NURd209dMedicaldSurgicaldNursingdIIdd|ddExamd2dReviewdd|ddFortisdCollege
Fortis College d
NUR 209 / NUR209 Medical Surgical d d d d d d
Nursing II d
Exam 2 Comprehensive Review (2026/2027 d d d d d
Update)
Name: ______________________ Date: _________________ Score: _______ / 1
d d d d d
___ __ 00
1. A nurse is caring for a client with left-
dd d d d d d d d d
sided heart failure. Which assessment finding should the nurse expect?
d d d d d d d d d
A. Jugular venous dis B. Crackles in the lun C. Hepatome D. Dependent periphera
d d d d d d d d d d
tention g bases galy l edema d d
Correct Answer: B d d
Rationale: Left- d
sided heart failure causes backup of blood into the pulmonary circulation, leading to pu
d d d d d d d d d d d d d
lmonary congestion manifested as crackles in the lung bases. Jugular venous distention
d d d d d d d d d d d
, hepatomegaly, and dependent peripheral edema are signs of right-
d d d d d d d d d
sided heart failure due to systemic venous congestion.
d d d d d d d
2. A client admitted with an acute myocardial infarction (MI) reports severe substernal
d d d d d d d d d d d d d
chest pain unrelieved by nitroglycerin. Which prescribed medication should the nurse a
d d d d d d d d d d d
dminister first? d
A. Heparin IV bolu B. Morphine sulfate I C. Metoprolol IV pus D. Clopidogrel P
d d d d d d d d d d d
s V h O
Correct Answer: B d d
Rationale: Morphine sulfate is the first-d d d d d
line analgesic for acute MI pain unrelieved by nitroglycerin because it reduces myocar
d d d d d d d d d d d d
1
, NURd209dMedicaldSurgicaldNursingdIIdd|ddExamd2dReviewdd|ddFortisdCollege
dial oxygen demand by decreasing preload, heart rate, and anxiety. Heparin and clopid
d d d d d d d d d d d d
ogrel are important anticoagulants but do not address pain. Metoprolol reduces heart r
d d d d d d d d d d d d
ate but is not an analgesic and is secondary to pain management in this acute scenario.
d d d d d d d d d d d d d d d
3. The nurse receives morning report on four clients with heart failure. Which client sho
d d d d d d d d d d d d d d
uld the nurse assess first?
d d d d
A. A client with a
d d d d d B. A client with a b C. A client who report D. A client with 1+
d d d d d d d d d d d d d d
weight gain of 0.5 d d d d lood pressure of 11 s increasing dyspnea pitting edema in bil
d d d d d d d d d
kg over 2 days
d d d 0/70 mmHg when lying flat
d ateral ankles d d d
Correct Answer: C d d
Rationale: Increasing dyspnea when lying flat (orthopnea) indicates worsening pulmo
d d d d d d d d d
nary congestion and is the highest priority because it suggests acute decompensation of
d d d d d d d d d d d d
d heart failure. Weight gain, mild edema, and blood pressure changes are important but l
d d d d d d d d d d d d d
ess urgent than acute respiratory compromise. The nurse must assess and intervene for
d d d d d d d d d d d d d
the client showing signs of worsening pulmonary edema first.
d d d d d d d d
4. A client with heart failure is prescribed furosemide 40 mg IV. Which laboratory valu
d d d d d d d d d d d d d d
e should the nurse monitor most closely?
d d d d d d
A. Sodium d B. Potassium d C. Calcium d D. Magnesiumd
Correct Answer: B d d
Rationale: Furosemide is a loop diuretic that causes significant loss of potassium throu
d d d d d d d d d d d d
gh increased urinary excretion. Hypokalemia can precipitate life-
d d d d d d d
threatening dysrhythmias, especially in clients with heart failure who may already be o
d d d d d d d d d d d d
n digoxin. While sodium, calcium, and magnesium should also be monitored, potassium
d d d d d d d d d d d
d is the most critical lab value for furosemide therapy.
