Exam 1: NU 189 / NU189 (Latest 2026/2027) Medical-Surgical Nursing II | Test Review Questions & Answers | 100 % Correct | Grade A
OBJECTIVE ASSESSMENT - EXAM
Medical-Surgical Nursing II
Exam 1 — Comprehensive Review
75 100% 2026/2027 80%
Questions Verified Answers Edition Passing Score
TOPICS COVERED
• Cardiovascular Disorders • Gastrointestinal Disorders
• Respiratory System Pathologies • Renal & Genitourinary Conditions
• Endocrine & Metabolic Conditions • Musculoskeletal & Integumentary
• Hematologic & Oncologic Nursing • Immune & Inflammatory Responses
COVER PAGE - 1
, SECTION 1: CARDIOVASCULAR DISORDERS Q1-Q15
Q1
A 68-year-old male with a history of hypertension presents to the emergency department with crushing
chest pain radiating to his left arm. His blood pressure is 92/58 mmHg, heart rate is 110 bpm, and he is
diaphoretic. The 12-lead ECG shows ST-segment elevation in leads V1-V4.
A. Administer sublingual nitroglycerin and observe for 30 minutes
B. Begin fibrinolytic therapy immediately without further testing
C. Activate the cardiac catheterization lab for primary PCI within 90 minutes
D. Give aspirin only and schedule a stress test for the next day
Correct Answer: C
Rationale: ST-elevation in anterior leads indicates an anterior STEMI. The patient is hemodynamically unstable with
hypotension, making immediate primary PCI the gold standard. Door-to-balloon time should be under 90 minutes.
Q2
A 72-year-old female with chronic heart failure is admitted with worsening dyspnea and bilateral crackles
on auscultation. Her current medications include furosemide 40 mg daily and lisinopril 10 mg daily. Her
BNP is 1,850 pg/mL and she has gained 4 kg in the past week.
A. Increase lisinopril to 20 mg daily and add carvedilol
B. Administer IV furosemide and restrict sodium intake to 2g daily
C. Start dobutamine infusion at 5 mcg/kg/min immediately
D. Discontinue all medications and initiate fluid challenge
Correct Answer: B
Rationale: This patient is in acute decompensated heart failure with volume overload evidenced by weight gain and elevated
BNP. IV diuretics are first-line for fluid removal, plus sodium restriction. Dobutamine is reserved for cardiogenic shock.
, Q3
A 55-year-old male post-CABG day 2 develops a temperature of 38.8°C, chest pain with inspiration, and a
pericardial friction rub on auscultation. His white blood cell count is elevated at 14,500/mm³.
A. This is expected postoperative pain; administer morphine and continue monitoring
B. Begin broad-spectrum antibiotics for mediastinitis immediately
C. Administer NSAIDs and colchicine for post-pericardiotomy syndrome
D. Perform emergency pericardiocentesis for cardiac tamponade
Correct Answer: C
Rationale: Post-pericardiotomy syndrome typically occurs 2-4 weeks after cardiac surgery but can present earlier. It presents
with fever, pleuritic chest pain, and pericardial friction rub. NSAIDs and colchicine are standard treatment.
Q4
A 45-year-old female with atrial fibrillation is prescribed warfarin. Her INR goal is 2.0-3.0. After 5 days of
therapy, her INR is 4.2. She reports no bleeding, bruising, or melena.
A. Continue current warfarin dose and recheck INR in one week
B. Hold warfarin for one dose, then resume at a reduced dose
C. Administer vitamin K 10 mg IV immediately
D. Discontinue warfarin permanently and switch to aspirin
Correct Answer: B
Rationale: An INR of 4.2 without bleeding is a supratherapeutic level. The appropriate management is to hold one dose and
reduce the maintenance dose. Vitamin K is reserved for INR greater than 10 or serious bleeding.
Q5
A 60-year-old male with a history of dilated cardiomyopathy has an ejection fraction of 30%. He is being
evaluated for implantable cardioverter-defibrillator placement. His NYHA functional class is II and he is on
optimal medical therapy.
A. ICD is contraindicated because his NYHA class is too mild
B. ICD is indicated for primary prevention of sudden cardiac death
C. ICD should only be placed after a documented cardiac arrest
D. Biventricular pacemaker alone is sufficient without defibrillator capability
Correct Answer: B
Rationale: ICD placement for primary prevention is indicated in patients with ischemic or non-ischemic cardiomyopathy, EF less
than or equal to 35%, NYHA class II-III, and optimal medical therapy. This patient meets all criteria.
