NSG 223 Medical-Surgical Nursing II Final Exam | Herzing University 2026/2027 | Page 1
,NSG 223 Medical-Surgical Nursing II Final Exam | Herzing University 2026/2027 | Page 2
, Examination Instructions
This comprehensive final examination consists of 100 multiple-choice questions organized into eight sections
aligned with the NSG 223 Medical-Surgical Nursing II curriculum at Herzing University for the 2026/2027 academic
year. Each question has four answer options (A through D), with exactly one correct answer.
Content Distribution: Cardiovascular (18), Respiratory (14), Gastrointestinal (14), Renal/Genitourinary (12),
Neurological (14), Endocrine (12), Musculoskeletal (10), and Integrated Clinical Scenarios (6 questions).
Question Design: 70% scenario-based questions testing clinical application of nursing knowledge; 20% direct recall
questions assessing foundational concepts; and 10% clinical judgment and priority-setting questions requiring
synthesis and analysis of complex patient scenarios.
Answer Key: Each question is followed by the correct answer and a comprehensive rationale explaining why the
correct answer is right and why the distractors are incorrect. Rationales include pathophysiology, clinical
manifestations, nursing interventions, pharmacology, and Herzing NSG 223 course-specific concepts.
NSG 223 Medical-Surgical Nursing II Final Exam | Herzing University 2026/2027 | Page 3
, SECTION Disorders: Cardiovascular Disorders
Q1. A 68-year-old patient is admitted to the hospital with dyspnea on exertion, orthopnea, and a cough that produces pink,
frothy sputum. The nurse recognizes these findings are most consistent with which condition?
A. Right-sided heart failure
B. Left-sided heart failure [CORRECT]
C. Cor pulmonale
D. Pulmonary embolism
Correct Answer: B
Rationale: Pink, frothy sputum, orthopnea, and dyspnea on exertion are classic signs of left-sided heart failure resulting from pulmonary
congestion. Right-sided heart failure typically presents with peripheral edema, jugular venous distention, and hepatomegaly due to
systemic venous congestion. Cor pulmonale is right-sided heart failure secondary to pulmonary disease, and a pulmonary embolism
presents with sudden-onset dyspnea, pleuritic chest pain, and hypoxemia.
Q2. A nurse is assessing a patient with right-sided heart failure. Which of the following findings would the nurse most
likely observe?
A. Crackles in the lung fields bilaterally
B. Jugular venous distention and dependent peripheral edema [CORRECT]
C. S3 gallop rhythm on auscultation
D. Paroxysmal nocturnal dyspnea
Correct Answer: B
Rationale: Right-sided heart failure causes backup of blood into the systemic venous system, leading to jugular venous distention,
dependent peripheral edema, hepatosplenomegaly, and ascites. Crackles, S3 gallop, and paroxysmal nocturnal dyspnea are
manifestations of left-sided heart failure due to pulmonary congestion. The nurse must differentiate between left and right heart failure to
anticipate appropriate interventions and monitor for worsening symptoms.
Q3. A patient with heart failure is classified as NYHA Class III. The nurse explains to the patient that this classification
means:
A. No limitation of physical activity; ordinary activity does not cause symptoms
B. Slight limitation of physical activity; comfortable at rest but ordinary activity causes fatigue or dyspnea
C. Marked limitation of physical activity; comfortable only at rest and less-than-ordinary activity causes
symptoms [CORRECT]
D. Unable to carry on any physical activity without discomfort; symptoms present at rest
Correct Answer: C
Rationale: NYHA Class III is defined as marked limitation of physical activity where the patient is comfortable only at rest, and
less-than-ordinary activity causes fatigue, palpitations, or dyspnea. Class I has no limitations, Class II has slight limitation with ordinary
activity, and Class IV indicates inability to carry on any activity without symptoms even at rest. The NYHA classification guides
therapeutic decisions and helps patients understand their functional capacity.
Q4. A patient with heart failure is prescribed lisinopril (an ACE inhibitor). The nurse should educate the patient about
which of the following potential side effects?
