GALEN COLLEGE OF NURSING | NUR 242
Med-Surg Nursing
Exam 4
Comprehensive examination covering immunologic, oncologic,
endocrine, gastrointestinal, reproductive, dermatologic, and
infectious disease disorders with integrated clinical reasoning
scenarios aligned to NCLEX-RN competencies.
Academic Year:
Questions: 100 Multiple-Choice with Verified Rationales
A+ GUARANTEE | NCLEX-RN ALIGNED
,Galen NUR 242 Exam 4 | Med-Surg Nursing | 2026/2027
Galen NUR 242 Exam 4
Medical-Surgical Nursing Examination
Academic Year
Subject Details
Course NUR 242 - Medical-Surgical Nursing
Total Questions 100 Multiple-Choice Questions
Format 4 Options (A-D), One Correct Answer with Rationale
Sections 8 Content Sections + Integrated Clinical Scenarios
Cognitive Levels 30% Recall, 50% Application, 20% Analysis
Section 1: Immunologic Disorders (HIV/AIDS, Autoimmune Disorders, and
Hypersensitivity Reactions)
Q1: A patient with HIV has a CD4+ T-cell count of 180 cells/mm3. The nurse understands that this
patient meets the diagnostic criteria for which condition?
A. B. HIV infection without AIDS
B. C. AIDS (Acquired Immunodeficiency Syndrome) **[CORRECT]**
C. D. Acute retroviral syndrome **[CORRECT]**
D. A. HIV asymptomatic phase
Correct Answer: C
Rationale: The CD4+ T-cell count is the primary marker of HIV disease progression. A CD4 count below 200 cells/mm3
meets the CDC surveillance definition for AIDS regardless of the presence of opportunistic infections. This threshold
indicates severe immunosuppression, placing the patient at high risk for opportunistic infections such as Pneumocystis jirovecii
pneumonia and Kaposi's sarcoma.
Q2: A nurse is providing discharge teaching to a patient newly diagnosed with HIV who will begin
HAART. Which statement by the patient indicates the need for further teaching?
A. D. 'I should take my medications at the same time every day.' **[CORRECT]**
B. A. 'If I miss a dose, I should take a double dose the next time to catch up.' **[CORRECT]**
C. C. 'I will need regular blood tests to check my CD4 count and viral load.'
D. B. 'I understand that adhering to my medication schedule is critical to prevent drug resistance.'
Correct Answer: A
Rationale: Patients on HAART should never double up on doses after missing one, as this increases the risk of toxicity and
adverse effects. Instead, they should take the next scheduled dose at the regular time. Adherence to the prescribed regimen is
essential because missed doses promote viral replication and the development of drug-resistant strains of HIV.
Q3: Which of the following is the most common route of HIV transmission worldwide?
Galen College of Nursing Page 1
, Galen NUR 242 Exam 4 | Med-Surg Nursing | 2026/2027
A. A. Blood transfusions
B. B. Sexual contact (blood, semen, vaginal secretions) **[CORRECT]**
C. D. Sharing eating utensils
D. C. Casual contact (handshakes, hugging)
Correct Answer: B
Rationale: Sexual contact remains the most prevalent mode of HIV transmission globally, involving the exchange of blood,
semen, and vaginal secretions. HIV is not transmitted through casual contact such as hugging, handshakes, or sharing
utensils. Understanding transmission routes is critical for patient education and risk reduction counseling.
Q4: A patient with HIV presents with fever, sore throat, lymphadenopathy, and a maculopapular rash.
These manifestations are most consistent with which stage of HIV infection?
A. A. Acute retroviral syndrome (primary infection) **[CORRECT]**
B. C. AIDS-defining illness
C. B. Clinical latency (chronic infection)
D. D. End-stage HIV disease
Correct Answer: A
Rationale: Acute retroviral syndrome occurs 2 to 4 weeks after initial HIV exposure and mimics mononucleosis or influenza.
Symptoms include fever, sore throat, lymphadenopathy, and a maculopapular rash. This stage represents the period of rapid
viral replication and is highly infectious. Nurses should recognize these symptoms and facilitate early HIV testing.
