Exam 1: NU 189 / NU189 (Latest 2026/2027) Medical-Surgical Nursing II | Test Review Questions & Answers | 100 % Correct | Grade A - Galen
2026/2027
OBJECTIVE ASSESSMENT - EXAM
Exam 1: NU 189 / NU189 (Latest 2026/2027)
Medical-Surgical Nursing II | Test Review Questions
& Answers | 100 % Correct | Grade A - Galen
2026/2027
75 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular Disorders & Management Neurological Disorders & Assessment
Respiratory Disorders & Critical Care Gastrointestinal & Renal Disorders
Endocrine Disorders & Pharmacology Perioperative & Emergency Nursing
COVER PAGE - 1
, SECTION 1 | Cardiovascular Disorders | Q1-Q15 | Exam 1: NU 189 / NU189 (Latest 2026/2027) Medical-Surgical Nursing II |
Test Review Questions & Answers | 100 % Correct | Grade A - Galen 2026/2027 2026/2027
Q1 Question 1 of 75
Q1. A 68-year-old patient admitted with heart failure reports increasing shortness of breath over the past three
days and notes that their shoes feel unusually tight. The nurse assesses bilateral ankle edema and a weight
gain of 2.3 kg since the last clinic visit five days ago. Which nursing intervention should the nurse prioritize for
this patient?
A. Obtain a 12-lead electrocardiogram and notify the healthcare provider
B. Administer prescribed sublingual nitroglycerin immediately
C. Place the patient in high-Fowler's position and provide supplemental oxygen
D. Restrict fluid intake to 1500 mL per 24 hours
Correct Answer: D
Rationale:
Fluid restriction is the priority intervention for a heart failure patient exhibiting signs of volume overload, including rapid weight
gain and peripheral edema. High-Fowler's positioning and oxygen provide symptomatic relief but do not address the
underlying fluid retention. Nitroglycerin is indicated for acute chest pain rather than fluid overload alone. An ECG is important
but is not the immediate priority over addressing the fluid imbalance.
Q2 Question 2 of 75
Q2. A 72-year-old woman returns to the cardiac unit following transcatheter aortic valve replacement. The
nurse notes a new onset of cool, pulseless right lower extremity with mottled skin appearance on assessment.
Which action should the nurse take first?
A. Apply warm blankets to the affected extremity and reassess in 30 minutes
B. Document the finding and reassess the extremity in one hour
C. Reposition the patient to a left lateral position to improve circulation
D. Notify the surgeon immediately of suspected arterial embolization
Correct Answer: D
Rationale:
A pulseless, cool, mottled extremity after TAVR suggests arterial embolization, which is a surgical emergency requiring
immediate notification of the surgeon. Warm blankets will not restore arterial blood flow to an occluded vessel. Repositioning
will not resolve an acute arterial occlusion. Delaying notification risks permanent limb ischemia and potential amputation.
Q3 Question 3 of 75
Q3. A 55-year-old patient receiving warfarin therapy for deep vein thrombosis has an International Normalized
Ratio of 4.2. The patient reports no signs of bleeding, but recent blood work shows a hemoglobin of 8.5 g/dL.
Which intervention should the nurse anticipate?
A. Administer protamine sulfate subcutaneously and continue warfarin therapy
B. Administer fresh frozen plasma and protamine sulfate immediately
C. Reduce the warfarin dose by fifty percent and recheck INR in one week
D. Administer intravenous vitamin K and hold the next dose of warfarin
Correct Answer: D
Rationale:
An INR of 4.2 significantly exceeds the therapeutic range of 2.0 to 3.0 for DVT treatment, indicating a high bleeding risk that
requires vitamin K to promote clotting factor synthesis. Warfarin should be held until the INR returns to a therapeutic level.
Protamine sulfate is the reversal agent for heparin, not warfarin. Fresh frozen plasma is reserved for active bleeding, not
asymptomatic elevation.
Exam 1: NU 189 / NU189 (Latest 2026/2027) Medical-Surgical Nursing II | Test Review Questions & Answers | 100 % Correct | Grade A - Galen 2026/2027 - 2026/2027 | P
, Q4 Question 4 of 75
Q4. A 60-year-old patient arrives at the emergency department with crushing substernal chest pain that began
45 minutes ago and radiates to the left arm. Initial troponin I is 0.04 ng/mL and myoglobin is elevated above
normal limits. Which diagnostic finding is most critical for determining immediate treatment?
