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MDC 2 - MEDICAL-SURGICAL
NURSING 2 EXAM: 100 QUESTIONS
WITH ANSWERS & RATIONALES
Topics:
Cardiovascular,
Respiratory,
Endocrine,
Renal,
Neurological,
Fluid/Electrolytes,
Pharmacology
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SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-22)
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QUESTION 1
A client with heart failure is prescribed furosemide (Lasix) 40 mg IV. Which
assessment finding requires the nurse to notify the provider BEFORE administering
the medication?
A) Blood pressure of 138/88 mmHg
B) Serum potassium of 3.1 mEq/L
C) Urine output of 50 mL/hour
D) Weight gain of 0.5 kg since yesterday
ANSWER: B
,RATIONALE: A serum potassium of 3.1 mEq/L indicates hypokalemia (normal 3.5-5.0
mEq/L). Furosemide is a loop diuretic that causes potassium wasting. Administering
furosemide with an already low potassium level places the client at risk for severe
hypokalemia, which can precipitate life-threatening cardiac dysrhythmias. The
provider must be notified for potassium replacement prior to or concurrent with
diuretic administration.
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QUESTION 2
A nurse is caring for a client who had an acute myocardial infarction (MI) 24
hours ago. The client suddenly becomes restless and reports chest pain. The
12-lead ECG shows new ST elevation in leads V1-V4. What is the nurse's PRIORITY
action?
A) Administer supplemental oxygen at 2 L/min via nasal cannula
B) Call a rapid response and notify the provider immediately
C) Obtain a 12-lead ECG and compare with the baseline
D) Administer sublingual nitroglycerin and reassess
ANSWER: B
RATIONALE: New ST elevation following an MI is a medical emergency indicating
possible re-infarction or extension of the MI. The nurse's priority action is
to activate the rapid response team and notify the provider immediately. Time
is critical ("time is muscle") as reperfusion therapy must be initiated rapidly.
While oxygen and nitroglycerin may be ordered, mobilizing the team comes first.
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QUESTION 3
A client with chronic heart failure has been prescribed carvedilol (Coreg). The
client asks why they are taking a beta-blocker for heart failure when they thought
beta-blockers slowed the heart. Which response by the nurse is BEST?
A) "Beta-blockers are used only short-term until another medication works."
,B) "Carvedilol blocks the effects of adrenaline, reducing cardiac workload and
slowing disease progression over time."
C) "Your doctor made an error - beta-blockers are usually contraindicated in
heart failure."
D) "Carvedilol increases your heart rate to improve cardiac output."
ANSWER: B
RATIONALE: Carvedilol (a non-selective beta-blocker) is used in stable heart
failure to reduce the harmful effects of chronic sympathetic nervous system
activation (adrenaline/norepinephrine), which over time causes cardiac remodeling.
Beta-blockers reduce heart rate, decrease myocardial oxygen demand, and have been
shown to reduce mortality and slow disease progression in heart failure patients.
They are now a cornerstone of heart failure with reduced ejection fraction (HFrEF)
therapy.
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QUESTION 4
The nurse is assessing a client with left-sided heart failure. Which clinical
findings are MOST consistent with this condition? (Select all that apply as
the single best answer)
A) Jugular venous distension and peripheral edema
B) Crackles in the lungs, orthopnea, and pink frothy sputum
C) Ascites, hepatomegaly, and anorexia
D) Bradycardia and hypotension
ANSWER: B
RATIONALE: Left-sided heart failure causes blood to back up into the pulmonary
circulation, resulting in pulmonary congestion. Classic signs include crackles
(rales) due to pulmonary edema, orthopnea (difficulty breathing when lying flat),
paroxysmal nocturnal dyspnea, and in severe cases, pink frothy sputum indicating
pulmonary edema. Options A and C are signs of right-sided heart failure (systemic
venous congestion).
, --------------------------------------------------------------------------------
QUESTION 5
A client is admitted with unstable angina. The nurse anticipates which medication
to be included in the treatment plan?
A) Aspirin, heparin, and nitroglycerin
B) Warfarin, digoxin, and morphine
C) Metformin, amlodipine, and furosemide
D) Alteplase, clopidogrel, and nifedipine
ANSWER: A
RATIONALE: The standard initial management of unstable angina includes: Aspirin
(antiplatelet to prevent thrombus formation), heparin (anticoagulation to prevent
thrombus extension), and nitroglycerin (vasodilation to reduce preload and relieve
chest pain). These agents address the underlying pathophysiology of unstable angina,
which involves plaque rupture and partial coronary artery occlusion.
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QUESTION 6
A client is admitted with atrial fibrillation with a ventricular rate of 148 bpm.
The client is hemodynamically stable. Which medication does the nurse anticipate
will be prescribed FIRST?
A) Amiodarone IV
B) Adenosine IV push
C) Synchronized cardioversion
D) Diltiazem IV infusion
ANSWER: D
RATIONALE: In hemodynamically stable atrial fibrillation with rapid ventricular
response, rate control is the initial priority. Diltiazem (a calcium channel
blocker) or beta-blockers are first-line agents for rate control. Amiodarone
======================================
====
MDC 2 - MEDICAL-SURGICAL
NURSING 2 EXAM: 100 QUESTIONS
WITH ANSWERS & RATIONALES
Topics:
Cardiovascular,
Respiratory,
Endocrine,
Renal,
Neurological,
Fluid/Electrolytes,
Pharmacology
======================================
======================================
====
--------------------------------------------------------------------------------
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-22)
--------------------------------------------------------------------------------
QUESTION 1
A client with heart failure is prescribed furosemide (Lasix) 40 mg IV. Which
assessment finding requires the nurse to notify the provider BEFORE administering
the medication?
