GALEN | NUR 242
OBJECTIVE ASSESSMENT - EXAM
Galen NUR 242 Exam 4
(2026/2027) | Med-Surg Nursing
| (A+ Guarantee) | PDF
2026/2027
Med-Surg Nursing | Board Exam Preparation
75 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Heart Failure & Cardiac Dysrhythmias GI Bleeding & Peptic Ulcer Disease
Diabetes Mellitus & Hypoglycemia Management DVT/PE & Peripheral Arterial Disease
Seizure Disorders & Status Epilepticus Osteoarthritis & Joint Replacement Care
COVER PAGE - 1
,SECTION 1 | Cardiovascular Disorders | Q1-Q18 | Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guara
Q1 Question 1 of 75
A 68-year-old male is admitted with acute decompensated heart failure. He reports
increasing dyspnea on exertion over the past week and has 2+ pitting edema in both lower
extremities. His vital signs show BP 162/94 mmHg, HR 110 bpm, RR 24/min, and SpO2
89% on room air. Which nursing intervention should be the nurse's first priority?
A. Administer supplemental oxygen via nasal cannula to improve oxygenation
B. Administer furosemide 40 mg IV push as ordered
C. Place the patient in a high-Fowler's position with legs dangling
D. Insert an indwelling urinary catheter to monitor output
Correct Answer: A
Rationale:
The patient is hypoxemic with SpO2 89%, indicating impaired gas exchange as the most immediate
life-threatening problem. Supplemental oxygen is the first priority to address hypoxemia before other
interventions. While furosemide and positioning are important, they do not address the immediate
oxygenation deficit.
Q2 Question 2 of 75
A 55-year-old female with a history of atrial fibrillation is prescribed warfarin 5 mg daily. She
asks the nurse why she needs frequent blood tests. The nurse explains that which
laboratory value is monitored to maintain therapeutic anticoagulation?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Prothrombin time (PT) in seconds only
D. D-dimer level
Correct Answer: C
Rationale:
Warfarin therapy is monitored using the PT/INR, which standardizes PT results across laboratories. The
therapeutic INR range for atrial fibrillation is typically 2.0-3.0. aPTT monitors heparin therapy, not warfarin.
D-dimer indicates fibrin breakdown products, not anticoagulant effect.
Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guarantee) | PDF 2026/2027 -- 2026/2027 | Passing Score: 80% | Page 3
2
,Q3 Question 3 of 75
A 72-year-old male recovering from a myocardial infarction develops ventricular tachycardia
with a pulse. His blood pressure is 88/52 mmHg, and he is diaphoretic and confused. Which
action should the nurse take first?
A. Prepare for synchronized cardioversion
B. Administer amiodarone 150 mg IV push over 10 minutes
C. Begin cardiopulmonary resuscitation immediately
D. Apply a transcutaneous pacemaker
Correct Answer: D
Rationale:
The patient has unstable ventricular tachycardia (hypotension, altered mental status, signs of poor
perfusion). Synchronized cardioversion is the first intervention for unstable tachyarrhythmias with a pulse.
CPR is not indicated because the patient has a pulse. Amiodarone may be given after cardioversion if the
rhythm persists.
Q4 Question 4 of 75
A 45-year-old female with stage 2 hypertension is started on lisinopril. She returns for a
follow-up visit 2 weeks later and reports a persistent dry cough. Which explanation by the
nurse is most accurate?
A. The cough is likely caused by bronchospasm from the medication
B. ACE inhibitors increase bradykinin levels, which can irritate the cough reflex
C. The cough indicates an allergic reaction requiring immediate discontinuation
D. This side effect is caused by increased prostaglandin production in the lungs
Correct Answer: D
Rationale:
ACE inhibitors block the conversion of angiotensin I to II, but also inhibit bradykinin breakdown.
Accumulation of bradykinin irritates the cough reflex, causing a dry, nonproductive cough in about 10-20% of
patients. This is a known side effect, not an allergic reaction, and often resolves after switching to an ARB.
Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guarantee) | PDF 2026/2027 -- 2026/2027 | Passing Score: 80% | Page 5
4
, Q5 Question 5 of 75
A 62-year-old male with peripheral arterial disease complains of severe leg pain at rest that
worsens when elevating his legs. He has diminished pedal pulses and pale, cool skin on his
feet. Which nursing intervention is most appropriate to promote tissue perfusion?
A. Elevate the foot of the bed to improve venous return
B. Keep the legs in a dependent position or flat to enhance arterial blood flow
C. Apply warm compresses to the lower extremities to dilate vessels
D. Encourage vigorous walking exercise to promote collateral circulation
Correct Answer: C
Rationale:
In peripheral arterial disease, gravity-assisted blood flow improves perfusion. Keeping legs dependent or flat
enhances arterial flow to ischemic tissues. Elevation worsens ischemia by reducing perfusion pressure.
Warm compresses can increase metabolic demand in already ischemic tissue and cause burns due to
decreased sensation. Vigorous exercise may worsen tissue injury in severe PAD.
Q6 Question 6 of 75
A 58-year-old female is admitted with a suspected pulmonary embolism. She reports sudden
onset of pleuritic chest pain and dyspnea. Her vital signs are BP 142/88 mmHg, HR 118
bpm, RR 28/min, and SpO2 90% on 2L nasal cannula. Which diagnostic test is considered
the gold standard for confirming a pulmonary embolism?
A. D-dimer blood test
B. Ventilation-perfusion (V/Q) scan
C. Computed tomography pulmonary angiography (CTPA)
D. Chest X-ray
Correct Answer: A
Rationale:
D-dimer is a sensitive but not specific test used to rule out pulmonary embolism in low-risk patients. CTPA is
the gold standard for confirming PE. V/Q scans are used when CTPA is contraindicated. Chest X-ray is often
normal or shows nonspecific findings in PE.
Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guarantee) | PDF 2026/2027 -- 2026/2027 | Passing Score: 80% | Page 7
6
OBJECTIVE ASSESSMENT - EXAM
Galen NUR 242 Exam 4
(2026/2027) | Med-Surg Nursing
| (A+ Guarantee) | PDF
2026/2027
Med-Surg Nursing | Board Exam Preparation
75 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Heart Failure & Cardiac Dysrhythmias GI Bleeding & Peptic Ulcer Disease
Diabetes Mellitus & Hypoglycemia Management DVT/PE & Peripheral Arterial Disease
Seizure Disorders & Status Epilepticus Osteoarthritis & Joint Replacement Care
COVER PAGE - 1
,SECTION 1 | Cardiovascular Disorders | Q1-Q18 | Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guara
Q1 Question 1 of 75
A 68-year-old male is admitted with acute decompensated heart failure. He reports
increasing dyspnea on exertion over the past week and has 2+ pitting edema in both lower
extremities. His vital signs show BP 162/94 mmHg, HR 110 bpm, RR 24/min, and SpO2
89% on room air. Which nursing intervention should be the nurse's first priority?
A. Administer supplemental oxygen via nasal cannula to improve oxygenation
B. Administer furosemide 40 mg IV push as ordered
C. Place the patient in a high-Fowler's position with legs dangling
D. Insert an indwelling urinary catheter to monitor output
Correct Answer: A
Rationale:
The patient is hypoxemic with SpO2 89%, indicating impaired gas exchange as the most immediate
life-threatening problem. Supplemental oxygen is the first priority to address hypoxemia before other
interventions. While furosemide and positioning are important, they do not address the immediate
oxygenation deficit.
Q2 Question 2 of 75
A 55-year-old female with a history of atrial fibrillation is prescribed warfarin 5 mg daily. She
asks the nurse why she needs frequent blood tests. The nurse explains that which
laboratory value is monitored to maintain therapeutic anticoagulation?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Prothrombin time (PT) in seconds only
D. D-dimer level
Correct Answer: C
Rationale:
Warfarin therapy is monitored using the PT/INR, which standardizes PT results across laboratories. The
therapeutic INR range for atrial fibrillation is typically 2.0-3.0. aPTT monitors heparin therapy, not warfarin.