A. Creatine kinase-MB level to be drawn in six hours for comparison
B. Complete blood count with differential to check for infection
C. B-type natriuretic peptide level to assess heart failure severity
D. ST-segment elevation on the 12-lead electrocardiogram
Correct Answer: D
Rationale:
ST-segment elevation on the ECG identifies ST-elevation myocardial infarction, which requires immediate reperfusion
therapy through percutaneous coronary intervention or thrombolytics. Troponin elevation confirms myocardial injury but takes
hours to peak and cannot guide immediate reperfusion decisions. CK-MB is less specific than troponin. BNP is used for heart
failure assessment, not acute coronary syndrome evaluation.
Q5 Question 5 of 75
Q5. A 76-year-old patient with acute pulmonary edema is experiencing severe dyspnea and is producing pink
frothy sputum. The patient's blood pressure is 190/110 mmHg and oxygen saturation is 82% on room air. Which
medication should the nurse anticipate being administered first?
A. Intravenous morphine sulfate to reduce anxiety and respiratory rate
B. Oral metoprolol to decrease heart rate and myocardial oxygen demand
C. Sublingual nitroglycerin to reduce preload and afterload
D. Intravenous furosemide to reduce pulmonary congestion rapidly
Correct Answer: D
Rationale:
Intravenous furosemide is the first-line medication for acute pulmonary edema because it rapidly reduces preload by
promoting diuresis, which directly decreases pulmonary congestion. Morphine may be given for anxiety and vasodilation but
is not the first priority medication. Nitroglycerin reduces preload but works more gradually than furosemide. Metoprolol is
contraindicated in acute decompensated heart failure.
Q6 Question 6 of 75
Q6. A 58-year-old patient with new-onset atrial fibrillation is being discharged on dabigatran therapy. Which
statement by the patient indicates a need for further teaching about this medication?
A. I will take this medication with a full glass of water at the same time each day
B. I should avoid taking over-the-counter aspirin or ibuprofen while on this medication
C. I can open the capsule and sprinkle the contents on applesauce if I have trouble swallowing pills
D. I will notify my dentist that I am taking a blood thinner before any dental procedure
Correct Answer: C
Rationale:
Dabigatran capsules must be swallowed whole because opening them increases bioavailability and the associated bleeding
risk. The medication should never be crushed or opened for administration. Taking it with water at the same time daily,
avoiding NSAIDs that further increase bleeding risk, and informing all healthcare providers about anticoagulant use are all
correct patient education points.
Q7 Question 7 of 75
Exam 1: NU 189 / NU189 (Latest 2026/2027) Medical-Surgical Nursing II | Test Review Questions & Answers | 100 % Correct | Grade A - Galen 2026/2027 - 2026/2027 | P
2026/2027
OBJECTIVE ASSESSMENT - EXAM
Exam 1: NU 189 / NU189 (Latest 2026/2027)
Medical-Surgical Nursing II | Test Review Questions
& Answers | 100 % Correct | Grade A - Galen
2026/2027
75 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular Disorders & Management Neurological Disorders & Assessment
Respiratory Disorders & Critical Care Gastrointestinal & Renal Disorders
Endocrine Disorders & Pharmacology Perioperative & Emergency Nursing
COVER PAGE - 1
, SECTION 1 | Cardiovascular Disorders | Q1-Q15 | Exam 1: NU 189 / NU189 (Latest 2026/2027) Medical-Surgical Nursing II |
Test Review Questions & Answers | 100 % Correct | Grade A - Galen 2026/2027 2026/2027
Q1 Question 1 of 75
Q1. A 68-year-old patient admitted with heart failure reports increasing shortness of breath over the past three
days and notes that their shoes feel unusually tight. The nurse assesses bilateral ankle edema and a weight
gain of 2.3 kg since the last clinic visit five days ago. Which nursing intervention should the nurse prioritize for
this patient?
A. Obtain a 12-lead electrocardiogram and notify the healthcare provider
B. Administer prescribed sublingual nitroglycerin immediately
C. Place the patient in high-Fowler's position and provide supplemental oxygen
D. Restrict fluid intake to 1500 mL per 24 hours
Correct Answer: D
Rationale:
Fluid restriction is the priority intervention for a heart failure patient exhibiting signs of volume overload, including rapid weight
gain and peripheral edema. High-Fowler's positioning and oxygen provide symptomatic relief but do not address the
underlying fluid retention. Nitroglycerin is indicated for acute chest pain rather than fluid overload alone. An ECG is important
but is not the immediate priority over addressing the fluid imbalance.
Q2 Question 2 of 75
Q2. A 72-year-old woman returns to the cardiac unit following transcatheter aortic valve replacement. The
nurse notes a new onset of cool, pulseless right lower extremity with mottled skin appearance on assessment.
Which action should the nurse take first?
