NU 185 Exam 2 (2026/2027)
Medical-Surgical Nursing II
Cardiovascular, Respiratory, Hematologic & Fluid-Electrolyte Disorders
100% Accurate Answers with Rationales
Course: NU 185
Academic Year: 2026-2027
Total Questions: 65
, NU 185 Exam 2 | Medical-Surgical Nursing II
Table of Contents
Table of Contents .................................................................................................................................. 2
Section I: Cardiovascular Disorders ................................................................................................... 1
Section II: Respiratory Disorders ...................................................................................................... 13
Section III: Hematologic Disorders ................................................................................................... 21
Section IV: Fluid, Electrolyte & Acid-Base Imbalances.................................................................. 27
2
, NU 185 Exam 2 | Medical-Surgical Nursing II
Section I: Cardiovascular Disorders
1. A 52-year-old male patient is diagnosed with primary hypertension after multiple elevated
blood pressure readings averaging 158/96 mmHg. The patient has no identifiable cause for his
hypertension. Which lifestyle modification should the nurse prioritize when providing health
education?
A. Increase sodium intake to maintain vascular B. Adopt the DASH diet, reduce sodium to less
volume and prevent orthostatic hypotension than 2,300 mg/day, and engage in 150 minutes of
moderate aerobic exercise weekly
C. Eliminate all caffeine intake and begin a high- D. Restrict all physical activity to prevent
protein diet to reduce cardiac workload exertional increases in blood pressure
Correct Answer: B. Adopt the DASH diet, reduce sodium to less than 2,300 mg/day, and engage
in 150 minutes of moderate aerobic exercise weekly
Rationale: The DASH (Dietary Approaches to Stop Hypertension) diet combined with sodium
restriction to less than 2,300 mg/day and regular moderate aerobic exercise (150 minutes per week)
are first-line lifestyle modifications per JNC 8 and AHA guidelines for primary hypertension. These
interventions can lower systolic BP by 8-14 mmHg. Sodium should be restricted, not increased.
Caffeine moderation is reasonable but not the priority. Physical activity should be encouraged, not
restricted, as exercise lowers blood pressure.
2. A patient is prescribed lisinopril, an ACE inhibitor, for hypertension management. Which
instruction should the nurse include in the discharge teaching?
A. Expect a persistent dry cough and continue the B. Report signs of angioedema such as lip, tongue,
medication; the cough is harmless or throat swelling immediately and seek
emergency care
C. Increase potassium-rich foods in the diet to D. Take the medication with potassium
prevent hypokalemia caused by ACE inhibitors supplements to enhance its antihypertensive effect
Correct Answer: B. Report signs of angioedema such as lip, tongue, or throat swelling
immediately and seek emergency care
Rationale: ACE inhibitors like lisinopril carry a black box warning for angioedema, which involves
swelling of the lips, tongue, throat, and face and can compromise the airway. Patients must be
instructed to stop the drug and seek emergency care immediately if angioedema occurs. While a dry
cough is a common side effect (10-15% of patients), if it is intolerable the provider may switch to an
1
, NU 185 Exam 2 | Medical-Surgical Nursing II
ARB. ACE inhibitors cause hyperkalemia, not hypokalemia, so potassium supplements should be
avoided. Patients should avoid salt substitutes high in potassium.
3. A 45-year-old female patient presents with blood pressure of 210/130 mmHg, severe
headache, visual disturbances, and confusion. She has a history of chronic kidney disease.
Which condition does this presentation MOST likely indicate, and what is the initial treatment
priority?
A. Hypertensive urgency; administer oral B. Hypertensive emergency; initiate IV
clonidine and schedule a follow-up in one week antihypertensive therapy and reduce mean arterial
pressure by no more than 25% in the first hour
C. Essential hypertension; increase her current D. White coat hypertension; reassure the patient
dose of oral amlodipine and monitor at home and repeat BP measurement in one month
Correct Answer: B. Hypertensive emergency; initiate IV antihypertensive therapy and reduce
mean arterial pressure by no more than 25% in the first hour
Rationale: This patient meets criteria for a hypertensive emergency: severely elevated BP (≥180/120
mmHg) with target organ damage (encephalopathy—headache, visual changes, confusion). The
initial treatment priority is IV antihypertensive therapy (such as nitroprusside, labetalol, or
nicardipine) with careful BP reduction. Current guidelines recommend reducing MAP by no more
than 25% in the first hour to prevent cerebral hypoperfusion. Hypertensive urgency lacks end-organ
damage and is treated with oral agents. This is not white coat hypertension given the severe
symptoms.
4. A patient with hypertension is switched from lisinopril to losartan. The nurse understands
that losartan is preferred in this situation for which reason?
