NU 185 Exam 3 - Med-Surg II (2026)
Actual Questions & Answers | 100% Guarantee Pass
75 Questions | Verified Answers | Grade A
Section 1: Cardiovascular Disorders (Heart Failure, Valvular Disease, Endocarditis, &
Vascular Disorders)
Q1: A 68-year-old patient with a history of hypertension presents to the clinic reporting increasing dyspnea
on exertion, orthopnea requiring three pillows to sleep, and a persistent nonproductive cough. Assessment
reveals bilateral crackles in the lung bases, an S3 gallop, and 2+ pitting edema in the lower extremities.
Which type of heart failure is this patient most likely experiencing?
A. Right-sided heart failure
B. Left-sided heart failure [CORRECT]
C. Biventricular heart failure
D. Cor pulmonale
Correct Answer: B
Rationale: The patient demonstrates classic left-sided heart failure symptoms including dyspnea on exertion, orthopnea, bilateral
crackles (pulmonary congestion), and an S3 gallop, which reflects impaired left ventricular systolic or diastolic function. Right-sided
heart failure typically presents with jugular venous distension, peripheral edema, hepatomegaly, and ascites due to systemic venous
congestion. While this patient also has edema suggesting some right-sided involvement, the primary presentation of pulmonary
congestion with crackles and S3 is most consistent with left-sided heart failure. Cor pulmonale is right heart failure secondary to
pulmonary disease.
Q2: A nurse is providing discharge teaching to a patient newly diagnosed with heart failure. Which
instruction should the nurse prioritize to detect early signs of fluid retention and worsening heart failure at
home?
A. Monitor blood pressure daily and report if above 140/90 mmHg
B. Weigh yourself every morning before breakfast and report a gain of 2 lbs or more in one day
[CORRECT]
C. Count your pulse daily and report if below 60 beats per minute
D. Measure your abdominal girth weekly and report any increase of 1 inch
Correct Answer: B
Rationale: Daily weights are the most reliable early indicator of fluid retention in heart failure patients. A weight gain of 2 to 3
pounds in one day or 5 pounds in one week signals fluid retention that requires immediate intervention such as adjusting diuretic
dosage. Blood pressure monitoring, while important, does not provide early detection of fluid overload. Pulse monitoring is relevant
for patients on beta-blockers or digoxin but does not detect fluid retention. Abdominal girth measurement is more specific to ascites,
which is a later finding of right-sided heart failure.
Q3: A 55-year-old patient is prescribed lisinopril, an ACE inhibitor, for the management of heart failure
with reduced ejection fraction. The nurse should educate the patient to monitor for which potential adverse
effect?
A. Hyperkalemia and a persistent dry cough [CORRECT]
, B. Hypokalemia and bradycardia
C. Hyponatremia and tinnitus
D. Hypercalcemia and muscle weakness
Correct Answer: A
Rationale: ACE inhibitors are first-line pharmacotherapy for heart failure with reduced ejection fraction. They inhibit the
conversion of angiotensin I to angiotensin II, reducing aldosterone secretion, which can lead to hyperkalemia due to decreased
potassium excretion. A persistent dry cough occurs in approximately 10 to 20 percent of patients due to bradykinin accumulation.
Hypokalemia is associated with thiazide and loop diuretics, not ACE inhibitors. Hyponatremia and tinnitus are not typical adverse
effects. Hypercalcemia is not associated with ACE inhibitor therapy.
Q4: A 32-year-old intravenous drug user presents with fever, chills, night sweats, and a new holosystolic
murmur heard best at the left lower sternal border. Physical examination reveals tender, raised,
erythematous lesions on the palms and splinter hemorrhages under the fingernails. Blood cultures are
drawn. Which finding is most specific for diagnosing infective endocarditis in this patient?
A. Fever of 38.5 degrees C (101.3 degrees F)
B. New or changing cardiac murmur
C. Splinter hemorrhages under the fingernails
D. Positive blood cultures from two separate sites [CORRECT]
Correct Answer: D
Rationale: According to the modified Duke criteria for infective endocarditis, positive blood cultures from two separate sites are a
major criterion and the most specific diagnostic finding. Two sets of blood cultures from different venipuncture sites demonstrating
the same organism are highly specific for endocarditis. While a new or changing murmur is also a major criterion, blood cultures
provide definitive microbiologic identification. Fever is a nonspecific finding. Splinter hemorrhages, Osler nodes, Janeway lesions,
and Roth spots are minor criteria or immunologic phenomena that support the diagnosis but are not specific to endocarditis alone.
Q5: A patient is diagnosed with infective endocarditis caused by Streptococcus viridans. The health care
provider prescribes intravenous antibiotics for 4 weeks. The nurse understands that prolonged antibiotic
therapy is necessary for which reason?
