MED SURG 201 Medical-Surgical Nursing Final Exam
2026/2027 – 200 Practice Questions & Answers with
Detailed Rationales | Comprehensive Study Guide
Section 1: Cardiovascular Nursing (Questions 1–20)
1. A patient reports crushing chest pain radiating to the left arm, accompanied by diaphoresis.
What should the nurse do first?
A. Offer oral fluids B. Assess the patient, activate the appropriate emergency response, and
obtain a rapid ECG C. Encourage the patient to walk D. Schedule a routine outpatient
appointment
Correct Answer: B
Rationale: Chest pain with radiation and diaphoresis may indicate acute coronary syndrome.
Immediate assessment, emergency escalation, and rapid ECG evaluation help identify a time-
sensitive cardiac emergency.
2. Which laboratory marker is most specific for myocardial injury?
A. Serum sodium B. Troponin C. Hemoglobin D. Serum albumin
Correct Answer: B
Rationale: Cardiac troponin is a highly sensitive and specific marker of myocardial injury,
although results must be interpreted alongside symptoms, ECG findings, and clinical context.
3. Which finding is most characteristic of left-sided heart failure?
A. Pulmonary crackles and dyspnea B. Isolated ankle injury C. Increased bowel sounds D.
Yellow discoloration of the skin
Correct Answer: A
Rationale: Left ventricular failure can cause blood to back up into the pulmonary circulation,
resulting in pulmonary congestion, crackles, orthopnea, and shortness of breath.
,4. A patient with heart failure develops severe breathlessness and pink, frothy sputum. What is
the priority nursing action?
A. Place the patient flat B. Encourage oral fluids C. Sit the patient upright and activate urgent
clinical assistance D. Delay intervention until the next assessment
Correct Answer: C
Rationale: Pink, frothy sputum and severe dyspnea suggest acute pulmonary edema. Upright
positioning can improve breathing, while immediate assistance and respiratory support are
essential.
5. Which assessment finding is most consistent with right-sided heart failure?
A. Peripheral edema and jugular venous distention B. Sudden hearing loss C. Abdominal rigidity
from trauma D. Increased visual acuity
Correct Answer: A
Rationale: Right-sided heart failure causes systemic venous congestion, commonly producing
dependent edema, jugular venous distention, hepatomegaly, and sometimes ascites.
6. Which instruction is most important for a patient prescribed warfarin?
A. Double the dose after a missed dose B. Avoid all green vegetables permanently C. Attend
INR monitoring and report unusual bleeding D. Stop treatment when feeling better
Correct Answer: C
Rationale: Warfarin requires monitoring of the international normalized ratio (INR). Patients
should report bleeding, check before starting new medicines, and maintain a reasonably
consistent vitamin K intake.
7. Which finding is most concerning in a patient with hypertension?
A. Blood pressure of 118/76 mmHg B. Severe headache with new confusion and markedly
elevated blood pressure C. Mild thirst after exercise D. A pulse of 72 beats/minute
Correct Answer: B
Rationale: Severe hypertension accompanied by acute neurological symptoms may indicate a
hypertensive emergency with target-organ injury. Immediate evaluation is required.
8. Which lifestyle modification can help lower blood pressure?
,A. Increasing sodium intake B. Avoiding all physical activity C. Following a DASH-style diet
and limiting sodium D. Smoking to reduce stress
Correct Answer: C
Rationale: A DASH-style eating pattern, reduced sodium intake, regular physical activity, and
appropriate weight management can help control hypertension.
9. A patient taking digoxin reports nausea and blurred yellow vision. What should the nurse
suspect?
A. Digoxin toxicity B. Improved cardiac function C. Iron deficiency alone D. Hypothermia
Correct Answer: A
Rationale: Gastrointestinal symptoms and visual disturbances can indicate digoxin toxicity. The
nurse should assess the patient, review the pulse and laboratory results, and notify the prescribing
clinician.
10. Which electrolyte imbalance increases the risk of digoxin-related dysrhythmias?
A. Hypokalemia B. Hypernatremia alone C. Mild hyperchloremia D. Elevated phosphate alone
Correct Answer: A
Rationale: Low potassium increases myocardial sensitivity to digoxin and can increase toxicity
risk. Potassium and renal function should be monitored as clinically indicated.
