NSG 3100 Exam 4 Practice Exam
(2026/2027) | Galen College of
Nursing — Fundamentals/Medical-
Surgical Nursing.
Case Studies: 3 (Questions 21-25, 36-40, 51-55)
Medication Scenarios: 5 (Questions 6, 16, 26, 41, 56)
SATA Questions: 5 (Questions 12, 18, 31, 47, 59)
Complication Recognition: 4 scenarios (Questions 8, 28, 43, 52)
Prioritization Scenarios: 3 (Questions 15, 35, 50)
SECTION 1: CARDIOVASCULAR (Questions 1-12)
Q1: A nurse is assessing a client with left-sided heart failure. Which finding requires immediate
intervention?
A. Jugular vein distention and hepatomegaly
B. Dependent edema in the lower extremities and ascites
C. Crackles in the lung bases and an SpO₂ of 88% on room air [CORRECT]
D. Weight gain of 2 pounds over 24 hours and fatigue
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion due to blood backing up into
the pulmonary circulation. Crackles and oxygen desaturation indicate acute pulmonary edema,
which requires immediate intervention. Right-sided failure findings include jugular vein
distention, hepatomegaly, and dependent edema. Weight gain alone is less urgent than
respiratory compromise.
Q2: A client is prescribed digoxin 0.25 mg PO daily. Before administering the medication, the
nurse notes the client's apical pulse is 52 beats/minute and the serum potassium is 3.2 mEq/L.
What is the priority nursing action?
,A. Administer the digoxin as prescribed and document the findings
B. Hold the digoxin and notify the healthcare provider [CORRECT]
C. Administer the digoxin and request a potassium supplement
D. Hold the digoxin and administer a potassium supplement
Correct Answer: B
Rationale: Digoxin should be held when the apical pulse is below 60 beats/minute in adults.
Additionally, hypokalemia (potassium below 3.5 mEq/L) increases the risk of digoxin toxicity.
The nurse must hold the medication and notify the provider for further orders. Administering
potassium without an order is outside nursing scope. Digoxin toxicity can cause life-threatening
dysrhythmias.
Q3: A nurse is teaching a client about nitroglycerin sublingual tablets for angina. Which
statement by the client indicates a need for further teaching?
A. "I should sit down before taking my nitroglycerin."
B. "I can take up to three tablets, five minutes apart."
C. "I should store my nitroglycerin in a clear plastic container in the bathroom." [CORRECT]
D. "If my chest pain is not relieved after three tablets, I should call 911."
Correct Answer: C
Rationale: Nitroglycerin must be stored in its original dark glass container, away from light, heat,
and moisture. Storing in a clear container or in the bathroom degrades the medication. The
client should sit down before taking nitroglycerin due to hypotension risk. Taking up to three
tablets at five-minute intervals and calling 911 if unrelieved is correct.
Q4: A client with deep vein thrombosis (DVT) is receiving a continuous heparin infusion. The
nurse notes the client's aPTT is 85 seconds (therapeutic range: 60-80 seconds). What is the
priority nursing action?
A. Stop the heparin infusion immediately
B. Administer protamine sulfate as an antidote
C. Continue the heparin infusion and monitor for bleeding [CORRECT]
D. Increase the heparin infusion rate
Correct Answer: C
, Rationale: An aPTT of 85 seconds is only slightly above therapeutic range and does not require
immediate intervention. The nurse should continue the infusion and monitor for bleeding.
Protamine sulfate is reserved for significant heparin overdose or life-threatening bleeding.
Stopping the infusion without orders is inappropriate. Increasing the rate would be dangerous.
Q5: A nurse is caring for a client who just returned from a cardiac catheterization via the right
femoral artery. Which assessment finding requires immediate action?
A. The client reports mild discomfort at the catheter insertion site
B. The client's right pedal pulse is weak but palpable
C. The client's blood pressure is 110/70 mmHg and heart rate is 88 beats/minute
D. The client's right foot is pale, cool, and the pedal pulse is absent [CORRECT]
Correct Answer: D
Rationale: An absent pedal pulse with a pale, cool foot indicates arterial occlusion at the
catheterization site, a medical emergency requiring immediate intervention. Mild discomfort
and a weak but palpable pulse can be monitored. Stable vital signs are expected. Arterial
occlusion can lead to tissue ischemia and limb loss.
Q6 (MEDICATION SCENARIO):
A nurse is preparing to administer furosemide 40 mg IV push to a client with heart failure and
pulmonary edema.
Question: The client's morning labs show potassium 3.1 mEq/L, magnesium 1.4 mEq/L, and
digoxin level 1.2 ng/mL. Which is the priority nursing action?
A. Administer the furosemide as ordered and monitor urine output
B. Hold the furosemide and notify the healthcare provider about the electrolyte levels
[CORRECT]
C. Administer the furosemide and request an order for potassium replacement
D. Administer the furosemide and monitor for digoxin toxicity
Correct Answer: B
Rationale: The client has significant hypokalemia (K⁺ below 3.5 mEq/L) and hypomagnesemia
(Mg²⁺ below 1.5 mEq/L). Administering furosemide will further deplete potassium and
magnesium, increasing the risk of digoxin toxicity and fatal dysrhythmias. The nurse must hold
the medication and notify the provider. The digoxin level is within normal range (0.5-2.0 ng/mL).
