NU 185/ NU185 EXAM 3 – MEDICAL-SURGICAL
NURSING II REVIEW | COMPREHENSIVE
QUESTIONS AND ANSWERS | VERIFIED AND
WELL-DETAILED ANSWERS | DETAILED
EXPLANATIONS AND RATIONALES | COMPLETE
EXAM PREPARATION STUDY GUIDE | PRACTICE
QUESTIONS | LATEST EXAM UPDATE
CORE DOMAINS
1. Cardiovascular disorders and perfusion
2. Gastrointestinal and hepatobiliary disorders
3. Neurological disorders and altered neurological function
4. Renal and urinary disorders
5. Endocrine and metabolic disorders
6. Integumentary disorders and wound/pressure-injury care
7. Musculoskeletal and mobility-related conditions
8. Oncology and treatment-related nursing care
9. Pediatric and congenital medical-surgical considerations
10. Pharmacology, safety, prioritization, and clinical judgment
INTRODUCTION
This 100-question practice assessment is designed to strengthen knowledge and clinical
reasoning for NU 185/NU185 Medical-Surgical Nursing II Exam 3 preparation. The questions
emphasize assessment, pathophysiology, prioritization, pharmacologic safety, patient
education, nursing interventions, complications, and interpretation of clinical findings.
Rather than relying primarily on memorization, many questions require application and
clinical judgment. Use each rationale to identify why the correct response is appropriate and
why competing choices are less appropriate. The assessment is intended as a study resource
rather than a representation of official examination content.
,SECTION ONE: QUESTIONS 1–100
NU 185/NU185 Medical-Surgical Nursing II Exam 3 — 100-Question Practice Assessment
Question 1.
A client with suspected cardiogenic shock has a blood pressure of 82/48 mm Hg, cool
clammy skin, confusion, and urine output of 15 mL/hr. Which finding is most concerning as
an indicator of inadequate tissue perfusion?
A. Cool extremities
B. Confusion
C. Mild peripheral edema
D. Heart rate of 104/min
Correct Answer: B. Confusion
Explanation: A change in mental status is an early and clinically important indicator of
decreased cerebral perfusion and cellular hypoxia. In shock, the brain, heart, and kidneys are
particularly vulnerable to inadequate perfusion. Cool skin and tachycardia may occur with
shock, but acute confusion indicates compromised cerebral perfusion.
Question 2.
A nurse is caring for a client with cardiogenic shock. Which assessment finding requires the
most immediate intervention?
A. Urine output of 35 mL/hr
B. Heart rate of 108/min
C. New onset confusion and decreased level of consciousness
D. Mild bilateral ankle edema
Correct Answer: C. New onset confusion and decreased level of consciousness
Explanation: Acute neurological changes suggest worsening cerebral perfusion and
hypoxemia. This is a priority finding in shock because progressive tissue hypoperfusion can
rapidly lead to organ dysfunction. The other findings may occur with cardiac dysfunction but
are less immediately indicative of worsening cerebral perfusion.
Question 3.
A client with infective endocarditis is receiving intravenous antibiotics. Which finding is most
important for the nurse to monitor?
A. Blood culture results
B. Daily hair loss
C. Increased appetite
D. Mild thirst
,Correct Answer: A. Blood culture results
Explanation: Blood cultures help identify the causative organism and determine whether
treatment is successfully clearing the infection. Infective endocarditis commonly requires
prolonged antimicrobial therapy. Persistent positive cultures may indicate ongoing infection
or treatment failure.
Question 4.
Which assessment finding is most characteristic of acute pericarditis?
A. Chest pain relieved by lying flat
B. Chest pain improved by sitting upright and leaning forward
C. Painless peripheral edema
D. Chest pain occurring only after meals
Correct Answer: B. Chest pain improved by sitting upright and leaning forward
Explanation: Pericardial inflammation commonly produces sharp chest pain that is
aggravated by lying down and relieved by sitting upright and leaning forward. A pericardial
friction rub may also be present.
Question 5.
A client with pericarditis develops hypotension, jugular venous distention, and muffled heart
sounds. Which complication should the nurse suspect?
A. Cardiac tamponade
B. Pulmonary embolism
C. Stable angina
D. Chronic venous insufficiency
Correct Answer: A. Cardiac tamponade
Explanation: Hypotension, jugular venous distention, and muffled heart sounds are classic
findings associated with cardiac tamponade. Fluid accumulating in the pericardial space can
compress the heart and impair ventricular filling, reducing cardiac output.
