NUR209 EXAM 1 Actual Exam 2026/2027
Complete Questions and Verified Answers
with Detailed Rationales Medical Surgical
Nursing II 100% Correct Grade A Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
Q1: A nurse is caring for a patient with heart failure who has been receiving furosemide 40 mg
IV daily. Which laboratory value requires immediate intervention?
A. Sodium 135 mEq/L
B. Potassium 2.8 mEq/L [CORRECT]
C. Creatinine 1.0 mg/dL
D. Hemoglobin 12.5 g/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that can cause significant potassium loss, leading to
hypokalemia. A potassium level of 2.8 mEq/L is critically low and increases the risk of life-
threatening dysrhythmias (B). Sodium 135 mEq/L (A) is within normal range. Creatinine 1.0
mg/dL (C) is normal. Hemoglobin 12.5 g/dL (D) is within normal range for some populations.
Q2: A patient with hypertension reports taking their medication only when they have a headache.
The nurse understands this patient requires education about:
A. The chronic nature of hypertension and need for daily medication regardless of symptoms
[CORRECT]
B. The fact that headaches are the best indicator of high blood pressure
C. The need to increase medication dosage when headaches occur
D. The importance of taking medication only when blood pressure is above 160/100
Correct Answer: A
Rationale: Hypertension is often asymptomatic, and organ damage occurs silently. Patients must
understand that medication must be taken daily to prevent complications, not just when
symptoms occur (A). Headaches are not a reliable indicator of blood pressure (B), and PRN
dosing (D) is inappropriate for chronic management.
,Q3: A patient with stable angina reports chest pain with exertion that is relieved by rest. Which
medication should the nurse ensure is readily available for immediate use?
A. Aspirin 325 mg daily
B. Nitroglycerin sublingual [CORRECT]
C. Metoprolol 50 mg oral
D. Atorvastatin 40 mg daily
Correct Answer: B
Rationale: Nitroglycerin sublingual is the standard acute treatment for angina pectoris, acting
within minutes to dilate coronary arteries and reduce myocardial oxygen demand (B). Aspirin
(A), metoprolol (C), and atorvastatin (D) are chronic preventive therapies, not for acute relief.
Q4: A patient is admitted with STEMI (ST-elevation myocardial infarction). The nurse prepares
for reperfusion therapy knowing the gold standard is:
A. Fibrinolytic therapy within 6 hours
B. Percutaneous coronary intervention (PCI) within 90 minutes of first medical contact
[CORRECT]
C. Coronary artery bypass grafting within 24 hours
D. Anticoagulation with heparin alone
Correct Answer: B
Rationale: PCI (angioplasty with stenting) is the preferred reperfusion strategy for STEMI when
available within 90 minutes of first medical contact (door-to-balloon time) (B). Fibrinolytics (A)
are used if PCI cannot be performed within 120 minutes. CABG (C) is for specific anatomical
lesions.
Q5: A patient with heart failure has crackles in the lung bases, an S3 gallop, and reports waking
up breathless at night. These findings indicate:
A. Right-sided heart failure
B. Left-sided heart failure [CORRECT]
C. Biventricular failure
D. Cardiogenic shock
Correct Answer: B
Rationale: Pulmonary congestion (crackles), S3 gallop (ventricular volume overload), and
paroxysmal nocturnal dyspnea (PND) are classic signs of left-sided heart failure due to
, pulmonary venous congestion (B). Right-sided failure (A) presents with systemic congestion
(JVD, peripheral edema, hepatomegaly).
Q6: A patient with atrial fibrillation has an irregularly irregular pulse with no discernible P
waves on ECG. The nurse knows the priority concern is:
A. Hypertension
B. Risk of thromboembolism and stroke [CORRECT]
C. Bradycardia
D. Ventricular fibrillation
Correct Answer: B
Rationale: Atrial fibrillation causes blood stasis in the atria, particularly the left atrial
appendage, increasing stroke risk 5-fold. Anticoagulation assessment and stroke prevention are
priorities (B). While rate control is important, thromboembolism prevention is critical.
Q7: A patient with a mechanical heart valve is taking warfarin. The nurse understands the
therapeutic INR range is typically:
A. 1.5-2.0
B. 2.0-3.0
C. 2.5-3.5 [CORRECT]
D. 3.5-4.5
Correct Answer: C
Rationale: Mechanical heart valves require higher anticoagulation intensity due to
thrombogenicity. The target INR is typically 2.5-3.5 (C), higher than the 2.0-3.0 for atrial
fibrillation or venous thromboembolism (B). Bioprosthetic valves may use 2.0-3.0 for only 3
months.
Q8: A patient with peripheral arterial disease (PAD) reports leg pain when walking that resolves
with rest. The nurse recognizes this as:
A. Venous insufficiency
B. Intermittent claudication [CORRECT]
C. Rest pain
D. Deep vein thrombosis
Correct Answer: B
Rationale: Intermittent claudication is reproducible ischemic muscle pain occurring with
Complete Questions and Verified Answers
with Detailed Rationales Medical Surgical
Nursing II 100% Correct Grade A Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
Q1: A nurse is caring for a patient with heart failure who has been receiving furosemide 40 mg
IV daily. Which laboratory value requires immediate intervention?
