NUR209 Exam 2 Medical-Surgical Nursing II Questions with Answers—
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1. During which phase of the cardiac cycle do the atrioventricular (AV) valves close?
A. Isovolumetric relaxation
B. Isovolumetric contraction (ventricular systole begins)
C. Rapid ventricular filling
D. Atrial systole
Answer: B
Rationale: As ventricular pressure rises above atrial pressure at the start of ventricular
systole, the AV valves (mitral and tricuspid) snap shut, producing S1. This is isovolumetric
contraction because ventricular volume does not change until the semilunar valves open.
2. A nurse hears a nursing student describe the cardiac cycle. Which statement by the
student requires correction?
A. "The semilunar valves open when ventricular pressure exceeds aortic/pulmonary
pressure."
B. "S2 is produced by closure of the aortic and pulmonic valves."
C. "Diastole is the period of ventricular contraction and ejection."
D. "Coronary artery filling occurs primarily during diastole."
Answer: C
Rationale: Diastole is the period of ventricular relaxation and filling, not contraction.
Systole refers to contraction and ejection. Coronary perfusion occurs mainly in diastole
when aortic pressure exceeds intraventricular pressure.
3. A patient reports crushing substernal chest pain radiating to the left arm,
unrelieved by rest. What is the nurse's priority action?
A. Administer an antacid
B. Obtain a 12-lead ECG and notify the provider immediately
C. Document the finding and reassess in 1 hour
D. Ambulate the patient to assess symptom relief
Answer: B
Rationale: Chest pain suggestive of acute coronary syndrome requires an immediate 12-
lead ECG within 10 minutes to identify ST-segment changes, along with prompt provider
notification, since "time is muscle" in myocardial infarction.
,4. Which characteristic of chest pain is most consistent with angina pectoris rather
than pericarditis?
A. Pain worsens with deep inspiration
B. Pain relieved by leaning forward
C. Pain precipitated by exertion and relieved by rest or nitroglycerin
D. Pain accompanied by a pericardial friction rub
Answer: C
Rationale: Angina is classically exertional, pressure-like, and relieved within minutes by
rest or nitroglycerin. Pleuritic pain that worsens with inspiration, improves with leaning
forward, and a friction rub point to pericarditis.
5. A patient with suspected MI has normal troponin at presentation. What is the
appropriate nursing action?
A. Rule out MI and discharge the patient
B. Repeat troponin levels serially per protocol (e.g., at 3-6 hours)
C. Administer thrombolytics immediately
D. No further cardiac workup is needed
Answer: B
Rationale: Troponin may not be elevated immediately after symptom onset; serial
troponin measurements are required to rule out myocardial injury, as levels typically rise
within 3-6 hours and peak later.
6. Which finding best differentiates left-sided heart failure from right-sided heart
failure?
A. Jugular venous distention and peripheral edema
B. Pulmonary crackles and dyspnea
C. Hepatomegaly and ascites
D. Weight gain alone
Answer: B
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation, producing crackles, dyspnea, and orthopnea. Right-sided failure causes
systemic venous congestion (JVD, hepatomegaly, peripheral edema, ascites).
7. A patient with heart failure is prescribed furosemide (Lasix). Which assessment
finding requires immediate provider notification?
A. Serum potassium of 3.0 mEq/L
B. Urine output of 60 mL/hr
, C. Weight loss of 1 lb in 24 hours
D. Blood pressure of 128/78 mmHg
Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium wasting; a level of 3.0
mEq/L is hypokalemia and increases the risk of dangerous dysrhythmias, especially in
patients also on digoxin.
8. Which teaching point is essential for a patient newly diagnosed with heart failure?
A. "Weigh yourself weekly at any time of day."
B. "Call your provider if you gain more than 2-3 lbs in a day or 5 lbs in a week."
C. "Increase your sodium intake to maintain fluid balance."
D. "Fluid restriction is never necessary in heart failure."
Answer: B
Rationale: Daily weights at the same time each morning are used to detect fluid
retention early. A gain of 2-3 lbs in one day or 5 lbs in a week signals worsening heart
failure and should be reported promptly.
