Medical-Surgical Nursing II Final Exam
— Complete Test Bank Review
(2026/2027).
Q1. A client with heart failure with reduced ejection fraction (HFrEF) has an ejection fraction of
32%. Which medication class is a cornerstone of therapy to reduce mortality in this condition?
A. Calcium channel blockers
B. Digoxin alone
C. ACE inhibitors [CORRECT]
D. Loop diuretics only
Correct Answer: C
Rationale: ACE inhibitors (or ARBs/ARNIs) reduce afterload, prevent remodeling, and decrease
mortality in HFrEF. Calcium channel blockers are generally avoided in HFrEF; digoxin is
adjunctive for rate control or symptoms; diuretics manage fluid but do not improve long-term
survival as first-line disease-modifying therapy.
Q2. The nurse teaches a client with heart failure about daily weights. Which statement indicates
correct understanding?
A. “I should weigh myself once a week after breakfast.”
B. “A weight gain of 2–3 pounds overnight is normal.”
C. “I will weigh myself every morning after voiding, using the same scale.” [CORRECT]
D. “I only need to report a weight gain of more than 10 pounds.”
Correct Answer: C
Rationale: Daily morning weights after voiding on the same scale are the most sensitive
indicator of fluid status (1 kg ≈ 1 L fluid). Weekly weights or delayed reporting miss early
decompensation.
Q3. A client’s BNP level is 850 pg/mL. The nurse interprets this finding as most consistent with:
A. Normal cardiac function
B. Mild dehydration
C. Heart failure exacerbation [CORRECT]
D. Acute myocardial infarction only
Correct Answer: C
Rationale: BNP >100 pg/mL supports heart failure; levels in the hundreds to thousands indicate
volume overload or decompensation. It is not specific for MI alone and is not elevated in simple
dehydration.
,Q4. A client with HFpEF is admitted with dyspnea. Which pathophysiology best explains HFpEF?
A. Systolic dysfunction with EF <40%
B. Impaired ventricular filling with EF ≥50% [CORRECT]
C. Primary valvular regurgitation
D. Pure right-sided failure only
Correct Answer: B
Rationale: HFpEF involves diastolic dysfunction (stiff ventricle, impaired filling) with preserved
EF (≥50%). HFrEF is systolic dysfunction with reduced EF.
Q5. A client reports sudden crushing chest pain radiating to the left arm, diaphoresis, and
nausea unrelieved by three doses of nitroglycerin. Which laboratory value is most specific for
confirming myocardial injury?
A. CK-MB only
B. Troponin I or T [CORRECT]
C. BNP
D. D-dimer
Correct Answer: B
Rationale: Cardiac troponins are the most sensitive and specific markers of myocardial necrosis.
CK-MB is less specific; BNP reflects wall stress; D-dimer is for thrombosis/PE.
Q6. Priority nursing action for a client with suspected acute coronary syndrome and ongoing
chest pain is:
A. Obtain a 12-lead ECG and administer oxygen if hypoxic [CORRECT]
B. Give a full meal to prevent hypoglycemia
C. Encourage ambulation to reduce anxiety
D. Delay all interventions until cardiac catheterization
Correct Answer: A
Rationale: Immediate ECG, vital signs, oxygen if needed, aspirin, and nitroglycerin (if
appropriate) follow ACS protocols. Ambulation or delays increase myocardial oxygen demand
and risk.
Q7. A client in atrial fibrillation with rapid ventricular response is prescribed anticoagulation.
The primary rationale is to prevent:
A. Ventricular tachycardia
B. Thromboembolism and stroke [CORRECT]
C. Bradycardia
D. Heart block
Correct Answer: B
Rationale: Atrial fibrillation allows blood stasis in the atria, promoting clot formation and
, embolization, especially to the brain. Rate control and rhythm strategies address rate/rhythm,
but anticoagulation targets stroke risk.
Q8. The nurse observes a client’s monitor showing a wide-complex tachycardia at 180 bpm and
the client is pulseless. The priority intervention is:
A. Administer adenosine
B. Synchronized cardioversion
C. Defibrillation [CORRECT]
D. Start CPR and give atropine
Correct Answer: C
Rationale: Pulseless ventricular tachycardia is treated as cardiac arrest with immediate
defibrillation and CPR. Adenosine is for stable narrow-complex SVT; synchronized cardioversion
is for unstable but pulse-present VT.
Q9. A client with hypertension is prescribed a beta-blocker. Which assessment finding requires
immediate notification of the provider?
A. Heart rate 58 bpm
B. Blood pressure 138/86 mm Hg
C. Heart rate 42 bpm with dizziness [CORRECT]
D. Mild fatigue
Correct Answer: C
Rationale: Symptomatic bradycardia indicates excessive beta-blockade and risk of inadequate
cardiac output. Asymptomatic mild bradycardia or controlled BP is expected; mild fatigue is
common.
Q10. A client develops muffled heart sounds, jugular venous distention, and hypotension after
cardiac surgery. The nurse suspects:
A. Pulmonary embolism
B. Cardiac tamponade [CORRECT]
C. Tension pneumothorax
D. Acute heart failure only
Correct Answer: B
Rationale: Beck’s triad (hypotension, JVD, muffled sounds) is classic for cardiac tamponade.
Immediate pericardiocentesis or return to surgery is required.
Q11. A client with a newly implanted permanent pacemaker should be taught to:
A. Avoid all electrical devices permanently
B. Report dizziness or prolonged hiccups [CORRECT]
C. Lift heavy objects with the affected arm immediately
D. Discontinue anticoagulation if previously prescribed
— Complete Test Bank Review
(2026/2027).
