NUR 242 EXAM 1 – MEDICAL-SURGICAL NURSING (GALEN COLLEGE) | COMPREHENSIVE
EXAM PRACTICE & ACTUAL STUDY GUIDE | FULL TESTBANK | 150 ADVANCED PRACTICE
QUESTIONS & 100% CORRECT ANSWERS WITH RATIONALES | 2026/2027 LATEST UPDATE
i. Foundations of Medical-Surgical Nursing and Clinical Judgment
ii. Fluid, Electrolyte, and Acid–Base Disorders
iii. Cardiovascular Disorders and Nursing Management
iv. Respiratory Disorders and Critical Respiratory Assessment
v. Renal and Urinary Disorders
vi. Gastrointestinal and Hepatic Disorders
vii. Endocrine and Metabolic Disorders
viii. Neurologic Disorders
ix. Hematologic and Immune Disorders
x. Infection, Inflammation, and Sepsis
xi. Perioperative and Postoperative Nursing Care
xii. Oncology and Complex Chronic Illness
xiii. Pharmacologic Safety and Medication Management
xiv. Prioritization, Delegation, Documentation, and Patient Safety
xv. Integrated Clinical Judgment and Advanced Case-Based Nursing
DESCRIPTION
This 2026/2027 NUR 242 Medical-Surgical Nursing Exam 1 practice resource provides
advanced preparation for students developing clinical judgment, assessment, prioritization,
intervention, and evaluation skills. It covers major medical-surgical concepts through 150
challenging scenario-based questions designed to reinforce application rather than simple
memorization. The questions emphasize patient deterioration, fluid and electrolyte
abnormalities, cardiovascular and respiratory disorders, renal and gastrointestinal
conditions, neurologic and endocrine problems, infection, pharmacologic safety,
postoperative care, delegation, and evidence-informed nursing decisions. It is appropriate
for nursing students seeking rigorous exam preparation and deeper mastery of clinical
reasoning. It contains 150 questions and answers with rationales. Purchase and instantly get
a downloadable and editable PDF.
QUESTIONS 1–150
Question 1
A postoperative patient becomes restless and anxious 2 hours after abdominal surgery. The
respiratory rate is 28/min, oxygen saturation is 91% on room air, and the patient reports
increasing shortness of breath. Which nursing action is the priority?
A. Administer the prescribed opioid analgesic
B. Encourage the patient to ambulate
C. Apply supplemental oxygen and assess respiratory status
D. Place the patient in a supine position
,🔴 Correct Answer: C. Apply supplemental oxygen and assess respiratory status.
🔵 Explanation: Restlessness and anxiety can be early manifestations of hypoxemia. The nurse
should immediately support oxygenation while performing a focused respiratory assessment
and identifying the underlying cause.
Question 2
A patient with heart failure has gained 2.5 kg (5.5 lb) in 3 days and reports worsening
orthopnea. Which finding most strongly indicates fluid-volume excess?
A. Flat neck veins when upright
B. Bilateral pulmonary crackles
C. Dry oral mucosa
D. Urine specific gravity of 1.001
🔴 Correct Answer: B. Bilateral pulmonary crackles.
🔵 Explanation: Pulmonary crackles result from fluid accumulating in the alveoli and are a
significant manifestation of worsening volume overload in heart failure.
Question 3
A patient receiving IV potassium chloride reports burning at the IV site. The nurse observes
swelling and erythema around the catheter. What should the nurse do first?
A. Increase the infusion rate
B. Stop the infusion
C. Apply a warm compress while continuing the infusion
D. Flush the catheter rapidly with normal saline
🔴 Correct Answer: B. Stop the infusion.
🔵 Explanation: IV potassium is highly irritating and can cause tissue injury if infiltration or
extravasation occurs. The infusion should be stopped immediately and the IV site assessed.
Question 4
A patient with chronic obstructive pulmonary disease has a baseline oxygen saturation of
90%. The patient suddenly becomes drowsy with a respiratory rate of 8/min after receiving
an opioid. Which interpretation is most appropriate?
