NUR209 / NUR 209 Medical-Surgical Nursing II – Fortis
Actual Exam 2026/2027 | Complete Exam-Style Questions
with Detailed Rationales | 100% Verified – Pass
Guaranteed – A+ Graded
Cardiovascular and Respiratory Management
Q1: A patient with a history of heart failure is admitted with worsening shortness of breath.
Which assessment finding is the most reliable early indicator of worsening left-sided heart
failure?
A. Bilateral pitting edema in the lower extremities
B. Jugular venous distention when sitting upright
C. Crackles heard in the lung bases upon auscultation [CORRECT]
D. Unexplained weight gain of 1 pound over three days
Correct Answer: C
Rationale: This choice is correct because crackles in the lung bases indicate pulmonary
congestion, which is a hallmark early sign of left-sided heart failure. This aligns with the
principle that left ventricular dysfunction primarily backs up fluid into the pulmonary
circulation.
Q2: A patient on the telemetry unit suddenly develops atrial fibrillation with a rapid
ventricular response of 150 bpm. The patient is conscious but reports mild chest
palpitations. What is the nurse’s priority action?
A. Prepare for immediate synchronized cardioversion.
B. Administer the prescribed IV diltiazem to control the heart rate. [CORRECT]
C. Instruct the patient to perform the Valsalva maneuver.
D. Obtain a 12-lead ECG before taking any other action.
Correct Answer: B
Rationale: The best answer is to administer the prescribed rate-control medication, as the
patient is stable but symptomatic. This matches the principle that pharmacological rate
control is the first-line intervention for stable atrial fibrillation with rapid ventricular
response.
Q3: A patient newly prescribed lisinopril for hypertension calls the clinic complaining of a
persistent, dry, hacking cough. What is the most appropriate nursing response?
A. "This is a common side effect; let me notify your provider to discuss changing your
medication." [CORRECT]
B. "You should stop taking the medication immediately and come to the emergency
department."
C. "Try taking the medication with food to see if the cough improves."
D. "This means you are having an allergic reaction, so we will switch you to a diuretic."
Correct Answer: A
, Rationale: This choice is correct because a dry, nonproductive cough is a well-known, non-
allergic side effect of ACE inhibitors that often requires a medication change. This aligns with
the principle of validating the patient's symptom while initiating appropriate provider
collaboration.
Q4: A patient with severe COPD is admitted with an exacerbation. The nurse notes the
patient's oxygen saturation is 89% on room air. Which action is most appropriate?
A. Apply a non-rebreather mask at 15 L/min to quickly raise the saturation.
B. Administer low-flow oxygen via nasal cannula to maintain SpO2 between 88% and 92%.
[CORRECT]
C. Withhold oxygen therapy to stimulate the patient's hypoxic drive.
D. Prepare the patient for immediate endotracheal intubation.
Correct Answer: B
Rationale: This choice is correct because patients with severe COPD often rely on a hypoxic
drive to breathe, and excessive oxygen can suppress their respiratory effort. This matches
the principle of targeting a safe, lower oxygen saturation range to prevent hypercapnia in
this specific population.
Q5: A patient admitted for pneumonia suddenly becomes confused and agitated, with an
oxygen saturation dropping to 85% despite being on 2 L/min of oxygen. What should the
nurse do first?
A. Administer the prescribed PRN lorazepam for agitation.
B. Increase the oxygen flow rate and elevate the head of the bed. [CORRECT]
C. Restrain the patient to prevent them from pulling out the IV line.
D. Obtain a stat arterial blood gas before making any changes.
Correct Answer: B
Rationale: The best answer is to address the hypoxia immediately by increasing oxygen and
optimizing lung expansion, as the confusion is likely a direct result of low oxygen levels. This
aligns with the principle of treating the underlying physiological cause of an acute change in
mental status before addressing the behavior.
Q6: A patient has a chest tube connected to a closed drainage system. The nurse observes
continuous, vigorous bubbling in the water seal chamber. How should the nurse interpret
this finding?
A. The system is functioning normally and actively removing air.
B. The patient is experiencing a re-expansion pulmonary edema.
C. There is an air leak in the system or the patient's pleural space. [CORRECT]
D. The suction control chamber is set too high.
Correct Answer: C
Rationale: This choice is correct because continuous bubbling in the water seal chamber,
rather than intermittent bubbling with coughing or exhalation, indicates an ongoing air leak.
This matches the principle that the water seal chamber should only show tidaling or
intermittent bubbles, not continuous ones.
Q7: A patient is being evaluated for right-sided heart failure. Which cluster of assessment
findings should the nurse expect to document?
