NSG223 / NSG 223 Final Exam
Medical-Surgical Nursing II
Questions and Verified Answers | 100% Correct | Grade A
Latest Update
Herzing University
Total Questions 100 (25% Recall, 50% Application, 25% Analysis)
Format Multiple Choice (A-D), Single Best Answer
Sections 10 (Cardiovascular, Respiratory, GI/Liver, Renal, Endocrine, Neuro, MSK, Heme/Onc, Critical Care, Integrated)
Standards QSEN Competencies and 2026-2027 Medical-Surgical Nursing Guidelines
,NSG223 Final Exam | Medical-Surgical Nursing II | Herzing University 2026-2027 Page 2
Section 1: Cardiovascular and Peripheral Vascular Disorders
Hypertension, Heart Failure, CAD, ACS, Dysrhythmias, PAD, DVT, AAA
Q1: A client with primary hypertension is prescribed lisinopril, an ACE inhibitor. The nurse should teach the
client to monitor for which most common adverse effect?
A. Hyperkalemia and a persistent dry cough [CORRECT]
B. Hypokalemia and bradycardia
C. Hypocalcemia and peripheral edema
D. Hyponatremia and tinnitus
Correct Answer: A
Rationale: ACE inhibitors such as lisinopril block the conversion of angiotensin I to angiotensin II, reducing aldosterone secretion,
which leads to potassium retention and hyperkalemia. A persistent dry cough occurs in up to 20% of patients due to bradykinin
accumulation. Hypokalemia is associated with thiazide and loop diuretics, not ACE inhibitors. Hypocalcemia and tinnitus are not
typical adverse effects of this medication class.
Q2: A client presents to the emergency department with a blood pressure of 210/126 mmHg, headache,
confusion, and left arm weakness. The nurse recognizes this as which condition, and what is the priority
intervention?
A. Hypertensive urgency; administer oral clonidine and reassess in 24 hours
B. Hypertensive emergency with target organ damage; initiate IV antihypertensive therapy [CORRECT]
C. Malignant hypertension; administer IV furosemide and restrict fluids
D. Hypertensive crisis; administer sublingual nifedipine for rapid BP reduction
Correct Answer: B
Rationale: This client has a hypertensive emergency (BP >180/120 with evidence of target organ damage: neurologic changes
including confusion and left arm weakness suggesting CNS involvement). Hypertensive emergency requires IV antihypertensives
such as labetalol, nicardipine, or sodium nitroprusside for controlled BP reduction. Sublingual nifedipine is contraindicated due to
risk of precipitous, uncontrolled BP drop.
Q3: A client with left-sided heart failure reports increasing dyspnea when lying flat and needs to use three
pillows to sleep. The nurse documents this finding using which medical terminology?
A. Orthopnea [CORRECT]
B. Paroxysmal nocturnal dyspnea
C. Platypnea
D. Cheyne-Stokes respirations
Correct Answer: A
Rationale: Orthopnea is defined as dyspnea that occurs when lying flat and is relieved by sitting upright. It is a classic sign of
left-sided heart failure caused by increased venous return when supine, increasing pulmonary congestion. PND is sudden severe
dyspnea that awakens the client from sleep. Platypnea is the opposite. Cheyne-Stokes describes periodic breathing with alternating
apneic and hyperpneic phases.
Q4: A client is admitted with right-sided heart failure. Which assessment finding would the nurse most likely
observe?
A. Crackles on auscultation of bilateral lung fields
,NSG223 Final Exam | Medical-Surgical Nursing II | Herzing University 2026-2027 Page 3
B. Jugular venous distention (JVD) and dependent peripheral edema [CORRECT]
C. S3 gallop and moist cough with frothy sputum
D. Paroxysmal nocturnal dyspnea and exercise intolerance
Correct Answer: B
Rationale: Right-sided heart failure causes systemic venous congestion, leading to jugular venous distention, dependent peripheral
edema, hepatomegaly, ascites, and weight gain. Crackles, S3 gallop, and frothy sputum are signs of left-sided heart failure with
pulmonary congestion. PND is also more characteristic of left-sided heart failure.
Q5: A client with heart failure is prescribed a sodium restriction of 2 grams per day and daily morning
weights. The nurse teaches the client that which weight gain threshold should be reported to the healthcare
provider?
A. 1 pound in a week
B. 2 to 3 pounds in one day or 5 pounds in one week [CORRECT]
C. 5 pounds in one day
D. Any weight gain regardless of amount
Correct Answer: B
Rationale: For clients with heart failure, a weight gain of 2 to 3 pounds in one day or 5 pounds in one week indicates fluid
retention and is a warning sign of impending decompensation. The client should report this immediately as it may necessitate
medication adjustment such as increasing diuretic dosage. Daily weights (same time, same scale, same clothing) are essential
self-management strategies.
