Galen College of Nursing | NUR 242 Medical-Surgical Nursing Concepts
NUR 242 Medical-Surgical Nursing Concepts
Exam 2 Comprehensive Examination
2026/2027 | Verified Questions
Galen College of Nursing | NUR 242 Medical-Surgical Nursing Concepts | University-Level Nursing Students
50 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Galen College of Nursing | NUR 242 Medical-Surgical Nursing Concepts
Examination 2 Actual Exam | Academic Year 2026/2027
NUR 242 Medical-Surgical Nursing Concepts Exam 2 Comprehensive Examination 2026/2027 | Verified Questions
,INTRODUCTION
This collection presents fifty (50) original, university-level questions developed for the NUR 242 Medical-
Surgical Nursing Concepts Exam 2 Comprehensive Examination at Galen College of Nursing. The material is
organized into four core domains: Cardiovascular System and Alterations; Respiratory System and
Alterations; Fluid, Electrolyte, and Acid-Base Balance; and Hematologic and Immune System Alterations.
Every item is written to reinforce the official NUR 242 Exam 2 course objectives, supporting actual exam
readiness and the development of clinical proficiency in physiologic interpretation, nursing assessment,
clinical judgment, and safe medication and transfusion care for adults with acute and chronic illness. All
content is aligned to the 2026/2027 academic year and reflects current evidence-based clinical care and
patient safety standards.
ACTUAL QUESTIONS
Domain 1: Cardiovascular System and Alterations
Question 1. A client arrives in the emergency department with crushing substernal chest pain
that began 90 minutes ago. Vital signs are blood pressure 148/92, pulse 104, respirations 22,
and oxygen saturation 94 percent on room air. Which action is the priority for the nurse to
anticipate?
A. Admission to a medical unit with a 12 lead tracing obtained the next morning
B. Supplemental oxygen at 10 liters per mask for every client with chest pain regardless of saturation
C. Observation for 12 hours while waiting for cardiac enzyme results before any intervention
D. Rapid reperfusion with activation of the cardiac catheterization laboratory for primary percutaneous
coronary intervention, with aspirin and nitroglycerin given as adjuncts and oxygen given only if the
saturation falls below 90 percent
Correct Answer: D
Rationale: Galen NUR 242 course materials and Ignatavicius emphasize that care for ST elevation
myocardial infarction is time driven, with a first medical contact to device goal of 90 minutes or less, so
reperfusion takes priority over everything else. Aspirin and nitroglycerin are adjuncts, and oxygen is
reserved for a saturation below 90 percent because routine oxygen in clients with normal saturation offers
no benefit.
Question 2. A client with heart failure reports increased shortness of breath and a weight gain
of 3 pounds since the previous day. Which finding indicates left sided rather than right sided
failure?
A. Dependent edema, jugular venous distention, and hepatojugular reflux
B. Dyspnea, orthopnea, and crackles in the lung bases caused by pulmonary congestion
C. Ascites, nausea, and weight gain from systemic venous congestion
D. Cool extremities and diminished peripheral pulses from reduced forward flow
Correct Answer: B
Rationale: Per Galen NUR 242 course materials and Harding and colleagues, left sided failure backs
pressure into the pulmonary circulation, producing dyspnea, orthopnea, paroxysmal nocturnal dyspnea,
and crackles. Right sided failure produces systemic venous congestion with jugular venous distention,
hepatomegaly, ascites, and dependent edema, and a gain of 2 to 3 pounds in a day signals fluid retention
that is reported.
Question 3. A client is admitted with a blood pressure of 214/126 mm Hg, severe headache,
and blurred vision. Which intervention does the nurse anticipate?
A. Immediate sublingual nifedipine to bring the pressure down rapidly
B. Oral medication at home with a clinic appointment in one week
C. Rapid reduction of the blood pressure to the normal range within 30 minutes
D. Admission for continuous blood pressure monitoring with a titratable intravenous agent, lowering
the mean arterial pressure by no more than about 25 percent over the first hours
Correct Answer: D
NUR 242 Medical-Surgical Nursing Concepts Exam 2 Comprehensive Examination 2026/2027 | Verified Questions
, Rationale: Per standard medical-surgical nursing method, severe hypertension with acute target organ
damage is a hypertensive emergency that requires a titratable intravenous agent in a monitored setting.
Reducing the pressure too quickly risks cerebral, myocardial, and renal ischemia, and short acting oral
agents such as immediate release nifedipine are avoided because they cause unpredictable drops in
pressure.
Question 4. A client with chronic stable angina is prescribed sublingual nitroglycerin. Which
statement by the client indicates correct understanding?
A. I should swallow the tablet with water and expect relief within 1 hour
B. I can take up to 10 tablets in an hour if the pain continues
C. I will sit or lie down before taking the tablet and repeat one tablet every 5 minutes up to three doses,
calling emergency services if the pain is unrelieved
D. I will store the tablets in a plastic bag in my car so they are always handy
Correct Answer: C
Rationale: Galen NUR 242 course materials and current clinical care guidelines indicate that sublingual
nitroglycerin is taken at the first sign of pain, one tablet every 5 minutes for up to three doses, with
emergency services activated if the pain persists. Sitting or lying down reduces falls from hypotension, and
the tablets must stay in the original dark glass container because heat, light, and moisture destroy potency.