A. Orthopnea, paroxysmal nocturnal dyspnea, and pulmonary crackles
Actual Exam 2026/2027 | Complete Exam-Style Questions
with Detailed Rationales | 100% Verified – Pass
Guaranteed – A+ Graded
Cardiovascular and Respiratory Management
Q1: A patient with a history of heart failure is admitted with worsening shortness of breath.
Which assessment finding is the most reliable early indicator of worsening left-sided heart
failure?
A. Bilateral pitting edema in the lower extremities
B. Jugular venous distention when sitting upright
C. Crackles heard in the lung bases upon auscultation [CORRECT]
D. Unexplained weight gain of 1 pound over three days
Correct Answer: C
Rationale: This choice is correct because crackles in the lung bases indicate pulmonary
congestion, which is a hallmark early sign of left-sided heart failure. This aligns with the
principle that left ventricular dysfunction primarily backs up fluid into the pulmonary
circulation.
Q2: A patient on the telemetry unit suddenly develops atrial fibrillation with a rapid
ventricular response of 150 bpm. The patient is conscious but reports mild chest
palpitations. What is the nurse’s priority action?
A. Prepare for immediate synchronized cardioversion.
B. Administer the prescribed IV diltiazem to control the heart rate. [CORRECT]
C. Instruct the patient to perform the Valsalva maneuver.
D. Obtain a 12-lead ECG before taking any other action.
Correct Answer: B
Rationale: The best answer is to administer the prescribed rate-control medication, as the
patient is stable but symptomatic. This matches the principle that pharmacological rate
control is the first-line intervention for stable atrial fibrillation with rapid ventricular
response.
Q3: A patient newly prescribed lisinopril for hypertension calls the clinic complaining of a
persistent, dry, hacking cough. What is the most appropriate nursing response?
A. "This is a common side effect; let me notify your provider to discuss changing your
medication." [CORRECT]
B. "You should stop taking the medication immediately and come to the emergency
department."
C. "Try taking the medication with food to see if the cough improves."
D. "This means you are having an allergic reaction, so we will switch you to a diuretic."
Correct Answer: A
, Rationale: This choice is correct because a dry, nonproductive cough is a well-known, non-
allergic side effect of ACE inhibitors that often requires a medication change. This aligns with
the principle of validating the patient's symptom while initiating appropriate provider
collaboration.
Q4: A patient with severe COPD is admitted with an exacerbation. The nurse notes the
patient's oxygen saturation is 89% on room air. Which action is most appropriate?
A. Apply a non-rebreather mask at 15 L/min to quickly raise the saturation.
B. Administer low-flow oxygen via nasal cannula to maintain SpO2 between 88% and 92%.
[CORRECT]
C. Withhold oxygen therapy to stimulate the patient's hypoxic drive.
D. Prepare the patient for immediate endotracheal intubation.
Correct Answer: B
Rationale: This choice is correct because patients with severe COPD often rely on a hypoxic
drive to breathe, and excessive oxygen can suppress their respiratory effort. This matches
the principle of targeting a safe, lower oxygen saturation range to prevent hypercapnia in
this specific population.
Q5: A patient admitted for pneumonia suddenly becomes confused and agitated, with an
oxygen saturation dropping to 85% despite being on 2 L/min of oxygen. What should the
nurse do first?
A. Administer the prescribed PRN lorazepam for agitation.
B. Increase the oxygen flow rate and elevate the head of the bed. [CORRECT]
C. Restrain the patient to prevent them from pulling out the IV line.
D. Obtain a stat arterial blood gas before making any changes.
Correct Answer: B
Rationale: The best answer is to address the hypoxia immediately by increasing oxygen and
optimizing lung expansion, as the confusion is likely a direct result of low oxygen levels. This
aligns with the principle of treating the underlying physiological cause of an acute change in
mental status before addressing the behavior.
Q6: A patient has a chest tube connected to a closed drainage system. The nurse observes
continuous, vigorous bubbling in the water seal chamber. How should the nurse interpret
this finding?
A. The system is functioning normally and actively removing air.
B. The patient is experiencing a re-expansion pulmonary edema.
C. There is an air leak in the system or the patient's pleural space. [CORRECT]
D. The suction control chamber is set too high.
Correct Answer: C
Rationale: This choice is correct because continuous bubbling in the water seal chamber,
rather than intermittent bubbling with coughing or exhalation, indicates an ongoing air leak.
This matches the principle that the water seal chamber should only show tidaling or
intermittent bubbles, not continuous ones.
Q7: A patient is being evaluated for right-sided heart failure. Which cluster of assessment
findings should the nurse expect to document?
A. Orthopnea, paroxysmal nocturnal dyspnea, and pulmonary crackles
