NUR 209 Medical Surgical Nursing II | Exam 2 Review | Fortis College
Fortis College
NUR 209 / NUR209 Medical Surgical Nursing II
Exam 2 Comprehensive Review (2026/2027 Update)
Name: Date: Score: _______ / 100
_________________________ ___________________
Instructions
This review contains 100 NCLEX-style multiple choice questions with answers and
rationales.
Each question has four options (A, B, C, D). Select the best answer for each question.
The correct answer is highlighted in green and the rationale follows each question.
Questions focus on application and analysis-level clinical judgment.
Topics covered: Cardiovascular, Respiratory, Neurological, Endocrine, GI/Renal,
Hematology/Immune, Musculoskeletal, Integumentary, Burns, Perioperative, Acid-
Base,
Oncology, Infection Control, and Sensory Disorders.
1. A nurse is caring for a client with left-sided heart failure. Which assessment
finding should the nurse expect?
A. Jugular venous B. Crackles in the C. Hepatomegaly D. Dependent
distention lung bases peripheral edema
Correct Answer: B
Rationale: Left-sided heart failure causes backup of blood into the pulmonary
circulation, leading to pulmonary congestion manifested as crackles in the lung
bases. Jugular venous distention, hepatomegaly, and dependent peripheral edema
are signs of right-sided heart failure due to systemic venous congestion.
1
, NUR 209 Medical Surgical Nursing II | Exam 2 Review | Fortis College
2. A client admitted with an acute myocardial infarction (MI) reports severe
substernal chest pain unrelieved by nitroglycerin. Which prescribed medication
should the nurse administer first?
A. Heparin IV B. Morphine sulfate C. Metoprolol IV D. Clopidogrel PO
bolus IV push
Correct Answer: B
Rationale: Morphine sulfate is the first-line analgesic for acute MI pain unrelieved
by nitroglycerin because it reduces myocardial oxygen demand by decreasing
preload, heart rate, and anxiety. Heparin and clopidogrel are important
anticoagulants but do not address pain. Metoprolol reduces heart rate but is not an
analgesic and is secondary to pain management in this acute scenario.
3. The nurse receives morning report on four clients with heart failure. Which client
should the nurse assess first?
A. A client with a B. A client with a C. A client who D. A client with 1+
weight gain of 0.5 blood pressure of reports increasing pitting edema in
kg over 2 days 110/70 mmHg dyspnea when lying bilateral ankles
flat
Correct Answer: C
Rationale: Increasing dyspnea when lying flat (orthopnea) indicates worsening
pulmonary congestion and is the highest priority because it suggests acute
decompensation of heart failure. Weight gain, mild edema, and blood pressure
changes are important but less urgent than acute respiratory compromise. The nurse
must assess and intervene for the client showing signs of worsening pulmonary
edema first.
4. A client with heart failure is prescribed furosemide 40 mg IV. Which laboratory
value should the nurse monitor most closely?
A. Sodium B. Potassium C. Calcium D. Magnesium
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant loss of potassium
through increased urinary excretion. Hypokalemia can precipitate life-threatening
dysrhythmias, especially in clients with heart failure who may already be on digoxin.
2
, NUR 209 Medical Surgical Nursing II | Exam 2 Review | Fortis College
While sodium, calcium, and magnesium should also be monitored, potassium is the
most critical lab value for furosemide therapy.
5. A client on a cardiac telemetry monitor has a rhythm showing absent P waves,
irregular R-R intervals, and a wavy baseline. The nurse identifies this as which
dysrhythmia?
A. Atrial B. Atrial flutter C. Ventricular D. Second-degree
fibrillation tachycardia heart block type I
Correct Answer: A
Rationale: Atrial fibrillation is characterized by absent P waves (replaced by chaotic
fibrillatory waves producing a wavy baseline), irregular R-R intervals, and an
irregularly irregular rhythm. Atrial flutter has sawtooth P waves with a regular
ventricular rate. Ventricular tachycardia shows wide QRS complexes without P
waves. Second-degree heart block type I (Wenckebach) shows progressively
lengthening PR intervals with a dropped QRS.
6. A nurse is delegating care for a client with stable chronic hypertension. Which task
is most appropriate to assign to the unlicensed assistive personnel (UAP)?
A. Teaching the client about a low- B. Measuring the client's blood pressure
sodium diet
C. Evaluating the client's response to a D. Adjusting the client's medication
new antihypertensive dosage based on blood pressure readings
Correct Answer: B
Rationale: Measuring blood pressure is a standardized, repetitive task within the
UAP scope of practice. Teaching, evaluating responses to medications, and adjusting
dosages require nursing education and clinical judgment and cannot be delegated to
UAP. The nurse retains responsibility for assessment, teaching, and medication
management.
