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 (Questions 1-25)
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 a blood pressure of 220/130 mmHg, headache,
and blurred vision. The nurse recognizes this as hypertensive crisis. Which medication is most
appropriate for initial management?
A. Oral metoprolol
B. IV nitroprusside [CORRECT]
C. Oral lisinopril
D. Subcutaneous heparin
Correct Answer: B
Rationale: Hypertensive crisis requires immediate reduction of blood pressure with IV agents
that have rapid onset and short duration, allowing precise titration. IV nitroprusside is a potent
arterial and venous vasodilator used for hypertensive emergencies (B). Oral agents (A, C) have
,slower onset and are inappropriate for crisis management. Heparin (D) is an anticoagulant and
not indicated.
Q3: A patient with coronary artery disease reports chest pain while walking up stairs that
resolves with rest. The nurse recognizes this as which type of angina?
A. Unstable angina
B. Stable angina [CORRECT]
C. Variant angina
D. Non-anginal pain
Correct Answer: B
Rationale: Stable angina is predictable chest pain that occurs with exertion or stress and is
relieved by rest or nitroglycerin (B). Unstable angina (A) occurs at rest or with increasing
frequency/severity. Variant angina (C) occurs at rest due to coronary artery spasm. The
predictable pattern described indicates stable angina.
Q4: A patient with acute myocardial infarction is receiving tissue plasminogen activator (tPA).
Which nursing intervention is priority during administration?
A. Monitor for signs of bleeding [CORRECT]
B. Apply sequential compression devices
C. Encourage ambulation
D. Administer aspirin rectally
Correct Answer: A
Rationale: Thrombolytics like tPA dissolve clots but carry significant bleeding risk, including
intracranial hemorrhage. The nurse must monitor for bleeding (gum bleeding, hematuria, melena,
neurological changes) and maintain strict bed rest during and after infusion (A). SCDs (B) are
contraindicated during thrombolysis due to bleeding risk. Ambulation (C) is contraindicated.
Aspirin is given orally, not rectally (D).
Q5: A patient with heart failure has crackles bilaterally, orthopnea, and an S3 gallop. These
findings indicate which type of heart failure?
A. Right-sided heart failure
B. Left-sided heart failure [CORRECT]
C. Biventricular heart failure
D. Diastolic heart failure only
, Correct Answer: B
Rationale: Crackles (pulmonary congestion), orthopnea (difficulty breathing when supine), and
S3 gallop (volume overload) are classic signs of left-sided heart failure causing pulmonary
venous congestion (B). Right-sided failure (A) presents with JVD, peripheral edema, and
hepatomegaly. While biventricular failure (C) includes both, these specific findings indicate left-
sided involvement.
Q6: A patient with atrial fibrillation has an irregularly irregular pulse with no discernible P
waves on ECG. Which complication is this patient at highest risk for?
A. Ventricular tachycardia
B. Stroke [CORRECT]
C. Asystole
D. First-degree heart block
Correct Answer: B
Rationale: Atrial fibrillation causes ineffective atrial contraction and blood stasis, particularly in
the left atrial appendage, increasing thrombus formation risk. Emboli can travel to the brain
causing stroke (B). Anticoagulation is essential for stroke prevention in AF. While other
arrhythmias can occur, stroke is the most significant long-term risk.
Q7: A patient with a mechanical heart valve is taking warfarin. The nurse notes an INR of 4.5.
Which action is most appropriate?
A. Administer vitamin K immediately
B. Hold the next dose and notify the provider [CORRECT]
C. Continue the current dose
D. Increase the dose to achieve therapeutic range
Correct Answer: B
Rationale: An INR of 4.5 is above the typical therapeutic range (2.0-3.0 for mechanical valves).
The nurse should hold the next warfarin dose and notify the provider to prevent bleeding
complications (B). Vitamin K (A) is reserved for serious bleeding or INR >10. Continuing (C) or
increasing (D) the dose would worsen the situation.
Q8: A patient with peripheral arterial disease reports intermittent claudication when walking
more than two blocks. Which intervention should the nurse prioritize?
