NUR 242 – MEDICAL-SURGICAL NURSING EXAM 2 GALEN COLLEGE OF NURSING QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES GRADED A+ LATEST
Question 1
The nurse is monitoring the fluid volume status of a client diagnosed with heart failure who is at
high risk for fluid volume excess. Which of the following interventions is the most sensitive and
effective method for monitoring this client's fluid status?
A. Monitoring urine specific gravity once per shift.
B. Assessing skin turgor every 4 hours.
C. Weighing the client every morning before breakfast.
D. Measuring strict oral intake and output each shift.
Correct Answer: C. Weighing the client every morning before breakfast.
Rationale: Daily weight measured at the same time, on the same scale, wearing the same type of
clothing, and after the first void is the most sensitive, reliable, and objective indicator of overall
fluid volume status. Weight changes reflect acute fluid shifts much earlier and more accurately
than skin turgor (which is unreliable in older adults), I&O records (which can be prone to
measurement errors), or urine specific gravity.
Question 2
The nurse recognizes unstable angina when a patient reporting chest pain describes which pattern
of symptoms?
A. Mild chest pain that occurs only during extreme physical exertion.
B. Chest pain that is reliably relieved within 5 minutes of rest and one sublingual nitroglycerin.
C. Chest pain that occurs at rest or with minimal activity, representing a new or worsening
pattern.
D. Nocturnal calf and leg cramps that occur only while sleeping.
Correct Answer: C. Chest pain that occurs at rest or with minimal activity, representing a new
or worsening pattern.
Rationale: Unstable angina is characterized by chest pain that is unexpected, occurs at rest or
with minimal exertion, is more severe or prolonged than previous episodes, and is not reliably
relieved by rest or nitroglycerin. This indicates an unstable plaque rupture and is a precursor to a
myocardial infarction (MI), requiring immediate evaluation.
Question 3
,NUR 242 – MEDICAL-SURGICAL NURSING EXAM 2 GALEN COLLEGE OF NURSING QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES GRADED A+ LATEST
The nurse suspects left-sided heart failure rather than right-sided heart failure when observing
which clinical manifestation?
A. Jugular venous distention (JVD) and hepatomegaly.
B. Dependent bilateral pitting ankle edema.
C. Crackles on lung auscultation, orthopnea, and a cough with pink, frothy sputum.
D. Bounding peripheral pulses and rapid weight gain.
Correct Answer: C. Crackles on lung auscultation, orthopnea, and a cough with pink, frothy
sputum.
Rationale: Left-sided heart failure leads to pulmonary congestion as the left ventricle fails to
pump blood efficiently into the systemic circulation, causing blood to back up into the left atrium
and pulmonary veins. This results in fluid leaking into the alveoli, causing crackles, dyspnea,
orthopnea, and pink, frothy sputum (a sign of acute pulmonary edema). In contrast, JVD,
hepatomegaly, and dependent edema are classic signs of right-sided heart failure (systemic
venous congestion).
Question 4
A client with atrial fibrillation is discharged with a new prescription for Warfarin (Coumadin).
Which dietary instruction should the nurse include in the client's discharge teaching?
A. "Completely eliminate all green leafy vegetables from your diet."
B. "Maintain a consistent daily intake of foods rich in Vitamin K."
C. "Take a daily over-the-counter Vitamin K supplement to stabilize your blood levels."
D. "Double your Warfarin dose on days you consume salads or spinach."
Correct Answer: B. "Maintain a consistent daily intake of foods rich in Vitamin K."
Rationale: Vitamin K is the direct antidote to Warfarin. Abruptly increasing Vitamin K intake
can decrease the therapeutic effectiveness of Warfarin, while abruptly reducing Vitamin K can
dangerously increase the risk of bleeding. The key to maintaining a stable, therapeutic PT/INR is
consistency in dietary Vitamin K intake rather than complete elimination.
