NUR209 MEDICAL SURGICAL NURSING II EXAM 2026/2027 |
Comprehensive Review | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular & Hematological Disorders (20 Questions)
Q1: A 68-year-old client with a history of atrial fibrillation is receiving warfarin 5 mg daily.
The nurse reviews the morning laboratory results and notes an INR of 4.2. Which action
should the nurse take first?
A. Notify the healthcare provider immediately to request a vitamin K order
B. Assess the client for signs of active bleeding, including gums, stool, and skin
C. Hold the next dose of warfarin and document in the medical record
D. Prepare to administer fresh frozen plasma per standing protocol
B. Assess the client for signs of active bleeding, including gums, stool, and skin
[CORRECT]
Correct Answer: B
Rationale: Per the NCLEX-RN Test Plan (2026/2027), priority-setting follows the ABC
framework—assessment for life-threatening bleeding precedes any intervention. While
holding the dose (C) and notifying the provider (A) are appropriate, the nurse must first
,determine if the client is actively hemorrhaging. FFP (D) is reserved for severe bleeding
with INR >10 or active hemorrhage, not an INR of 4.2.
Q2: A client is admitted with acute decompensated heart failure. The nurse notes
dyspnea, crackles bilaterally, jugular venous distention, and 3+ pitting edema of the
lower extremities. Which nursing intervention is the priority?
A. Administer furosemide 40 mg IV push as prescribed
B. Place the client in high Fowler's position with legs dependent
C. Apply supplemental oxygen at 2 L/min via nasal cannula
D. Insert an indwelling urinary catheter to monitor hourly output
B. Place the client in high Fowler's position with legs dependent [CORRECT]
Correct Answer: B
Rationale: Positioning is the fastest, non-pharmacologic intervention to reduce venous
return and pulmonary congestion, directly addressing the ABC priority of
airway/breathing (NCLEX-RN Test Plan, Physiological Integrity). While oxygen (C) and
furosemide (A) are critical, positioning requires no order and provides immediate
symptom relief. Catheter insertion (D) is important for monitoring but is not the priority.
,Q3: A nurse is caring for a client 24 hours post-op following total hip arthroplasty. The
client reports sudden onset of chest pain and shortness of breath. Vital signs: BP 88/52,
HR 118, RR 28, SpO2 86% on room air. Which action should the nurse take first?
A. Apply supplemental oxygen via non-rebreather mask at 15 L/min
B. Activate the rapid response team and notify the surgeon
C. Prepare to administer heparin bolus per protocol
D. Obtain a 12-lead ECG immediately
A. Apply supplemental oxygen via non-rebreather mask at 15 L/min [CORRECT]
Correct Answer: A
Rationale: The client exhibits classic signs of pulmonary embolism (PE) with hypoxemia
(SpO2 86%). Per Maslow's hierarchy and the ABC framework, oxygenation is the
absolute priority before any other intervention (NCLEX-RN Test Plan, Safe and Effective
Care Environment). While activating rapid response (B), preparing heparin (C), and
obtaining ECG (D) are all necessary, they follow immediate oxygen administration.
Q4: A client with chronic heart failure is prescribed lisinopril 10 mg PO daily, metoprolol
succinate 50 mg PO daily, and spironolactone 25 mg PO daily. The nurse should monitor
for which potential adverse effect combination?
A. Hyperkalemia and hypotension
B. Hypokalemia and tachycardia
C. Hypernatremia and hypertension
, D. Hyponatremia and bradycardia
A. Hyperkalemia and hypotension [CORRECT]
Correct Answer: A
Rationale: ACE inhibitors (lisinopril) and potassium-sparing diuretics (spironolactone)
both increase serum potassium, creating additive risk for hyperkalemia. ACE inhibitors
and beta-blockers (metoprolol) both lower blood pressure. This combination is common
in heart failure management but requires vigilant electrolyte and BP monitoring
(NCLEX-RN Test Plan, Pharmacological and Parenteral Therapies).
Q5: A client with sickle cell disease presents to the emergency department with severe
pain rated 10/10 in the lower back and extremities. The nurse reviews the physician's
orders. Which order should the nurse question?
A. Morphine sulfate 2 mg IV every 2 hours PRN for pain
B. Normal saline at 125 mL/hr continuous infusion
C. Oxygen at 2 L/min via nasal cannula to maintain SpO2 >92%
D. Meperidine 50 mg IV every 4 hours PRN for severe pain
D. Meperidine 50 mg IV every 4 hours PRN for severe pain [CORRECT]
Correct Answer: D
Comprehensive Review | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular & Hematological Disorders (20 Questions)
Q1: A 68-year-old client with a history of atrial fibrillation is receiving warfarin 5 mg daily.
