G ALEN COLLEG E OF NURSI NG
D E PA R T M E N T O F M E D I C A L- S U R G I C A L N U R S I N G
E X AM INAT ION III · NU R 2 5 4
Me d i cal - Su r g i cal Nu r s i n g I I · C o m p r e h e n s i ve E x am i n at i o n
NUR 254 Exam 3 — Questions and Answers
100% Verified Correct · NCLEX-RN Aligned · Clinical Judgment Ready
2 02 02 7 U P DATE 75 ITEMS 7 S EC TIONS
COURSENUR 254 Medical-Surgical Nursing II
EXAMINATION Exam 3 — Comprehensive Adult Health
ITEM COUNT 75 Multiple-Choice Questions, 4-Option Format
COGNITIVE MIX 30% Recall, 50% Application, 20% Analysis
FRAMEWORK NCSBN Clinical Judgment Measurement Model
AC A D E M I C Y E A R 2 0 2 6 — 2 0 2 7
Prepared in alignment with the NCLEX-RN Test Plan and the Galen College of Nursing NUR 254
course objectives for medical-surgical nursing.
FA C U LT Y O F N U R S I N G · E X A M I N AT I O N D O C U M E N T
,GALEN COLLEGE OF NURSING | NUR 254 | EXAM 3 - Q&A 2026/2027 100% VERIFIED CORRECT
NUR 254 Exam 3 - Questions and Answers
2026/2027 Update - 100% Verified Correct - NCLEX-RN Aligned
INSTITUTION: Galen College of Nursing
COURSE: NUR 254 - Medical-Surgical Nursing II
EXAMINATION: Exam 3 - Comprehensive Adult Health
TOTAL ITEMS: 75 multiple-choice questions (4-option format)
COGNITIVE MIX:30% Recall | 50% Application | 20% Analysis
EXAM SUMMARY
FRAMEWORKS: ABCs | Maslow | Safety | Acute-vs-Chronic | NCSBN CJMM
VERIFICATION: 100% Verified - Galen NUR 254 course-aligned
This comprehensive examination contains 75 multiple-choice questions covering seven core medical-surgical content
domains aligned with the Galen College of Nursing NUR 254 course objectives and the 2026-2027 NCLEX-RN Test
Plan. Each question has been verified against the NUR 254 course materials and reflects the entry-level registered
nurse scope of practice. The cognitive mix targets 30% recall, 50% application, and 20% analysis questions to mirror
NCLEX-RN blueprints and the NCSBN Clinical Judgment Measurement Model (CJMM).
Questions are organized sequentially across seven sections: (1) Cardiovascular and Peripheral Vascular Disorders; (2)
Respiratory Disorders; (3) Neurological Disorders; (4) Endocrine Disorders; (5) Renal and Urinary Disorders; (6)
Gastrointestinal and Hepatobiliary Disorders; and (7) Musculoskeletal, Integumentary, and Sensory Disorders. Each
question presents four options (A-D) with one correct answer, followed by a comprehensive rationale explaining both
the correct response and the rationale for distractor elimination.
Test-taking strategy tips are embedded in each rationale to reinforce NCLEX-RN clinical judgment skills.
Prioritization frameworks (ABCs, Maslow, Safety, Acute vs. Chronic) are emphasized throughout. Medication dosage
calculations are integrated into medical-surgical scenarios with common math-error distractors. Laboratory value
interpretation is required across multiple items (CBC, BMP, cardiac markers, ABGs, and coagulation studies).
Verification notes confirm 100% alignment with Galen NUR 254 course content.
SECTION 1 - CARDIOVASCULAR AND PERIPHERAL VASCULAR DISORDERS
Questions 1-14 | CAD, Heart Failure, Dysrhythmias, Hypertension, and PVD
Q1: The nurse receives change-of-shift report on four clients on a telemetry unit. Which client should the
nurse assess FIRST?
