NUR 242 MED SURG EXAM 3
GALEN COLLEGE OF NURSING | LATEST ACTUAL EXAM
COMPLETE QUESTIONS WITH CORRECT ANSWERS AND
RATIONALES ALREADY GRADED A+
SECTION A: CARDIOVASCULAR DISORDERS (Questions 1–50)
1. A client is admitted with acute decompensated heart failure. Which assessment
finding is most concerning?
A. Dyspnea on exertion
B. Peripheral edema
C. Crackles in the lung bases and SpO2 of 88% ✔
D. Jugular venous distention
Rationale: Crackles and hypoxemia indicate pulmonary congestion and impaired
gas exchange, which can lead to respiratory failure. This is an acute, life-
threatening finding requiring immediate intervention (oxygen, diuretics,
positioning).
2. A client with heart failure is prescribed furosemide (Lasix). Which laboratory
value should the nurse monitor most closely?
A. Serum potassium ✔
B. Serum sodium
C. Serum calcium
D. Serum magnesium
Rationale: Furosemide is a loop diuretic that causes potassium loss (hypokalemia).
Hypokalemia can precipitate cardiac arrhythmias, especially in clients on digoxin.
Potassium levels should be monitored closely.
3. A client is diagnosed with infective endocarditis. The nurse should monitor for
which complication?
A. Heart failure and embolic events ✔
B. Myocardial infarction
C. Pulmonary embolism
1
,D. Renal failure
Rationale: Infective endocarditis can cause valvular damage leading to heart
failure and embolic events (vegetations can break off and travel to the brain,
lungs, or other organs). Embolic strokes are a major complication.
4. A client with atrial fibrillation is prescribed warfarin. The nurse should monitor
which laboratory value to evaluate therapeutic effectiveness?
A. aPTT
B. INR ✔
C. Platelet count
D. PT
Rationale: Warfarin is monitored by INR (International Normalized Ratio), with a
therapeutic goal of 2-3 for atrial fibrillation. aPTT is used for heparin. PT is used
but INR standardizes it.
5. A client is admitted with a myocardial infarction (MI). Which finding indicates a
complication of papillary muscle rupture?
A. New onset of a murmur and acute heart failure ✔
B. Decreased cardiac enzymes
C. Resolution of chest pain
D. Normal ECG
Rationale: Papillary muscle rupture is a complication of MI causing acute mitral
regurgitation, heard as a new systolic murmur, and acute heart failure (pulmonary
edema, hypotension). It is a surgical emergency.
6. The nurse is caring for a client with a temporary pacemaker. The nurse notes
that the pacemaker is not capturing (spikes without QRS complexes). The nurse
should:
A. Turn the pacemaker off
B. Increase the milliamperage (mA) output ✔
C. Decrease the heart rate setting
D. Document the finding and continue monitoring
2
,Rationale: Failure to capture means the electrical stimulus is not depolarizing the
ventricles. The nurse should increase the current (mA) until capture is achieved.
The provider should be notified.
7. A client with heart failure has an ejection fraction (EF) of 30%. The nurse
understands that this indicates:
A. Normal cardiac function
B. Mildly reduced cardiac function
C. Moderately reduced cardiac function
D. Severely reduced cardiac function ✔
Rationale: Normal EF is 55-65%. An EF of 30% indicates severe systolic
dysfunction. Clients with heart failure with reduced EF (HFrEF) are at risk for fluid
overload and low cardiac output.
8. A client is receiving IV nitroglycerin for angina. The nurse should monitor for
which side effect?
A. Hypotension and headache ✔
B. Hypertension and tachycardia
C. Bradycardia and hypotension
D. Hyperglycemia
Rationale: Nitroglycerin is a vasodilator that can cause hypotension (especially
with IV administration) and headache (due to vasodilation). Blood pressure
should be monitored closely.
9. A client with peripheral artery disease (PAD) reports leg pain with exercise that
is relieved by rest. The nurse documents this as:
A. Rest pain
B. Intermittent claudication ✔
C. Venous insufficiency
D. Neuropathic pain
3
, Rationale: Intermittent claudication is pain (cramping, aching) in the legs that
occurs with exercise and is relieved by rest. It is a classic symptom of PAD due to
ischemia. Rest pain occurs at rest and indicates severe disease.
10. The nurse is assessing a client with a suspected abdominal aortic aneurysm
(AAA). Which finding is most concerning?
A. Pulsatile abdominal mass
B. Back pain and hypotension ✔
C. Bruit over the abdomen
D. Nausea and vomiting
Rationale: Back pain and hypotension are signs of a rupturing AAA, which is a life-
threatening emergency. A pulsatile mass and bruit are signs of an intact AAA.
Rupture requires immediate surgical intervention.
11. A client with chronic venous insufficiency (CVI) has lower extremity edema
and skin changes. Which intervention is most important?
A. Elevate the legs above the heart level and apply compression stockings ✔
B. Keep the legs in a dependent position
C. Apply heat to the legs
D. Avoid walking
Rationale: CVI is managed by elevating the legs (to promote venous return),
compression stockings (to reduce edema), and ambulation. Heat and dependency
worsen edema.
12. A client is prescribed digoxin for heart failure. Which finding indicates digoxin
toxicity?
