NSG 303 — Medical-Surgical Nursing III
exam Questions and Correct Answers
(Verified Answers) Plus Rationale 2027
Q&A| Instant Download Pdf
1. A client with chronic heart failure reports increasing dyspnea,
orthopnea, and a 3-kg weight gain over 3 days. Which finding is
most concerning?
A. Heart rate of 88 beats/min
B. Mild fatigue after activity
C. Bilateral crackles and increasing respiratory distress
D. Blood pressure of 128/78 mmHg
Rationale: Rapid weight gain, orthopnea, crackles, and worsening
respiratory distress suggest fluid accumulation and acute pulmonary
congestion. This can progress to pulmonary edema and requires prompt
intervention.
, 2. A nurse is caring for a client with acute pulmonary edema. Which
intervention should the nurse implement first?
A. Encourage oral fluids
B. Place the client in a supine position
C. Position the client upright and administer oxygen as prescribed
D. Encourage ambulation
Rationale: Upright positioning decreases venous return and improves
lung expansion. Supplemental oxygen helps correct hypoxemia while
additional treatment is initiated.
3. Which assessment finding is most characteristic of left-sided heart
failure?
A. Ascites
B. Dependent edema
C. Hepatomegaly
D. Pulmonary crackles
Rationale: Left-sided heart failure causes blood to back up into the
pulmonary circulation, producing pulmonary congestion and crackles.
Right-sided failure more commonly causes systemic venous congestion.
4. A client taking digoxin reports nausea, loss of appetite, and
yellow-green visual disturbances. What should the nurse do?
,A. Administer the next dose with food
B. Encourage increased potassium intake immediately
C. Withhold the medication and notify the healthcare provider
D. Reassure the client that these are expected effects
Rationale: Gastrointestinal symptoms and visual disturbances are
classic manifestations of digoxin toxicity. The medication should be
withheld and the provider notified for further evaluation.
5. Which laboratory value is especially important to monitor in a
client receiving furosemide?
A. Sodium only
B. Hemoglobin
C. Potassium
D. Platelet count
Rationale: Furosemide is a loop diuretic that can cause significant
potassium loss. Hypokalemia can produce muscle weakness and
potentially dangerous cardiac dysrhythmias.
6. A client with atrial fibrillation is prescribed warfarin. Which
laboratory test is used to monitor the therapeutic effect?
A. aPTT
B. Platelet count
, C. INR
D. Serum creatinine
Rationale: Warfarin therapy is monitored using the prothrombin time
expressed as the international normalized ratio (INR). Monitoring helps
maintain therapeutic anticoagulation while reducing bleeding risk.
7. Which symptom in a client with atrial fibrillation requires
immediate attention?
A. Mild fatigue
B. Occasional palpitations
C. Sudden unilateral weakness and difficulty speaking
D. Heart rate of 92 beats/min
Rationale: Sudden neurologic deficits may indicate an embolic ischemic
stroke. Atrial fibrillation increases the risk of thromboembolism because
ineffective atrial contraction can promote clot formation.
8. A client with infective endocarditis is receiving intravenous
antibiotics. Which finding should the nurse report immediately?
A. Mild fatigue
B. Decreased appetite
C. New heart murmur with increasing dyspnea
D. Temperature of 37.2°C
exam Questions and Correct Answers
(Verified Answers) Plus Rationale 2027
Q&A| Instant Download Pdf
1. A client with chronic heart failure reports increasing dyspnea,
orthopnea, and a 3-kg weight gain over 3 days. Which finding is
most concerning?
A. Heart rate of 88 beats/min
B. Mild fatigue after activity
C. Bilateral crackles and increasing respiratory distress
D. Blood pressure of 128/78 mmHg
Rationale: Rapid weight gain, orthopnea, crackles, and worsening
respiratory distress suggest fluid accumulation and acute pulmonary
congestion. This can progress to pulmonary edema and requires prompt
intervention.
, 2. A nurse is caring for a client with acute pulmonary edema. Which
intervention should the nurse implement first?
A. Encourage oral fluids
B. Place the client in a supine position
C. Position the client upright and administer oxygen as prescribed
D. Encourage ambulation
Rationale: Upright positioning decreases venous return and improves
lung expansion. Supplemental oxygen helps correct hypoxemia while
additional treatment is initiated.
3. Which assessment finding is most characteristic of left-sided heart
failure?
A. Ascites
B. Dependent edema
C. Hepatomegaly
D. Pulmonary crackles
Rationale: Left-sided heart failure causes blood to back up into the
pulmonary circulation, producing pulmonary congestion and crackles.
Right-sided failure more commonly causes systemic venous congestion.
4. A client taking digoxin reports nausea, loss of appetite, and
yellow-green visual disturbances. What should the nurse do?
,A. Administer the next dose with food
B. Encourage increased potassium intake immediately
C. Withhold the medication and notify the healthcare provider
D. Reassure the client that these are expected effects
Rationale: Gastrointestinal symptoms and visual disturbances are
classic manifestations of digoxin toxicity. The medication should be
withheld and the provider notified for further evaluation.
5. Which laboratory value is especially important to monitor in a
client receiving furosemide?
A. Sodium only
B. Hemoglobin
C. Potassium
D. Platelet count
Rationale: Furosemide is a loop diuretic that can cause significant
potassium loss. Hypokalemia can produce muscle weakness and
potentially dangerous cardiac dysrhythmias.
6. A client with atrial fibrillation is prescribed warfarin. Which
laboratory test is used to monitor the therapeutic effect?
A. aPTT
B. Platelet count
, C. INR
D. Serum creatinine
Rationale: Warfarin therapy is monitored using the prothrombin time
expressed as the international normalized ratio (INR). Monitoring helps
maintain therapeutic anticoagulation while reducing bleeding risk.
7. Which symptom in a client with atrial fibrillation requires
immediate attention?
A. Mild fatigue
B. Occasional palpitations
C. Sudden unilateral weakness and difficulty speaking
D. Heart rate of 92 beats/min
Rationale: Sudden neurologic deficits may indicate an embolic ischemic
stroke. Atrial fibrillation increases the risk of thromboembolism because
ineffective atrial contraction can promote clot formation.
8. A client with infective endocarditis is receiving intravenous
antibiotics. Which finding should the nurse report immediately?
A. Mild fatigue
B. Decreased appetite
C. New heart murmur with increasing dyspnea
D. Temperature of 37.2°C
