NUR 242 MIDTERM EXAM PRACTICE | MEDICAL-SURGICAL NURSING (GALEN COLLEGE) |
COMPREHENSIVE ACTUAL STUDY GUIDE | FULL TESTBANK | 150 ADVANCED PRACTICE
QUESTIONS & 100% CORRECT ANSWERS WITH RATIONALES | EXAM PREPARATION |
2026/2027 LATEST UPDATE
i. Health Assessment, Clinical Judgment & Prioritization
ii. Fluid, Electrolyte & Acid–Base Disorders
iii. Cardiovascular Disorders & Hemodynamic Management
iv. Respiratory Disorders & Oxygenation
v. Neurologic Disorders & Acute Neurologic Care
vi. Renal & Urinary Disorders
vii. Gastrointestinal & Hepatobiliary Disorders
viii. Endocrine & Metabolic Disorders
ix. Infection, Sepsis & Immune Responses
x. Perioperative Care, Pain & Patient Safety
xi. Oncology, Hematologic Disorders & Transfusion Safety
xii. Medication Management, Delegation & Documentation
xiii. Complex Clinical Decision-Making & Integrated Med-Surg Care
DESCRIPTION
This comprehensive 2026/2027 NUR 242 Medical-Surgical Nursing practice study guide is
designed for Galen College students preparing for a demanding midterm examination. It
emphasizes advanced clinical judgment, assessment, prioritization, pathophysiology,
pharmacologic safety, interpretation of laboratory findings, patient deterioration, and
evidence-based nursing interventions. The question set progresses from complex
application to extremely challenging clinical scenarios and includes 150 questions with
answers and concise rationales. It is appropriate for nursing students seeking rigorous exam
preparation and stronger decision-making skills. Students should expect realistic patient
situations requiring prioritization and evaluation. Purchase and instantly get a downloadable
and editable PDF for convenient review, practice, and study throughout 2026/2027.
PRACTICE QUESTIONS
Question 1
A postoperative patient becomes restless and confused. The respiratory rate is 30/min,
oxygen saturation is 88% on room air, and breath sounds are diminished bilaterally. Which
action should the nurse take first?
A. Administer the prescribed opioid analgesic.
B. Apply supplemental oxygen and assess respiratory status.
C. Encourage the patient to ambulate.
D. Obtain a urine specimen.
🔴 Correct Answer: B. Apply supplemental oxygen and assess respiratory status.
🔵 Explanation: Restlessness and confusion can be early manifestations of hypoxemia. Airway
,and breathing take priority, so oxygen should be applied while respiratory status is rapidly
reassessed.
Question 2
A patient with heart failure has gained 2.5 kg (5.5 lb) in 3 days. Which finding most strongly
indicates worsening fluid overload?
A. Dry oral mucosa
B. Orthostatic hypotension
C. New bilateral crackles
D. Urine specific gravity of 1.030
🔴 Correct Answer: C. New bilateral crackles
🔵 Explanation: Rapid weight gain reflects fluid retention, and new pulmonary crackles
suggest pulmonary congestion from worsening heart failure.
Question 3
A patient receiving IV potassium chloride reports burning at the IV site. What should the
nurse do first?
A. Increase the infusion rate.
B. Stop the infusion and assess the IV site.
C. Apply a heating pad and continue the infusion.
D. Flush the catheter forcefully.
🔴 Correct Answer: B. Stop the infusion and assess the IV site.
🔵 Explanation: IV potassium is irritating and can cause tissue injury if infiltration occurs. The
infusion should be stopped and the IV assessed immediately.
Question 4
A patient with COPD receiving oxygen becomes increasingly somnolent. Which assessment
is most important?
A. Skin temperature
B. Bowel sounds
C. Level of consciousness and ventilation
D. Peripheral pulses
🔴 Correct Answer: C. Level of consciousness and ventilation
🔵 Explanation: Increasing somnolence may indicate worsening hypercapnia and ventilatory
failure. Respiratory rate, effort, mental status, and blood gases may be needed.
Question 5
A patient with suspected septic shock has a blood pressure of 82/46 mm Hg, lactate of 4.5
mmol/L, and altered mental status. Which intervention has the highest priority?
,A. Restrict fluids.
B. Initiate prescribed rapid isotonic fluid resuscitation.
C. Administer a sedative.
D. Encourage oral fluids.
🔴 Correct Answer: B. Initiate prescribed rapid isotonic fluid resuscitation.
🔵 Explanation: Hypotension, elevated lactate, and altered mentation indicate impaired tissue
perfusion. Rapid crystalloid resuscitation is a key early intervention while cultures, antibiotics,
and further hemodynamic management proceed.
Question 6
A patient with potassium of 6.8 mEq/L develops peaked T waves. Which prescription should
the nurse anticipate as an immediate priority?
A. Oral potassium supplement
B. IV calcium preparation
C. Sodium-restricted diet
D. Magnesium supplement
🔴 Correct Answer: B. IV calcium preparation
🔵 Explanation: Severe hyperkalemia with ECG changes creates a life-threatening
dysrhythmia risk. IV calcium stabilizes the cardiac membrane while therapies are initiated to
shift or remove potassium.
