NUR 242 EXAM 4 – 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
TABLE OF CONTENTS
i. Perfusion and cardiovascular assessment — Questions 1–30
ii. Musculoskeletal assessment and clinical reasoning — Questions 31–45
iii. Sensory, perception, and cognition — Questions 46–75
iv. Neurologic disorders and neurologic emergencies — Questions 76–100
v. Head-to-toe assessment and clinical prioritization — Questions 101–120
vi. Mobility and musculoskeletal disorders — Questions 121–140
vii. Integrated advanced clinical judgment and patient safety — Questions 141–150
DESCRIPTION
This comprehensive NUR 242 Medical-Surgical Nursing Exam 4 practice resource is
designed for advanced preparation in adult health nursing, emphasizing perfusion,
musculoskeletal assessment, mobility, sensory and cognitive disorders, neurologic
conditions, and comprehensive physical assessment. It develops clinical judgment through
challenging patient scenarios, prioritization, interpretation of assessment findings, safety
decisions, medication considerations, and evidence-based nursing interventions. It is
appropriate for nursing students preparing for advanced course examinations and NCLEX-
style clinical reasoning. The resource contains 150+ practice questions and answers with
concise rationales for focused review. Updated for 2026/2027 study preparation. Purchase
and instantly get a downloadable and editable PDF.
PERFUSION AND CARDIOVASCULAR ASSESSMENT
Question 1
A patient with acute left-sided heart failure develops severe dyspnea, crackles throughout
both lung fields, and an oxygen saturation of 82% despite supplemental oxygen. Which
intervention should the nurse prioritize?
A. Encourage oral fluid intake
B. Place the patient in high-Fowler position
C. Administer a prescribed sedative
D. Place the patient in a supine position
🔴 Correct Answer: B. Place the patient in high-Fowler position.
🔵 Explanation: High-Fowler positioning decreases venous return and improves lung
expansion, helping reduce pulmonary congestion and work of breathing. Severe hypoxemia
and pulmonary edema require immediate respiratory support.
Question 2
A patient with peripheral arterial disease reports severe calf pain while walking that resolves
after resting. Which interpretation is most appropriate?
,A. Venous congestion
B. Intermittent claudication
C. Neuropathic pain
D. Acute compartment syndrome
🔴 Correct Answer: B. Intermittent claudication.
🔵 Explanation: Intermittent claudication results from inadequate arterial blood flow during
increased muscle demand. Pain typically occurs with activity and improves with rest.
Question 3
A patient with suspected acute arterial occlusion has sudden leg pain, pallor, paresthesia,
pulselessness, and coolness. What is the nurse's priority action?
A. Apply a compression stocking
B. Elevate the affected extremity
C. Notify the provider immediately
D. Encourage ambulation
🔴 Correct Answer: C. Notify the provider immediately.
🔵 Explanation: The classic findings indicate acute limb ischemia, a vascular emergency.
Rapid intervention is required to restore circulation and prevent tissue necrosis.
Question 4
A patient with chronic venous insufficiency has bilateral lower-leg edema and brownish
discoloration around the ankles. Which intervention is most appropriate?
A. Keep the legs dependent
B. Encourage prolonged bed rest
C. Elevate the legs when resting
D. Apply ice directly to the skin
🔴 Correct Answer: C. Elevate the legs when resting.
🔵 Explanation: Elevation promotes venous return and decreases dependent edema. Chronic
venous insufficiency commonly produces edema and hemosiderin-related skin discoloration.
Question 5
A patient receiving warfarin for atrial fibrillation reports black, tarry stools. Which action
should the nurse take first?
A. Administer the next dose with food
B. Hold the medication and notify the provider
C. Encourage increased dietary vitamin K
D. Document the finding as expected
🔴 Correct Answer: B. Hold the medication and notify the provider.
🔵 Explanation: Melena may indicate gastrointestinal bleeding. Anticoagulant therapy can
worsen bleeding, requiring prompt evaluation and possible reversal.
,Question 6
A patient develops crushing substernal chest pain radiating to the jaw with diaphoresis.
Which diagnostic test should the nurse anticipate as the priority?
A. Colonoscopy
B. 12-lead ECG
C. Pulmonary function test
D. Bone scan
🔴 Correct Answer: B. 12-lead ECG.
🔵 Explanation: A 12-lead ECG rapidly identifies ischemic changes and possible myocardial
infarction, making it a priority diagnostic study for acute coronary syndrome.
Question 7
A patient with myocardial infarction suddenly develops severe dyspnea, pink frothy sputum,
and diffuse crackles. Which complication is most likely?
A. Pulmonary edema
B. Pneumothorax
C. Pulmonary embolism
D. Pericarditis
🔴 Correct Answer: A. Pulmonary edema.
🔵 Explanation: Acute left ventricular failure can cause rapid pulmonary fluid accumulation,
producing severe dyspnea, crackles, and pink frothy sputum.
