1
NUR209 EXAM 2 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 1-20)
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 potassium wasting through the
kidneys, potentially causing severe hypokalemia. A potassium level of 2.8 mEq/L is critically
low (normal 3.5-5.0 mEq/L) and increases risk of life-threatening ventricular dysrhythmias,
muscle weakness, and cardiac arrest. The nurse must immediately notify the provider and
administer potassium replacement per protocol. Sodium 135 mEq/L is low-normal; creatinine 1.0
mg/dL is normal; hemoglobin 12.5 g/dL is acceptable.
Q2: A patient with hypertension is prescribed lisinopril. Which instruction is most important for
the nurse to provide?
A. Take the medication on an empty stomach
B. Report persistent dry cough to the provider. [CORRECT]
C. Avoid all potassium-containing foods
D. Stop medication if dizziness occurs
Correct Answer: B
Rationale: Lisinopril is an ACE inhibitor; dry cough occurs in 5-20% of patients due to
,2
bradykinin accumulation and is the most common reason for discontinuation. While bothersome,
the patient should report it rather than stop abruptly. ACE inhibitors can be taken with food;
potassium restriction isn't required unless hyperkalemia develops; dizziness requires evaluation
but not automatic discontinuation.
Q3: A patient with stable angina reports chest pain during activity. Which intervention should the
nurse implement first?
A. Administer sublingual nitroglycerin. [CORRECT]
B. Call the cardiac catheterization lab
C. Prepare for thrombolytic therapy
D. Obtain a 12-lead ECG
Correct Answer: A
Rationale: For stable angina (predictable, exertion-induced chest pain relieved by rest or
nitroglycerin), the immediate intervention is sublingual nitroglycerin to dilate coronary arteries
and reduce myocardial oxygen demand. If pain persists after 3 doses 5 minutes apart, then
suspect MI and obtain ECG. Cardiac cath lab and thrombolytics are for acute MI, not stable
angina.
Q4: A patient presents with STEMI. Which medication should the nurse administer within 30
minutes of arrival per protocol?
A. Clopidogrel only
B. Aspirin 325 mg chewable. [CORRECT]
C. Warfarin loading dose
D. Heparin subcutaneous
Correct Answer: B
Rationale: Aspirin (antiplatelet) is a cornerstone of immediate STEMI management, reducing
mortality by 25% when given within 30 minutes. Unless contraindicated (allergy, active
bleeding), 325 mg chewable aspirin should be administered immediately. Clopidogrel is given in
addition to aspirin; warfarin isn't used for acute MI; heparin is given IV, not subcutaneous, for
STEMI.
Q5: A patient with heart failure has the following assessment findings: dyspnea at rest, crackles
bilaterally, JVD 6 cm, and 3+ pitting edema in lower extremities. Which classification best
describes this presentation?
, 3
A. Left-sided heart failure only
B. Right-sided heart failure only
C. Biventricular heart failure. [CORRECT]
D. Diastolic heart failure only
Correct Answer: C
Rationale: This patient exhibits both left-sided failure manifestations (pulmonary congestion:
dyspnea, crackles) and right-sided failure manifestations (systemic congestion: JVD, peripheral
edema), indicating biventricular failure. Left-sided alone would show pulmonary symptoms
without systemic congestion; right-sided alone would show systemic congestion without
pulmonary edema; diastolic failure refers to preserved EF with impaired filling.
Q6: A patient with atrial fibrillation is prescribed warfarin. Which laboratory value indicates
therapeutic anticoagulation?
A. PT 12 seconds
B. INR 2.5. [CORRECT]
C. aPTT 35 seconds
D. Platelet count 150,000/mm³
Correct Answer: B
Rationale: For atrial fibrillation stroke prevention, therapeutic warfarin anticoagulation is INR
2.0-3.0 (target 2.5). PT is less reliable due to variability between labs; aPTT monitors heparin,
not warfarin; platelet count indicates bleeding risk but not anticoagulation status. The nurse must
ensure patient understands dietary vitamin K consistency and monitoring requirements.
Q7: A patient with heart failure is prescribed carvedilol. Which assessment finding requires the
nurse to hold the dose and notify the provider?
A. Heart rate 88 bpm
B. Blood pressure 92/58 mmHg. [CORRECT]
C. Respiratory rate 18/min
D. Oxygen saturation 94%
Correct Answer: B
Correct Answer: B
Rationale: Carvedilol is a beta-blocker used in heart failure that can cause hypotension and
bradycardia. Hold parameters typically include systolic BP <90 mmHg or heart rate <60 bpm. BP
92/58 mmHg is borderline but requires notification; HR 88 is acceptable; RR 18 and SpO2 94%
are within normal limits. Beta-blockers can worsen acute decompensated heart failure and are
contraindicated in cardiogenic shock.
