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 causes significant renal potassium wasting. A
potassium level of 2.8 mEq/L represents severe hypokalemia that can precipitate life-threatening
ventricular dysrhythmias (B). Immediate intervention includes potassium replacement and
cardiac monitoring. Normal potassium is 3.5-5.0 mEq/L. The other values are within normal
limits and do not require urgent action.
Q2: A patient with hypertension presents with blood pressure 220/130 mmHg, headache, blurred
vision, and confusion. The nurse recognizes this as:
A. Hypertensive urgency requiring oral medication within 24 hours
B. Hypertensive emergency requiring immediate IV antihypertensive therapy. [CORRECT]
C. Primary hypertension requiring lifestyle modifications only
D. Orthostatic hypotension requiring fluid replacement
Correct Answer: B
,Rationale: Hypertensive emergency is defined as severe hypertension (>180/120 mmHg) with
evidence of acute target organ damage (encephalopathy, papilledema, renal failure, acute
coronary syndrome, pulmonary edema). This patient has neurological symptoms (headache,
blurred vision, confusion) indicating end-organ involvement, requiring immediate IV
antihypertensive therapy (B) with agents like nicardipine, labetalol, or nitroprusside in an ICU
setting.
Q3: A patient with stable angina reports chest pain while walking upstairs. The nurse administers
sublingual nitroglycerin. Which action is most appropriate?
A. Have the patient lie flat to enhance absorption
B. Have the patient sit or lie down to prevent hypotension. [CORRECT]
C. Instruct the patient to chew the tablet for faster onset
D. Administer a second tablet immediately if pain persists
Correct Answer: B
Rationale: Nitroglycerin causes venodilation and arterial dilation, potentially causing significant
hypotension and reflex tachycardia. The patient should sit or lie down (B) to prevent falls from
orthostatic hypotension. Tablets are placed under the tongue (not chewed), and if pain persists
after 5 minutes, a second tablet may be given, with emergency services called if three tablets do
not relieve pain.
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 of hospital arrival
B. Within 90 minutes of first medical contact. [CORRECT]
C. Within 3 hours of symptom onset
D. Within 24 hours of admission
Correct Answer: B
Rationale: Current ACC/AHA guidelines recommend primary PCI within 90 minutes of first
medical contact (door-to-balloon time) (B) for optimal outcomes in STEMI. If PCI cannot be
performed within this timeframe, fibrinolytic therapy should be considered within 30 minutes of
hospital arrival (door-to-needle time) if no contraindications exist. Delays beyond these
timeframes increase myocardial damage and mortality.
Q5: A patient with acute myocardial infarction develops a new harsh holosystolic murmur at the
apex, pulmonary edema, and hypotension. The nurse recognizes this as:
, A. Papillary muscle rupture causing acute mitral regurgitation. [CORRECT]
B. Ventricular septal defect
C. Acute pericarditis
D. Dressler's syndrome
Correct Answer: A
Rationale: Papillary muscle rupture is a mechanical complication of MI (usually inferior MI
affecting posterior papillary muscle) occurring 2-7 days post-infarction. It causes acute severe
mitral regurgitation, presenting with sudden pulmonary edema, cardiogenic shock, and a new
holosystolic murmur (A). This is a surgical emergency. Ventricular septal defect (B) produces a
holosystolic murmur at the left sternal border with a thrill.
Q6: A patient with heart failure has an S3 gallop on auscultation. The nurse understands this
sound indicates:
A. Atrial contraction against a stiff ventricle
B. Rapid ventricular filling into a compliant, volume-overloaded ventricle. [CORRECT]
C. Mitral valve prolapse
D. Pericardial friction rub
Correct Answer: B
Rationale: An S3 gallop (ventricular gallop) occurs during early diastole when blood flows
rapidly into a dilated, volume-overloaded ventricle with decreased compliance, creating
vibrations (B). It is a sign of systolic heart failure (HFrEF) and volume overload. An S4 sound
(atrial gallop) represents atrial contraction against a stiff ventricle (diastolic dysfunction/HFpEF).
Q7: A patient with atrial fibrillation is prescribed warfarin. The nurse teaches the patient to
maintain consistent intake of which vitamin to ensure stable INR?
