NSG223 / NSG 223 Exam 2 (Latest Update)
Medical-Surgical Nursing II
Questions and Verified Answers | 100% Correct | Grade A
Herzing University | 2026-2027 Curriculum
50 Multiple-Choice Questions
Section 1: Heart Failure, Cardiomyopathy, and Valvular Disorders (Q1-Q15)
Q1: A nurse is assessing a client with left-sided heart failure. Which of the following findings should the nurse
expect?
A.. Peripheral edema and jugular venous distention
B.. Dyspnea, pulmonary crackles, and S3 gallop **[CORRECT]**
C.. Hepatomegaly and ascites
D.. Weight gain and anorexia
Correct Answer: B
Rationale: Left-sided heart failure results in inadequate left ventricular output, causing blood to back up into the pulmonary
circulation. This produces respiratory manifestations including dyspnea, pulmonary crackles from fluid in the alveoli,
paroxysmal nocturnal dyspnea (PND), orthopnea, and an S3 gallop from ventricular volume overload. Peripheral edema,
JVD, hepatomegaly, ascites, weight gain, and anorexia are manifestations of right-sided heart failure, where blood backs up
into the systemic venous circulation. Confusing left and right-sided HF signs is one of the most common errors on NSG 223
exams.
Q2: A client with heart failure is prescribed furosemide. Which nursing intervention is most important for the
nurse to implement?
A.. Monitor for hyperkalemia
B.. Assess daily weights and intake and output **[CORRECT]**
C.. Encourage a high-sodium diet
D.. Administer the medication at bedtime
Correct Answer: B
Rationale: Furosemide is a loop diuretic that decreases fluid volume in heart failure by promoting renal excretion of sodium
and water. The most critical nursing intervention is monitoring daily weights (reporting a gain of 2-3 lb/day or 5 lb/week) and
strict intake and output measurements to evaluate fluid balance and drug effectiveness. Furosemide causes hypokalemia (not
hyperkalemia) due to potassium wasting, so the nurse should monitor for low potassium levels. A low-sodium diet (less than 2
g/day) is recommended for heart failure, not a high-sodium diet. Furosemide should be administered in the morning to prevent
nocturia, not at bedtime.
NSG223 / NSG 223 Exam 2 | Medical-Surgical Nursing II | Herzing University Page 1
, Q3: A nurse is providing discharge teaching to a client with heart failure. Which statement by the client indicates
an understanding of the teaching?
A.. I will weigh myself once a month and call my doctor if I gain 10 pounds.
B.. I will restrict my fluid intake to no more than 8 cups per day unless my doctor says otherwise.
C.. I will report a weight gain of 2-3 pounds in a day or 5 pounds in a week to my provider.
**[CORRECT]**
D.. I will stop taking my carvedilol when I feel better and my symptoms improve.
Correct Answer: C
Rationale: Daily weight monitoring is the most reliable indicator of fluid retention in heart failure. Clients should be taught to
weigh themselves at the same time each day on the same scale and to report a weight gain of 2-3 lb in one day or 5 lb in one
week to their healthcare provider, as this may indicate worsening fluid overload requiring medication adjustment. Fluid
restriction is individualized and only implemented if ordered by the provider, not as a universal rule. Beta-blockers such as
carvedilol must never be abruptly discontinued, as sudden withdrawal can cause rebound tachycardia, increased myocardial
oxygen demand, and exacerbation of heart failure symptoms. Monthly weight monitoring is insufficient for early detection of
fluid overload.
Q4: A client with heart failure has a BNP level of 650 pg/mL. The nurse understands that this result indicates
which of the following?
A.. Normal cardiac function
B.. Mild fluid retention only
C.. Significant heart failure requiring immediate clinical evaluation **[CORRECT]**
D.. Renal failure as the primary problem
Correct Answer: C
Rationale: B-type Natriuretic Peptide (BNP) is a cardiac biomarker secreted by the ventricles in response to volume expansion
and pressure overload. A normal BNP level is less than 100 pg/mL. A BNP of 650 pg/mL is markedly elevated and indicates
significant heart failure with considerable ventricular wall stretch. BNP levels correlate with heart failure severity: levels
above 400 pg/mL generally indicate severe heart failure. While BNP can be mildly elevated in renal failure due to decreased
clearance, a level this high is most specific to cardiac etiology and warrants prompt clinical evaluation and treatment
adjustment per the 2026 GDMT guidelines for heart failure management.