11. Which symptom is commonly associated with peripheral arterial disease?
A. Leg pain during walking that improves with rest B. Bilateral ear pain after meals C. Persistent
painless jaundice D. Sudden abdominal enlargement after drinking water
Correct Answer: A
Rationale: Intermittent claudication results from inadequate blood supply to working muscles
during exercise and commonly improves with rest.
12. Which assessment finding is more characteristic of chronic venous insufficiency?
A. Cool, pale foot with absent pulses B. Ankle edema with brown skin discoloration C. Sudden
facial drooping D. Severe wheezing after exposure to pollen
Correct Answer: B
, Rationale: Venous hypertension can cause dependent edema, hemosiderin-related brown
pigmentation, and venous ulcers, often near the medial ankle.
13. Which symptom is most concerning for a deep vein thrombosis (DVT)?
A. Unilateral calf swelling and tenderness B. Symmetrical fingernail growth C. Bilateral blurred
vision after reading D. Mild hunger before lunch
Correct Answer: A
Rationale: Unilateral swelling, warmth, and tenderness may indicate DVT. Prompt assessment is
important because a thrombus can embolize to the lungs.
14. A patient suddenly develops dyspnea, pleuritic chest pain, and tachycardia after surgery.
Which complication should the nurse suspect?
A. Pulmonary embolism B. Chronic constipation C. Otitis media D. Cataracts
Correct Answer: A
Rationale: Sudden respiratory symptoms and tachycardia after surgery may indicate pulmonary
embolism. The nurse should initiate urgent assessment and emergency escalation.
15. Which intervention helps prevent venous thromboembolism after surgery?
A. Prolonged bed rest without movement B. Early ambulation when permitted C. Restricting all
leg movement D. Massaging a painful, swollen calf
Correct Answer: B
Rationale: Early mobilization, prescribed mechanical prophylaxis, and anticoagulants when
indicated reduce postoperative venous thromboembolism risk. A suspected DVT should not be
massaged.
16. What does an elevated BNP or NT-proBNP level help assess in a patient with dyspnea?
A. Possible heart failure B. Bone fracture severity C. Hearing impairment D. Blood glucose
alone
Correct Answer: A
Rationale: BNP and NT-proBNP are released in response to cardiac wall stress. They can
support heart failure assessment but must be interpreted with the clinical examination and other
tests.
2026/2027 – 200 Practice Questions & Answers with
Detailed Rationales | Comprehensive Study Guide
Section 1: Cardiovascular Nursing (Questions 1–20)
1. A patient reports crushing chest pain radiating to the left arm, accompanied by diaphoresis.
What should the nurse do first?
A. Offer oral fluids B. Assess the patient, activate the appropriate emergency response, and
obtain a rapid ECG C. Encourage the patient to walk D. Schedule a routine outpatient
appointment
Correct Answer: B
Rationale: Chest pain with radiation and diaphoresis may indicate acute coronary syndrome.
Immediate assessment, emergency escalation, and rapid ECG evaluation help identify a time-
sensitive cardiac emergency.
2. Which laboratory marker is most specific for myocardial injury?
A. Serum sodium B. Troponin C. Hemoglobin D. Serum albumin
Correct Answer: B
Rationale: Cardiac troponin is a highly sensitive and specific marker of myocardial injury,
although results must be interpreted alongside symptoms, ECG findings, and clinical context.
3. Which finding is most characteristic of left-sided heart failure?
A. Pulmonary crackles and dyspnea B. Isolated ankle injury C. Increased bowel sounds D.
Yellow discoloration of the skin
Correct Answer: A
Rationale: Left ventricular failure can cause blood to back up into the pulmonary circulation,
resulting in pulmonary congestion, crackles, orthopnea, and shortness of breath.
,4. A patient with heart failure develops severe breathlessness and pink, frothy sputum. What is
the priority nursing action?
A. Place the patient flat B. Encourage oral fluids C. Sit the patient upright and activate urgent
clinical assistance D. Delay intervention until the next assessment
Correct Answer: C
Rationale: Pink, frothy sputum and severe dyspnea suggest acute pulmonary edema. Upright
positioning can improve breathing, while immediate assistance and respiratory support are
essential.
5. Which assessment finding is most consistent with right-sided heart failure?
A. Peripheral edema and jugular venous distention B. Sudden hearing loss C. Abdominal rigidity
from trauma D. Increased visual acuity
Correct Answer: A
Rationale: Right-sided heart failure causes systemic venous congestion, commonly producing
dependent edema, jugular venous distention, hepatomegaly, and sometimes ascites.
