NUR 242 Medical-Surgical Nursing Exam 2 | Questions
With 100% Correct Answers And Detailed Rationale |
2026/2027 Updates
Question 1.
A patient with infective endocarditis is prescribed IV antibiotic therapy for 6 weeks.
The nurse knows that the primary goal of prolonged antibiotic therapy is to:
A. Reduce fever and inflammation.
B. Eradicate the vegetation on the heart valve and prevent embolization.
C. Prevent the development of rheumatic fever.
D. Treat concurrent pneumonia.
Correct Answer: B
Rationale: Infective endocarditis is characterized by the formation of vegetations
(collections of platelets, fibrin, microorganisms, and inflammatory cells) on the heart valves
or endocardium. Prolonged IV antibiotic therapy (typically 4–6 weeks) is required to
penetrate the avascular vegetation and eradicate the infection. Eradication prevents
complications including: septic emboli (stroke, splenic infarct), valve destruction, heart
failure, and mycotic aneurysms. Blood cultures are obtained before starting antibiotics.
Surgery may be needed for large vegetations (>10 mm), recurrent emboli, or refractory
heart failure.
Question 2.
A patient with peripheral arterial disease (PAD) reports severe leg pain when
walking two blocks that resolves with rest. The nurse documents this as:
A. Rest pain.
B. Intermittent claudication.
C. Neuropathic pain.
D. Referred pain.
Correct Answer: B
Rationale: Intermittent claudication is cramping pain in the lower extremities (calves,
thighs, or buttocks) caused by ischemia during exercise, which resolves with rest. It is the
,classic symptom of peripheral arterial disease due to atherosclerotic narrowing. Rest pain
(pain at rest, especially at night with leg elevation) indicates critical limb ischemia.
Neuropathic pain is burning/tingling from nerve damage (diabetic neuropathy). Referred
pain originates from a different source. PAD management includes: smoking cessation,
antiplatelet therapy (aspirin, clopidogrel), statins, exercise rehabilitation, cilostazol, and
revascularization for severe cases.
Question 3.
A patient is recovering from coronary artery bypass graft (CABG) surgery. On
postoperative day 2, the patient develops atrial fibrillation with a rapid ventricular
response. The nurse knows that this complication occurs in up to 30% of CABG
patients and is primarily caused by:
A. Inadequate pain control.
B. Pericardial inflammation and atrial ischemia.
C. Overdose of beta-blockers.
D. Hypovolemia from excessive diuresis.
Correct Answer: B
Rationale: Postoperative atrial fibrillation (POAF) is the most common complication after
cardiac surgery, occurring in 25–40% of CABG patients. It typically develops within 2–4
days postoperatively. The primary mechanisms include: pericardial inflammation (from
surgical manipulation and pericardiotomy), atrial ischemia (from cardioplegia or graft
compromise), autonomic imbalance, and electrolyte disturbances (hypokalemia,
hypomagnesemia). Treatment includes: beta-blockers (first-line prophylaxis and
treatment), amiodarone, anticoagulation if AF persists >48 hours, and electrolyte repletion.
It increases stroke risk and length of stay.
Question 4.
A patient with a thoracic aortic aneurysm is being monitored. The nurse knows that
the most serious complication requiring immediate surgical intervention is:
A. Stable aneurysm measuring 4.0 cm in diameter.
B. Sudden onset of tearing chest pain radiating to the back with hypotension.
C. Chronic cough from aneurysm compression of the trachea.
D. Asymptomatic bradycardia.
, Correct Answer: B
Rationale: The most serious complication of a thoracic aortic aneurysm is rupture or acute
aortic dissection, which presents as sudden, severe, tearing chest or back pain ('ripping'
quality), hypotension, tachycardia, and signs of shock. This is a surgical emergency with
mortality exceeding 50% if not treated immediately. A 4.0 cm aneurysm is below the typical
surgical threshold (5.5 cm for ascending, 6.0 cm for descending). Chronic cough and
bradycardia are not emergencies. Dissection can also cause pulse deficits, neurologic
deficits, and acute MI if the coronary ostia are involved.
Question 5.
A patient with lung cancer is scheduled for a lobectomy. During preoperative
teaching, the nurse emphasizes deep breathing and incentive spirometry. The nurse
explains that the primary purpose of these exercises after thoracic surgery is to:
A. Reduce postoperative pain.
B. Prevent atelectasis and pneumonia by expanding alveoli and mobilizing secretions.
C. Decrease the need for opioid analgesics.
D. Promote rapid wound healing of the surgical incision.
Correct Answer: B
Rationale: After thoracic surgery (lobectomy, pneumonectomy, wedge resection), deep
breathing exercises and incentive spirometry are essential to prevent atelectasis and
pneumonia. Thoracic surgery, pain, and immobility cause shallow breathing and suppressed
cough, leading to alveolar collapse and retained secretions. Incentive spirometry
encourages sustained maximal inspiration, re-expanding alveoli. Early ambulation, effective
pain control, and chest physiotherapy are also critical. While pain reduction is important, it
is not the primary purpose of breathing exercises.
Question 6.
A patient with active pulmonary tuberculosis (TB) is started on a four-drug regimen.
The nurse knows that the standard first-line treatment for drug-susceptible TB
includes:
A. Isoniazid, rifampin, pyrazinamide, and ethambutol (RIPE therapy).
B. Ciprofloxacin, metronidazole, vancomycin, and azithromycin.
C. Penicillin G, streptomycin, and doxycycline.
With 100% Correct Answers And Detailed Rationale |
2026/2027 Updates
Question 1.
