1
NUR 242 Exam 1 Medical-Surgical Nursing
Galen College Official Practice Exam Actual
Exam 2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiac & Vascular Disorders | Q1 – Q10
Section 2 | Respiratory Disorders | Q11 – Q20
Section 3 | Renal & Urinary Disorders | Q21 – Q30
Section 4 | Gastrointestinal & Endocrine Disorders | Q31 – Q40
Section 5 | NGN-Style Clinical Judgment & Integrated Case Analysis | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIAC & VASCULAR DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old patient admitted with left-sided heart failure reports worsening
shortness of breath and exhibits a persistent cough producing pink, frothy sputum.
Assessment reveals crackles throughout the bilateral lung fields and an oxygen
saturation of 88%. What is the priority nursing action?
A. Administer the prescribed intravenous furosemide
,2
B. Place the patient in high Fowler's position
C. Restrict the patient's oral fluid intake immediately
D. Prepare for endotracheal intubation
Correct Answer: B
Rationale: Placing the patient in high Fowler's position decreases venous return to
the heart and reduces pulmonary congestion, providing immediate symptomatic
relief for dyspnea. Administering diuretics is essential but takes several minutes to
onset, making positioning the fastest way to improve oxygenation. Always
prioritize non-invasive interventions that instantly alter respiratory mechanics
before awaiting medication effects.
Question 2 of 50
A 72-year-old female with a history of right-sided heart failure presents to the
clinic with a weight gain of 4 pounds over the last three days. Assessment reveals
3+ pitting edema in the bilateral lower extremities and a distended jugular vein.
The provider prescribes spironolactone 25 mg daily. The nurse should monitor the
patient closely for which electrolyte imbalance?
A. Hyponatremia
B. Hypokalemia
C. Hypercalcemia
D. Hyperkalemia ✓ CORRECT
Correct Answer: D
Rationale: Spironolactone is a potassium-sparing diuretic, meaning it promotes
sodium and water excretion while retaining potassium, posing a significant risk for
hyperkalemia. Hypokalemia is the primary risk with loop or thiazide diuretics,
,3
making it the most tempting incorrect choice for students mixing up diuretic
classes. Monitor the serum potassium closely and educate the patient to avoid
potassium-rich foods like bananas and salt substitutes.
Question 3 of 50
A 58-year-old male with coronary artery disease calls the clinic nurse reporting
chest pain that began 15 minutes ago while mowing the lawn. He states he took
one sublingual nitroglycerin tablet 5 minutes ago, but the pain has not subsided.
What is the most appropriate nursing instruction?
A. Instruct the patient to take a second nitroglycerin tablet and call 911 if pain
persists after 5 minutes
B. Advise the patient to lie down and rest until the chest pain completely resolves
C. Instruct the patient to chew an aspirin 325 mg tablet and drive to the emergency
room
D. Advise the patient to take two more nitroglycerin tablets simultaneously
Correct Answer: A
Rationale: The standard protocol for angina requires taking a second sublingual
nitroglycerin tablet 5 minutes after the first if pain persists, and calling 911 if pain
continues 5 minutes after the second dose. Driving to the emergency room is
unsafe during an active cardiac event, and taking two tablets simultaneously risks
profound hypotension. Remember the "take, wait 5 min, take, wait 5 min, take, call
911" rule for sublingual nitroglycerin.
Question 4 of 50
A 65-year-old patient is admitted to the emergency department with a suspected
acute myocardial infarction. The initial 12-lead ECG reveals ST-segment elevation
, 4
in leads II, III, and aVF. The nurse recognizes this finding indicates an infarction in
which area of the heart?
A. Anterior wall
B. Lateral wall
C. Inferior wall ✓ CORRECT
D. Septal wall
Correct Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF is the classic
electrocardiographic pattern indicating an inferior wall myocardial infarction. An
anterior wall MI typically presents with ST elevation in the precordial leads V1
through V4, which is a common confusion point. Inferior MIs are often associated
with right ventricular involvement and require cautious fluid management.
Question 5 of 50
A 55-year-old patient with newly diagnosed hypertension has been taking lisinopril
10 mg daily for two weeks and reports a persistent dry, hacking cough to the clinic
nurse. The patient's blood pressure is well controlled at 124/78 mm Hg. What is the
best nursing action?