Question 5. A nurse assesses a client with peripheral arterial disease. Which finding is most
consistent with this condition?
A. Brownish discoloration and stasis ulcers around the medial ankle
B. Edema that improves when the legs are elevated
C. Warm skin with a bounding pedal pulse on the affected side
D. Intermittent claudication with pain on walking that is relieved by rest, dependent rubor, and
diminished pedal pulses
Correct Answer: D
Rationale: Galen NUR 242 course materials and Ignatavicius emphasize that peripheral arterial disease
reduces arterial inflow, producing claudication relieved by rest, dependent rubor, cool thin skin,
diminished pulses, and nonhealing toe or foot wounds. Venous disease produces the opposite pattern with
edema, hemosiderin staining, and stasis ulcers, and elevating the legs worsens arterial pain because it
further reduces perfusion.
Question 6. A client with a deep vein thrombosis is discharged on warfarin. Which statement
indicates understanding of this therapy?
A. I will keep my intake of vitamin K rich foods consistent, have my international normalized ratio
checked regularly, and report unusual bruising or bleeding
B. I can stop the medication once the pain and swelling go away
C. I should increase leafy green vegetables to speed up the medication
D. No blood monitoring is needed because this medication is taken by mouth
Correct Answer: A
Rationale: Per Galen NUR 242 course materials and Harding and colleagues, warfarin requires regular
international normalized ratio monitoring with a usual target of 2 to 3, and a consistent vitamin K intake
keeps the level stable rather than eliminating those foods. Therapy continues for the prescribed course even
after symptoms resolve, and unusual bruising, bleeding, or dark stools are reported promptly.
Question 7. A client returns to the unit after a cardiac catheterization using the femoral
approach. Which nursing action is most important during the first hours?
A. Ambulate the client within 30 minutes to prevent stiffness
B. Keep the head of the bed flat and allow the leg to bend for comfort
C. Keep the affected leg straight, monitor the insertion site and distal pulses, and report bleeding,
hematoma, or loss of pulse immediately
D. Apply a tight clamp over the dressing to prevent any bleeding
NUR 242 Medical-Surgical Nursing Concepts Exam 2 Comprehensive Examination 2026/2027 | Verified Questions
NUR 242 Medical-Surgical Nursing Concepts
Exam 2 Comprehensive Examination
2026/2027 | Verified Questions
Galen College of Nursing | NUR 242 Medical-Surgical Nursing Concepts | University-Level Nursing Students
50 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Galen College of Nursing | NUR 242 Medical-Surgical Nursing Concepts
Examination 2 Actual Exam | Academic Year 2026/2027
NUR 242 Medical-Surgical Nursing Concepts Exam 2 Comprehensive Examination 2026/2027 | Verified Questions
,INTRODUCTION
This collection presents fifty (50) original, university-level questions developed for the NUR 242 Medical-
Surgical Nursing Concepts Exam 2 Comprehensive Examination at Galen College of Nursing. The material is
organized into four core domains: Cardiovascular System and Alterations; Respiratory System and
Alterations; Fluid, Electrolyte, and Acid-Base Balance; and Hematologic and Immune System Alterations.
Every item is written to reinforce the official NUR 242 Exam 2 course objectives, supporting actual exam
readiness and the development of clinical proficiency in physiologic interpretation, nursing assessment,
clinical judgment, and safe medication and transfusion care for adults with acute and chronic illness. All
content is aligned to the 2026/2027 academic year and reflects current evidence-based clinical care and
patient safety standards.
ACTUAL QUESTIONS
Domain 1: Cardiovascular System and Alterations
Question 1. A client arrives in the emergency department with crushing substernal chest pain
that began 90 minutes ago. Vital signs are blood pressure 148/92, pulse 104, respirations 22,
and oxygen saturation 94 percent on room air. Which action is the priority for the nurse to
anticipate?
A. Admission to a medical unit with a 12 lead tracing obtained the next morning
B. Supplemental oxygen at 10 liters per mask for every client with chest pain regardless of saturation
C. Observation for 12 hours while waiting for cardiac enzyme results before any intervention
D. Rapid reperfusion with activation of the cardiac catheterization laboratory for primary percutaneous
coronary intervention, with aspirin and nitroglycerin given as adjuncts and oxygen given only if the
saturation falls below 90 percent
Correct Answer: D
Rationale: Galen NUR 242 course materials and Ignatavicius emphasize that care for ST elevation
myocardial infarction is time driven, with a first medical contact to device goal of 90 minutes or less, so
reperfusion takes priority over everything else. Aspirin and nitroglycerin are adjuncts, and oxygen is
reserved for a saturation below 90 percent because routine oxygen in clients with normal saturation offers
no benefit.