Question 7
A patient with sodium of 118 mEq/L is confused and reports a severe headache. Which
intervention is most appropriate?
A. Encourage free-water intake.
B. Institute seizure precautions.
C. Administer hypotonic IV fluid.
D. Encourage unrestricted oral intake.
🔴 Correct Answer: B. Institute seizure precautions.
🔵 Explanation: Severe symptomatic hyponatremia can cause cerebral edema and seizures.
Neurologic monitoring and seizure precautions are priorities.
Question 8
A patient with metabolic acidosis has deep, rapid respirations. Which acid-base mechanism
is the patient demonstrating?
A. Respiratory compensation through carbon dioxide retention
B. Respiratory compensation through increased carbon dioxide elimination
C. Renal compensation through bicarbonate excretion
D. Metabolic compensation through sodium retention
, 🔴 Correct Answer: B. Respiratory compensation through increased carbon dioxide
elimination
🔵 Explanation: In metabolic acidosis, the lungs compensate by increasing ventilation and
eliminating CO₂, thereby reducing carbonic acid.
Question 9
A patient has ABGs: pH 7.28, PaCO₂ 52 mm Hg, HCO₃⁻ 24 mEq/L. How should the nurse
interpret these findings?
A. Uncompensated respiratory acidosis
B. Compensated respiratory alkalosis
C. Uncompensated metabolic acidosis
D. Compensated metabolic alkalosis
🔴 Correct Answer: A. Uncompensated respiratory acidosis
🔵 Explanation: The pH is acidic and PaCO₂ is elevated, while bicarbonate remains normal,
indicating primary respiratory acidosis without metabolic compensation.
Question 10
A patient with vomiting has pH 7.50, PaCO₂ 45 mm Hg, and HCO₃⁻ 34 mEq/L. What is the
primary disorder?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Metabolic acidosis
🔴 Correct Answer: C. Metabolic alkalosis
🔵 Explanation: Elevated pH and bicarbonate indicate metabolic alkalosis, which can occur
after significant gastric acid loss from vomiting.
Question 11
A patient with suspected myocardial infarction reports crushing chest pain radiating to the
jaw. Which assessment should receive immediate attention?
A. Last bowel movement
B. Cardiac rhythm and hemodynamic status
C. Dietary preferences
D. Sleep pattern
🔴 Correct Answer: B. Cardiac rhythm and hemodynamic status
🔵 Explanation: Acute coronary syndrome can rapidly produce lethal dysrhythmias and
hemodynamic instability. Continuous cardiac and cardiovascular assessment is essential.
Question 12
COMPREHENSIVE ACTUAL STUDY GUIDE | FULL TESTBANK | 150 ADVANCED PRACTICE
QUESTIONS & 100% CORRECT ANSWERS WITH RATIONALES | EXAM PREPARATION |
2026/2027 LATEST UPDATE
i. Health Assessment, Clinical Judgment & Prioritization
ii. Fluid, Electrolyte & Acid–Base Disorders
iii. Cardiovascular Disorders & Hemodynamic Management
iv. Respiratory Disorders & Oxygenation
v. Neurologic Disorders & Acute Neurologic Care
vi. Renal & Urinary Disorders
vii. Gastrointestinal & Hepatobiliary Disorders
viii. Endocrine & Metabolic Disorders
ix. Infection, Sepsis & Immune Responses
x. Perioperative Care, Pain & Patient Safety
xi. Oncology, Hematologic Disorders & Transfusion Safety
xii. Medication Management, Delegation & Documentation
xiii. Complex Clinical Decision-Making & Integrated Med-Surg Care
DESCRIPTION
This comprehensive 2026/2027 NUR 242 Medical-Surgical Nursing practice study guide is
designed for Galen College students preparing for a demanding midterm examination. It
emphasizes advanced clinical judgment, assessment, prioritization, pathophysiology,
pharmacologic safety, interpretation of laboratory findings, patient deterioration, and
evidence-based nursing interventions. The question set progresses from complex
application to extremely challenging clinical scenarios and includes 150 questions with
answers and concise rationales. It is appropriate for nursing students seeking rigorous exam
preparation and stronger decision-making skills. Students should expect realistic patient
situations requiring prioritization and evaluation. Purchase and instantly get a downloadable
and editable PDF for convenient review, practice, and study throughout 2026/2027.
PRACTICE QUESTIONS
Question 1
A postoperative patient becomes restless and confused. The respiratory rate is 30/min,
oxygen saturation is 88% on room air, and breath sounds are diminished bilaterally. Which
action should the nurse take first?
A. Administer the prescribed opioid analgesic.
B. Apply supplemental oxygen and assess respiratory status.
C. Encourage the patient to ambulate.
D. Obtain a urine specimen.
🔴 Correct Answer: B. Apply supplemental oxygen and assess respiratory status.
🔵 Explanation: Restlessness and confusion can be early manifestations of hypoxemia. Airway
,and breathing take priority, so oxygen should be applied while respiratory status is rapidly
reassessed.