Question 6.
A client is being evaluated for infective endocarditis. Which diagnostic study provides direct
visualization of cardiac structures and is particularly useful for identifying vegetations?
A. Electrocardiogram
B. Transesophageal echocardiography
C. Chest radiograph
D. Pulse oximetry
Correct Answer: B. Transesophageal echocardiography
, Explanation: Transesophageal echocardiography provides detailed visualization of cardiac
valves and structures and is highly useful for detecting vegetations associated with infective
endocarditis. Blood cultures are also essential for identifying the infectious organism.
Question 7.
A client with a dysrhythmia becomes unstable with hypotension and altered mental status
but still has a pulse. Which intervention may be indicated depending on the rhythm?
A. Synchronized cardioversion
B. Oral fluid restriction
C. Routine ambulation
D. Delayed outpatient follow-up
Correct Answer: A. Synchronized cardioversion
Explanation: Synchronized cardioversion is used for certain unstable tachydysrhythmias
when the patient has a pulse. The synchronized shock is timed with the cardiac cycle to
reduce the risk of inducing ventricular fibrillation.
Question 8.
A client is scheduled for elective cardioversion. Which nursing action is appropriate?
A. Withhold all monitoring during the procedure
B. Ensure appropriate sedation and continuous cardiac monitoring
C. Encourage vigorous exercise immediately beforehand
D. Remove emergency equipment from the bedside
Correct Answer: B. Ensure appropriate sedation and continuous cardiac monitoring
Explanation: Elective cardioversion is generally performed with appropriate sedation while
the patient's rhythm, blood pressure, and oxygenation are monitored. Resuscitation
equipment should be immediately available.
Question 9.
Which statement best describes the purpose of an implantable cardioverter-defibrillator
(ICD)?
A. It permanently replaces the sinoatrial node
B. It detects and treats potentially life-threatening ventricular dysrhythmias
C. It eliminates the need for all cardiac medications
D. It prevents every type of heart failure
Correct Answer: B. It detects and treats potentially life-threatening ventricular
dysrhythmias
NURSING II REVIEW | COMPREHENSIVE
QUESTIONS AND ANSWERS | VERIFIED AND
WELL-DETAILED ANSWERS | DETAILED
EXPLANATIONS AND RATIONALES | COMPLETE
EXAM PREPARATION STUDY GUIDE | PRACTICE
QUESTIONS | LATEST EXAM UPDATE
CORE DOMAINS
1. Cardiovascular disorders and perfusion
2. Gastrointestinal and hepatobiliary disorders
3. Neurological disorders and altered neurological function
4. Renal and urinary disorders
5. Endocrine and metabolic disorders
6. Integumentary disorders and wound/pressure-injury care
7. Musculoskeletal and mobility-related conditions
8. Oncology and treatment-related nursing care
9. Pediatric and congenital medical-surgical considerations
10. Pharmacology, safety, prioritization, and clinical judgment
INTRODUCTION
This 100-question practice assessment is designed to strengthen knowledge and clinical
reasoning for NU 185/NU185 Medical-Surgical Nursing II Exam 3 preparation. The questions
emphasize assessment, pathophysiology, prioritization, pharmacologic safety, patient
education, nursing interventions, complications, and interpretation of clinical findings.
Rather than relying primarily on memorization, many questions require application and
clinical judgment. Use each rationale to identify why the correct response is appropriate and
why competing choices are less appropriate. The assessment is intended as a study resource
rather than a representation of official examination content.
,SECTION ONE: QUESTIONS 1–100
NU 185/NU185 Medical-Surgical Nursing II Exam 3 — 100-Question Practice Assessment
Question 1.
A client with suspected cardiogenic shock has a blood pressure of 82/48 mm Hg, cool
clammy skin, confusion, and urine output of 15 mL/hr. Which finding is most concerning as
an indicator of inadequate tissue perfusion?
A. Cool extremities
B. Confusion
C. Mild peripheral edema
D. Heart rate of 104/min
Correct Answer: B. Confusion
Explanation: A change in mental status is an early and clinically important indicator of
decreased cerebral perfusion and cellular hypoxia. In shock, the brain, heart, and kidneys are
particularly vulnerable to inadequate perfusion. Cool skin and tachycardia may occur with
shock, but acute confusion indicates compromised cerebral perfusion.
