NUR209 EXAM 1 Actual Exam 2026/2027
Complete Questions and Verified Answers
with Detailed Rationales Medical Surgical
Nursing II 100% Correct Grade A Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS
Q1: A nurse is caring for a patient with heart failure who has been receiving furosemide 40 mg
IV daily. Which laboratory value requires immediate intervention?
• A. Sodium 135 mEq/L
• B. Potassium 2.8 mEq/L [CORRECT]
• C. Creatinine 1.0 mg/dL
• D. Hemoglobin 12.5 g/dL
Correct Answer: B Rationale: Furosemide is a loop diuretic that can cause significant
potassium loss, leading to hypokalemia. A potassium level of 2.8 mEq/L is critically low and
increases the risk of life-threatening dysrhythmias (B). Sodium 135 mEq/L (A) is within normal
range. Creatinine 1.0 mg/dL (C) is normal. Hemoglobin 12.5 g/dL (D) is within normal range for
some populations.
Q2: A patient with hypertension presents with blood pressure 220/130 mmHg, headache, and
confusion. The nurse recognizes this as hypertensive emergency. Which medication is most
appropriate for initial management?
• A. Oral metoprolol
• B. IV labetalol or nicardipine [CORRECT]
• C. Sublingual nifedipine
• D. Oral lisinopril
Correct Answer: B Rationale: Hypertensive emergency requires immediate BP reduction with
IV antihypertensives to prevent end-organ damage. IV labetalol (combined alpha/beta-blocker)
,or nicardipine (calcium channel blocker) allow titration and controlled reduction (B). Oral agents
(A, D) act too slowly. Sublingual nifedipine (C) causes unpredictable rapid drops and is
contraindicated due to risk of cerebral hypoperfusion.
Q3: A patient with stable angina reports chest pain 6/10 after walking two blocks. The nurse
administers sublingual nitroglycerin. Which finding indicates the medication is effective?
• A. Blood pressure increase of 20 mmHg
• B. Chest pain relief within 5 minutes [CORRECT]
• C. Heart rate increase to 120 bpm
• D. Respiratory rate decrease to 10/min
Correct Answer: B Rationale: Nitroglycerin relieves angina by causing coronary vasodilation
and reducing preload/afterload. Effective response is pain relief within 5 minutes (B). Blood
pressure typically decreases, not increases (A). Reflex tachycardia may occur but is not the
therapeutic goal (C). Respiratory rate change (D) is not a primary indicator of effectiveness.
Q4: A patient with STEMI is being prepared for percutaneous coronary intervention (PCI). The
nurse understands the goal door-to-balloon time is:
• A. Within 30 minutes
• B. Within 90 minutes [CORRECT]
• C. Within 24 hours
• D. Within 48 hours
Correct Answer: B Rationale: Current guidelines recommend PCI within 90 minutes of first
medical contact (door-to-balloon time) for optimal myocardial salvage in STEMI (B). Door-to-
needle time for fibrinolytics is 30 minutes (A). Delays beyond 90 minutes (C, D) increase infarct
size and mortality.
Q5: A patient with heart failure has crackles bilaterally, JVD, and 3+ pitting edema. Which type
of heart failure is most likely present?
• A. Right-sided heart failure
• B. Left-sided heart failure [CORRECT]
• C. Biventricular failure only
, • D. Diastolic heart failure only
Correct Answer: B Rationale: Crackles (pulmonary congestion), JVD (elevated central venous
pressure), and peripheral edema suggest left-sided heart failure with backward failure leading to
pulmonary congestion (B). Right-sided failure (A) primarily shows JVD, hepatomegaly, and
edema without pulmonary congestion. While biventricular failure (C) is possible, the
presentation is classic for left-sided failure. Diastolic failure (D) may present similarly but the
question asks for the type based on side.
Q6: A patient with atrial fibrillation has an irregularly irregular pulse, rate 150, and is
hypotensive. The nurse prepares for:
• A. Defibrillation
• B. Synchronized cardioversion [CORRECT]
• C. Carotid massage
• D. Valsalva maneuver
Correct Answer: B Rationale: Unstable atrial fibrillation with hypotension requires immediate
synchronized cardioversion to restore perfusion (B). Defibrillation (A) is for pulseless rhythms.
Carotid massage (C) and Valsalva (D) are vagal maneuvers for stable SVT, not unstable AF.
Q7: A patient with a mechanical heart valve is prescribed warfarin. The nurse understands the
therapeutic INR target is:
• A. 1.5-2.0
• B. 2.0-3.0
• C. 2.5-3.5 [CORRECT]
• D. 3.5-4.5
Correct Answer: C Rationale: Mechanical heart valves require higher anticoagulation intensity
than other indications. The target INR is 2.5-3.5 for most mechanical valves to prevent
thrombosis while minimizing bleeding risk (C). 1.5-2.0 (A) is subtherapeutic. 2.0-3.0 (B) is for
atrial fibrillation or bioprosthetic valves. 3.5-4.5 (D) increases bleeding risk without additional
benefit.
