,NUR209Medical-Surgical Nursing II Final Exam
Study Guide & 150 Practice Questions Fortis
College 2026/2027
1. A 68-year-old client with a history of hypertension is admitted with acute decompensated
heart failure. The nurse notes jugular venous distention, bilateral crackles, and an S3 gallop.
Which nursing action has the highest priority during the first hour of care?
A. Administer prescribed intravenous loop diuretic and reassess respiratory status
B. Encourage ambulation to the bathroom to promote venous return
C. Restrict all oral fluids until a pulmonary artery catheter is placed
D. Place the client in Trendelenburg position to improve cardiac output
Correct Answer: A. Administer prescribed intravenous loop diuretic and reassess respiratory
status
Rationale: Acute volume overload requires prompt diuresis to reduce preload and improve gas
exchange. Ambulation increases cardiac demand; Trendelenburg worsens pulmonary
congestion; invasive monitoring is not the immediate priority when clinical signs of fluid
overload are clear.
,2. A client arrives in the emergency department with crushing substernal chest pain radiating to
the left arm. The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. The nurse
anticipates that reperfusion therapy will target which coronary artery territory?
A. Left anterior descending artery supplying the anterior wall
B. Circumflex artery supplying the lateral wall
C. Right coronary artery supplying the inferior wall
D. Left main coronary artery supplying the entire left ventricle
Correct Answer: C. Right coronary artery supplying the inferior wall
Rationale: ST elevation in II, III, and aVF indicates an inferior-wall STEMI, most often caused by
occlusion of the right coronary artery. Anterior changes involve V1–V4 (LAD); lateral changes
involve I, aVL, V5–V6 (circumflex).
3. A client with atrial fibrillation is started on warfarin. The nurse provides discharge teaching
about dietary consistency. Which statement by the client indicates correct understanding?
A. "I will eliminate all green leafy vegetables from my diet permanently."
B. "I can eat spinach every day as long as the amount stays about the same each week."
C. "I should take a double dose of warfarin on days I eat salad."
, D. "Vitamin K supplements will help my warfarin work better."
Correct Answer: B. "I can eat spinach every day as long as the amount stays about the same
each week."
Rationale: Consistency in vitamin K intake is the key teaching point; abrupt large changes alter
INR. Complete elimination is unnecessary and nutritionally undesirable. Doubling the dose or
adding vitamin K can cause dangerous INR fluctuations.
4. A post-operative client develops sudden dyspnea, tachycardia, and a feeling of impending
doom two days after total hip arthroplasty. The nurse suspects pulmonary embolism. Which
assessment finding would most strongly support this suspicion?
A. Unilateral leg swelling with a positive Homans sign only
B. Pleural friction rub heard at the bases bilaterally
C. Gradual onset of productive cough with yellow sputum
D. Acute onset hypoxemia with clear lung fields on auscultation
Correct Answer: D. Acute onset hypoxemia with clear lung fields on auscultation
Study Guide & 150 Practice Questions Fortis
College 2026/2027
1. A 68-year-old client with a history of hypertension is admitted with acute decompensated
heart failure. The nurse notes jugular venous distention, bilateral crackles, and an S3 gallop.
Which nursing action has the highest priority during the first hour of care?
A. Administer prescribed intravenous loop diuretic and reassess respiratory status
B. Encourage ambulation to the bathroom to promote venous return
C. Restrict all oral fluids until a pulmonary artery catheter is placed
D. Place the client in Trendelenburg position to improve cardiac output
Correct Answer: A. Administer prescribed intravenous loop diuretic and reassess respiratory
status
Rationale: Acute volume overload requires prompt diuresis to reduce preload and improve gas
exchange. Ambulation increases cardiac demand; Trendelenburg worsens pulmonary
congestion; invasive monitoring is not the immediate priority when clinical signs of fluid
overload are clear.
,2. A client arrives in the emergency department with crushing substernal chest pain radiating to
the left arm. The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. The nurse
anticipates that reperfusion therapy will target which coronary artery territory?
A. Left anterior descending artery supplying the anterior wall
B. Circumflex artery supplying the lateral wall
C. Right coronary artery supplying the inferior wall
D. Left main coronary artery supplying the entire left ventricle
Correct Answer: C. Right coronary artery supplying the inferior wall
Rationale: ST elevation in II, III, and aVF indicates an inferior-wall STEMI, most often caused by
occlusion of the right coronary artery. Anterior changes involve V1–V4 (LAD); lateral changes
involve I, aVL, V5–V6 (circumflex).
3. A client with atrial fibrillation is started on warfarin. The nurse provides discharge teaching
about dietary consistency. Which statement by the client indicates correct understanding?
A. "I will eliminate all green leafy vegetables from my diet permanently."
B. "I can eat spinach every day as long as the amount stays about the same each week."
C. "I should take a double dose of warfarin on days I eat salad."
, D. "Vitamin K supplements will help my warfarin work better."
Correct Answer: B. "I can eat spinach every day as long as the amount stays about the same
each week."
Rationale: Consistency in vitamin K intake is the key teaching point; abrupt large changes alter
INR. Complete elimination is unnecessary and nutritionally undesirable. Doubling the dose or
adding vitamin K can cause dangerous INR fluctuations.
4. A post-operative client develops sudden dyspnea, tachycardia, and a feeling of impending
doom two days after total hip arthroplasty. The nurse suspects pulmonary embolism. Which
assessment finding would most strongly support this suspicion?
A. Unilateral leg swelling with a positive Homans sign only
B. Pleural friction rub heard at the bases bilaterally
C. Gradual onset of productive cough with yellow sputum
D. Acute onset hypoxemia with clear lung fields on auscultation
Correct Answer: D. Acute onset hypoxemia with clear lung fields on auscultation
