MEDSURG II - MODULE 3
COMPREHENSIVE FINAL EXAM
Course: Medical-Surgical Nursing II
Total Questions: 82
1. A nurse assesses a client with mitral valve stenosis. What clinical sign or symptom would alert the
nurse to the possibility that the client's stenosis has progressed?
a. Oxygen saturation of 92%
b. Dyspnea on exertion
c. Muted systolic murmur
d. Upper extremity weakness
Correct Answer: b. Dyspnea on exertion
Rationale: As mitral valve stenosis progresses, the valve opening narrows further, increasing pressure in
the left atrium and pulmonary circulation. This leads to worsening dyspnea, initially on exertion and
eventually at rest. While an SpO2 of 92% is abnormal, dyspnea is a direct symptom of the progressing
pathology. The murmur of stenosis is diastolic, not systolic .
2. A nurse cares for a client recovering from prosthetic valve replacement surgery. The client asks,
"Why will I need to take anticoagulants for the rest of my life?" What is the best response by the
nurse?
a. "The prosthetic valve places you at greater risk for a heart attack."
b. "Blood clots form more easily in artificial replacement valves."
c. "The vein taken from your leg reduces circulation in the leg."
d. "The surgery left a lot of small clots in your heart and lungs."
Correct Answer: b. "Blood clots form more easily in artificial replacement valves."
Rationale: Mechanical prosthetic valves are made of materials that are not recognized by the body as
"self," making them a surface where platelets can adhere and initiate clot formation. Lifelong
anticoagulation is essential to prevent thromboembolic events like stroke .
,3. After teaching a client who is being discharged home after mitral valve replacement surgery, the
nurse assesses the client's understanding. Which client statement indicates a need for additional
teaching?
a. "I'll be able to carry heavy loads after 6 months of rest."
b. "I will have my teeth cleaned by my dentist in 2 weeks."
c. "I must avoid eating foods high in vitamin K like spinach."
d. "I must use an electric razor instead of a straight razor to shave."
Correct Answer: b. "I will have my teeth cleaned by my dentist in 2 weeks."
Rationale: Clients with prosthetic valves are at high risk for infective endocarditis. Dental procedures
can introduce bacteria into the bloodstream. They require prophylactic antibiotics before any dental
cleaning or invasive procedure. Scheduling a cleaning so soon after surgery without mentioning
antibiotic prophylaxis indicates a need for more teaching .
4. A nurse assesses a client who has mitral valve regurgitation. For which cardiac dysrhythmia would
the nurse assess?
a. Premature ventricular contractions
b. Atrial fibrillation
c. Symptomatic bradycardia
d. Sinus tachycardia
Correct Answer: b. Atrial fibrillation
Rationale: Mitral valve regurgitation causes volume overload and stretching of the left atrium. This
enlargement can disrupt the electrical conduction pathways within the atrium, making it a common
substrate for the development of atrial fibrillation .
5. A nurse assesses a client with pericarditis. Which assessment finding would the nurse expect to
find?
a. Heart rate that speeds up and slows down
b. Friction rub at the left lower sternal border
c. Presence of a regular gallop rhythm
d. Coarse crackles in bilateral lung bases
Correct Answer: b. Friction rub at the left lower sternal border
Rationale: Inflammation of the pericardial layers creates a rough, scratchy sound as the heart beats. This
pericardial friction rub is best heard with the diaphragm of the stethoscope at the left lower sternal
border, especially during exhalation .
6. A nurse is caring for a client with acute pericarditis who reports substernal precordial pain that
radiates to the left side of the neck. Which non-pharmacologic comfort measure would the nurse
implement?
a. Apply an ice pack to the client's chest
b. Provide a neck rub, especially on the left side
, c. Allow the client to lie in bed with the lights down
d. Sit the client up with a pillow to lean forward on
Correct Answer: d. Sit the client up with a pillow to lean forward on
Rationale: The pain of pericarditis is often pleuritic and positional. It is typically worse when lying supine
and relieved by sitting up and leaning forward (the "pericardial position"), which reduces pressure on
the inflamed pericardial sac .
7. A nurse cares for a client with infective endocarditis. Which infection control precautions would the
nurse use?
a. Standard precautions
b. Bleeding precautions
c. Reverse isolation
d. Contact isolation
Correct Answer: a. Standard precautions
Rationale: Infective endocarditis is an infection of the endocardial surface of the heart. It is not
transmitted from person to person. Therefore, standard precautions are appropriate unless the client
has another infectious comorbidity .
8. A nurse assesses clients on a cardiac unit. Which clients would the nurse identify as at high risk for
developing infective endocarditis? (Select All That Apply)
a. A client who is an intravenous drug user
b. A client with a history of rheumatic heart disease
c. A client with a diagnosis of aortic valve stenosis
d. A client with a history of a myocardial infarction 10 years ago
e. A client who had a coronary artery bypass graft 5 years ago using a femoral vein
Correct Answers: a, b, c
Rationale: High-risk groups for infective endocarditis include IV drug users (due to repeated exposure to
bacteria), and clients with damaged or abnormal valves, such as those from rheumatic heart disease or
valve stenosis. A past MI or CABG surgery does not inherently place a client at high risk for endocarditis
unless a prosthetic valve was placed .