Q5: A client is classified as NYHA Class III heart failure. The nurse correctly understands that this client has
which level of functional limitation?
A.. No limitation of physical activity; ordinary activity does not cause symptoms.
B.. Slight limitation; comfortable at rest but ordinary activity causes symptoms.
C.. Marked limitation; comfortable only at rest; less than ordinary activity causes symptoms.
**[CORRECT]**
D.. Unable to perform any physical activity without discomfort; symptoms present at rest.
Correct Answer: C
Rationale: The New York Heart Association (NYHA) Functional Classification system categorizes heart failure into four
classes based on the degree of functional limitation. Class I indicates no limitation of physical activity. Class II indicates slight
limitation, with symptoms occurring during ordinary activity. Class III indicates marked limitation, where the client is
comfortable only at rest and experiences symptoms with less than ordinary activity. Class IV indicates the most severe form,
with symptoms present at rest and inability to carry on any physical activity without discomfort. Accurate classification guides
both pharmacologic management and activity recommendations per the 2026 GDMT guidelines.
NSG223 / NSG 223 Exam 2 | Medical-Surgical Nursing II | Herzing University Page 2
, Q6: A nurse is caring for a client prescribed enalapril, an ACE inhibitor, for heart failure. Which adverse effect
should the nurse monitor for and report to the provider?
A.. Hypokalemia and dehydration
B.. Hyperkalemia and a persistent dry cough **[CORRECT]**
C.. Bradycardia and hypotension only
D.. Increased urine output and hypernatremia
Correct Answer: B
Rationale: ACE inhibitors such as enalapril are first-line pharmacologic therapy for heart failure because they decrease both
preload and afterload by inhibiting the conversion of angiotensin I to angiotensin II and reducing aldosterone secretion.
However, decreased aldosterone leads to potassium retention, placing the client at risk for hyperkalemia. The nurse should
monitor serum potassium levels and renal function closely. Additionally, ACE inhibitors cause accumulation of bradykinin,
which produces a persistent dry cough in approximately 10-20% of patients. If the cough is intolerable, the provider may
switch to an ARB, which does not affect bradykinin. Hypokalemia is associated with loop diuretics, not ACE inhibitors. While
hypotension can occur, it is not the only concern.
Q7: A client with dilated cardiomyopathy is being discharged home. Which instruction should the nurse include in
the discharge teaching?
A.. Limit fluid intake to 3 liters daily and avoid all physical activity.
B.. Avoid alcohol consumption and report palpitations or increased fatigue. **[CORRECT]**
C.. Take over-the-counter NSAIDs regularly for joint pain management.
D.. Increase dietary sodium to 4 g per day to maintain blood pressure.
Correct Answer: B
Rationale: Dilated cardiomyopathy is the most common type of cardiomyopathy, characterized by ventricular dilation and
impaired systolic function. Alcohol is a known cause of dilated cardiomyopathy and continued consumption can worsen the
condition, so complete alcohol avoidance is essential. Clients should also report palpitations, increased fatigue, or signs of
worsening heart failure promptly, as they are at increased risk for arrhythmias and sudden cardiac death. NSAIDs should be
avoided as they promote sodium and water retention, worsening heart failure. Sodium should be restricted to less than 2 g/day,
not increased. Fluid restrictions are individualized and activity should be encouraged within tolerance, not avoided entirely. An
ICD may be indicated for primary prevention of sudden cardiac death.
Q8: A nurse is assessing a client with hypertrophic cardiomyopathy (HCM). Which finding is most concerning and
requires immediate intervention?
A.. A systolic ejection murmur heard at the right upper sternal border
B.. Syncope during physical exertion **[CORRECT]**
C.. Asymmetric septal hypertrophy noted on echocardiogram
D.. A family history of sudden cardiac death
Correct Answer: B
Rationale: Hypertrophic cardiomyopathy is characterized by asymmetric septal hypertrophy that impairs diastolic filling and
causes dynamic left ventricular outflow tract obstruction. While all the findings listed are associated with HCM, syncope
during physical exertion is the most concerning because it indicates reduced cardiac output from the obstructive physiology and
is a warning sign of impending sudden cardiac death. HCM is the leading cause of sudden cardiac death in young athletes.
