,NUR 242 | Exam 1 | Original Medical-Surgical Nursing Practice
NUR 242 exam 1| Medical-Surgical 2026 Update |
100% Correct – Galen College
1. Which response best reflects a culture of safety after a near miss?
A) Hide the event because no injury occurred
B) Report and analyze the event to identify system improvements without reflexive blame
C) Delete related documentation
D) Punish the first person involved without investigation
Correct Answer: Report and analyze the event to identify system improvements without reflexive blame
Rationale: Near-miss reporting helps organizations identify latent hazards and improve systems before harm
occurs.
2. Which perioperative pattern is most concerning for malignant hyperthermia?
A) Rapid hypermetabolism with rising carbon dioxide, muscle rigidity, tachycardia, and increasing
temperature
B) Mild postoperative thirst
C) Stable bradycardia after sleep
D) Isolated incisional itching
Correct Answer: Rapid hypermetabolism with rising carbon dioxide, muscle rigidity, tachycardia, and
increasing temperature
Rationale: Malignant hyperthermia is a life-threatening hypermetabolic reaction requiring immediate
recognition and treatment.
3. Which discharge action best supports safe care coordination?
A) Delay referrals until a complication occurs
B) Reconcile medications and provide understandable follow-up and emergency instructions
C) Assume the family understands the plan without checking
D) Give only the diagnosis name
Correct Answer: Reconcile medications and provide understandable follow-up and emergency
instructions
Rationale: Care coordination reduces gaps during transitions by reconciling medications, clarifying self-care
and warning signs, and connecting the patient with appropriate follow-up resources.
4. Which condition can cause metabolic alkalosis?
A) Severe diarrhea
B) Diabetic ketoacidosis
C) Prolonged vomiting with loss of gastric acid
D) Lactic acid accumulation
Correct Answer: Prolonged vomiting with loss of gastric acid
Rationale: Loss of hydrogen and chloride through vomiting can increase serum bicarbonate relative to acid.
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, NUR 242 | Exam 1 | Original Medical-Surgical Nursing Practice
5. A patient with severe hyperkalemia requires priority monitoring of which system?
A) Skin pigmentation
B) Cardiac rhythm
C) Visual acuity only
D) Hearing only
Correct Answer: Cardiac rhythm
Rationale: Hyperkalemia can cause life-threatening conduction disturbances and dysrhythmias.
6. During adult medical-surgical care, the nurse applies pulse oximetry. Which option best
supportssafe clinical decision-making?
A) Warm well-perfused fingers
B) A correctly placed sensor with good waveform
C) Poor peripheral perfusion or motion artifact
D) Stable sensor position
Correct Answer: Poor peripheral perfusion or motion artifact
Rationale: Pulse oximeters depend on adequate pulsatile blood flow and clean signal detection. Applying this
concept requires linking the patient's findings to the relevant physiologic or safety priority rather than
choosing an unrelated action.
7. During adult medical-surgical care, the nurse applies hyponatremia. Which option best
supportssafe clinical decision-making?
A) Increased hair growth
B) New confusion or seizure activity
C) Isolated toenail thickening
D) Improved alertness after exercise
Correct Answer: New confusion or seizure activity
Rationale: Low serum sodium can cause cerebral edema and neurologic dysfunction, especially when the
decline is rapid or severe. Applying this concept requires linking the patient's findings to the relevant
physiologic or safety priority rather than choosing an unrelated action.
8. Which finding suggests impaired arterial perfusion to a limb?
A) Normal sensation and color
B) Warm edema with strong pulses only
C) Symmetric warm feet with brisk refill
D) Cool pale extremity with diminished pulses and delayed capillary refill
Correct Answer: Cool pale extremity with diminished pulses and delayed capillary refill
Rationale: Arterial insufficiency reduces distal blood flow, affecting temperature, color, pulses, refill, pain, and
tissue integrity.