Q1. A client with heart failure with reduced ejection fraction (HFrEF) has an ejection fraction of
32%. Which medication class is a cornerstone of therapy to reduce mortality in this condition?
A. Calcium channel blockers
B. Digoxin alone
C. ACE inhibitors [CORRECT]
D. Loop diuretics only
Correct Answer: C
Rationale: ACE inhibitors (or ARBs/ARNIs) reduce afterload, prevent remodeling, and decrease
mortality in HFrEF. Calcium channel blockers are generally avoided in HFrEF; digoxin is
adjunctive for rate control or symptoms; diuretics manage fluid but do not improve long-term
survival as first-line disease-modifying therapy.
Q2. The nurse teaches a client with heart failure about daily weights. Which statement indicates
correct understanding?
A. “I should weigh myself once a week after breakfast.”
B. “A weight gain of 2–3 pounds overnight is normal.”
C. “I will weigh myself every morning after voiding, using the same scale.” [CORRECT]
D. “I only need to report a weight gain of more than 10 pounds.”
Correct Answer: C
Rationale: Daily morning weights after voiding on the same scale are the most sensitive
indicator of fluid status (1 kg ≈ 1 L fluid). Weekly weights or delayed reporting miss early
decompensation.
Q3. A client’s BNP level is 850 pg/mL. The nurse interprets this finding as most consistent with:
A. Normal cardiac function
B. Mild dehydration
C. Heart failure exacerbation [CORRECT]
D. Acute myocardial infarction only
Correct Answer: C
Rationale: BNP >100 pg/mL supports heart failure; levels in the hundreds to thousands indicate
volume overload or decompensation. It is not specific for MI alone and is not elevated in simple
dehydration.
,Q4. A client with HFpEF is admitted with dyspnea. Which pathophysiology best explains HFpEF?
A. Systolic dysfunction with EF <40%
B. Impaired ventricular filling with EF ≥50% [CORRECT]
C. Primary valvular regurgitation
D. Pure right-sided failure only
Correct Answer: B
Rationale: HFpEF involves diastolic dysfunction (stiff ventricle, impaired filling) with preserved
EF (≥50%). HFrEF is systolic dysfunction with reduced EF.
Q5. A client reports sudden crushing chest pain radiating to the left arm, diaphoresis, and
nausea unrelieved by three doses of nitroglycerin. Which laboratory value is most specific for
confirming myocardial injury?
A. CK-MB only
B. Troponin I or T [CORRECT]
C. BNP
D. D-dimer
Correct Answer: B
Rationale: Cardiac troponins are the most sensitive and specific markers of myocardial necrosis.
CK-MB is less specific; BNP reflects wall stress; D-dimer is for thrombosis/PE.
Q6. Priority nursing action for a client with suspected acute coronary syndrome and ongoing
chest pain is:
A. Obtain a 12-lead ECG and administer oxygen if hypoxic [CORRECT]
B. Give a full meal to prevent hypoglycemia
C. Encourage ambulation to reduce anxiety
D. Delay all interventions until cardiac catheterization
Correct Answer: A
Rationale: Immediate ECG, vital signs, oxygen if needed, aspirin, and nitroglycerin (if
appropriate) follow ACS protocols. Ambulation or delays increase myocardial oxygen demand
and risk.
Q7. A client in atrial fibrillation with rapid ventricular response is prescribed anticoagulation.
The primary rationale is to prevent:
A. Ventricular tachycardia
B. Thromboembolism and stroke [CORRECT]
C. Bradycardia
D. Heart block
Correct Answer: B
Rationale: Atrial fibrillation allows blood stasis in the atria, promoting clot formation and
, embolization, especially to the brain. Rate control and rhythm strategies address rate/rhythm,
but anticoagulation targets stroke risk.
Q8. The nurse observes a client’s monitor showing a wide-complex tachycardia at 180 bpm and
the client is pulseless. The priority intervention is:
A. Administer adenosine
B. Synchronized cardioversion
C. Defibrillation [CORRECT]
D. Start CPR and give atropine
Correct Answer: C
Rationale: Pulseless ventricular tachycardia is treated as cardiac arrest with immediate
defibrillation and CPR. Adenosine is for stable narrow-complex SVT; synchronized cardioversion
is for unstable but pulse-present VT.
Q9. A client with hypertension is prescribed a beta-blocker. Which assessment finding requires
immediate notification of the provider?
A. Heart rate 58 bpm
B. Blood pressure 138/86 mm Hg
C. Heart rate 42 bpm with dizziness [CORRECT]
D. Mild fatigue
Correct Answer: C
Rationale: Symptomatic bradycardia indicates excessive beta-blockade and risk of inadequate
cardiac output. Asymptomatic mild bradycardia or controlled BP is expected; mild fatigue is
common.
Q10. A client develops muffled heart sounds, jugular venous distention, and hypotension after
cardiac surgery. The nurse suspects:
A. Pulmonary embolism
B. Cardiac tamponade [CORRECT]
C. Tension pneumothorax
D. Acute heart failure only
Correct Answer: B
Rationale: Beck’s triad (hypotension, JVD, muffled sounds) is classic for cardiac tamponade.
Immediate pericardiocentesis or return to surgery is required.
Q11. A client with a newly implanted permanent pacemaker should be taught to:
A. Avoid all electrical devices permanently
B. Report dizziness or prolonged hiccups [CORRECT]
C. Lift heavy objects with the affected arm immediately
D. Discontinue anticoagulation if previously prescribed