Q5: A patient with AIDS is diagnosed with Pneumocystis jirovecii pneumonia (PJP). Which nursing
intervention is the highest priority?
A. D. Encourage increased oral fluid intake **[CORRECT]**
B. B. Maintain airborne precautions
C. A. Administer prescribed antibiotics (trimethoprim-sulfamethoxazole) **[CORRECT]**
D. C. Monitor for signs of fluid overload
Correct Answer: A
Rationale: PJP is an opportunistic infection that is life-threatening in immunocompromised patients. The highest priority is
initiating the prescribed treatment, typically trimethoprim-sulfamethoxazole (TMP-SMX), as the causative organism does not
respond to standard antibiotics. PJP is not transmitted person-to-person, so airborne precautions are unnecessary. Nursing
care also includes monitoring oxygenation and supporting respiratory function.
Q6: A patient receiving a blood transfusion develops urticaria, dyspnea, and hypotension within
minutes. The nurse recognizes this as which type of hypersensitivity reaction?
A. C. Type III - Immune Complex **[CORRECT]**
B. D. Type IV - Delayed Cell-Mediated
C. B. Type II - Cytotoxic
D. A. Type I - Anaphylactic (IgE-mediated) **[CORRECT]**
Correct Answer: A
Rationale: Anaphylactic transfusion reactions are Type I hypersensitivity responses mediated by IgE antibodies. They occur
rapidly (within minutes) when pre-formed IgE antibodies react with allergens in the transfused blood product. Symptoms
include urticaria, dyspnea, wheezing, hypotension, and angioedema. Immediate cessation of the transfusion and emergency
treatment with epinephrine is required.
Q7: A nurse is caring for a patient with Goodpasture syndrome. The nurse understands that this
condition is caused by which pathophysiological mechanism?
A. B. IgE-mediated mast cell degranulation
B. D. T-cell mediated delayed hypersensitivity
C. A. Immune complex deposition in tissues **[CORRECT]**
Galen College of Nursing Page 2
Med-Surg Nursing
Exam 4
Comprehensive examination covering immunologic, oncologic,
endocrine, gastrointestinal, reproductive, dermatologic, and
infectious disease disorders with integrated clinical reasoning
scenarios aligned to NCLEX-RN competencies.
Academic Year:
Questions: 100 Multiple-Choice with Verified Rationales
A+ GUARANTEE | NCLEX-RN ALIGNED
,Galen NUR 242 Exam 4 | Med-Surg Nursing | 2026/2027
Galen NUR 242 Exam 4
Medical-Surgical Nursing Examination
Academic Year
Subject Details
Course NUR 242 - Medical-Surgical Nursing
Total Questions 100 Multiple-Choice Questions
Format 4 Options (A-D), One Correct Answer with Rationale
Sections 8 Content Sections + Integrated Clinical Scenarios
Cognitive Levels 30% Recall, 50% Application, 20% Analysis
Section 1: Immunologic Disorders (HIV/AIDS, Autoimmune Disorders, and
Hypersensitivity Reactions)
Q1: A patient with HIV has a CD4+ T-cell count of 180 cells/mm3. The nurse understands that this
patient meets the diagnostic criteria for which condition?
A. B. HIV infection without AIDS
B. C. AIDS (Acquired Immunodeficiency Syndrome) **[CORRECT]**
C. D. Acute retroviral syndrome **[CORRECT]**
D. A. HIV asymptomatic phase
Correct Answer: C
Rationale: The CD4+ T-cell count is the primary marker of HIV disease progression. A CD4 count below 200 cells/mm3
meets the CDC surveillance definition for AIDS regardless of the presence of opportunistic infections. This threshold
indicates severe immunosuppression, placing the patient at high risk for opportunistic infections such as Pneumocystis jirovecii
pneumonia and Kaposi's sarcoma.
Q2: A nurse is providing discharge teaching to a patient newly diagnosed with HIV who will begin
HAART. Which statement by the patient indicates the need for further teaching?
