NUR 242 Exam 3 | Med-Surg Nursing | Galen College of Nursing | 2026-2027 Page 1
NUR 242 Exam 3
Medical-Surgical Nursing Examination
Galen College of Nursing | 2026 - 2027 Academic Year
100 Questions | Comprehensive Assessment with Rationales
Instructions: Select the ONE best answer for each question. Each question includes the correct answer marked with
[CORRECT], the confirmed answer letter, and a comprehensive rationale with Med-Surg nursing reasoning.
Section 1: Cardiovascular Disorders (Hypertension, Heart Failure, CAD, MI, and
Dysrhythmias) (Q1-Q25)
Q1: A 52-year-old patient is diagnosed with Stage 2 hypertension per the ACC/AHA guidelines. Which blood
pressure reading supports this classification?
A. 118/76 mmHg
B. 126/82 mmHg
C. 144/92 mmHg [CORRECT]
D. 150/78 mmHg
Correct Answer: C
Rationale: Stage 2 hypertension per the ACC/AHA guidelines is defined as a systolic BP of 140 mmHg or higher, or a diastolic BP
of 90 mmHg or higher. A reading of 144/92 mmHg meets both criteria. Stage 1 is 130-139/80-89 mmHg, elevated is 120-129 with
diastolic below 80, and normal is below 120/80 mmHg.
Q2: A patient with secondary hypertension has elevated serum aldosterone levels and hypokalemia. Which
condition is the most likely cause?
A. Coarctation of the aorta
B. Primary aldosteronism (Conn syndrome) [CORRECT]
C. Pheochromocytoma
D. Renal artery stenosis
Correct Answer: B
Rationale: Primary aldosteronism is characterized by excessive aldosterone secretion, leading to sodium retention, potassium
excretion (hypokalemia), and hypertension. Pheochromocytoma presents with episodic hypertension and diaphoresis due to
catecholamine excess. Coarctation typically presents with blood pressure differences between upper and lower extremities.
Q3: The nurse is providing discharge teaching to a patient newly prescribed lisinopril, an ACE inhibitor.
Which statement indicates a need for further education?
A. I will monitor my blood pressure at home daily.
B. I will call my doctor if I develop a persistent dry cough.
C. I can use salt substitutes containing potassium to flavor my food. [CORRECT]
D. I will avoid taking NSAIDs like ibuprofen while on this medication.
Correct Answer: C
Rationale: ACE inhibitors cause potassium retention by reducing aldosterone production. Salt substitutes containing potassium
chloride significantly increase the risk of hyperkalemia, which can lead to fatal cardiac dysrhythmias. Patients must avoid
potassium-based salt substitutes and foods high in potassium.
,NUR 242 Exam 3 | Med-Surg Nursing | Galen College of Nursing | 2026-2027 Page 2
Q4: A patient with heart failure reports increasing shortness of breath when lying flat and now requires three
pillows to sleep. The nurse documents this as:
A. Paroxysmal nocturnal dyspnea (PND)
B. Orthopnea [CORRECT]
C. BiPAP tolerance
D. Cheyne-Stokes respirations
Correct Answer: B
Rationale: Orthopnea is the inability to breathe comfortably when lying flat, relieved by sitting upright. It is a classic sign of
left-sided heart failure caused by increased venous return in the supine position, increasing pulmonary congestion. PND is sudden
episodes of breathlessness that awaken the patient from sleep.
Q5: A patient with NYHA Class III heart failure is started on carvedilol. Which instruction is most important
for discharge teaching?
A. Take this medication on an empty stomach for best absorption.
B. Do not abruptly stop taking this medication; it must be tapered gradually. [CORRECT]
C. Expect a rapid improvement in exercise tolerance within the first week.
D. Increase your fluid intake to 3 liters per day.
Correct Answer: B
Rationale: Beta-blockers must never be stopped abruptly, as sudden withdrawal can cause rebound tachycardia, hypertension, and
potentially life-threatening cardiac events. Carvedilol is started at a low dose and titrated slowly upward. Fluid restriction is typically
recommended in heart failure, not increased intake.
Q6: A patient with left-sided heart failure presents with crackles, S3 gallop, and tachycardia. Which additional
finding would the nurse most likely assess?