A. Notify the provider to discontinue the lisinopril and prescribe an alternative
antihypertensive
B. Reassure the patient that the cough is harmless and will resolve over the next
month
C. Instruct the patient to take an over-the-counter cough suppressant daily
D. Educate the patient that the cough indicates a developing allergic reaction to the
medication
NUR 242 Exam 1 Medical-Surgical Nursing
Galen College Official Practice Exam Actual
Exam 2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiac & Vascular Disorders | Q1 – Q10
Section 2 | Respiratory Disorders | Q11 – Q20
Section 3 | Renal & Urinary Disorders | Q21 – Q30
Section 4 | Gastrointestinal & Endocrine Disorders | Q31 – Q40
Section 5 | NGN-Style Clinical Judgment & Integrated Case Analysis | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIAC & VASCULAR DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old patient admitted with left-sided heart failure reports worsening
shortness of breath and exhibits a persistent cough producing pink, frothy sputum.
Assessment reveals crackles throughout the bilateral lung fields and an oxygen
saturation of 88%. What is the priority nursing action?
A. Administer the prescribed intravenous furosemide
,2
B. Place the patient in high Fowler's position
C. Restrict the patient's oral fluid intake immediately
D. Prepare for endotracheal intubation
Correct Answer: B
Rationale: Placing the patient in high Fowler's position decreases venous return to
the heart and reduces pulmonary congestion, providing immediate symptomatic
relief for dyspnea. Administering diuretics is essential but takes several minutes to
onset, making positioning the fastest way to improve oxygenation. Always
prioritize non-invasive interventions that instantly alter respiratory mechanics
before awaiting medication effects.
Question 2 of 50
A 72-year-old female with a history of right-sided heart failure presents to the
clinic with a weight gain of 4 pounds over the last three days. Assessment reveals
3+ pitting edema in the bilateral lower extremities and a distended jugular vein.
The provider prescribes spironolactone 25 mg daily. The nurse should monitor the
patient closely for which electrolyte imbalance?
A. Hyponatremia
B. Hypokalemia
C. Hypercalcemia
D. Hyperkalemia ✓ CORRECT
Correct Answer: D
Rationale: Spironolactone is a potassium-sparing diuretic, meaning it promotes
sodium and water excretion while retaining potassium, posing a significant risk for
hyperkalemia. Hypokalemia is the primary risk with loop or thiazide diuretics,
,3
making it the most tempting incorrect choice for students mixing up diuretic
classes. Monitor the serum potassium closely and educate the patient to avoid
potassium-rich foods like bananas and salt substitutes.
Question 3 of 50
A 58-year-old male with coronary artery disease calls the clinic nurse reporting
chest pain that began 15 minutes ago while mowing the lawn. He states he took
one sublingual nitroglycerin tablet 5 minutes ago, but the pain has not subsided.
What is the most appropriate nursing instruction?
A. Instruct the patient to take a second nitroglycerin tablet and call 911 if pain
persists after 5 minutes
B. Advise the patient to lie down and rest until the chest pain completely resolves
C. Instruct the patient to chew an aspirin 325 mg tablet and drive to the emergency
room
D. Advise the patient to take two more nitroglycerin tablets simultaneously
Correct Answer: A
Rationale: The standard protocol for angina requires taking a second sublingual
nitroglycerin tablet 5 minutes after the first if pain persists, and calling 911 if pain
continues 5 minutes after the second dose. Driving to the emergency room is
unsafe during an active cardiac event, and taking two tablets simultaneously risks
profound hypotension. Remember the "take, wait 5 min, take, wait 5 min, take, call
911" rule for sublingual nitroglycerin.
Question 4 of 50
A 65-year-old patient is admitted to the emergency department with a suspected
acute myocardial infarction. The initial 12-lead ECG reveals ST-segment elevation
, 4
in leads II, III, and aVF. The nurse recognizes this finding indicates an infarction in
which area of the heart?
A. Anterior wall
B. Lateral wall
C. Inferior wall ✓ CORRECT
D. Septal wall
Correct Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF is the classic
electrocardiographic pattern indicating an inferior wall myocardial infarction. An
anterior wall MI typically presents with ST elevation in the precordial leads V1
through V4, which is a common confusion point. Inferior MIs are often associated
with right ventricular involvement and require cautious fluid management.
Question 5 of 50
A 55-year-old patient with newly diagnosed hypertension has been taking lisinopril
10 mg daily for two weeks and reports a persistent dry, hacking cough to the clinic
nurse. The patient's blood pressure is well controlled at 124/78 mm Hg. What is the
best nursing action?
A. Notify the provider to discontinue the lisinopril and prescribe an alternative
antihypertensive
B. Reassure the patient that the cough is harmless and will resolve over the next
month
C. Instruct the patient to take an over-the-counter cough suppressant daily
D. Educate the patient that the cough indicates a developing allergic reaction to the
medication