Question 5
,NUR 242 – MEDICAL-SURGICAL NURSING EXAM 2 GALEN COLLEGE OF NURSING QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES GRADED A+ LATEST
A client presents to the emergency department with severe chest pain radiating to the left arm.
The 12-lead electrocardiogram (ECG) reveals ST-segment elevation in leads $V_1$ through
$V_4$. Which action should the nurse prioritize first?
A. Obtain a mobile chest X-ray to rule out cardiomegaly.
B. Administer a scheduled high-fat meal to support energy levels.
C. Activate the STEMI protocol and prepare the client for immediate reperfusion therapy.
D. Encourage early ambulation to improve collateral circulation.
Correct Answer: C. Activate the STEMI protocol and prepare the client for immediate
reperfusion therapy.
Rationale: An ECG showing ST-elevation indicates a ST-elevation Myocardial Infarction
(STEMI), signifying complete coronary artery occlusion and active myocardial necrosis. "Time
is muscle." The priority intervention is rapid coronary reperfusion (via percutaneous coronary
intervention [PCI] or fibrinolytic therapy) to minimize irreversible myocardial damage.
Question 6
Which laboratory value is the most specific and sensitive marker for confirming acute
myocardial injury?
A. Creatine Kinase-MB (CK-MB)
B. Troponin I
C. Myoglobin
D. Lactate Dehydrogenase (LDH)
Correct Answer: B. Troponin I
Rationale: Troponins (specifically Troponin I and Troponin T) are highly specific proteins
found only in cardiac muscle tissue. They are released into the bloodstream following
myocardial injury. Unlike CK-MB or myoglobin, which can be elevated due to skeletal muscle
damage, Troponin I is highly specific to the heart and remains elevated for up to 10–14 days.
Question 7
In the medical management of coronary artery disease (CAD), beta-adrenergic blockers (e.g.,
Metoprolol) are frequently prescribed. What is the primary therapeutic purpose of beta-blockers
in clients with CAD?
, NUR 242 – MEDICAL-SURGICAL NURSING EXAM 2 GALEN COLLEGE OF NURSING QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES GRADED A+ LATEST
A. To directly dilate the coronary arteries and relieve spasms.
B. To decrease the workload and oxygen demand of the heart.
C. To lower serum homocysteine and low-density lipoprotein (LDL) levels.
D. To prevent the conversion of Angiotensin I to Angiotensin II.
Correct Answer: B. To decrease the workload and oxygen demand of the heart.
Rationale: Beta-blockers block the beta-1 adrenergic receptors in the heart, which decreases the
heart rate, reduces myocardial contractility, and lowers systemic blood pressure. By lowering
these parameters, beta-blockers decrease the metabolic workload and oxygen consumption of the
myocardium, helping to prevent angina and protect cardiac tissue.
Question 8
The nurse is evaluating the laboratory results of a client suspected of having severe fluid volume
excess (overhydration). Which of the following set of values is most consistent with this
diagnosis?
A. Elevated hematocrit, elevated blood urea nitrogen (BUN), and elevated serum sodium.
B. Decreased hematocrit, decreased BUN, and decreased serum osmolality.
C. Elevated urine specific gravity and increased serum potassium.
D. Elevated serum osmolality and normal hemoglobin.
Correct Answer: B. Decreased hematocrit, decreased BUN, and decreased serum osmolality.
Rationale: Fluid volume excess leads to hemodilution, where the excess water in the vascular
space dilutes blood constituents. Consequently, the concentration of red blood cells (hematocrit),
blood urea nitrogen (BUN), serum sodium, and the overall serum osmolality will decrease
(typically serum osmolality $< 275\text{ mOsm/kg}$).
Question 9
A nurse is reviewing the ECG of a client with a serum calcium level of $7.2\text{ mg/dL}$
(hypocalcemia). Which of the following electrocardiographic changes is most characteristic of
this electrolyte imbalance?
