NUR 242 Medical-Surgical Nursing Comprehensive
Final Exam 2026/2027 | 100 Questions With Correct
Answers And Explained Rationale
Question 1.
A patient with acute decompensated heart failure has crackles in the lung bases,
jugular venous distension, and peripheral edema. The nurse knows these findings
indicate:
A. Left-sided heart failure with pulmonary congestion.
B. Right-sided heart failure with systemic venous congestion.
C. Biventricular failure with both pulmonary and systemic congestion.
D. Isolated systolic dysfunction without volume overload.
Correct Answer: C
Rationale: Crackles and JVD together suggest biventricular failure. Left-sided failure causes
pulmonary congestion (crackles, dyspnea, orthopnea). Right-sided failure causes systemic
venous congestion (JVD, peripheral edema, hepatomegaly). When both sets of symptoms
are present, both ventricles are failing. Treatment includes: diuretics, nitrates, ACE
inhibitors/ARBs/ARNIs, beta-blockers, and inotropes if needed.
Question 2.
A patient with atrial fibrillation is prescribed warfarin. The target INR range for
stroke prevention in AFib is:
A. 1.5–2.0.
B. 2.0–3.0.
C. 2.5–3.5.
D. 3.0–4.0.
Correct Answer: B
Rationale: For most patients with atrial fibrillation, the target INR on warfarin is 2.0–3.0.
For mechanical heart valves (especially mitral), the target is higher at 2.5–3.5. DOACs
(apixaban, rivaroxaban, dabigatran, edoxaban) are alternatives that do not require INR
monitoring.
,Question 3.
A patient with a STEMI receives fibrinolytic therapy with alteplase. The nurse knows
that the most serious complication to monitor for is:
A. Bradycardia.
B. Bleeding, including intracranial hemorrhage.
C. Hyperglycemia.
D. Hypotension from vasodilation.
Correct Answer: B
Rationale: Fibrinolytic therapy (thrombolytics) carries a 0.5–1% risk of intracranial
hemorrhage, which is potentially fatal. Absolute contraindications include: prior
hemorrhagic stroke, ischemic stroke within 3 months, known intracranial malignancy or
vascular malformation, active bleeding, and suspected aortic dissection. The nurse must
monitor for signs of bleeding: altered mental status, severe headache, hypotension, and new
neurologic deficits.
Question 4.
A patient with hypertrophic cardiomyopathy is being discharged. The nurse should
teach the patient to avoid:
A. Light walking.
B. Competitive sports and strenuous isometric exercise.
C. Sexual activity.
D. Yoga and stretching.
Correct Answer: B
Rationale: Hypertrophic cardiomyopathy (HCM) is the leading cause of sudden cardiac
death in young athletes. Patients should avoid competitive sports, heavy weightlifting, and
dehydration. Moderate aerobic activity, sexual activity, and yoga are generally safe. ICD
placement is recommended for high-risk patients.
Question 5.
,A patient with infective endocarditis is prescribed IV antibiotics for 6 weeks. The
nurse knows that blood cultures should be obtained:
A. After 48 hours of antibiotic therapy to confirm eradication.
B. Before starting antibiotics and then as needed based on clinical response.
C. Only at the completion of therapy.
D. Daily for the first 7 days regardless of response.
Correct Answer: B
Rationale: Blood cultures must be obtained BEFORE starting antibiotics to identify the
organism and guide therapy. Repeat cultures are obtained to document clearance of
bacteremia, typically every 24–48 hours until negative. Daily cultures for 7 days are
unnecessary.
Question 6.
A patient with peripheral arterial disease reports calf pain when walking that
resolves with rest. This is documented as:
A. Rest pain.
B. Intermittent claudication.
C. Neuropathic pain.
D. Referred pain.
Correct Answer: B
Rationale: Intermittent claudication is pain with exercise that resolves with rest, caused by
arterial insufficiency. It is the hallmark symptom of PAD. Rest pain occurs at rest and
indicates critical limb ischemia. Management includes: smoking cessation, antiplatelet
therapy, statins, exercise rehabilitation, and cilostazol.
Question 7.
A patient post-CABG develops atrial fibrillation on day 2. The nurse knows this occurs
in up to 40% of patients and is primarily caused by:
A. Inadequate pain control.
B. Pericardial inflammation and atrial ischemia.
, C. Beta-blocker overdose.
D. Hypovolemia.
Correct Answer: B
Rationale: Postoperative atrial fibrillation after cardiac surgery is primarily caused by
pericardial inflammation, atrial ischemia, autonomic imbalance, and electrolyte
disturbances. It typically occurs 2–4 days postoperatively. Treatment includes: beta-
blockers, amiodarone, anticoagulation if AF persists >48 hours, and electrolyte repletion.
Question 8.
A patient with a thoracic aortic aneurysm develops sudden, tearing chest pain
radiating to the back with hypotension. The nurse recognizes this as:
A. Stable aneurysm.
B. Acute aortic dissection—surgical emergency.
C. Unstable angina.
D. Pulmonary embolism.
Correct Answer: B
Rationale: Acute aortic dissection presents with sudden, severe, tearing chest or back pain,
often with hypertension (though hypotension indicates rupture or tamponade). It is a
surgical emergency. Type A dissections (involving ascending aorta) require emergency
surgery. Type B dissections (descending aorta) may be managed medically with beta-
blockade and vasodilators.
Question 9.
A patient with heart failure is prescribed sacubitril/valsartan (Entresto). The nurse
knows this medication is contraindicated with:
A. Beta-blockers.
B. ACE inhibitors.
C. Diuretics.
D. Digoxin.
Correct Answer: B
Final Exam 2026/2027 | 100 Questions With Correct
Answers And Explained Rationale
Question 1.
