NUR 209 Medical-Surgical Nursing Midterm Exam Prep
Document | 2026/2027 Edition | 150 Verified Questions - 134
Questions with Answers
NUR 209 Medical-Surgical Nursing Midterm Exam 2026-134 QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation document for NUR 209 Medical-Surgical Nursing covers the
entire midterm curriculum for the 2026/2027 academic year. It includes 150 verified questions and
answers, organized into four core domains, ensuring thorough coverage of all major topics. Each
question is accompanied by a detailed rationale and distractors analysis, facilitating a deep
understanding of medical-surgical nursing concepts. This resource is essential for nursing students
aiming to excel in their midterm examinations.
Key Features:
Foundations of Medical-Surgical Nursing: Evidence-based practice, patient safety, and quality improvement
Perioperative Nursing: Preoperative, intraoperative, and postoperative care
Management of Patients with Respiratory Disorders: Asthma, COPD, pneumonia, and respiratory failure
Management of Patients with Cardiovascular Disorders: Hypertension, heart failure, myocardial infarction, and
arrhythmias
Management of Patients with Neurological Disorders: Stroke, seizures, Parkinson's disease, and multiple
sclerosis
Management of Patients with Renal and Urinary Disorders: Acute kidney injury, chronic kidney disease, and
urinary tract infections
Management of Patients with Gastrointestinal Disorders: Peptic ulcer disease, inflammatory bowel disease, and
liver cirrhosis
Management of Patients with Endocrine Disorders: Diabetes mellitus, thyroid disorders, and adrenal
insufficiency
Management of Patients with Musculoskeletal Disorders: Fractures, osteoarthritis, and rheumatoid arthritis
Management of Patients with Hematologic Disorders: Anemia, coagulopathies, and leukemia
Management of Patients with Oncologic Disorders: Cancer screening, chemotherapy, and radiation therapy
Management of Patients with Infectious Diseases: Sepsis, HIV/AIDS, and tuberculosis
Fluid, Electrolyte, and Acid-Base Balance: Assessment and management of imbalances
Pain Management: Pharmacological and non-pharmacological interventions
Nursing Leadership and Management: Delegation, prioritization, and ethical issues
Professional Nursing Practice: Legal and ethical considerations, patient advocacy, and interdisciplinary
collaboration
Updates for 2026:
- Updated to reflect the latest 2026-2027 NCLEX-RN test plan and medical-surgical nursing guidelines
- Incorporated new evidence-based practice recommendations for patient care
- Revised rationales to include current pharmacological treatments and nursing interventions
- Enhanced distractors analysis to improve critical thinking and test-taking skills
- Aligned with the latest American Association of Colleges of Nursing (AACN) competencies
Abstract:
This exam preparation document is meticulously designed for nursing students enrolled in NUR 209
Medical-Surgical Nursing. It provides a comprehensive review of the four core domains: perioperative care,
Page 1
,management of patients with acute and chronic conditions, fluid and electrolyte balance, and professional nursing
practice. The 150 verified questions are structured to mirror the format and difficulty of the actual midterm exam,
with detailed rationales that explain both correct and incorrect answers. Emphasis is placed on clinical reasoning,
prioritization, and evidence-based interventions, ensuring students are well-prepared to apply theoretical
knowledge in clinical scenarios. The content is aligned with the 2026/2027 academic year and the latest
NCLEX-RN test plan, making it an indispensable tool for achieving a high score and enhancing patient care
competencies.
Keywords:
Medical-Surgical Nursing, NUR 209, Exam Prep, NCLEX-RN, Perioperative Care, Fluid and Electrolyte Balance,
Nursing Interventions, Evidence-Based Practice
Answer Format:
Each question is followed by the correct answer, a comprehensive rationale explaining why it is correct, and a brief
analysis of why the other options are incorrect. This format reinforces understanding and aids in retention of key
concepts.