A. Shortened ST segment and wide T waves.
B. Tall, peaked T waves and a widened QRS complex.
AND VERIFIED ANSWERS WITH RATIONALES GRADED A+ LATEST
Question 1
The nurse is monitoring the fluid volume status of a client diagnosed with heart failure who is at
high risk for fluid volume excess. Which of the following interventions is the most sensitive and
effective method for monitoring this client's fluid status?
A. Monitoring urine specific gravity once per shift.
B. Assessing skin turgor every 4 hours.
C. Weighing the client every morning before breakfast.
D. Measuring strict oral intake and output each shift.
Correct Answer: C. Weighing the client every morning before breakfast.
Rationale: Daily weight measured at the same time, on the same scale, wearing the same type of
clothing, and after the first void is the most sensitive, reliable, and objective indicator of overall
fluid volume status. Weight changes reflect acute fluid shifts much earlier and more accurately
than skin turgor (which is unreliable in older adults), I&O records (which can be prone to
measurement errors), or urine specific gravity.
Question 2
The nurse recognizes unstable angina when a patient reporting chest pain describes which pattern
of symptoms?
A. Mild chest pain that occurs only during extreme physical exertion.
B. Chest pain that is reliably relieved within 5 minutes of rest and one sublingual nitroglycerin.
C. Chest pain that occurs at rest or with minimal activity, representing a new or worsening
pattern.
D. Nocturnal calf and leg cramps that occur only while sleeping.
Correct Answer: C. Chest pain that occurs at rest or with minimal activity, representing a new
or worsening pattern.
Rationale: Unstable angina is characterized by chest pain that is unexpected, occurs at rest or
with minimal exertion, is more severe or prolonged than previous episodes, and is not reliably
relieved by rest or nitroglycerin. This indicates an unstable plaque rupture and is a precursor to a
myocardial infarction (MI), requiring immediate evaluation.
Question 3
,NUR 242 – MEDICAL-SURGICAL NURSING EXAM 2 GALEN COLLEGE OF NURSING QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES GRADED A+ LATEST
The nurse suspects left-sided heart failure rather than right-sided heart failure when observing
which clinical manifestation?
A. Jugular venous distention (JVD) and hepatomegaly.
B. Dependent bilateral pitting ankle edema.
C. Crackles on lung auscultation, orthopnea, and a cough with pink, frothy sputum.
D. Bounding peripheral pulses and rapid weight gain.
Correct Answer: C. Crackles on lung auscultation, orthopnea, and a cough with pink, frothy
sputum.
Rationale: Left-sided heart failure leads to pulmonary congestion as the left ventricle fails to
pump blood efficiently into the systemic circulation, causing blood to back up into the left atrium
and pulmonary veins. This results in fluid leaking into the alveoli, causing crackles, dyspnea,
orthopnea, and pink, frothy sputum (a sign of acute pulmonary edema). In contrast, JVD,
hepatomegaly, and dependent edema are classic signs of right-sided heart failure (systemic
venous congestion).
Question 4
A client with atrial fibrillation is discharged with a new prescription for Warfarin (Coumadin).
Which dietary instruction should the nurse include in the client's discharge teaching?
A. "Completely eliminate all green leafy vegetables from your diet."
B. "Maintain a consistent daily intake of foods rich in Vitamin K."
C. "Take a daily over-the-counter Vitamin K supplement to stabilize your blood levels."
D. "Double your Warfarin dose on days you consume salads or spinach."
Correct Answer: B. "Maintain a consistent daily intake of foods rich in Vitamin K."
Rationale: Vitamin K is the direct antidote to Warfarin. Abruptly increasing Vitamin K intake
can decrease the therapeutic effectiveness of Warfarin, while abruptly reducing Vitamin K can
dangerously increase the risk of bleeding. The key to maintaining a stable, therapeutic PT/INR is
consistency in dietary Vitamin K intake rather than complete elimination.
