NUR 242 — Medical-Surgical Nursing Exam 3 • Galen College (A+ Guarantee)
NUR 242 Exam 3 ()
Medical-Surgical Nursing — Galen College of Nursing (A+ Guarantee)
Comprehensive Practice Exam • 110 Multiple-Choice Questions
Cardiovascular • Respiratory • Neurological • Renal • Endocrine • GI • Musculoskeletal • Emergency & Prioritization
Instructions: This comprehensive practice exam assesses mastery of medical-surgical nursing content aligned with the
Galen College of Nursing NUR 242 Exam 3 blueprint for the 2026/2027 academic year. Each question presents four
options (A–D) with exactly one correct answer. The correct option is flagged [CORRECT], followed by a clinical rationale
integrating pathophysiology, assessment priorities, nursing interventions, and pharmacology. Cognitive distribution: 30%
recall, 50% application, 20% analysis. Question styles include scenario-based clinical judgment, lab value interpretation,
rhythm interpretation, medication safety and calculations, delegation and scope of practice, and commonly confused
concept pairs (Heart failure vs. COPD exacerbation, DKA vs. HHS, AKI vs. CKD, Stroke vs. Seizure). Use this exam for
self-assessment, targeted review, and A+ competency verification.
Section Topic Questions
Section 1 Cardiovascular System Q1–Q18
Section 2 Respiratory System Q19–Q34
Section 3 Neurological System Q35–Q49
Section 4 Renal and Urinary System Q50–Q63
Section 5 Endocrine System Q64–Q77
Section 6 Gastrointestinal System Q78–Q91
Section 7 Musculoskeletal and Integumentary Systems Q92–Q101
Section 8 Emergency, Critical Care, and Prioritization Q102–Q110
Total All medical-surgical nursing competencies 110
Section 1: Cardiovascular System
Heart Failure, Dysrhythmias, ACS, & Vascular Disorders (Q1-Q18)
Q1: A 68-year-old patient is admitted with acute decompensated heart failure. Which assessment finding is
the MOST reliable indicator of worsening cardiac output?
Competency: Heart Failure - Assessment
A. Bilateral crackles in the lung bases
B. Weight gain of 1.5 kg overnight despite diuretics [CORRECT]
C. Fatigue reported when ambulating to the bathroom
D. Heart rate of 92 bpm and irregular
Correct Answer: B
Rationale: Rapid weight gain (1-2 kg/day) is the most sensitive indicator of fluid retention and worsening heart failure, reflecting
net fluid accumulation before crackles or dyspnea appear. Crackles (A) indicate pulmonary congestion but occur later; fatigue (C)
is nonspecific; tachycardia (D) may have many causes. Daily weights are the gold standard for HF monitoring.
NUR 242 Exam 3 (2026/2027) — 110 Questions Page 1
,NUR 242 — Medical-Surgical Nursing Exam 3 • Galen College (A+ Guarantee)
Q2: A patient with left-sided heart failure is receiving furosemide 40 mg IV. Which finding indicates the
medication is having the intended therapeutic effect?
Competency: Heart Failure - Pharmacology
A. Potassium 5.2 mEq/L
B. Urine output of 320 mL in 2 hours [CORRECT]
C. Blood pressure 88/52 mmHg
D. Jugular venous distention unchanged
Correct Answer: B
Rationale: Furosemide is a loop diuretic intended to increase urine output and reduce preload; 320 mL in 2 hours indicates
effective diuresis. Hyperkalemia (A) is opposite of expected (hypokalemia from potassium loss); hypotension (C) suggests
over-diuresis; unchanged JVD (D) indicates failure to reduce venous congestion.
Q3: The nurse is caring for a patient with a pulmonary artery catheter showing a cardiac index of 1.8
L/min/m². Which finding would the nurse anticipate?
