HERZING NSG233-238 MED SURG NURSING III
EXAM 2 2026 EXAM QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES JUST
RELEASED.PDF
Question 1
A nurse is caring for a patient admitted with acute decompensated heart failure. Which
assessment finding requires immediate intervention?
A. Bilateral 2+ pedal edema
B. Blood pressure of 146/88 mm Hg
C. Oxygen saturation of 86% with pink frothy sputum
D. Heart rate of 104 beats/minute
Answer: C. Oxygen saturation of 86% with pink frothy sputum
Rationale: Pink frothy sputum and hypoxemia are signs of acute pulmonary edema, a life-
threatening complication requiring immediate intervention to improve oxygenation and
decrease cardiac workload.*
Question 2
A patient with diabetic ketoacidosis (DKA) is receiving intravenous regular insulin. Which
laboratory value indicates that treatment is effective?
A. Serum potassium 5.6 mEq/L
B. Blood glucose remains 350 mg/dL
C. Serum bicarbonate increases to 22 mEq/L
,D. Urine ketones remain positive
Answer: C. Serum bicarbonate increases to 22 mEq/L
Rationale: Resolution of metabolic acidosis, reflected by normalization of bicarbonate, is a
key indicator that DKA treatment is successful.*
Question 3
Which assessment finding in a patient with chronic obstructive pulmonary disease (COPD)
requires immediate nursing intervention?
A. Barrel-shaped chest
B. Productive morning cough
C. Increasing confusion and restlessness
D. Diminished breath sounds
Answer: C. Increasing confusion and restlessness
Rationale: Mental status changes may indicate worsening hypoxemia or hypercapnia and
require immediate evaluation.*
Question 4
A nurse is caring for a patient receiving a continuous heparin infusion. Which laboratory
value is most important to monitor?
A. INR
B. Platelet count
C. Activated partial thromboplastin time (aPTT)
D. Hemoglobin A1c
,Answer: C. Activated partial thromboplastin time (aPTT)
Rationale: aPTT is used to monitor the therapeutic effectiveness and safety of
unfractionated heparin therapy.*
Question 5
A patient with acute ischemic stroke is being evaluated for alteplase (tPA) therapy. Which
finding is a contraindication?
A. Blood glucose of 140 mg/dL
B. Symptom onset 2 hours ago
C. History of intracranial hemorrhage
D. Blood pressure of 160/90 mm Hg
Answer: C. History of intracranial hemorrhage
Rationale: A previous intracranial hemorrhage is a contraindication because alteplase
significantly increases bleeding risk.*
Question 6
A patient with chronic kidney disease has peaked T waves on the cardiac monitor. Which
electrolyte imbalance should the nurse suspect?
A. Hyponatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypermagnesemia
Answer: C. Hyperkalemia
, Rationale: Peaked T waves are a classic ECG manifestation of hyperkalemia, which can
progress to fatal dysrhythmias.*
Question 7
A patient develops sudden shortness of breath, tachycardia, and pleuritic chest pain after
surgery. Which complication is most likely?
A. Atelectasis
B. Pneumonia
C. Pulmonary embolism
D. Pleural effusion
Answer: C. Pulmonary embolism
Rationale: The sudden onset of dyspnea, chest pain, and tachycardia in a postoperative
patient strongly suggests pulmonary embolism.*
Question 8
Which assessment finding is expected in a patient with left-sided heart failure?
A. Hepatomegaly
B. Ascites
C. Bibasilar crackles
D. Jugular venous distention
Answer: C. Bibasilar crackles
Rationale: Left ventricular failure causes pulmonary congestion, producing crackles,
dyspnea, and orthopnea.*
EXAM 2 2026 EXAM QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES JUST
RELEASED.PDF
Question 1
A nurse is caring for a patient admitted with acute decompensated heart failure. Which
assessment finding requires immediate intervention?
A. Bilateral 2+ pedal edema
B. Blood pressure of 146/88 mm Hg
C. Oxygen saturation of 86% with pink frothy sputum
D. Heart rate of 104 beats/minute
Answer: C. Oxygen saturation of 86% with pink frothy sputum
Rationale: Pink frothy sputum and hypoxemia are signs of acute pulmonary edema, a life-
threatening complication requiring immediate intervention to improve oxygenation and
decrease cardiac workload.*
Question 2
A patient with diabetic ketoacidosis (DKA) is receiving intravenous regular insulin. Which
laboratory value indicates that treatment is effective?
A. Serum potassium 5.6 mEq/L
B. Blood glucose remains 350 mg/dL
C. Serum bicarbonate increases to 22 mEq/L
,D. Urine ketones remain positive
Answer: C. Serum bicarbonate increases to 22 mEq/L
Rationale: Resolution of metabolic acidosis, reflected by normalization of bicarbonate, is a
key indicator that DKA treatment is successful.*
Question 3
Which assessment finding in a patient with chronic obstructive pulmonary disease (COPD)
requires immediate nursing intervention?
A. Barrel-shaped chest
B. Productive morning cough
C. Increasing confusion and restlessness
D. Diminished breath sounds
Answer: C. Increasing confusion and restlessness
Rationale: Mental status changes may indicate worsening hypoxemia or hypercapnia and
require immediate evaluation.*
Question 4
A nurse is caring for a patient receiving a continuous heparin infusion. Which laboratory
value is most important to monitor?
A. INR
B. Platelet count
C. Activated partial thromboplastin time (aPTT)
D. Hemoglobin A1c
,Answer: C. Activated partial thromboplastin time (aPTT)
Rationale: aPTT is used to monitor the therapeutic effectiveness and safety of
unfractionated heparin therapy.*
Question 5
A patient with acute ischemic stroke is being evaluated for alteplase (tPA) therapy. Which
finding is a contraindication?
A. Blood glucose of 140 mg/dL
B. Symptom onset 2 hours ago
C. History of intracranial hemorrhage
D. Blood pressure of 160/90 mm Hg
Answer: C. History of intracranial hemorrhage
Rationale: A previous intracranial hemorrhage is a contraindication because alteplase
significantly increases bleeding risk.*
Question 6
A patient with chronic kidney disease has peaked T waves on the cardiac monitor. Which
electrolyte imbalance should the nurse suspect?
A. Hyponatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypermagnesemia
Answer: C. Hyperkalemia
, Rationale: Peaked T waves are a classic ECG manifestation of hyperkalemia, which can
progress to fatal dysrhythmias.*
Question 7
A patient develops sudden shortness of breath, tachycardia, and pleuritic chest pain after
surgery. Which complication is most likely?
A. Atelectasis
B. Pneumonia
C. Pulmonary embolism
D. Pleural effusion
Answer: C. Pulmonary embolism
Rationale: The sudden onset of dyspnea, chest pain, and tachycardia in a postoperative
patient strongly suggests pulmonary embolism.*
Question 8
Which assessment finding is expected in a patient with left-sided heart failure?
A. Hepatomegaly
B. Ascites
C. Bibasilar crackles
D. Jugular venous distention
Answer: C. Bibasilar crackles
Rationale: Left ventricular failure causes pulmonary congestion, producing crackles,
dyspnea, and orthopnea.*