Compliance Checklist:
Aligned with 2026/2027 NUR 209 course syllabus
Meets NCLEX-RN test plan requirements
Includes evidence-based practice guidelines
Covers all four core domains comprehensively
Provides detailed rationales for every question
Verified for accuracy by subject matter experts
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-30 Preoperative assessment, Intraoperative care, 20%
Postoperative complications, Anesthesia,
Patient education
Management of Patients with 31-90 Respiratory disorders, Cardiovascular 40%
Acute and Chronic Conditions disorders, Neurological disorders, Renal
disorders, Gastrointestinal disorders,
Endocrine disorders, Musculoskeletal
disorders, Hematologic disorders, Oncologic
disorders, Infectious diseases
Fluid, Electrolyte, and 91-120 Fluid volume imbalances, Electrolyte 20%
Acid-Base Balance imbalances, Acid-base imbalances, IV
therapy, Blood transfusions
Professional Nursing Practice 121-150 Leadership and management, Delegation, 20%
Prioritization, Ethical and legal issues,
Patient advocacy, Interdisciplinary
collaboration
Page 2
,Q1. A patient with acute decompensated heart failure and preserved ejection fraction
presents with severe pulmonary congestion. Despite IV diuretics, urine output
remains low. Which hemodynamic finding most likely explains this resistance to
diuretic therapy?
A. Elevated pulmonary capillary wedge pressure with low cardiac output
B. Elevated right atrial pressure with reduced renal perfusion pressure
C. Normal cardiac output with high systemic vascular resistance
D. Low pulmonary capillary wedge pressure with high cardiac output
Correct Answer: B. Elevated right atrial pressure with reduced renal perfusion
pressure
Rationale: In HFpEF, elevated right atrial pressure increases renal venous pressure and
reduces renal perfusion pressure, impairing diuretic response. Low cardiac output (A) is
less typical in HFpEF. High SVR (C) is not the primary mechanism. Low PCWP (D) would
not cause congestion.
Why Wrong:
A - Low cardiac output is more characteristic of HFrEF, not HFpEF.
C - High SVR is a compensatory response but does not directly explain diuretic
resistance.
D - Low PCWP would indicate euvolemia or hypovolemia, not pulmonary congestion.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 24
Q2. A patient on mechanical ventilation develops acute respiratory distress syndrome
(ARDS). The provider orders lung-protective ventilation. Which ventilator setting
best adheres to the ARDSNet protocol?
A. Tidal volume 6 mL/kg ideal body weight with plateau pressure 30 cm H2O
B. Tidal volume 10 mL/kg actual weight with PEEP 5 cm H2O
C. Tidal volume 8 mL/kg ideal body weight with plateau pressure 35 cm H2O
D. Tidal volume 12 mL/kg ideal body weight with permissive hypercapnia
Correct Answer: A. Tidal volume 6 mL/kg ideal body weight with plateau pressure 30
cm H2O
Rationale: ARDSNet recommends low tidal volume ventilation (6 mL/kg IBW) and plateau
pressure 30 cm H2O to prevent ventilator-induced lung injury. Higher tidal volumes (B,
D) increase barotrauma. A plateau of 35 (C) exceeds the recommended limit.
Why Wrong:
B - 10 mL/kg and low PEEP do not provide lung protection.
C - Plateau pressure above 30 cm H2O is associated with increased mortality.
D - 12 mL/kg is harmful; permissive hypercapnia is used but with low tidal volumes.
Reference: ARDSNet, NEJM 2000; updated in 2024 SCCM guidelines
Page 3
, Q3. A patient with a subarachnoid hemorrhage develops delayed cerebral ischemia.
Which intervention is most likely to improve outcomes?
