NUR209 - Medical Surgical Nursing II | Comprehensive Review Examination 2026/2027 Update - Grade A
NUR209 / NUR 209 - Medical Surgical Nursing II
Comprehensive Review Examination with Verified Answers
Latest 2026/2027 Update | 100 Questions | 100% Correct | Grade A
Fortis College | Aligned with 2026-2027 NCLEX-RN Test Plan
Total Questions 100 Cognitive Mix 30% Recall | 50% Application | 20% Analysis
Question Style 75% Scenario-based | 25% Direct KnowledgeFormat Multiple Choice (4 options, 1 correct)
Sections 9 clinical content areas Special Focus Priority Setting | Delegation | Therapeutic Communication
Section 1: Cardiovascular Disorders - Assessment & Management
Q1: A 58-year-old male presents to the ED with crushing chest pressure radiating to the left arm, diaphoresis, and
nausea. Which finding is most consistent with an acute myocardial infarction (MI)?
A. Pain relieved by antacids, lasting less than 5 minutes
B. Substernal chest pressure lasting more than 20 minutes, unrelieved by rest or nitroglycerin [CORRECT]
C. Sharp, stabbing chest pain that worsens with deep inspiration
D. Chest discomfort that improves when leaning forward while sitting up
Correct Answer: B
Rationale: Acute MI presents as prolonged substernal chest pressure unrelieved by nitroglycerin or rest. Antacid-relieved pain
suggests GI origin; pleuritic pain suggests pleurisy/pericarditis; pain relieved by sitting forward and leaning forward is classic
for pericarditis.
Q2: A patient is receiving tissue plasminogen activator (tPA) for an ST-elevation MI. Which assessment finding
requires the nurse to immediately stop the infusion and notify the provider?
A. Heart rate of 88 beats/minute and regular
B. Blood pressure of 110/70 mmHg
C. Decreased level of consciousness and sudden severe headache [CORRECT]
D. Mild oozing from the IV insertion site
Correct Answer: C
Rationale: Decreased level of consciousness with sudden severe headache signals possible intracranial hemorrhage, the most
catastrophic complication of fibrinolytic therapy. The infusion must be stopped immediately. Mild IV site oozing is expected;
stable vitals are reassuring.
Q3: A patient with heart failure has a new prescription for furosemide 40 mg IV daily. Which laboratory value
requires priority follow-up before administering the dose?
A. Sodium 136 mEq/L
B. Potassium 3.1 mEq/L [CORRECT]
C. Magnesium 1.9 mg/dL
D. Calcium 8.8 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting. A potassium of 3.1 mEq/L (hypokalemia)
places the patient at risk for life-threatening dysrhythmias, especially when combined with digoxin. The provider should be
notified and potassium replaced before administration.
Page 1 | Fortis College | NCLEX-RN Aligned
,NUR209 - Medical Surgical Nursing II | Comprehensive Review Examination 2026/2027 Update - Grade A
Q4: The nurse is caring for a patient with atrial fibrillation with a rapid ventricular response of 152 beats/minute.
Which initial action is most appropriate?
A. Administer scheduled metoprolol 50 mg PO
B. Assess the patient for hemodynamic instability and prepare for synchronized cardioversion if unstable
[CORRECT]
C. Encourage the patient to bear down against a closed glottis
D. Apply a nitroglycerin patch 0.4 mg/hr
Correct Answer: B
Rationale: Unstable atrial fibrillation (hypotension, chest pain, altered mental status, heart failure) requires immediate
synchronized cardioversion. Stable patients may receive rate-control medications IV. Vagal maneuvers are for stable
supraventricular tachycardia, not AFib.
Q5: A patient receiving IV heparin for a deep vein thrombosis has an aPTT of 110 seconds (control 30-40
seconds). The heparin protocol indicates to hold the next dose. Which additional action is most important?
A. Administer vitamin K intravenously
B. Assess the patient for signs of bleeding, such as gum oozing, melena, or hematuria [CORRECT]
C. Increase the heparin infusion rate per protocol
D. Administer protamine sulfate immediately
Correct Answer: B
Rationale: An aPTT of 110 seconds reflects supratherapeutic heparin and high bleeding risk. The nurse must assess for bleeding
and notify the provider. Protamine sulfate is the antidote but is given only for significant bleeding, not prophylactically. Vitamin
K reverses warfarin, not heparin.