Question 2.
A nurse is caring for a client with cardiogenic shock. Which assessment finding requires the
most immediate intervention?
A. Urine output of 35 mL/hr
B. Heart rate of 108/min
C. New onset confusion and decreased level of consciousness
D. Mild bilateral ankle edema
Correct Answer: C. New onset confusion and decreased level of consciousness
Explanation: Acute neurological changes suggest worsening cerebral perfusion and
hypoxemia. This is a priority finding in shock because progressive tissue hypoperfusion can
rapidly lead to organ dysfunction. The other findings may occur with cardiac dysfunction but
are less immediately indicative of worsening cerebral perfusion.
Question 3.
A client with infective endocarditis is receiving intravenous antibiotics. Which finding is most
important for the nurse to monitor?
A. Blood culture results
B. Daily hair loss
C. Increased appetite
D. Mild thirst
,Correct Answer: A. Blood culture results
Explanation: Blood cultures help identify the causative organism and determine whether
treatment is successfully clearing the infection. Infective endocarditis commonly requires
prolonged antimicrobial therapy. Persistent positive cultures may indicate ongoing infection
or treatment failure.
Question 4.
Which assessment finding is most characteristic of acute pericarditis?
A. Chest pain relieved by lying flat
B. Chest pain improved by sitting upright and leaning forward
C. Painless peripheral edema
D. Chest pain occurring only after meals
Correct Answer: B. Chest pain improved by sitting upright and leaning forward
Explanation: Pericardial inflammation commonly produces sharp chest pain that is
aggravated by lying down and relieved by sitting upright and leaning forward. A pericardial
friction rub may also be present.
Question 5.
A client with pericarditis develops hypotension, jugular venous distention, and muffled heart
sounds. Which complication should the nurse suspect?
A. Cardiac tamponade
B. Pulmonary embolism
C. Stable angina
D. Chronic venous insufficiency
Correct Answer: A. Cardiac tamponade
Explanation: Hypotension, jugular venous distention, and muffled heart sounds are classic
findings associated with cardiac tamponade. Fluid accumulating in the pericardial space can
compress the heart and impair ventricular filling, reducing cardiac output.
Question 6.
A client is being evaluated for infective endocarditis. Which diagnostic study provides direct
visualization of cardiac structures and is particularly useful for identifying vegetations?
A. Electrocardiogram
B. Transesophageal echocardiography
C. Chest radiograph
D. Pulse oximetry
Correct Answer: B. Transesophageal echocardiography
, Explanation: Transesophageal echocardiography provides detailed visualization of cardiac
valves and structures and is highly useful for detecting vegetations associated with infective
endocarditis. Blood cultures are also essential for identifying the infectious organism.
Question 7.
A client with a dysrhythmia becomes unstable with hypotension and altered mental status
but still has a pulse. Which intervention may be indicated depending on the rhythm?
A. Synchronized cardioversion
B. Oral fluid restriction
C. Routine ambulation
D. Delayed outpatient follow-up
Correct Answer: A. Synchronized cardioversion
Explanation: Synchronized cardioversion is used for certain unstable tachydysrhythmias
when the patient has a pulse. The synchronized shock is timed with the cardiac cycle to
reduce the risk of inducing ventricular fibrillation.
Question 8.
A client is scheduled for elective cardioversion. Which nursing action is appropriate?
A. Withhold all monitoring during the procedure
B. Ensure appropriate sedation and continuous cardiac monitoring
C. Encourage vigorous exercise immediately beforehand
D. Remove emergency equipment from the bedside
Correct Answer: B. Ensure appropriate sedation and continuous cardiac monitoring
Explanation: Elective cardioversion is generally performed with appropriate sedation while
the patient's rhythm, blood pressure, and oxygenation are monitored. Resuscitation
equipment should be immediately available.
Question 9.
Which statement best describes the purpose of an implantable cardioverter-defibrillator
(ICD)?
A. It permanently replaces the sinoatrial node
B. It detects and treats potentially life-threatening ventricular dysrhythmias
C. It eliminates the need for all cardiac medications
D. It prevents every type of heart failure
Correct Answer: B. It detects and treats potentially life-threatening ventricular
dysrhythmias