d d d d d d d d
5. A client on a cardiac telemetry monitor has a rhythm showing absent P waves, irregul
d d d d d d d d d d d d d d d
ar R-R intervals, and a wavy baseline. The nurse identifies this as which dysrhythmia?
d d d d d d d d d d d d d
A. Atrial fibrillatio B. Atrial flutt C. Ventricular tachycard D. Second-
d d d d d d d
n er ia degree heart block typ d d d
eI d
Correct Answer: A d d
2
, NURd209dMedicaldSurgicaldNursingdIIdd|ddExamd2dReviewdd|ddFortisdCollege
Rationale: Atrial fibrillation is characterized by absent P waves (replaced by chaotic fi
d d d d d d d d d d d d
brillatory waves producing a wavy baseline), irregular R-
d d d d d d d
R intervals, and an irregularly irregular rhythm. Atrial flutter has sawtooth P waves wit
d d d d d d d d d d d d d
h a regular ventricular rate. Ventricular tachycardia shows wide QRS complexes witho
d d d d d d d d d d d
ut P waves. Second-
d d d
degree heart block type I (Wenckebach) shows progressively lengthening PR intervals
d d d d d d d d d d d
with a dropped QRS. d d d
6. A nurse is delegating care for a client with stable chronic hypertension. Which task is
d d d d d d d d d d d d d d d d
most appropriate to assign to the unlicensed assistive personnel (UAP)?
d d d d d d d d d
A. Teaching the client about a low-
d d d d d d B. Measuring the client's blood pressure
d d d d d
sodium diet d
C. Evaluating the client's response to D. Adjusting the client's medication dosage bas
d d d d d d d d d d d
a new antihypertensive
d d d ed on blood pressure readings d d d d
Correct Answer: B d d
Rationale: Measuring blood pressure is a standardized, repetitive task within the UAP
d d d d d d d d d d d d
scope of practice. Teaching, evaluating responses to medications, and adjusting dosage
d d d d d d d d d d
s require nursing education and clinical judgment and cannot be delegated to UAP. The
d d d d d d d d d d d d d
d nurse retains responsibility for assessment, teaching, and medication management.
d d d d d d d d
7. A client with deep vein thrombosis (DVT) is prescribed heparin infusion. The nurse n
d d d d d d d d d d d d d d
otes the client's aPTT is 45 seconds with a control of 30 seconds. What action should the
d d d d d d d d d d d d d d d d
d nurse take? d
A. Increase the heparin infusion rate
d d d d d B. Stop the heparin infusion imme
d d d d d
diately
C. Continue the current infusion rate and recheck D. Administer protamine sulfate
d d d d d d d d d d d
in 6 hours d d
Correct Answer: A d d
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5 to 2.
d d d d d d d d d d d d d
5 times the control value. With a control of 30 seconds, the therapeutic range is 45-
d d d d d d d d d d d d d d d
75 seconds. An aPTT of 45 seconds is at the lower end, suggesting subtherapeutic antic
d d d d d d d d d d d d d d
oagulation. The nurse should increase the infusion rate per protocol. Stopping heparin
d d d d d d d d d d d d
3
, NURd209dMedicaldSurgicaldNursingdIIdd|ddExamd2dReviewdd|ddFortisdCollege
or giving protamine sulfate is for dangerously elevated aPTT, not subtherapeutic levels
d d d d d d d d d d d
.