Competency: Heart Failure - Hemodynamics
A. Warm, flushed, dry skin
B. Capillary refill less than 2 seconds
C. Cool, pale extremities with weak peripheral pulses [CORRECT]
D. Urinary output of 60 mL/hr
Correct Answer: C
Rationale: A cardiac index of 1.8 L/min/m² is critically low (normal 2.5-4.0), indicating poor perfusion; cool pale extremities
and weak pulses reflect peripheral vasoconstriction from compensatory sympathetic response. Warm skin (A) and rapid capillary
refill (B) indicate adequate perfusion; urine output of 60 mL/hr (D) reflects renal perfusion that would be unlikely with such low
cardiac output.
Q4: A patient with heart failure has a new prescription for carvedilol. What is the MOST important nursing
action before administration?
Competency: Heart Failure - Pharmacology
A. Administer on an empty stomach
B. Assess heart rate and blood pressure; hold if HR <60 or systolic BP <100 [CORRECT]
C. Give with grapefruit juice to enhance absorption
D. Monitor for hyperkalemia
Correct Answer: B
Rationale: Carvedilol is a beta-blocker that reduces heart rate and blood pressure; it should be held for bradycardia (HR <60) or
hypotension (systolic <100) to avoid precipitating acute decompensation. It should be given with food (A); grapefruit juice (C)
interacts with CYP3A4 drugs, not carvedilol; hyperkalemia (D) is more relevant to ACE inhibitors or ARBs.
NUR 242 Exam 3 (2026/2027) — 110 Questions Page 2
,NUR 242 — Medical-Surgical Nursing Exam 3 • Galen College (A+ Guarantee)
Q5: A patient on telemetry shows a heart rate of 180, QRS wide and bizarre, >0.12 sec, and P waves that are
not visible. The patient is hypotensive and diaphoretic. Which dysrhythmia is MOST likely?
Competency: Dysrhythmias - Identification
A. Atrial fibrillation
B. Ventricular tachycardia [CORRECT]
C. Supraventricular tachycardia
D. First-degree AV block
Correct Answer: B
Rationale: Wide QRS (>0.12 sec), rate >100, absent P waves, and hemodynamic instability are classic for ventricular
tachycardia. Atrial fibrillation (A) has irregularly irregular rhythm with fibrillatory waves; SVT (C) has narrow QRS; first-degree
AV block (D) has prolonged PR interval with normal rate. Unstable VT requires immediate synchronized cardioversion.
Q6: The nurse observes the rhythm below: no P waves, irregularly irregular R-R intervals, rate 130. Which
complication is this patient at HIGHEST risk for?
Competency: Dysrhythmias - Complications
A. Pulmonary embolism
B. Ischemic stroke from atrial thrombus [CORRECT]
C. Ventricular fibrillation
D. Cardiac tamponade
Correct Answer: B
Rationale: Atrial fibrillation (no P waves, irregularly irregular rhythm) causes blood stasis in the atria, leading to thrombus
formation and a 5x increased risk of ischemic stroke. PE (A) is not directly caused by AFib; V-fib (C) is a separate lethal rhythm;
tamponade (D) is unrelated. Anticoagulation (CHA2DS2-VASc score) is essential for stroke prevention.
Q7: A patient presents with chest pain rated 8/10, diaphoresis, and nausea. The 12-lead ECG shows ST
elevation in leads II, III, and aVF. Which area of the heart is experiencing injury?
Competency: ACS - ECG Interpretation
A. Anterior wall
B. Inferior wall [CORRECT]
C. Lateral wall
D. Septal wall
Correct Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall MI, typically caused by occlusion of the right coronary
artery. Anterior (A) is V1-V4; lateral (C) is I, aVL, V5-V6; septal (D) is V1-V2. Inferior MI may cause bradycardia and right
ventricular involvement; nitroglycerin must be used cautiously with right-sided MI due to preload dependence.
NUR 242 Exam 3 (2026/2027) — 110 Questions Page 3
, NUR 242 — Medical-Surgical Nursing Exam 3 • Galen College (A+ Guarantee)
Q8: A patient with chest pain is receiving nitroglycerin sublingual 0.4 mg every 5 minutes. After the second
dose, blood pressure drops to 88/52. What is the PRIORITY nursing action?
