NUR 242 MEDICAL-SURGICAL NURSING COMPREHENSIVE
FINAL EXAM 2026/2027 | 100 QUESTIONS WITH CORRECT
ANSWERS AND EXPLAINED RATIONALE
Question 1.
A patient with acute decompensated heart failure has crackles in
the lung bases, jugular venous distension, and peripheral edema.
The nurse knows these findings indicate:
A. Left-sided heart failure with pulmonary congestion.
B. Right-sided heart failure with systemic venous congestion.
C. Biventricular failure with both pulmonary and systemic
congestion.
D. Isolated systolic dysfunction without volume overload.
Correct Answer: C
Rationale: Crackles and JVD together suggest biventricular failure.
Left-sided failure causes pulmonary congestion (crackles,
dyspnea, orthopnea). Right-sided failure causes systemic venous
congestion (JVD, peripheral edema, hepatomegaly). When both
sets of symptoms are present, both ventricles are failing.
Treatment includes diuretics, nitrates, ACE inhibitors/ARBs/ARNIs,
beta-blockers, and inotropes if needed.
Question 2.
A patient with atrial fibrillation is prescribed warfarin. The target
INR range for stroke prevention in AFib is:
A. 1.5–2.0.
B. 2.0–3.0.
C. 2.5–3.5.
D. 3.0–4.0.
,Correct Answer: B
Rationale: For most patients with atrial fibrillation, the target INR
on warfarin is 2.0–3.0. For mechanical heart valves (especially
mitral), the target is higher at 2.5–3.5. DOACs (apixaban,
rivaroxaban, dabigatran, edoxaban) are alternatives that do not
require INR monitoring.
Question 3.
A nurse is caring for a client receiving heparin infusion. Which
laboratory value should the nurse monitor to evaluate therapeutic
effectiveness?
A. PT/INR
B. aPTT
C. Bleeding time
D. Platelet count
Correct Answer: B
Rationale: Heparin therapy is monitored using the activated
partial thromboplastin time (aPTT). The therapeutic range is
typically 1.5–2.5 times the control value. PT/INR is used for
warfarin monitoring. Platelet count is monitored for heparin-
induced thrombocytopenia (HIT), but aPTT evaluates
effectiveness.
Question 4.
A client with deep vein thrombosis (DVT) is started on enoxaparin.
Which instruction should the nurse include in teaching?
A. "You should massage the affected leg to improve circulation."
B. "You will need frequent blood tests to check your INR."
C. "The medication is given subcutaneously in the abdomen."
,D. "You should avoid all physical activity until the clot resolves."
Correct Answer: C
Rationale: Enoxaparin is a low molecular weight heparin given
subcutaneously, typically in the abdomen. It does not require
routine INR monitoring. Massaging the affected leg is
contraindicated because it can dislodge the clot. Early ambulation
is encouraged as tolerated.
Question 5.
A nurse is assessing a client with peripheral arterial disease
(PAD). Which finding is most consistent with this condition?
A. Warm, swollen extremities
B. Decreased pedal pulses and cool skin
C. Dependent rubor relieved by elevation
D. Thick, brown discoloration of the ankles
Correct Answer: B
Rationale: PAD results from atherosclerosis, leading to decreased
arterial blood flow. Classic findings include decreased or absent
pulses, cool extremities, pallor on elevation, and dependent rubor.
Venous insufficiency causes warm, swollen extremities and brown
discoloration (hemosiderin staining).
Question 6.
A client is admitted with an acute myocardial infarction (MI).
Which laboratory test is most specific for myocardial injury?
A. CK-MB
B. Troponin I
C. Myoglobin
, D. LDH
Correct Answer: B
Rationale: Troponin I and T are highly specific for myocardial injury
and remain elevated for 7–14 days. CK-MB is less specific and
returns to normal in 2–3 days. Myoglobin rises early but is not
specific. LDH is outdated and nonspecific.
Question 7.
A nurse is teaching a client about nitroglycerin. Which statement
indicates the client understands proper administration?
A. "I will swallow the tablet with water."
B. "I will take one tablet every 5 minutes for up to 3 doses."
C. "I will take the tablet only if my pain is severe."
D. "I will lie down after taking the tablet."
Correct Answer: B
Rationale: Sublingual nitroglycerin should be taken at the onset of
chest pain. The client may take one tablet every 5 minutes for up
to three doses. If pain persists after three doses, emergency
services should be called. The tablet should not be swallowed.
Lying down is not required but may help if dizziness occurs.
Question 8.
A client with heart failure is prescribed furosemide. Which
assessment finding requires immediate intervention?