A. Sodium 135 mEq/L
B. Potassium 2.8 mEq/L [CORRECT]
C. Creatinine 1.0 mg/dL
D. Hemoglobin 12.5 g/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that can cause significant potassium loss, leading to
hypokalemia. A potassium level of 2.8 mEq/L is critically low and increases the risk of life-
threatening dysrhythmias (B). Sodium 135 mEq/L (A) is within normal range. Creatinine 1.0
mg/dL (C) is normal. Hemoglobin 12.5 g/dL (D) is within normal range for some populations.
Q2: A patient with hypertension reports taking their medication only when they have a headache.
The nurse understands this patient requires education about:
A. The chronic nature of hypertension and need for daily medication regardless of symptoms
[CORRECT]
B. The fact that headaches are the best indicator of high blood pressure
C. The need to increase medication dosage when headaches occur
D. The importance of taking medication only when blood pressure is above 160/100
Correct Answer: A
Rationale: Hypertension is often asymptomatic, and organ damage occurs silently. Patients must
understand that medication must be taken daily to prevent complications, not just when
symptoms occur (A). Headaches are not a reliable indicator of blood pressure (B), and PRN
dosing (D) is inappropriate for chronic management.
,Q3: A patient with stable angina reports chest pain with exertion that is relieved by rest. Which
medication should the nurse ensure is readily available for immediate use?
A. Aspirin 325 mg daily
B. Nitroglycerin sublingual [CORRECT]
C. Metoprolol 50 mg oral
D. Atorvastatin 40 mg daily
Correct Answer: B
Rationale: Nitroglycerin sublingual is the standard acute treatment for angina pectoris, acting
within minutes to dilate coronary arteries and reduce myocardial oxygen demand (B). Aspirin
(A), metoprolol (C), and atorvastatin (D) are chronic preventive therapies, not for acute relief.
Q4: A patient is admitted with STEMI (ST-elevation myocardial infarction). The nurse prepares
for reperfusion therapy knowing the gold standard is:
A. Fibrinolytic therapy within 6 hours
B. Percutaneous coronary intervention (PCI) within 90 minutes of first medical contact
[CORRECT]
C. Coronary artery bypass grafting within 24 hours
D. Anticoagulation with heparin alone
Correct Answer: B
Rationale: PCI (angioplasty with stenting) is the preferred reperfusion strategy for STEMI when
available within 90 minutes of first medical contact (door-to-balloon time) (B). Fibrinolytics (A)
are used if PCI cannot be performed within 120 minutes. CABG (C) is for specific anatomical
lesions.
Q5: A patient with heart failure has crackles in the lung bases, an S3 gallop, and reports waking
up breathless at night. These findings indicate:
A. Right-sided heart failure
B. Left-sided heart failure [CORRECT]
C. Biventricular failure
D. Cardiogenic shock
Correct Answer: B
Rationale: Pulmonary congestion (crackles), S3 gallop (ventricular volume overload), and
paroxysmal nocturnal dyspnea (PND) are classic signs of left-sided heart failure due to
, pulmonary venous congestion (B). Right-sided failure (A) presents with systemic congestion
(JVD, peripheral edema, hepatomegaly).
Q6: A patient with atrial fibrillation has an irregularly irregular pulse with no discernible P
waves on ECG. The nurse knows the priority concern is:
A. Hypertension
B. Risk of thromboembolism and stroke [CORRECT]
C. Bradycardia
D. Ventricular fibrillation
Correct Answer: B
Rationale: Atrial fibrillation causes blood stasis in the atria, particularly the left atrial
appendage, increasing stroke risk 5-fold. Anticoagulation assessment and stroke prevention are
priorities (B). While rate control is important, thromboembolism prevention is critical.
Q7: A patient with a mechanical heart valve is taking warfarin. The nurse understands the
therapeutic INR range is typically:
A. 1.5-2.0
B. 2.0-3.0
C. 2.5-3.5 [CORRECT]
D. 3.5-4.5
Correct Answer: C
Rationale: Mechanical heart valves require higher anticoagulation intensity due to
thrombogenicity. The target INR is typically 2.5-3.5 (C), higher than the 2.0-3.0 for atrial
fibrillation or venous thromboembolism (B). Bioprosthetic valves may use 2.0-3.0 for only 3
months.
Q8: A patient with peripheral arterial disease (PAD) reports leg pain when walking that resolves
with rest. The nurse recognizes this as:
A. Venous insufficiency
B. Intermittent claudication [CORRECT]
C. Rest pain
D. Deep vein thrombosis
Correct Answer: B
Rationale: Intermittent claudication is reproducible ischemic muscle pain occurring with