Q6: A patient with heart failure reports a 2 kg weight gain over 24 hours and increased dyspnea on exertion.
Which interpretation by the nurse is most accurate?
A. This is a normal fluctuation related to dietary intake
B. The patient is retaining fluid and the heart failure is likely worsening [CORRECT]
C. The weight gain is likely related to constipation
D. The patient needs to restrict protein intake immediately
Correct Answer: B
Rationale: A weight gain of 1 kg (2.2 lb) in 24 hours or 2.5 kg in a week indicates fluid retention and worsening heart failure.
Patients are taught daily weights at the same time, same scale, same clothing. The provider should be notified for medication
adjustment.
Q7: The nurse is preparing to administer nitroglycerin sublingual 0.4 mg to a patient with chest pain. Which
action by the nurse is correct?
A. Administer the medication with a full glass of water
B. Instruct the patient to sit or lie down before administration and avoid swallowing until dissolved [CORRECT]
C. Crush the tablet before giving it to speed onset
D. Assess blood pressure 30 minutes after administration
Correct Answer: B
Rationale: Nitroglycerin causes vasodilation and orthostatic hypotension, so the patient should sit or lie down. The tablet must
be placed under the tongue and allowed to dissolve; it should not be swallowed, crushed, or taken with water. Blood pressure
should be assessed before and 5 minutes after administration.
Page 2 | Fortis College | NCLEX-RN Aligned
, NUR209 - Medical Surgical Nursing II | Comprehensive Review Examination 2026/2027 Update - Grade A
Q8: A patient with a permanent pacemaker is being discharged. Which statement by the patient indicates a need
for further teaching?
A. I will carry my pacemaker identification card at all times
B. I should avoid standing near microwave ovens because they will interfere with my pacemaker [CORRECT]
C. I will inform airport security about my pacemaker before going through the metal detector
D. I will check my pulse daily and report a rate below the set pacemaker rate
Correct Answer: B
Rationale: Modern microwave ovens do not interfere with pacemakers; this is outdated teaching. The patient should carry the ID
card, inform security personnel, and monitor the pulse. Other precautions include avoiding strong electromagnetic fields like
MRI scanners (unless MRI-conditional device).
Q9: A patient with left-sided heart failure develops dyspnea, bilateral crackles, and a productive cough with pink,
frothy sputum. Which position is most beneficial initially?
A. Supine with legs flat
B. High Fowler's position with legs dangling if tolerated [CORRECT]
C. Trendelenburg position
D. Left lateral Sims' position
Correct Answer: B
Rationale: High Fowler's position with legs dangling decreases venous return to the heart and improves lung expansion,
providing immediate relief for acute pulmonary edema. Supine and Trendelenburg positions increase venous return and worsen
pulmonary congestion.
Q10: Which serum cardiac biomarker is most specific for myocardial injury and rises within 3-4 hours after an
acute MI?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Troponin I or T [CORRECT]
D. Lactate dehydrogenase (LDH)
Correct Answer: C
Rationale: Troponin I and T are the most sensitive and specific markers for myocardial injury, rising within 3-4 hours and
remaining elevated for 7-10 days. CK-MB returns to normal in 2-3 days and is less specific. Myoglobin rises early but is not
cardiac-specific; LDH is no longer used clinically.
Q11: The nurse is delegating care for four cardiac patients. Which task is most appropriate to delegate to a
licensed practical nurse (LPN)?
A. Performing the initial admission assessment of a patient with new-onset chest pain
B. Administering scheduled oral metoprolol 25 mg to a stable patient [CORRECT]
C. Developing the discharge teaching plan for a patient with a new pacemaker
D. Evaluating the response to IV nitroglycerin in a patient with unstable angina
Correct Answer: B
Rationale: LPNs may administer oral medications to stable patients. Initial assessments, discharge teaching plan development,
and evaluation of IV titrated medications require RN scope of practice. Delegation must consider patient stability and
complexity.
Q12: A patient 2 days post-MI tells the nurse, "I'm afraid I'll never be able to have sex again." Which response by
the nurse is most therapeutic?