Q8: A patient with peripheral arterial disease reports severe foot pain at rest that improves when
dangling the leg over the bed. The nurse documents this as:
Complete Questions and Verified Answers
with Detailed Rationales Medical Surgical
Nursing II 100% Correct Grade A Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS
Q1: A nurse is caring for a patient with heart failure who has been receiving furosemide 40 mg
IV daily. Which laboratory value requires immediate intervention?
• A. Sodium 135 mEq/L
• B. Potassium 2.8 mEq/L [CORRECT]
• C. Creatinine 1.0 mg/dL
• D. Hemoglobin 12.5 g/dL
Correct Answer: B Rationale: Furosemide is a loop diuretic that can cause significant
potassium loss, leading to hypokalemia. A potassium level of 2.8 mEq/L is critically low and
increases the risk of life-threatening dysrhythmias (B). Sodium 135 mEq/L (A) is within normal
range. Creatinine 1.0 mg/dL (C) is normal. Hemoglobin 12.5 g/dL (D) is within normal range for
some populations.
Q2: A patient with hypertension presents with blood pressure 220/130 mmHg, headache, and
confusion. The nurse recognizes this as hypertensive emergency. Which medication is most
appropriate for initial management?
• A. Oral metoprolol
• B. IV labetalol or nicardipine [CORRECT]
• C. Sublingual nifedipine
• D. Oral lisinopril
Correct Answer: B Rationale: Hypertensive emergency requires immediate BP reduction with
IV antihypertensives to prevent end-organ damage. IV labetalol (combined alpha/beta-blocker)
,or nicardipine (calcium channel blocker) allow titration and controlled reduction (B). Oral agents
(A, D) act too slowly. Sublingual nifedipine (C) causes unpredictable rapid drops and is
contraindicated due to risk of cerebral hypoperfusion.
Q3: A patient with stable angina reports chest pain 6/10 after walking two blocks. The nurse
administers sublingual nitroglycerin. Which finding indicates the medication is effective?
• A. Blood pressure increase of 20 mmHg
• B. Chest pain relief within 5 minutes [CORRECT]
• C. Heart rate increase to 120 bpm
• D. Respiratory rate decrease to 10/min
Correct Answer: B Rationale: Nitroglycerin relieves angina by causing coronary vasodilation
and reducing preload/afterload. Effective response is pain relief within 5 minutes (B). Blood
pressure typically decreases, not increases (A). Reflex tachycardia may occur but is not the
therapeutic goal (C). Respiratory rate change (D) is not a primary indicator of effectiveness.
Q4: A patient with STEMI is being prepared for percutaneous coronary intervention (PCI). The
nurse understands the goal door-to-balloon time is:
• A. Within 30 minutes
• B. Within 90 minutes [CORRECT]
• C. Within 24 hours
• D. Within 48 hours
Correct Answer: B Rationale: Current guidelines recommend PCI within 90 minutes of first
medical contact (door-to-balloon time) for optimal myocardial salvage in STEMI (B). Door-to-
needle time for fibrinolytics is 30 minutes (A). Delays beyond 90 minutes (C, D) increase infarct
size and mortality.
Q5: A patient with heart failure has crackles bilaterally, JVD, and 3+ pitting edema. Which type
of heart failure is most likely present?
• A. Right-sided heart failure
• B. Left-sided heart failure [CORRECT]
• C. Biventricular failure only
, • D. Diastolic heart failure only
Correct Answer: B Rationale: Crackles (pulmonary congestion), JVD (elevated central venous
pressure), and peripheral edema suggest left-sided heart failure with backward failure leading to
pulmonary congestion (B). Right-sided failure (A) primarily shows JVD, hepatomegaly, and
edema without pulmonary congestion. While biventricular failure (C) is possible, the
presentation is classic for left-sided failure. Diastolic failure (D) may present similarly but the
question asks for the type based on side.
Q6: A patient with atrial fibrillation has an irregularly irregular pulse, rate 150, and is
hypotensive. The nurse prepares for:
• A. Defibrillation
• B. Synchronized cardioversion [CORRECT]
• C. Carotid massage
• D. Valsalva maneuver
Correct Answer: B Rationale: Unstable atrial fibrillation with hypotension requires immediate
synchronized cardioversion to restore perfusion (B). Defibrillation (A) is for pulseless rhythms.
Carotid massage (C) and Valsalva (D) are vagal maneuvers for stable SVT, not unstable AF.
Q7: A patient with a mechanical heart valve is prescribed warfarin. The nurse understands the
therapeutic INR target is:
• A. 1.5-2.0
• B. 2.0-3.0
• C. 2.5-3.5 [CORRECT]
• D. 3.5-4.5
Correct Answer: C Rationale: Mechanical heart valves require higher anticoagulation intensity
than other indications. The target INR is 2.5-3.5 for most mechanical valves to prevent
thrombosis while minimizing bleeding risk (C). 1.5-2.0 (A) is subtherapeutic. 2.0-3.0 (B) is for
atrial fibrillation or bioprosthetic valves. 3.5-4.5 (D) increases bleeding risk without additional
benefit.
Q8: A patient with peripheral arterial disease reports severe foot pain at rest that improves when
dangling the leg over the bed. The nurse documents this as:
