NUR 242 - Medical-Surgical Nursing | Exam 1 | Galen College (A+ Guarantee) | 2026/2027 Page 1
NUR 242 - Medical-Surgical Nursing
Exam 1 (2026/2027) | Galen College of Nursing | A+ Guarantee | Comprehensive Practice & Study Review
Total Questions: 110 | Cognitive Distribution: 30% Recall - 50% Application - 20% Analysis
Format: 75% Scenario-Based, 25% Direct Recall | Item Type: Multiple Choice (4 options, single best answer)
A+ Guarantee: Verified answers with detailed rationales covering pathophysiology, assessment priorities, and nursing
interventions.
Read each stem carefully. Apply clinical judgment, prioritization frameworks (ABC, Maslow, Safety), and Galen College
med-surg standards to select the single best answer.
Section 1: Foundations of Medical-Surgical Nursing (Roles, Scope, Settings, & EBP) -
Q1-Q12
Q1. A new graduate RN is orienting to a 32-bed medical-surgical unit at an acute care hospital. Which
statement by the nurse best reflects the primary role of the med-surg nurse?
A. "My main job is to carry out provider orders accurately and efficiently."
B. "I coordinate and deliver comprehensive care to adult patients with acute and chronic conditions
across the continuum." [CORRECT]
C. "I primarily perform technical procedures such as IV insertion and wound care."
D. "My role is limited to documentation and reporting changes to the provider."
Correct Answer: B
Rationale: The med-surg RN coordinates and delivers comprehensive, holistic care to adult patients with acute and chronic
conditions, integrating assessment, intervention, teaching, advocacy, and care coordination across the continuum. The other
options reduce the role to task execution, procedures, or documentation alone, missing the coordination and holistic
dimensions central to med-surg practice. Study note: the RN role is synthesis, coordination, and judgment - not task execution.
Q2. An experienced med-surg RN is caring for a 78-year-old patient with heart failure, type 2 diabetes, and
chronic kidney disease. The patient expresses fatigue and asks the nurse whether they will ever get better.
Which response best demonstrates a chronic illness care approach?
A. "Once we treat your heart failure, your other conditions will resolve."
B. "You have several chronic conditions that we will manage together to optimize your daily function
and quality of life." [CORRECT]
C. "Chronic illness is permanent, so you should focus only on accepting your limitations."
D. "Your fatigue will disappear after the hospitalization."
Correct Answer: B
Rationale: Chronic illness management focuses on optimizing function, quality of life, and self-management across time
rather than cure. The nurse acknowledges the chronic nature of the conditions and frames care as collaborative management.
The other options either falsely promise cure (A), promote passive resignation (C), or dismiss the patient's lived experience
(D). Study note: chronic care = management + function + quality of life; acute care = stabilize + cure.
Q3. A med-surg nurse implements an evidence-based fall-prevention bundle on the unit. Which statement
best describes evidence-based practice (EBP) in med-surg nursing?
A. EBP uses only the nurse's personal experience to guide interventions
B. EBP integrates best available research evidence, clinical expertise, and patient values and preferences
[CORRECT]
C. EBP relies exclusively on provider orders and hospital policy
D. EBP applies research findings without considering the individual patient
Verified Answers + A+ Rationales - Comprehensive Study Review NUR 242 Exam 1 - 110 Items
,NUR 242 - Medical-Surgical Nursing | Exam 1 | Galen College (A+ Guarantee) | 2026/2027 Page 2
Correct Answer: B
Rationale: EBP integrates three components: (1) best available external research evidence, (2) the nurse's clinical expertise,
and (3) patient values and preferences. The other options each omit at least one pillar. Study note: this triad is foundational for
Galen med-surg standards - memorize it cold.
Q4. Which acute care setting is most appropriate for a patient who requires continuous cardiac monitoring,
IV vasoactive medications, and frequent neurological checks but does not require mechanical ventilation?