Question 2. A client with heart failure reports increased shortness of breath and a weight gain
of 3 pounds since the previous day. Which finding indicates left sided rather than right sided
failure?
A. Dependent edema, jugular venous distention, and hepatojugular reflux
B. Dyspnea, orthopnea, and crackles in the lung bases caused by pulmonary congestion
C. Ascites, nausea, and weight gain from systemic venous congestion
D. Cool extremities and diminished peripheral pulses from reduced forward flow
Correct Answer: B
Rationale: Per Galen NUR 242 course materials and Harding and colleagues, left sided failure backs
pressure into the pulmonary circulation, producing dyspnea, orthopnea, paroxysmal nocturnal dyspnea,
and crackles. Right sided failure produces systemic venous congestion with jugular venous distention,
hepatomegaly, ascites, and dependent edema, and a gain of 2 to 3 pounds in a day signals fluid retention
that is reported.
Question 3. A client is admitted with a blood pressure of 214/126 mm Hg, severe headache,
and blurred vision. Which intervention does the nurse anticipate?
A. Immediate sublingual nifedipine to bring the pressure down rapidly
B. Oral medication at home with a clinic appointment in one week
C. Rapid reduction of the blood pressure to the normal range within 30 minutes
D. Admission for continuous blood pressure monitoring with a titratable intravenous agent, lowering
the mean arterial pressure by no more than about 25 percent over the first hours
Correct Answer: D
NUR 242 Medical-Surgical Nursing Concepts Exam 2 Comprehensive Examination 2026/2027 | Verified Questions
, Rationale: Per standard medical-surgical nursing method, severe hypertension with acute target organ
damage is a hypertensive emergency that requires a titratable intravenous agent in a monitored setting.
Reducing the pressure too quickly risks cerebral, myocardial, and renal ischemia, and short acting oral
agents such as immediate release nifedipine are avoided because they cause unpredictable drops in
pressure.
Question 4. A client with chronic stable angina is prescribed sublingual nitroglycerin. Which
statement by the client indicates correct understanding?
A. I should swallow the tablet with water and expect relief within 1 hour
B. I can take up to 10 tablets in an hour if the pain continues
C. I will sit or lie down before taking the tablet and repeat one tablet every 5 minutes up to three doses,
calling emergency services if the pain is unrelieved
D. I will store the tablets in a plastic bag in my car so they are always handy
Correct Answer: C
Rationale: Galen NUR 242 course materials and current clinical care guidelines indicate that sublingual
nitroglycerin is taken at the first sign of pain, one tablet every 5 minutes for up to three doses, with
emergency services activated if the pain persists. Sitting or lying down reduces falls from hypotension, and
the tablets must stay in the original dark glass container because heat, light, and moisture destroy potency.
Question 5. A nurse assesses a client with peripheral arterial disease. Which finding is most
consistent with this condition?
A. Brownish discoloration and stasis ulcers around the medial ankle
B. Edema that improves when the legs are elevated
C. Warm skin with a bounding pedal pulse on the affected side
D. Intermittent claudication with pain on walking that is relieved by rest, dependent rubor, and
diminished pedal pulses
Correct Answer: D
Rationale: Galen NUR 242 course materials and Ignatavicius emphasize that peripheral arterial disease
reduces arterial inflow, producing claudication relieved by rest, dependent rubor, cool thin skin,
diminished pulses, and nonhealing toe or foot wounds. Venous disease produces the opposite pattern with
edema, hemosiderin staining, and stasis ulcers, and elevating the legs worsens arterial pain because it
further reduces perfusion.
Question 6. A client with a deep vein thrombosis is discharged on warfarin. Which statement
indicates understanding of this therapy?
A. I will keep my intake of vitamin K rich foods consistent, have my international normalized ratio
checked regularly, and report unusual bruising or bleeding
B. I can stop the medication once the pain and swelling go away
C. I should increase leafy green vegetables to speed up the medication
D. No blood monitoring is needed because this medication is taken by mouth
Correct Answer: A
Rationale: Per Galen NUR 242 course materials and Harding and colleagues, warfarin requires regular
international normalized ratio monitoring with a usual target of 2 to 3, and a consistent vitamin K intake
keeps the level stable rather than eliminating those foods. Therapy continues for the prescribed course even
after symptoms resolve, and unusual bruising, bleeding, or dark stools are reported promptly.
Question 7. A client returns to the unit after a cardiac catheterization using the femoral
approach. Which nursing action is most important during the first hours?
A. Ambulate the client within 30 minutes to prevent stiffness
B. Keep the head of the bed flat and allow the leg to bend for comfort
C. Keep the affected leg straight, monitor the insertion site and distal pulses, and report bleeding,
hematoma, or loss of pulse immediately
D. Apply a tight clamp over the dressing to prevent any bleeding
NUR 242 Medical-Surgical Nursing Concepts Exam 2 Comprehensive Examination 2026/2027 | Verified Questions
