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MED SURG 2: CARDIAC AND NEUROLOGICAL DISORDERS
Focused Questions with Answers and Rationales
Section 1: Cardiac Disorders (Questions)
1. A nurse is caring for a client with acute decompensated
heart failure. Which assessment finding indicates the
treatment has been effective?
A. Weight gain of 2 lb in 24 hours
B. Decreased crackles and improved oxygen saturation
C. Increased jugular vein distention
D. Worsening peripheral edema
Answer: B
Rationale: Effective heart failure treatment reduces
pulmonary congestion. Decreased crackles and improved
oxygenation indicate fluid is being mobilized out of the
lungs. Weight gain, JVD, and worsening edema indicate
persistent or worsening fluid overload.
2. A client with heart failure is prescribed carvedilol. The
nurse should monitor for which adverse effect?
,https://www.stuvia.com/user/performance
A. Tachycardia
B. Bradycardia and hypotension
C. Hypertension
D. Hyperglycemia
Answer: B
Rationale: Carvedilol is a non-selective beta-blocker that
decreases heart rate, blood pressure, and myocardial
contractility. Bradycardia and hypotension are expected
effects that require monitoring. It may also mask
hypoglycemia symptoms in diabetic patients.
3. Which statement by a client with heart failure indicates
understanding of fluid restriction?
A. "I can drink as much water as I want as long as I take my
diuretic."
B. "I need to count all liquids, including soup, ice cream,
and water with medications."
C. "I only need to restrict fluids when I feel short of
breath."
D. "Fluid restriction only applies to water, not other
,https://www.stuvia.com/user/performance
beverages."
Answer: B
Rationale: All fluids count toward the daily fluid
restriction, including water, juice, soup, gelatin, ice
cream, and water used for medications. Patients must
understand that fluid restriction is continuous, not just
when symptomatic.
4. A client is receiving a continuous heparin infusion for a
deep vein thrombosis. Which laboratory value should the
nurse monitor to evaluate effectiveness?
A. INR
B. aPTT
C. Platelet count only
D. Bleeding time
Answer: B
Rationale: Heparin is titrated based on aPTT (activated
partial thromboplastin time), typically maintained at 1.5-
2.5 times the control value. INR monitors warfarin;
, https://www.stuvia.com/user/performance
platelet count is monitored for heparin-induced
thrombocytopenia but not for dose adjustment.
5. A client with atrial fibrillation is prescribed dabigatran. The
nurse should instruct the client that:
A. The medication requires frequent INR monitoring
B. The medication has a specific reversal agent called
idarucizumab
C. The medication must be taken with food
D. The medication cannot be crushed or chewed
Answer: B
Rationale: Dabigatran (a direct thrombin inhibitor) has a
specific reversal agent—idarucizumab (Praxbind)—used
in emergencies. It does not require routine INR
monitoring. The capsules should not be crushed or
opened, but this is not the most distinctive teaching
point.
6. A client with acute coronary syndrome has an order for
morphine sulfate 2 mg IV. The nurse should assess which
vital sign before administration?
MED SURG 2: CARDIAC AND NEUROLOGICAL DISORDERS
Focused Questions with Answers and Rationales
Section 1: Cardiac Disorders (Questions)
1. A nurse is caring for a client with acute decompensated
heart failure. Which assessment finding indicates the
treatment has been effective?
A. Weight gain of 2 lb in 24 hours
B. Decreased crackles and improved oxygen saturation
C. Increased jugular vein distention
D. Worsening peripheral edema
Answer: B
Rationale: Effective heart failure treatment reduces
pulmonary congestion. Decreased crackles and improved
oxygenation indicate fluid is being mobilized out of the
lungs. Weight gain, JVD, and worsening edema indicate
persistent or worsening fluid overload.
2. A client with heart failure is prescribed carvedilol. The
nurse should monitor for which adverse effect?
,https://www.stuvia.com/user/performance
A. Tachycardia
B. Bradycardia and hypotension
C. Hypertension
D. Hyperglycemia
Answer: B
Rationale: Carvedilol is a non-selective beta-blocker that
decreases heart rate, blood pressure, and myocardial
contractility. Bradycardia and hypotension are expected
effects that require monitoring. It may also mask
hypoglycemia symptoms in diabetic patients.
3. Which statement by a client with heart failure indicates
understanding of fluid restriction?
A. "I can drink as much water as I want as long as I take my
diuretic."
B. "I need to count all liquids, including soup, ice cream,
and water with medications."
C. "I only need to restrict fluids when I feel short of
breath."
D. "Fluid restriction only applies to water, not other
,https://www.stuvia.com/user/performance
beverages."
Answer: B
Rationale: All fluids count toward the daily fluid
restriction, including water, juice, soup, gelatin, ice
cream, and water used for medications. Patients must
understand that fluid restriction is continuous, not just
when symptomatic.
4. A client is receiving a continuous heparin infusion for a
deep vein thrombosis. Which laboratory value should the
nurse monitor to evaluate effectiveness?
A. INR
B. aPTT
C. Platelet count only
D. Bleeding time
Answer: B
Rationale: Heparin is titrated based on aPTT (activated
partial thromboplastin time), typically maintained at 1.5-
2.5 times the control value. INR monitors warfarin;
, https://www.stuvia.com/user/performance
platelet count is monitored for heparin-induced
thrombocytopenia but not for dose adjustment.
5. A client with atrial fibrillation is prescribed dabigatran. The
nurse should instruct the client that:
A. The medication requires frequent INR monitoring
B. The medication has a specific reversal agent called
idarucizumab
C. The medication must be taken with food
D. The medication cannot be crushed or chewed
Answer: B
Rationale: Dabigatran (a direct thrombin inhibitor) has a
specific reversal agent—idarucizumab (Praxbind)—used
in emergencies. It does not require routine INR
monitoring. The capsules should not be crushed or
opened, but this is not the most distinctive teaching
point.
6. A client with acute coronary syndrome has an order for
morphine sulfate 2 mg IV. The nurse should assess which
vital sign before administration?