A. Intensive care unit (ICU)
B. Step-down / intermediate care unit [CORRECT]
C. Skilled nursing facility (SNF)
D. Long-term acute care hospital (LTACH)
Correct Answer: B
Rationale: A step-down or intermediate care unit is designed for patients who need a level of care between general med-surg
and intensive care - such as continuous cardiac monitoring and vasoactive drips but not mechanical ventilation. The ICU is
reserved for the most critically ill; SNFs and LTACHs are for subacute, long-term needs. Study note: telemetry/step-down =
monitoring + drips, no vent; ICU = vent + multi-organ support.
Q5. A charge nurse on a med-surg unit is preparing to admit a patient transferred from the ICU. Which
information is most critical to obtain during the handoff communication using SBAR?
A. The patient's preferred meal choices and dietary restrictions
B. Current vital signs, active lines/drains/airways, code status, and pending tests/procedures
[CORRECT]
C. The patient's home medication list only
D. The name of the patient's primary care provider
Correct Answer: B
Rationale: SBAR (Situation, Background, Assessment, Recommendation) handoff must include current clinical status, active
lines/drains/airways, code status, and pending tests/procedures - these directly affect immediate safety and care continuity.
Meal preferences and home meds are important but secondary to acute clinical status. Study note: handoff priorities = airway,
lines, code status, pending tests, allergies.
Q6. A patient is admitted with acute decompensated heart failure. The nurse identifies the problem of
"Excess Fluid Volume." This is an example of which type of nursing diagnosis?
A. Actual diagnosis [CORRECT]
B. Risk diagnosis
C. Health promotion diagnosis
D. Possible diagnosis
Correct Answer: A
Rationale: An actual nursing diagnosis is supported by defining characteristics (signs and symptoms) present at the time of
assessment - here, the patient currently exhibits fluid overload. A risk diagnosis applies when the patient is vulnerable but does
not yet have symptoms; health promotion diagnoses focus on readiness to improve wellness; possible diagnoses need additional
data to confirm. Study note: actual = present signs/symptoms; risk = no symptoms but vulnerability; wellness = readiness to
enhance.
Q7. A nurse is preparing to discharge a patient after hospitalization for pneumonia. Which action best
reflects the coordination of care across the continuum?
A. Telling the patient to follow up with their primary care provider when they feel better
B. Arranging home health services, providing written discharge instructions, scheduling a follow-up
appointment, and reconciling medications [CORRECT]
C. Giving the patient a printed prescription and asking them to fill it on their own
D. Asking the patient's family to arrange transportation home
Verified Answers + A+ Rationales - Comprehensive Study Review NUR 242 Exam 1 - 110 Items
, NUR 242 - Medical-Surgical Nursing | Exam 1 | Galen College (A+ Guarantee) | 2026/2027 Page 3
Correct Answer: B
Rationale: Effective care coordination at discharge includes arranging any needed home health services, providing written
and verbal discharge instructions, scheduling a follow-up appointment, and performing medication reconciliation - all of
which reduce readmission risk. The other options leave critical gaps that increase readmission likelihood. Study note: Galen
prioritizes discharge planning as core med-surg content - remember "MASTAR" - Meds, Appointment, Services, Teaching,
Advice, Return precautions.
Q8. A med-surg RN working night shift notices that a confused elderly patient has been placed in wrist
restraints by the prior shift for safety. Which action by the nurse is most appropriate?
A. Leave the restraints in place until the provider's order expires
B. Assess the patient, attempt alternative de-escalation measures, and ensure the original restraint order
is current and re-evaluated per facility policy [CORRECT]
C. Immediately remove the restraints without assessment
D. Apply additional restraints to prevent the patient from falling
Correct Answer: B
Rationale: Restraints must be reassessed each shift, with the least restrictive alternative tried first, the provider order verified
as current, and ongoing evaluation per facility policy. Leaving restraints in place without reassessment (A) violates standards,
removing them without assessment (C) may endanger the patient, and applying more restraints (D) is never appropriate
without reassessment. Study note: restraints = least restrictive, time-limited, reassessed every shift, original order within 24
hours.