9. An ACE inhibitor is prescribed for a patient with heart failure. Which adverse effect
should the nurse monitor for?
A. Persistent dry cough and hyperkalemia
B. Hypokalemia and hypertension
C. Bradycardia and hypoglycemia
D. Hypernatremia and constipation
Answer: A
Rationale: ACE inhibitors reduce afterload and preload but commonly cause a persistent
dry cough (from bradykinin accumulation) and can cause hyperkalemia by decreasing
aldosterone secretion.
10. Which class of medication reduces both preload and afterload in heart failure
management by dilating veins and arteries?
A. Beta-blockers
B. Nitrates
C. Loop diuretics
D. Digoxin
Answer: B
, Rationale: Nitrates cause venous dilation (reducing preload) and, at higher doses,
arterial dilation (reducing afterload), decreasing cardiac workload and myocardial
oxygen demand.
11. A patient taking digoxin reports nausea, vomiting, and seeing yellow-green halos
around lights. The nurse should suspect:
A. Therapeutic digoxin level
B. Digitalis (digoxin) toxicity
C. Hypernatremia
D. Beta-blocker overdose
Answer: B
Rationale: Visual disturbances such as yellow-green halos, along with GI upset (anorexia,
nausea, vomiting) and dysrhythmias, are classic early signs of digoxin toxicity.
12. Before administering digoxin, the nurse should prioritize checking which value?
A. Serum sodium
B. Apical heart rate and serum potassium level
C. Blood glucose
D. Serum calcium only
Answer: B
Rationale: Digoxin should be held for an apical pulse below 60 bpm in adults.
Hypokalemia increases the risk of digoxin toxicity because digoxin and potassium
compete for the same myocardial binding sites.
13. Which electrolyte imbalance most increases a patient's risk for digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia (mild)
Answer: B
Rationale: Low serum potassium enhances digoxin's binding to the Na+/K+-ATPase
pump, increasing myocardial excitability and the risk of toxicity, including dysrhythmias.
14. A therapeutic serum digoxin level is generally considered to be:
A. 0.5-2.0 ng/mL
B. 5-10 ng/mL
C. 10-20 ng/mL
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1. During which phase of the cardiac cycle do the atrioventricular (AV) valves close?
A. Isovolumetric relaxation
B. Isovolumetric contraction (ventricular systole begins)
C. Rapid ventricular filling
D. Atrial systole
Answer: B
Rationale: As ventricular pressure rises above atrial pressure at the start of ventricular
systole, the AV valves (mitral and tricuspid) snap shut, producing S1. This is isovolumetric
contraction because ventricular volume does not change until the semilunar valves open.
2. A nurse hears a nursing student describe the cardiac cycle. Which statement by the
student requires correction?
A. "The semilunar valves open when ventricular pressure exceeds aortic/pulmonary
pressure."
B. "S2 is produced by closure of the aortic and pulmonic valves."
C. "Diastole is the period of ventricular contraction and ejection."
D. "Coronary artery filling occurs primarily during diastole."
Answer: C
Rationale: Diastole is the period of ventricular relaxation and filling, not contraction.
Systole refers to contraction and ejection. Coronary perfusion occurs mainly in diastole
when aortic pressure exceeds intraventricular pressure.
3. A patient reports crushing substernal chest pain radiating to the left arm,
unrelieved by rest. What is the nurse's priority action?
A. Administer an antacid
B. Obtain a 12-lead ECG and notify the provider immediately
C. Document the finding and reassess in 1 hour
D. Ambulate the patient to assess symptom relief
Answer: B
Rationale: Chest pain suggestive of acute coronary syndrome requires an immediate 12-
lead ECG within 10 minutes to identify ST-segment changes, along with prompt provider
notification, since "time is muscle" in myocardial infarction.
,4. Which characteristic of chest pain is most consistent with angina pectoris rather
than pericarditis?
A. Pain worsens with deep inspiration
B. Pain relieved by leaning forward
C. Pain precipitated by exertion and relieved by rest or nitroglycerin
D. Pain accompanied by a pericardial friction rub
Answer: C
Rationale: Angina is classically exertional, pressure-like, and relieved within minutes by
rest or nitroglycerin. Pleuritic pain that worsens with inspiration, improves with leaning
forward, and a friction rub point to pericarditis.
