Page 1 of 55
AVN 2035 MED SURG 3 MIDTERM EXAM QUESTIONS LATEST EDITION
2026 – 2027 VERSION SOLVED QUESTIONS & ANSWERS
AVN 2035 MED SURG 3 MIDTERM EXAM
Questions with Answers & Rationales
Based on Stanbridge University AVN 2035 Medical Surgical Nursing III Curriculum |
Updated 2026-2027
Question 1: A nurse is caring for a client with heart failure who reports shortness of
breath and has crackles in the lung bases. Which position should the nurse place the
client in to relieve dyspnea?
A) Supine position
B) Trendelenburg position
C) High Fowler's position
D) Left lateral position
Correct Answer: C
Rationale: High Fowler's position (sitting upright) uses gravity to decrease venous
return and reduce pulmonary congestion, making breathing easier. Supine and
Trendelenburg positions worsen dyspnea.
Question 2: A client with heart failure is prescribed furosemide (Lasix). Which
laboratory value should the nurse monitor closely?
A) Serum sodium
B) Serum potassium
, Page 2 of 55
C) Serum calcium
D) Serum magnesium
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting (hypokalemia).
Hypokalemia can lead to cardiac arrhythmias, especially in clients taking digoxin.
Question 3: A nurse is assessing a client with right-sided heart failure. Which finding
should the nurse expect?
A) Crackles in the lungs
B) Orthopnea
C) Peripheral edema and jugular venous distension
D) Pulmonary congestion
Correct Answer: C
Rationale: Right-sided heart failure causes systemic venous congestion, leading to
peripheral edema, jugular venous distension, hepatomegaly, and ascites. Crackles and
pulmonary congestion are signs of left-sided heart failure.
Question 4: A client on warfarin has an INR of 4.5. What is the nurse's priority action?
A) Administer vitamin K immediately
B) Hold the warfarin and notify the provider
C) Administer the warfarin as scheduled
D) Increase the warfarin dose
Correct Answer: B
Rationale: An INR above 4.0 indicates increased bleeding risk. The nurse should hold
the dose and notify the provider. Vitamin K may be ordered for significant bleeding.
Question 5: A client with peripheral arterial disease (PAD) would most likely exhibit
which finding?
A) Brownish discoloration of the lower legs
B) Dependent rubor with elevation pallor
, Page 3 of 55
C) Pitting edema
D) Varicose veins
Correct Answer: B
Rationale: PAD is characterized by pallor when the extremity is elevated (decreased
blood flow) and rubor (redness) when dependent (reactive hyperemia). Brownish
discoloration, edema, and varicose veins suggest venous insufficiency.
Question 6: A nurse is assessing a patient admitted with acute pericarditis. Which
physical assessment finding should the nurse expect to document?
A) A loud mid-systolic click heard at the apex
B) A grating, high-pitched friction rub heard best when the patient leans forward
C) Distant, muffled heart sounds with a narrowed pulse pressure
D) Bounding peripheral pulses and a prominent S3 gallop
Correct Answer: B
Rationale: A pericardial friction rub is the hallmark sign of pericarditis, caused by
inflamed pericardial layers rubbing together. It is scratchy or grating and is loudest when
the patient sits up and leans forward. Muffled heart sounds indicate cardiac
tamponade.
Question 7: A patient with a history of chronic atrial fibrillation is prescribed oral
warfarin. Which laboratory value indicates that the patient's therapy is within the
therapeutic target range?
A) Activated partial thromboplastin time (aPTT) of 65 seconds
B) An International Normalized Ratio (INR) between 2.0 and 3.0
C) Prothrombin time (PT) of 11 seconds
D) Platelet count of 150,000/mm³
Correct Answer: B
Rationale: For standard atrial fibrillation, the therapeutic goal for warfarin is an INR of
2.0 to 3.0 to prevent thromboembolic events without causing excessive bleeding. aPTT
is used to monitor heparin.
, Page 4 of 55
Question 8: A nurse is caring for a patient who is 4 hours postoperative following a
pericardial window procedure. The nurse notes jugular venous distention, a sudden
drop in blood pressure from 130/80 to 92/64 mmHg, and distant, muffled heart sounds.
Which action should the nurse take first?
A) Administer a 500 mL bolus of normal saline
B) Increase the oxygen flow rate via nasal cannula
C) Notify the healthcare provider immediately to prepare for emergency
pericardiocentesis
D) Obtain a 12-lead ECG
Correct Answer: C
Rationale: These findings represent Beck's Triad (JVD, hypotension, muffled heart
sounds), which is diagnostic for cardiac tamponade. This is a life-threatening
emergency where fluid accumulation compresses the heart. The priority is to notify the
provider for emergency pericardiocentesis.
Question 9: A client with hypertension has a blood pressure of 180/110 mmHg. The
nurse should first:
A) Administer sublingual nifedipine
B) Recheck the blood pressure in the other arm
C) Notify the healthcare provider immediately
D) Instruct the patient to rest and recheck in 15 minutes
Correct Answer: D
Rationale: A single elevated reading should be confirmed after the patient has rested. If
hypertension is confirmed, notify the provider. Sublingual nifedipine is no longer
recommended for hypertensive emergencies due to risk of rapid, uncontrolled
hypotension.
Question 10: A client is prescribed lisinopril (Prinivil). Which adverse effect should the
nurse monitor for?