A. Urine output of 50 mL/hr
B. Potassium level of 3.1 mEq/L
C. Weight loss of 1 kg in 24 hours
D. Blood pressure of 110/70 mm Hg
FINAL EXAM 2026/2027 | 100 QUESTIONS WITH CORRECT
ANSWERS AND EXPLAINED RATIONALE
Question 1.
A patient with acute decompensated heart failure has crackles in
the lung bases, jugular venous distension, and peripheral edema.
The nurse knows these findings indicate:
A. Left-sided heart failure with pulmonary congestion.
B. Right-sided heart failure with systemic venous congestion.
C. Biventricular failure with both pulmonary and systemic
congestion.
D. Isolated systolic dysfunction without volume overload.
Correct Answer: C
Rationale: Crackles and JVD together suggest biventricular failure.
Left-sided failure causes pulmonary congestion (crackles,
dyspnea, orthopnea). Right-sided failure causes systemic venous
congestion (JVD, peripheral edema, hepatomegaly). When both
sets of symptoms are present, both ventricles are failing.
Treatment includes diuretics, nitrates, ACE inhibitors/ARBs/ARNIs,
beta-blockers, and inotropes if needed.
Question 2.
A patient with atrial fibrillation is prescribed warfarin. The target
INR range for stroke prevention in AFib is:
A. 1.5–2.0.
B. 2.0–3.0.
C. 2.5–3.5.
D. 3.0–4.0.
,Correct Answer: B
Rationale: For most patients with atrial fibrillation, the target INR
on warfarin is 2.0–3.0. For mechanical heart valves (especially
mitral), the target is higher at 2.5–3.5. DOACs (apixaban,
rivaroxaban, dabigatran, edoxaban) are alternatives that do not
require INR monitoring.
Question 3.
A nurse is caring for a client receiving heparin infusion. Which
laboratory value should the nurse monitor to evaluate therapeutic
effectiveness?
A. PT/INR
B. aPTT
C. Bleeding time
D. Platelet count
Correct Answer: B
Rationale: Heparin therapy is monitored using the activated
partial thromboplastin time (aPTT). The therapeutic range is
typically 1.5–2.5 times the control value. PT/INR is used for
warfarin monitoring. Platelet count is monitored for heparin-
induced thrombocytopenia (HIT), but aPTT evaluates
effectiveness.
Question 4.
A client with deep vein thrombosis (DVT) is started on enoxaparin.
Which instruction should the nurse include in teaching?
A. "You should massage the affected leg to improve circulation."
B. "You will need frequent blood tests to check your INR."
C. "The medication is given subcutaneously in the abdomen."
,D. "You should avoid all physical activity until the clot resolves."
Correct Answer: C
Rationale: Enoxaparin is a low molecular weight heparin given
subcutaneously, typically in the abdomen. It does not require
routine INR monitoring. Massaging the affected leg is
contraindicated because it can dislodge the clot. Early ambulation
is encouraged as tolerated.
Question 5.
A nurse is assessing a client with peripheral arterial disease
(PAD). Which finding is most consistent with this condition?
A. Warm, swollen extremities
B. Decreased pedal pulses and cool skin
C. Dependent rubor relieved by elevation
D. Thick, brown discoloration of the ankles
Correct Answer: B
Rationale: PAD results from atherosclerosis, leading to decreased
arterial blood flow. Classic findings include decreased or absent
pulses, cool extremities, pallor on elevation, and dependent rubor.
Venous insufficiency causes warm, swollen extremities and brown
discoloration (hemosiderin staining).
Question 6.
A client is admitted with an acute myocardial infarction (MI).
Which laboratory test is most specific for myocardial injury?
A. CK-MB
B. Troponin I
C. Myoglobin
, D. LDH
Correct Answer: B
Rationale: Troponin I and T are highly specific for myocardial injury
and remain elevated for 7–14 days. CK-MB is less specific and
returns to normal in 2–3 days. Myoglobin rises early but is not
specific. LDH is outdated and nonspecific.
Question 7.
A nurse is teaching a client about nitroglycerin. Which statement
indicates the client understands proper administration?
A. "I will swallow the tablet with water."
B. "I will take one tablet every 5 minutes for up to 3 doses."
C. "I will take the tablet only if my pain is severe."
D. "I will lie down after taking the tablet."
Correct Answer: B
Rationale: Sublingual nitroglycerin should be taken at the onset of
chest pain. The client may take one tablet every 5 minutes for up
to three doses. If pain persists after three doses, emergency
services should be called. The tablet should not be swallowed.
Lying down is not required but may help if dizziness occurs.
Question 8.
A client with heart failure is prescribed furosemide. Which
assessment finding requires immediate intervention?
A. Urine output of 50 mL/hr
B. Potassium level of 3.1 mEq/L
C. Weight loss of 1 kg in 24 hours
D. Blood pressure of 110/70 mm Hg