Question 2
A patient with heart failure has gained 2.5 kg (5.5 lb) in 3 days. Which finding most strongly
indicates worsening fluid overload?
A. Dry oral mucosa
B. Orthostatic hypotension
C. New bilateral crackles
D. Urine specific gravity of 1.030
🔴 Correct Answer: C. New bilateral crackles
🔵 Explanation: Rapid weight gain reflects fluid retention, and new pulmonary crackles
suggest pulmonary congestion from worsening heart failure.
Question 3
A patient receiving IV potassium chloride reports burning at the IV site. What should the
nurse do first?
A. Increase the infusion rate.
B. Stop the infusion and assess the IV site.
C. Apply a heating pad and continue the infusion.
D. Flush the catheter forcefully.
🔴 Correct Answer: B. Stop the infusion and assess the IV site.
🔵 Explanation: IV potassium is irritating and can cause tissue injury if infiltration occurs. The
infusion should be stopped and the IV assessed immediately.
Question 4
A patient with COPD receiving oxygen becomes increasingly somnolent. Which assessment
is most important?
A. Skin temperature
B. Bowel sounds
C. Level of consciousness and ventilation
D. Peripheral pulses
🔴 Correct Answer: C. Level of consciousness and ventilation
🔵 Explanation: Increasing somnolence may indicate worsening hypercapnia and ventilatory
failure. Respiratory rate, effort, mental status, and blood gases may be needed.
Question 5
A patient with suspected septic shock has a blood pressure of 82/46 mm Hg, lactate of 4.5
mmol/L, and altered mental status. Which intervention has the highest priority?
,A. Restrict fluids.
B. Initiate prescribed rapid isotonic fluid resuscitation.
C. Administer a sedative.
D. Encourage oral fluids.
🔴 Correct Answer: B. Initiate prescribed rapid isotonic fluid resuscitation.
🔵 Explanation: Hypotension, elevated lactate, and altered mentation indicate impaired tissue
perfusion. Rapid crystalloid resuscitation is a key early intervention while cultures, antibiotics,
and further hemodynamic management proceed.
Question 6
A patient with potassium of 6.8 mEq/L develops peaked T waves. Which prescription should
the nurse anticipate as an immediate priority?
A. Oral potassium supplement
B. IV calcium preparation
C. Sodium-restricted diet
D. Magnesium supplement
🔴 Correct Answer: B. IV calcium preparation
🔵 Explanation: Severe hyperkalemia with ECG changes creates a life-threatening
dysrhythmia risk. IV calcium stabilizes the cardiac membrane while therapies are initiated to
shift or remove potassium.
Question 7
A patient with sodium of 118 mEq/L is confused and reports a severe headache. Which
intervention is most appropriate?
A. Encourage free-water intake.
B. Institute seizure precautions.
C. Administer hypotonic IV fluid.
D. Encourage unrestricted oral intake.
🔴 Correct Answer: B. Institute seizure precautions.
🔵 Explanation: Severe symptomatic hyponatremia can cause cerebral edema and seizures.
Neurologic monitoring and seizure precautions are priorities.
Question 8
A patient with metabolic acidosis has deep, rapid respirations. Which acid-base mechanism
is the patient demonstrating?
A. Respiratory compensation through carbon dioxide retention
B. Respiratory compensation through increased carbon dioxide elimination
C. Renal compensation through bicarbonate excretion
D. Metabolic compensation through sodium retention
, 🔴 Correct Answer: B. Respiratory compensation through increased carbon dioxide
elimination
🔵 Explanation: In metabolic acidosis, the lungs compensate by increasing ventilation and
eliminating CO₂, thereby reducing carbonic acid.
Question 9
A patient has ABGs: pH 7.28, PaCO₂ 52 mm Hg, HCO₃⁻ 24 mEq/L. How should the nurse
interpret these findings?
A. Uncompensated respiratory acidosis
B. Compensated respiratory alkalosis
C. Uncompensated metabolic acidosis
D. Compensated metabolic alkalosis
🔴 Correct Answer: A. Uncompensated respiratory acidosis
🔵 Explanation: The pH is acidic and PaCO₂ is elevated, while bicarbonate remains normal,
indicating primary respiratory acidosis without metabolic compensation.
Question 10
A patient with vomiting has pH 7.50, PaCO₂ 45 mm Hg, and HCO₃⁻ 34 mEq/L. What is the
primary disorder?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Metabolic acidosis
🔴 Correct Answer: C. Metabolic alkalosis
🔵 Explanation: Elevated pH and bicarbonate indicate metabolic alkalosis, which can occur
after significant gastric acid loss from vomiting.
Question 11
A patient with suspected myocardial infarction reports crushing chest pain radiating to the
jaw. Which assessment should receive immediate attention?
A. Last bowel movement
B. Cardiac rhythm and hemodynamic status
C. Dietary preferences
D. Sleep pattern
🔴 Correct Answer: B. Cardiac rhythm and hemodynamic status
🔵 Explanation: Acute coronary syndrome can rapidly produce lethal dysrhythmias and
hemodynamic instability. Continuous cardiac and cardiovascular assessment is essential.
Question 12