A. Peripheral edema and JVD
B. Hepatomegaly and ascites
C. Dyspnea on exertion and fatigue [CORRECT]
D. Bruit over the abdominal aorta
Correct Answer: C
Rationale: Left-sided heart failure primarily causes pulmonary congestion resulting in dyspnea on exertion, fatigue, orthopnea,
crackles, and S3 gallop. Peripheral edema, JVD, hepatomegaly, and ascites are signs of right-sided heart failure. An abdominal
bruit suggests renal artery stenosis.
Q7: A patient with heart failure is prescribed furosemide 40 mg IV. Which lab value requires the nurse to
notify the provider before administering?
A. Sodium 138 mEq/L
B. Potassium 3.0 mEq/L [CORRECT]
C. Chloride 98 mEq/L
D. Magnesium 2.0 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic causing significant potassium excretion. A potassium level of 3.0 mEq/L indicates
hypokalemia, increasing the risk of cardiac dysrhythmias. Administering furosemide would further lower potassium. Normal
potassium is 3.5-5.0 mEq/L.
Q8: A nurse is monitoring a patient receiving digoxin for heart failure. Which finding indicates digoxin
toxicity?
A. Apical heart rate 72 bpm and BP 120/80 mmHg
B. Serum digoxin level 1.2 ng/mL and improved appetite
, NUR 242 Exam 3 | Med-Surg Nursing | Galen College of Nursing | 2026-2027 Page 3
C. Nausea, vomiting, and visual disturbances such as yellow halos around objects [CORRECT]
D. Weight loss of 2 pounds over the past week
Correct Answer: C
Rationale: Digoxin toxicity presents with GI symptoms (nausea, vomiting), visual disturbances (yellow halos, blurred vision), and
cardiac dysrhythmias. The therapeutic range is 0.8-2.0 ng/mL. A heart rate of 72 bpm and a level of 1.2 ng/mL are within normal
parameters.
Q9: A patient with heart failure asks why daily weights are necessary. Which response is most appropriate?
A. Daily weights help determine if your diet is adequate.
B. A weight gain of 2-3 pounds in a day or 3-5 pounds in a week indicates fluid retention requiring
intervention. [CORRECT]
C. Daily weights are only needed in the hospital.
D. Weight monitoring helps track exercise effectiveness.
Correct Answer: B
Rationale: Daily weights are the most reliable indicator of fluid retention in heart failure. A sudden weight gain of 2-3 lbs/day or
3-5 lbs/week suggests worsening fluid retention even before visible edema. This allows timely intervention such as adjusting diuretic
doses.
Q10: A 62-year-old presents with substernal chest pressure radiating to the left arm and jaw that began 2 hours
ago. Which action should the nurse take FIRST?
A. Obtain a 12-lead ECG. [CORRECT]
B. Administer prescribed nitroglycerin sublingually.
C. Draw blood for cardiac biomarkers.
D. Prepare the patient for cardiac catheterization.
Correct Answer: A
Rationale: The first priority for suspected acute coronary syndrome is a 12-lead ECG to determine STEMI, NSTEMI, or unstable
angina. The ECG guides the treatment pathway. Time is critical: the door-to-ECG goal is within 10 minutes. Other interventions
follow ECG results.
Q11: A patient with stable angina is being educated on nitroglycerin. Which statement demonstrates correct
understanding?
A. I will take one tablet every 10 minutes for up to three doses.
B. I will call 911 if pain is not relieved after one tablet.
C. I will sit or lie down before taking nitroglycerin because it can cause dizziness. [CORRECT]
D. I will keep tablets in my wallet for easy access.
Correct Answer: C
Rationale: Nitroglycerin causes vasodilation leading to orthostatic hypotension and dizziness. Patients should sit or lie down before
taking it. The correct dosing is one tablet every 5 minutes, up to three doses. If pain is not relieved after the first dose, the patient
should call 911.
Q12: A patient is admitted with unstable angina. How does it differ from stable angina?
A. It is relieved by rest and nitroglycerin within minutes.
B. It occurs with a predictable pattern of exertion.
C. It is new onset, increasing in frequency, or occurs at rest, and often precedes MI. [CORRECT]
D. It is caused by coronary artery vasospasm.
Correct Answer: C
Rationale: Unstable angina is characterized by chest pain that is new, occurs at rest, increases in frequency or severity, or is not
relieved by the usual amount of nitroglycerin. It represents a critical warning sign of impending MI. Prinzmetal angina is caused by
NUR 242 Exam 3
Medical-Surgical Nursing Examination
Galen College of Nursing | 2026 - 2027 Academic Year
100 Questions | Comprehensive Assessment with Rationales
Instructions: Select the ONE best answer for each question. Each question includes the correct answer marked with
[CORRECT], the confirmed answer letter, and a comprehensive rationale with Med-Surg nursing reasoning.