A. The bacteria are resistant to most antibiotics and require high-dose extended therapy
B. The cardiac valves are avascular, making antibiotic penetration difficult and requiring prolonged treatment
C. The infection forms a biofilm within the vegetations that protects bacteria from immune clearance and
requires extended therapy for eradication [CORRECT]
D. The patient is immunocompromised and needs extended therapy to prevent relapse
Correct Answer: C
Rationale: Infective endocarditis treatment requires 4 to 6 weeks of intravenous antibiotics because the bacteria within the cardiac
vegetations are embedded in a biofilm matrix of fibrin, platelets, and extracellular polymeric substances. This biofilm protects
bacteria from phagocytosis and makes antibiotic penetration challenging, necessitating sustained bactericidal concentrations over an
extended period. The cardiac valves are not entirely avascular; they receive blood supply from the vas vasorum. The duration is not
primarily determined by antibiotic resistance or immunocompromise but by the nature of the infection site within the vegetations.
Q6: A postoperative patient who has been on bed rest for 5 days develops unilateral left leg pain, swelling,
warmth, and erythema. The nurse suspects deep vein thrombosis (DVT). Which of the following represents
Virchow's triad, the three factors that contribute to thrombus formation?
A. Hypertension, hyperlipidemia, and hyperglycemia
B. Venous stasis, endothelial injury, and hypercoagulability [CORRECT]
, C. Thrombocytopenia, prolonged PT, and elevated aPTT
D. Infection, inflammation, and immune complex deposition
Correct Answer: B
Rationale: Virchow's triad describes the three pathophysiological factors contributing to venous thrombus formation: venous stasis
(reduced blood flow as seen with bed rest and immobility), endothelial injury (damage to the vessel wall from surgery, trauma, or
intravenous catheters), and hypercoagulability (increased clotting tendency from surgery, malignancy, or genetic factors).
Hypertension, hyperlipidemia, and hyperglycemia are cardiovascular risk factors but do not constitute Virchow's triad.
Thrombocytopenia and prolonged coagulation times indicate bleeding risk rather than clotting risk. Infection and inflammation are
not components of Virchow's triad.
Q7: A patient with a confirmed deep vein thrombosis is started on a continuous intravenous heparin
infusion. Which laboratory value should the nurse monitor to evaluate the therapeutic effectiveness of
heparin therapy?
A. International Normalized Ratio (INR)
B. Activated partial thromboplastin time (aPTT) [CORRECT]
C. Prothrombin time (PT)
D. Platelet count only
Correct Answer: B
Rationale: The aPTT is the primary laboratory value used to monitor therapeutic effectiveness of unfractionated heparin therapy.
The therapeutic range for aPTT is typically 1.5 to 2.5 times the control value, which correlates with therapeutic anticoagulation.
INR and PT are used to monitor warfarin therapy, not heparin. While platelet count should be monitored every 2 to 3 days to detect
heparin-induced thrombocytopenia (HIT), it does not assess the therapeutic anticoagulant effect of heparin. The aPTT must be
drawn at consistent intervals, typically every 6 hours during dose titration.
Q8: A 65-year-old male presents for a routine physical examination. The nurse practitioner palpates a
pulsatile abdominal mass approximately 5 cm in diameter and auscultates a bruit over the mass. The patient
reports mild, vague lower back discomfort. What is the priority nursing action?
A. Schedule a follow-up appointment in 6 months to re-evaluate the mass
B. Instruct the patient to increase fluid intake and avoid straining during bowel movements
C. Refer the patient immediately for surgical evaluation and diagnostic imaging such as CT angiography or
ultrasound [CORRECT]
D. Administer an analgesic and document the finding in the patient record
Correct Answer: C
Rationale: A pulsatile abdominal mass with a bruit is the classic presentation of an abdominal aortic aneurysm (AAA), which
carries a high risk of rupture and life-threatening hemorrhage. The priority action is immediate referral for diagnostic imaging
(abdominal ultrasound or CT angiography) and surgical evaluation. AAAs greater than 5.5 cm or those that are rapidly expanding
or symptomatic require urgent or emergent surgical repair (open or endovascular). Delaying evaluation could result in fatal rupture.
Increasing fluid intake and administering analgesics do not address the life-threatening nature of this finding.
Q9: A 72-year-old patient is admitted with a hypertensive crisis, with a blood pressure reading of 210/130
mmHg and reports of severe headache, visual changes, and confusion. Which intravenous antihypertensive
medication is most appropriate for the initial management of this hypertensive emergency?