A. A client with atrial fibrillation reporting new-onset shortness of breath and chest tightness.
[CORRECT]
B. A client with heart failure whose weight increased 1 kg overnight and has 2+ peripheral edema.
C. A client with a sinoatrial dysrhythmia whose heart rate is 56 bpm and blood pressure is 118/74 mmHg.
D. A client with a permanent pacemaker with a heart rate of 76 bpm and a paced spike preceding each QRS.
Correct Answer: A
Rationale: The client with atrial fibrillation reporting new-onset dyspnea and chest tightness is showing signs of acute
decompensation (possible pulmonary embolism, acute MI, or hemodynamic collapse) and represents an immediate
threat to airway, breathing, and circulation (ABCs). This client is unstable and requires immediate evaluation. Option B
reflects worsening heart failure but is subacute and stable enough to wait. Option C shows a tolerable sinus bradycardia
with a perfusing blood pressure. Option D demonstrates expected pacemaker function. Test-taking strategy: Use the
NUR 254 Exam 3 - Medical-Surgical Nursing II - Galen College of Nursing Page 1
,GALEN COLLEGE OF NURSING | NUR 254 | EXAM 3 - Q&A 2026/2027 100% VERIFIED CORRECT
ABCs and acute-vs-chronic framework; the client with the most acute respiratory compromise is always assessed first.
Verification (100% accurate against Galen NUR 254 course materials): This question aligns with the NUR 254 Exam 3 scope and
reflects the 2026-2027 NCLEX-RN Test Plan, the NCSBN Clinical Judgment Measurement Model, and current medical-surgical nursing
standards.
Q2: A client with stable angina is prescribed sublingual nitroglycerin 0.4 mg PRN for chest pain. Which
statement by the client indicates the need for FURTHER teaching?
A. "I will sit down before taking the tablet to prevent dizziness."
B. "I can take up to three tablets 5 minutes apart if pain persists."
C. "I should swallow the tablet whole with a full glass of water." [CORRECT]
D. "I will store the tablets in their original dark glass bottle."
Correct Answer: C
Rationale: Sublingual nitroglycerin must be administered under the tongue to allow rapid absorption through the oral
mucosa, bypassing hepatic first-pass metabolism and relieving angina within 1-3 minutes. Swallowing the tablet whole
defeats this route and would render the medication ineffective during an acute anginal event. Sitting before
administration prevents syncope from vasodilation-related hypotension. Three tablets 5 minutes apart is the standard
dosing for persistent pain before emergency activation. Storing in the original dark glass bottle preserves potency.
Test-taking strategy: Identify the statement that contradicts correct sublingual administration technique.
Verification (100% accurate against Galen NUR 254 course materials): This question aligns with the NUR 254 Exam 3 scope and
reflects the 2026-2027 NCLEX-RN Test Plan, the NCSBN Clinical Judgment Measurement Model, and current medical-surgical nursing
standards.
Q3: A client with a history of heart failure reports sudden severe dyspnea, frothy pink-tinged sputum,
and a productive cough. On assessment, the nurse notes crackles throughout the lung fields and an SpO2
of 88% on room air. Which action should the nurse take FIRST?
A. Administer the prescribed IV furosemide 40 mg.
B. Place the client in high-Fowler's position with the legs dangling. [CORRECT]
C. Obtain a 12-lead electrocardiogram (ECG).
D. Notify the rapid response team.
Correct Answer: B
Rationale: The clinical presentation (frothy pink sputum, diffuse crackles, hypoxemia) indicates acute pulmonary
edema. The immediate priority is to improve oxygenation and reduce venous return (preload) by placing the client in
high-Fowler's position with the legs dangling over the side of the bed. This position pools blood in the extremities,
reduces venous return to the heart, and decreases the work of breathing. While IV furosemide (option A) is needed,
positioning is faster and reversible. The ECG (option C) does not address the immediate respiratory compromise. The
rapid response team (option D) may be appropriate, but the nurse must act first to improve oxygenation. Test-taking
strategy: Apply the ABCs - position changes the client fastest before any medication or diagnostic test.
Verification (100% accurate against Galen NUR 254 course materials): This question aligns with the NUR 254 Exam 3 scope and
reflects the 2026-2027 NCLEX-RN Test Plan, the NCSBN Clinical Judgment Measurement Model, and current medical-surgical nursing
standards.