Q6: A client arrives at the emergency department with crushing substernal chest pain radiating to the left
arm. The cardiac monitor shows ST-segment elevation in leads II, III, and aVF. Which intervention should
the nurse implement first?
A. Administer morphine sulfate IV for pain relief
B. Administer sublingual nitroglycerin and assess response
C. Obtain a 12-lead ECG and prepare for immediate reperfusion therapy [CORRECT]
D. Administer aspirin 325 mg orally and apply oxygen
Correct Answer: C
Rationale: This client has an ST-elevation myocardial infarction (STEMI) with ST elevation in II, III, and aVF indicating an
inferior wall MI. The priority is obtaining a 12-lead ECG and preparing for immediate reperfusion therapy (PCI preferred within
90 minutes). While MONA is part of the protocol, the critical time-sensitive intervention is reperfusion.
Q7: A client with newly diagnosed atrial fibrillation has an irregularly irregular rhythm with absent P waves.
The nurse understands that the priority nursing intervention is focused on preventing which complication?
A. Pulmonary edema from rapid ventricular response
B. Cardiogenic shock from decreased cardiac output
C. Thromboembolism, particularly ischemic stroke [CORRECT]
D. Complete heart block requiring pacemaker placement
Correct Answer: C
Rationale: Atrial fibrillation causes blood to pool in the atria due to loss of effective atrial contraction, creating a high risk for
thrombus formation in the left atrial appendage. Clients require anticoagulation based on CHA2DS2-VASc score. Prevention of
thromboembolism (especially stroke) is the highest priority intervention.
, NSG223 Final Exam | Medical-Surgical Nursing II | Herzing University 2026-2027 Page 4
Q8: A client on the cardiac telemetry unit suddenly becomes unresponsive with no palpable pulse. The
monitor shows a chaotic, irregular waveform with no discernible P waves, QRS complexes, or T waves. Which
action should the nurse take immediately?
A. Begin chest compressions and call for the defibrillator [CORRECT]
B. Administer IV amiodarone 300 mg bolus
C. Perform carotid sinus massage to restore normal rhythm
D. Intubate and initiate mechanical ventilation
Correct Answer: A
Rationale: The client is in ventricular fibrillation (VFib), a lethal dysrhythmia with no effective cardiac output. The immediate
priority is initiating high-quality CPR and defibrillation. Per ACLS guidelines, defibrillation should be performed within 2 minutes.
Amiodarone is given after the first defibrillation if VFib persists. Carotid sinus massage is contraindicated in unstable rhythms.
Q9: A client with peripheral arterial disease (PAD) reports calf pain when walking two blocks that is relieved
by rest. The nurse teaches that which intervention is most critical for slowing disease progression?
A. Elevating the legs above heart level when resting
B. Smoking cessation [CORRECT]
C. Wearing compression stockings during the day
D. Taking warm baths to improve peripheral circulation
Correct Answer: B
Rationale: The client describes classic intermittent claudication. Smoking cessation is the single most critical intervention because
smoking causes vasoconstriction, promotes atherosclerosis, and accelerates disease progression. Elevating legs is contraindicated in
arterial insufficiency. Compression stockings are for venous insufficiency. Warm baths increase burn risk due to decreased
sensation.
Q10: A postoperative client develops unilateral left calf pain, swelling, and warmth. The nurse performs
Homan's sign and the client reports calf pain. Which interpretation is most accurate?
A. A positive Homan's sign confirms the diagnosis of deep vein thrombosis
B. Homan's sign is unreliable for DVT diagnosis and further diagnostic testing is needed [CORRECT]
C. A negative Homan's sign rules out DVT as the cause of symptoms
D. Homan's sign is only valid when the client is experiencing calf pain at rest
Correct Answer: B
Rationale: Homan's sign is unreliable and nonspecific for DVT diagnosis. It can be positive in other conditions and negative when
DVT is present. The gold standard is venous duplex ultrasonography. The client's unilateral calf pain, swelling, and warmth are
classic DVT symptoms warranting immediate diagnostic evaluation and anticoagulation.