A. The finding represents expected COPD progression
B. The patient is developing opioid-related respiratory depression
C. The patient is experiencing an uncomplicated COPD exacerbation
D. The patient requires immediate oral fluids
🔴 Correct Answer: B. The patient is developing opioid-related respiratory depression.
🔵 Explanation: Marked respiratory slowing and new somnolence after opioid administration
strongly suggest opioid-induced respiratory depression. Immediate airway and ventilatory
assessment is required.
,Question 5
A patient with severe hyponatremia becomes confused and develops a generalized seizure.
Which intervention is the priority?
A. Restrict dietary sodium
B. Institute seizure precautions and protect the airway
C. Encourage free-water intake
D. Administer hypotonic IV fluid
🔴 Correct Answer: B. Institute seizure precautions and protect the airway.
🔵 Explanation: Severe hyponatremia can cause cerebral edema and seizures. Immediate
priorities are airway protection, injury prevention, neurologic assessment, and treatment of
the sodium abnormality.
Question 6
A patient with suspected myocardial infarction reports crushing substernal chest pressure
radiating to the jaw. Which action should the nurse prioritize?
A. Obtain a 12-lead ECG promptly
B. Encourage the patient to walk to reduce anxiety
C. Delay assessment until laboratory results return
D. Administer an antacid and reassess in 30 minutes
🔴 Correct Answer: A. Obtain a 12-lead ECG promptly.
🔵 Explanation: Rapid ECG acquisition is essential in suspected acute coronary syndrome
because it identifies ischemic or STEMI patterns and guides urgent reperfusion decisions.
Question 7
A patient with pneumonia suddenly develops severe dyspnea, diffuse crackles, and an
oxygen saturation of 82% despite supplemental oxygen. Which complication should the
nurse suspect?
A. Acute respiratory distress syndrome
B. Stable chronic bronchitis
C. Uncomplicated pleurisy
D. Mild respiratory alkalosis
🔴 Correct Answer: A. Acute respiratory distress syndrome.
🔵 Explanation: Severe refractory hypoxemia with bilateral pulmonary involvement during
serious infection is characteristic of acute respiratory distress syndrome and requires urgent
escalation of care.
Question 8
, A patient with chronic kidney disease has a serum potassium level of 6.7 mEq/L and peaked
T waves on ECG. Which prescription should the nurse anticipate as an immediate priority?
A. Oral potassium supplementation
B. IV calcium administration
C. Increased dietary potassium
D. Hypotonic IV fluid
🔴 Correct Answer: B. IV calcium administration.
🔵 Explanation: Severe hyperkalemia with ECG changes is life-threatening. IV calcium
stabilizes the cardiac membrane while additional therapies shift or remove potassium.
Question 9
A patient with acute pancreatitis reports severe epigastric pain radiating to the back and
persistent vomiting. Which nursing intervention is most appropriate initially?
A. Encourage a high-fat meal
B. Maintain prescribed bowel rest and aggressive supportive therapy
C. Place the patient flat after meals
D. Encourage alcohol consumption to stimulate appetite
🔴 Correct Answer: B. Maintain prescribed bowel rest and aggressive supportive therapy.
🔵 Explanation: Acute pancreatitis requires supportive management, including fluid
resuscitation, pain control, monitoring, and limitation of pancreatic stimulation according to
the patient's clinical condition and treatment plan.
Question 10
A patient with diabetic ketoacidosis has a serum potassium of 5.6 mEq/L before insulin
therapy. Which explanation best describes why potassium still requires close monitoring?
A. Insulin will shift potassium into cells
B. DKA always causes total-body potassium excess
C. Potassium cannot change during insulin therapy
D. Hyperkalemia eliminates the risk of hypokalemia
🔴 Correct Answer: A. Insulin will shift potassium into cells.
🔵 Explanation: Although serum potassium may initially be elevated because of extracellular
shifting, total-body potassium is often depleted in DKA. Insulin can rapidly move potassium
intracellularly, producing dangerous hypokalemia.
Question 11
A patient with a traumatic brain injury develops increasing blood pressure, bradycardia, and
irregular respirations. Which complication should the nurse suspect?