A. Losartan provides faster blood pressure B. Losartan blocks the angiotensin II receptor
reduction than ACE inhibitors directly and has a lower incidence of cough and
angioedema compared to ACE inhibitors
C. Losartan does not affect potassium levels, D. Losartan provides better renal protection than
making it safer for patients with renal disease ACE inhibitors in diabetic patients
Correct Answer: B. Losartan blocks the angiotensin II receptor directly and has a lower
incidence of cough and angioedema compared to ACE inhibitors
Rationale: Angiotensin II receptor blockers (ARBs) like losartan block the angiotensin II type 1 (AT1)
receptor directly, preventing angiotensin II-mediated vasoconstriction and aldosterone release. ARBs
have a significantly lower incidence of ACE inhibitor-associated cough and angioedema because they
do not affect bradykinin metabolism. ARBs still raise potassium levels and require similar monitoring
2
Medical-Surgical Nursing II
Cardiovascular, Respiratory, Hematologic & Fluid-Electrolyte Disorders
100% Accurate Answers with Rationales
Course: NU 185
Academic Year: 2026-2027
Total Questions: 65
, NU 185 Exam 2 | Medical-Surgical Nursing II
Table of Contents
Table of Contents .................................................................................................................................. 2
Section I: Cardiovascular Disorders ................................................................................................... 1
Section II: Respiratory Disorders ...................................................................................................... 13
Section III: Hematologic Disorders ................................................................................................... 21
Section IV: Fluid, Electrolyte & Acid-Base Imbalances.................................................................. 27
2
, NU 185 Exam 2 | Medical-Surgical Nursing II
Section I: Cardiovascular Disorders
1. A 52-year-old male patient is diagnosed with primary hypertension after multiple elevated
blood pressure readings averaging 158/96 mmHg. The patient has no identifiable cause for his
hypertension. Which lifestyle modification should the nurse prioritize when providing health
education?
A. Increase sodium intake to maintain vascular B. Adopt the DASH diet, reduce sodium to less
volume and prevent orthostatic hypotension than 2,300 mg/day, and engage in 150 minutes of
moderate aerobic exercise weekly
C. Eliminate all caffeine intake and begin a high- D. Restrict all physical activity to prevent
protein diet to reduce cardiac workload exertional increases in blood pressure
Correct Answer: B. Adopt the DASH diet, reduce sodium to less than 2,300 mg/day, and engage
in 150 minutes of moderate aerobic exercise weekly
Rationale: The DASH (Dietary Approaches to Stop Hypertension) diet combined with sodium
restriction to less than 2,300 mg/day and regular moderate aerobic exercise (150 minutes per week)
are first-line lifestyle modifications per JNC 8 and AHA guidelines for primary hypertension. These
interventions can lower systolic BP by 8-14 mmHg. Sodium should be restricted, not increased.
Caffeine moderation is reasonable but not the priority. Physical activity should be encouraged, not
restricted, as exercise lowers blood pressure.
2. A patient is prescribed lisinopril, an ACE inhibitor, for hypertension management. Which
instruction should the nurse include in the discharge teaching?
A. Expect a persistent dry cough and continue the B. Report signs of angioedema such as lip, tongue,
medication; the cough is harmless or throat swelling immediately and seek
emergency care
C. Increase potassium-rich foods in the diet to D. Take the medication with potassium
prevent hypokalemia caused by ACE inhibitors supplements to enhance its antihypertensive effect
Correct Answer: B. Report signs of angioedema such as lip, tongue, or throat swelling
immediately and seek emergency care
Rationale: ACE inhibitors like lisinopril carry a black box warning for angioedema, which involves
swelling of the lips, tongue, throat, and face and can compromise the airway. Patients must be
instructed to stop the drug and seek emergency care immediately if angioedema occurs. While a dry
cough is a common side effect (10-15% of patients), if it is intolerable the provider may switch to an
1
, NU 185 Exam 2 | Medical-Surgical Nursing II
ARB. ACE inhibitors cause hyperkalemia, not hypokalemia, so potassium supplements should be
avoided. Patients should avoid salt substitutes high in potassium.
3. A 45-year-old female patient presents with blood pressure of 210/130 mmHg, severe
headache, visual disturbances, and confusion. She has a history of chronic kidney disease.
Which condition does this presentation MOST likely indicate, and what is the initial treatment
priority?
A. Hypertensive urgency; administer oral B. Hypertensive emergency; initiate IV
clonidine and schedule a follow-up in one week antihypertensive therapy and reduce mean arterial
pressure by no more than 25% in the first hour
C. Essential hypertension; increase her current D. White coat hypertension; reassure the patient
dose of oral amlodipine and monitor at home and repeat BP measurement in one month
Correct Answer: B. Hypertensive emergency; initiate IV antihypertensive therapy and reduce
mean arterial pressure by no more than 25% in the first hour
Rationale: This patient meets criteria for a hypertensive emergency: severely elevated BP (≥180/120
mmHg) with target organ damage (encephalopathy—headache, visual changes, confusion). The
initial treatment priority is IV antihypertensive therapy (such as nitroprusside, labetalol, or
nicardipine) with careful BP reduction. Current guidelines recommend reducing MAP by no more
than 25% in the first hour to prevent cerebral hypoperfusion. Hypertensive urgency lacks end-organ
damage and is treated with oral agents. This is not white coat hypertension given the severe
symptoms.
4. A patient with hypertension is switched from lisinopril to losartan. The nurse understands
that losartan is preferred in this situation for which reason?
A. Losartan provides faster blood pressure B. Losartan blocks the angiotensin II receptor
reduction than ACE inhibitors directly and has a lower incidence of cough and
angioedema compared to ACE inhibitors
C. Losartan does not affect potassium levels, D. Losartan provides better renal protection than
making it safer for patients with renal disease ACE inhibitors in diabetic patients
Correct Answer: B. Losartan blocks the angiotensin II receptor directly and has a lower
incidence of cough and angioedema compared to ACE inhibitors
Rationale: Angiotensin II receptor blockers (ARBs) like losartan block the angiotensin II type 1 (AT1)
receptor directly, preventing angiotensin II-mediated vasoconstriction and aldosterone release. ARBs
have a significantly lower incidence of ACE inhibitor-associated cough and angioedema because they
do not affect bradykinin metabolism. ARBs still raise potassium levels and require similar monitoring
2