Q11: A 68-year-old male with a known abdominal aortic aneurysm (AAA) measuring 4.8 cm reports sudden
severe back pain and abdominal fullness. The nurse's priority action is to:
A. Administer prescribed analgesic and reassess pain in 30 minutes
B. Auscultate the abdomen for a bruit and measure abdominal girth
C. Prepare the client for emergency surgical intervention and notify the surgical team immediately
[CORRECT]
D. Assist the client to a side-lying position to relieve abdominal pressure
Correct Answer: C
Medical-Surgical Nursing II
Questions and Verified Answers | 100% Correct | Grade A
Latest Update
Herzing University
Total Questions 100 (25% Recall, 50% Application, 25% Analysis)
Format Multiple Choice (A-D), Single Best Answer
Sections 10 (Cardiovascular, Respiratory, GI/Liver, Renal, Endocrine, Neuro, MSK, Heme/Onc, Critical Care, Integrated)
Standards QSEN Competencies and 2026-2027 Medical-Surgical Nursing Guidelines
,NSG223 Final Exam | Medical-Surgical Nursing II | Herzing University 2026-2027 Page 2
Section 1: Cardiovascular and Peripheral Vascular Disorders
Hypertension, Heart Failure, CAD, ACS, Dysrhythmias, PAD, DVT, AAA
Q1: A client with primary hypertension is prescribed lisinopril, an ACE inhibitor. The nurse should teach the
client to monitor for which most common adverse effect?
A. Hyperkalemia and a persistent dry cough [CORRECT]
B. Hypokalemia and bradycardia
C. Hypocalcemia and peripheral edema
D. Hyponatremia and tinnitus
Correct Answer: A
Rationale: ACE inhibitors such as lisinopril block the conversion of angiotensin I to angiotensin II, reducing aldosterone secretion,
which leads to potassium retention and hyperkalemia. A persistent dry cough occurs in up to 20% of patients due to bradykinin
accumulation. Hypokalemia is associated with thiazide and loop diuretics, not ACE inhibitors. Hypocalcemia and tinnitus are not
typical adverse effects of this medication class.
Q2: A client presents to the emergency department with a blood pressure of 210/126 mmHg, headache,
confusion, and left arm weakness. The nurse recognizes this as which condition, and what is the priority
intervention?
A. Hypertensive urgency; administer oral clonidine and reassess in 24 hours
B. Hypertensive emergency with target organ damage; initiate IV antihypertensive therapy [CORRECT]
C. Malignant hypertension; administer IV furosemide and restrict fluids
D. Hypertensive crisis; administer sublingual nifedipine for rapid BP reduction
Correct Answer: B
Rationale: This client has a hypertensive emergency (BP >180/120 with evidence of target organ damage: neurologic changes
including confusion and left arm weakness suggesting CNS involvement). Hypertensive emergency requires IV antihypertensives
such as labetalol, nicardipine, or sodium nitroprusside for controlled BP reduction. Sublingual nifedipine is contraindicated due to
risk of precipitous, uncontrolled BP drop.
Q3: A client with left-sided heart failure reports increasing dyspnea when lying flat and needs to use three
pillows to sleep. The nurse documents this finding using which medical terminology?
A. Orthopnea [CORRECT]
B. Paroxysmal nocturnal dyspnea
C. Platypnea
D. Cheyne-Stokes respirations
Correct Answer: A
Rationale: Orthopnea is defined as dyspnea that occurs when lying flat and is relieved by sitting upright. It is a classic sign of
left-sided heart failure caused by increased venous return when supine, increasing pulmonary congestion. PND is sudden severe
dyspnea that awakens the client from sleep. Platypnea is the opposite. Cheyne-Stokes describes periodic breathing with alternating
apneic and hyperpneic phases.
Q4: A client is admitted with right-sided heart failure. Which assessment finding would the nurse most likely
observe?
A. Crackles on auscultation of bilateral lung fields
,NSG223 Final Exam | Medical-Surgical Nursing II | Herzing University 2026-2027 Page 3
B. Jugular venous distention (JVD) and dependent peripheral edema [CORRECT]
C. S3 gallop and moist cough with frothy sputum
D. Paroxysmal nocturnal dyspnea and exercise intolerance
Correct Answer: B
Rationale: Right-sided heart failure causes systemic venous congestion, leading to jugular venous distention, dependent peripheral
edema, hepatomegaly, ascites, and weight gain. Crackles, S3 gallop, and frothy sputum are signs of left-sided heart failure with
pulmonary congestion. PND is also more characteristic of left-sided heart failure.
Q5: A client with heart failure is prescribed a sodium restriction of 2 grams per day and daily morning
weights. The nurse teaches the client that which weight gain threshold should be reported to the healthcare
provider?
A. 1 pound in a week
B. 2 to 3 pounds in one day or 5 pounds in one week [CORRECT]
C. 5 pounds in one day
D. Any weight gain regardless of amount
Correct Answer: B
Rationale: For clients with heart failure, a weight gain of 2 to 3 pounds in one day or 5 pounds in one week indicates fluid
retention and is a warning sign of impending decompensation. The client should report this immediately as it may necessitate
medication adjustment such as increasing diuretic dosage. Daily weights (same time, same scale, same clothing) are essential
self-management strategies.
