NSG 252 Exam 1 Advanced Medical-Surgical Nursing II / Nursing Concepts Study Guide & Question Bank 2026/2027 PDF – Complete Exam Prep with Verified Answers & Rationales | Instant Download

NSG 252 Exam 1 Advanced Medical-Surgical
Nursing II / Nursing Concepts
Complete Study Guide & Question Bank
2026/2027

SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-40)
Question 1
A patient with heart failure is prescribed digoxin. Which assessment finding
indicates potential digoxin toxicity?
A) Heart rate of 72 bpm
B) Serum potassium of 4.0 mEq/L
C) Yellow-green halos around lights
D) Blood pressure of 130/80 mmHg
Answer: C) Yellow-green halos around lights
Rationale: Visual disturbances, particularly yellow-green halos around lights, are
classic signs of digoxin toxicity. Other signs include nausea, vomiting, anorexia,
and cardiac dysrhythmias. Normal heart rate (72 bpm), normal potassium (4.0
mEq/L), and normal blood pressure (130/80 mmHg) do not indicate toxicity. The
therapeutic range for digoxin is 0.8-2.0 ng/mL, and levels above 2.0 ng/mL
increase toxicity risk.


Question 2
A patient with acute decompensated heart failure presents with pulmonary edema.
Which medication should the nurse anticipate administering first?
A) Digoxin
B) Furosemide

,C) Spironolactone
D) Metoprolol
Answer: B) Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload and
pulmonary congestion in acute heart failure. It is the first-line medication for
pulmonary edema. Digoxin is used for chronic management, spironolactone is a
potassium-sparing diuretic used in chronic HF, and metoprolol is a beta-blocker
used for long-term management but should not be started in acute decompensation.


Question 3
A patient with heart failure has an ejection fraction of 35%. The nurse understands
this indicates:
A) Normal cardiac function
B) Heart failure with preserved ejection fraction (HFpEF)
C) Heart failure with reduced ejection fraction (HFrEF)
D) Hypertrophic cardiomyopathy
Answer: C) Heart failure with reduced ejection fraction (HFrEF)
Rationale: An ejection fraction of 35% indicates HFrEF (less than 40%). Normal
EF is 55-70%. HFpEF is characterized by EF greater than 50%. Hypertrophic
cardiomyopathy typically presents with EF greater than 50% but with diastolic
dysfunction.


Question 4
Which dietary instruction is most important for a patient with heart failure?
A) "Increase your daily fluid intake to 3 liters"
B) "Limit your sodium intake to 2 grams per day"
C) "Eat a high-fat diet to maintain energy"
D) "Avoid all carbohydrates"
Answer: B) "Limit your sodium intake to 2 grams per day"

,Rationale: Sodium restriction (typically 2g/day or less) is crucial in heart failure
management to prevent fluid retention. Increased fluid intake would worsen fluid
overload, high-fat diets are not recommended, and carbohydrate avoidance is not
standard therapy for HF unless other comorbidities exist.


Question 5
The nurse is assessing a patient with pericarditis. Which finding is most
characteristic of this condition?
A) Murmur that increases with squatting
B) Pericardial friction rub
C) Jugular venous distention
D) Hepatomegaly
Answer: B) Pericardial friction rub
Rationale: A pericardial friction rub is the hallmark sign of pericarditis, caused by
inflamed pericardial layers rubbing together. Murmurs that increase with squatting
are associated with hypertrophic cardiomyopathy. JVD and hepatomegaly indicate
right-sided heart failure.


Question 6
A patient with infective endocarditis is receiving IV antibiotics. Which assessment
finding requires immediate intervention?
A) Temperature of 99.8°F (37.7°C)
B) Heart rate of 88 bpm
C) Petechiae on the conjunctiva
D) Sudden onset of severe left-sided weakness
Answer: D) Sudden onset of severe left-sided weakness
Rationale: Sudden onset of severe left-sided weakness suggests an embolic stroke,
a complication of infective endocarditis. This requires immediate intervention.
Low-grade fever, heart rate of 88 bpm, and petechiae are all expected findings in
endocarditis but do not require emergent intervention.

, Question 7 k




A patient is diagnosed with aortic stenosis. The nurse understands that the most
k k k k k k k k k k k k




common cause in older adults is:
k k k k k k




A) Rheumatic fever k




B) Congenital bicuspid valve k k




C) Calcific degeneration k




D) Infective endocarditis k




Answer: C) Calcific degeneration
k k k




Rationale: Calcific degeneration is the most common cause of aortic stenosis in
k k k k k k k k k k k




older adults. Rheumatic fever is more common in younger patients. Congenital
k k k k k k k k k k k




bicuspid valve is a common cause in patients under age 65. Infective endocarditis can
k k k k k k k k k k k k k k




cause valve damage but is not the most common cause.
k k k k k k k k k k




Question 8 k




Which assessment finding is consistent with right-sided heart failure?
k k k k k k k k




A) Pulmonary crackles k




B) Orthopnea
C) Peripheral edema k




D) Paroxysmal nocturnal dyspnea k k




Answer: C) Peripheral edema
k k k




Rationale: Peripheral edema is a classic sign of right-sided heart failure due to
k k k k k k k k k k k k




systemic venous congestion. Pulmonary crackles, orthopnea, and PND are signs of
k k k k k k k k k k k




left-sided heart failure.
k k k




Question 9 k




A patient with unstable angina is prescribed nitroglycerin sublingually. What is the
k k k k k k k k k k k




mechanism of action of this medication?
k k k k k k




A) Increases cardiac contractility k k