A. D. 'I should take my medications at the same time every day.' **[CORRECT]**
B. A. 'If I miss a dose, I should take a double dose the next time to catch up.' **[CORRECT]**
C. C. 'I will need regular blood tests to check my CD4 count and viral load.'
D. B. 'I understand that adhering to my medication schedule is critical to prevent drug resistance.'
Correct Answer: A
Rationale: Patients on HAART should never double up on doses after missing one, as this increases the risk of toxicity and
adverse effects. Instead, they should take the next scheduled dose at the regular time. Adherence to the prescribed regimen is
essential because missed doses promote viral replication and the development of drug-resistant strains of HIV.
Q3: Which of the following is the most common route of HIV transmission worldwide?
Galen College of Nursing Page 1
, Galen NUR 242 Exam 4 | Med-Surg Nursing | 2026/2027
A. A. Blood transfusions
B. B. Sexual contact (blood, semen, vaginal secretions) **[CORRECT]**
C. D. Sharing eating utensils
D. C. Casual contact (handshakes, hugging)
Correct Answer: B
Rationale: Sexual contact remains the most prevalent mode of HIV transmission globally, involving the exchange of blood,
semen, and vaginal secretions. HIV is not transmitted through casual contact such as hugging, handshakes, or sharing
utensils. Understanding transmission routes is critical for patient education and risk reduction counseling.
Q4: A patient with HIV presents with fever, sore throat, lymphadenopathy, and a maculopapular rash.
These manifestations are most consistent with which stage of HIV infection?
A. A. Acute retroviral syndrome (primary infection) **[CORRECT]**
B. C. AIDS-defining illness
C. B. Clinical latency (chronic infection)
D. D. End-stage HIV disease
Correct Answer: A
Rationale: Acute retroviral syndrome occurs 2 to 4 weeks after initial HIV exposure and mimics mononucleosis or influenza.
Symptoms include fever, sore throat, lymphadenopathy, and a maculopapular rash. This stage represents the period of rapid
viral replication and is highly infectious. Nurses should recognize these symptoms and facilitate early HIV testing.
Q5: A patient with AIDS is diagnosed with Pneumocystis jirovecii pneumonia (PJP). Which nursing
intervention is the highest priority?
A. D. Encourage increased oral fluid intake **[CORRECT]**
B. B. Maintain airborne precautions
C. A. Administer prescribed antibiotics (trimethoprim-sulfamethoxazole) **[CORRECT]**
D. C. Monitor for signs of fluid overload
Correct Answer: A
Rationale: PJP is an opportunistic infection that is life-threatening in immunocompromised patients. The highest priority is
initiating the prescribed treatment, typically trimethoprim-sulfamethoxazole (TMP-SMX), as the causative organism does not
respond to standard antibiotics. PJP is not transmitted person-to-person, so airborne precautions are unnecessary. Nursing
care also includes monitoring oxygenation and supporting respiratory function.
Q6: A patient receiving a blood transfusion develops urticaria, dyspnea, and hypotension within
minutes. The nurse recognizes this as which type of hypersensitivity reaction?
A. C. Type III - Immune Complex **[CORRECT]**
B. D. Type IV - Delayed Cell-Mediated
C. B. Type II - Cytotoxic
D. A. Type I - Anaphylactic (IgE-mediated) **[CORRECT]**
Correct Answer: A
Rationale: Anaphylactic transfusion reactions are Type I hypersensitivity responses mediated by IgE antibodies. They occur
rapidly (within minutes) when pre-formed IgE antibodies react with allergens in the transfused blood product. Symptoms
include urticaria, dyspnea, wheezing, hypotension, and angioedema. Immediate cessation of the transfusion and emergency
treatment with epinephrine is required.
Q7: A nurse is caring for a patient with Goodpasture syndrome. The nurse understands that this
condition is caused by which pathophysiological mechanism?
A. B. IgE-mediated mast cell degranulation
B. D. T-cell mediated delayed hypersensitivity
C. A. Immune complex deposition in tissues **[CORRECT]**
Galen College of Nursing Page 2
