NU 185 Exam 5 - Medical-Surgical Nursing II
(2026) Actual Questions and Answers | 100% Guarantee Pass | Verified Grade A
60 Questions | Cardiovascular | Respiratory | GI | Renal | Endocrine | Hematologic | Integrated Scenarios
Section 1: Cardiovascular Disorders (Heart Failure, Valvular Disease, & Vascular
Disorders) - Q1-Q12
Q1. A 68-year-old patient presents with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, JVD,
bilateral crackles, and 3+ pitting edema. BNP is 650 pg/mL. Which type of heart failure is this patient most likely
experiencing?
A. Isolated right-sided heart failure
B. Biventricular heart failure [CORRECT]
C. Isolated left-sided heart failure
D. Acute respiratory distress syndrome
Correct Answer: B
Rationale: The patient demonstrates both left-sided heart failure (dyspnea, orthopnea, PND, crackles from pulmonary congestion) and
right-sided heart failure (JVD, peripheral edema). BNP >100 pg/mL indicates heart failure. When both sets of symptoms coexist,
biventricular heart failure is present, common in advanced stages. Isolated failure would not produce combined findings, and ARDS does
not cause JVD or edema.
Q2. The nurse is providing discharge teaching to a patient recently diagnosed with heart failure. Which statement
by the patient indicates the need for further education regarding self-management at home?
A. I will weigh myself every morning and report a weight gain of more than 2 pounds in one day
B. I should limit my sodium intake to less than 3 grams per day
C. I can stop taking my carvedilol if I feel well and have no symptoms [CORRECT]
D. I will take my furosemide in the morning to avoid nighttime urination
Correct Answer: C
Rationale: Beta-blockers (carvedilol) must never be abruptly discontinued even if asymptomatic. Sudden cessation causes rebound
tachycardia, hypertension, and HF exacerbation. Beta-blockers reduce mortality by blocking sympathetic activation. Weight monitoring,
sodium restriction, and morning diuretic dosing are all appropriate self-management strategies.
Q3. A patient with heart failure is prescribed enalapril (Vasotec), an ACE inhibitor. The nurse should monitor the
patient for which common side effects?
A. Hyperkalemia and dry, persistent cough [CORRECT]
B. Hypokalemia and bradycardia
C. Hypercalcemia and tinnitus
D. Hypoglycemia and weight gain
Correct Answer: A
Rationale: ACE inhibitors block angiotensin I to angiotensin II conversion, reducing aldosterone secretion, which causes potassium retention
(hyperkalemia). A dry, nonproductive cough occurs in 10-20% of patients from bradykinin accumulation. If intolerable, an ARB may be
substituted. Hypokalemia is associated with loop diuretics, not ACE inhibitors.
Q4. A 72-year-old patient is admitted with suspected aortic stenosis. Which classic triad of symptoms should the
nurse assess for?
A. Syncope, angina, and dyspnea on exertion [CORRECT]
NU 185 Med-Surg II Exam 5 (2026) | Page 1
, B. Fatigue, palpitations, and hemoptysis
C. Orthopnea, ascites, and peripheral edema
D. Pleuritic chest pain, fever, and friction rub
Correct Answer: A
Rationale: The classic triad of aortic stenosis is syncope (reduced cerebral perfusion), angina (increased myocardial O2 demand), and
dyspnea on exertion (pulmonary congestion from elevated LA pressures). A crescendo-decrescendo systolic ejection murmur is heard at the
right upper sternal border. Fatigue and palpitations suggest mitral regurgitation; option D describes pericarditis.
Q5. The nurse auscultates a holosystolic murmur at the cardiac apex radiating to the left axilla. The patient reports
fatigue and increasing dyspnea. Which valvular disorder is most consistent?
A. Aortic stenosis
B. Mitral regurgitation [CORRECT]
C. Aortic regurgitation
D. Mitral stenosis
Correct Answer: B
Rationale: Mitral regurgitation produces a holosystolic murmur at the apex radiating to the left axilla from blood flowing backward
through the incompetent mitral valve. Fatigue and dyspnea result from reduced cardiac output and pulmonary congestion. Aortic stenosis
causes a crescendo-decrescendo murmur at the right sternal border; aortic regurgitation causes a diastolic murmur with bounding pulses;
mitral stenosis causes a diastolic rumbling murmur.
Q6. A patient with aortic regurgitation is seen for a routine follow-up. Which characteristic finding should the nurse
expect on physical examination?