A patient with acute decompensated heart failure has crackles in the lung bases,
jugular venous distension, and peripheral edema. The nurse knows these findings
indicate:
A. Left-sided heart failure with pulmonary congestion.
B. Right-sided heart failure with systemic venous congestion.
C. Biventricular failure with both pulmonary and systemic congestion.
D. Isolated systolic dysfunction without volume overload.
Correct Answer: C
Rationale: Crackles and JVD together suggest biventricular failure. Left-sided failure causes
pulmonary congestion (crackles, dyspnea, orthopnea). Right-sided failure causes systemic
venous congestion (JVD, peripheral edema, hepatomegaly). When both sets of symptoms
are present, both ventricles are failing. Treatment includes: diuretics, nitrates, ACE
inhibitors/ARBs/ARNIs, beta-blockers, and inotropes if needed.
Question 2.
A patient with atrial fibrillation is prescribed warfarin. The target INR range for
stroke prevention in AFib is:
A. 1.5–2.0.
B. 2.0–3.0.
C. 2.5–3.5.
D. 3.0–4.0.
Correct Answer: B
Rationale: For most patients with atrial fibrillation, the target INR on warfarin is 2.0–3.0.
For mechanical heart valves (especially mitral), the target is higher at 2.5–3.5. DOACs
(apixaban, rivaroxaban, dabigatran, edoxaban) are alternatives that do not require INR
monitoring.
,Question 3.
A patient with a STEMI receives fibrinolytic therapy with alteplase. The nurse knows
that the most serious complication to monitor for is:
A. Bradycardia.
B. Bleeding, including intracranial hemorrhage.
C. Hyperglycemia.
D. Hypotension from vasodilation.
Correct Answer: B
Rationale: Fibrinolytic therapy (thrombolytics) carries a 0.5–1% risk of intracranial
hemorrhage, which is potentially fatal. Absolute contraindications include: prior
hemorrhagic stroke, ischemic stroke within 3 months, known intracranial malignancy or
vascular malformation, active bleeding, and suspected aortic dissection. The nurse must
monitor for signs of bleeding: altered mental status, severe headache, hypotension, and new
neurologic deficits.
Question 4.
A patient with hypertrophic cardiomyopathy is being discharged. The nurse should
teach the patient to avoid:
A. Light walking.
B. Competitive sports and strenuous isometric exercise.
C. Sexual activity.
D. Yoga and stretching.
Correct Answer: B
Rationale: Hypertrophic cardiomyopathy (HCM) is the leading cause of sudden cardiac
death in young athletes. Patients should avoid competitive sports, heavy weightlifting, and
dehydration. Moderate aerobic activity, sexual activity, and yoga are generally safe. ICD
placement is recommended for high-risk patients.
Question 5.
,A patient with infective endocarditis is prescribed IV antibiotics for 6 weeks. The
nurse knows that blood cultures should be obtained:
A. After 48 hours of antibiotic therapy to confirm eradication.
B. Before starting antibiotics and then as needed based on clinical response.
C. Only at the completion of therapy.
D. Daily for the first 7 days regardless of response.
Correct Answer: B
Rationale: Blood cultures must be obtained BEFORE starting antibiotics to identify the
organism and guide therapy. Repeat cultures are obtained to document clearance of
bacteremia, typically every 24–48 hours until negative. Daily cultures for 7 days are
unnecessary.
Question 6.
A patient with peripheral arterial disease reports calf pain when walking that
resolves with rest. This is documented as:
A. Rest pain.
B. Intermittent claudication.
C. Neuropathic pain.
D. Referred pain.
Correct Answer: B
Rationale: Intermittent claudication is pain with exercise that resolves with rest, caused by
arterial insufficiency. It is the hallmark symptom of PAD. Rest pain occurs at rest and
indicates critical limb ischemia. Management includes: smoking cessation, antiplatelet
therapy, statins, exercise rehabilitation, and cilostazol.
Question 7.
A patient post-CABG develops atrial fibrillation on day 2. The nurse knows this occurs
in up to 40% of patients and is primarily caused by:
A. Inadequate pain control.
B. Pericardial inflammation and atrial ischemia.
, C. Beta-blocker overdose.
D. Hypovolemia.
Correct Answer: B
Rationale: Postoperative atrial fibrillation after cardiac surgery is primarily caused by
pericardial inflammation, atrial ischemia, autonomic imbalance, and electrolyte
disturbances. It typically occurs 2–4 days postoperatively. Treatment includes: beta-
blockers, amiodarone, anticoagulation if AF persists >48 hours, and electrolyte repletion.
Question 8.
A patient with a thoracic aortic aneurysm develops sudden, tearing chest pain
radiating to the back with hypotension. The nurse recognizes this as:
A. Stable aneurysm.
B. Acute aortic dissection—surgical emergency.
C. Unstable angina.
D. Pulmonary embolism.
Correct Answer: B
Rationale: Acute aortic dissection presents with sudden, severe, tearing chest or back pain,
often with hypertension (though hypotension indicates rupture or tamponade). It is a
surgical emergency. Type A dissections (involving ascending aorta) require emergency
surgery. Type B dissections (descending aorta) may be managed medically with beta-
blockade and vasodilators.
Question 9.
A patient with heart failure is prescribed sacubitril/valsartan (Entresto). The nurse
knows this medication is contraindicated with:
A. Beta-blockers.
B. ACE inhibitors.
C. Diuretics.
D. Digoxin.
Correct Answer: B