Section 1: Cardiovascular Disorders (Hypertension, Heart Failure, CAD, MI, and
Dysrhythmias) (Q1-Q25)
Q1: A 52-year-old patient is diagnosed with Stage 2 hypertension per the ACC/AHA guidelines. Which blood
pressure reading supports this classification?
A. 118/76 mmHg
B. 126/82 mmHg
C. 144/92 mmHg [CORRECT]
D. 150/78 mmHg
Correct Answer: C
Rationale: Stage 2 hypertension per the ACC/AHA guidelines is defined as a systolic BP of 140 mmHg or higher, or a diastolic BP
of 90 mmHg or higher. A reading of 144/92 mmHg meets both criteria. Stage 1 is 130-139/80-89 mmHg, elevated is 120-129 with
diastolic below 80, and normal is below 120/80 mmHg.
Q2: A patient with secondary hypertension has elevated serum aldosterone levels and hypokalemia. Which
condition is the most likely cause?
A. Coarctation of the aorta
B. Primary aldosteronism (Conn syndrome) [CORRECT]
C. Pheochromocytoma
D. Renal artery stenosis
Correct Answer: B
Rationale: Primary aldosteronism is characterized by excessive aldosterone secretion, leading to sodium retention, potassium
excretion (hypokalemia), and hypertension. Pheochromocytoma presents with episodic hypertension and diaphoresis due to
catecholamine excess. Coarctation typically presents with blood pressure differences between upper and lower extremities.
Q3: The nurse is providing discharge teaching to a patient newly prescribed lisinopril, an ACE inhibitor.
Which statement indicates a need for further education?
A. I will monitor my blood pressure at home daily.
B. I will call my doctor if I develop a persistent dry cough.
C. I can use salt substitutes containing potassium to flavor my food. [CORRECT]
D. I will avoid taking NSAIDs like ibuprofen while on this medication.
Correct Answer: C
Rationale: ACE inhibitors cause potassium retention by reducing aldosterone production. Salt substitutes containing potassium
chloride significantly increase the risk of hyperkalemia, which can lead to fatal cardiac dysrhythmias. Patients must avoid
potassium-based salt substitutes and foods high in potassium.
,NUR 242 Exam 3 | Med-Surg Nursing | Galen College of Nursing | 2026-2027 Page 2
Q4: A patient with heart failure reports increasing shortness of breath when lying flat and now requires three
pillows to sleep. The nurse documents this as:
A. Paroxysmal nocturnal dyspnea (PND)
B. Orthopnea [CORRECT]
C. BiPAP tolerance
D. Cheyne-Stokes respirations
Correct Answer: B
Rationale: Orthopnea is the inability to breathe comfortably when lying flat, relieved by sitting upright. It is a classic sign of
left-sided heart failure caused by increased venous return in the supine position, increasing pulmonary congestion. PND is sudden
episodes of breathlessness that awaken the patient from sleep.
Q5: A patient with NYHA Class III heart failure is started on carvedilol. Which instruction is most important
for discharge teaching?
A. Take this medication on an empty stomach for best absorption.
B. Do not abruptly stop taking this medication; it must be tapered gradually. [CORRECT]
C. Expect a rapid improvement in exercise tolerance within the first week.
D. Increase your fluid intake to 3 liters per day.
Correct Answer: B
Rationale: Beta-blockers must never be stopped abruptly, as sudden withdrawal can cause rebound tachycardia, hypertension, and
potentially life-threatening cardiac events. Carvedilol is started at a low dose and titrated slowly upward. Fluid restriction is typically
recommended in heart failure, not increased intake.
Q6: A patient with left-sided heart failure presents with crackles, S3 gallop, and tachycardia. Which additional
finding would the nurse most likely assess?