A. Pulsus paradoxus greater than 10 mmHg
B. Bounding peripheral pulses and water-hammer pulse [CORRECT]
C. Irregularly irregular pulse with absent P waves
D. Weak, thready pulse with narrowed pulse pressure
Correct Answer: B
Rationale: Aortic regurgitation allows blood to flow backward from the aorta into the LV during diastole, causing widened pulse pressure,
bounding pulses, and water-hammer (Corrigan) pulse. A diastolic blowing murmur is heard at the left sternal border. Pulsus paradoxus is
associated with cardiac tamponade; irregularly irregular pulse is atrial fibrillation.
Q7. A patient with mitral stenosis is admitted. The nurse understands this condition increases the risk for which
complication?
A. Right-sided heart failure and atrial fibrillation [CORRECT]
B. Aortic dissection and myocardial infarction
C. Pulmonary embolism and deep vein thrombosis
D. Hypertensive crisis and retinal damage
Correct Answer: A
Rationale: Mitral stenosis impairs blood flow from LA to LV, causing LA enlargement and increased pulmonary pressures. The enlarged
LA predisposes to atrial fibrillation, and chronic pressure elevation leads to right-sided heart failure (cor pulmonale). A low-pitched
rumbling diastolic murmur at the apex is the hallmark. Aortic dissection, MI, PE, DVT, and hypertensive crisis are not directly associated.
Q8. A patient is admitted with suspected abdominal aortic aneurysm (AAA). Which assessment finding is most
critical to report immediately?
A. Pulsatile abdominal mass with mid-abdominal tenderness
B. Severe back pain and hypotension with tachycardia [CORRECT]
C. Bruit auscultated over the abdominal aorta
D. Weight loss and decreased appetite over the past month
Correct Answer: B
Rationale: Severe back pain with hypotension and tachycardia is the classic presentation of ruptured or actively expanding AAA, a
life-threatening surgical emergency. While pulsatile mass and bruit indicate unruptured AAA, shock signs suggest rupture with extremely
high mortality if not treated emergently. Risk factors include HTN, smoking, atherosclerosis, age >65, and male sex.
NU 185 Med-Surg II Exam 5 (2026) | Page 2
(2026) Actual Questions and Answers | 100% Guarantee Pass | Verified Grade A
60 Questions | Cardiovascular | Respiratory | GI | Renal | Endocrine | Hematologic | Integrated Scenarios
Section 1: Cardiovascular Disorders (Heart Failure, Valvular Disease, & Vascular
Disorders) - Q1-Q12
Q1. A 68-year-old patient presents with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, JVD,
bilateral crackles, and 3+ pitting edema. BNP is 650 pg/mL. Which type of heart failure is this patient most likely
experiencing?
A. Isolated right-sided heart failure
B. Biventricular heart failure [CORRECT]
C. Isolated left-sided heart failure
D. Acute respiratory distress syndrome
Correct Answer: B
Rationale: The patient demonstrates both left-sided heart failure (dyspnea, orthopnea, PND, crackles from pulmonary congestion) and
right-sided heart failure (JVD, peripheral edema). BNP >100 pg/mL indicates heart failure. When both sets of symptoms coexist,
biventricular heart failure is present, common in advanced stages. Isolated failure would not produce combined findings, and ARDS does
not cause JVD or edema.
Q2. The nurse is providing discharge teaching to a patient recently diagnosed with heart failure. Which statement
by the patient indicates the need for further education regarding self-management at home?
A. I will weigh myself every morning and report a weight gain of more than 2 pounds in one day
B. I should limit my sodium intake to less than 3 grams per day
C. I can stop taking my carvedilol if I feel well and have no symptoms [CORRECT]
D. I will take my furosemide in the morning to avoid nighttime urination
Correct Answer: C
Rationale: Beta-blockers (carvedilol) must never be abruptly discontinued even if asymptomatic. Sudden cessation causes rebound
tachycardia, hypertension, and HF exacerbation. Beta-blockers reduce mortality by blocking sympathetic activation. Weight monitoring,
sodium restriction, and morning diuretic dosing are all appropriate self-management strategies.
Q3. A patient with heart failure is prescribed enalapril (Vasotec), an ACE inhibitor. The nurse should monitor the
patient for which common side effects?