9. Which measure helps reduce postoperative venous thromboembolism risk?
A) Keeping the legs immobile for several days
B) Placing a pillow directly behind the knees continuously
Page 3
NUR 242 exam 1| Medical-Surgical 2026 Update |
100% Correct – Galen College
1. Which response best reflects a culture of safety after a near miss?
A) Hide the event because no injury occurred
B) Report and analyze the event to identify system improvements without reflexive blame
C) Delete related documentation
D) Punish the first person involved without investigation
Correct Answer: Report and analyze the event to identify system improvements without reflexive blame
Rationale: Near-miss reporting helps organizations identify latent hazards and improve systems before harm
occurs.
2. Which perioperative pattern is most concerning for malignant hyperthermia?
A) Rapid hypermetabolism with rising carbon dioxide, muscle rigidity, tachycardia, and increasing
temperature
B) Mild postoperative thirst
C) Stable bradycardia after sleep
D) Isolated incisional itching
Correct Answer: Rapid hypermetabolism with rising carbon dioxide, muscle rigidity, tachycardia, and
increasing temperature
Rationale: Malignant hyperthermia is a life-threatening hypermetabolic reaction requiring immediate
recognition and treatment.
3. Which discharge action best supports safe care coordination?
A) Delay referrals until a complication occurs
B) Reconcile medications and provide understandable follow-up and emergency instructions
C) Assume the family understands the plan without checking
D) Give only the diagnosis name
Correct Answer: Reconcile medications and provide understandable follow-up and emergency
instructions
Rationale: Care coordination reduces gaps during transitions by reconciling medications, clarifying self-care
and warning signs, and connecting the patient with appropriate follow-up resources.
4. Which condition can cause metabolic alkalosis?
A) Severe diarrhea
B) Diabetic ketoacidosis
C) Prolonged vomiting with loss of gastric acid
D) Lactic acid accumulation
Correct Answer: Prolonged vomiting with loss of gastric acid
Rationale: Loss of hydrogen and chloride through vomiting can increase serum bicarbonate relative to acid.
Page 2
, NUR 242 | Exam 1 | Original Medical-Surgical Nursing Practice
5. A patient with severe hyperkalemia requires priority monitoring of which system?
A) Skin pigmentation
B) Cardiac rhythm
C) Visual acuity only
D) Hearing only
Correct Answer: Cardiac rhythm
Rationale: Hyperkalemia can cause life-threatening conduction disturbances and dysrhythmias.
6. During adult medical-surgical care, the nurse applies pulse oximetry. Which option best
supportssafe clinical decision-making?
A) Warm well-perfused fingers
B) A correctly placed sensor with good waveform
C) Poor peripheral perfusion or motion artifact
D) Stable sensor position
Correct Answer: Poor peripheral perfusion or motion artifact
Rationale: Pulse oximeters depend on adequate pulsatile blood flow and clean signal detection. Applying this
concept requires linking the patient's findings to the relevant physiologic or safety priority rather than
choosing an unrelated action.
7. During adult medical-surgical care, the nurse applies hyponatremia. Which option best
supportssafe clinical decision-making?
A) Increased hair growth
B) New confusion or seizure activity
C) Isolated toenail thickening
D) Improved alertness after exercise
Correct Answer: New confusion or seizure activity
Rationale: Low serum sodium can cause cerebral edema and neurologic dysfunction, especially when the
decline is rapid or severe. Applying this concept requires linking the patient's findings to the relevant
physiologic or safety priority rather than choosing an unrelated action.
8. Which finding suggests impaired arterial perfusion to a limb?
A) Normal sensation and color
B) Warm edema with strong pulses only
C) Symmetric warm feet with brisk refill
D) Cool pale extremity with diminished pulses and delayed capillary refill
Correct Answer: Cool pale extremity with diminished pulses and delayed capillary refill
Rationale: Arterial insufficiency reduces distal blood flow, affecting temperature, color, pulses, refill, pain, and
tissue integrity.
9. Which measure helps reduce postoperative venous thromboembolism risk?
A) Keeping the legs immobile for several days
B) Placing a pillow directly behind the knees continuously
Page 3