A. Apply warm blankets to the affected extremity and reassess in 30 minutes
B. Document the finding and reassess the extremity in one hour
C. Reposition the patient to a left lateral position to improve circulation
D. Notify the surgeon immediately of suspected arterial embolization
Correct Answer: D
Rationale:
A pulseless, cool, mottled extremity after TAVR suggests arterial embolization, which is a surgical emergency requiring
immediate notification of the surgeon. Warm blankets will not restore arterial blood flow to an occluded vessel. Repositioning
will not resolve an acute arterial occlusion. Delaying notification risks permanent limb ischemia and potential amputation.
Q3 Question 3 of 75
Q3. A 55-year-old patient receiving warfarin therapy for deep vein thrombosis has an International Normalized
Ratio of 4.2. The patient reports no signs of bleeding, but recent blood work shows a hemoglobin of 8.5 g/dL.
Which intervention should the nurse anticipate?
A. Administer protamine sulfate subcutaneously and continue warfarin therapy
B. Administer fresh frozen plasma and protamine sulfate immediately
C. Reduce the warfarin dose by fifty percent and recheck INR in one week
D. Administer intravenous vitamin K and hold the next dose of warfarin
Correct Answer: D
Rationale:
An INR of 4.2 significantly exceeds the therapeutic range of 2.0 to 3.0 for DVT treatment, indicating a high bleeding risk that
requires vitamin K to promote clotting factor synthesis. Warfarin should be held until the INR returns to a therapeutic level.
Protamine sulfate is the reversal agent for heparin, not warfarin. Fresh frozen plasma is reserved for active bleeding, not
asymptomatic elevation.
Exam 1: NU 189 / NU189 (Latest 2026/2027) Medical-Surgical Nursing II | Test Review Questions & Answers | 100 % Correct | Grade A - Galen 2026/2027 - 2026/2027 | P
, Q4 Question 4 of 75
Q4. A 60-year-old patient arrives at the emergency department with crushing substernal chest pain that began
45 minutes ago and radiates to the left arm. Initial troponin I is 0.04 ng/mL and myoglobin is elevated above
normal limits. Which diagnostic finding is most critical for determining immediate treatment?
A. Creatine kinase-MB level to be drawn in six hours for comparison
B. Complete blood count with differential to check for infection
C. B-type natriuretic peptide level to assess heart failure severity
D. ST-segment elevation on the 12-lead electrocardiogram
Correct Answer: D
Rationale:
ST-segment elevation on the ECG identifies ST-elevation myocardial infarction, which requires immediate reperfusion
therapy through percutaneous coronary intervention or thrombolytics. Troponin elevation confirms myocardial injury but takes
hours to peak and cannot guide immediate reperfusion decisions. CK-MB is less specific than troponin. BNP is used for heart
failure assessment, not acute coronary syndrome evaluation.
Q5 Question 5 of 75
Q5. A 76-year-old patient with acute pulmonary edema is experiencing severe dyspnea and is producing pink
frothy sputum. The patient's blood pressure is 190/110 mmHg and oxygen saturation is 82% on room air. Which
medication should the nurse anticipate being administered first?
A. Intravenous morphine sulfate to reduce anxiety and respiratory rate
B. Oral metoprolol to decrease heart rate and myocardial oxygen demand
C. Sublingual nitroglycerin to reduce preload and afterload
D. Intravenous furosemide to reduce pulmonary congestion rapidly
Correct Answer: D
Rationale:
Intravenous furosemide is the first-line medication for acute pulmonary edema because it rapidly reduces preload by
promoting diuresis, which directly decreases pulmonary congestion. Morphine may be given for anxiety and vasodilation but
is not the first priority medication. Nitroglycerin reduces preload but works more gradually than furosemide. Metoprolol is
contraindicated in acute decompensated heart failure.
Q6 Question 6 of 75
Q6. A 58-year-old patient with new-onset atrial fibrillation is being discharged on dabigatran therapy. Which
statement by the patient indicates a need for further teaching about this medication?
A. I will take this medication with a full glass of water at the same time each day
B. I should avoid taking over-the-counter aspirin or ibuprofen while on this medication
C. I can open the capsule and sprinkle the contents on applesauce if I have trouble swallowing pills
D. I will notify my dentist that I am taking a blood thinner before any dental procedure
Correct Answer: C
Rationale:
Dabigatran capsules must be swallowed whole because opening them increases bioavailability and the associated bleeding
risk. The medication should never be crushed or opened for administration. Taking it with water at the same time daily,
avoiding NSAIDs that further increase bleeding risk, and informing all healthcare providers about anticoagulant use are all
correct patient education points.
Q7 Question 7 of 75
Exam 1: NU 189 / NU189 (Latest 2026/2027) Medical-Surgical Nursing II | Test Review Questions & Answers | 100 % Correct | Grade A - Galen 2026/2027 - 2026/2027 | P