OBJECTIVE ASSESSMENT - EXAM
Medical-Surgical Nursing II
Exam 1 — Comprehensive Review
75 100% 2026/2027 80%
Questions Verified Answers Edition Passing Score
TOPICS COVERED
• Cardiovascular Disorders • Gastrointestinal Disorders
• Respiratory System Pathologies • Renal & Genitourinary Conditions
• Endocrine & Metabolic Conditions • Musculoskeletal & Integumentary
• Hematologic & Oncologic Nursing • Immune & Inflammatory Responses
COVER PAGE - 1
, SECTION 1: CARDIOVASCULAR DISORDERS Q1-Q15
Q1
A 68-year-old male with a history of hypertension presents to the emergency department with crushing
chest pain radiating to his left arm. His blood pressure is 92/58 mmHg, heart rate is 110 bpm, and he is
diaphoretic. The 12-lead ECG shows ST-segment elevation in leads V1-V4.
A. Administer sublingual nitroglycerin and observe for 30 minutes
B. Begin fibrinolytic therapy immediately without further testing
C. Activate the cardiac catheterization lab for primary PCI within 90 minutes
D. Give aspirin only and schedule a stress test for the next day
Correct Answer: C
Rationale: ST-elevation in anterior leads indicates an anterior STEMI. The patient is hemodynamically unstable with
hypotension, making immediate primary PCI the gold standard. Door-to-balloon time should be under 90 minutes.
Q2
A 72-year-old female with chronic heart failure is admitted with worsening dyspnea and bilateral crackles
on auscultation. Her current medications include furosemide 40 mg daily and lisinopril 10 mg daily. Her
BNP is 1,850 pg/mL and she has gained 4 kg in the past week.
A. Increase lisinopril to 20 mg daily and add carvedilol
B. Administer IV furosemide and restrict sodium intake to 2g daily
C. Start dobutamine infusion at 5 mcg/kg/min immediately
D. Discontinue all medications and initiate fluid challenge
Correct Answer: B
Rationale: This patient is in acute decompensated heart failure with volume overload evidenced by weight gain and elevated
BNP. IV diuretics are first-line for fluid removal, plus sodium restriction. Dobutamine is reserved for cardiogenic shock.
, Q3
A 55-year-old male post-CABG day 2 develops a temperature of 38.8°C, chest pain with inspiration, and a
pericardial friction rub on auscultation. His white blood cell count is elevated at 14,500/mm³.
A. This is expected postoperative pain; administer morphine and continue monitoring
B. Begin broad-spectrum antibiotics for mediastinitis immediately
C. Administer NSAIDs and colchicine for post-pericardiotomy syndrome
D. Perform emergency pericardiocentesis for cardiac tamponade
Correct Answer: C
Rationale: Post-pericardiotomy syndrome typically occurs 2-4 weeks after cardiac surgery but can present earlier. It presents
with fever, pleuritic chest pain, and pericardial friction rub. NSAIDs and colchicine are standard treatment.
Q4
A 45-year-old female with atrial fibrillation is prescribed warfarin. Her INR goal is 2.0-3.0. After 5 days of
therapy, her INR is 4.2. She reports no bleeding, bruising, or melena.
A. Continue current warfarin dose and recheck INR in one week
B. Hold warfarin for one dose, then resume at a reduced dose
C. Administer vitamin K 10 mg IV immediately
D. Discontinue warfarin permanently and switch to aspirin
Correct Answer: B
Rationale: An INR of 4.2 without bleeding is a supratherapeutic level. The appropriate management is to hold one dose and
reduce the maintenance dose. Vitamin K is reserved for INR greater than 10 or serious bleeding.
Q5
A 60-year-old male with a history of dilated cardiomyopathy has an ejection fraction of 30%. He is being
evaluated for implantable cardioverter-defibrillator placement. His NYHA functional class is II and he is on
optimal medical therapy.
A. ICD is contraindicated because his NYHA class is too mild
B. ICD is indicated for primary prevention of sudden cardiac death
C. ICD should only be placed after a documented cardiac arrest
D. Biventricular pacemaker alone is sufficient without defibrillator capability
Correct Answer: B
Rationale: ICD placement for primary prevention is indicated in patients with ischemic or non-ischemic cardiomyopathy, EF less
than or equal to 35%, NYHA class II-III, and optimal medical therapy. This patient meets all criteria.