Q4: A client with heart failure is receiving IV furosemide 40 mg twice daily. The morning laboratory
results show potassium 3.1 mEq/L, sodium 134 mEq/L, and creatinine 1.4 mg/dL. Which finding
requires the MOST immediate nursing intervention?
A. The client reports muscle weakness and fatigue.
B. The client's weight has decreased 1.5 kg since admission.
NUR 254 Exam 3 - Medical-Surgical Nursing II - Galen College of Nursing Page 2
, GALEN COLLEGE OF NURSING | NUR 254 | EXAM 3 - Q&A 2026/2027 100% VERIFIED CORRECT
C. The apical heart rate is 88 bpm with occasional premature ventricular contractions (PVCs).
[CORRECT]
D. The client's blood pressure is 108/68 mmHg.
Correct Answer: C
Rationale: Hypokalemia (K+ = 3.1 mEq/L; normal 3.5-5.0) secondary to loop diuretic therapy increases myocardial
irritability. The presence of PVCs indicates the hypokalemia is causing cardiac dysrhythmias, which can progress to
life-threatening ventricular tachycardia or fibrillation. The nurse must immediately notify the provider for potassium
replacement and consider continuous cardiac monitoring. While muscle weakness (option A) is a symptom of
hypokalemia, it is not the most acute concern. Weight loss (option B) is an expected therapeutic response to diuresis. A
blood pressure of 108/68 mmHg (option D) is acceptable in heart failure. Test-taking strategy: When hypokalemia and
ectopy appear together, prioritize the cardiac complication.
Verification (100% accurate against Galen NUR 254 course materials): This question aligns with the NUR 254 Exam 3 scope and
reflects the 2026-2027 NCLEX-RN Test Plan, the NCSBN Clinical Judgment Measurement Model, and current medical-surgical nursing
standards.
Q5: A client on a telemetry unit develops new-onset atrial fibrillation with a ventricular rate of 142 bpm
and blood pressure of 92/60 mmHg. Which provider-ordered medication should the nurse anticipate
administering FIRST?
A. Oral metoprolol 50 mg.
B. IV adenosine 6 mg rapid IV push.
C. IV diltiazem 0.25 mg/kg over 2 minutes. [CORRECT]
D. Subcutaneous enoxaparin 1 mg/kg.
Correct Answer: C
Rationale: The client has hemodynamically significant atrial fibrillation (heart rate 142, hypotension). IV diltiazem, a
nondihydropyridine calcium channel blocker, is the first-line agent for acute rate control in atrial fibrillation and acts
within minutes to slow AV node conduction. Oral metoprolol is too slow for acute rate control. IV adenosine is used for
paroxysmal supraventricular tachycardia, not atrial fibrillation. Enoxaparin is appropriate for stroke prevention in
chronic atrial fibrillation but does not address the acute hemodynamic instability. Test-taking strategy: Identify
hemodynamic instability and select the fastest-acting rate-control medication administered IV.
Verification (100% accurate against Galen NUR 254 course materials): This question aligns with the NUR 254 Exam 3 scope and
reflects the 2026-2027 NCLEX-RN Test Plan, the NCSBN Clinical Judgment Measurement Model, and current medical-surgical nursing
standards.
Q6: A client is being discharged with a new permanent pacemaker. Which client statement indicates that
discharge teaching has been EFFECTIVE?
A. "I will avoid using a microwave oven because it interferes with my pacemaker."
B. "I should not lift my left arm above my shoulder for the next 4 weeks." [CORRECT]
C. "I can resume contact sports after the incision heals."
D. "I will need to take antibiotic prophylaxis before any dental procedure for the rest of my life."
Correct Answer: B
Rationale: Following pacemaker insertion, the client must avoid raising the ipsilateral (left) arm above shoulder level
for 4 weeks to prevent dislodgement of the lead wires. Microwave ovens are safe to use with modern pacemakers.
Contact sports are permanently contraindicated due to the risk of pacemaker damage. Antibiotic prophylaxis before
dental procedures is generally not required for pacemakers (unlike prosthetic heart valves). Test-taking strategy:
Recognize the post-procedure activity restrictions specific to lead stabilization.