The nurse reviews the morning laboratory results and notes an INR of 4.2. Which action
should the nurse take first?
A. Notify the healthcare provider immediately to request a vitamin K order
B. Assess the client for signs of active bleeding, including gums, stool, and skin
C. Hold the next dose of warfarin and document in the medical record
D. Prepare to administer fresh frozen plasma per standing protocol
B. Assess the client for signs of active bleeding, including gums, stool, and skin
[CORRECT]
Correct Answer: B
Rationale: Per the NCLEX-RN Test Plan (2026/2027), priority-setting follows the ABC
framework—assessment for life-threatening bleeding precedes any intervention. While
holding the dose (C) and notifying the provider (A) are appropriate, the nurse must first
,determine if the client is actively hemorrhaging. FFP (D) is reserved for severe bleeding
with INR >10 or active hemorrhage, not an INR of 4.2.
Q2: A client is admitted with acute decompensated heart failure. The nurse notes
dyspnea, crackles bilaterally, jugular venous distention, and 3+ pitting edema of the
lower extremities. Which nursing intervention is the priority?
A. Administer furosemide 40 mg IV push as prescribed
B. Place the client in high Fowler's position with legs dependent
C. Apply supplemental oxygen at 2 L/min via nasal cannula
D. Insert an indwelling urinary catheter to monitor hourly output
B. Place the client in high Fowler's position with legs dependent [CORRECT]
Correct Answer: B
Rationale: Positioning is the fastest, non-pharmacologic intervention to reduce venous
return and pulmonary congestion, directly addressing the ABC priority of
airway/breathing (NCLEX-RN Test Plan, Physiological Integrity). While oxygen (C) and
furosemide (A) are critical, positioning requires no order and provides immediate
symptom relief. Catheter insertion (D) is important for monitoring but is not the priority.
,Q3: A nurse is caring for a client 24 hours post-op following total hip arthroplasty. The
client reports sudden onset of chest pain and shortness of breath. Vital signs: BP 88/52,
HR 118, RR 28, SpO2 86% on room air. Which action should the nurse take first?
A. Apply supplemental oxygen via non-rebreather mask at 15 L/min
B. Activate the rapid response team and notify the surgeon
C. Prepare to administer heparin bolus per protocol
D. Obtain a 12-lead ECG immediately
A. Apply supplemental oxygen via non-rebreather mask at 15 L/min [CORRECT]
Correct Answer: A
Rationale: The client exhibits classic signs of pulmonary embolism (PE) with hypoxemia
(SpO2 86%). Per Maslow's hierarchy and the ABC framework, oxygenation is the
absolute priority before any other intervention (NCLEX-RN Test Plan, Safe and Effective
Care Environment). While activating rapid response (B), preparing heparin (C), and
obtaining ECG (D) are all necessary, they follow immediate oxygen administration.
Q4: A client with chronic heart failure is prescribed lisinopril 10 mg PO daily, metoprolol
succinate 50 mg PO daily, and spironolactone 25 mg PO daily. The nurse should monitor
for which potential adverse effect combination?
A. Hyperkalemia and hypotension
B. Hypokalemia and tachycardia
C. Hypernatremia and hypertension
, D. Hyponatremia and bradycardia
A. Hyperkalemia and hypotension [CORRECT]
Correct Answer: A
Rationale: ACE inhibitors (lisinopril) and potassium-sparing diuretics (spironolactone)
both increase serum potassium, creating additive risk for hyperkalemia. ACE inhibitors
and beta-blockers (metoprolol) both lower blood pressure. This combination is common
in heart failure management but requires vigilant electrolyte and BP monitoring
(NCLEX-RN Test Plan, Pharmacological and Parenteral Therapies).
Q5: A client with sickle cell disease presents to the emergency department with severe
pain rated 10/10 in the lower back and extremities. The nurse reviews the physician's
orders. Which order should the nurse question?
A. Morphine sulfate 2 mg IV every 2 hours PRN for pain
B. Normal saline at 125 mL/hr continuous infusion
C. Oxygen at 2 L/min via nasal cannula to maintain SpO2 >92%
D. Meperidine 50 mg IV every 4 hours PRN for severe pain
D. Meperidine 50 mg IV every 4 hours PRN for severe pain [CORRECT]
Correct Answer: D