Q9. A new graduate RN delegates vital signs and ambulation assistance to a licensed practical nurse (LPN)
and patient feeding to unlicensed assistive personnel (UAP). Which principle guides appropriate delegation in
med-surg nursing?
A. The RN retains accountability for the overall nursing care and must supervise tasks delegated to
others [CORRECT]
B. The LPN and UAP assume full accountability for delegated tasks
C. Delegation transfers all responsibility from the RN
D. The RN only delegates tasks they personally dislike
Correct Answer: A
Rationale: The Five Rights of Delegation include right task, right circumstance, right person, right direction/communication,
and right supervision/evaluation. The RN retains accountability for the overall nursing care and must supervise delegated tasks
appropriately. Delegation never transfers the RN's overall accountability. Study note: "delegate the task, not the
accountability" - the RN remains responsible for oversight and outcomes.
Q10. Which regulatory body establishes and enforces the scope of nursing practice for RNs in the state where
Galen College graduates will practice?
A. The American Nurses Association (ANA)
B. The State Board of Nursing [CORRECT]
C. The Joint Commission
D. The National Council of State Boards of Nursing (NCSBN) directly
Correct Answer: B
Rationale: The State Board of Nursing regulates nursing scope of practice within each state, including licensure, discipline,
and scope definition. The ANA provides professional standards but does not have legal regulatory authority; The Joint
Commission accredits organizations; the NCSBN coordinates national testing (NCLEX) but does not directly regulate
individual state scope. Study note: scope of practice = State Board of Nursing; accreditation = Joint Commission; professional
standards = ANA.
Q11. A med-surg nurse is caring for a patient with limited English proficiency. The patient's adult child
offers to interpret. Which action by the nurse is most appropriate?
Verified Answers + A+ Rationales - Comprehensive Study Review NUR 242 Exam 1 - 110 Items
NUR 242 - Medical-Surgical Nursing
Exam 1 (2026/2027) | Galen College of Nursing | A+ Guarantee | Comprehensive Practice & Study Review
Total Questions: 110 | Cognitive Distribution: 30% Recall - 50% Application - 20% Analysis
Format: 75% Scenario-Based, 25% Direct Recall | Item Type: Multiple Choice (4 options, single best answer)
A+ Guarantee: Verified answers with detailed rationales covering pathophysiology, assessment priorities, and nursing
interventions.
Read each stem carefully. Apply clinical judgment, prioritization frameworks (ABC, Maslow, Safety), and Galen College
med-surg standards to select the single best answer.
Section 1: Foundations of Medical-Surgical Nursing (Roles, Scope, Settings, & EBP) -
Q1-Q12
Q1. A new graduate RN is orienting to a 32-bed medical-surgical unit at an acute care hospital. Which
statement by the nurse best reflects the primary role of the med-surg nurse?
A. "My main job is to carry out provider orders accurately and efficiently."
B. "I coordinate and deliver comprehensive care to adult patients with acute and chronic conditions
across the continuum." [CORRECT]
C. "I primarily perform technical procedures such as IV insertion and wound care."
D. "My role is limited to documentation and reporting changes to the provider."
Correct Answer: B
Rationale: The med-surg RN coordinates and delivers comprehensive, holistic care to adult patients with acute and chronic
conditions, integrating assessment, intervention, teaching, advocacy, and care coordination across the continuum. The other
options reduce the role to task execution, procedures, or documentation alone, missing the coordination and holistic
dimensions central to med-surg practice. Study note: the RN role is synthesis, coordination, and judgment - not task execution.
Q2. An experienced med-surg RN is caring for a 78-year-old patient with heart failure, type 2 diabetes, and
chronic kidney disease. The patient expresses fatigue and asks the nurse whether they will ever get better.