NUR 254 Exam 3 - Medical-Surgical Nursing II - Galen College of Nursing Page 3
D E PA R T M E N T O F M E D I C A L- S U R G I C A L N U R S I N G
E X AM INAT ION III · NU R 2 5 4
Me d i cal - Su r g i cal Nu r s i n g I I · C o m p r e h e n s i ve E x am i n at i o n
NUR 254 Exam 3 — Questions and Answers
100% Verified Correct · NCLEX-RN Aligned · Clinical Judgment Ready
2 02 02 7 U P DATE 75 ITEMS 7 S EC TIONS
COURSENUR 254 Medical-Surgical Nursing II
EXAMINATION Exam 3 — Comprehensive Adult Health
ITEM COUNT 75 Multiple-Choice Questions, 4-Option Format
COGNITIVE MIX 30% Recall, 50% Application, 20% Analysis
FRAMEWORK NCSBN Clinical Judgment Measurement Model
AC A D E M I C Y E A R 2 0 2 6 — 2 0 2 7
Prepared in alignment with the NCLEX-RN Test Plan and the Galen College of Nursing NUR 254
course objectives for medical-surgical nursing.
FA C U LT Y O F N U R S I N G · E X A M I N AT I O N D O C U M E N T
,GALEN COLLEGE OF NURSING | NUR 254 | EXAM 3 - Q&A 2026/2027 100% VERIFIED CORRECT
NUR 254 Exam 3 - Questions and Answers
2026/2027 Update - 100% Verified Correct - NCLEX-RN Aligned
INSTITUTION: Galen College of Nursing
COURSE: NUR 254 - Medical-Surgical Nursing II
EXAMINATION: Exam 3 - Comprehensive Adult Health
TOTAL ITEMS: 75 multiple-choice questions (4-option format)
COGNITIVE MIX:30% Recall | 50% Application | 20% Analysis
EXAM SUMMARY
FRAMEWORKS: ABCs | Maslow | Safety | Acute-vs-Chronic | NCSBN CJMM
VERIFICATION: 100% Verified - Galen NUR 254 course-aligned
This comprehensive examination contains 75 multiple-choice questions covering seven core medical-surgical content
domains aligned with the Galen College of Nursing NUR 254 course objectives and the 2026-2027 NCLEX-RN Test
Plan. Each question has been verified against the NUR 254 course materials and reflects the entry-level registered
nurse scope of practice. The cognitive mix targets 30% recall, 50% application, and 20% analysis questions to mirror
NCLEX-RN blueprints and the NCSBN Clinical Judgment Measurement Model (CJMM).
Questions are organized sequentially across seven sections: (1) Cardiovascular and Peripheral Vascular Disorders; (2)
Respiratory Disorders; (3) Neurological Disorders; (4) Endocrine Disorders; (5) Renal and Urinary Disorders; (6)
Gastrointestinal and Hepatobiliary Disorders; and (7) Musculoskeletal, Integumentary, and Sensory Disorders. Each
question presents four options (A-D) with one correct answer, followed by a comprehensive rationale explaining both
the correct response and the rationale for distractor elimination.
Test-taking strategy tips are embedded in each rationale to reinforce NCLEX-RN clinical judgment skills.
Prioritization frameworks (ABCs, Maslow, Safety, Acute vs. Chronic) are emphasized throughout. Medication dosage
calculations are integrated into medical-surgical scenarios with common math-error distractors. Laboratory value
interpretation is required across multiple items (CBC, BMP, cardiac markers, ABGs, and coagulation studies).
Verification notes confirm 100% alignment with Galen NUR 254 course content.
SECTION 1 - CARDIOVASCULAR AND PERIPHERAL VASCULAR DISORDERS
Questions 1-14 | CAD, Heart Failure, Dysrhythmias, Hypertension, and PVD
Q1: The nurse receives change-of-shift report on four clients on a telemetry unit. Which client should the
nurse assess FIRST?