The systolic ejection murmur is a classic auscultatory finding. Family history is important for risk stratification. However,
syncope is an immediate clinical red flag requiring urgent evaluation for possible ICD placement and activity restriction per
2026 AHA/ACC guidelines.
NSG223 / NSG 223 Exam 2 | Medical-Surgical Nursing II | Herzing University Page 3
Medical-Surgical Nursing II
Questions and Verified Answers | 100% Correct | Grade A
Herzing University | 2026-2027 Curriculum
50 Multiple-Choice Questions
Section 1: Heart Failure, Cardiomyopathy, and Valvular Disorders (Q1-Q15)
Q1: A nurse is assessing a client with left-sided heart failure. Which of the following findings should the nurse
expect?
A.. Peripheral edema and jugular venous distention
B.. Dyspnea, pulmonary crackles, and S3 gallop **[CORRECT]**
C.. Hepatomegaly and ascites
D.. Weight gain and anorexia
Correct Answer: B
Rationale: Left-sided heart failure results in inadequate left ventricular output, causing blood to back up into the pulmonary
circulation. This produces respiratory manifestations including dyspnea, pulmonary crackles from fluid in the alveoli,
paroxysmal nocturnal dyspnea (PND), orthopnea, and an S3 gallop from ventricular volume overload. Peripheral edema,
JVD, hepatomegaly, ascites, weight gain, and anorexia are manifestations of right-sided heart failure, where blood backs up
into the systemic venous circulation. Confusing left and right-sided HF signs is one of the most common errors on NSG 223
exams.
Q2: A client with heart failure is prescribed furosemide. Which nursing intervention is most important for the
nurse to implement?
A.. Monitor for hyperkalemia
B.. Assess daily weights and intake and output **[CORRECT]**
C.. Encourage a high-sodium diet
D.. Administer the medication at bedtime
Correct Answer: B
Rationale: Furosemide is a loop diuretic that decreases fluid volume in heart failure by promoting renal excretion of sodium
and water. The most critical nursing intervention is monitoring daily weights (reporting a gain of 2-3 lb/day or 5 lb/week) and
strict intake and output measurements to evaluate fluid balance and drug effectiveness. Furosemide causes hypokalemia (not
hyperkalemia) due to potassium wasting, so the nurse should monitor for low potassium levels. A low-sodium diet (less than 2
g/day) is recommended for heart failure, not a high-sodium diet. Furosemide should be administered in the morning to prevent
nocturia, not at bedtime.
NSG223 / NSG 223 Exam 2 | Medical-Surgical Nursing II | Herzing University Page 1
, Q3: A nurse is providing discharge teaching to a client with heart failure. Which statement by the client indicates
an understanding of the teaching?
A.. I will weigh myself once a month and call my doctor if I gain 10 pounds.
B.. I will restrict my fluid intake to no more than 8 cups per day unless my doctor says otherwise.
C.. I will report a weight gain of 2-3 pounds in a day or 5 pounds in a week to my provider.
**[CORRECT]**
D.. I will stop taking my carvedilol when I feel better and my symptoms improve.
Correct Answer: C
Rationale: Daily weight monitoring is the most reliable indicator of fluid retention in heart failure. Clients should be taught to
weigh themselves at the same time each day on the same scale and to report a weight gain of 2-3 lb in one day or 5 lb in one
week to their healthcare provider, as this may indicate worsening fluid overload requiring medication adjustment. Fluid
restriction is individualized and only implemented if ordered by the provider, not as a universal rule. Beta-blockers such as
carvedilol must never be abruptly discontinued, as sudden withdrawal can cause rebound tachycardia, increased myocardial
oxygen demand, and exacerbation of heart failure symptoms. Monthly weight monitoring is insufficient for early detection of
fluid overload.
Q4: A client with heart failure has a BNP level of 650 pg/mL. The nurse understands that this result indicates
which of the following?
A.. Normal cardiac function
B.. Mild fluid retention only
C.. Significant heart failure requiring immediate clinical evaluation **[CORRECT]**
D.. Renal failure as the primary problem
Correct Answer: C
Rationale: B-type Natriuretic Peptide (BNP) is a cardiac biomarker secreted by the ventricles in response to volume expansion
and pressure overload. A normal BNP level is less than 100 pg/mL. A BNP of 650 pg/mL is markedly elevated and indicates
significant heart failure with considerable ventricular wall stretch. BNP levels correlate with heart failure severity: levels
above 400 pg/mL generally indicate severe heart failure. While BNP can be mildly elevated in renal failure due to decreased
clearance, a level this high is most specific to cardiac etiology and warrants prompt clinical evaluation and treatment
adjustment per the 2026 GDMT guidelines for heart failure management.
Q5: A client is classified as NYHA Class III heart failure. The nurse correctly understands that this client has
which level of functional limitation?