Which response best demonstrates a chronic illness care approach?
A. "Once we treat your heart failure, your other conditions will resolve."
B. "You have several chronic conditions that we will manage together to optimize your daily function
and quality of life." [CORRECT]
C. "Chronic illness is permanent, so you should focus only on accepting your limitations."
D. "Your fatigue will disappear after the hospitalization."
Correct Answer: B
Rationale: Chronic illness management focuses on optimizing function, quality of life, and self-management across time
rather than cure. The nurse acknowledges the chronic nature of the conditions and frames care as collaborative management.
The other options either falsely promise cure (A), promote passive resignation (C), or dismiss the patient's lived experience
(D). Study note: chronic care = management + function + quality of life; acute care = stabilize + cure.
Q3. A med-surg nurse implements an evidence-based fall-prevention bundle on the unit. Which statement
best describes evidence-based practice (EBP) in med-surg nursing?
A. EBP uses only the nurse's personal experience to guide interventions
B. EBP integrates best available research evidence, clinical expertise, and patient values and preferences
[CORRECT]
C. EBP relies exclusively on provider orders and hospital policy
D. EBP applies research findings without considering the individual patient
Verified Answers + A+ Rationales - Comprehensive Study Review NUR 242 Exam 1 - 110 Items
,NUR 242 - Medical-Surgical Nursing | Exam 1 | Galen College (A+ Guarantee) | 2026/2027 Page 2
Correct Answer: B
Rationale: EBP integrates three components: (1) best available external research evidence, (2) the nurse's clinical expertise,
and (3) patient values and preferences. The other options each omit at least one pillar. Study note: this triad is foundational for
Galen med-surg standards - memorize it cold.
Q4. Which acute care setting is most appropriate for a patient who requires continuous cardiac monitoring,
IV vasoactive medications, and frequent neurological checks but does not require mechanical ventilation?
A. Intensive care unit (ICU)
B. Step-down / intermediate care unit [CORRECT]
C. Skilled nursing facility (SNF)
D. Long-term acute care hospital (LTACH)
Correct Answer: B
Rationale: A step-down or intermediate care unit is designed for patients who need a level of care between general med-surg
and intensive care - such as continuous cardiac monitoring and vasoactive drips but not mechanical ventilation. The ICU is
reserved for the most critically ill; SNFs and LTACHs are for subacute, long-term needs. Study note: telemetry/step-down =
monitoring + drips, no vent; ICU = vent + multi-organ support.
Q5. A charge nurse on a med-surg unit is preparing to admit a patient transferred from the ICU. Which
information is most critical to obtain during the handoff communication using SBAR?
A. The patient's preferred meal choices and dietary restrictions
B. Current vital signs, active lines/drains/airways, code status, and pending tests/procedures
[CORRECT]
C. The patient's home medication list only
D. The name of the patient's primary care provider
Correct Answer: B
Rationale: SBAR (Situation, Background, Assessment, Recommendation) handoff must include current clinical status, active
lines/drains/airways, code status, and pending tests/procedures - these directly affect immediate safety and care continuity.
Meal preferences and home meds are important but secondary to acute clinical status. Study note: handoff priorities = airway,
lines, code status, pending tests, allergies.
Q6. A patient is admitted with acute decompensated heart failure. The nurse identifies the problem of
"Excess Fluid Volume." This is an example of which type of nursing diagnosis?
A. Actual diagnosis [CORRECT]
B. Risk diagnosis
C. Health promotion diagnosis
D. Possible diagnosis
Correct Answer: A
Rationale: An actual nursing diagnosis is supported by defining characteristics (signs and symptoms) present at the time of
assessment - here, the patient currently exhibits fluid overload. A risk diagnosis applies when the patient is vulnerable but does
not yet have symptoms; health promotion diagnoses focus on readiness to improve wellness; possible diagnoses need additional
data to confirm. Study note: actual = present signs/symptoms; risk = no symptoms but vulnerability; wellness = readiness to
enhance.