Question 5
,NUR 242 – MEDICAL-SURGICAL NURSING EXAM 2 GALEN COLLEGE OF NURSING QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES GRADED A+ LATEST
A client presents to the emergency department with severe chest pain radiating to the left arm.
The 12-lead electrocardiogram (ECG) reveals ST-segment elevation in leads $V_1$ through
$V_4$. Which action should the nurse prioritize first?
A. Obtain a mobile chest X-ray to rule out cardiomegaly.
B. Administer a scheduled high-fat meal to support energy levels.
C. Activate the STEMI protocol and prepare the client for immediate reperfusion therapy.
D. Encourage early ambulation to improve collateral circulation.
Correct Answer: C. Activate the STEMI protocol and prepare the client for immediate
reperfusion therapy.
Rationale: An ECG showing ST-elevation indicates a ST-elevation Myocardial Infarction
(STEMI), signifying complete coronary artery occlusion and active myocardial necrosis. "Time
is muscle." The priority intervention is rapid coronary reperfusion (via percutaneous coronary
intervention [PCI] or fibrinolytic therapy) to minimize irreversible myocardial damage.
Question 6
Which laboratory value is the most specific and sensitive marker for confirming acute
myocardial injury?
A. Creatine Kinase-MB (CK-MB)
B. Troponin I
C. Myoglobin
D. Lactate Dehydrogenase (LDH)
Correct Answer: B. Troponin I
Rationale: Troponins (specifically Troponin I and Troponin T) are highly specific proteins
found only in cardiac muscle tissue. They are released into the bloodstream following
myocardial injury. Unlike CK-MB or myoglobin, which can be elevated due to skeletal muscle
damage, Troponin I is highly specific to the heart and remains elevated for up to 10–14 days.
Question 7
In the medical management of coronary artery disease (CAD), beta-adrenergic blockers (e.g.,
Metoprolol) are frequently prescribed. What is the primary therapeutic purpose of beta-blockers
in clients with CAD?
, NUR 242 – MEDICAL-SURGICAL NURSING EXAM 2 GALEN COLLEGE OF NURSING QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES GRADED A+ LATEST
A. To directly dilate the coronary arteries and relieve spasms.
B. To decrease the workload and oxygen demand of the heart.
C. To lower serum homocysteine and low-density lipoprotein (LDL) levels.
D. To prevent the conversion of Angiotensin I to Angiotensin II.
Correct Answer: B. To decrease the workload and oxygen demand of the heart.
Rationale: Beta-blockers block the beta-1 adrenergic receptors in the heart, which decreases the
heart rate, reduces myocardial contractility, and lowers systemic blood pressure. By lowering
these parameters, beta-blockers decrease the metabolic workload and oxygen consumption of the
myocardium, helping to prevent angina and protect cardiac tissue.
Question 8
The nurse is evaluating the laboratory results of a client suspected of having severe fluid volume
excess (overhydration). Which of the following set of values is most consistent with this
diagnosis?
A. Elevated hematocrit, elevated blood urea nitrogen (BUN), and elevated serum sodium.
B. Decreased hematocrit, decreased BUN, and decreased serum osmolality.
C. Elevated urine specific gravity and increased serum potassium.
D. Elevated serum osmolality and normal hemoglobin.
Correct Answer: B. Decreased hematocrit, decreased BUN, and decreased serum osmolality.
Rationale: Fluid volume excess leads to hemodilution, where the excess water in the vascular
space dilutes blood constituents. Consequently, the concentration of red blood cells (hematocrit),
blood urea nitrogen (BUN), serum sodium, and the overall serum osmolality will decrease
(typically serum osmolality $< 275\text{ mOsm/kg}$).
Question 9
A nurse is reviewing the ECG of a client with a serum calcium level of $7.2\text{ mg/dL}$
(hypocalcemia). Which of the following electrocardiographic changes is most characteristic of
this electrolyte imbalance?
A. Shortened ST segment and wide T waves.
B. Tall, peaked T waves and a widened QRS complex.