A) Hyperkalemia
B) Hypokalemia
C) Tachycardia
AVN 2035 MED SURG 3 MIDTERM EXAM QUESTIONS LATEST EDITION
2026 – 2027 VERSION SOLVED QUESTIONS & ANSWERS
AVN 2035 MED SURG 3 MIDTERM EXAM
Questions with Answers & Rationales
Based on Stanbridge University AVN 2035 Medical Surgical Nursing III Curriculum |
Updated 2026-2027
Question 1: A nurse is caring for a client with heart failure who reports shortness of
breath and has crackles in the lung bases. Which position should the nurse place the
client in to relieve dyspnea?
A) Supine position
B) Trendelenburg position
C) High Fowler's position
D) Left lateral position
Correct Answer: C
Rationale: High Fowler's position (sitting upright) uses gravity to decrease venous
return and reduce pulmonary congestion, making breathing easier. Supine and
Trendelenburg positions worsen dyspnea.
Question 2: A client with heart failure is prescribed furosemide (Lasix). Which
laboratory value should the nurse monitor closely?
A) Serum sodium
B) Serum potassium
, Page 2 of 55
C) Serum calcium
D) Serum magnesium
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting (hypokalemia).
Hypokalemia can lead to cardiac arrhythmias, especially in clients taking digoxin.
Question 3: A nurse is assessing a client with right-sided heart failure. Which finding
should the nurse expect?
A) Crackles in the lungs
B) Orthopnea
C) Peripheral edema and jugular venous distension
D) Pulmonary congestion
Correct Answer: C
Rationale: Right-sided heart failure causes systemic venous congestion, leading to
peripheral edema, jugular venous distension, hepatomegaly, and ascites. Crackles and
pulmonary congestion are signs of left-sided heart failure.
Question 4: A client on warfarin has an INR of 4.5. What is the nurse's priority action?
A) Administer vitamin K immediately
B) Hold the warfarin and notify the provider
C) Administer the warfarin as scheduled
D) Increase the warfarin dose
Correct Answer: B
Rationale: An INR above 4.0 indicates increased bleeding risk. The nurse should hold
the dose and notify the provider. Vitamin K may be ordered for significant bleeding.
Question 5: A client with peripheral arterial disease (PAD) would most likely exhibit
which finding?
A) Brownish discoloration of the lower legs
B) Dependent rubor with elevation pallor
, Page 3 of 55
C) Pitting edema
D) Varicose veins
Correct Answer: B
Rationale: PAD is characterized by pallor when the extremity is elevated (decreased
blood flow) and rubor (redness) when dependent (reactive hyperemia). Brownish
discoloration, edema, and varicose veins suggest venous insufficiency.
Question 6: A nurse is assessing a patient admitted with acute pericarditis. Which
physical assessment finding should the nurse expect to document?
A) A loud mid-systolic click heard at the apex
B) A grating, high-pitched friction rub heard best when the patient leans forward
C) Distant, muffled heart sounds with a narrowed pulse pressure
D) Bounding peripheral pulses and a prominent S3 gallop
Correct Answer: B
Rationale: A pericardial friction rub is the hallmark sign of pericarditis, caused by
inflamed pericardial layers rubbing together. It is scratchy or grating and is loudest when
the patient sits up and leans forward. Muffled heart sounds indicate cardiac
tamponade.
Question 7: A patient with a history of chronic atrial fibrillation is prescribed oral
warfarin. Which laboratory value indicates that the patient's therapy is within the
therapeutic target range?
A) Activated partial thromboplastin time (aPTT) of 65 seconds
B) An International Normalized Ratio (INR) between 2.0 and 3.0
C) Prothrombin time (PT) of 11 seconds
D) Platelet count of 150,000/mm³
Correct Answer: B
Rationale: For standard atrial fibrillation, the therapeutic goal for warfarin is an INR of
2.0 to 3.0 to prevent thromboembolic events without causing excessive bleeding. aPTT
is used to monitor heparin.
, Page 4 of 55
Question 8: A nurse is caring for a patient who is 4 hours postoperative following a
pericardial window procedure. The nurse notes jugular venous distention, a sudden
drop in blood pressure from 130/80 to 92/64 mmHg, and distant, muffled heart sounds.
Which action should the nurse take first?
A) Administer a 500 mL bolus of normal saline
B) Increase the oxygen flow rate via nasal cannula
C) Notify the healthcare provider immediately to prepare for emergency
pericardiocentesis
D) Obtain a 12-lead ECG
Correct Answer: C
Rationale: These findings represent Beck's Triad (JVD, hypotension, muffled heart
sounds), which is diagnostic for cardiac tamponade. This is a life-threatening
emergency where fluid accumulation compresses the heart. The priority is to notify the
provider for emergency pericardiocentesis.
Question 9: A client with hypertension has a blood pressure of 180/110 mmHg. The
nurse should first:
A) Administer sublingual nifedipine
B) Recheck the blood pressure in the other arm
C) Notify the healthcare provider immediately
D) Instruct the patient to rest and recheck in 15 minutes
Correct Answer: D
Rationale: A single elevated reading should be confirmed after the patient has rested. If
hypertension is confirmed, notify the provider. Sublingual nifedipine is no longer
recommended for hypertensive emergencies due to risk of rapid, uncontrolled
hypotension.
Question 10: A client is prescribed lisinopril (Prinivil). Which adverse effect should the
nurse monitor for?
A) Hyperkalemia
B) Hypokalemia
C) Tachycardia
