NUR 242 Medical-Surgical Nursing
Exam 4: Practice Questions with
Answers & Rationales (2026/2027)
1. A client with heart failure has crackles in all lung fields, jugular
venous distention, and 3+ pitting edema. Which medication should
the nurse expect to administer first?
Correct Answer: Furosemide
Rationale: Furosemide is a loop diuretic that reduces preload by
promoting diuresis, relieving pulmonary congestion and edema. It is first-
line for acute decompensated heart failure with fluid overload .
2. A client with atrial fibrillation is prescribed warfarin. Which
laboratory test should the nurse monitor to evaluate therapeutic
effect?
Correct Answer: INR
Rationale: Warfarin anticoagulation is monitored by INR. The therapeutic
target INR for atrial fibrillation is 2–3 (2.5–3.5 for mechanical valves). aPTT is
used to monitor heparin therapy .
3. A nurse is caring for a patient with heart failure who has gained 2 kg
(4.4 lbs) in 24 hours. Which action should the nurse take first?
Correct Answer: Assess lung sounds and oxygen saturation
Rationale: The nurse must first assess the patient's respiratory status (lung
sounds, SpO2) to detect pulmonary edema. Assessment always precedes
intervention. Elevating HOB helps breathing but assessment comes first .
,4. A client with heart failure is prescribed furosemide and
spironolactone. Which assessment finding requires the nurse to
contact the provider before administering spironolactone?
Correct Answer: Potassium 5.4 mEq/L
Rationale: Spironolactone is potassium-sparing and can increase
potassium levels. An elevated potassium level (5.4 mEq/L) is a concern for
hyperkalemia. Sodium 138, pulse 76, and mild pedal edema are not
contraindications .
5. The nurse assesses a client with left-sided heart failure. Which
symptom is most consistent with this condition?
Correct Answer: Dyspnea and crackles in both lung bases
Rationale: Left-sided heart failure primarily causes pulmonary
congestion—shortness of breath, dyspnea, crackles, restlessness, and
decreased activity tolerance. Jugular vein distention and ascites are
associated with right-sided heart failure .
6. Which lab value would the nurse expect to be elevated in a client
with decompensated heart failure?
Correct Answer: BNP
Rationale: BNP (B-type natriuretic peptide) is elevated in response to
ventricular stretch in heart failure. Amylase is linked to pancreatic issues;
calcium and platelets are not primary HF diagnostic markers .
7. A client with heart failure develops acute pulmonary edema,
suddenly complaining of severe dyspnea and producing pink frothy
sputum. Which action should the nurse take first?
Correct Answer: Place the client in high Fowler's position and apply
oxygen
, Rationale: Pulmonary edema is an emergency. High Fowler's position
improves ventilation, and oxygen should be applied immediately. Extra
fluids worsen pulmonary congestion; supine position impairs breathing;
urine collection is not a priority in an emergency .
8. A client presents with BP 196/124 mm Hg, severe headache, blurred
vision, and chest pain. Which nursing action is priority?
Correct Answer: Administer ordered IV antihypertensive medication and
monitor BP frequently
Rationale: This is hypertensive crisis (≥180/120) with symptoms. IV
antihypertensive medication (e.g., nicardipine, nitroglycerin, labetalol) is
indicated, with BP monitoring every 15–30 minutes. BP should be lowered
slowly to avoid cerebral ischemia. Trendelenburg is contraindicated;
ambulation is unsafe .
9. When teaching about thiazide diuretics for hypertension, which
statement by the client indicates Correct understanding?
Correct Answer: "They help lower my blood pressure by promoting
sodium and water loss."
Rationale: Thiazide diuretics inhibit sodium, chloride, and water
reabsorption, lowering BP. They do not block beta receptors (that's beta
blockers). Potassium monitoring is necessary (they can cause hypokalemia).
BP monitoring is required .
10. What is cardiac output?
Correct Answer: The volume of blood pumped by the heart in one minute
Rationale: Cardiac output (CO) is the total volume of blood ejected by the
heart per minute. It is calculated as Heart Rate × Stroke Volume. Normal
adult CO is about 4–8 L/min .
11. Which of the following symptoms in women may be a sign of
myocardial ischemia and should be thoroughly evaluated?