EXAM PRACTICE & ACTUAL STUDY GUIDE | FULL TESTBANK | 150 ADVANCED PRACTICE
QUESTIONS & 100% CORRECT ANSWERS WITH RATIONALES | 2026/2027 LATEST UPDATE
i. Foundations of Medical-Surgical Nursing and Clinical Judgment
ii. Fluid, Electrolyte, and Acid–Base Disorders
iii. Cardiovascular Disorders and Nursing Management
iv. Respiratory Disorders and Critical Respiratory Assessment
v. Renal and Urinary Disorders
vi. Gastrointestinal and Hepatic Disorders
vii. Endocrine and Metabolic Disorders
viii. Neurologic Disorders
ix. Hematologic and Immune Disorders
x. Infection, Inflammation, and Sepsis
xi. Perioperative and Postoperative Nursing Care
xii. Oncology and Complex Chronic Illness
xiii. Pharmacologic Safety and Medication Management
xiv. Prioritization, Delegation, Documentation, and Patient Safety
xv. Integrated Clinical Judgment and Advanced Case-Based Nursing
DESCRIPTION
This 2026/2027 NUR 242 Medical-Surgical Nursing Exam 1 practice resource provides
advanced preparation for students developing clinical judgment, assessment, prioritization,
intervention, and evaluation skills. It covers major medical-surgical concepts through 150
challenging scenario-based questions designed to reinforce application rather than simple
memorization. The questions emphasize patient deterioration, fluid and electrolyte
abnormalities, cardiovascular and respiratory disorders, renal and gastrointestinal
conditions, neurologic and endocrine problems, infection, pharmacologic safety,
postoperative care, delegation, and evidence-informed nursing decisions. It is appropriate
for nursing students seeking rigorous exam preparation and deeper mastery of clinical
reasoning. It contains 150 questions and answers with rationales. Purchase and instantly get
a downloadable and editable PDF.
QUESTIONS 1–150
Question 1
A postoperative patient becomes restless and anxious 2 hours after abdominal surgery. The
respiratory rate is 28/min, oxygen saturation is 91% on room air, and the patient reports
increasing shortness of breath. Which nursing action is the priority?
A. Administer the prescribed opioid analgesic
B. Encourage the patient to ambulate
C. Apply supplemental oxygen and assess respiratory status
D. Place the patient in a supine position
,🔴 Correct Answer: C. Apply supplemental oxygen and assess respiratory status.
🔵 Explanation: Restlessness and anxiety can be early manifestations of hypoxemia. The nurse
should immediately support oxygenation while performing a focused respiratory assessment
and identifying the underlying cause.
Question 2
A patient with heart failure has gained 2.5 kg (5.5 lb) in 3 days and reports worsening
orthopnea. Which finding most strongly indicates fluid-volume excess?
A. Flat neck veins when upright
B. Bilateral pulmonary crackles
C. Dry oral mucosa
D. Urine specific gravity of 1.001
🔴 Correct Answer: B. Bilateral pulmonary crackles.
🔵 Explanation: Pulmonary crackles result from fluid accumulating in the alveoli and are a
significant manifestation of worsening volume overload in heart failure.
Question 3
A patient receiving IV potassium chloride reports burning at the IV site. The nurse observes
swelling and erythema around the catheter. What should the nurse do first?
A. Increase the infusion rate
B. Stop the infusion
C. Apply a warm compress while continuing the infusion
D. Flush the catheter rapidly with normal saline
🔴 Correct Answer: B. Stop the infusion.
🔵 Explanation: IV potassium is highly irritating and can cause tissue injury if infiltration or
extravasation occurs. The infusion should be stopped immediately and the IV site assessed.
Question 4
A patient with chronic obstructive pulmonary disease has a baseline oxygen saturation of
90%. The patient suddenly becomes drowsy with a respiratory rate of 8/min after receiving
an opioid. Which interpretation is most appropriate?