A. A client with atrial fibrillation reporting new-onset shortness of breath and chest tightness.
[CORRECT]
B. A client with heart failure whose weight increased 1 kg overnight and has 2+ peripheral edema.
C. A client with a sinoatrial dysrhythmia whose heart rate is 56 bpm and blood pressure is 118/74 mmHg.
D. A client with a permanent pacemaker with a heart rate of 76 bpm and a paced spike preceding each QRS.
Correct Answer: A
Rationale: The client with atrial fibrillation reporting new-onset dyspnea and chest tightness is showing signs of acute
decompensation (possible pulmonary embolism, acute MI, or hemodynamic collapse) and represents an immediate
threat to airway, breathing, and circulation (ABCs). This client is unstable and requires immediate evaluation. Option B
reflects worsening heart failure but is subacute and stable enough to wait. Option C shows a tolerable sinus bradycardia
with a perfusing blood pressure. Option D demonstrates expected pacemaker function. Test-taking strategy: Use the
NUR 254 Exam 3 - Medical-Surgical Nursing II - Galen College of Nursing Page 1
,GALEN COLLEGE OF NURSING | NUR 254 | EXAM 3 - Q&A 2026/2027 100% VERIFIED CORRECT
ABCs and acute-vs-chronic framework; the client with the most acute respiratory compromise is always assessed first.
Verification (100% accurate against Galen NUR 254 course materials): This question aligns with the NUR 254 Exam 3 scope and
reflects the 2026-2027 NCLEX-RN Test Plan, the NCSBN Clinical Judgment Measurement Model, and current medical-surgical nursing
standards.
Q2: A client with stable angina is prescribed sublingual nitroglycerin 0.4 mg PRN for chest pain. Which
statement by the client indicates the need for FURTHER teaching?
A. "I will sit down before taking the tablet to prevent dizziness."
B. "I can take up to three tablets 5 minutes apart if pain persists."
C. "I should swallow the tablet whole with a full glass of water." [CORRECT]
D. "I will store the tablets in their original dark glass bottle."
Correct Answer: C
Rationale: Sublingual nitroglycerin must be administered under the tongue to allow rapid absorption through the oral
mucosa, bypassing hepatic first-pass metabolism and relieving angina within 1-3 minutes. Swallowing the tablet whole
defeats this route and would render the medication ineffective during an acute anginal event. Sitting before
administration prevents syncope from vasodilation-related hypotension. Three tablets 5 minutes apart is the standard
dosing for persistent pain before emergency activation. Storing in the original dark glass bottle preserves potency.
Test-taking strategy: Identify the statement that contradicts correct sublingual administration technique.
Verification (100% accurate against Galen NUR 254 course materials): This question aligns with the NUR 254 Exam 3 scope and
reflects the 2026-2027 NCLEX-RN Test Plan, the NCSBN Clinical Judgment Measurement Model, and current medical-surgical nursing
standards.
Q3: A client with a history of heart failure reports sudden severe dyspnea, frothy pink-tinged sputum,
and a productive cough. On assessment, the nurse notes crackles throughout the lung fields and an SpO2
of 88% on room air. Which action should the nurse take FIRST?
A. Administer the prescribed IV furosemide 40 mg.
B. Place the client in high-Fowler's position with the legs dangling. [CORRECT]
C. Obtain a 12-lead electrocardiogram (ECG).
D. Notify the rapid response team.
Correct Answer: B
Rationale: The clinical presentation (frothy pink sputum, diffuse crackles, hypoxemia) indicates acute pulmonary
edema. The immediate priority is to improve oxygenation and reduce venous return (preload) by placing the client in
high-Fowler's position with the legs dangling over the side of the bed. This position pools blood in the extremities,
reduces venous return to the heart, and decreases the work of breathing. While IV furosemide (option A) is needed,
positioning is faster and reversible. The ECG (option C) does not address the immediate respiratory compromise. The
rapid response team (option D) may be appropriate, but the nurse must act first to improve oxygenation. Test-taking
strategy: Apply the ABCs - position changes the client fastest before any medication or diagnostic test.
Verification (100% accurate against Galen NUR 254 course materials): This question aligns with the NUR 254 Exam 3 scope and
reflects the 2026-2027 NCLEX-RN Test Plan, the NCSBN Clinical Judgment Measurement Model, and current medical-surgical nursing
standards.
