,NUR 201 Exam 2 Medical-Surgical Nursing I Questions And Answers
2026/2027 Jersey College
Q1. A patient has jugular venous distention while sitting at a 45-
degree angle. Which condition should the nurse consider most
strongly?
A) Reduced right atrial pressure
B) Severe dehydration
C) Elevated right-sided cardiac filling pressure
D) Decreased systemic venous volume
Correct Answer: C) Elevated right-sided cardiac filling pressure
Rationale: Jugular venous distention reflects increased central venous
pressure and can occur with right-sided heart failure, fluid overload, or other
conditions that increase right atrial pressure.
Q2. Which finding most strongly suggests reduced peripheral
perfusion during a cardiovascular assessment?
A) Warm extremities with brisk capillary refill
B) Capillary refill greater than 2 seconds with cool extremities
C) Bilateral 2+ peripheral pulses
D) Pink nail beds
Correct Answer: B) Capillary refill greater than 2 seconds with cool
extremities
Rationale: Delayed capillary refill and cool skin suggest inadequate
peripheral blood flow and can occur when cardiac output or arterial perfusion
is reduced.
Q3. Where is the normal point of maximal impulse typically located
in an adult?
A) Fifth left intercostal space near the midclavicular line
B) Second right intercostal space at the sternal border
C) Fourth right intercostal space at the midaxillary line
D) Sixth left intercostal space at the posterior axillary line
Correct Answer: A) Fifth left intercostal space near the midclavicular line
Rationale: The normal apical impulse is generally palpated at the fifth left
intercostal space along or near the midclavicular line.
,Q4. A patient's point of maximal impulse is displaced laterally from
its expected location. What does this finding most strongly suggest?
A) Reduced ventricular workload
B) Normal cardiac anatomy in every adult
C) Decreased left ventricular size
D) Cardiac enlargement, particularly left ventricular enlargement
Correct Answer: D) Cardiac enlargement, particularly left ventricular
enlargement
Rationale: Enlargement of the left ventricle can shift the apical impulse
laterally and sometimes downward from its normal position.
Q5. A palpable vibration is felt over the precordium while the nurse
auscultates a loud murmur. How should the palpable finding be
documented?
A) Heave
B) S3 gallop
C) Thrill
D) Friction rub
Correct Answer: C) Thrill
Rationale: A thrill is a palpable vibration produced by turbulent blood flow
and is often associated with a loud cardiac murmur.
Q6. An S3 heart sound in an older adult with dyspnea and edema
most strongly supports which interpretation?
A) Normal closure of the semilunar valves
B) Normal age-related finding without significance
C) Decreased ventricular filling
D) Ventricular volume overload or heart failure
Correct Answer: D) Ventricular volume overload or heart failure
Rationale: An S3 results from rapid ventricular filling and, in an older adult,
commonly indicates ventricular volume overload or impaired ventricular
function.
Q7. What does an S4 heart sound most commonly indicate?
A) Excessively compliant ventricle
B) Complete absence of atrial contraction
, C) A stiff, noncompliant ventricle
D) Normal ventricular emptying
Correct Answer: C) A stiff, noncompliant ventricle
Rationale: S4 occurs when atrial contraction forces blood into a stiff
ventricle and is associated with conditions such as longstanding
hypertension or ventricular hypertrophy.
Q8. A scratching, grating sound is heard over the precordium and
changes with patient position. Which finding is most likely?
A) Normal S2
B) Ventricular gallop
C) Pericardial friction rub
D) Carotid bruit
Correct Answer: C) Pericardial friction rub
Rationale: Inflamed pericardial surfaces can rub against one another and
produce a characteristic scratching or grating sound.
Q9. Which laboratory test is most specific for myocardial injury in a
patient with suspected acute myocardial infarction?
A) Cardiac troponin
B) Serum sodium
C) Hemoglobin A1C
D) Serum amylase
Correct Answer: A) Cardiac troponin
Rationale: Cardiac troponins are highly sensitive and specific biomarkers of
myocardial injury and are central to the evaluation of suspected acute
myocardial infarction.
Q10. B-type natriuretic peptide is elevated in many patients with
heart failure because it is released in response to what physiologic
change?