A. Encourage strict bed rest
B. Teach about smoking cessation and supervised exercise [CORRECT]
Complete Questions and Verified Answers
with Detailed Rationales Medical Surgical
Nursing II 100% Correct Grade A Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
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 a blood pressure of 220/130 mmHg, headache,
and blurred vision. The nurse recognizes this as hypertensive crisis. Which medication is most
appropriate for initial management?
A. Oral metoprolol
B. IV nitroprusside [CORRECT]
C. Oral lisinopril
D. Subcutaneous heparin
Correct Answer: B
Rationale: Hypertensive crisis requires immediate reduction of blood pressure with IV agents
that have rapid onset and short duration, allowing precise titration. IV nitroprusside is a potent
arterial and venous vasodilator used for hypertensive emergencies (B). Oral agents (A, C) have
,slower onset and are inappropriate for crisis management. Heparin (D) is an anticoagulant and
not indicated.
Q3: A patient with coronary artery disease reports chest pain while walking up stairs that
resolves with rest. The nurse recognizes this as which type of angina?
A. Unstable angina
B. Stable angina [CORRECT]
C. Variant angina
D. Non-anginal pain
Correct Answer: B
Rationale: Stable angina is predictable chest pain that occurs with exertion or stress and is
relieved by rest or nitroglycerin (B). Unstable angina (A) occurs at rest or with increasing
frequency/severity. Variant angina (C) occurs at rest due to coronary artery spasm. The
predictable pattern described indicates stable angina.
Q4: A patient with acute myocardial infarction is receiving tissue plasminogen activator (tPA).
Which nursing intervention is priority during administration?
A. Monitor for signs of bleeding [CORRECT]
B. Apply sequential compression devices
C. Encourage ambulation
D. Administer aspirin rectally
Correct Answer: A
Rationale: Thrombolytics like tPA dissolve clots but carry significant bleeding risk, including
intracranial hemorrhage. The nurse must monitor for bleeding (gum bleeding, hematuria, melena,
neurological changes) and maintain strict bed rest during and after infusion (A). SCDs (B) are
contraindicated during thrombolysis due to bleeding risk. Ambulation (C) is contraindicated.
Aspirin is given orally, not rectally (D).
Q5: A patient with heart failure has crackles bilaterally, orthopnea, and an S3 gallop. These
findings indicate which type of heart failure?
A. Right-sided heart failure
B. Left-sided heart failure [CORRECT]
C. Biventricular heart failure
D. Diastolic heart failure only
, Correct Answer: B
Rationale: Crackles (pulmonary congestion), orthopnea (difficulty breathing when supine), and
S3 gallop (volume overload) are classic signs of left-sided heart failure causing pulmonary
venous congestion (B). Right-sided failure (A) presents with JVD, peripheral edema, and
hepatomegaly. While biventricular failure (C) includes both, these specific findings indicate left-
sided involvement.
Q6: A patient with atrial fibrillation has an irregularly irregular pulse with no discernible P
waves on ECG. Which complication is this patient at highest risk for?
A. Ventricular tachycardia
B. Stroke [CORRECT]
C. Asystole
D. First-degree heart block
Correct Answer: B
Rationale: Atrial fibrillation causes ineffective atrial contraction and blood stasis, particularly in
the left atrial appendage, increasing thrombus formation risk. Emboli can travel to the brain
causing stroke (B). Anticoagulation is essential for stroke prevention in AF. While other
arrhythmias can occur, stroke is the most significant long-term risk.
Q7: A patient with a mechanical heart valve is taking warfarin. The nurse notes an INR of 4.5.
Which action is most appropriate?
A. Administer vitamin K immediately
B. Hold the next dose and notify the provider [CORRECT]
C. Continue the current dose
D. Increase the dose to achieve therapeutic range
Correct Answer: B
Rationale: An INR of 4.5 is above the typical therapeutic range (2.0-3.0 for mechanical valves).
The nurse should hold the next warfarin dose and notify the provider to prevent bleeding
complications (B). Vitamin K (A) is reserved for serious bleeding or INR >10. Continuing (C) or
increasing (D) the dose would worsen the situation.
Q8: A patient with peripheral arterial disease reports intermittent claudication when walking
more than two blocks. Which intervention should the nurse prioritize?
A. Encourage strict bed rest
B. Teach about smoking cessation and supervised exercise [CORRECT]