5. A patient with suspected MI has normal troponin at presentation. What is the
appropriate nursing action?
A. Rule out MI and discharge the patient
B. Repeat troponin levels serially per protocol (e.g., at 3-6 hours)
C. Administer thrombolytics immediately
D. No further cardiac workup is needed
Answer: B
Rationale: Troponin may not be elevated immediately after symptom onset; serial
troponin measurements are required to rule out myocardial injury, as levels typically rise
within 3-6 hours and peak later.
6. Which finding best differentiates left-sided heart failure from right-sided heart
failure?
A. Jugular venous distention and peripheral edema
B. Pulmonary crackles and dyspnea
C. Hepatomegaly and ascites
D. Weight gain alone
Answer: B
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation, producing crackles, dyspnea, and orthopnea. Right-sided failure causes
systemic venous congestion (JVD, hepatomegaly, peripheral edema, ascites).
7. A patient with heart failure is prescribed furosemide (Lasix). Which assessment
finding requires immediate provider notification?
A. Serum potassium of 3.0 mEq/L
B. Urine output of 60 mL/hr
, C. Weight loss of 1 lb in 24 hours
D. Blood pressure of 128/78 mmHg
Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium wasting; a level of 3.0
mEq/L is hypokalemia and increases the risk of dangerous dysrhythmias, especially in
patients also on digoxin.
8. Which teaching point is essential for a patient newly diagnosed with heart failure?
A. "Weigh yourself weekly at any time of day."
B. "Call your provider if you gain more than 2-3 lbs in a day or 5 lbs in a week."
C. "Increase your sodium intake to maintain fluid balance."
D. "Fluid restriction is never necessary in heart failure."
Answer: B
Rationale: Daily weights at the same time each morning are used to detect fluid
retention early. A gain of 2-3 lbs in one day or 5 lbs in a week signals worsening heart
failure and should be reported promptly.
9. An ACE inhibitor is prescribed for a patient with heart failure. Which adverse effect
should the nurse monitor for?
A. Persistent dry cough and hyperkalemia
B. Hypokalemia and hypertension
C. Bradycardia and hypoglycemia
D. Hypernatremia and constipation
Answer: A
Rationale: ACE inhibitors reduce afterload and preload but commonly cause a persistent
dry cough (from bradykinin accumulation) and can cause hyperkalemia by decreasing
aldosterone secretion.
10. Which class of medication reduces both preload and afterload in heart failure
management by dilating veins and arteries?
A. Beta-blockers
B. Nitrates
C. Loop diuretics
D. Digoxin
Answer: B
, Rationale: Nitrates cause venous dilation (reducing preload) and, at higher doses,
arterial dilation (reducing afterload), decreasing cardiac workload and myocardial
oxygen demand.
11. A patient taking digoxin reports nausea, vomiting, and seeing yellow-green halos
around lights. The nurse should suspect:
A. Therapeutic digoxin level
B. Digitalis (digoxin) toxicity
C. Hypernatremia
D. Beta-blocker overdose
Answer: B
Rationale: Visual disturbances such as yellow-green halos, along with GI upset (anorexia,
nausea, vomiting) and dysrhythmias, are classic early signs of digoxin toxicity.
12. Before administering digoxin, the nurse should prioritize checking which value?
A. Serum sodium
B. Apical heart rate and serum potassium level
C. Blood glucose
D. Serum calcium only
Answer: B
Rationale: Digoxin should be held for an apical pulse below 60 bpm in adults.
Hypokalemia increases the risk of digoxin toxicity because digoxin and potassium
compete for the same myocardial binding sites.
13. Which electrolyte imbalance most increases a patient's risk for digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia (mild)
Answer: B
Rationale: Low serum potassium enhances digoxin's binding to the Na+/K+-ATPase
pump, increasing myocardial excitability and the risk of toxicity, including dysrhythmias.
14. A therapeutic serum digoxin level is generally considered to be:
A. 0.5-2.0 ng/mL
B. 5-10 ng/mL
C. 10-20 ng/mL
