,NUR 242 Exam 3 | Medical-Surgical Nursing
Concepts (2026/2027) PDF | Galen College
1. A client with left ventricular heart failure develops worsening dyspnea and
crackles. What is the nurse's priority action?
A) Administer oxygen at 2 L/min
B) Place the client in high‑Fowler’s position
C) Notify the healthcare provider
D) Obtain a 12‑lead ECG
Correct Answer: Place the client in high‑Fowler’s position
Rationale: High‑Fowler’s position reduces venous return and promotes lung
expansion, providing immediate relief. Oxygen and provider notification follow.
This is the first independent nursing intervention for acute pulmonary
congestion.
2. A client with right‑sided heart failure is most likely to exhibit which finding?
A) Crackles in the lung bases
B) Paroxysmal nocturnal dyspnea
C) Dependent edema and jugular vein distention
D) Frothy pink sputum
Correct Answer: Dependent edema and jugular vein distention
Rationale: Right‑sided failure backs blood into the systemic circulation, causing
peripheral edema and JVD. Left‑sided failure produces pulmonary congestion.
,3. The nurse is teaching a client with heart failure about daily weights. Which
instruction ensures accuracy?
A) Weigh yourself at the same time each morning, after voiding, wearing similar
clothing
B) Use a different scale each time
C) Weigh after breakfast
D) Weigh only when you feel bloated
Correct Answer: Weigh yourself at the same time each morning, after voiding,
wearing similar clothing
Rationale: Consistent weighing conditions detect fluid retention accurately. A
2‑pound gain in a day warrants reporting. Inconsistent times and scales produce
unreliable results.
4. A client receiving furosemide has a serum potassium of 3.0 mEq/L. The nurse
should monitor for which ECG change?
A) Peaked T waves
B) Widened QRS
C) ST segment elevation
D) Flattened T waves and U waves
Correct Answer: Flattened T waves and U waves
, Rationale: Hypokalemia alters repolarization, producing T‑wave flattening and U
waves. Peaked T waves indicate hyperkalemia. The nurse must report the level
and anticipate potassium replacement.
5. A client with atrial fibrillation is prescribed warfarin. The therapeutic INR
range is typically:
A) 1.0–1.5
B) 2.0–3.0
C) 2.5–3.5
D) 3.0–4.0
Correct Answer: 2.0–3.0
Rationale: For most indications including AFib, the target INR is 2.0–3.0. Higher
ranges are used for mechanical heart valves. Regular monitoring prevents
bleeding or thrombotic complications.
6. The nurse is monitoring a client receiving IV heparin. Which laboratory value
indicates the infusion is therapeutic?
A) aPTT 60 seconds
B) INR 2.5
C) Platelet count 150,000
D) aPTT 30 seconds
Correct Answer: aPTT 60 seconds
Concepts (2026/2027) PDF | Galen College
1. A client with left ventricular heart failure develops worsening dyspnea and
crackles. What is the nurse's priority action?
A) Administer oxygen at 2 L/min
B) Place the client in high‑Fowler’s position
C) Notify the healthcare provider
D) Obtain a 12‑lead ECG
Correct Answer: Place the client in high‑Fowler’s position
Rationale: High‑Fowler’s position reduces venous return and promotes lung
expansion, providing immediate relief. Oxygen and provider notification follow.
This is the first independent nursing intervention for acute pulmonary
congestion.
2. A client with right‑sided heart failure is most likely to exhibit which finding?
A) Crackles in the lung bases
B) Paroxysmal nocturnal dyspnea
C) Dependent edema and jugular vein distention
D) Frothy pink sputum
Correct Answer: Dependent edema and jugular vein distention
Rationale: Right‑sided failure backs blood into the systemic circulation, causing
peripheral edema and JVD. Left‑sided failure produces pulmonary congestion.
,3. The nurse is teaching a client with heart failure about daily weights. Which
instruction ensures accuracy?
A) Weigh yourself at the same time each morning, after voiding, wearing similar
clothing
B) Use a different scale each time
C) Weigh after breakfast
D) Weigh only when you feel bloated
Correct Answer: Weigh yourself at the same time each morning, after voiding,
wearing similar clothing
Rationale: Consistent weighing conditions detect fluid retention accurately. A
2‑pound gain in a day warrants reporting. Inconsistent times and scales produce
unreliable results.
4. A client receiving furosemide has a serum potassium of 3.0 mEq/L. The nurse
should monitor for which ECG change?
A) Peaked T waves
B) Widened QRS
C) ST segment elevation
D) Flattened T waves and U waves
Correct Answer: Flattened T waves and U waves
, Rationale: Hypokalemia alters repolarization, producing T‑wave flattening and U
waves. Peaked T waves indicate hyperkalemia. The nurse must report the level
and anticipate potassium replacement.
5. A client with atrial fibrillation is prescribed warfarin. The therapeutic INR
range is typically:
A) 1.0–1.5
B) 2.0–3.0
C) 2.5–3.5
D) 3.0–4.0
Correct Answer: 2.0–3.0
Rationale: For most indications including AFib, the target INR is 2.0–3.0. Higher
ranges are used for mechanical heart valves. Regular monitoring prevents
bleeding or thrombotic complications.
6. The nurse is monitoring a client receiving IV heparin. Which laboratory value
indicates the infusion is therapeutic?
A) aPTT 60 seconds
B) INR 2.5
C) Platelet count 150,000
D) aPTT 30 seconds
Correct Answer: aPTT 60 seconds