A. Hyperkalemia and dry, persistent cough [CORRECT]
B. Hypokalemia and bradycardia
C. Hypercalcemia and tinnitus
D. Hypoglycemia and weight gain
Correct Answer: A
Rationale: ACE inhibitors block angiotensin I to angiotensin II conversion, reducing aldosterone secretion, which causes potassium retention
(hyperkalemia). A dry, nonproductive cough occurs in 10-20% of patients from bradykinin accumulation. If intolerable, an ARB may be
substituted. Hypokalemia is associated with loop diuretics, not ACE inhibitors.
Q4. A 72-year-old patient is admitted with suspected aortic stenosis. Which classic triad of symptoms should the
nurse assess for?
A. Syncope, angina, and dyspnea on exertion [CORRECT]
NU 185 Med-Surg II Exam 5 (2026) | Page 1
, B. Fatigue, palpitations, and hemoptysis
C. Orthopnea, ascites, and peripheral edema
D. Pleuritic chest pain, fever, and friction rub
Correct Answer: A
Rationale: The classic triad of aortic stenosis is syncope (reduced cerebral perfusion), angina (increased myocardial O2 demand), and
dyspnea on exertion (pulmonary congestion from elevated LA pressures). A crescendo-decrescendo systolic ejection murmur is heard at the
right upper sternal border. Fatigue and palpitations suggest mitral regurgitation; option D describes pericarditis.
Q5. The nurse auscultates a holosystolic murmur at the cardiac apex radiating to the left axilla. The patient reports
fatigue and increasing dyspnea. Which valvular disorder is most consistent?
A. Aortic stenosis
B. Mitral regurgitation [CORRECT]
C. Aortic regurgitation
D. Mitral stenosis
Correct Answer: B
Rationale: Mitral regurgitation produces a holosystolic murmur at the apex radiating to the left axilla from blood flowing backward
through the incompetent mitral valve. Fatigue and dyspnea result from reduced cardiac output and pulmonary congestion. Aortic stenosis
causes a crescendo-decrescendo murmur at the right sternal border; aortic regurgitation causes a diastolic murmur with bounding pulses;
mitral stenosis causes a diastolic rumbling murmur.
Q6. A patient with aortic regurgitation is seen for a routine follow-up. Which characteristic finding should the nurse
expect on physical examination?
A. Pulsus paradoxus greater than 10 mmHg
B. Bounding peripheral pulses and water-hammer pulse [CORRECT]
C. Irregularly irregular pulse with absent P waves
D. Weak, thready pulse with narrowed pulse pressure
Correct Answer: B
Rationale: Aortic regurgitation allows blood to flow backward from the aorta into the LV during diastole, causing widened pulse pressure,
bounding pulses, and water-hammer (Corrigan) pulse. A diastolic blowing murmur is heard at the left sternal border. Pulsus paradoxus is
associated with cardiac tamponade; irregularly irregular pulse is atrial fibrillation.
Q7. A patient with mitral stenosis is admitted. The nurse understands this condition increases the risk for which
complication?
A. Right-sided heart failure and atrial fibrillation [CORRECT]
B. Aortic dissection and myocardial infarction
C. Pulmonary embolism and deep vein thrombosis
D. Hypertensive crisis and retinal damage
Correct Answer: A
Rationale: Mitral stenosis impairs blood flow from LA to LV, causing LA enlargement and increased pulmonary pressures. The enlarged
LA predisposes to atrial fibrillation, and chronic pressure elevation leads to right-sided heart failure (cor pulmonale). A low-pitched
rumbling diastolic murmur at the apex is the hallmark. Aortic dissection, MI, PE, DVT, and hypertensive crisis are not directly associated.
Q8. A patient is admitted with suspected abdominal aortic aneurysm (AAA). Which assessment finding is most
critical to report immediately?
A. Pulsatile abdominal mass with mid-abdominal tenderness
B. Severe back pain and hypotension with tachycardia [CORRECT]
C. Bruit auscultated over the abdominal aorta
D. Weight loss and decreased appetite over the past month
Correct Answer: B
Rationale: Severe back pain with hypotension and tachycardia is the classic presentation of ruptured or actively expanding AAA, a
life-threatening surgical emergency. While pulsatile mass and bruit indicate unruptured AAA, shock signs suggest rupture with extremely
high mortality if not treated emergently. Risk factors include HTN, smoking, atherosclerosis, age >65, and male sex.
NU 185 Med-Surg II Exam 5 (2026) | Page 2