Q6: A client arrives at the emergency department with crushing substernal chest pain radiating to the left
arm. The cardiac monitor shows ST-segment elevation in leads II, III, and aVF. Which intervention should
the nurse implement first?
A. Administer morphine sulfate IV for pain relief
B. Administer sublingual nitroglycerin and assess response
C. Obtain a 12-lead ECG and prepare for immediate reperfusion therapy [CORRECT]
D. Administer aspirin 325 mg orally and apply oxygen
Correct Answer: C
Rationale: This client has an ST-elevation myocardial infarction (STEMI) with ST elevation in II, III, and aVF indicating an
inferior wall MI. The priority is obtaining a 12-lead ECG and preparing for immediate reperfusion therapy (PCI preferred within
90 minutes). While MONA is part of the protocol, the critical time-sensitive intervention is reperfusion.
Q7: A client with newly diagnosed atrial fibrillation has an irregularly irregular rhythm with absent P waves.
The nurse understands that the priority nursing intervention is focused on preventing which complication?
A. Pulmonary edema from rapid ventricular response
B. Cardiogenic shock from decreased cardiac output
C. Thromboembolism, particularly ischemic stroke [CORRECT]
D. Complete heart block requiring pacemaker placement
Correct Answer: C
Rationale: Atrial fibrillation causes blood to pool in the atria due to loss of effective atrial contraction, creating a high risk for
thrombus formation in the left atrial appendage. Clients require anticoagulation based on CHA2DS2-VASc score. Prevention of
thromboembolism (especially stroke) is the highest priority intervention.
, NSG223 Final Exam | Medical-Surgical Nursing II | Herzing University 2026-2027 Page 4
Q8: A client on the cardiac telemetry unit suddenly becomes unresponsive with no palpable pulse. The
monitor shows a chaotic, irregular waveform with no discernible P waves, QRS complexes, or T waves. Which
action should the nurse take immediately?
A. Begin chest compressions and call for the defibrillator [CORRECT]
B. Administer IV amiodarone 300 mg bolus
C. Perform carotid sinus massage to restore normal rhythm
D. Intubate and initiate mechanical ventilation
Correct Answer: A
Rationale: The client is in ventricular fibrillation (VFib), a lethal dysrhythmia with no effective cardiac output. The immediate
priority is initiating high-quality CPR and defibrillation. Per ACLS guidelines, defibrillation should be performed within 2 minutes.
Amiodarone is given after the first defibrillation if VFib persists. Carotid sinus massage is contraindicated in unstable rhythms.
Q9: A client with peripheral arterial disease (PAD) reports calf pain when walking two blocks that is relieved
by rest. The nurse teaches that which intervention is most critical for slowing disease progression?
A. Elevating the legs above heart level when resting
B. Smoking cessation [CORRECT]
C. Wearing compression stockings during the day
D. Taking warm baths to improve peripheral circulation
Correct Answer: B
Rationale: The client describes classic intermittent claudication. Smoking cessation is the single most critical intervention because
smoking causes vasoconstriction, promotes atherosclerosis, and accelerates disease progression. Elevating legs is contraindicated in
arterial insufficiency. Compression stockings are for venous insufficiency. Warm baths increase burn risk due to decreased
sensation.
Q10: A postoperative client develops unilateral left calf pain, swelling, and warmth. The nurse performs
Homan's sign and the client reports calf pain. Which interpretation is most accurate?
A. A positive Homan's sign confirms the diagnosis of deep vein thrombosis
B. Homan's sign is unreliable for DVT diagnosis and further diagnostic testing is needed [CORRECT]
C. A negative Homan's sign rules out DVT as the cause of symptoms
D. Homan's sign is only valid when the client is experiencing calf pain at rest
Correct Answer: B
Rationale: Homan's sign is unreliable and nonspecific for DVT diagnosis. It can be positive in other conditions and negative when
DVT is present. The gold standard is venous duplex ultrasonography. The client's unilateral calf pain, swelling, and warmth are
classic DVT symptoms warranting immediate diagnostic evaluation and anticoagulation.
Q11: A 68-year-old male with a known abdominal aortic aneurysm (AAA) measuring 4.8 cm reports sudden
severe back pain and abdominal fullness. The nurse's priority action is to:
A. Administer prescribed analgesic and reassess pain in 30 minutes
B. Auscultate the abdomen for a bruit and measure abdominal girth
C. Prepare the client for emergency surgical intervention and notify the surgical team immediately
[CORRECT]
D. Assist the client to a side-lying position to relieve abdominal pressure
Correct Answer: C
