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NSG 223 MED SURG II PROCTORED MIDTERM PRACTICE
Questions with Detailed Rationales
SECTION 1: CARDIOVASCULAR (Questions 1–15)
Question 1
A client with heart failure reports a weight gain of 3 lb in 24
hours and worsening dyspnea. Which action should the nurse
take first?
A. Document the findings
B. Notify the provider and assess for fluid overload
C. Encourage the client to rest
D. Decrease IV fluids
Answer: B
Rationale: Rapid weight gain and worsening dyspnea indicate
fluid overload; the nurse should assess and notify the provider
promptly.
Question 2
A nurse is caring for a client with acute myocardial infarction.
Which laboratory value is most specific for myocardial injury?
A. CK-MB
B. Troponin I
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C. Myoglobin
D. BNP
Answer: B
Rationale: Troponin I is the most specific and sensitive
biomarker for myocardial injury.
Question 3
A client is receiving alteplase for an acute ischemic stroke.
Which finding requires immediate discontinuation of the
infusion?
A. New onset of severe headache and decreased level of
consciousness
B. Blood pressure 150/90
C. Heart rate 88
D. Mild bleeding at IV site
Answer: A
Rationale: Severe headache and decreased LOC may indicate
intracranial hemorrhage, a life-threatening complication of
thrombolytic therapy.
Question 4
A client with peripheral arterial disease asks why walking causes
leg pain. What is the nurse's best response?
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A. "The pain is from muscle spasms."
B. "Your muscles are not getting enough blood flow during
exercise."
C. "The pain is from nerve damage."
D. "Your veins are not working properly."
Answer: B
Rationale: Intermittent claudication is caused by inadequate
arterial blood flow to muscles during exercise, producing
ischemic pain.
Question 5
Which ECG finding indicates a client is at risk for ventricular
arrhythmias and sudden cardiac death?
A. Prolonged QT interval
B. Sinus bradycardia
C. Premature atrial contractions
D. First-degree AV block
Answer: A
Rationale: Prolonged QT interval increases risk of torsades de
pointes and sudden cardiac death.
Question 6
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A nurse is teaching a client with heart failure about daily
weights. Which statement indicates correct understanding?
A. "I will weigh myself once a week."
B. "I will weigh myself every morning after voiding and report a
gain of 2–3 lb in a day."
C. "I will weigh myself only when I feel bloated."
D. "Weight gain is not important."
Answer: B
Rationale: Daily morning weights after voiding are essential to
detect fluid retention early.
Question 7
A client with hypertension is prescribed amlodipine. Which side
effect is most common?
A. Cough
B. Peripheral edema
C. Hyperkalemia
D. Bradycardia
Answer: B
Rationale: Amlodipine, a calcium channel blocker, commonly
causes peripheral edema due to vasodilation.
Question 8
NSG 223 MED SURG II PROCTORED MIDTERM PRACTICE
Questions with Detailed Rationales
SECTION 1: CARDIOVASCULAR (Questions 1–15)
Question 1
A client with heart failure reports a weight gain of 3 lb in 24
hours and worsening dyspnea. Which action should the nurse
take first?
A. Document the findings
B. Notify the provider and assess for fluid overload
C. Encourage the client to rest
D. Decrease IV fluids
Answer: B
Rationale: Rapid weight gain and worsening dyspnea indicate
fluid overload; the nurse should assess and notify the provider
promptly.
Question 2
A nurse is caring for a client with acute myocardial infarction.
Which laboratory value is most specific for myocardial injury?
A. CK-MB
B. Troponin I
, Page |2
C. Myoglobin
D. BNP
Answer: B
Rationale: Troponin I is the most specific and sensitive
biomarker for myocardial injury.
Question 3
A client is receiving alteplase for an acute ischemic stroke.
Which finding requires immediate discontinuation of the
infusion?
A. New onset of severe headache and decreased level of
consciousness
B. Blood pressure 150/90
C. Heart rate 88
D. Mild bleeding at IV site
Answer: A
Rationale: Severe headache and decreased LOC may indicate
intracranial hemorrhage, a life-threatening complication of
thrombolytic therapy.
Question 4
A client with peripheral arterial disease asks why walking causes
leg pain. What is the nurse's best response?
, Page |3
A. "The pain is from muscle spasms."
B. "Your muscles are not getting enough blood flow during
exercise."
C. "The pain is from nerve damage."
D. "Your veins are not working properly."
Answer: B
Rationale: Intermittent claudication is caused by inadequate
arterial blood flow to muscles during exercise, producing
ischemic pain.
Question 5
Which ECG finding indicates a client is at risk for ventricular
arrhythmias and sudden cardiac death?
A. Prolonged QT interval
B. Sinus bradycardia
C. Premature atrial contractions
D. First-degree AV block
Answer: A
Rationale: Prolonged QT interval increases risk of torsades de
pointes and sudden cardiac death.
Question 6
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A nurse is teaching a client with heart failure about daily
weights. Which statement indicates correct understanding?
A. "I will weigh myself once a week."
B. "I will weigh myself every morning after voiding and report a
gain of 2–3 lb in a day."
C. "I will weigh myself only when I feel bloated."
D. "Weight gain is not important."
Answer: B
Rationale: Daily morning weights after voiding are essential to
detect fluid retention early.
Question 7
A client with hypertension is prescribed amlodipine. Which side
effect is most common?
A. Cough
B. Peripheral edema
C. Hyperkalemia
D. Bradycardia
Answer: B
Rationale: Amlodipine, a calcium channel blocker, commonly
causes peripheral edema due to vasodilation.
Question 8
