Page |1
NSG 223 MED SURG II FINAL EXAM PRACTICE Questions
with Detailed Rationales
Institution: Herzing University
SECTION 1: CARDIOVASCULAR
A nurse is caring for a client with heart failure with reduced
ejection fraction (HFrEF). Which medication has the strongest
evidence for reducing mortality?
A. Digoxin
B. Furosemide
C. Lisinopril
D. Aspirin
Answer: C
Rationale: ACE inhibitors such as lisinopril reduce mortality in
HFrEF by decreasing afterload and remodeling. Digoxin and
furosemide relieve symptoms but do not improve mortality.
Aspirin is not standard for HF unless indicated for CAD.
Question 2
A client with acute coronary syndrome is prescribed aspirin and
clopidogrel. Which finding would be most concerning?
A. Heart rate 88
B. Platelet count 180,000
, Page |2
C. New black tarry stools
D. Blood pressure 130/80
Answer: C
Rationale: Black tarry stools indicate GI bleeding, a major
concern with dual antiplatelet therapy. The nurse should hold
the medication and notify the provider.
Question 3
A nurse is assessing a client with peripheral arterial disease.
Which finding is expected?
A. Warm, red legs
B. Brown discoloration and edema
C. Cool, pale extremities with diminished pulses
D. Pitting edema
Answer: C
Rationale: PAD causes decreased arterial flow, leading to cool,
pale skin, diminished pulses, and intermittent claudication.
Brown discoloration/edema suggests venous insufficiency.
Question 4
A client with atrial fibrillation is started on warfarin. Which lab
value indicates therapeutic effect?
A. INR 1.0
, Page |3
B. INR 2.5
C. aPTT 40 seconds
D. Platelet count 150,000
Answer: B
Rationale: For most indications including atrial fibrillation, the
therapeutic INR range is 2.0–3.0.
Question 5
A nurse is assessing a client with heart failure. Which finding
indicates fluid volume overload?
A. Weight loss
B. Crackles in lung bases and dyspnea
C. Hypotension
D. Dry mucous membranes
Answer: B
Rationale: Crackles and dyspnea indicate pulmonary congestion
from fluid overload in heart failure.
Question 6
A client with hypertension is prescribed lisinopril. Which
adverse effect should the nurse monitor for?
A. Hypokalemia
B. Cough and hyperkalemia
, Page |4
C. Bradycardia
D. Peripheral edema
Answer: B
Rationale: ACE inhibitors commonly cause a dry cough and
hyperkalemia due to reduced aldosterone.
Question 7
A nurse is providing discharge teaching for a client with heart
failure. Which statement indicates a need for further teaching?
A. “I will weigh myself daily.”
B. “I will limit sodium to 2–3 grams per day.”
C. “I will stop taking my furosemide if I feel better.”
D. “I will report a weight gain of 2–3 pounds in a day.”
Answer: C
Rationale: Heart failure medications should not be stopped
without provider instruction; diuretics are often continued to
prevent fluid overload.
Question 8
A client with a deep vein thrombosis is started on heparin.
Which lab should be monitored?
A. INR
B. aPTT
NSG 223 MED SURG II FINAL EXAM PRACTICE Questions
with Detailed Rationales
Institution: Herzing University
SECTION 1: CARDIOVASCULAR
A nurse is caring for a client with heart failure with reduced
ejection fraction (HFrEF). Which medication has the strongest
evidence for reducing mortality?
A. Digoxin
B. Furosemide
C. Lisinopril
D. Aspirin
Answer: C
Rationale: ACE inhibitors such as lisinopril reduce mortality in
HFrEF by decreasing afterload and remodeling. Digoxin and
furosemide relieve symptoms but do not improve mortality.
Aspirin is not standard for HF unless indicated for CAD.
Question 2
A client with acute coronary syndrome is prescribed aspirin and
clopidogrel. Which finding would be most concerning?
A. Heart rate 88
B. Platelet count 180,000
, Page |2
C. New black tarry stools
D. Blood pressure 130/80
Answer: C
Rationale: Black tarry stools indicate GI bleeding, a major
concern with dual antiplatelet therapy. The nurse should hold
the medication and notify the provider.
Question 3
A nurse is assessing a client with peripheral arterial disease.
Which finding is expected?
A. Warm, red legs
B. Brown discoloration and edema
C. Cool, pale extremities with diminished pulses
D. Pitting edema
Answer: C
Rationale: PAD causes decreased arterial flow, leading to cool,
pale skin, diminished pulses, and intermittent claudication.
Brown discoloration/edema suggests venous insufficiency.
Question 4
A client with atrial fibrillation is started on warfarin. Which lab
value indicates therapeutic effect?
A. INR 1.0
, Page |3
B. INR 2.5
C. aPTT 40 seconds
D. Platelet count 150,000
Answer: B
Rationale: For most indications including atrial fibrillation, the
therapeutic INR range is 2.0–3.0.
Question 5
A nurse is assessing a client with heart failure. Which finding
indicates fluid volume overload?
A. Weight loss
B. Crackles in lung bases and dyspnea
C. Hypotension
D. Dry mucous membranes
Answer: B
Rationale: Crackles and dyspnea indicate pulmonary congestion
from fluid overload in heart failure.
Question 6
A client with hypertension is prescribed lisinopril. Which
adverse effect should the nurse monitor for?
A. Hypokalemia
B. Cough and hyperkalemia
, Page |4
C. Bradycardia
D. Peripheral edema
Answer: B
Rationale: ACE inhibitors commonly cause a dry cough and
hyperkalemia due to reduced aldosterone.
Question 7
A nurse is providing discharge teaching for a client with heart
failure. Which statement indicates a need for further teaching?
A. “I will weigh myself daily.”
B. “I will limit sodium to 2–3 grams per day.”
C. “I will stop taking my furosemide if I feel better.”
D. “I will report a weight gain of 2–3 pounds in a day.”
Answer: C
Rationale: Heart failure medications should not be stopped
without provider instruction; diuretics are often continued to
prevent fluid overload.
Question 8
A client with a deep vein thrombosis is started on heparin.
Which lab should be monitored?
A. INR
B. aPTT
