COMPLETE (2026) EXAM Questions and Answers (Verified Answers) (Latest
Update 2026)
TI MED-SURG 2 —
1. A nurse is caring for a client experiencing chest pain unrelieved by rest. Which action should
the nurse take FIRST?
A. Obtain a 12-lead ECG
B. Check troponin levels
C. Administer morphine
D. Start a heparin infusion
Rationale: ECG must be obtained immediately to identify ischemia or MI.
2. A client with heart failure reports increased SOB and a 3-lb weight gain in 24 hr. Which
finding indicates worsening heart failure?
A. Bounding pulses
B. Crackles in lung bases
C. BP 130/90
D. HR 88/min
Rationale: Pulmonary crackles reflect fluid overload from HF exacerbation.
3. A client receiving IV furosemide develops muscle weakness. Which lab should the nurse
check?
A. Hemoglobin
B. Sodium
C. Potassium
D. Chloride
Rationale: Loop diuretics cause potassium loss → muscle weakness.
4. A client with atrial fibrillation is starting warfarin. Which statement indicates
understanding?
A. “I will increase green leafy vegetables.”
B. “I need to avoid acetaminophen.”
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,C. “I will keep my diet consistent each week.”
D. “I do not need blood tests.”
Rationale: Consistent vitamin K intake keeps INR stable.
5. A nurse notes ST depression on the ECG. The client is likely experiencing:
A. Ventricular fibrillation
B. Acute STEMI
C. Myocardial ischemia
D. Pericarditis
Rationale: ST depression indicates ischemia, not injury.
6. A client with pericarditis has pulsus paradoxus. This finding suggests:
A. Cardiogenic shock
B. Cardiac tamponade
C. Right-sided HF
D. MI
Rationale: Pulsus paradoxus is a hallmark sign of tamponade.
7. A nurse is preparing to administer nitroglycerin. Which assessment is PRIORITY?
A. Pain score
B. Heart rate
C. Blood pressure
D. Oxygen saturation
Rationale: Nitroglycerin can cause dangerous hypotension.
8. A client with left-sided HF is at increased risk for:
A. Peripheral edema
B. Jugular distention
C. Pulmonary congestion
D. Weight loss
Rationale: Left HF → fluid backs up into lungs.
9. A client with endocarditis reports new onset of flank pain. The nurse should suspect:
A. Kidney infection
B. Emboli to renal arteries
C. Hydronephrosis
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,D. Dehydration
Rationale: Infective endocarditis can cause emboli to kidneys.
10. Which assessment finding is an early indicator of shock?
A. Hypotension
B. Decreased urine output
C. Tachycardia
D. Peripheral cyanosis
Rationale: Tachycardia compensates early to maintain perfusion.
QUESTIONS 11–20 — RESPIRATORY
11. A client with COPD is receiving oxygen at 4 L/min. The nurse should monitor for:
A. Pneumothorax
B. Oxygen toxicity
C. Hypoventilation
D. Pulmonary edema
Rationale: High O₂ can decrease drive to breathe in COPD.
12. Which finding indicates TB treatment is effective?
A. Decreased cough
B. Negative sputum cultures
C. Appetite improvement
D. Weight gain
Rationale: Only negative sputum cultures confirm non-infectious.
13. A client suddenly becomes dyspneic post-thoracentesis. FIRST action?
A. Increase O₂
B. Assess lung sounds
C. Notify provider
D. Obtain ABGs
Rationale: Risk of pneumothorax — assess immediately.
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, 14. A nurse gives albuterol to a client with asthma. Which finding shows improvement?
A. Decreased respiratory rate
B. Improved wheezing
C. Increased peak flow reading
D. Clear sputum
Rationale: Peak flow improvement shows bronchodilation.
15. Which finding requires immediate action for a client with pneumonia?
A. Cough with sputum
B. Fever 101°F
C. Confusion
D. Crackles
Rationale: Confusion indicates hypoxia — emergency.
16. A client with a chest tube has continuous bubbling in the water seal chamber. This
indicates:
A. Suction working
B. Normal operation
C. Air leak
D. Blocked tubing
Rationale: Continuous bubbling = air leak.
17. A client with a pulmonary embolism is receiving heparin. Monitor for:
A. Hypertension
B. Bruising/bleeding
C. Tachypnea
D. Chest pain
Rationale: Heparin increases bleeding risk.
18. Which position helps improve gas exchange in ARDS?
A. Supine
B. High Fowler’s
C. Prone position
D. Side-lying
Rationale: Prone positioning improves oxygenation in ARDS.
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