A. The finding represents expected COPD progression
B. The patient is developing opioid-related respiratory depression
C. The patient is experiencing an uncomplicated COPD exacerbation
D. The patient requires immediate oral fluids
🔴 Correct Answer: B. The patient is developing opioid-related respiratory depression.
🔵 Explanation: Marked respiratory slowing and new somnolence after opioid administration
strongly suggest opioid-induced respiratory depression. Immediate airway and ventilatory
assessment is required.
,Question 5
A patient with severe hyponatremia becomes confused and develops a generalized seizure.
Which intervention is the priority?
A. Restrict dietary sodium
B. Institute seizure precautions and protect the airway
C. Encourage free-water intake
D. Administer hypotonic IV fluid
🔴 Correct Answer: B. Institute seizure precautions and protect the airway.
🔵 Explanation: Severe hyponatremia can cause cerebral edema and seizures. Immediate
priorities are airway protection, injury prevention, neurologic assessment, and treatment of
the sodium abnormality.
Question 6
A patient with suspected myocardial infarction reports crushing substernal chest pressure
radiating to the jaw. Which action should the nurse prioritize?
A. Obtain a 12-lead ECG promptly
B. Encourage the patient to walk to reduce anxiety
C. Delay assessment until laboratory results return
D. Administer an antacid and reassess in 30 minutes
🔴 Correct Answer: A. Obtain a 12-lead ECG promptly.
🔵 Explanation: Rapid ECG acquisition is essential in suspected acute coronary syndrome
because it identifies ischemic or STEMI patterns and guides urgent reperfusion decisions.
Question 7
A patient with pneumonia suddenly develops severe dyspnea, diffuse crackles, and an
oxygen saturation of 82% despite supplemental oxygen. Which complication should the
nurse suspect?
A. Acute respiratory distress syndrome
B. Stable chronic bronchitis
C. Uncomplicated pleurisy
D. Mild respiratory alkalosis
🔴 Correct Answer: A. Acute respiratory distress syndrome.
🔵 Explanation: Severe refractory hypoxemia with bilateral pulmonary involvement during
serious infection is characteristic of acute respiratory distress syndrome and requires urgent
escalation of care.
Question 8
, A patient with chronic kidney disease has a serum potassium level of 6.7 mEq/L and peaked
T waves on ECG. Which prescription should the nurse anticipate as an immediate priority?
A. Oral potassium supplementation
B. IV calcium administration
C. Increased dietary potassium
D. Hypotonic IV fluid
🔴 Correct Answer: B. IV calcium administration.
🔵 Explanation: Severe hyperkalemia with ECG changes is life-threatening. IV calcium
stabilizes the cardiac membrane while additional therapies shift or remove potassium.
Question 9
A patient with acute pancreatitis reports severe epigastric pain radiating to the back and
persistent vomiting. Which nursing intervention is most appropriate initially?
A. Encourage a high-fat meal
B. Maintain prescribed bowel rest and aggressive supportive therapy
C. Place the patient flat after meals
D. Encourage alcohol consumption to stimulate appetite
🔴 Correct Answer: B. Maintain prescribed bowel rest and aggressive supportive therapy.
🔵 Explanation: Acute pancreatitis requires supportive management, including fluid
resuscitation, pain control, monitoring, and limitation of pancreatic stimulation according to
the patient's clinical condition and treatment plan.
Question 10
A patient with diabetic ketoacidosis has a serum potassium of 5.6 mEq/L before insulin
therapy. Which explanation best describes why potassium still requires close monitoring?
A. Insulin will shift potassium into cells
B. DKA always causes total-body potassium excess
C. Potassium cannot change during insulin therapy
D. Hyperkalemia eliminates the risk of hypokalemia
🔴 Correct Answer: A. Insulin will shift potassium into cells.
🔵 Explanation: Although serum potassium may initially be elevated because of extracellular
shifting, total-body potassium is often depleted in DKA. Insulin can rapidly move potassium
intracellularly, producing dangerous hypokalemia.
Question 11
A patient with a traumatic brain injury develops increasing blood pressure, bradycardia, and
irregular respirations. Which complication should the nurse suspect?