Question 8
A patient with heart failure has gained 2.5 kg in three days. Which interpretation is most
clinically significant?
A. Increased muscle mass
B. Fluid retention
C. Improved nutritional status
D. Expected variation
🔴 Correct Answer: B. Fluid retention.
🔵 Explanation: Rapid weight gain is more consistent with fluid accumulation than tissue
gain and may indicate worsening heart failure.
Question 9
A patient with atrial fibrillation is at increased risk for which major complication?
A. Ischemic stroke
B. Pneumothorax
C. Appendicitis
D. Peptic ulcer disease
, 🔴 Correct Answer: A. Ischemic stroke.
🔵 Explanation: Atrial fibrillation causes ineffective atrial contraction and blood stasis,
increasing thrombus formation and systemic embolization.
Question 10
A patient reports unilateral calf swelling, warmth, and tenderness after prolonged
immobility. Which action is most appropriate?
A. Massage the calf
B. Encourage vigorous exercise
C. Notify the provider of suspected DVT
D. Apply a heating pad and reassess tomorrow
🔴 Correct Answer: C. Notify the provider of suspected DVT.
🔵 Explanation: Unilateral swelling, warmth, and tenderness are concerning for deep-vein
thrombosis. Massage may dislodge a thrombus and should be avoided.
Question 11
Which assessment finding most strongly suggests decreased peripheral arterial perfusion?
A. Warm skin and bounding pulses
B. Dependent edema
C. Cool, pale extremity with diminished pulses
D. Brown ankle pigmentation
🔴 Correct Answer: C. Cool, pale extremity with diminished pulses.
🔵 Explanation: Arterial insufficiency decreases oxygenated blood flow, producing coolness,
pallor, diminished pulses, and often pain with activity.
Question 12
A patient with chronic heart failure receives furosemide. Which laboratory result requires
the greatest concern?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Chloride 101 mEq/L
D. Calcium 9.2 mg/dL
🔴 Correct Answer: B. Potassium 2.9 mEq/L.
🔵 Explanation: Furosemide promotes potassium loss. Significant hypokalemia increases the
risk of dangerous cardiac dysrhythmias.
Question 13
A patient with acute pulmonary edema is prescribed IV nitroglycerin. Which finding requires
immediate reassessment before administration?
A. Blood pressure 84/52 mm Hg
B. Heart rate 96/min
EXAM PRACTICE & ACTUAL STUDY GUIDE | FULL TESTBANK | 150 ADVANCED PRACTICE
QUESTIONS & 100% CORRECT ANSWERS WITH RATIONALES | 2026/2027 LATEST UPDATE
TABLE OF CONTENTS
i. Perfusion and cardiovascular assessment — Questions 1–30
ii. Musculoskeletal assessment and clinical reasoning — Questions 31–45
iii. Sensory, perception, and cognition — Questions 46–75
iv. Neurologic disorders and neurologic emergencies — Questions 76–100
v. Head-to-toe assessment and clinical prioritization — Questions 101–120
vi. Mobility and musculoskeletal disorders — Questions 121–140
vii. Integrated advanced clinical judgment and patient safety — Questions 141–150
DESCRIPTION
This comprehensive NUR 242 Medical-Surgical Nursing Exam 4 practice resource is
designed for advanced preparation in adult health nursing, emphasizing perfusion,
musculoskeletal assessment, mobility, sensory and cognitive disorders, neurologic
conditions, and comprehensive physical assessment. It develops clinical judgment through
challenging patient scenarios, prioritization, interpretation of assessment findings, safety
decisions, medication considerations, and evidence-based nursing interventions. It is
appropriate for nursing students preparing for advanced course examinations and NCLEX-
style clinical reasoning. The resource contains 150+ practice questions and answers with
concise rationales for focused review. Updated for 2026/2027 study preparation. Purchase
and instantly get a downloadable and editable PDF.
PERFUSION AND CARDIOVASCULAR ASSESSMENT
Question 1
A patient with acute left-sided heart failure develops severe dyspnea, crackles throughout
both lung fields, and an oxygen saturation of 82% despite supplemental oxygen. Which
intervention should the nurse prioritize?
A. Encourage oral fluid intake
B. Place the patient in high-Fowler position
C. Administer a prescribed sedative
D. Place the patient in a supine position
🔴 Correct Answer: B. Place the patient in high-Fowler position.
🔵 Explanation: High-Fowler positioning decreases venous return and improves lung
expansion, helping reduce pulmonary congestion and work of breathing. Severe hypoxemia
and pulmonary edema require immediate respiratory support.
Question 2
A patient with peripheral arterial disease reports severe calf pain while walking that resolves
after resting. Which interpretation is most appropriate?
,A. Venous congestion
B. Intermittent claudication
C. Neuropathic pain
D. Acute compartment syndrome
🔴 Correct Answer: B. Intermittent claudication.