Exam 4: Practice Questions with
Answers & Rationales (2026/2027)
1. A client with heart failure has crackles in all lung fields, jugular
venous distention, and 3+ pitting edema. Which medication should
the nurse expect to administer first?
Correct Answer: Furosemide
Rationale: Furosemide is a loop diuretic that reduces preload by
promoting diuresis, relieving pulmonary congestion and edema. It is first-
line for acute decompensated heart failure with fluid overload .
2. A client with atrial fibrillation is prescribed warfarin. Which
laboratory test should the nurse monitor to evaluate therapeutic
effect?
Correct Answer: INR
Rationale: Warfarin anticoagulation is monitored by INR. The therapeutic
target INR for atrial fibrillation is 2–3 (2.5–3.5 for mechanical valves). aPTT is
used to monitor heparin therapy .
3. A nurse is caring for a patient with heart failure who has gained 2 kg
(4.4 lbs) in 24 hours. Which action should the nurse take first?
Correct Answer: Assess lung sounds and oxygen saturation
Rationale: The nurse must first assess the patient's respiratory status (lung
sounds, SpO2) to detect pulmonary edema. Assessment always precedes
intervention. Elevating HOB helps breathing but assessment comes first .
,4. A client with heart failure is prescribed furosemide and
spironolactone. Which assessment finding requires the nurse to
contact the provider before administering spironolactone?
Correct Answer: Potassium 5.4 mEq/L
Rationale: Spironolactone is potassium-sparing and can increase
potassium levels. An elevated potassium level (5.4 mEq/L) is a concern for
hyperkalemia. Sodium 138, pulse 76, and mild pedal edema are not
contraindications .
5. The nurse assesses a client with left-sided heart failure. Which
symptom is most consistent with this condition?
Correct Answer: Dyspnea and crackles in both lung bases
Rationale: Left-sided heart failure primarily causes pulmonary
congestion—shortness of breath, dyspnea, crackles, restlessness, and
decreased activity tolerance. Jugular vein distention and ascites are
associated with right-sided heart failure .
6. Which lab value would the nurse expect to be elevated in a client
with decompensated heart failure?
Correct Answer: BNP
Rationale: BNP (B-type natriuretic peptide) is elevated in response to
ventricular stretch in heart failure. Amylase is linked to pancreatic issues;
calcium and platelets are not primary HF diagnostic markers .
7. A client with heart failure develops acute pulmonary edema,
suddenly complaining of severe dyspnea and producing pink frothy
sputum. Which action should the nurse take first?
Correct Answer: Place the client in high Fowler's position and apply
oxygen
, Rationale: Pulmonary edema is an emergency. High Fowler's position
improves ventilation, and oxygen should be applied immediately. Extra
fluids worsen pulmonary congestion; supine position impairs breathing;
urine collection is not a priority in an emergency .
8. A client presents with BP 196/124 mm Hg, severe headache, blurred
vision, and chest pain. Which nursing action is priority?
Correct Answer: Administer ordered IV antihypertensive medication and
monitor BP frequently
Rationale: This is hypertensive crisis (≥180/120) with symptoms. IV
antihypertensive medication (e.g., nicardipine, nitroglycerin, labetalol) is
indicated, with BP monitoring every 15–30 minutes. BP should be lowered
slowly to avoid cerebral ischemia. Trendelenburg is contraindicated;
ambulation is unsafe .
9. When teaching about thiazide diuretics for hypertension, which
statement by the client indicates Correct understanding?
Correct Answer: "They help lower my blood pressure by promoting
sodium and water loss."
Rationale: Thiazide diuretics inhibit sodium, chloride, and water
reabsorption, lowering BP. They do not block beta receptors (that's beta
blockers). Potassium monitoring is necessary (they can cause hypokalemia).
BP monitoring is required .
10. What is cardiac output?
Correct Answer: The volume of blood pumped by the heart in one minute
Rationale: Cardiac output (CO) is the total volume of blood ejected by the
heart per minute. It is calculated as Heart Rate × Stroke Volume. Normal
adult CO is about 4–8 L/min .
11. Which of the following symptoms in women may be a sign of
myocardial ischemia and should be thoroughly evaluated?