Topic: Dysrhythmias & Conduction Disorders (Questions 9-25)
9. A telemetry nurse assesses a client who has a heart rate of 35 bpm on the cardiac monitor. Which
assessment would the nurse complete next?
a. Pulmonary auscultation
b. Pulse strength and amplitude
c. Level of consciousness
d. Mobility and gait stability
COMPREHENSIVE FINAL EXAM
Course: Medical-Surgical Nursing II
Total Questions: 82
1. A nurse assesses a client with mitral valve stenosis. What clinical sign or symptom would alert the
nurse to the possibility that the client's stenosis has progressed?
a. Oxygen saturation of 92%
b. Dyspnea on exertion
c. Muted systolic murmur
d. Upper extremity weakness
Correct Answer: b. Dyspnea on exertion
Rationale: As mitral valve stenosis progresses, the valve opening narrows further, increasing pressure in
the left atrium and pulmonary circulation. This leads to worsening dyspnea, initially on exertion and
eventually at rest. While an SpO2 of 92% is abnormal, dyspnea is a direct symptom of the progressing
pathology. The murmur of stenosis is diastolic, not systolic .
2. A nurse cares for a client recovering from prosthetic valve replacement surgery. The client asks,
"Why will I need to take anticoagulants for the rest of my life?" What is the best response by the
nurse?
a. "The prosthetic valve places you at greater risk for a heart attack."
b. "Blood clots form more easily in artificial replacement valves."
c. "The vein taken from your leg reduces circulation in the leg."
d. "The surgery left a lot of small clots in your heart and lungs."
Correct Answer: b. "Blood clots form more easily in artificial replacement valves."
Rationale: Mechanical prosthetic valves are made of materials that are not recognized by the body as
"self," making them a surface where platelets can adhere and initiate clot formation. Lifelong
anticoagulation is essential to prevent thromboembolic events like stroke .
,3. After teaching a client who is being discharged home after mitral valve replacement surgery, the
nurse assesses the client's understanding. Which client statement indicates a need for additional
teaching?
a. "I'll be able to carry heavy loads after 6 months of rest."
b. "I will have my teeth cleaned by my dentist in 2 weeks."
c. "I must avoid eating foods high in vitamin K like spinach."
d. "I must use an electric razor instead of a straight razor to shave."
Correct Answer: b. "I will have my teeth cleaned by my dentist in 2 weeks."
Rationale: Clients with prosthetic valves are at high risk for infective endocarditis. Dental procedures
can introduce bacteria into the bloodstream. They require prophylactic antibiotics before any dental
cleaning or invasive procedure. Scheduling a cleaning so soon after surgery without mentioning
antibiotic prophylaxis indicates a need for more teaching .
4. A nurse assesses a client who has mitral valve regurgitation. For which cardiac dysrhythmia would
the nurse assess?
a. Premature ventricular contractions
b. Atrial fibrillation
c. Symptomatic bradycardia
d. Sinus tachycardia
Correct Answer: b. Atrial fibrillation
Rationale: Mitral valve regurgitation causes volume overload and stretching of the left atrium. This
enlargement can disrupt the electrical conduction pathways within the atrium, making it a common
substrate for the development of atrial fibrillation .
5. A nurse assesses a client with pericarditis. Which assessment finding would the nurse expect to
find?
a. Heart rate that speeds up and slows down
b. Friction rub at the left lower sternal border
c. Presence of a regular gallop rhythm
d. Coarse crackles in bilateral lung bases
Correct Answer: b. Friction rub at the left lower sternal border
Rationale: Inflammation of the pericardial layers creates a rough, scratchy sound as the heart beats. This
pericardial friction rub is best heard with the diaphragm of the stethoscope at the left lower sternal
border, especially during exhalation .
6. A nurse is caring for a client with acute pericarditis who reports substernal precordial pain that
radiates to the left side of the neck. Which non-pharmacologic comfort measure would the nurse
implement?
a. Apply an ice pack to the client's chest
b. Provide a neck rub, especially on the left side
, c. Allow the client to lie in bed with the lights down
d. Sit the client up with a pillow to lean forward on
Correct Answer: d. Sit the client up with a pillow to lean forward on
Rationale: The pain of pericarditis is often pleuritic and positional. It is typically worse when lying supine
and relieved by sitting up and leaning forward (the "pericardial position"), which reduces pressure on
the inflamed pericardial sac .
7. A nurse cares for a client with infective endocarditis. Which infection control precautions would the
nurse use?
a. Standard precautions
b. Bleeding precautions
c. Reverse isolation
d. Contact isolation
Correct Answer: a. Standard precautions
Rationale: Infective endocarditis is an infection of the endocardial surface of the heart. It is not
transmitted from person to person. Therefore, standard precautions are appropriate unless the client
has another infectious comorbidity .
8. A nurse assesses clients on a cardiac unit. Which clients would the nurse identify as at high risk for
developing infective endocarditis? (Select All That Apply)
a. A client who is an intravenous drug user
b. A client with a history of rheumatic heart disease
c. A client with a diagnosis of aortic valve stenosis
d. A client with a history of a myocardial infarction 10 years ago
e. A client who had a coronary artery bypass graft 5 years ago using a femoral vein
Correct Answers: a, b, c
Rationale: High-risk groups for infective endocarditis include IV drug users (due to repeated exposure to
bacteria), and clients with damaged or abnormal valves, such as those from rheumatic heart disease or
valve stenosis. A past MI or CABG surgery does not inherently place a client at high risk for endocarditis
unless a prosthetic valve was placed .
Topic: Dysrhythmias & Conduction Disorders (Questions 9-25)
9. A telemetry nurse assesses a client who has a heart rate of 35 bpm on the cardiac monitor. Which
assessment would the nurse complete next?
a. Pulmonary auscultation
b. Pulse strength and amplitude
c. Level of consciousness
d. Mobility and gait stability
