answer: B
Rationale: Warfarin is monitored by INR (target usually 2-
3 for most indications). Heparin is monitored by aPTT.
8. The nurse is caring for a client with peripheral arterial
disease. Which assessment finding is expected?
A. Warm, reddened extremities
B. Edema and brown pigmentation
C. Cool, pale extremities with diminished pulses
D. Irregular, painful ulcers with drainage
Answer: C
Rationale: PAD is due to arterial insufficiency, causing
cool, pale, shiny skin, diminished/absent pulses, and
intermittent claudication. Venous disease causes edema
and brown discoloration.
9. A client is scheduled for a cardiac catheterization. Which
nursing action is most important before the procedure?
A. Administer a sedative
B. Assess for allergies to iodine or shellfish
C. Ensure the client has a full bladder
D. Remove all jewelry and dentures