7. A client with deep vein thrombosis (DVT) is prescribed heparin infusion. The
nurse notes the client's aPTT is 45 seconds with a control of 30 seconds. What action
should the nurse take?
A. Increase the heparin infusion rate B. Stop the heparin infusion immediately
3
, NUR 209 Medical Surgical Nursing II | Exam 2 Review | Fortis College
C. Continue the current infusion rate and D. Administer protamine sulfate
recheck in 6 hours
Correct Answer: A
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5 to
2.5 times the control value. With a control of 30 seconds, the therapeutic range is 45-
75 seconds. An aPTT of 45 seconds is at the lower end, suggesting subtherapeutic
anticoagulation. The nurse should increase the infusion rate per protocol. Stopping
heparin or giving protamine sulfate is for dangerously elevated aPTT, not
subtherapeutic levels.
8. A client with peripheral arterial disease (PAD) reports leg pain when walking two
blocks that is relieved by rest. The nurse documents this as which finding?
A. Thromboangiitis B. Intermittent C. Chronic venous D. Raynaud's
obliterans claudication insufficiency phenomenon
Correct Answer: B
Rationale: Intermittent claudication is the classic symptom of PAD, characterized by
pain in the calf or leg muscles during exercise that is relieved by rest. It occurs due to
inadequate arterial blood flow to meet increased metabolic demands during activity.
Thromboangiitis obliterans (Buerger's disease) and Raynaud's phenomenon involve
vasospasm of small vessels. Chronic venous insufficiency presents with ankle edema
and stasis changes, not exercise-induced pain.
9. A client has a new prescription for enoxaparin (Lovenox) following hip
replacement surgery. Which statement by the client indicates a need for further
teaching?
A. I will inject the B. I should report C. I will take D. I will avoid
medication into my any unusual aspirin daily for shaving with a
abdominal fat bruising or pain relief straight razor
bleeding
Correct Answer: C
Rationale: The client should avoid concurrent use of aspirin or other NSAIDs with
enoxaparin because the combination significantly increases bleeding risk.
Enoxaparin is a low-molecular-weight heparin, and adding antiplatelet agents like
4
Fortis College
NUR 209 / NUR209 Medical Surgical Nursing II
Exam 2 Comprehensive Review (2026/2027 Update)
Name: Date: Score: _______ / 100
_________________________ ___________________
Instructions
This review contains 100 NCLEX-style multiple choice questions with answers and
rationales.
Each question has four options (A, B, C, D). Select the best answer for each question.
The correct answer is highlighted in green and the rationale follows each question.
Questions focus on application and analysis-level clinical judgment.
Topics covered: Cardiovascular, Respiratory, Neurological, Endocrine, GI/Renal,
Hematology/Immune, Musculoskeletal, Integumentary, Burns, Perioperative, Acid-
Base,
Oncology, Infection Control, and Sensory Disorders.
1. A nurse is caring for a client with left-sided heart failure. Which assessment
finding should the nurse expect?
A. Jugular venous B. Crackles in the C. Hepatomegaly D. Dependent
distention lung bases peripheral edema
Correct Answer: B
Rationale: Left-sided heart failure causes backup of blood into the pulmonary
circulation, leading to pulmonary congestion manifested as crackles in the lung
bases. Jugular venous distention, hepatomegaly, and dependent peripheral edema
are signs of right-sided heart failure due to systemic venous congestion.
1
, NUR 209 Medical Surgical Nursing II | Exam 2 Review | Fortis College
2. A client admitted with an acute myocardial infarction (MI) reports severe
substernal chest pain unrelieved by nitroglycerin. Which prescribed medication
should the nurse administer first?
A. Heparin IV B. Morphine sulfate C. Metoprolol IV D. Clopidogrel PO
bolus IV push
Correct Answer: B
Rationale: Morphine sulfate is the first-line analgesic for acute MI pain unrelieved
by nitroglycerin because it reduces myocardial oxygen demand by decreasing
preload, heart rate, and anxiety. Heparin and clopidogrel are important
anticoagulants but do not address pain. Metoprolol reduces heart rate but is not an
analgesic and is secondary to pain management in this acute scenario.
3. The nurse receives morning report on four clients with heart failure. Which client
should the nurse assess first?