Page 3 | Fortis College | NCLEX-RN Aligned
NUR209 / NUR 209 - Medical Surgical Nursing II
Comprehensive Review Examination with Verified Answers
Latest 2026/2027 Update | 100 Questions | 100% Correct | Grade A
Fortis College | Aligned with 2026-2027 NCLEX-RN Test Plan
Total Questions 100 Cognitive Mix 30% Recall | 50% Application | 20% Analysis
Question Style 75% Scenario-based | 25% Direct KnowledgeFormat Multiple Choice (4 options, 1 correct)
Sections 9 clinical content areas Special Focus Priority Setting | Delegation | Therapeutic Communication
Section 1: Cardiovascular Disorders - Assessment & Management
Q1: A 58-year-old male presents to the ED with crushing chest pressure radiating to the left arm, diaphoresis, and
nausea. Which finding is most consistent with an acute myocardial infarction (MI)?
A. Pain relieved by antacids, lasting less than 5 minutes
B. Substernal chest pressure lasting more than 20 minutes, unrelieved by rest or nitroglycerin [CORRECT]
C. Sharp, stabbing chest pain that worsens with deep inspiration
D. Chest discomfort that improves when leaning forward while sitting up
Correct Answer: B
Rationale: Acute MI presents as prolonged substernal chest pressure unrelieved by nitroglycerin or rest. Antacid-relieved pain
suggests GI origin; pleuritic pain suggests pleurisy/pericarditis; pain relieved by sitting forward and leaning forward is classic
for pericarditis.
Q2: A patient is receiving tissue plasminogen activator (tPA) for an ST-elevation MI. Which assessment finding
requires the nurse to immediately stop the infusion and notify the provider?
A. Heart rate of 88 beats/minute and regular
B. Blood pressure of 110/70 mmHg
C. Decreased level of consciousness and sudden severe headache [CORRECT]
D. Mild oozing from the IV insertion site
Correct Answer: C
Rationale: Decreased level of consciousness with sudden severe headache signals possible intracranial hemorrhage, the most
catastrophic complication of fibrinolytic therapy. The infusion must be stopped immediately. Mild IV site oozing is expected;
stable vitals are reassuring.
Q3: A patient with heart failure has a new prescription for furosemide 40 mg IV daily. Which laboratory value
requires priority follow-up before administering the dose?
A. Sodium 136 mEq/L
B. Potassium 3.1 mEq/L [CORRECT]
C. Magnesium 1.9 mg/dL
D. Calcium 8.8 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting. A potassium of 3.1 mEq/L (hypokalemia)
places the patient at risk for life-threatening dysrhythmias, especially when combined with digoxin. The provider should be
notified and potassium replaced before administration.
Page 1 | Fortis College | NCLEX-RN Aligned
,NUR209 - Medical Surgical Nursing II | Comprehensive Review Examination 2026/2027 Update - Grade A
Q4: The nurse is caring for a patient with atrial fibrillation with a rapid ventricular response of 152 beats/minute.
Which initial action is most appropriate?
A. Administer scheduled metoprolol 50 mg PO
B. Assess the patient for hemodynamic instability and prepare for synchronized cardioversion if unstable
[CORRECT]
C. Encourage the patient to bear down against a closed glottis
D. Apply a nitroglycerin patch 0.4 mg/hr
Correct Answer: B
Rationale: Unstable atrial fibrillation (hypotension, chest pain, altered mental status, heart failure) requires immediate
synchronized cardioversion. Stable patients may receive rate-control medications IV. Vagal maneuvers are for stable
supraventricular tachycardia, not AFib.
Q5: A patient receiving IV heparin for a deep vein thrombosis has an aPTT of 110 seconds (control 30-40
seconds). The heparin protocol indicates to hold the next dose. Which additional action is most important?
A. Administer vitamin K intravenously
B. Assess the patient for signs of bleeding, such as gum oozing, melena, or hematuria [CORRECT]
C. Increase the heparin infusion rate per protocol
D. Administer protamine sulfate immediately
Correct Answer: B
Rationale: An aPTT of 110 seconds reflects supratherapeutic heparin and high bleeding risk. The nurse must assess for bleeding
and notify the provider. Protamine sulfate is the antidote but is given only for significant bleeding, not prophylactically. Vitamin
K reverses warfarin, not heparin.
