NU 189 / NU189 EXAM 4 MEDICAL-SURGICAL NURSING
II COMPREHENSIVE EXAMINATION QUESTIONS &
ANSWERS WITH RATIONALE ACTUAL 2026!!!
1. A patient with angina reports chest pain that started 10 minutes ago. Which action should the nurse
take first?
A. Administer morphine sulfate 4 mg IV push
B. Apply oxygen at 2 L/min via nasal cannula
C. Obtain a 12-lead electrocardiogram
D. Administer sublingual nitroglycerin 0.4 mg
ANSWER: B. Apply oxygen at 2 L/min via nasal cannula
Rationale: Oxygen administration is the priority intervention for angina to increase myocardial oxygen
supply and reduce ischemic pain. While nitroglycerin is also indicated, the initial action should be to
ensure adequate oxygenation. Morphine may be given if pain persists, and ECG should be obtained
promptly, but oxygen application is the immediate first step.
2. A patient prescribed nitroglycerin (NTG) sublingual tablets asks the nurse how many tablets can be
taken before calling the healthcare provider. Which response is correct?
A. "You may take up to 5 tablets before calling your provider"
B. "Take 1 tablet every 5 minutes for up to 3 doses, then call if pain persists"
C. "Take 2 tablets immediately and call the provider right away"
D. "There is no limit; take as needed for chest pain"
ANSWER: B. "Take 1 tablet every 5 minutes for up to 3 doses, then call if pain persists"
,Rationale: The standard protocol for sublingual nitroglycerin is to take one tablet every 5 minutes, up to
a maximum of three doses. If chest pain persists after three doses, the patient should call the healthcare
provider or seek emergency medical attention. Taking more than three doses without medical
supervision can lead to severe hypotension.
3. The nurse is reviewing cardiac biomarker results. Which laboratory value is most specific for
myocardial injury?
A. C-reactive protein (CRP)
B. Brain natriuretic peptide (BNP)
C. Troponin I
D. Creatine kinase-MB (CK-MB)
ANSWER: C. Troponin I
Rationale: Troponin I and T are the most specific cardiac biomarkers for myocardial injury. They are not
normally found in blood and rise within 3-4 hours of myocardial injury, remaining elevated for up to 10-
14 days. CRP is a marker of inflammation, BNP indicates heart failure, and CK-MB is less specific than
troponin for cardiac injury.
4. A patient with heart failure is exhibiting signs of fluid overload. Which assessment finding would the
nurse expect?
A. Decreased jugular venous pressure
B. Crackles in the lung bases
C. Thready peripheral pulses
D. Decreased blood pressure
ANSWER: B. Crackles in the lung bases
,Rationale: Crackles (rales) in the lung bases are a classic sign of pulmonary congestion in heart failure
due to fluid accumulation in the alveoli. Jugular venous pressure would be increased, not decreased.
Peripheral pulses may be bounding due to fluid volume excess. Blood pressure may be elevated initially
or normal, but not decreased.
5. The nurse is positioning a patient with severe heart failure. Which position provides the greatest
benefit for this patient?
A. Supine position with legs elevated
B. Left lateral recumbent position
C. High Fowler's position
D. Trendelenburg position
ANSWER: C. High Fowler's position
Rationale: High Fowler's position (sitting upright at 90 degrees) decreases venous return to the heart,
reduces preload, and decreases myocardial oxygen demand. This position also allows for better lung
expansion and improved gas exchange in patients with heart failure and pulmonary congestion.
6. A patient with stage D heart failure is placed on a fluid restriction. Which statement by the patient
indicates understanding of the dietary teaching?
A. "I can drink as much as I want as long as it's water"
B. "I should limit my total fluid intake to about 2 liters per day"
C. "Fluid restriction only applies to beverages, not foods like soup"
D. "I can have unlimited ice chips since they are not liquid"
ANSWER: B. "I should limit my total fluid intake to about 2 liters per day"
Rationale: Patients with stage D heart failure typically require fluid restriction to 1.5-2 liters per day to
prevent fluid overload and worsening symptoms. All fluids including soups, gelatin, ice cream, and ice
, chips must be counted toward the daily limit. Patients should be educated about measuring and tracking
all fluid intake.
7. A patient is diagnosed with peripheral arterial disease (PAD). The nurse expects which characteristic
symptom during assessment?
A. Intermittent claudication with exercise
B. Bilateral lower extremity edema
C. Warm, erythematous skin on the feet
D. Visible varicose veins
ANSWER: A. Intermittent claudication with exercise
Rationale: Intermittent claudication, characterized by muscle pain, cramping, or fatigue in the lower
extremities that occurs with exercise and is relieved by rest, is the hallmark symptom of PAD. This occurs
because narrowed arteries cannot supply adequate blood flow during increased metabolic demand.
8. The nurse is developing an exercise plan for a patient with peripheral arterial disease (PAD). Which
recommendation is most appropriate?
A. Bed rest with limited activity
B. Walking 30-45 minutes, 3 times per week
C. High-intensity interval training daily
D. Weight lifting to improve circulation
ANSWER: B. Walking 30-45 minutes, 3 times per week
Rationale: Walking exercise is the most effective nonpharmacologic treatment for PAD. The
recommended regimen is 30-45 minutes of walking, 3-4 times per week. This promotes collateral
circulation development, improves walking distance, and reduces symptoms. Patients should walk to the
point of claudication, rest until symptoms resolve, then resume walking.
