GALEN COLLEGE OF NURSING NUR 242
MEDICAL-SURGICAL NURSING EXAM 2 STUDY GUIDE
2026/2027 Academic Year
75 PRACTICE QUESTIONS | VERIFIED ANSWERS | 100% CORRECT | GRADED A+
1. A client with Chronic Obstructive Pulmonary Disease (COPD) is being discharged. Which
statement by the client indicates understanding of pursed-lip breathing?
A. I should inhale through my mouth and exhale through my nose.
B. This technique will help me strengthen my diaphragm.
C. It helps keep my airways open longer so I can get more air out.
D. I should use this only when I am exercising.
Rationale: Pursed-lip breathing creates positive expiratory pressure, which prevents airway col-
lapse in clients with emphysema, allowing for better CO2 excretion.
2. (SATA) A nurse is assessing a client for suspected Right-Sided Heart Failure. Which find-
ings should the nurse expect? Select all that apply.
- Jugular Venous Distention (JVD)
- Dependent Edema
- Hepatomegaly
- Pulmonary Crackles
- Splenomegaly
Rationale: Right-sided heart failure causes systemic venous congestion, leading to JVD, organomegaly,
and peripheral edema. Pulmonary crackles are associated with Left-sided heart failure.
3. The nurse is reviewing the Arterial Blood Gas (ABG) results for a client: pH 7.30, PaCO2
52, HCO3 24. How does the nurse interpret these results?
A. Metabolic Acidosis
B. Respiratory Acidosis, Uncompensated
C. Respiratory Alkalosis, Partially Compensated
D. Metabolic Alkalosis
Rationale: The pH is low (acidosis), and the PaCO2 is high (respiratory cause). The HCO3 is normal,
meaning no compensation has occurred yet.
4. A client post-op day 1 following abdominal surgery reports sudden shortness of breath
and chest pain. The nurse’s first action should be:
A. Call the provider.
B. Elevate the head of the bed and apply oxygen.
C. Administer the ordered PRN pain medication.
1
, D. Check the surgical site for hemorrhage.
Rationale: Using the ABC prioritization framework, respiratory distress requires immediate posi-
tioning (High-Fowler’s) and oxygenation before further assessment.
5. A client with a potassium level of 6.2 mEq/L is admitted. The nurse should immediately
monitor for:
A. Seizures
B. Cardiac Dysrhythmias
C. Tetany
D. Constipation
Rationale: Hyperkalemia directly affects the electrical conductivity of the heart, leading to peaked
T-waves, widened QRS, and potential cardiac arrest.
6. The nurse is preparing to administer Nitroglycerin sublingual to a client with stable
angina. Which vital sign must be assessed immediately prior to administration?
A. Respiratory Rate
B. Blood Pressure
C. Temperature
D. Oxygen Saturation
Rationale: Nitroglycerin is a potent vasodilator. It can cause significant hypotension; therefore,
BP must be verified to ensure safety.
7. (Ordered Response) Place the nursing actions in order of priority for a client suspected
of having a Myocardial Infarction (MI):
1. Administer Oxygen.
2. Obtain a 12-lead ECG.
3. Administer Sublingual Nitroglycerin.
4. Administer Morphine IV.
Rationale: Oxygenation is first, followed by rapid diagnosis (ECG), then vasodilators (Nitro), then
pain/workload reduction (Morphine).
8. A client is receiving a continuous Heparin infusion for a Pulmonary Embolism. The aPTT
is 115 seconds (Control: 35). What is the nurse’s priority?
A. Increase the infusion rate.
B. Stop the infusion and prepare Protamine Sulfate.
C. Document the finding as therapeutic.
D. Draw a PT/INR.
Rationale: A therapeutic aPTT is 1.5–2.5 times the control (approx. 52–87). 115 seconds is signifi-
cantly high, placing the client at extreme risk for hemorrhage.
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, 9. (SATA) Which are early signs of Septic Shock? Select all that apply.
- Tachypnea
- Tachycardia
- Altered Mental Status (Confusion)
- Severe Hypotension
- Warm, flushed skin
Rationale: In the early (Hyperdynamic) phase of sepsis, the body compensates with tachycardia
and tachypnea. Hypotension is often a late sign.
10. A client with Chronic Kidney Disease (CKD) has a phosphorus level of 5.5 mg/dL. Which
medication does the nurse expect to administer?
A. Calcium Acetate (PhosLo)
B. Furosemide (Lasix)
C. Epoetin Alfa
D. Magnesium Hydroxide
Rationale: Calcium Acetate is a phosphate binder that must be taken with meals to prevent the
absorption of dietary phosphorus.
11. A client has a chest tube placed for a pneumothorax. The nurse notes continuous bub-
bling in the water-seal chamber. This indicates:
A. The lung has fully re-expanded.
B. There is an air leak in the system.
C. The suction is working correctly.
D. The client is breathing too fast.
Rationale: Continuous bubbling in the water-seal chamber is abnormal and indicates that air is
entering the system from an unintended opening.
12. The nurse is caring for a client with an Acute Myocardial Infarction. Which lab value is
the most sensitive and specific for cardiac muscle damage?
A. Troponin T or I
B. Myoglobin
C. CK-MB
D. BNP
Rationale: Troponins are only found in cardiac muscle and rise within hours of injury, staying
elevated for up to two weeks.
13. A client is being prepared for surgery. The nurse notes the client has not signed the
informed consent form. What is the nurse’s role?