A. Anorexia, nausea, and visual disturbances (halos) ✔
B. Tachycardia and hypertension
C. Polyuria and polydipsia
D. Hyperkalemia
4
GALEN COLLEGE OF NURSING | LATEST ACTUAL EXAM
COMPLETE QUESTIONS WITH CORRECT ANSWERS AND
RATIONALES ALREADY GRADED A+
SECTION A: CARDIOVASCULAR DISORDERS (Questions 1–50)
1. A client is admitted with acute decompensated heart failure. Which assessment
finding is most concerning?
A. Dyspnea on exertion
B. Peripheral edema
C. Crackles in the lung bases and SpO2 of 88% ✔
D. Jugular venous distention
Rationale: Crackles and hypoxemia indicate pulmonary congestion and impaired
gas exchange, which can lead to respiratory failure. This is an acute, life-
threatening finding requiring immediate intervention (oxygen, diuretics,
positioning).
2. A client with heart failure is prescribed furosemide (Lasix). Which laboratory
value should the nurse monitor most closely?
A. Serum potassium ✔
B. Serum sodium
C. Serum calcium
D. Serum magnesium
Rationale: Furosemide is a loop diuretic that causes potassium loss (hypokalemia).
Hypokalemia can precipitate cardiac arrhythmias, especially in clients on digoxin.
Potassium levels should be monitored closely.
3. A client is diagnosed with infective endocarditis. The nurse should monitor for
which complication?
A. Heart failure and embolic events ✔
B. Myocardial infarction
C. Pulmonary embolism
1
,D. Renal failure
Rationale: Infective endocarditis can cause valvular damage leading to heart
failure and embolic events (vegetations can break off and travel to the brain,
lungs, or other organs). Embolic strokes are a major complication.
4. A client with atrial fibrillation is prescribed warfarin. The nurse should monitor
which laboratory value to evaluate therapeutic effectiveness?
A. aPTT
B. INR ✔
C. Platelet count
D. PT
Rationale: Warfarin is monitored by INR (International Normalized Ratio), with a
therapeutic goal of 2-3 for atrial fibrillation. aPTT is used for heparin. PT is used
but INR standardizes it.
5. A client is admitted with a myocardial infarction (MI). Which finding indicates a
complication of papillary muscle rupture?
A. New onset of a murmur and acute heart failure ✔
B. Decreased cardiac enzymes
C. Resolution of chest pain
D. Normal ECG
Rationale: Papillary muscle rupture is a complication of MI causing acute mitral
regurgitation, heard as a new systolic murmur, and acute heart failure (pulmonary
edema, hypotension). It is a surgical emergency.
6. The nurse is caring for a client with a temporary pacemaker. The nurse notes
that the pacemaker is not capturing (spikes without QRS complexes). The nurse
should:
A. Turn the pacemaker off
B. Increase the milliamperage (mA) output ✔
C. Decrease the heart rate setting
D. Document the finding and continue monitoring
2
,Rationale: Failure to capture means the electrical stimulus is not depolarizing the
ventricles. The nurse should increase the current (mA) until capture is achieved.
The provider should be notified.
7. A client with heart failure has an ejection fraction (EF) of 30%. The nurse
understands that this indicates:
A. Normal cardiac function
B. Mildly reduced cardiac function
C. Moderately reduced cardiac function
D. Severely reduced cardiac function ✔
Rationale: Normal EF is 55-65%. An EF of 30% indicates severe systolic
dysfunction. Clients with heart failure with reduced EF (HFrEF) are at risk for fluid
overload and low cardiac output.
8. A client is receiving IV nitroglycerin for angina. The nurse should monitor for
which side effect?
A. Hypotension and headache ✔
B. Hypertension and tachycardia
C. Bradycardia and hypotension
D. Hyperglycemia
Rationale: Nitroglycerin is a vasodilator that can cause hypotension (especially
with IV administration) and headache (due to vasodilation). Blood pressure
should be monitored closely.
9. A client with peripheral artery disease (PAD) reports leg pain with exercise that
is relieved by rest. The nurse documents this as:
A. Rest pain
B. Intermittent claudication ✔
C. Venous insufficiency
D. Neuropathic pain
3
, Rationale: Intermittent claudication is pain (cramping, aching) in the legs that
occurs with exercise and is relieved by rest. It is a classic symptom of PAD due to
ischemia. Rest pain occurs at rest and indicates severe disease.
10. The nurse is assessing a client with a suspected abdominal aortic aneurysm
(AAA). Which finding is most concerning?
A. Pulsatile abdominal mass
B. Back pain and hypotension ✔
C. Bruit over the abdomen
D. Nausea and vomiting
Rationale: Back pain and hypotension are signs of a rupturing AAA, which is a life-
threatening emergency. A pulsatile mass and bruit are signs of an intact AAA.
Rupture requires immediate surgical intervention.
11. A client with chronic venous insufficiency (CVI) has lower extremity edema
and skin changes. Which intervention is most important?
A. Elevate the legs above the heart level and apply compression stockings ✔
B. Keep the legs in a dependent position
C. Apply heat to the legs
D. Avoid walking
Rationale: CVI is managed by elevating the legs (to promote venous return),
compression stockings (to reduce edema), and ambulation. Heat and dependency
worsen edema.
12. A client is prescribed digoxin for heart failure. Which finding indicates digoxin
toxicity?
A. Anorexia, nausea, and visual disturbances (halos) ✔
B. Tachycardia and hypertension
C. Polyuria and polydipsia
D. Hyperkalemia
4