A. Oral hydrochlorothiazide 25 mg
B. Intravenous labetalol or nicardipine [CORRECT]
C. Sublingual nifedipine 10 mg
Actual Questions & Answers | 100% Guarantee Pass
75 Questions | Verified Answers | Grade A
Section 1: Cardiovascular Disorders (Heart Failure, Valvular Disease, Endocarditis, &
Vascular Disorders)
Q1: A 68-year-old patient with a history of hypertension presents to the clinic reporting increasing dyspnea
on exertion, orthopnea requiring three pillows to sleep, and a persistent nonproductive cough. Assessment
reveals bilateral crackles in the lung bases, an S3 gallop, and 2+ pitting edema in the lower extremities.
Which type of heart failure is this patient most likely experiencing?
A. Right-sided heart failure
B. Left-sided heart failure [CORRECT]
C. Biventricular heart failure
D. Cor pulmonale
Correct Answer: B
Rationale: The patient demonstrates classic left-sided heart failure symptoms including dyspnea on exertion, orthopnea, bilateral
crackles (pulmonary congestion), and an S3 gallop, which reflects impaired left ventricular systolic or diastolic function. Right-sided
heart failure typically presents with jugular venous distension, peripheral edema, hepatomegaly, and ascites due to systemic venous
congestion. While this patient also has edema suggesting some right-sided involvement, the primary presentation of pulmonary
congestion with crackles and S3 is most consistent with left-sided heart failure. Cor pulmonale is right heart failure secondary to
pulmonary disease.
Q2: A nurse is providing discharge teaching to a patient newly diagnosed with heart failure. Which
instruction should the nurse prioritize to detect early signs of fluid retention and worsening heart failure at
home?
A. Monitor blood pressure daily and report if above 140/90 mmHg
B. Weigh yourself every morning before breakfast and report a gain of 2 lbs or more in one day
[CORRECT]
C. Count your pulse daily and report if below 60 beats per minute
D. Measure your abdominal girth weekly and report any increase of 1 inch
Correct Answer: B
Rationale: Daily weights are the most reliable early indicator of fluid retention in heart failure patients. A weight gain of 2 to 3
pounds in one day or 5 pounds in one week signals fluid retention that requires immediate intervention such as adjusting diuretic
dosage. Blood pressure monitoring, while important, does not provide early detection of fluid overload. Pulse monitoring is relevant
for patients on beta-blockers or digoxin but does not detect fluid retention. Abdominal girth measurement is more specific to ascites,
which is a later finding of right-sided heart failure.
Q3: A 55-year-old patient is prescribed lisinopril, an ACE inhibitor, for the management of heart failure
with reduced ejection fraction. The nurse should educate the patient to monitor for which potential adverse
effect?
A. Hyperkalemia and a persistent dry cough [CORRECT]
, B. Hypokalemia and bradycardia
C. Hyponatremia and tinnitus
D. Hypercalcemia and muscle weakness
Correct Answer: A
Rationale: ACE inhibitors are first-line pharmacotherapy for heart failure with reduced ejection fraction. They inhibit the
conversion of angiotensin I to angiotensin II, reducing aldosterone secretion, which can lead to hyperkalemia due to decreased
potassium excretion. A persistent dry cough occurs in approximately 10 to 20 percent of patients due to bradykinin accumulation.
Hypokalemia is associated with thiazide and loop diuretics, not ACE inhibitors. Hyponatremia and tinnitus are not typical adverse
effects. Hypercalcemia is not associated with ACE inhibitor therapy.
Q4: A 32-year-old intravenous drug user presents with fever, chills, night sweats, and a new holosystolic
murmur heard best at the left lower sternal border. Physical examination reveals tender, raised,
erythematous lesions on the palms and splinter hemorrhages under the fingernails. Blood cultures are
drawn. Which finding is most specific for diagnosing infective endocarditis in this patient?
A. Fever of 38.5 degrees C (101.3 degrees F)
B. New or changing cardiac murmur
C. Splinter hemorrhages under the fingernails
D. Positive blood cultures from two separate sites [CORRECT]
Correct Answer: D
Rationale: According to the modified Duke criteria for infective endocarditis, positive blood cultures from two separate sites are a
major criterion and the most specific diagnostic finding. Two sets of blood cultures from different venipuncture sites demonstrating
the same organism are highly specific for endocarditis. While a new or changing murmur is also a major criterion, blood cultures
provide definitive microbiologic identification. Fever is a nonspecific finding. Splinter hemorrhages, Osler nodes, Janeway lesions,
and Roth spots are minor criteria or immunologic phenomena that support the diagnosis but are not specific to endocarditis alone.
Q5: A patient is diagnosed with infective endocarditis caused by Streptococcus viridans. The health care
provider prescribes intravenous antibiotics for 4 weeks. The nurse understands that prolonged antibiotic
therapy is necessary for which reason?