NUR209 EXAM 2 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 1-20)
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 potassium wasting through the
kidneys, potentially causing severe hypokalemia. A potassium level of 2.8 mEq/L is critically
low (normal 3.5-5.0 mEq/L) and increases risk of life-threatening ventricular dysrhythmias,
muscle weakness, and cardiac arrest. The nurse must immediately notify the provider and
administer potassium replacement per protocol. Sodium 135 mEq/L is low-normal; creatinine 1.0
mg/dL is normal; hemoglobin 12.5 g/dL is acceptable.
Q2: A patient with hypertension is prescribed lisinopril. Which instruction is most important for
the nurse to provide?
A. Take the medication on an empty stomach
B. Report persistent dry cough to the provider. [CORRECT]
C. Avoid all potassium-containing foods
D. Stop medication if dizziness occurs
Correct Answer: B
Rationale: Lisinopril is an ACE inhibitor; dry cough occurs in 5-20% of patients due to
,2
bradykinin accumulation and is the most common reason for discontinuation. While bothersome,
the patient should report it rather than stop abruptly. ACE inhibitors can be taken with food;
potassium restriction isn't required unless hyperkalemia develops; dizziness requires evaluation
but not automatic discontinuation.
Q3: A patient with stable angina reports chest pain during activity. Which intervention should the
nurse implement first?
A. Administer sublingual nitroglycerin. [CORRECT]
B. Call the cardiac catheterization lab
C. Prepare for thrombolytic therapy
D. Obtain a 12-lead ECG
Correct Answer: A
Rationale: For stable angina (predictable, exertion-induced chest pain relieved by rest or
nitroglycerin), the immediate intervention is sublingual nitroglycerin to dilate coronary arteries
and reduce myocardial oxygen demand. If pain persists after 3 doses 5 minutes apart, then
suspect MI and obtain ECG. Cardiac cath lab and thrombolytics are for acute MI, not stable
angina.
Q4: A patient presents with STEMI. Which medication should the nurse administer within 30
minutes of arrival per protocol?
A. Clopidogrel only
B. Aspirin 325 mg chewable. [CORRECT]
C. Warfarin loading dose
D. Heparin subcutaneous
Correct Answer: B
Rationale: Aspirin (antiplatelet) is a cornerstone of immediate STEMI management, reducing
mortality by 25% when given within 30 minutes. Unless contraindicated (allergy, active
bleeding), 325 mg chewable aspirin should be administered immediately. Clopidogrel is given in
addition to aspirin; warfarin isn't used for acute MI; heparin is given IV, not subcutaneous, for
STEMI.
Q5: A patient with heart failure has the following assessment findings: dyspnea at rest, crackles
bilaterally, JVD 6 cm, and 3+ pitting edema in lower extremities. Which classification best
describes this presentation?
, 3
A. Left-sided heart failure only
B. Right-sided heart failure only
C. Biventricular heart failure. [CORRECT]
D. Diastolic heart failure only
Correct Answer: C
Rationale: This patient exhibits both left-sided failure manifestations (pulmonary congestion:
dyspnea, crackles) and right-sided failure manifestations (systemic congestion: JVD, peripheral
edema), indicating biventricular failure. Left-sided alone would show pulmonary symptoms
without systemic congestion; right-sided alone would show systemic congestion without
pulmonary edema; diastolic failure refers to preserved EF with impaired filling.
Q6: A patient with atrial fibrillation is prescribed warfarin. Which laboratory value indicates
therapeutic anticoagulation?
A. PT 12 seconds
B. INR 2.5. [CORRECT]
C. aPTT 35 seconds
D. Platelet count 150,000/mm³
Correct Answer: B
Rationale: For atrial fibrillation stroke prevention, therapeutic warfarin anticoagulation is INR
2.0-3.0 (target 2.5). PT is less reliable due to variability between labs; aPTT monitors heparin,
not warfarin; platelet count indicates bleeding risk but not anticoagulation status. The nurse must
ensure patient understands dietary vitamin K consistency and monitoring requirements.
Q7: A patient with heart failure is prescribed carvedilol. Which assessment finding requires the
nurse to hold the dose and notify the provider?
A. Heart rate 88 bpm
B. Blood pressure 92/58 mmHg. [CORRECT]
C. Respiratory rate 18/min
D. Oxygen saturation 94%
Correct Answer: B
Correct Answer: B
Rationale: Carvedilol is a beta-blocker used in heart failure that can cause hypotension and
bradycardia. Hold parameters typically include systolic BP <90 mmHg or heart rate <60 bpm. BP
92/58 mmHg is borderline but requires notification; HR 88 is acceptable; RR 18 and SpO2 94%
are within normal limits. Beta-blockers can worsen acute decompensated heart failure and are
contraindicated in cardiogenic shock.