A. Induced hypertension with vasopressors to maintain cerebral perfusion
B. Routine administration of prophylactic antiepileptic drugs
C. Strict bed rest with head of bed flat to increase venous return
D. Immediate lumbar puncture to reduce intracranial pressure
Correct Answer: A. Induced hypertension with vasopressors to maintain cerebral
perfusion
Rationale: Delayed cerebral ischemia is treated with triple-H therapy, including induced
hypertension to improve cerebral blood flow through vasospastic vessels. Prophylactic
AEDs (B) are not recommended routinely. Bed rest (C) does not treat vasospasm. Lumbar
puncture (D) is used for diagnosis, not treatment.
Why Wrong:
B - Prophylactic AEDs do not prevent delayed cerebral ischemia.
C - Flat positioning may increase ICP and does not address vasospasm.
D - Lumbar puncture is contraindicated with elevated ICP from SAH.
Reference: Connolly et al., Stroke 2022; AHA/ASA guidelines
Q4. A patient with chronic kidney disease stage 4 is started on lisinopril. Which
laboratory value requires immediate attention before the next dose?
A. Serum potassium 5.8 mEq/L
B. Serum creatinine 2.2 mg/dL (baseline 2.0)
C. Blood urea nitrogen 40 mg/dL
D. Hemoglobin 10.5 g/dL
Correct Answer: A. Serum potassium 5.8 mEq/L
Rationale: ACE inhibitors can cause hyperkalemia, especially in CKD. A potassium of 5.8
mEq/L is critical and requires intervention. A slight creatinine rise (B) is expected and
acceptable if <30% above baseline. Elevated BUN (C) is common in CKD. Anemia (D) is
chronic and not an immediate contraindication.
Why Wrong:
B - A <30% rise in creatinine is acceptable with ACE inhibitor initiation.
C - BUN elevation is expected in CKD and not drug-specific.
D - Anemia is a chronic complication, not an acute contraindication.
Reference: KDIGO 2024 Clinical Practice Guideline for the Management of CKD
Q5. A patient on warfarin for mechanical mitral valve develops a pulmonary
embolism. INR is 2.0. Which treatment strategy is most appropriate?
A. Hold warfarin and start IV heparin bridge
Page 4
Document | 2026/2027 Edition | 150 Verified Questions - 134
Questions with Answers
NUR 209 Medical-Surgical Nursing Midterm Exam 2026-134 QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation document for NUR 209 Medical-Surgical Nursing covers the
entire midterm curriculum for the 2026/2027 academic year. It includes 150 verified questions and
answers, organized into four core domains, ensuring thorough coverage of all major topics. Each
question is accompanied by a detailed rationale and distractors analysis, facilitating a deep
understanding of medical-surgical nursing concepts. This resource is essential for nursing students
aiming to excel in their midterm examinations.
Key Features:
Foundations of Medical-Surgical Nursing: Evidence-based practice, patient safety, and quality improvement
Perioperative Nursing: Preoperative, intraoperative, and postoperative care
Management of Patients with Respiratory Disorders: Asthma, COPD, pneumonia, and respiratory failure
Management of Patients with Cardiovascular Disorders: Hypertension, heart failure, myocardial infarction, and
arrhythmias
Management of Patients with Neurological Disorders: Stroke, seizures, Parkinson's disease, and multiple
sclerosis
Management of Patients with Renal and Urinary Disorders: Acute kidney injury, chronic kidney disease, and
urinary tract infections
Management of Patients with Gastrointestinal Disorders: Peptic ulcer disease, inflammatory bowel disease, and
liver cirrhosis
Management of Patients with Endocrine Disorders: Diabetes mellitus, thyroid disorders, and adrenal
insufficiency
Management of Patients with Musculoskeletal Disorders: Fractures, osteoarthritis, and rheumatoid arthritis
Management of Patients with Hematologic Disorders: Anemia, coagulopathies, and leukemia
Management of Patients with Oncologic Disorders: Cancer screening, chemotherapy, and radiation therapy
Management of Patients with Infectious Diseases: Sepsis, HIV/AIDS, and tuberculosis
Fluid, Electrolyte, and Acid-Base Balance: Assessment and management of imbalances
