NSG 233 Medical-SurGical NurSiNG ii HeSi actual exaM – HiGHer
educatioN NurSiNG curriculuM – 2026/2027 acadeMic Year –
Verified QueStioNS aNd aNSwerS for uNiVerSitY-leVel NurSiNG
StudeNtS || Verified BY exPertS
DOMAIN 1: CARDIOVASCULAR AND RESPIRATORY DISORDERS (Questions 1–30)
Question 1
A client with heart failure has severe dyspnea, pink frothy sputum, and crackles. Which position
is priority?
A) High Fowler position with legs dependent if tolerated
B) Flat supine with legs elevated
C) Prone with head lower than feet
D) Left side-lying with no oxygen assessment
correct aNSwer: A
<span style="color:red">Rationale: Upright positioning reduces venous return and improves
lung expansion during acute pulmonary edema. High Fowler's position with legs dependent
promotes fluid shifting to lower extremities, reducing pulmonary congestion.</span>
Question 2
A client with chest pressure has ST elevation on the ECG monitor. Which action is priority?
A) Offer a full meal
B) Activate emergency cardiac response and obtain rapid provider-directed care
C) Delay until morning rounds
D) Encourage ambulation in the hallway
correct aNSwer: B
<span style="color:red">Rationale: ST elevation with ischemic symptoms suggests acute
coronary occlusion requiring rapid intervention. Time is muscle—immediate activation of the
cardiac response team is essential to minimize myocardial damage.</span>
Question 3
Which finding is most concerning after femoral cardiac catheterization?
,A) Mild bruising at insertion site
B) Client voids clear urine
C) Cool pale foot with diminished pedal pulse
D) Client reports hunger
correct aNSwer: C
<span style="color:red">Rationale: A cool, pale foot with diminished pedal pulse suggests
acute arterial occlusion, a limb-threatening complication. This requires immediate assessment
and intervention. Mild bruising, clear urine, and hunger are expected findings.</span>
Question 4
A client with COPD is receiving oxygen at 2 L/min via nasal cannula. Which finding indicates the
client is receiving the correct oxygen flow?
A) Oxygen saturation of 96%
B) Respiratory rate of 32 breaths/min
C) Confusion and drowsiness
D) Headache
correct aNSwer: A
<span style="color:red">Rationale: An oxygen saturation of 96% indicates adequate
oxygenation. For patients with COPD, oxygen should be titrated to maintain SpO₂ of 88-92% to
avoid suppressing the hypoxic drive. Confusion, drowsiness, and headache may indicate
hypercapnia.</span>
Question 5
A client is experiencing an acute asthma exacerbation. Which medication should be
administered first?
A) Inhaled corticosteroid
B) Oral prednisone
C) Inhaled albuterol
D) Inhaled ipratropium
correct aNSwer: C
<span style="color:red">Rationale: Inhaled albuterol is a short-acting beta-2 agonist that
provides rapid bronchodilation and is the first-line treatment for acute asthma exacerbations.
Inhaled corticosteroids are used for maintenance therapy.</span>
Question 6
A client with a chest tube has continuous bubbling in the water seal chamber. What is the most
likely cause?
,A) Normal functioning of the chest tube
B) An air leak
C) The patient is breathing too deeply
D) The suction is set too high
correct aNSwer: B
<span style="color:red">Rationale: Continuous bubbling in the water seal chamber indicates an
air leak in the system. Tidaling (fluctuation) in the water seal chamber is normal. Intermittent
bubbling may occur with exhalation.</span>
Question 7
A client with left-sided heart failure is most likely to present with which finding?
A) Jugular venous distention
B) Peripheral edema
C) Pulmonary crackles
D) Hepatomegaly
correct aNSwer: C
<span style="color:red">Rationale: Left-sided heart failure causes backup of blood into the
pulmonary circulation, resulting in pulmonary congestion and crackles. JVD, peripheral edema,
and hepatomegaly are signs of right-sided heart failure.</span>
Question 8
A client with angina is prescribed nitroglycerin sublingually. Which instruction should the nurse
provide?