A. Explain the risks and benefits of the surgery.
B. Witness the client’s signature and verify they are competent.
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MEDICAL-SURGICAL NURSING EXAM 2 STUDY GUIDE
2026/2027 Academic Year
75 PRACTICE QUESTIONS | VERIFIED ANSWERS | 100% CORRECT | GRADED A+
1. A client with Chronic Obstructive Pulmonary Disease (COPD) is being discharged. Which
statement by the client indicates understanding of pursed-lip breathing?
A. I should inhale through my mouth and exhale through my nose.
B. This technique will help me strengthen my diaphragm.
C. It helps keep my airways open longer so I can get more air out.
D. I should use this only when I am exercising.
Rationale: Pursed-lip breathing creates positive expiratory pressure, which prevents airway col-
lapse in clients with emphysema, allowing for better CO2 excretion.
2. (SATA) A nurse is assessing a client for suspected Right-Sided Heart Failure. Which find-
ings should the nurse expect? Select all that apply.
- Jugular Venous Distention (JVD)
- Dependent Edema
- Hepatomegaly
- Pulmonary Crackles
- Splenomegaly
Rationale: Right-sided heart failure causes systemic venous congestion, leading to JVD, organomegaly,
and peripheral edema. Pulmonary crackles are associated with Left-sided heart failure.
3. The nurse is reviewing the Arterial Blood Gas (ABG) results for a client: pH 7.30, PaCO2
52, HCO3 24. How does the nurse interpret these results?
A. Metabolic Acidosis
B. Respiratory Acidosis, Uncompensated
C. Respiratory Alkalosis, Partially Compensated
D. Metabolic Alkalosis
Rationale: The pH is low (acidosis), and the PaCO2 is high (respiratory cause). The HCO3 is normal,
meaning no compensation has occurred yet.
4. A client post-op day 1 following abdominal surgery reports sudden shortness of breath
and chest pain. The nurse’s first action should be:
A. Call the provider.
B. Elevate the head of the bed and apply oxygen.
C. Administer the ordered PRN pain medication.
1
, D. Check the surgical site for hemorrhage.
Rationale: Using the ABC prioritization framework, respiratory distress requires immediate posi-
tioning (High-Fowler’s) and oxygenation before further assessment.
5. A client with a potassium level of 6.2 mEq/L is admitted. The nurse should immediately
monitor for:
A. Seizures
B. Cardiac Dysrhythmias
C. Tetany
D. Constipation
Rationale: Hyperkalemia directly affects the electrical conductivity of the heart, leading to peaked
T-waves, widened QRS, and potential cardiac arrest.
6. The nurse is preparing to administer Nitroglycerin sublingual to a client with stable
angina. Which vital sign must be assessed immediately prior to administration?
A. Respiratory Rate
B. Blood Pressure
C. Temperature
D. Oxygen Saturation
Rationale: Nitroglycerin is a potent vasodilator. It can cause significant hypotension; therefore,
BP must be verified to ensure safety.
7. (Ordered Response) Place the nursing actions in order of priority for a client suspected
of having a Myocardial Infarction (MI):
1. Administer Oxygen.
2. Obtain a 12-lead ECG.
3. Administer Sublingual Nitroglycerin.
4. Administer Morphine IV.
Rationale: Oxygenation is first, followed by rapid diagnosis (ECG), then vasodilators (Nitro), then
pain/workload reduction (Morphine).
8. A client is receiving a continuous Heparin infusion for a Pulmonary Embolism. The aPTT
is 115 seconds (Control: 35). What is the nurse’s priority?
A. Increase the infusion rate.
B. Stop the infusion and prepare Protamine Sulfate.
C. Document the finding as therapeutic.
D. Draw a PT/INR.
Rationale: A therapeutic aPTT is 1.5–2.5 times the control (approx. 52–87). 115 seconds is signifi-
cantly high, placing the client at extreme risk for hemorrhage.
2
, 9. (SATA) Which are early signs of Septic Shock? Select all that apply.
- Tachypnea
- Tachycardia
- Altered Mental Status (Confusion)
- Severe Hypotension
- Warm, flushed skin
Rationale: In the early (Hyperdynamic) phase of sepsis, the body compensates with tachycardia
and tachypnea. Hypotension is often a late sign.
10. A client with Chronic Kidney Disease (CKD) has a phosphorus level of 5.5 mg/dL. Which
medication does the nurse expect to administer?
A. Calcium Acetate (PhosLo)
B. Furosemide (Lasix)
C. Epoetin Alfa
D. Magnesium Hydroxide
Rationale: Calcium Acetate is a phosphate binder that must be taken with meals to prevent the
absorption of dietary phosphorus.
11. A client has a chest tube placed for a pneumothorax. The nurse notes continuous bub-
bling in the water-seal chamber. This indicates:
A. The lung has fully re-expanded.
B. There is an air leak in the system.
C. The suction is working correctly.
D. The client is breathing too fast.
Rationale: Continuous bubbling in the water-seal chamber is abnormal and indicates that air is
entering the system from an unintended opening.
12. The nurse is caring for a client with an Acute Myocardial Infarction. Which lab value is
the most sensitive and specific for cardiac muscle damage?
A. Troponin T or I
B. Myoglobin
C. CK-MB
D. BNP
Rationale: Troponins are only found in cardiac muscle and rise within hours of injury, staying
elevated for up to two weeks.
13. A client is being prepared for surgery. The nurse notes the client has not signed the
informed consent form. What is the nurse’s role?
A. Explain the risks and benefits of the surgery.
B. Witness the client’s signature and verify they are competent.
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