A. Vitamin A
B. Vitamin K. [CORRECT]
C. Vitamin C
D. Vitamin D
Correct Answer: B
Rationale: Warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X). Consistent
vitamin K intake (B) is essential because sudden increases (leafy greens) decrease INR
(increasing clot risk), while sudden decreases increase INR (increasing bleeding risk). Patients
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 causes significant renal potassium wasting. A
potassium level of 2.8 mEq/L represents severe hypokalemia that can precipitate life-threatening
ventricular dysrhythmias (B). Immediate intervention includes potassium replacement and
cardiac monitoring. Normal potassium is 3.5-5.0 mEq/L. The other values are within normal
limits and do not require urgent action.
Q2: A patient with hypertension presents with blood pressure 220/130 mmHg, headache, blurred
vision, and confusion. The nurse recognizes this as:
A. Hypertensive urgency requiring oral medication within 24 hours
B. Hypertensive emergency requiring immediate IV antihypertensive therapy. [CORRECT]
C. Primary hypertension requiring lifestyle modifications only
D. Orthostatic hypotension requiring fluid replacement
Correct Answer: B
,Rationale: Hypertensive emergency is defined as severe hypertension (>180/120 mmHg) with
evidence of acute target organ damage (encephalopathy, papilledema, renal failure, acute
coronary syndrome, pulmonary edema). This patient has neurological symptoms (headache,
blurred vision, confusion) indicating end-organ involvement, requiring immediate IV
antihypertensive therapy (B) with agents like nicardipine, labetalol, or nitroprusside in an ICU
setting.
Q3: A patient with stable angina reports chest pain while walking upstairs. The nurse administers
sublingual nitroglycerin. Which action is most appropriate?
A. Have the patient lie flat to enhance absorption
B. Have the patient sit or lie down to prevent hypotension. [CORRECT]
C. Instruct the patient to chew the tablet for faster onset
D. Administer a second tablet immediately if pain persists
Correct Answer: B
Rationale: Nitroglycerin causes venodilation and arterial dilation, potentially causing significant
hypotension and reflex tachycardia. The patient should sit or lie down (B) to prevent falls from
orthostatic hypotension. Tablets are placed under the tongue (not chewed), and if pain persists
after 5 minutes, a second tablet may be given, with emergency services called if three tablets do
not relieve pain.
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 of hospital arrival
B. Within 90 minutes of first medical contact. [CORRECT]
C. Within 3 hours of symptom onset
D. Within 24 hours of admission
Correct Answer: B
Rationale: Current ACC/AHA guidelines recommend primary PCI within 90 minutes of first
medical contact (door-to-balloon time) (B) for optimal outcomes in STEMI. If PCI cannot be
performed within this timeframe, fibrinolytic therapy should be considered within 30 minutes of
hospital arrival (door-to-needle time) if no contraindications exist. Delays beyond these
timeframes increase myocardial damage and mortality.
Q5: A patient with acute myocardial infarction develops a new harsh holosystolic murmur at the
apex, pulmonary edema, and hypotension. The nurse recognizes this as:
, A. Papillary muscle rupture causing acute mitral regurgitation. [CORRECT]
B. Ventricular septal defect
C. Acute pericarditis
D. Dressler's syndrome
Correct Answer: A
Rationale: Papillary muscle rupture is a mechanical complication of MI (usually inferior MI
affecting posterior papillary muscle) occurring 2-7 days post-infarction. It causes acute severe
mitral regurgitation, presenting with sudden pulmonary edema, cardiogenic shock, and a new
holosystolic murmur (A). This is a surgical emergency. Ventricular septal defect (B) produces a
holosystolic murmur at the left sternal border with a thrill.
Q6: A patient with heart failure has an S3 gallop on auscultation. The nurse understands this
sound indicates:
A. Atrial contraction against a stiff ventricle
B. Rapid ventricular filling into a compliant, volume-overloaded ventricle. [CORRECT]
C. Mitral valve prolapse
D. Pericardial friction rub
Correct Answer: B
Rationale: An S3 gallop (ventricular gallop) occurs during early diastole when blood flows
rapidly into a dilated, volume-overloaded ventricle with decreased compliance, creating
vibrations (B). It is a sign of systolic heart failure (HFrEF) and volume overload. An S4 sound
(atrial gallop) represents atrial contraction against a stiff ventricle (diastolic dysfunction/HFpEF).
Q7: A patient with atrial fibrillation is prescribed warfarin. The nurse teaches the patient to
maintain consistent intake of which vitamin to ensure stable INR?
A. Vitamin A
B. Vitamin K. [CORRECT]
C. Vitamin C
D. Vitamin D
Correct Answer: B
Rationale: Warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X). Consistent
vitamin K intake (B) is essential because sudden increases (leafy greens) decrease INR
(increasing clot risk), while sudden decreases increase INR (increasing bleeding risk). Patients