A) Swallow the tablet with water
B) Place the tablet under the tongue and allow it to dissolve
C) Chew the tablet for faster absorption
D) Apply the tablet to the skin
correct aNSwer: B
<span style="color:red">Rationale: Sublingual nitroglycerin should be placed under the tongue
and allowed to dissolve completely. It is absorbed through the oral mucosa, bypassing first-pass
metabolism, and provides rapid relief of anginal pain.</span>
Question 9
A client with a history of atrial fibrillation is prescribed warfarin. Which laboratory test should the
nurse monitor?
, A) Activated partial thromboplastin time (aPTT)
B) Prothrombin time (PT) and INR
C) Platelet count
D) Bleeding time
correct aNSwer: B
<span style="color:red">Rationale: Warfarin is monitored using PT and INR. The therapeutic
INR range for atrial fibrillation is typically 2.0-3.0. aPTT is used to monitor heparin
therapy.</span>
Question 10
A client is receiving digoxin for heart failure. Which is a sign of digoxin toxicity?
A) Heart rate of 72 bpm
B) Visual disturbances (yellow-green halos)
C) Blood pressure of 120/80 mmHg
D) Potassium level of 4.0 mEq/L
correct aNSwer: B
<span style="color:red">Rationale: Visual disturbances (yellow-green halos, blurred vision) are
classic signs of digoxin toxicity. Other signs include nausea, vomiting, anorexia, and cardiac
arrhythmias. Hypokalemia increases the risk of toxicity.</span>
Question 11
A client with peripheral artery disease reports leg pain that occurs when walking and is relieved
by rest. This is known as:
A) Rest pain
B) Intermittent claudication
C) Venous insufficiency
D) Neuropathy
correct aNSwer: B
<span style="color:red">Rationale: Intermittent claudication is ischemic muscle pain caused by
inadequate blood flow during exercise, which is relieved by rest. Rest pain occurs at rest and
indicates severe ischemia.</span>
Question 12
A client with a new tracheostomy has a dislodged tube. What is the priority intervention?
A) Call the provider
B) Attempt to reinsert the tube
educatioN NurSiNG curriculuM – 2026/2027 acadeMic Year –
Verified QueStioNS aNd aNSwerS for uNiVerSitY-leVel NurSiNG
StudeNtS || Verified BY exPertS
DOMAIN 1: CARDIOVASCULAR AND RESPIRATORY DISORDERS (Questions 1–30)
Question 1
A client with heart failure has severe dyspnea, pink frothy sputum, and crackles. Which position
is priority?
A) High Fowler position with legs dependent if tolerated
B) Flat supine with legs elevated
C) Prone with head lower than feet
D) Left side-lying with no oxygen assessment
correct aNSwer: A
<span style="color:red">Rationale: Upright positioning reduces venous return and improves
lung expansion during acute pulmonary edema. High Fowler's position with legs dependent
promotes fluid shifting to lower extremities, reducing pulmonary congestion.</span>
Question 2
A client with chest pressure has ST elevation on the ECG monitor. Which action is priority?
A) Offer a full meal
B) Activate emergency cardiac response and obtain rapid provider-directed care
C) Delay until morning rounds
D) Encourage ambulation in the hallway
correct aNSwer: B
<span style="color:red">Rationale: ST elevation with ischemic symptoms suggests acute
coronary occlusion requiring rapid intervention. Time is muscle—immediate activation of the
cardiac response team is essential to minimize myocardial damage.</span>
Question 3
Which finding is most concerning after femoral cardiac catheterization?
,A) Mild bruising at insertion site
B) Client voids clear urine
C) Cool pale foot with diminished pedal pulse
D) Client reports hunger
correct aNSwer: C
<span style="color:red">Rationale: A cool, pale foot with diminished pedal pulse suggests
acute arterial occlusion, a limb-threatening complication. This requires immediate assessment
and intervention. Mild bruising, clear urine, and hunger are expected findings.</span>
Question 4
A client with COPD is receiving oxygen at 2 L/min via nasal cannula. Which finding indicates the
client is receiving the correct oxygen flow?