Competency: ACS - Pharmacology
A. Administer the third dose to relieve pain
B. Withhold the next dose and place patient supine [CORRECT]
C. Administer aspirin 325 mg chewable
D. Increase IV fluids to 250 mL/hr
Correct Answer: B
Rationale: Nitroglycerin causes vasodilation and hypotension; with systolic BP <90, the nurse must withhold the next dose and
place the patient supine to improve venous return and blood pressure. Administering another dose (A) would worsen hypotension;
aspirin (C) is appropriate but not the priority; fluid bolus (D) may be needed after positioning but the immediate action is
withholding and positioning.
Q9: A patient post-PCI with stent placement is being discharged on clopidogrel and aspirin. What is the
MOST critical teaching point?
Competency: ACS - Patient Teaching
A. Stop clopidogrel after 2 weeks to prevent bleeding
B. Do not stop clopidogrel without cardiologist approval; prevents in-stent thrombosis [CORRECT]
C. Take clopidogrel only when chest pain occurs
D. Switch to ibuprofen for headache instead of acetaminophen
Correct Answer: B
Rationale: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is essential for at least 12 months post-stent to prevent
life-threatening stent thrombosis; premature discontinuation dramatically increases MI risk. Stopping at 2 weeks (A) is dangerous;
clopidogrel (C) is prophylactic not PRN; ibuprofen (D) increases bleeding risk with antiplatelets and should be avoided.
Q10: A patient with peripheral arterial disease has an ankle-brachial index of 0.5. Which clinical
manifestation would the nurse expect to find?
Competency: Vascular Disorders - Assessment
A. Brown pigmentation around the ankles
B. Intermittent claudication progressing to rest pain [CORRECT]
C. Edema and warm extremities
D. Ulcers with irregular borders around the malleolus
Correct Answer: B
Rationale: An ABI of 0.5 indicates severe PAD; classic symptoms include intermittent claudication progressing to rest pain, with
cool pale extremities and decreased pulses. Brown pigmentation (A) and edema (C) are venous insufficiency signs; venous ulcers
(D) appear near the malleolus with irregular borders, while arterial ulcers are punch-out, painful, on toes.
NUR 242 Exam 3 (2026/2027) — 110 Questions Page 4
NUR 242 Exam 3 ()
Medical-Surgical Nursing — Galen College of Nursing (A+ Guarantee)
Comprehensive Practice Exam • 110 Multiple-Choice Questions
Cardiovascular • Respiratory • Neurological • Renal • Endocrine • GI • Musculoskeletal • Emergency & Prioritization
Instructions: This comprehensive practice exam assesses mastery of medical-surgical nursing content aligned with the
Galen College of Nursing NUR 242 Exam 3 blueprint for the 2026/2027 academic year. Each question presents four
options (A–D) with exactly one correct answer. The correct option is flagged [CORRECT], followed by a clinical rationale
integrating pathophysiology, assessment priorities, nursing interventions, and pharmacology. Cognitive distribution: 30%
recall, 50% application, 20% analysis. Question styles include scenario-based clinical judgment, lab value interpretation,
rhythm interpretation, medication safety and calculations, delegation and scope of practice, and commonly confused
concept pairs (Heart failure vs. COPD exacerbation, DKA vs. HHS, AKI vs. CKD, Stroke vs. Seizure). Use this exam for
self-assessment, targeted review, and A+ competency verification.
Section Topic Questions
Section 1 Cardiovascular System Q1–Q18
Section 2 Respiratory System Q19–Q34
Section 3 Neurological System Q35–Q49
Section 4 Renal and Urinary System Q50–Q63
Section 5 Endocrine System Q64–Q77
Section 6 Gastrointestinal System Q78–Q91
Section 7 Musculoskeletal and Integumentary Systems Q92–Q101
Section 8 Emergency, Critical Care, and Prioritization Q102–Q110
Total All medical-surgical nursing competencies 110
Section 1: Cardiovascular System
Heart Failure, Dysrhythmias, ACS, & Vascular Disorders (Q1-Q18)
Q1: A 68-year-old patient is admitted with acute decompensated heart failure. Which assessment finding is
the MOST reliable indicator of worsening cardiac output?