A. A client with a B. A client with a C. A client who D. A client with 1+
weight gain of 0.5 blood pressure of reports increasing pitting edema in
kg over 2 days 110/70 mmHg dyspnea when lying bilateral ankles
flat
Correct Answer: C
Rationale: Increasing dyspnea when lying flat (orthopnea) indicates worsening
pulmonary congestion and is the highest priority because it suggests acute
decompensation of heart failure. Weight gain, mild edema, and blood pressure
changes are important but less urgent than acute respiratory compromise. The nurse
must assess and intervene for the client showing signs of worsening pulmonary
edema first.
4. A client with heart failure is prescribed furosemide 40 mg IV. Which laboratory
value should the nurse monitor most closely?
A. Sodium B. Potassium C. Calcium D. Magnesium
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant loss of potassium
through increased urinary excretion. Hypokalemia can precipitate life-threatening
dysrhythmias, especially in clients with heart failure who may already be on digoxin.
2
, NUR 209 Medical Surgical Nursing II | Exam 2 Review | Fortis College
While sodium, calcium, and magnesium should also be monitored, potassium is the
most critical lab value for furosemide therapy.
5. A client on a cardiac telemetry monitor has a rhythm showing absent P waves,
irregular R-R intervals, and a wavy baseline. The nurse identifies this as which
dysrhythmia?
A. Atrial B. Atrial flutter C. Ventricular D. Second-degree
fibrillation tachycardia heart block type I
Correct Answer: A
Rationale: Atrial fibrillation is characterized by absent P waves (replaced by chaotic
fibrillatory waves producing a wavy baseline), irregular R-R intervals, and an
irregularly irregular rhythm. Atrial flutter has sawtooth P waves with a regular
ventricular rate. Ventricular tachycardia shows wide QRS complexes without P
waves. Second-degree heart block type I (Wenckebach) shows progressively
lengthening PR intervals with a dropped QRS.
6. A nurse is delegating care for a client with stable chronic hypertension. Which task
is most appropriate to assign to the unlicensed assistive personnel (UAP)?
A. Teaching the client about a low- B. Measuring the client's blood pressure
sodium diet
C. Evaluating the client's response to a D. Adjusting the client's medication
new antihypertensive dosage based on blood pressure readings
Correct Answer: B
Rationale: Measuring blood pressure is a standardized, repetitive task within the
UAP scope of practice. Teaching, evaluating responses to medications, and adjusting
dosages require nursing education and clinical judgment and cannot be delegated to
UAP. The nurse retains responsibility for assessment, teaching, and medication
management.
7. A client with deep vein thrombosis (DVT) is prescribed heparin infusion. The
nurse notes the client's aPTT is 45 seconds with a control of 30 seconds. What action
should the nurse take?
A. Increase the heparin infusion rate B. Stop the heparin infusion immediately
3
, NUR 209 Medical Surgical Nursing II | Exam 2 Review | Fortis College
C. Continue the current infusion rate and D. Administer protamine sulfate
recheck in 6 hours
Correct Answer: A
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5 to
2.5 times the control value. With a control of 30 seconds, the therapeutic range is 45-
75 seconds. An aPTT of 45 seconds is at the lower end, suggesting subtherapeutic
anticoagulation. The nurse should increase the infusion rate per protocol. Stopping
heparin or giving protamine sulfate is for dangerously elevated aPTT, not
subtherapeutic levels.
8. A client with peripheral arterial disease (PAD) reports leg pain when walking two
blocks that is relieved by rest. The nurse documents this as which finding?
A. Thromboangiitis B. Intermittent C. Chronic venous D. Raynaud's
obliterans claudication insufficiency phenomenon
Correct Answer: B
Rationale: Intermittent claudication is the classic symptom of PAD, characterized by
pain in the calf or leg muscles during exercise that is relieved by rest. It occurs due to
inadequate arterial blood flow to meet increased metabolic demands during activity.
Thromboangiitis obliterans (Buerger's disease) and Raynaud's phenomenon involve
vasospasm of small vessels. Chronic venous insufficiency presents with ankle edema
and stasis changes, not exercise-induced pain.
9. A client has a new prescription for enoxaparin (Lovenox) following hip
replacement surgery. Which statement by the client indicates a need for further
teaching?
A. I will inject the B. I should report C. I will take D. I will avoid
medication into my any unusual aspirin daily for shaving with a
abdominal fat bruising or pain relief straight razor
bleeding
Correct Answer: C
Rationale: The client should avoid concurrent use of aspirin or other NSAIDs with
enoxaparin because the combination significantly increases bleeding risk.
Enoxaparin is a low-molecular-weight heparin, and adding antiplatelet agents like
4