A. Peripheral edema and JVD
B. Hepatomegaly and ascites
C. Dyspnea on exertion and fatigue [CORRECT]
D. Bruit over the abdominal aorta
Correct Answer: C
Rationale: Left-sided heart failure primarily causes pulmonary congestion resulting in dyspnea on exertion, fatigue, orthopnea,
crackles, and S3 gallop. Peripheral edema, JVD, hepatomegaly, and ascites are signs of right-sided heart failure. An abdominal
bruit suggests renal artery stenosis.
Q7: A patient with heart failure is prescribed furosemide 40 mg IV. Which lab value requires the nurse to
notify the provider before administering?
A. Sodium 138 mEq/L
B. Potassium 3.0 mEq/L [CORRECT]
C. Chloride 98 mEq/L
D. Magnesium 2.0 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic causing significant potassium excretion. A potassium level of 3.0 mEq/L indicates
hypokalemia, increasing the risk of cardiac dysrhythmias. Administering furosemide would further lower potassium. Normal
potassium is 3.5-5.0 mEq/L.
Q8: A nurse is monitoring a patient receiving digoxin for heart failure. Which finding indicates digoxin
toxicity?
A. Apical heart rate 72 bpm and BP 120/80 mmHg
B. Serum digoxin level 1.2 ng/mL and improved appetite
, NUR 242 Exam 3 | Med-Surg Nursing | Galen College of Nursing | 2026-2027 Page 3
C. Nausea, vomiting, and visual disturbances such as yellow halos around objects [CORRECT]
D. Weight loss of 2 pounds over the past week
Correct Answer: C
Rationale: Digoxin toxicity presents with GI symptoms (nausea, vomiting), visual disturbances (yellow halos, blurred vision), and
cardiac dysrhythmias. The therapeutic range is 0.8-2.0 ng/mL. A heart rate of 72 bpm and a level of 1.2 ng/mL are within normal
parameters.
Q9: A patient with heart failure asks why daily weights are necessary. Which response is most appropriate?
A. Daily weights help determine if your diet is adequate.
B. A weight gain of 2-3 pounds in a day or 3-5 pounds in a week indicates fluid retention requiring
intervention. [CORRECT]
C. Daily weights are only needed in the hospital.
D. Weight monitoring helps track exercise effectiveness.
Correct Answer: B
Rationale: Daily weights are the most reliable indicator of fluid retention in heart failure. A sudden weight gain of 2-3 lbs/day or
3-5 lbs/week suggests worsening fluid retention even before visible edema. This allows timely intervention such as adjusting diuretic
doses.
Q10: A 62-year-old presents with substernal chest pressure radiating to the left arm and jaw that began 2 hours
ago. Which action should the nurse take FIRST?
A. Obtain a 12-lead ECG. [CORRECT]
B. Administer prescribed nitroglycerin sublingually.
C. Draw blood for cardiac biomarkers.
D. Prepare the patient for cardiac catheterization.
Correct Answer: A
Rationale: The first priority for suspected acute coronary syndrome is a 12-lead ECG to determine STEMI, NSTEMI, or unstable
angina. The ECG guides the treatment pathway. Time is critical: the door-to-ECG goal is within 10 minutes. Other interventions
follow ECG results.
Q11: A patient with stable angina is being educated on nitroglycerin. Which statement demonstrates correct
understanding?
A. I will take one tablet every 10 minutes for up to three doses.
B. I will call 911 if pain is not relieved after one tablet.
C. I will sit or lie down before taking nitroglycerin because it can cause dizziness. [CORRECT]
D. I will keep tablets in my wallet for easy access.
Correct Answer: C
Rationale: Nitroglycerin causes vasodilation leading to orthostatic hypotension and dizziness. Patients should sit or lie down before
taking it. The correct dosing is one tablet every 5 minutes, up to three doses. If pain is not relieved after the first dose, the patient
should call 911.
Q12: A patient is admitted with unstable angina. How does it differ from stable angina?
A. It is relieved by rest and nitroglycerin within minutes.
B. It occurs with a predictable pattern of exertion.
C. It is new onset, increasing in frequency, or occurs at rest, and often precedes MI. [CORRECT]
D. It is caused by coronary artery vasospasm.
Correct Answer: C
Rationale: Unstable angina is characterized by chest pain that is new, occurs at rest, increases in frequency or severity, or is not
relieved by the usual amount of nitroglycerin. It represents a critical warning sign of impending MI. Prinzmetal angina is caused by