A. Hyperkalemia and a persistent dry cough [CORRECT]
B. Hypokalemia and bradycardia
C. Hypernatremia and increased urinary output
D. Tachycardia and increased appetite
Correct Answer: A
NSG 223 Medical-Surgical Nursing II Final Exam | Herzing University 2026/2027 | Page 4
,NSG 223 Medical-Surgical Nursing II Final Exam | Herzing University 2026/2027 | Page 2
, Examination Instructions
This comprehensive final examination consists of 100 multiple-choice questions organized into eight sections
aligned with the NSG 223 Medical-Surgical Nursing II curriculum at Herzing University for the 2026/2027 academic
year. Each question has four answer options (A through D), with exactly one correct answer.
Content Distribution: Cardiovascular (18), Respiratory (14), Gastrointestinal (14), Renal/Genitourinary (12),
Neurological (14), Endocrine (12), Musculoskeletal (10), and Integrated Clinical Scenarios (6 questions).
Question Design: 70% scenario-based questions testing clinical application of nursing knowledge; 20% direct recall
questions assessing foundational concepts; and 10% clinical judgment and priority-setting questions requiring
synthesis and analysis of complex patient scenarios.
Answer Key: Each question is followed by the correct answer and a comprehensive rationale explaining why the
correct answer is right and why the distractors are incorrect. Rationales include pathophysiology, clinical
manifestations, nursing interventions, pharmacology, and Herzing NSG 223 course-specific concepts.
NSG 223 Medical-Surgical Nursing II Final Exam | Herzing University 2026/2027 | Page 3
, SECTION Disorders: Cardiovascular Disorders
Q1. A 68-year-old patient is admitted to the hospital with dyspnea on exertion, orthopnea, and a cough that produces pink,
frothy sputum. The nurse recognizes these findings are most consistent with which condition?
A. Right-sided heart failure
B. Left-sided heart failure [CORRECT]
C. Cor pulmonale
D. Pulmonary embolism
Correct Answer: B
Rationale: Pink, frothy sputum, orthopnea, and dyspnea on exertion are classic signs of left-sided heart failure resulting from pulmonary
congestion. Right-sided heart failure typically presents with peripheral edema, jugular venous distention, and hepatomegaly due to
systemic venous congestion. Cor pulmonale is right-sided heart failure secondary to pulmonary disease, and a pulmonary embolism
presents with sudden-onset dyspnea, pleuritic chest pain, and hypoxemia.
Q2. A nurse is assessing a patient with right-sided heart failure. Which of the following findings would the nurse most
likely observe?
A. Crackles in the lung fields bilaterally
B. Jugular venous distention and dependent peripheral edema [CORRECT]
C. S3 gallop rhythm on auscultation
D. Paroxysmal nocturnal dyspnea
Correct Answer: B
Rationale: Right-sided heart failure causes backup of blood into the systemic venous system, leading to jugular venous distention,
dependent peripheral edema, hepatosplenomegaly, and ascites. Crackles, S3 gallop, and paroxysmal nocturnal dyspnea are
manifestations of left-sided heart failure due to pulmonary congestion. The nurse must differentiate between left and right heart failure to
anticipate appropriate interventions and monitor for worsening symptoms.
Q3. A patient with heart failure is classified as NYHA Class III. The nurse explains to the patient that this classification
means:
A. No limitation of physical activity; ordinary activity does not cause symptoms
B. Slight limitation of physical activity; comfortable at rest but ordinary activity causes fatigue or dyspnea
C. Marked limitation of physical activity; comfortable only at rest and less-than-ordinary activity causes
symptoms [CORRECT]
D. Unable to carry on any physical activity without discomfort; symptoms present at rest
Correct Answer: C
Rationale: NYHA Class III is defined as marked limitation of physical activity where the patient is comfortable only at rest, and
less-than-ordinary activity causes fatigue, palpitations, or dyspnea. Class I has no limitations, Class II has slight limitation with ordinary
activity, and Class IV indicates inability to carry on any activity without symptoms even at rest. The NYHA classification guides
therapeutic decisions and helps patients understand their functional capacity.
Q4. A patient with heart failure is prescribed lisinopril (an ACE inhibitor). The nurse should educate the patient about
which of the following potential side effects?
A. Hyperkalemia and a persistent dry cough [CORRECT]
B. Hypokalemia and bradycardia
C. Hypernatremia and increased urinary output
D. Tachycardia and increased appetite
Correct Answer: A
NSG 223 Medical-Surgical Nursing II Final Exam | Herzing University 2026/2027 | Page 4