A) Oxygen saturation of 96%
B) Respiratory rate of 32 breaths/min
C) Confusion and drowsiness
D) Headache
correct aNSwer: A
<span style="color:red">Rationale: An oxygen saturation of 96% indicates adequate
oxygenation. For patients with COPD, oxygen should be titrated to maintain SpO₂ of 88-92% to
avoid suppressing the hypoxic drive. Confusion, drowsiness, and headache may indicate
hypercapnia.</span>
Question 5
A client is experiencing an acute asthma exacerbation. Which medication should be
administered first?
A) Inhaled corticosteroid
B) Oral prednisone
C) Inhaled albuterol
D) Inhaled ipratropium
correct aNSwer: C
<span style="color:red">Rationale: Inhaled albuterol is a short-acting beta-2 agonist that
provides rapid bronchodilation and is the first-line treatment for acute asthma exacerbations.
Inhaled corticosteroids are used for maintenance therapy.</span>
Question 6
A client with a chest tube has continuous bubbling in the water seal chamber. What is the most
likely cause?
,A) Normal functioning of the chest tube
B) An air leak
C) The patient is breathing too deeply
D) The suction is set too high
correct aNSwer: B
<span style="color:red">Rationale: Continuous bubbling in the water seal chamber indicates an
air leak in the system. Tidaling (fluctuation) in the water seal chamber is normal. Intermittent
bubbling may occur with exhalation.</span>
Question 7
A client with left-sided heart failure is most likely to present with which finding?
A) Jugular venous distention
B) Peripheral edema
C) Pulmonary crackles
D) Hepatomegaly
correct aNSwer: C
<span style="color:red">Rationale: Left-sided heart failure causes backup of blood into the
pulmonary circulation, resulting in pulmonary congestion and crackles. JVD, peripheral edema,
and hepatomegaly are signs of right-sided heart failure.</span>
Question 8
A client with angina is prescribed nitroglycerin sublingually. Which instruction should the nurse
provide?
A) Swallow the tablet with water
B) Place the tablet under the tongue and allow it to dissolve
C) Chew the tablet for faster absorption
D) Apply the tablet to the skin
correct aNSwer: B
<span style="color:red">Rationale: Sublingual nitroglycerin should be placed under the tongue
and allowed to dissolve completely. It is absorbed through the oral mucosa, bypassing first-pass
metabolism, and provides rapid relief of anginal pain.</span>
Question 9
A client with a history of atrial fibrillation is prescribed warfarin. Which laboratory test should the
nurse monitor?
, A) Activated partial thromboplastin time (aPTT)
B) Prothrombin time (PT) and INR
C) Platelet count
D) Bleeding time
correct aNSwer: B
<span style="color:red">Rationale: Warfarin is monitored using PT and INR. The therapeutic
INR range for atrial fibrillation is typically 2.0-3.0. aPTT is used to monitor heparin
therapy.</span>
Question 10
A client is receiving digoxin for heart failure. Which is a sign of digoxin toxicity?
A) Heart rate of 72 bpm
B) Visual disturbances (yellow-green halos)
C) Blood pressure of 120/80 mmHg
D) Potassium level of 4.0 mEq/L
correct aNSwer: B
<span style="color:red">Rationale: Visual disturbances (yellow-green halos, blurred vision) are
classic signs of digoxin toxicity. Other signs include nausea, vomiting, anorexia, and cardiac
arrhythmias. Hypokalemia increases the risk of toxicity.</span>
Question 11
A client with peripheral artery disease reports leg pain that occurs when walking and is relieved
by rest. This is known as:
A) Rest pain
B) Intermittent claudication
C) Venous insufficiency
D) Neuropathy
correct aNSwer: B
<span style="color:red">Rationale: Intermittent claudication is ischemic muscle pain caused by
inadequate blood flow during exercise, which is relieved by rest. Rest pain occurs at rest and
indicates severe ischemia.</span>
Question 12
A client with a new tracheostomy has a dislodged tube. What is the priority intervention?
A) Call the provider
B) Attempt to reinsert the tube