Competency: Heart Failure - Assessment
A. Bilateral crackles in the lung bases
B. Weight gain of 1.5 kg overnight despite diuretics [CORRECT]
C. Fatigue reported when ambulating to the bathroom
D. Heart rate of 92 bpm and irregular
Correct Answer: B
Rationale: Rapid weight gain (1-2 kg/day) is the most sensitive indicator of fluid retention and worsening heart failure, reflecting
net fluid accumulation before crackles or dyspnea appear. Crackles (A) indicate pulmonary congestion but occur later; fatigue (C)
is nonspecific; tachycardia (D) may have many causes. Daily weights are the gold standard for HF monitoring.
NUR 242 Exam 3 (2026/2027) — 110 Questions Page 1
,NUR 242 — Medical-Surgical Nursing Exam 3 • Galen College (A+ Guarantee)
Q2: A patient with left-sided heart failure is receiving furosemide 40 mg IV. Which finding indicates the
medication is having the intended therapeutic effect?
Competency: Heart Failure - Pharmacology
A. Potassium 5.2 mEq/L
B. Urine output of 320 mL in 2 hours [CORRECT]
C. Blood pressure 88/52 mmHg
D. Jugular venous distention unchanged
Correct Answer: B
Rationale: Furosemide is a loop diuretic intended to increase urine output and reduce preload; 320 mL in 2 hours indicates
effective diuresis. Hyperkalemia (A) is opposite of expected (hypokalemia from potassium loss); hypotension (C) suggests
over-diuresis; unchanged JVD (D) indicates failure to reduce venous congestion.
Q3: The nurse is caring for a patient with a pulmonary artery catheter showing a cardiac index of 1.8
L/min/m². Which finding would the nurse anticipate?
Competency: Heart Failure - Hemodynamics
A. Warm, flushed, dry skin
B. Capillary refill less than 2 seconds
C. Cool, pale extremities with weak peripheral pulses [CORRECT]
D. Urinary output of 60 mL/hr
Correct Answer: C
Rationale: A cardiac index of 1.8 L/min/m² is critically low (normal 2.5-4.0), indicating poor perfusion; cool pale extremities
and weak pulses reflect peripheral vasoconstriction from compensatory sympathetic response. Warm skin (A) and rapid capillary
refill (B) indicate adequate perfusion; urine output of 60 mL/hr (D) reflects renal perfusion that would be unlikely with such low
cardiac output.
Q4: A patient with heart failure has a new prescription for carvedilol. What is the MOST important nursing
action before administration?
Competency: Heart Failure - Pharmacology
A. Administer on an empty stomach
B. Assess heart rate and blood pressure; hold if HR <60 or systolic BP <100 [CORRECT]
C. Give with grapefruit juice to enhance absorption
D. Monitor for hyperkalemia
Correct Answer: B
Rationale: Carvedilol is a beta-blocker that reduces heart rate and blood pressure; it should be held for bradycardia (HR <60) or
hypotension (systolic <100) to avoid precipitating acute decompensation. It should be given with food (A); grapefruit juice (C)
interacts with CYP3A4 drugs, not carvedilol; hyperkalemia (D) is more relevant to ACE inhibitors or ARBs.
NUR 242 Exam 3 (2026/2027) — 110 Questions Page 2
,NUR 242 — Medical-Surgical Nursing Exam 3 • Galen College (A+ Guarantee)
Q5: A patient on telemetry shows a heart rate of 180, QRS wide and bizarre, >0.12 sec, and P waves that are
not visible. The patient is hypotensive and diaphoretic. Which dysrhythmia is MOST likely?
Competency: Dysrhythmias - Identification
A. Atrial fibrillation
B. Ventricular tachycardia [CORRECT]
C. Supraventricular tachycardia
D. First-degree AV block
Correct Answer: B
Rationale: Wide QRS (>0.12 sec), rate >100, absent P waves, and hemodynamic instability are classic for ventricular
tachycardia. Atrial fibrillation (A) has irregularly irregular rhythm with fibrillatory waves; SVT (C) has narrow QRS; first-degree
AV block (D) has prolonged PR interval with normal rate. Unstable VT requires immediate synchronized cardioversion.