Pain Management: Pharmacological and non-pharmacological interventions
Nursing Leadership and Management: Delegation, prioritization, and ethical issues
Professional Nursing Practice: Legal and ethical considerations, patient advocacy, and interdisciplinary
collaboration
Updates for 2026:
- Updated to reflect the latest 2026-2027 NCLEX-RN test plan and medical-surgical nursing guidelines
- Incorporated new evidence-based practice recommendations for patient care
- Revised rationales to include current pharmacological treatments and nursing interventions
- Enhanced distractors analysis to improve critical thinking and test-taking skills
- Aligned with the latest American Association of Colleges of Nursing (AACN) competencies
Abstract:
This exam preparation document is meticulously designed for nursing students enrolled in NUR 209
Medical-Surgical Nursing. It provides a comprehensive review of the four core domains: perioperative care,
Page 1
,management of patients with acute and chronic conditions, fluid and electrolyte balance, and professional nursing
practice. The 150 verified questions are structured to mirror the format and difficulty of the actual midterm exam,
with detailed rationales that explain both correct and incorrect answers. Emphasis is placed on clinical reasoning,
prioritization, and evidence-based interventions, ensuring students are well-prepared to apply theoretical
knowledge in clinical scenarios. The content is aligned with the 2026/2027 academic year and the latest
NCLEX-RN test plan, making it an indispensable tool for achieving a high score and enhancing patient care
competencies.
Keywords:
Medical-Surgical Nursing, NUR 209, Exam Prep, NCLEX-RN, Perioperative Care, Fluid and Electrolyte Balance,
Nursing Interventions, Evidence-Based Practice
Answer Format:
Each question is followed by the correct answer, a comprehensive rationale explaining why it is correct, and a brief
analysis of why the other options are incorrect. This format reinforces understanding and aids in retention of key
concepts.
Compliance Checklist:
Aligned with 2026/2027 NUR 209 course syllabus
Meets NCLEX-RN test plan requirements
Includes evidence-based practice guidelines
Covers all four core domains comprehensively
Provides detailed rationales for every question
Verified for accuracy by subject matter experts
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-30 Preoperative assessment, Intraoperative care, 20%
Postoperative complications, Anesthesia,
Patient education
Management of Patients with 31-90 Respiratory disorders, Cardiovascular 40%
Acute and Chronic Conditions disorders, Neurological disorders, Renal
disorders, Gastrointestinal disorders,
Endocrine disorders, Musculoskeletal
disorders, Hematologic disorders, Oncologic
disorders, Infectious diseases
Fluid, Electrolyte, and 91-120 Fluid volume imbalances, Electrolyte 20%
Acid-Base Balance imbalances, Acid-base imbalances, IV
therapy, Blood transfusions
Professional Nursing Practice 121-150 Leadership and management, Delegation, 20%
Prioritization, Ethical and legal issues,
Patient advocacy, Interdisciplinary
collaboration
Page 2
,Q1. A patient with acute decompensated heart failure and preserved ejection fraction
presents with severe pulmonary congestion. Despite IV diuretics, urine output
remains low. Which hemodynamic finding most likely explains this resistance to
diuretic therapy?
A. Elevated pulmonary capillary wedge pressure with low cardiac output
B. Elevated right atrial pressure with reduced renal perfusion pressure
C. Normal cardiac output with high systemic vascular resistance
D. Low pulmonary capillary wedge pressure with high cardiac output
Correct Answer: B. Elevated right atrial pressure with reduced renal perfusion
pressure
Rationale: In HFpEF, elevated right atrial pressure increases renal venous pressure and
reduces renal perfusion pressure, impairing diuretic response. Low cardiac output (A) is
less typical in HFpEF. High SVR (C) is not the primary mechanism. Low PCWP (D) would
not cause congestion.
Why Wrong:
A - Low cardiac output is more characteristic of HFrEF, not HFpEF.