D-dimer indicates fibrin breakdown products, not anticoagulant effect.
Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guarantee) | PDF 2026/2027 -- 2026/2027 | Passing Score: 80% | Page 3
2
,Q3 Question 3 of 75
A 72-year-old male recovering from a myocardial infarction develops ventricular tachycardia
with a pulse. His blood pressure is 88/52 mmHg, and he is diaphoretic and confused. Which
action should the nurse take first?
A. Prepare for synchronized cardioversion
B. Administer amiodarone 150 mg IV push over 10 minutes
C. Begin cardiopulmonary resuscitation immediately
D. Apply a transcutaneous pacemaker
Correct Answer: D
Rationale:
The patient has unstable ventricular tachycardia (hypotension, altered mental status, signs of poor
perfusion). Synchronized cardioversion is the first intervention for unstable tachyarrhythmias with a pulse.
CPR is not indicated because the patient has a pulse. Amiodarone may be given after cardioversion if the
rhythm persists.
Q4 Question 4 of 75
A 45-year-old female with stage 2 hypertension is started on lisinopril. She returns for a
follow-up visit 2 weeks later and reports a persistent dry cough. Which explanation by the
nurse is most accurate?
A. The cough is likely caused by bronchospasm from the medication
B. ACE inhibitors increase bradykinin levels, which can irritate the cough reflex
C. The cough indicates an allergic reaction requiring immediate discontinuation
D. This side effect is caused by increased prostaglandin production in the lungs
Correct Answer: D
Rationale:
ACE inhibitors block the conversion of angiotensin I to II, but also inhibit bradykinin breakdown.
Accumulation of bradykinin irritates the cough reflex, causing a dry, nonproductive cough in about 10-20% of
patients. This is a known side effect, not an allergic reaction, and often resolves after switching to an ARB.
Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guarantee) | PDF 2026/2027 -- 2026/2027 | Passing Score: 80% | Page 5
4
, Q5 Question 5 of 75
A 62-year-old male with peripheral arterial disease complains of severe leg pain at rest that
worsens when elevating his legs. He has diminished pedal pulses and pale, cool skin on his
feet. Which nursing intervention is most appropriate to promote tissue perfusion?
A. Elevate the foot of the bed to improve venous return
B. Keep the legs in a dependent position or flat to enhance arterial blood flow
C. Apply warm compresses to the lower extremities to dilate vessels
D. Encourage vigorous walking exercise to promote collateral circulation
Correct Answer: C
Rationale:
In peripheral arterial disease, gravity-assisted blood flow improves perfusion. Keeping legs dependent or flat
enhances arterial flow to ischemic tissues. Elevation worsens ischemia by reducing perfusion pressure.
Warm compresses can increase metabolic demand in already ischemic tissue and cause burns due to
decreased sensation. Vigorous exercise may worsen tissue injury in severe PAD.
Q6 Question 6 of 75
A 58-year-old female is admitted with a suspected pulmonary embolism. She reports sudden
onset of pleuritic chest pain and dyspnea. Her vital signs are BP 142/88 mmHg, HR 118
bpm, RR 28/min, and SpO2 90% on 2L nasal cannula. Which diagnostic test is considered
the gold standard for confirming a pulmonary embolism?
A. D-dimer blood test
B. Ventilation-perfusion (V/Q) scan
C. Computed tomography pulmonary angiography (CTPA)
D. Chest X-ray
Correct Answer: A
Rationale:
D-dimer is a sensitive but not specific test used to rule out pulmonary embolism in low-risk patients. CTPA is
the gold standard for confirming PE. V/Q scans are used when CTPA is contraindicated. Chest X-ray is often
normal or shows nonspecific findings in PE.
Galen NUR 242 Exam 4 (2026/2027) | Med-Surg Nursing | (A+ Guarantee) | PDF 2026/2027 -- 2026/2027 | Passing Score: 80% | Page 7
6