A patient with infective endocarditis is prescribed IV antibiotic therapy for 6 weeks.
The nurse knows that the primary goal of prolonged antibiotic therapy is to:
A. Reduce fever and inflammation.
B. Eradicate the vegetation on the heart valve and prevent embolization.
C. Prevent the development of rheumatic fever.
D. Treat concurrent pneumonia.
Correct Answer: B
Rationale: Infective endocarditis is characterized by the formation of vegetations
(collections of platelets, fibrin, microorganisms, and inflammatory cells) on the heart valves
or endocardium. Prolonged IV antibiotic therapy (typically 4–6 weeks) is required to
penetrate the avascular vegetation and eradicate the infection. Eradication prevents
complications including: septic emboli (stroke, splenic infarct), valve destruction, heart
failure, and mycotic aneurysms. Blood cultures are obtained before starting antibiotics.
Surgery may be needed for large vegetations (>10 mm), recurrent emboli, or refractory
heart failure.
Question 2.
A patient with peripheral arterial disease (PAD) reports severe leg pain when
walking two blocks that resolves with rest. The nurse documents this as:
A. Rest pain.
B. Intermittent claudication.
C. Neuropathic pain.
D. Referred pain.
Correct Answer: B
Rationale: Intermittent claudication is cramping pain in the lower extremities (calves,
thighs, or buttocks) caused by ischemia during exercise, which resolves with rest. It is the
,classic symptom of peripheral arterial disease due to atherosclerotic narrowing. Rest pain
(pain at rest, especially at night with leg elevation) indicates critical limb ischemia.
Neuropathic pain is burning/tingling from nerve damage (diabetic neuropathy). Referred
pain originates from a different source. PAD management includes: smoking cessation,
antiplatelet therapy (aspirin, clopidogrel), statins, exercise rehabilitation, cilostazol, and
revascularization for severe cases.
Question 3.
A patient is recovering from coronary artery bypass graft (CABG) surgery. On
postoperative day 2, the patient develops atrial fibrillation with a rapid ventricular
response. The nurse knows that this complication occurs in up to 30% of CABG
patients and is primarily caused by:
A. Inadequate pain control.
B. Pericardial inflammation and atrial ischemia.
C. Overdose of beta-blockers.
D. Hypovolemia from excessive diuresis.
Correct Answer: B
Rationale: Postoperative atrial fibrillation (POAF) is the most common complication after
cardiac surgery, occurring in 25–40% of CABG patients. It typically develops within 2–4
days postoperatively. The primary mechanisms include: pericardial inflammation (from
surgical manipulation and pericardiotomy), atrial ischemia (from cardioplegia or graft
compromise), autonomic imbalance, and electrolyte disturbances (hypokalemia,
hypomagnesemia). Treatment includes: beta-blockers (first-line prophylaxis and
treatment), amiodarone, anticoagulation if AF persists >48 hours, and electrolyte repletion.
It increases stroke risk and length of stay.
Question 4.
A patient with a thoracic aortic aneurysm is being monitored. The nurse knows that
the most serious complication requiring immediate surgical intervention is:
A. Stable aneurysm measuring 4.0 cm in diameter.
B. Sudden onset of tearing chest pain radiating to the back with hypotension.
C. Chronic cough from aneurysm compression of the trachea.
D. Asymptomatic bradycardia.
, Correct Answer: B
Rationale: The most serious complication of a thoracic aortic aneurysm is rupture or acute
aortic dissection, which presents as sudden, severe, tearing chest or back pain ('ripping'
quality), hypotension, tachycardia, and signs of shock. This is a surgical emergency with
mortality exceeding 50% if not treated immediately. A 4.0 cm aneurysm is below the typical
surgical threshold (5.5 cm for ascending, 6.0 cm for descending). Chronic cough and
bradycardia are not emergencies. Dissection can also cause pulse deficits, neurologic
deficits, and acute MI if the coronary ostia are involved.
Question 5.
A patient with lung cancer is scheduled for a lobectomy. During preoperative
teaching, the nurse emphasizes deep breathing and incentive spirometry. The nurse
explains that the primary purpose of these exercises after thoracic surgery is to:
A. Reduce postoperative pain.
B. Prevent atelectasis and pneumonia by expanding alveoli and mobilizing secretions.
C. Decrease the need for opioid analgesics.
D. Promote rapid wound healing of the surgical incision.
Correct Answer: B
Rationale: After thoracic surgery (lobectomy, pneumonectomy, wedge resection), deep
breathing exercises and incentive spirometry are essential to prevent atelectasis and
pneumonia. Thoracic surgery, pain, and immobility cause shallow breathing and suppressed
cough, leading to alveolar collapse and retained secretions. Incentive spirometry
encourages sustained maximal inspiration, re-expanding alveoli. Early ambulation, effective
pain control, and chest physiotherapy are also critical. While pain reduction is important, it
is not the primary purpose of breathing exercises.
Question 6.
A patient with active pulmonary tuberculosis (TB) is started on a four-drug regimen.
The nurse knows that the standard first-line treatment for drug-susceptible TB
includes:
A. Isoniazid, rifampin, pyrazinamide, and ethambutol (RIPE therapy).
B. Ciprofloxacin, metronidazole, vancomycin, and azithromycin.
C. Penicillin G, streptomycin, and doxycycline.