A) Reduced hepatic blood flow
B) Decreased atrial electrical activity
C) Increased ventricular wall stretch and pressure
D) Reduced platelet production
Correct Answer: C) Increased ventricular wall stretch and pressure
2026/2027 Jersey College
Q1. A patient has jugular venous distention while sitting at a 45-
degree angle. Which condition should the nurse consider most
strongly?
A) Reduced right atrial pressure
B) Severe dehydration
C) Elevated right-sided cardiac filling pressure
D) Decreased systemic venous volume
Correct Answer: C) Elevated right-sided cardiac filling pressure
Rationale: Jugular venous distention reflects increased central venous
pressure and can occur with right-sided heart failure, fluid overload, or other
conditions that increase right atrial pressure.
Q2. Which finding most strongly suggests reduced peripheral
perfusion during a cardiovascular assessment?
A) Warm extremities with brisk capillary refill
B) Capillary refill greater than 2 seconds with cool extremities
C) Bilateral 2+ peripheral pulses
D) Pink nail beds
Correct Answer: B) Capillary refill greater than 2 seconds with cool
extremities
Rationale: Delayed capillary refill and cool skin suggest inadequate
peripheral blood flow and can occur when cardiac output or arterial perfusion
is reduced.
Q3. Where is the normal point of maximal impulse typically located
in an adult?
A) Fifth left intercostal space near the midclavicular line
B) Second right intercostal space at the sternal border
C) Fourth right intercostal space at the midaxillary line
D) Sixth left intercostal space at the posterior axillary line
Correct Answer: A) Fifth left intercostal space near the midclavicular line
Rationale: The normal apical impulse is generally palpated at the fifth left
intercostal space along or near the midclavicular line.
,Q4. A patient's point of maximal impulse is displaced laterally from
its expected location. What does this finding most strongly suggest?
A) Reduced ventricular workload
B) Normal cardiac anatomy in every adult
C) Decreased left ventricular size
D) Cardiac enlargement, particularly left ventricular enlargement
Correct Answer: D) Cardiac enlargement, particularly left ventricular
enlargement
Rationale: Enlargement of the left ventricle can shift the apical impulse
laterally and sometimes downward from its normal position.
Q5. A palpable vibration is felt over the precordium while the nurse
auscultates a loud murmur. How should the palpable finding be
documented?
A) Heave
B) S3 gallop
C) Thrill
D) Friction rub
Correct Answer: C) Thrill
Rationale: A thrill is a palpable vibration produced by turbulent blood flow
and is often associated with a loud cardiac murmur.
Q6. An S3 heart sound in an older adult with dyspnea and edema
most strongly supports which interpretation?
A) Normal closure of the semilunar valves
B) Normal age-related finding without significance
C) Decreased ventricular filling
D) Ventricular volume overload or heart failure
Correct Answer: D) Ventricular volume overload or heart failure
Rationale: An S3 results from rapid ventricular filling and, in an older adult,
commonly indicates ventricular volume overload or impaired ventricular
function.
Q7. What does an S4 heart sound most commonly indicate?
A) Excessively compliant ventricle
B) Complete absence of atrial contraction
, C) A stiff, noncompliant ventricle
D) Normal ventricular emptying
Correct Answer: C) A stiff, noncompliant ventricle
Rationale: S4 occurs when atrial contraction forces blood into a stiff
ventricle and is associated with conditions such as longstanding
hypertension or ventricular hypertrophy.
Q8. A scratching, grating sound is heard over the precordium and
changes with patient position. Which finding is most likely?
A) Normal S2
B) Ventricular gallop
C) Pericardial friction rub
D) Carotid bruit
Correct Answer: C) Pericardial friction rub
Rationale: Inflamed pericardial surfaces can rub against one another and
produce a characteristic scratching or grating sound.
Q9. Which laboratory test is most specific for myocardial injury in a
patient with suspected acute myocardial infarction?
A) Cardiac troponin
B) Serum sodium
C) Hemoglobin A1C
D) Serum amylase
Correct Answer: A) Cardiac troponin
Rationale: Cardiac troponins are highly sensitive and specific biomarkers of
myocardial injury and are central to the evaluation of suspected acute
myocardial infarction.
Q10. B-type natriuretic peptide is elevated in many patients with
heart failure because it is released in response to what physiologic
change?
A) Reduced hepatic blood flow
B) Decreased atrial electrical activity
C) Increased ventricular wall stretch and pressure
D) Reduced platelet production
Correct Answer: C) Increased ventricular wall stretch and pressure