C - High SVR is a compensatory response but does not directly explain diuretic
resistance.
D - Low PCWP would indicate euvolemia or hypovolemia, not pulmonary congestion.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 24
Q2. A patient on mechanical ventilation develops acute respiratory distress syndrome
(ARDS). The provider orders lung-protective ventilation. Which ventilator setting
best adheres to the ARDSNet protocol?
A. Tidal volume 6 mL/kg ideal body weight with plateau pressure 30 cm H2O
B. Tidal volume 10 mL/kg actual weight with PEEP 5 cm H2O
C. Tidal volume 8 mL/kg ideal body weight with plateau pressure 35 cm H2O
D. Tidal volume 12 mL/kg ideal body weight with permissive hypercapnia
Correct Answer: A. Tidal volume 6 mL/kg ideal body weight with plateau pressure 30
cm H2O
Rationale: ARDSNet recommends low tidal volume ventilation (6 mL/kg IBW) and plateau
pressure 30 cm H2O to prevent ventilator-induced lung injury. Higher tidal volumes (B,
D) increase barotrauma. A plateau of 35 (C) exceeds the recommended limit.
Why Wrong:
B - 10 mL/kg and low PEEP do not provide lung protection.
C - Plateau pressure above 30 cm H2O is associated with increased mortality.
D - 12 mL/kg is harmful; permissive hypercapnia is used but with low tidal volumes.
Reference: ARDSNet, NEJM 2000; updated in 2024 SCCM guidelines
Page 3
, Q3. A patient with a subarachnoid hemorrhage develops delayed cerebral ischemia.
Which intervention is most likely to improve outcomes?
A. Induced hypertension with vasopressors to maintain cerebral perfusion
B. Routine administration of prophylactic antiepileptic drugs
C. Strict bed rest with head of bed flat to increase venous return
D. Immediate lumbar puncture to reduce intracranial pressure
Correct Answer: A. Induced hypertension with vasopressors to maintain cerebral
perfusion
Rationale: Delayed cerebral ischemia is treated with triple-H therapy, including induced
hypertension to improve cerebral blood flow through vasospastic vessels. Prophylactic
AEDs (B) are not recommended routinely. Bed rest (C) does not treat vasospasm. Lumbar
puncture (D) is used for diagnosis, not treatment.
Why Wrong:
B - Prophylactic AEDs do not prevent delayed cerebral ischemia.
C - Flat positioning may increase ICP and does not address vasospasm.
D - Lumbar puncture is contraindicated with elevated ICP from SAH.
Reference: Connolly et al., Stroke 2022; AHA/ASA guidelines
Q4. A patient with chronic kidney disease stage 4 is started on lisinopril. Which
laboratory value requires immediate attention before the next dose?
A. Serum potassium 5.8 mEq/L
B. Serum creatinine 2.2 mg/dL (baseline 2.0)
C. Blood urea nitrogen 40 mg/dL
D. Hemoglobin 10.5 g/dL
Correct Answer: A. Serum potassium 5.8 mEq/L
Rationale: ACE inhibitors can cause hyperkalemia, especially in CKD. A potassium of 5.8
mEq/L is critical and requires intervention. A slight creatinine rise (B) is expected and
acceptable if <30% above baseline. Elevated BUN (C) is common in CKD. Anemia (D) is
chronic and not an immediate contraindication.
Why Wrong:
B - A <30% rise in creatinine is acceptable with ACE inhibitor initiation.
C - BUN elevation is expected in CKD and not drug-specific.
D - Anemia is a chronic complication, not an acute contraindication.
Reference: KDIGO 2024 Clinical Practice Guideline for the Management of CKD
Q5. A patient on warfarin for mechanical mitral valve develops a pulmonary
embolism. INR is 2.0. Which treatment strategy is most appropriate?
A. Hold warfarin and start IV heparin bridge
Page 4
