Galen | NUR 242
OBJECTIVE ASSESSMENT - EXAM
Galen NUR 242 Exam 4
(2026/2027) | Med-Surg Nursing
| (A+ Guarantee) | PDF
2026/2027
Medical-Surgical Nursing | Board Exam
50 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular Disorders & Heart
Respiratory
Failure Failure & Mechanical Ventilation
Renal Disease & Electrolyte Imbalances
Endocrine & Metabolic Emergencies
GI Bleeding & Liver Dysfunction
Neurological Trauma & Seizure Disorders
COVER PAGE - 1
,SECTION 1 | Cardiovascular & Hematologic Nursing | Q1-Q10 | Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing
Q1 Question 1 of 50
A 68-year-old male is admitted with acute decompensated heart failure. He reports dyspnea at
rest, orthopnea, and a 5-pound weight gain over 3 days. On assessment, the nurse notes
bilateral crackles, jugular venous distension, and 2+ pitting edema in the lower extremities.
Which nursing intervention should be prioritized during the first 8 hours of admission?
A. Administer furosemide 40 mg IV push and monitor urine output hourly.
B. Initiate a 2 g sodium diet and teach the patient about fluid restriction.
C. Place the patient in high Fowler's position and apply supplemental oxygen at 2 L/min.
D. Begin daily weights and instruct the patient to call for assistance before ambulating.
Correct Answer: A
Rationale:
In acute decompensated heart failure with fluid overload, the priority is rapid diuresis to reduce pulmonary
congestion and improve gas exchange. Furosemide is the first-line intervention. While positioning and oxygen
are supportive, they do not address the underlying fluid overload. Teaching and daily weights are important
but secondary to acute stabilization.
Q2 Question 2 of 50
A 54-year-old woman with a history of atrial fibrillation presents to the emergency department
with sudden onset of slurred speech, right-sided weakness, and a facial droop. Her last known
well time was 90 minutes ago, and she takes warfarin 5 mg daily with an INR of 2.8. Which
action is most appropriate for the nurse to anticipate?
A. Prepare the patient for immediate tissue plasminogen activator (tPA) administration.
B. Obtain a stat CT scan of the head and hold all anticoagulant doses.
C. Administer aspirin 325 mg chewable and initiate neuro checks every 15 minutes.
D. Start a heparin infusion at 18 units/kg/hr after obtaining a baseline PTT.
Correct Answer: B
Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guarantee) | PDF 2026/2027 -- 2026/2027 | Passing Score: 80% | Page 2 of 14
, Rationale:
A patient on warfarin with an elevated INR presenting with stroke symptoms must first have intracranial
hemorrhage ruled out via CT before any thrombolytic or anticoagulant therapy is considered. tPA is
contraindicated with an INR greater than 1.7. Aspirin and heparin could worsen a hemorrhagic stroke if
present.
Q3 Question 3 of 50
A 72-year-old man is recovering from an uncomplicated myocardial infarction treated with PCI
and stent placement 24 hours ago. He suddenly develops chest pain, hypotension,
tachycardia, and jugular venous distension. Heart sounds are muffled on auscultation. Which
condition should the nurse suspect and prepare to manage?
A. Papillary muscle rupture causing acute mitral regurgitation.
B. Cardiac tamponade secondary to ventricular free wall rupture.
C. Dressler syndrome with pericardial inflammation and friction rub.
D. Ventricular septal defect from septal wall necrosis and rupture.
Correct Answer: B
Rationale:
The classic triad of hypotension, jugular venous distension, and muffled heart sounds (Beck's triad) indicates
cardiac tamponade, a life-threatening complication of MI caused by ventricular free wall rupture. This requires
immediate pericardiocentesis. Papillary muscle rupture presents with a new murmur and pulmonary edema,
while a VSD causes a harsh holosystolic murmur.
Q4 Question 4 of 50
A 45-year-old woman with a history of deep vein thrombosis is receiving heparin infusion at
1,200 units per hour. Her baseline PTT was 32 seconds. Four hours after starting the infusion,
her PTT is 98 seconds. Based on this result, which adjustment should the nurse anticipate?