Q6: A patient with heart failure reports a 2 kg weight gain over 24 hours and increased dyspnea on exertion.
Which interpretation by the nurse is most accurate?
A. This is a normal fluctuation related to dietary intake
B. The patient is retaining fluid and the heart failure is likely worsening [CORRECT]
C. The weight gain is likely related to constipation
D. The patient needs to restrict protein intake immediately
Correct Answer: B
Rationale: A weight gain of 1 kg (2.2 lb) in 24 hours or 2.5 kg in a week indicates fluid retention and worsening heart failure.
Patients are taught daily weights at the same time, same scale, same clothing. The provider should be notified for medication
adjustment.
Q7: The nurse is preparing to administer nitroglycerin sublingual 0.4 mg to a patient with chest pain. Which
action by the nurse is correct?
A. Administer the medication with a full glass of water
B. Instruct the patient to sit or lie down before administration and avoid swallowing until dissolved [CORRECT]
C. Crush the tablet before giving it to speed onset
D. Assess blood pressure 30 minutes after administration
Correct Answer: B
Rationale: Nitroglycerin causes vasodilation and orthostatic hypotension, so the patient should sit or lie down. The tablet must
be placed under the tongue and allowed to dissolve; it should not be swallowed, crushed, or taken with water. Blood pressure
should be assessed before and 5 minutes after administration.
Page 2 | Fortis College | NCLEX-RN Aligned
, NUR209 - Medical Surgical Nursing II | Comprehensive Review Examination 2026/2027 Update - Grade A
Q8: A patient with a permanent pacemaker is being discharged. Which statement by the patient indicates a need
for further teaching?
A. I will carry my pacemaker identification card at all times
B. I should avoid standing near microwave ovens because they will interfere with my pacemaker [CORRECT]
C. I will inform airport security about my pacemaker before going through the metal detector
D. I will check my pulse daily and report a rate below the set pacemaker rate
Correct Answer: B
Rationale: Modern microwave ovens do not interfere with pacemakers; this is outdated teaching. The patient should carry the ID
card, inform security personnel, and monitor the pulse. Other precautions include avoiding strong electromagnetic fields like
MRI scanners (unless MRI-conditional device).
Q9: A patient with left-sided heart failure develops dyspnea, bilateral crackles, and a productive cough with pink,
frothy sputum. Which position is most beneficial initially?
A. Supine with legs flat
B. High Fowler's position with legs dangling if tolerated [CORRECT]
C. Trendelenburg position
D. Left lateral Sims' position
Correct Answer: B
Rationale: High Fowler's position with legs dangling decreases venous return to the heart and improves lung expansion,
providing immediate relief for acute pulmonary edema. Supine and Trendelenburg positions increase venous return and worsen
pulmonary congestion.
Q10: Which serum cardiac biomarker is most specific for myocardial injury and rises within 3-4 hours after an
acute MI?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Troponin I or T [CORRECT]
D. Lactate dehydrogenase (LDH)
Correct Answer: C
Rationale: Troponin I and T are the most sensitive and specific markers for myocardial injury, rising within 3-4 hours and
remaining elevated for 7-10 days. CK-MB returns to normal in 2-3 days and is less specific. Myoglobin rises early but is not
cardiac-specific; LDH is no longer used clinically.
Q11: The nurse is delegating care for four cardiac patients. Which task is most appropriate to delegate to a
licensed practical nurse (LPN)?
A. Performing the initial admission assessment of a patient with new-onset chest pain
B. Administering scheduled oral metoprolol 25 mg to a stable patient [CORRECT]
C. Developing the discharge teaching plan for a patient with a new pacemaker
D. Evaluating the response to IV nitroglycerin in a patient with unstable angina
Correct Answer: B
Rationale: LPNs may administer oral medications to stable patients. Initial assessments, discharge teaching plan development,
and evaluation of IV titrated medications require RN scope of practice. Delegation must consider patient stability and
complexity.
Q12: A patient 2 days post-MI tells the nurse, "I'm afraid I'll never be able to have sex again." Which response by
the nurse is most therapeutic?
Page 3 | Fortis College | NCLEX-RN Aligned