II COMPREHENSIVE EXAMINATION QUESTIONS &
ANSWERS WITH RATIONALE ACTUAL 2026!!!
1. A patient with angina reports chest pain that started 10 minutes ago. Which action should the nurse
take first?
A. Administer morphine sulfate 4 mg IV push
B. Apply oxygen at 2 L/min via nasal cannula
C. Obtain a 12-lead electrocardiogram
D. Administer sublingual nitroglycerin 0.4 mg
ANSWER: B. Apply oxygen at 2 L/min via nasal cannula
Rationale: Oxygen administration is the priority intervention for angina to increase myocardial oxygen
supply and reduce ischemic pain. While nitroglycerin is also indicated, the initial action should be to
ensure adequate oxygenation. Morphine may be given if pain persists, and ECG should be obtained
promptly, but oxygen application is the immediate first step.
2. A patient prescribed nitroglycerin (NTG) sublingual tablets asks the nurse how many tablets can be
taken before calling the healthcare provider. Which response is correct?
A. "You may take up to 5 tablets before calling your provider"
B. "Take 1 tablet every 5 minutes for up to 3 doses, then call if pain persists"
C. "Take 2 tablets immediately and call the provider right away"
D. "There is no limit; take as needed for chest pain"
ANSWER: B. "Take 1 tablet every 5 minutes for up to 3 doses, then call if pain persists"
,Rationale: The standard protocol for sublingual nitroglycerin is to take one tablet every 5 minutes, up to
a maximum of three doses. If chest pain persists after three doses, the patient should call the healthcare
provider or seek emergency medical attention. Taking more than three doses without medical
supervision can lead to severe hypotension.
3. The nurse is reviewing cardiac biomarker results. Which laboratory value is most specific for
myocardial injury?
A. C-reactive protein (CRP)
B. Brain natriuretic peptide (BNP)
C. Troponin I
D. Creatine kinase-MB (CK-MB)
ANSWER: C. Troponin I
Rationale: Troponin I and T are the most specific cardiac biomarkers for myocardial injury. They are not
normally found in blood and rise within 3-4 hours of myocardial injury, remaining elevated for up to 10-
14 days. CRP is a marker of inflammation, BNP indicates heart failure, and CK-MB is less specific than
troponin for cardiac injury.
4. A patient with heart failure is exhibiting signs of fluid overload. Which assessment finding would the
nurse expect?
A. Decreased jugular venous pressure
B. Crackles in the lung bases
C. Thready peripheral pulses
D. Decreased blood pressure
ANSWER: B. Crackles in the lung bases
,Rationale: Crackles (rales) in the lung bases are a classic sign of pulmonary congestion in heart failure
due to fluid accumulation in the alveoli. Jugular venous pressure would be increased, not decreased.
Peripheral pulses may be bounding due to fluid volume excess. Blood pressure may be elevated initially
or normal, but not decreased.
5. The nurse is positioning a patient with severe heart failure. Which position provides the greatest
benefit for this patient?
A. Supine position with legs elevated
B. Left lateral recumbent position
C. High Fowler's position
D. Trendelenburg position
ANSWER: C. High Fowler's position
Rationale: High Fowler's position (sitting upright at 90 degrees) decreases venous return to the heart,
reduces preload, and decreases myocardial oxygen demand. This position also allows for better lung
expansion and improved gas exchange in patients with heart failure and pulmonary congestion.
6. A patient with stage D heart failure is placed on a fluid restriction. Which statement by the patient
indicates understanding of the dietary teaching?
A. "I can drink as much as I want as long as it's water"
B. "I should limit my total fluid intake to about 2 liters per day"
C. "Fluid restriction only applies to beverages, not foods like soup"
D. "I can have unlimited ice chips since they are not liquid"
ANSWER: B. "I should limit my total fluid intake to about 2 liters per day"
Rationale: Patients with stage D heart failure typically require fluid restriction to 1.5-2 liters per day to
prevent fluid overload and worsening symptoms. All fluids including soups, gelatin, ice cream, and ice
, chips must be counted toward the daily limit. Patients should be educated about measuring and tracking
all fluid intake.
7. A patient is diagnosed with peripheral arterial disease (PAD). The nurse expects which characteristic
symptom during assessment?
A. Intermittent claudication with exercise
B. Bilateral lower extremity edema
C. Warm, erythematous skin on the feet
D. Visible varicose veins
ANSWER: A. Intermittent claudication with exercise
Rationale: Intermittent claudication, characterized by muscle pain, cramping, or fatigue in the lower
extremities that occurs with exercise and is relieved by rest, is the hallmark symptom of PAD. This occurs
because narrowed arteries cannot supply adequate blood flow during increased metabolic demand.
8. The nurse is developing an exercise plan for a patient with peripheral arterial disease (PAD). Which
recommendation is most appropriate?
A. Bed rest with limited activity
B. Walking 30-45 minutes, 3 times per week
C. High-intensity interval training daily
D. Weight lifting to improve circulation
ANSWER: B. Walking 30-45 minutes, 3 times per week
Rationale: Walking exercise is the most effective nonpharmacologic treatment for PAD. The
recommended regimen is 30-45 minutes of walking, 3-4 times per week. This promotes collateral
circulation development, improves walking distance, and reduces symptoms. Patients should walk to the
point of claudication, rest until symptoms resolve, then resume walking.