A) Blood pressure of 138/88 mmHg
B) Serum potassium of 3.1 mEq/L
C) Urine output of 50 mL/hour
D) Weight gain of 0.5 kg since yesterday
ANSWER: B
,RATIONALE: A serum potassium of 3.1 mEq/L indicates hypokalemia (normal 3.5-5.0
mEq/L). Furosemide is a loop diuretic that causes potassium wasting. Administering
furosemide with an already low potassium level places the client at risk for severe
hypokalemia, which can precipitate life-threatening cardiac dysrhythmias. The
provider must be notified for potassium replacement prior to or concurrent with
diuretic administration.
--------------------------------------------------------------------------------
QUESTION 2
A nurse is caring for a client who had an acute myocardial infarction (MI) 24
hours ago. The client suddenly becomes restless and reports chest pain. The
12-lead ECG shows new ST elevation in leads V1-V4. What is the nurse's PRIORITY
action?
A) Administer supplemental oxygen at 2 L/min via nasal cannula
B) Call a rapid response and notify the provider immediately
C) Obtain a 12-lead ECG and compare with the baseline
D) Administer sublingual nitroglycerin and reassess
ANSWER: B
RATIONALE: New ST elevation following an MI is a medical emergency indicating
possible re-infarction or extension of the MI. The nurse's priority action is
to activate the rapid response team and notify the provider immediately. Time
is critical ("time is muscle") as reperfusion therapy must be initiated rapidly.
While oxygen and nitroglycerin may be ordered, mobilizing the team comes first.
--------------------------------------------------------------------------------
QUESTION 3
A client with chronic heart failure has been prescribed carvedilol (Coreg). The
client asks why they are taking a beta-blocker for heart failure when they thought
beta-blockers slowed the heart. Which response by the nurse is BEST?
A) "Beta-blockers are used only short-term until another medication works."
,B) "Carvedilol blocks the effects of adrenaline, reducing cardiac workload and
slowing disease progression over time."
C) "Your doctor made an error - beta-blockers are usually contraindicated in
heart failure."
D) "Carvedilol increases your heart rate to improve cardiac output."
ANSWER: B
RATIONALE: Carvedilol (a non-selective beta-blocker) is used in stable heart
failure to reduce the harmful effects of chronic sympathetic nervous system
activation (adrenaline/norepinephrine), which over time causes cardiac remodeling.
Beta-blockers reduce heart rate, decrease myocardial oxygen demand, and have been
shown to reduce mortality and slow disease progression in heart failure patients.
They are now a cornerstone of heart failure with reduced ejection fraction (HFrEF)
therapy.
--------------------------------------------------------------------------------
QUESTION 4
The nurse is assessing a client with left-sided heart failure. Which clinical
findings are MOST consistent with this condition? (Select all that apply as
the single best answer)
A) Jugular venous distension and peripheral edema
B) Crackles in the lungs, orthopnea, and pink frothy sputum
C) Ascites, hepatomegaly, and anorexia
D) Bradycardia and hypotension
ANSWER: B
RATIONALE: Left-sided heart failure causes blood to back up into the pulmonary
circulation, resulting in pulmonary congestion. Classic signs include crackles
(rales) due to pulmonary edema, orthopnea (difficulty breathing when lying flat),
paroxysmal nocturnal dyspnea, and in severe cases, pink frothy sputum indicating
pulmonary edema. Options A and C are signs of right-sided heart failure (systemic
venous congestion).
, --------------------------------------------------------------------------------
QUESTION 5
A client is admitted with unstable angina. The nurse anticipates which medication
to be included in the treatment plan?
A) Aspirin, heparin, and nitroglycerin
B) Warfarin, digoxin, and morphine
C) Metformin, amlodipine, and furosemide
D) Alteplase, clopidogrel, and nifedipine
ANSWER: A
RATIONALE: The standard initial management of unstable angina includes: Aspirin
(antiplatelet to prevent thrombus formation), heparin (anticoagulation to prevent
thrombus extension), and nitroglycerin (vasodilation to reduce preload and relieve
chest pain). These agents address the underlying pathophysiology of unstable angina,
which involves plaque rupture and partial coronary artery occlusion.
--------------------------------------------------------------------------------
QUESTION 6
A client is admitted with atrial fibrillation with a ventricular rate of 148 bpm.
The client is hemodynamically stable. Which medication does the nurse anticipate
will be prescribed FIRST?
A) Amiodarone IV
B) Adenosine IV push
C) Synchronized cardioversion
D) Diltiazem IV infusion
ANSWER: D
RATIONALE: In hemodynamically stable atrial fibrillation with rapid ventricular
response, rate control is the initial priority. Diltiazem (a calcium channel
blocker) or beta-blockers are first-line agents for rate control. Amiodarone