Q7. A nurse is preparing to discharge a patient after hospitalization for pneumonia. Which action best
reflects the coordination of care across the continuum?
A. Telling the patient to follow up with their primary care provider when they feel better
B. Arranging home health services, providing written discharge instructions, scheduling a follow-up
appointment, and reconciling medications [CORRECT]
C. Giving the patient a printed prescription and asking them to fill it on their own
D. Asking the patient's family to arrange transportation home
Verified Answers + A+ Rationales - Comprehensive Study Review NUR 242 Exam 1 - 110 Items
, NUR 242 - Medical-Surgical Nursing | Exam 1 | Galen College (A+ Guarantee) | 2026/2027 Page 3
Correct Answer: B
Rationale: Effective care coordination at discharge includes arranging any needed home health services, providing written
and verbal discharge instructions, scheduling a follow-up appointment, and performing medication reconciliation - all of
which reduce readmission risk. The other options leave critical gaps that increase readmission likelihood. Study note: Galen
prioritizes discharge planning as core med-surg content - remember "MASTAR" - Meds, Appointment, Services, Teaching,
Advice, Return precautions.
Q8. A med-surg RN working night shift notices that a confused elderly patient has been placed in wrist
restraints by the prior shift for safety. Which action by the nurse is most appropriate?
A. Leave the restraints in place until the provider's order expires
B. Assess the patient, attempt alternative de-escalation measures, and ensure the original restraint order
is current and re-evaluated per facility policy [CORRECT]
C. Immediately remove the restraints without assessment
D. Apply additional restraints to prevent the patient from falling
Correct Answer: B
Rationale: Restraints must be reassessed each shift, with the least restrictive alternative tried first, the provider order verified
as current, and ongoing evaluation per facility policy. Leaving restraints in place without reassessment (A) violates standards,
removing them without assessment (C) may endanger the patient, and applying more restraints (D) is never appropriate
without reassessment. Study note: restraints = least restrictive, time-limited, reassessed every shift, original order within 24
hours.
Q9. A new graduate RN delegates vital signs and ambulation assistance to a licensed practical nurse (LPN)
and patient feeding to unlicensed assistive personnel (UAP). Which principle guides appropriate delegation in
med-surg nursing?
A. The RN retains accountability for the overall nursing care and must supervise tasks delegated to
others [CORRECT]
B. The LPN and UAP assume full accountability for delegated tasks
C. Delegation transfers all responsibility from the RN
D. The RN only delegates tasks they personally dislike
Correct Answer: A
Rationale: The Five Rights of Delegation include right task, right circumstance, right person, right direction/communication,
and right supervision/evaluation. The RN retains accountability for the overall nursing care and must supervise delegated tasks
appropriately. Delegation never transfers the RN's overall accountability. Study note: "delegate the task, not the
accountability" - the RN remains responsible for oversight and outcomes.
Q10. Which regulatory body establishes and enforces the scope of nursing practice for RNs in the state where
Galen College graduates will practice?
A. The American Nurses Association (ANA)
B. The State Board of Nursing [CORRECT]
C. The Joint Commission
D. The National Council of State Boards of Nursing (NCSBN) directly
Correct Answer: B
Rationale: The State Board of Nursing regulates nursing scope of practice within each state, including licensure, discipline,
and scope definition. The ANA provides professional standards but does not have legal regulatory authority; The Joint
Commission accredits organizations; the NCSBN coordinates national testing (NCLEX) but does not directly regulate
individual state scope. Study note: scope of practice = State Board of Nursing; accreditation = Joint Commission; professional
standards = ANA.
Q11. A med-surg nurse is caring for a patient with limited English proficiency. The patient's adult child
offers to interpret. Which action by the nurse is most appropriate?
Verified Answers + A+ Rationales - Comprehensive Study Review NUR 242 Exam 1 - 110 Items
