Galen NUR 242 Exams 3 – Med-Surg Concepts (2026) Actual Questions and
Answers (PDF).
Cardiovascular Disorders (1–25)
1. A patient with heart failure presents with crackles in both lung bases, S3 gallop,
and jugular venous distension. Which medication does the nurse expect to
administer first?
A. Metoprolol
B. Digoxin
C. Furosemide
D. Spironolactone
Answer: C. Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion. Metoprolol and spironolactone are long-term agents;
digoxin is second-line for symptom control.
2. A patient post-MI develops sudden hypotension, muffled heart sounds, and
distended neck veins. What is the priority action?
A. Administer nitroglycerin
B. Prepare for pericardiocentesis
C. Increase IV fluids
D. Give morphine for pain
,Answer: B. Prepare for pericardiocentesis
Rationale: These are signs of cardiac tamponade (Beck’s triad). Pericardiocentesis
relieves pressure. Nitroglycerin and fluids are contraindicated; morphine won’t
treat the tamponade.
3. The nurse is caring for a patient with unstable angina receiving IV nitroglycerin.
Which finding requires immediate action?
A. Heart rate 52 bpm
B. Blood pressure 85/50 mm Hg
C. Headache
D. Slight flushing
Answer: B. Blood pressure 85/50 mm Hg
Rationale: Nitroglycerin causes vasodilation; hypotension (SBP <90) requires dose
reduction or discontinuation. HR 52 may be acceptable; headache/flushing are
expected.
4. A patient with chronic heart failure has a potassium level of 5.8 mEq/L and is on
spironolactone. What is the nurse’s priority?
A. Administer potassium chloride
B. Hold the spironolactone and notify provider
C. Give furosemide immediately
,D. Encourage potassium-rich foods
Answer: B. Hold the spironolactone and notify provider
Rationale: Spironolactone is potassium-sparing; K+ >5.5 increases arrhythmia risk.
Hold drug, notify provider. KCl and K+ foods worsen hyperkalemia.
5. Which ECG finding is most characteristic of atrial fibrillation?
A. Absent P waves with irregularly irregular QRS complexes
B. Sawtooth flutter waves
C. Wide QRS >0.12 seconds
D. Tall peaked T waves
Answer: A. Absent P waves with irregularly irregular QRS complexes
Rationale: Atrial fibrillation has chaotic atrial activity with no discernible P waves.
Sawtooth waves are atrial flutter; wide QRS is ventricular conduction delay.
6. A patient with peripheral artery disease complains of leg pain when walking
that stops with rest. The nurse documents this as:
A. Rest pain
B. Neuropathic pain
C. Intermittent claudication
D. Venous stasis pain
, Answer: C. Intermittent claudication
Rationale: Claudication is reproducible ischemic muscle pain with exercise,
relieved by rest. Rest pain indicates severe disease.
7. Following a coronary artery bypass graft (CABG), which assessment finding
suggests cardiac tamponade?
A. Widening pulse pressure
B. Muffled heart sounds and pulsus paradoxus
C. Crackles in bilateral lung bases
D. Increased urine output
Answer: B. Muffled heart sounds and pulsus paradoxus
Rationale: Tamponade causes muffled heart sounds, pulsus paradoxus (drop in
SBP >10 with inspiration), and hypotension.
8. A patient with infective endocarditis develops sudden left-sided weakness and
slurred speech. The nurse suspects:
A. Septic emboli to the brain
B. Hypoglycemia
C. Intracranial hemorrhage
D. Vasovagal syncope
Answers (PDF).
Cardiovascular Disorders (1–25)
1. A patient with heart failure presents with crackles in both lung bases, S3 gallop,
and jugular venous distension. Which medication does the nurse expect to
administer first?
A. Metoprolol
B. Digoxin
C. Furosemide
D. Spironolactone
Answer: C. Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion. Metoprolol and spironolactone are long-term agents;
digoxin is second-line for symptom control.
2. A patient post-MI develops sudden hypotension, muffled heart sounds, and
distended neck veins. What is the priority action?
A. Administer nitroglycerin
B. Prepare for pericardiocentesis
C. Increase IV fluids
D. Give morphine for pain
,Answer: B. Prepare for pericardiocentesis
Rationale: These are signs of cardiac tamponade (Beck’s triad). Pericardiocentesis
relieves pressure. Nitroglycerin and fluids are contraindicated; morphine won’t
treat the tamponade.
3. The nurse is caring for a patient with unstable angina receiving IV nitroglycerin.
Which finding requires immediate action?
A. Heart rate 52 bpm
B. Blood pressure 85/50 mm Hg
C. Headache
D. Slight flushing
Answer: B. Blood pressure 85/50 mm Hg
Rationale: Nitroglycerin causes vasodilation; hypotension (SBP <90) requires dose
reduction or discontinuation. HR 52 may be acceptable; headache/flushing are
expected.
4. A patient with chronic heart failure has a potassium level of 5.8 mEq/L and is on
spironolactone. What is the nurse’s priority?
A. Administer potassium chloride
B. Hold the spironolactone and notify provider
C. Give furosemide immediately
,D. Encourage potassium-rich foods
Answer: B. Hold the spironolactone and notify provider
Rationale: Spironolactone is potassium-sparing; K+ >5.5 increases arrhythmia risk.
Hold drug, notify provider. KCl and K+ foods worsen hyperkalemia.
5. Which ECG finding is most characteristic of atrial fibrillation?
A. Absent P waves with irregularly irregular QRS complexes
B. Sawtooth flutter waves
C. Wide QRS >0.12 seconds
D. Tall peaked T waves
Answer: A. Absent P waves with irregularly irregular QRS complexes
Rationale: Atrial fibrillation has chaotic atrial activity with no discernible P waves.
Sawtooth waves are atrial flutter; wide QRS is ventricular conduction delay.
6. A patient with peripheral artery disease complains of leg pain when walking
that stops with rest. The nurse documents this as:
A. Rest pain
B. Neuropathic pain
C. Intermittent claudication
D. Venous stasis pain
, Answer: C. Intermittent claudication
Rationale: Claudication is reproducible ischemic muscle pain with exercise,
relieved by rest. Rest pain indicates severe disease.
7. Following a coronary artery bypass graft (CABG), which assessment finding
suggests cardiac tamponade?
A. Widening pulse pressure
B. Muffled heart sounds and pulsus paradoxus
C. Crackles in bilateral lung bases
D. Increased urine output
Answer: B. Muffled heart sounds and pulsus paradoxus
Rationale: Tamponade causes muffled heart sounds, pulsus paradoxus (drop in
SBP >10 with inspiration), and hypotension.
8. A patient with infective endocarditis develops sudden left-sided weakness and
slurred speech. The nurse suspects:
A. Septic emboli to the brain
B. Hypoglycemia
C. Intracranial hemorrhage
D. Vasovagal syncope