6. Which instruction is most important for a patient prescribed warfarin?
A. Double the dose after a missed dose B. Avoid all green vegetables permanently C. Attend
INR monitoring and report unusual bleeding D. Stop treatment when feeling better
Correct Answer: C
Rationale: Warfarin requires monitoring of the international normalized ratio (INR). Patients
should report bleeding, check before starting new medicines, and maintain a reasonably
consistent vitamin K intake.
7. Which finding is most concerning in a patient with hypertension?
A. Blood pressure of 118/76 mmHg B. Severe headache with new confusion and markedly
elevated blood pressure C. Mild thirst after exercise D. A pulse of 72 beats/minute
Correct Answer: B
Rationale: Severe hypertension accompanied by acute neurological symptoms may indicate a
hypertensive emergency with target-organ injury. Immediate evaluation is required.
8. Which lifestyle modification can help lower blood pressure?
,A. Increasing sodium intake B. Avoiding all physical activity C. Following a DASH-style diet
and limiting sodium D. Smoking to reduce stress
Correct Answer: C
Rationale: A DASH-style eating pattern, reduced sodium intake, regular physical activity, and
appropriate weight management can help control hypertension.
9. A patient taking digoxin reports nausea and blurred yellow vision. What should the nurse
suspect?
A. Digoxin toxicity B. Improved cardiac function C. Iron deficiency alone D. Hypothermia
Correct Answer: A
Rationale: Gastrointestinal symptoms and visual disturbances can indicate digoxin toxicity. The
nurse should assess the patient, review the pulse and laboratory results, and notify the prescribing
clinician.
10. Which electrolyte imbalance increases the risk of digoxin-related dysrhythmias?
A. Hypokalemia B. Hypernatremia alone C. Mild hyperchloremia D. Elevated phosphate alone
Correct Answer: A
Rationale: Low potassium increases myocardial sensitivity to digoxin and can increase toxicity
risk. Potassium and renal function should be monitored as clinically indicated.
11. Which symptom is commonly associated with peripheral arterial disease?
A. Leg pain during walking that improves with rest B. Bilateral ear pain after meals C. Persistent
painless jaundice D. Sudden abdominal enlargement after drinking water
Correct Answer: A
Rationale: Intermittent claudication results from inadequate blood supply to working muscles
during exercise and commonly improves with rest.
12. Which assessment finding is more characteristic of chronic venous insufficiency?
A. Cool, pale foot with absent pulses B. Ankle edema with brown skin discoloration C. Sudden
facial drooping D. Severe wheezing after exposure to pollen
Correct Answer: B
, Rationale: Venous hypertension can cause dependent edema, hemosiderin-related brown
pigmentation, and venous ulcers, often near the medial ankle.
13. Which symptom is most concerning for a deep vein thrombosis (DVT)?
A. Unilateral calf swelling and tenderness B. Symmetrical fingernail growth C. Bilateral blurred
vision after reading D. Mild hunger before lunch
Correct Answer: A
Rationale: Unilateral swelling, warmth, and tenderness may indicate DVT. Prompt assessment is
important because a thrombus can embolize to the lungs.
14. A patient suddenly develops dyspnea, pleuritic chest pain, and tachycardia after surgery.
Which complication should the nurse suspect?
A. Pulmonary embolism B. Chronic constipation C. Otitis media D. Cataracts
Correct Answer: A
Rationale: Sudden respiratory symptoms and tachycardia after surgery may indicate pulmonary
embolism. The nurse should initiate urgent assessment and emergency escalation.
15. Which intervention helps prevent venous thromboembolism after surgery?
A. Prolonged bed rest without movement B. Early ambulation when permitted C. Restricting all
leg movement D. Massaging a painful, swollen calf
Correct Answer: B
Rationale: Early mobilization, prescribed mechanical prophylaxis, and anticoagulants when
indicated reduce postoperative venous thromboembolism risk. A suspected DVT should not be
massaged.
16. What does an elevated BNP or NT-proBNP level help assess in a patient with dyspnea?
A. Possible heart failure B. Bone fracture severity C. Hearing impairment D. Blood glucose
alone
Correct Answer: A
Rationale: BNP and NT-proBNP are released in response to cardiac wall stress. They can
support heart failure assessment but must be interpreted with the clinical examination and other
tests.