A.. No limitation of physical activity; ordinary activity does not cause symptoms.
B.. Slight limitation; comfortable at rest but ordinary activity causes symptoms.
C.. Marked limitation; comfortable only at rest; less than ordinary activity causes symptoms.
**[CORRECT]**
D.. Unable to perform any physical activity without discomfort; symptoms present at rest.
Correct Answer: C
Rationale: The New York Heart Association (NYHA) Functional Classification system categorizes heart failure into four
classes based on the degree of functional limitation. Class I indicates no limitation of physical activity. Class II indicates slight
limitation, with symptoms occurring during ordinary activity. Class III indicates marked limitation, where the client is
comfortable only at rest and experiences symptoms with less than ordinary activity. Class IV indicates the most severe form,
with symptoms present at rest and inability to carry on any physical activity without discomfort. Accurate classification guides
both pharmacologic management and activity recommendations per the 2026 GDMT guidelines.
NSG223 / NSG 223 Exam 2 | Medical-Surgical Nursing II | Herzing University Page 2
, Q6: A nurse is caring for a client prescribed enalapril, an ACE inhibitor, for heart failure. Which adverse effect
should the nurse monitor for and report to the provider?
A.. Hypokalemia and dehydration
B.. Hyperkalemia and a persistent dry cough **[CORRECT]**
C.. Bradycardia and hypotension only
D.. Increased urine output and hypernatremia
Correct Answer: B
Rationale: ACE inhibitors such as enalapril are first-line pharmacologic therapy for heart failure because they decrease both
preload and afterload by inhibiting the conversion of angiotensin I to angiotensin II and reducing aldosterone secretion.
However, decreased aldosterone leads to potassium retention, placing the client at risk for hyperkalemia. The nurse should
monitor serum potassium levels and renal function closely. Additionally, ACE inhibitors cause accumulation of bradykinin,
which produces a persistent dry cough in approximately 10-20% of patients. If the cough is intolerable, the provider may
switch to an ARB, which does not affect bradykinin. Hypokalemia is associated with loop diuretics, not ACE inhibitors. While
hypotension can occur, it is not the only concern.
Q7: A client with dilated cardiomyopathy is being discharged home. Which instruction should the nurse include in
the discharge teaching?
A.. Limit fluid intake to 3 liters daily and avoid all physical activity.
B.. Avoid alcohol consumption and report palpitations or increased fatigue. **[CORRECT]**
C.. Take over-the-counter NSAIDs regularly for joint pain management.
D.. Increase dietary sodium to 4 g per day to maintain blood pressure.
Correct Answer: B
Rationale: Dilated cardiomyopathy is the most common type of cardiomyopathy, characterized by ventricular dilation and
impaired systolic function. Alcohol is a known cause of dilated cardiomyopathy and continued consumption can worsen the
condition, so complete alcohol avoidance is essential. Clients should also report palpitations, increased fatigue, or signs of
worsening heart failure promptly, as they are at increased risk for arrhythmias and sudden cardiac death. NSAIDs should be
avoided as they promote sodium and water retention, worsening heart failure. Sodium should be restricted to less than 2 g/day,
not increased. Fluid restrictions are individualized and activity should be encouraged within tolerance, not avoided entirely. An
ICD may be indicated for primary prevention of sudden cardiac death.
Q8: A nurse is assessing a client with hypertrophic cardiomyopathy (HCM). Which finding is most concerning and
requires immediate intervention?
A.. A systolic ejection murmur heard at the right upper sternal border
B.. Syncope during physical exertion **[CORRECT]**
C.. Asymmetric septal hypertrophy noted on echocardiogram
D.. A family history of sudden cardiac death
Correct Answer: B
Rationale: Hypertrophic cardiomyopathy is characterized by asymmetric septal hypertrophy that impairs diastolic filling and
causes dynamic left ventricular outflow tract obstruction. While all the findings listed are associated with HCM, syncope
during physical exertion is the most concerning because it indicates reduced cardiac output from the obstructive physiology and
is a warning sign of impending sudden cardiac death. HCM is the leading cause of sudden cardiac death in young athletes.
The systolic ejection murmur is a classic auscultatory finding. Family history is important for risk stratification. However,
syncope is an immediate clinical red flag requiring urgent evaluation for possible ICD placement and activity restriction per
2026 AHA/ACC guidelines.
NSG223 / NSG 223 Exam 2 | Medical-Surgical Nursing II | Herzing University Page 3