A. Continue the current infusion rate and recheck the PTT in 6 hours.
B. Reduce the infusion rate by 100 units per hour and recheck the PTT in 4 hours.
C. Hold the infusion for 1 hour, then resume at two-thirds the current rate.
D. Increase the infusion rate by 200 units per hour and recheck in 2 hours.
Correct Answer: C
Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guarantee) | PDF 2026/2027 -- 2026/2027 | Passing Score: 80% | Page 3 of 14
, Rationale:
A PTT of 98 seconds indicates supratherapeutic anticoagulation, as the therapeutic range for heparin is
typically 1.5 to 2.5 times the control (48-80 seconds). Standard protocol requires holding the infusion for one
hour, then resuming at a reduced rate (typically two-thirds), and rechecking. Simply reducing without holding
may prolong the supratherapeutic state.
Q5 Question 5 of 50
A 62-year-old male with end-stage renal disease on hemodysis three times weekly reports
increasing fatigue, dyspnea on exertion, and pallor. His hemoglobin is 6.8 g/dL, hematocrit is
21%, and ferritin is 45 ng/mL. Which collaborative intervention should the nurse expect to
implement first?
A. Administer epoetin alfa 4,000 units subcutaneously and assess response in 2 weeks.
B. Transfuse two units of packed red blood cells and monitor for fluid overload.
C. Initiate oral ferrous sulfate 325 mg three times daily with vitamin C.
D. Increase dialysis frequency to daily treatments to improve uremic clearance.
Correct Answer: B
Rationale:
With a hemoglobin of 6.8 g/dL and symptomatic anemia, the patient requires immediate transfusion of packed
red blood cells to restore oxygen-carrying capacity. Epoetin alfa is appropriate for chronic anemia
management but takes weeks to raise hemoglobin. Oral iron is insufficient in ESRD due to poor absorption.
Increasing dialysis frequency does not address the acute anemia.
Q6 Question 6 of 50
A 58-year-old man with a history of hypertension presents with a blood pressure of 220/130
mmHg, headache, blurred vision, and confusion. Fundoscopic examination reveals
papilledema. He is not currently on antihypertensive therapy. Which medication should the
nurse prepare to administer first?
A. Oral clonidine 0.2 mg to rapidly lower blood pressure within 30 minutes.
B. IV nicardipine infusion titrated to reduce mean arterial pressure by 10-20% in the first hour.
C. Sublingual nifedipine 10 mg for immediate blood pressure reduction.
D. IV hydralazine 20 mg push repeated every 20 minutes until normotensive.
Correct Answer: B
Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guarantee) | PDF 2026/2027 -- 2026/2027 | Passing Score: 80% | Page 4 of 14
OBJECTIVE ASSESSMENT - EXAM
Galen NUR 242 Exam 4
(2026/2027) | Med-Surg Nursing
| (A+ Guarantee) | PDF
2026/2027
Medical-Surgical Nursing | Board Exam
50 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular Disorders & Heart
Respiratory
Failure Failure & Mechanical Ventilation
Renal Disease & Electrolyte Imbalances
Endocrine & Metabolic Emergencies
GI Bleeding & Liver Dysfunction
Neurological Trauma & Seizure Disorders
COVER PAGE - 1
,SECTION 1 | Cardiovascular & Hematologic Nursing | Q1-Q10 | Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing
Q1 Question 1 of 50
A 68-year-old male is admitted with acute decompensated heart failure. He reports dyspnea at
rest, orthopnea, and a 5-pound weight gain over 3 days. On assessment, the nurse notes
bilateral crackles, jugular venous distension, and 2+ pitting edema in the lower extremities.
Which nursing intervention should be prioritized during the first 8 hours of admission?
A. Administer furosemide 40 mg IV push and monitor urine output hourly.
B. Initiate a 2 g sodium diet and teach the patient about fluid restriction.
C. Place the patient in high Fowler's position and apply supplemental oxygen at 2 L/min.
D. Begin daily weights and instruct the patient to call for assistance before ambulating.
Correct Answer: A
Rationale:
In acute decompensated heart failure with fluid overload, the priority is rapid diuresis to reduce pulmonary
congestion and improve gas exchange. Furosemide is the first-line intervention. While positioning and oxygen
are supportive, they do not address the underlying fluid overload. Teaching and daily weights are important
but secondary to acute stabilization.
Q2 Question 2 of 50
A 54-year-old woman with a history of atrial fibrillation presents to the emergency department
with sudden onset of slurred speech, right-sided weakness, and a facial droop. Her last known
well time was 90 minutes ago, and she takes warfarin 5 mg daily with an INR of 2.8. Which
action is most appropriate for the nurse to anticipate?