A. The bacteria are resistant to most antibiotics and require high-dose extended therapy
B. The cardiac valves are avascular, making antibiotic penetration difficult and requiring prolonged treatment
C. The infection forms a biofilm within the vegetations that protects bacteria from immune clearance and
requires extended therapy for eradication [CORRECT]
D. The patient is immunocompromised and needs extended therapy to prevent relapse
Correct Answer: C
Rationale: Infective endocarditis treatment requires 4 to 6 weeks of intravenous antibiotics because the bacteria within the cardiac
vegetations are embedded in a biofilm matrix of fibrin, platelets, and extracellular polymeric substances. This biofilm protects
bacteria from phagocytosis and makes antibiotic penetration challenging, necessitating sustained bactericidal concentrations over an
extended period. The cardiac valves are not entirely avascular; they receive blood supply from the vas vasorum. The duration is not
primarily determined by antibiotic resistance or immunocompromise but by the nature of the infection site within the vegetations.
Q6: A postoperative patient who has been on bed rest for 5 days develops unilateral left leg pain, swelling,
warmth, and erythema. The nurse suspects deep vein thrombosis (DVT). Which of the following represents
Virchow's triad, the three factors that contribute to thrombus formation?
A. Hypertension, hyperlipidemia, and hyperglycemia
B. Venous stasis, endothelial injury, and hypercoagulability [CORRECT]
, C. Thrombocytopenia, prolonged PT, and elevated aPTT
D. Infection, inflammation, and immune complex deposition
Correct Answer: B
Rationale: Virchow's triad describes the three pathophysiological factors contributing to venous thrombus formation: venous stasis
(reduced blood flow as seen with bed rest and immobility), endothelial injury (damage to the vessel wall from surgery, trauma, or
intravenous catheters), and hypercoagulability (increased clotting tendency from surgery, malignancy, or genetic factors).
Hypertension, hyperlipidemia, and hyperglycemia are cardiovascular risk factors but do not constitute Virchow's triad.
Thrombocytopenia and prolonged coagulation times indicate bleeding risk rather than clotting risk. Infection and inflammation are
not components of Virchow's triad.
Q7: A patient with a confirmed deep vein thrombosis is started on a continuous intravenous heparin
infusion. Which laboratory value should the nurse monitor to evaluate the therapeutic effectiveness of
heparin therapy?
A. International Normalized Ratio (INR)
B. Activated partial thromboplastin time (aPTT) [CORRECT]
C. Prothrombin time (PT)
D. Platelet count only
Correct Answer: B
Rationale: The aPTT is the primary laboratory value used to monitor therapeutic effectiveness of unfractionated heparin therapy.
The therapeutic range for aPTT is typically 1.5 to 2.5 times the control value, which correlates with therapeutic anticoagulation.
INR and PT are used to monitor warfarin therapy, not heparin. While platelet count should be monitored every 2 to 3 days to detect
heparin-induced thrombocytopenia (HIT), it does not assess the therapeutic anticoagulant effect of heparin. The aPTT must be
drawn at consistent intervals, typically every 6 hours during dose titration.
Q8: A 65-year-old male presents for a routine physical examination. The nurse practitioner palpates a
pulsatile abdominal mass approximately 5 cm in diameter and auscultates a bruit over the mass. The patient
reports mild, vague lower back discomfort. What is the priority nursing action?
A. Schedule a follow-up appointment in 6 months to re-evaluate the mass
B. Instruct the patient to increase fluid intake and avoid straining during bowel movements
C. Refer the patient immediately for surgical evaluation and diagnostic imaging such as CT angiography or
ultrasound [CORRECT]
D. Administer an analgesic and document the finding in the patient record
Correct Answer: C
Rationale: A pulsatile abdominal mass with a bruit is the classic presentation of an abdominal aortic aneurysm (AAA), which
carries a high risk of rupture and life-threatening hemorrhage. The priority action is immediate referral for diagnostic imaging
(abdominal ultrasound or CT angiography) and surgical evaluation. AAAs greater than 5.5 cm or those that are rapidly expanding
or symptomatic require urgent or emergent surgical repair (open or endovascular). Delaying evaluation could result in fatal rupture.
Increasing fluid intake and administering analgesics do not address the life-threatening nature of this finding.
Q9: A 72-year-old patient is admitted with a hypertensive crisis, with a blood pressure reading of 210/130
mmHg and reports of severe headache, visual changes, and confusion. Which intravenous antihypertensive
medication is most appropriate for the initial management of this hypertensive emergency?
A. Oral hydrochlorothiazide 25 mg
B. Intravenous labetalol or nicardipine [CORRECT]
C. Sublingual nifedipine 10 mg