(2026/2027) | Galen College of
Nursing — Fundamentals/Medical-
Surgical Nursing.
Case Studies: 3 (Questions 21-25, 36-40, 51-55)
Medication Scenarios: 5 (Questions 6, 16, 26, 41, 56)
SATA Questions: 5 (Questions 12, 18, 31, 47, 59)
Complication Recognition: 4 scenarios (Questions 8, 28, 43, 52)
Prioritization Scenarios: 3 (Questions 15, 35, 50)
SECTION 1: CARDIOVASCULAR (Questions 1-12)
Q1: A nurse is assessing a client with left-sided heart failure. Which finding requires immediate
intervention?
A. Jugular vein distention and hepatomegaly
B. Dependent edema in the lower extremities and ascites
C. Crackles in the lung bases and an SpO₂ of 88% on room air [CORRECT]
D. Weight gain of 2 pounds over 24 hours and fatigue
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion due to blood backing up into
the pulmonary circulation. Crackles and oxygen desaturation indicate acute pulmonary edema,
which requires immediate intervention. Right-sided failure findings include jugular vein
distention, hepatomegaly, and dependent edema. Weight gain alone is less urgent than
respiratory compromise.
Q2: A client is prescribed digoxin 0.25 mg PO daily. Before administering the medication, the
nurse notes the client's apical pulse is 52 beats/minute and the serum potassium is 3.2 mEq/L.
What is the priority nursing action?
,A. Administer the digoxin as prescribed and document the findings
B. Hold the digoxin and notify the healthcare provider [CORRECT]
C. Administer the digoxin and request a potassium supplement
D. Hold the digoxin and administer a potassium supplement
Correct Answer: B
Rationale: Digoxin should be held when the apical pulse is below 60 beats/minute in adults.
Additionally, hypokalemia (potassium below 3.5 mEq/L) increases the risk of digoxin toxicity.
The nurse must hold the medication and notify the provider for further orders. Administering
potassium without an order is outside nursing scope. Digoxin toxicity can cause life-threatening
dysrhythmias.
Q3: A nurse is teaching a client about nitroglycerin sublingual tablets for angina. Which
statement by the client indicates a need for further teaching?
A. "I should sit down before taking my nitroglycerin."
B. "I can take up to three tablets, five minutes apart."
C. "I should store my nitroglycerin in a clear plastic container in the bathroom." [CORRECT]
D. "If my chest pain is not relieved after three tablets, I should call 911."
Correct Answer: C
Rationale: Nitroglycerin must be stored in its original dark glass container, away from light, heat,
and moisture. Storing in a clear container or in the bathroom degrades the medication. The
client should sit down before taking nitroglycerin due to hypotension risk. Taking up to three
tablets at five-minute intervals and calling 911 if unrelieved is correct.
Q4: A client with deep vein thrombosis (DVT) is receiving a continuous heparin infusion. The
nurse notes the client's aPTT is 85 seconds (therapeutic range: 60-80 seconds). What is the
priority nursing action?
A. Stop the heparin infusion immediately
B. Administer protamine sulfate as an antidote
C. Continue the heparin infusion and monitor for bleeding [CORRECT]
D. Increase the heparin infusion rate
Correct Answer: C
, Rationale: An aPTT of 85 seconds is only slightly above therapeutic range and does not require
immediate intervention. The nurse should continue the infusion and monitor for bleeding.
Protamine sulfate is reserved for significant heparin overdose or life-threatening bleeding.
Stopping the infusion without orders is inappropriate. Increasing the rate would be dangerous.
Q5: A nurse is caring for a client who just returned from a cardiac catheterization via the right
femoral artery. Which assessment finding requires immediate action?
A. The client reports mild discomfort at the catheter insertion site
B. The client's right pedal pulse is weak but palpable
C. The client's blood pressure is 110/70 mmHg and heart rate is 88 beats/minute
D. The client's right foot is pale, cool, and the pedal pulse is absent [CORRECT]
Correct Answer: D
Rationale: An absent pedal pulse with a pale, cool foot indicates arterial occlusion at the
catheterization site, a medical emergency requiring immediate intervention. Mild discomfort
and a weak but palpable pulse can be monitored. Stable vital signs are expected. Arterial
occlusion can lead to tissue ischemia and limb loss.
Q6 (MEDICATION SCENARIO):
A nurse is preparing to administer furosemide 40 mg IV push to a client with heart failure and
pulmonary edema.
Question: The client's morning labs show potassium 3.1 mEq/L, magnesium 1.4 mEq/L, and
digoxin level 1.2 ng/mL. Which is the priority nursing action?
A. Administer the furosemide as ordered and monitor urine output
B. Hold the furosemide and notify the healthcare provider about the electrolyte levels
[CORRECT]
C. Administer the furosemide and request an order for potassium replacement
D. Administer the furosemide and monitor for digoxin toxicity
Correct Answer: B
Rationale: The client has significant hypokalemia (K⁺ below 3.5 mEq/L) and hypomagnesemia
(Mg²⁺ below 1.5 mEq/L). Administering furosemide will further deplete potassium and
magnesium, increasing the risk of digoxin toxicity and fatal dysrhythmias. The nurse must hold
the medication and notify the provider. The digoxin level is within normal range (0.5-2.0 ng/mL).