🔵 Explanation: Intermittent claudication results from inadequate arterial blood flow during
increased muscle demand. Pain typically occurs with activity and improves with rest.
Question 3
A patient with suspected acute arterial occlusion has sudden leg pain, pallor, paresthesia,
pulselessness, and coolness. What is the nurse's priority action?
A. Apply a compression stocking
B. Elevate the affected extremity
C. Notify the provider immediately
D. Encourage ambulation
🔴 Correct Answer: C. Notify the provider immediately.
🔵 Explanation: The classic findings indicate acute limb ischemia, a vascular emergency.
Rapid intervention is required to restore circulation and prevent tissue necrosis.
Question 4
A patient with chronic venous insufficiency has bilateral lower-leg edema and brownish
discoloration around the ankles. Which intervention is most appropriate?
A. Keep the legs dependent
B. Encourage prolonged bed rest
C. Elevate the legs when resting
D. Apply ice directly to the skin
🔴 Correct Answer: C. Elevate the legs when resting.
🔵 Explanation: Elevation promotes venous return and decreases dependent edema. Chronic
venous insufficiency commonly produces edema and hemosiderin-related skin discoloration.
Question 5
A patient receiving warfarin for atrial fibrillation reports black, tarry stools. Which action
should the nurse take first?
A. Administer the next dose with food
B. Hold the medication and notify the provider
C. Encourage increased dietary vitamin K
D. Document the finding as expected
🔴 Correct Answer: B. Hold the medication and notify the provider.
🔵 Explanation: Melena may indicate gastrointestinal bleeding. Anticoagulant therapy can
worsen bleeding, requiring prompt evaluation and possible reversal.
,Question 6
A patient develops crushing substernal chest pain radiating to the jaw with diaphoresis.
Which diagnostic test should the nurse anticipate as the priority?
A. Colonoscopy
B. 12-lead ECG
C. Pulmonary function test
D. Bone scan
🔴 Correct Answer: B. 12-lead ECG.
🔵 Explanation: A 12-lead ECG rapidly identifies ischemic changes and possible myocardial
infarction, making it a priority diagnostic study for acute coronary syndrome.
Question 7
A patient with myocardial infarction suddenly develops severe dyspnea, pink frothy sputum,
and diffuse crackles. Which complication is most likely?
A. Pulmonary edema
B. Pneumothorax
C. Pulmonary embolism
D. Pericarditis
🔴 Correct Answer: A. Pulmonary edema.
🔵 Explanation: Acute left ventricular failure can cause rapid pulmonary fluid accumulation,
producing severe dyspnea, crackles, and pink frothy sputum.
Question 8
A patient with heart failure has gained 2.5 kg in three days. Which interpretation is most
clinically significant?
A. Increased muscle mass
B. Fluid retention
C. Improved nutritional status
D. Expected variation
🔴 Correct Answer: B. Fluid retention.
🔵 Explanation: Rapid weight gain is more consistent with fluid accumulation than tissue
gain and may indicate worsening heart failure.
Question 9
A patient with atrial fibrillation is at increased risk for which major complication?
A. Ischemic stroke
B. Pneumothorax
C. Appendicitis
D. Peptic ulcer disease
, 🔴 Correct Answer: A. Ischemic stroke.
🔵 Explanation: Atrial fibrillation causes ineffective atrial contraction and blood stasis,
increasing thrombus formation and systemic embolization.
Question 10
A patient reports unilateral calf swelling, warmth, and tenderness after prolonged
immobility. Which action is most appropriate?
A. Massage the calf
B. Encourage vigorous exercise
C. Notify the provider of suspected DVT
D. Apply a heating pad and reassess tomorrow
🔴 Correct Answer: C. Notify the provider of suspected DVT.
🔵 Explanation: Unilateral swelling, warmth, and tenderness are concerning for deep-vein
thrombosis. Massage may dislodge a thrombus and should be avoided.
Question 11
Which assessment finding most strongly suggests decreased peripheral arterial perfusion?
A. Warm skin and bounding pulses
B. Dependent edema
C. Cool, pale extremity with diminished pulses
D. Brown ankle pigmentation
🔴 Correct Answer: C. Cool, pale extremity with diminished pulses.
🔵 Explanation: Arterial insufficiency decreases oxygenated blood flow, producing coolness,
pallor, diminished pulses, and often pain with activity.
Question 12
A patient with chronic heart failure receives furosemide. Which laboratory result requires
the greatest concern?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Chloride 101 mEq/L
D. Calcium 9.2 mg/dL
🔴 Correct Answer: B. Potassium 2.9 mEq/L.
🔵 Explanation: Furosemide promotes potassium loss. Significant hypokalemia increases the
risk of dangerous cardiac dysrhythmias.
Question 13
A patient with acute pulmonary edema is prescribed IV nitroglycerin. Which finding requires
immediate reassessment before administration?
A. Blood pressure 84/52 mm Hg
B. Heart rate 96/min