8. A client with peripheral arterial disease (PAD) reports leg pain when walking two blo
d d d d d d d d d d d d d d
cks that is relieved by rest. The nurse documents this as which finding?
d d d d d d d d d d d d
A. Thromboangiitis
d d B. Intermittent cla C. Chronic venous ins D. Raynaud's phe
d d d d d d d
obliterans udication ufficiency nomenon
Correct Answer: B d d
Rationale: Intermittent claudication is the classic symptom of PAD, characterized by p
d d d d d d d d d d d
ain in the calf or leg muscles during exercise that is relieved by rest. It occurs due to ina
d d d d d d d d d d d d d d d d d d
dequate arterial blood flow to meet increased metabolic demands during activity. Thro
d d d d d d d d d d d
mboangiitis obliterans (Buerger's disease) and Raynaud's phenomenon involve vasosp
d d d d d d d d
asm of small vessels. Chronic venous insufficiency presents with ankle edema and stasis
d d d d d d d d d d d d
d changes, not exercise-induced pain.
d d d
9. A client has a new prescription for enoxaparin (Lovenox) following hip replacement
d d d d d d d d d d d d d
surgery. Which statement by the client indicates a need for further teaching?
d d d d d d d d d d d
A. I will inject the med B. I should report any C. I will take aspi D. I will avoid sha
d d d d d d d d d d d d d d d d d d
ication into my abdom unusual bruising or bl rin daily for pain ving with a straigh
d d d d d d d d d d d d d
inal fat d eeding relief t razor d
Correct Answer: C d d
Rationale: The client should avoid concurrent use of aspirin or other NSAIDs with eno
d d d d d d d d d d d d d
xaparin because the combination significantly increases bleeding risk. Enoxaparin is a
d d d d d d d d d d d
low-molecular-
weight heparin, and adding antiplatelet agents like aspirin compounds the anticoagula
d d d d d d d d d d
nt effect. Injecting into abdominal fat, reporting bleeding, and avoiding straight razor s
d d d d d d d d d d d d
having are all correct self-management behaviors.
d d d d d
10. A nurse is preparing to administer digoxin to a client with heart failure. The client's
d d d d d d d d d d d d d d d d
apical pulse is 52 bpm. What is the nurse's best action?
d d d d d d d d d d
A. Administer the B. Hold the digoxin
d d d d d d d C. Administer hal D. Give the digoxin wi
d d d d d d
digoxin as prescrib and notify the provi
d d d d d f the prescribed do th a glass of orange jui
d d d d d d d d
ed der se ce
4
Fortis College d
NUR 209 / NUR209 Medical Surgical d d d d d d
Nursing II d
Exam 2 Comprehensive Review (2026/2027 d d d d d
Update)
Name: ______________________ Date: _________________ Score: _______ / 1
d d d d d
___ __ 00
1. A nurse is caring for a client with left-
dd d d d d d d d d
sided heart failure. Which assessment finding should the nurse expect?
d d d d d d d d d
A. Jugular venous dis B. Crackles in the lun C. Hepatome D. Dependent periphera
d d d d d d d d d d
tention g bases galy l edema d d
Correct Answer: B d d
Rationale: Left- d
sided heart failure causes backup of blood into the pulmonary circulation, leading to pu
d d d d d d d d d d d d d
lmonary congestion manifested as crackles in the lung bases. Jugular venous distention
d d d d d d d d d d d
, hepatomegaly, and dependent peripheral edema are signs of right-
d d d d d d d d d
sided heart failure due to systemic venous congestion.
d d d d d d d
2. A client admitted with an acute myocardial infarction (MI) reports severe substernal
d d d d d d d d d d d d d
chest pain unrelieved by nitroglycerin. Which prescribed medication should the nurse a
d d d d d d d d d d d
dminister first? d
A. Heparin IV bolu B. Morphine sulfate I C. Metoprolol IV pus D. Clopidogrel P
d d d d d d d d d d d
s V h O
Correct Answer: B d d
Rationale: Morphine sulfate is the first-d d d d d
line analgesic for acute MI pain unrelieved by nitroglycerin because it reduces myocar
d d d d d d d d d d d d
1
, NURd209dMedicaldSurgicaldNursingdIIdd|ddExamd2dReviewdd|ddFortisdCollege
dial oxygen demand by decreasing preload, heart rate, and anxiety. Heparin and clopid
d d d d d d d d d d d d
ogrel are important anticoagulants but do not address pain. Metoprolol reduces heart r
d d d d d d d d d d d d
ate but is not an analgesic and is secondary to pain management in this acute scenario.