Q6: The nurse observes the rhythm below: no P waves, irregularly irregular R-R intervals, rate 130. Which
complication is this patient at HIGHEST risk for?
Competency: Dysrhythmias - Complications
A. Pulmonary embolism
B. Ischemic stroke from atrial thrombus [CORRECT]
C. Ventricular fibrillation
D. Cardiac tamponade
Correct Answer: B
Rationale: Atrial fibrillation (no P waves, irregularly irregular rhythm) causes blood stasis in the atria, leading to thrombus
formation and a 5x increased risk of ischemic stroke. PE (A) is not directly caused by AFib; V-fib (C) is a separate lethal rhythm;
tamponade (D) is unrelated. Anticoagulation (CHA2DS2-VASc score) is essential for stroke prevention.
Q7: A patient presents with chest pain rated 8/10, diaphoresis, and nausea. The 12-lead ECG shows ST
elevation in leads II, III, and aVF. Which area of the heart is experiencing injury?
Competency: ACS - ECG Interpretation
A. Anterior wall
B. Inferior wall [CORRECT]
C. Lateral wall
D. Septal wall
Correct Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall MI, typically caused by occlusion of the right coronary
artery. Anterior (A) is V1-V4; lateral (C) is I, aVL, V5-V6; septal (D) is V1-V2. Inferior MI may cause bradycardia and right
ventricular involvement; nitroglycerin must be used cautiously with right-sided MI due to preload dependence.
NUR 242 Exam 3 (2026/2027) — 110 Questions Page 3
, NUR 242 — Medical-Surgical Nursing Exam 3 • Galen College (A+ Guarantee)
Q8: A patient with chest pain is receiving nitroglycerin sublingual 0.4 mg every 5 minutes. After the second
dose, blood pressure drops to 88/52. What is the PRIORITY nursing action?
Competency: ACS - Pharmacology
A. Administer the third dose to relieve pain
B. Withhold the next dose and place patient supine [CORRECT]
C. Administer aspirin 325 mg chewable
D. Increase IV fluids to 250 mL/hr
Correct Answer: B
Rationale: Nitroglycerin causes vasodilation and hypotension; with systolic BP <90, the nurse must withhold the next dose and
place the patient supine to improve venous return and blood pressure. Administering another dose (A) would worsen hypotension;
aspirin (C) is appropriate but not the priority; fluid bolus (D) may be needed after positioning but the immediate action is
withholding and positioning.
Q9: A patient post-PCI with stent placement is being discharged on clopidogrel and aspirin. What is the
MOST critical teaching point?
Competency: ACS - Patient Teaching
A. Stop clopidogrel after 2 weeks to prevent bleeding
B. Do not stop clopidogrel without cardiologist approval; prevents in-stent thrombosis [CORRECT]
C. Take clopidogrel only when chest pain occurs
D. Switch to ibuprofen for headache instead of acetaminophen
Correct Answer: B
Rationale: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is essential for at least 12 months post-stent to prevent
life-threatening stent thrombosis; premature discontinuation dramatically increases MI risk. Stopping at 2 weeks (A) is dangerous;
clopidogrel (C) is prophylactic not PRN; ibuprofen (D) increases bleeding risk with antiplatelets and should be avoided.
Q10: A patient with peripheral arterial disease has an ankle-brachial index of 0.5. Which clinical
manifestation would the nurse expect to find?
Competency: Vascular Disorders - Assessment
A. Brown pigmentation around the ankles
B. Intermittent claudication progressing to rest pain [CORRECT]
C. Edema and warm extremities
D. Ulcers with irregular borders around the malleolus
Correct Answer: B
Rationale: An ABI of 0.5 indicates severe PAD; classic symptoms include intermittent claudication progressing to rest pain, with
cool pale extremities and decreased pulses. Brown pigmentation (A) and edema (C) are venous insufficiency signs; venous ulcers
(D) appear near the malleolus with irregular borders, while arterial ulcers are punch-out, painful, on toes.
NUR 242 Exam 3 (2026/2027) — 110 Questions Page 4