A. Prepare the patient for immediate tissue plasminogen activator (tPA) administration.
B. Obtain a stat CT scan of the head and hold all anticoagulant doses.
C. Administer aspirin 325 mg chewable and initiate neuro checks every 15 minutes.
D. Start a heparin infusion at 18 units/kg/hr after obtaining a baseline PTT.
Correct Answer: B
Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guarantee) | PDF 2026/2027 -- 2026/2027 | Passing Score: 80% | Page 2 of 14
, Rationale:
A patient on warfarin with an elevated INR presenting with stroke symptoms must first have intracranial
hemorrhage ruled out via CT before any thrombolytic or anticoagulant therapy is considered. tPA is
contraindicated with an INR greater than 1.7. Aspirin and heparin could worsen a hemorrhagic stroke if
present.
Q3 Question 3 of 50
A 72-year-old man is recovering from an uncomplicated myocardial infarction treated with PCI
and stent placement 24 hours ago. He suddenly develops chest pain, hypotension,
tachycardia, and jugular venous distension. Heart sounds are muffled on auscultation. Which
condition should the nurse suspect and prepare to manage?
A. Papillary muscle rupture causing acute mitral regurgitation.
B. Cardiac tamponade secondary to ventricular free wall rupture.
C. Dressler syndrome with pericardial inflammation and friction rub.
D. Ventricular septal defect from septal wall necrosis and rupture.
Correct Answer: B
Rationale:
The classic triad of hypotension, jugular venous distension, and muffled heart sounds (Beck's triad) indicates
cardiac tamponade, a life-threatening complication of MI caused by ventricular free wall rupture. This requires
immediate pericardiocentesis. Papillary muscle rupture presents with a new murmur and pulmonary edema,
while a VSD causes a harsh holosystolic murmur.
Q4 Question 4 of 50
A 45-year-old woman with a history of deep vein thrombosis is receiving heparin infusion at
1,200 units per hour. Her baseline PTT was 32 seconds. Four hours after starting the infusion,
her PTT is 98 seconds. Based on this result, which adjustment should the nurse anticipate?
A. Continue the current infusion rate and recheck the PTT in 6 hours.
B. Reduce the infusion rate by 100 units per hour and recheck the PTT in 4 hours.
C. Hold the infusion for 1 hour, then resume at two-thirds the current rate.
D. Increase the infusion rate by 200 units per hour and recheck in 2 hours.
Correct Answer: C
Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guarantee) | PDF 2026/2027 -- 2026/2027 | Passing Score: 80% | Page 3 of 14
, Rationale:
A PTT of 98 seconds indicates supratherapeutic anticoagulation, as the therapeutic range for heparin is
typically 1.5 to 2.5 times the control (48-80 seconds). Standard protocol requires holding the infusion for one
hour, then resuming at a reduced rate (typically two-thirds), and rechecking. Simply reducing without holding
may prolong the supratherapeutic state.
Q5 Question 5 of 50
A 62-year-old male with end-stage renal disease on hemodysis three times weekly reports
increasing fatigue, dyspnea on exertion, and pallor. His hemoglobin is 6.8 g/dL, hematocrit is
21%, and ferritin is 45 ng/mL. Which collaborative intervention should the nurse expect to
implement first?
A. Administer epoetin alfa 4,000 units subcutaneously and assess response in 2 weeks.
B. Transfuse two units of packed red blood cells and monitor for fluid overload.
C. Initiate oral ferrous sulfate 325 mg three times daily with vitamin C.
D. Increase dialysis frequency to daily treatments to improve uremic clearance.
Correct Answer: B
Rationale:
With a hemoglobin of 6.8 g/dL and symptomatic anemia, the patient requires immediate transfusion of packed
red blood cells to restore oxygen-carrying capacity. Epoetin alfa is appropriate for chronic anemia
management but takes weeks to raise hemoglobin. Oral iron is insufficient in ESRD due to poor absorption.
Increasing dialysis frequency does not address the acute anemia.
Q6 Question 6 of 50
A 58-year-old man with a history of hypertension presents with a blood pressure of 220/130
mmHg, headache, blurred vision, and confusion. Fundoscopic examination reveals
papilledema. He is not currently on antihypertensive therapy. Which medication should the
nurse prepare to administer first?
A. Oral clonidine 0.2 mg to rapidly lower blood pressure within 30 minutes.
B. IV nicardipine infusion titrated to reduce mean arterial pressure by 10-20% in the first hour.
C. Sublingual nifedipine 10 mg for immediate blood pressure reduction.
D. IV hydralazine 20 mg push repeated every 20 minutes until normotensive.
Correct Answer: B
Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guarantee) | PDF 2026/2027 -- 2026/2027 | Passing Score: 80% | Page 4 of 14
