NRSG 110 Exam 1 V3 | NRSG 110 Medical Surgical
Nursing II | Actual Q&A with Rationale (NRSG110
Exam 1) | Ivy Tech
1. A nurse is assessing a patient with suspected left-sided heart failure. Which clinical
manifestation should the nurse expect to find?
A. Dyspnea and crackles
B. Jugular venous distention
C. Hepatosplenomegaly
D. Peripheral edema
Correct Answer: A
Explanation: Left-sided heart failure results in pulmonary congestion because the left
ventricle cannot effectively pump blood into the systemic circulation. This leads to
symptoms such as dyspnea, orthopnea, and crackles during lung auscultation. The other
options listed are characteristic of right-sided heart failure where blood backs up into the
systemic venous system.
2. A client is being treated for heart failure and is prescribed Digoxin. Which of the following
findings should the nurse identify as an early sign of Digoxin toxicity?
A. Sudden increase in energy
B. Blurred yellow vision
,C. Anorexia and nausea
D. Tachycardia
Correct Answer: C
Explanation: Gastrointestinal symptoms such as anorexia, nausea, and vomiting are
typically the earliest signs of Digoxin toxicity. Visual disturbances, such as yellow-green
halos, usually occur later as toxicity progresses. The nurse must monitor serum digoxin
levels and electrolyte balances, particularly potassium, as hypokalemia increases the risk of
toxicity.
3. The nurse is providing discharge teaching to a client diagnosed with Peripheral Arterial
Disease (PAD). Which of the following instructions should be included in the plan of care?
A. Elevate the legs above the level of the heart when resting.
B. Apply a heating pad to the feet to improve circulation.
C. Dangle the legs off the side of the bed to relieve pain.
D. Use compression stockings throughout the day.
E. Perform vigorous aerobic exercise for 60 minutes daily.
Correct Answer: C
Explanation: In PAD, blood flow to the lower extremities is compromised, so dangling the
legs helps gravity assist arterial blood flow to the tissues. Elevating the legs would further
, decrease the blood supply and increase pain. Patients should avoid direct heat and
vigorous exercise that might cause injury to poorly perfused tissues.
4. A client with a history of hypertension is prescribed a new medication, Propranolol. Which
of the following conditions in the client’s history should the nurse report to the provider
immediately?
A. Migraine headaches
B. Tachycardia
C. Asthma
D. Glaucoma
Correct Answer: C
Explanation: Propranolol is a non-selective beta-blocker that can cause
bronchoconstriction by blocking beta-2 receptors in the lungs. This makes it
contraindicated or highly risky for patients with asthma or COPD. The nurse must assess
the client’s respiratory history before administering this class of medication.
5. A nurse is reviewing the laboratory results for a client with Iron Deficiency Anemia. Which
finding is consistent with this diagnosis?
A. Elevated hemoglobin
B. Decreased ferritin levels
C. Increased mean corpuscular volume (MCV)
Nursing II | Actual Q&A with Rationale (NRSG110
Exam 1) | Ivy Tech
1. A nurse is assessing a patient with suspected left-sided heart failure. Which clinical
manifestation should the nurse expect to find?
A. Dyspnea and crackles
B. Jugular venous distention
C. Hepatosplenomegaly
D. Peripheral edema
Correct Answer: A
Explanation: Left-sided heart failure results in pulmonary congestion because the left
ventricle cannot effectively pump blood into the systemic circulation. This leads to
symptoms such as dyspnea, orthopnea, and crackles during lung auscultation. The other
options listed are characteristic of right-sided heart failure where blood backs up into the
systemic venous system.
2. A client is being treated for heart failure and is prescribed Digoxin. Which of the following
findings should the nurse identify as an early sign of Digoxin toxicity?
A. Sudden increase in energy
B. Blurred yellow vision
,C. Anorexia and nausea
D. Tachycardia
Correct Answer: C
Explanation: Gastrointestinal symptoms such as anorexia, nausea, and vomiting are
typically the earliest signs of Digoxin toxicity. Visual disturbances, such as yellow-green
halos, usually occur later as toxicity progresses. The nurse must monitor serum digoxin
levels and electrolyte balances, particularly potassium, as hypokalemia increases the risk of
toxicity.
3. The nurse is providing discharge teaching to a client diagnosed with Peripheral Arterial
Disease (PAD). Which of the following instructions should be included in the plan of care?
A. Elevate the legs above the level of the heart when resting.
B. Apply a heating pad to the feet to improve circulation.
C. Dangle the legs off the side of the bed to relieve pain.
D. Use compression stockings throughout the day.
E. Perform vigorous aerobic exercise for 60 minutes daily.
Correct Answer: C
Explanation: In PAD, blood flow to the lower extremities is compromised, so dangling the
legs helps gravity assist arterial blood flow to the tissues. Elevating the legs would further
, decrease the blood supply and increase pain. Patients should avoid direct heat and
vigorous exercise that might cause injury to poorly perfused tissues.
4. A client with a history of hypertension is prescribed a new medication, Propranolol. Which
of the following conditions in the client’s history should the nurse report to the provider
immediately?
A. Migraine headaches
B. Tachycardia
C. Asthma
D. Glaucoma
Correct Answer: C
Explanation: Propranolol is a non-selective beta-blocker that can cause
bronchoconstriction by blocking beta-2 receptors in the lungs. This makes it
contraindicated or highly risky for patients with asthma or COPD. The nurse must assess
the client’s respiratory history before administering this class of medication.
5. A nurse is reviewing the laboratory results for a client with Iron Deficiency Anemia. Which
finding is consistent with this diagnosis?
A. Elevated hemoglobin
B. Decreased ferritin levels
C. Increased mean corpuscular volume (MCV)