d d d d d d d d d d d d d d d
3. The nurse receives morning report on four clients with heart failure. Which client sho
d d d d d d d d d d d d d d
uld the nurse assess first?
d d d d
A. A client with a
d d d d d B. A client with a b C. A client who report D. A client with 1+
d d d d d d d d d d d d d d
weight gain of 0.5 d d d d lood pressure of 11 s increasing dyspnea pitting edema in bil
d d d d d d d d d
kg over 2 days
d d d 0/70 mmHg when lying flat
d ateral ankles d d d
Correct Answer: C d d
Rationale: Increasing dyspnea when lying flat (orthopnea) indicates worsening pulmo
d d d d d d d d d
nary congestion and is the highest priority because it suggests acute decompensation of
d d d d d d d d d d d d
d heart failure. Weight gain, mild edema, and blood pressure changes are important but l
d d d d d d d d d d d d d
ess urgent than acute respiratory compromise. The nurse must assess and intervene for
d d d d d d d d d d d d d
the client showing signs of worsening pulmonary edema first.
d d d d d d d d
4. A client with heart failure is prescribed furosemide 40 mg IV. Which laboratory valu
d d d d d d d d d d d d d d
e should the nurse monitor most closely?
d d d d d d
A. Sodium d B. Potassium d C. Calcium d D. Magnesiumd
Correct Answer: B d d
Rationale: Furosemide is a loop diuretic that causes significant loss of potassium throu
d d d d d d d d d d d d
gh increased urinary excretion. Hypokalemia can precipitate life-
d d d d d d d
threatening dysrhythmias, especially in clients with heart failure who may already be o
d d d d d d d d d d d d
n digoxin. While sodium, calcium, and magnesium should also be monitored, potassium
d d d d d d d d d d d
d is the most critical lab value for furosemide therapy.
d d d d d d d d
5. A client on a cardiac telemetry monitor has a rhythm showing absent P waves, irregul
d d d d d d d d d d d d d d d
ar R-R intervals, and a wavy baseline. The nurse identifies this as which dysrhythmia?
d d d d d d d d d d d d d
A. Atrial fibrillatio B. Atrial flutt C. Ventricular tachycard D. Second-
d d d d d d d
n er ia degree heart block typ d d d
eI d
Correct Answer: A d d
2
, NURd209dMedicaldSurgicaldNursingdIIdd|ddExamd2dReviewdd|ddFortisdCollege
Rationale: Atrial fibrillation is characterized by absent P waves (replaced by chaotic fi
d d d d d d d d d d d d
brillatory waves producing a wavy baseline), irregular R-
d d d d d d d
R intervals, and an irregularly irregular rhythm. Atrial flutter has sawtooth P waves wit
d d d d d d d d d d d d d
h a regular ventricular rate. Ventricular tachycardia shows wide QRS complexes witho
d d d d d d d d d d d
ut P waves. Second-
d d d
degree heart block type I (Wenckebach) shows progressively lengthening PR intervals
d d d d d d d d d d d
with a dropped QRS. d d d
6. A nurse is delegating care for a client with stable chronic hypertension. Which task is
d d d d d d d d d d d d d d d d
most appropriate to assign to the unlicensed assistive personnel (UAP)?
d d d d d d d d d
A. Teaching the client about a low-
d d d d d d B. Measuring the client's blood pressure
d d d d d
sodium diet d
C. Evaluating the client's response to D. Adjusting the client's medication dosage bas
d d d d d d d d d d d
a new antihypertensive
d d d ed on blood pressure readings d d d d
Correct Answer: B d d
Rationale: Measuring blood pressure is a standardized, repetitive task within the UAP
d d d d d d d d d d d d
scope of practice. Teaching, evaluating responses to medications, and adjusting dosage
d d d d d d d d d d
s require nursing education and clinical judgment and cannot be delegated to UAP. The
d d d d d d d d d d d d d
d nurse retains responsibility for assessment, teaching, and medication management.