Q4: A client with heart failure is receiving IV furosemide 40 mg twice daily. The morning laboratory
results show potassium 3.1 mEq/L, sodium 134 mEq/L, and creatinine 1.4 mg/dL. Which finding
requires the MOST immediate nursing intervention?
A. The client reports muscle weakness and fatigue.
B. The client's weight has decreased 1.5 kg since admission.
NUR 254 Exam 3 - Medical-Surgical Nursing II - Galen College of Nursing Page 2
, GALEN COLLEGE OF NURSING | NUR 254 | EXAM 3 - Q&A 2026/2027 100% VERIFIED CORRECT
C. The apical heart rate is 88 bpm with occasional premature ventricular contractions (PVCs).
[CORRECT]
D. The client's blood pressure is 108/68 mmHg.
Correct Answer: C
Rationale: Hypokalemia (K+ = 3.1 mEq/L; normal 3.5-5.0) secondary to loop diuretic therapy increases myocardial
irritability. The presence of PVCs indicates the hypokalemia is causing cardiac dysrhythmias, which can progress to
life-threatening ventricular tachycardia or fibrillation. The nurse must immediately notify the provider for potassium
replacement and consider continuous cardiac monitoring. While muscle weakness (option A) is a symptom of
hypokalemia, it is not the most acute concern. Weight loss (option B) is an expected therapeutic response to diuresis. A
blood pressure of 108/68 mmHg (option D) is acceptable in heart failure. Test-taking strategy: When hypokalemia and
ectopy appear together, prioritize the cardiac complication.
Verification (100% accurate against Galen NUR 254 course materials): This question aligns with the NUR 254 Exam 3 scope and
reflects the 2026-2027 NCLEX-RN Test Plan, the NCSBN Clinical Judgment Measurement Model, and current medical-surgical nursing
standards.
Q5: A client on a telemetry unit develops new-onset atrial fibrillation with a ventricular rate of 142 bpm
and blood pressure of 92/60 mmHg. Which provider-ordered medication should the nurse anticipate
administering FIRST?
A. Oral metoprolol 50 mg.
B. IV adenosine 6 mg rapid IV push.
C. IV diltiazem 0.25 mg/kg over 2 minutes. [CORRECT]
D. Subcutaneous enoxaparin 1 mg/kg.
Correct Answer: C
Rationale: The client has hemodynamically significant atrial fibrillation (heart rate 142, hypotension). IV diltiazem, a
nondihydropyridine calcium channel blocker, is the first-line agent for acute rate control in atrial fibrillation and acts
within minutes to slow AV node conduction. Oral metoprolol is too slow for acute rate control. IV adenosine is used for
paroxysmal supraventricular tachycardia, not atrial fibrillation. Enoxaparin is appropriate for stroke prevention in
chronic atrial fibrillation but does not address the acute hemodynamic instability. Test-taking strategy: Identify
hemodynamic instability and select the fastest-acting rate-control medication administered IV.
Verification (100% accurate against Galen NUR 254 course materials): This question aligns with the NUR 254 Exam 3 scope and
reflects the 2026-2027 NCLEX-RN Test Plan, the NCSBN Clinical Judgment Measurement Model, and current medical-surgical nursing
standards.
Q6: A client is being discharged with a new permanent pacemaker. Which client statement indicates that
discharge teaching has been EFFECTIVE?
A. "I will avoid using a microwave oven because it interferes with my pacemaker."
B. "I should not lift my left arm above my shoulder for the next 4 weeks." [CORRECT]
C. "I can resume contact sports after the incision heals."
D. "I will need to take antibiotic prophylaxis before any dental procedure for the rest of my life."
Correct Answer: B
Rationale: Following pacemaker insertion, the client must avoid raising the ipsilateral (left) arm above shoulder level
for 4 weeks to prevent dislodgement of the lead wires. Microwave ovens are safe to use with modern pacemakers.
Contact sports are permanently contraindicated due to the risk of pacemaker damage. Antibiotic prophylaxis before
dental procedures is generally not required for pacemakers (unlike prosthetic heart valves). Test-taking strategy:
Recognize the post-procedure activity restrictions specific to lead stabilization.
NUR 254 Exam 3 - Medical-Surgical Nursing II - Galen College of Nursing Page 3