d d d d d d d d
7. A client with deep vein thrombosis (DVT) is prescribed heparin infusion. The nurse n
d d d d d d d d d d d d d d
otes the client's aPTT is 45 seconds with a control of 30 seconds. What action should the
d d d d d d d d d d d d d d d d
d nurse take? d
A. Increase the heparin infusion rate
d d d d d B. Stop the heparin infusion imme
d d d d d
diately
C. Continue the current infusion rate and recheck D. Administer protamine sulfate
d d d d d d d d d d d
in 6 hours d d
Correct Answer: A d d
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5 to 2.
d d d d d d d d d d d d d
5 times the control value. With a control of 30 seconds, the therapeutic range is 45-
d d d d d d d d d d d d d d d
75 seconds. An aPTT of 45 seconds is at the lower end, suggesting subtherapeutic antic
d d d d d d d d d d d d d d
oagulation. The nurse should increase the infusion rate per protocol. Stopping heparin
d d d d d d d d d d d d
3
, NURd209dMedicaldSurgicaldNursingdIIdd|ddExamd2dReviewdd|ddFortisdCollege
or giving protamine sulfate is for dangerously elevated aPTT, not subtherapeutic levels
d d d d d d d d d d d
.
8. A client with peripheral arterial disease (PAD) reports leg pain when walking two blo
d d d d d d d d d d d d d d
cks that is relieved by rest. The nurse documents this as which finding?
d d d d d d d d d d d d
A. Thromboangiitis
d d B. Intermittent cla C. Chronic venous ins D. Raynaud's phe
d d d d d d d
obliterans udication ufficiency nomenon
Correct Answer: B d d
Rationale: Intermittent claudication is the classic symptom of PAD, characterized by p
d d d d d d d d d d d
ain in the calf or leg muscles during exercise that is relieved by rest. It occurs due to ina
d d d d d d d d d d d d d d d d d d
dequate arterial blood flow to meet increased metabolic demands during activity. Thro
d d d d d d d d d d d
mboangiitis obliterans (Buerger's disease) and Raynaud's phenomenon involve vasosp
d d d d d d d d
asm of small vessels. Chronic venous insufficiency presents with ankle edema and stasis
d d d d d d d d d d d d
d changes, not exercise-induced pain.
d d d
9. A client has a new prescription for enoxaparin (Lovenox) following hip replacement
d d d d d d d d d d d d d
surgery. Which statement by the client indicates a need for further teaching?
d d d d d d d d d d d
A. I will inject the med B. I should report any C. I will take aspi D. I will avoid sha
d d d d d d d d d d d d d d d d d d
ication into my abdom unusual bruising or bl rin daily for pain ving with a straigh
d d d d d d d d d d d d d
inal fat d eeding relief t razor d
Correct Answer: C d d
Rationale: The client should avoid concurrent use of aspirin or other NSAIDs with eno
d d d d d d d d d d d d d
xaparin because the combination significantly increases bleeding risk. Enoxaparin is a
d d d d d d d d d d d
low-molecular-
weight heparin, and adding antiplatelet agents like aspirin compounds the anticoagula
d d d d d d d d d d
nt effect. Injecting into abdominal fat, reporting bleeding, and avoiding straight razor s
d d d d d d d d d d d d
having are all correct self-management behaviors.
d d d d d
10. A nurse is preparing to administer digoxin to a client with heart failure. The client's
d d d d d d d d d d d d d d d d
apical pulse is 52 bpm. What is the nurse's best action?
d d d d d d d d d d
A. Administer the B. Hold the digoxin
d d d d d d d C. Administer hal D. Give the digoxin wi
d d d d d d
digoxin as prescrib and notify the provi
d d d d d f the prescribed do th a glass of orange jui
d d d d d d d d
ed der se ce
4
