NUR 242 Exams 1-4 Combined Actual
Exam 2026/2027 | Verified Questions
Galen College of Nursing | Verified Q&A | Medical-Surgical
Nursing Students
Comprehensive 200-Question Original Actual Exam Set | 2026/2027
Introduction
This 2026/2027 comprehensive 200-question actual exam set provides original questions covering Exam 1
content on Fluid, Electrolyte, and Perioperative Nursing; Exam 2 content on Respiratory and Cardiovascular
Disorders; Exam 3 content on Gastrointestinal and Renal/Urinary Disorders; and Exam 4 content on Endocrine,
Neurological, and Musculoskeletal Disorders. The content is designed to reinforce official Galen College NUR 242
course objectives for actual exam readiness and academic success by strengthening prioritization,
pathophysiology, medication safety, perioperative judgment, oxygenation, perfusion, elimination, endocrine
stability, neurologic monitoring, and mobility-focused nursing care. Each item includes Verified Answers and
concise rationales grounded in medical-surgical nursing sources such as Ignatavicius and Lewis, evidence-based
clinical guidelines, and current nursing standards of care.
Domain: Exam 1 - Fluid, Electrolyte, and Perioperative Nursing
1. A client has potassium 6.7 mEq/L and peaked T waves. Which nursing action is priority?
A. Initiate prescribed hyperkalemia interventions and continuous cardiac monitoring.
B. Wait until the next routine round before taking action.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: A
Rationale: Severe hyperkalemia can cause lethal dysrhythmias, so cardiac monitoring and rapid
potassium-lowering therapy are urgent.
2. Which finding is most consistent with hypokalemia?
A. Wait until the next routine round before taking action.
B. Muscle weakness with flattened T waves.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: B
Rationale: Low potassium impairs neuromuscular and cardiac conduction, causing weakness and ECG
changes.
3. A client has sodium 122 mEq/L and new confusion. Which safety measure is most important?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Institute seizure precautions.
D. Record the finding without further nursing judgment.
Correct Answer: C
Rationale: Severe hyponatremia can cause cerebral edema and seizures.
4. Which manifestation is expected with hypernatremia?
A. Wait until the next routine round before taking action.
NUR 242 Exams 1-4 Combined Actual Exam 2026/2027 | Verified Questions
, B. Delegate the clinical decision to family members.
C. Record the finding without further nursing judgment.
D. Intense thirst and dry mucous membranes.
Correct Answer: D
Rationale: Hypernatremia reflects water deficit relative to sodium and stimulates thirst and dehydration
signs.
5. A client with calcium 7.2 mg/dL has tingling around the mouth. Which finding should the nurse
assess?
A. Positive Chvostek or Trousseau sign.
B. Wait until the next routine round before taking action.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: A
Rationale: Hypocalcemia increases neuromuscular excitability, producing tetany-related signs.
6. Which sign is expected with hypercalcemia?
A. Wait until the next routine round before taking action.
B. Decreased bowel motility and lethargy.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: B
Rationale: High calcium reduces neuromuscular excitability and slows gastrointestinal motility.
7. A client has magnesium 1.1 mg/dL. Which complication is most concerning?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Torsades de pointes or other dysrhythmia.
D. Record the finding without further nursing judgment.
Correct Answer: C
Rationale: Low magnesium can destabilize cardiac conduction and contribute to ventricular dysrhythmias.
8. Which finding suggests hypermagnesemia?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Record the finding without further nursing judgment.
D. Diminished deep tendon reflexes and respiratory depression.
Correct Answer: D
Rationale: Excess magnesium suppresses neuromuscular and respiratory function.
9. Which clinical finding supports fluid volume deficit?
A. Tachycardia with orthostatic hypotension.
B. Wait until the next routine round before taking action.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: A
Rationale: Volume deficit reduces venous return and causes compensatory tachycardia and postural
pressure drops.
10. Which finding indicates fluid volume excess?
A. Wait until the next routine round before taking action.
B. Crackles, bounding pulse, and dependent edema.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: B
Rationale: Fluid overload increases vascular volume and pulmonary congestion.
11. Which IV fluid is isotonic and commonly used for extracellular volume replacement?
NUR 242 Exams 1-4 Combined Actual Exam 2026/2027 | Verified Questions
, A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. 0.9 percent sodium chloride.
D. Record the finding without further nursing judgment.
Correct Answer: C
Rationale: Normal saline remains in the extracellular space and supports intravascular volume expansion.
12. Which IV fluid should the nurse question for a client with increased intracranial pressure?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Record the finding without further nursing judgment.
D. Hypotonic fluid.
Correct Answer: D
Rationale: Hypotonic fluids can shift water into brain cells and worsen cerebral edema.
13. A client receiving blood develops chills, back pain, and fever. What is the first action?
A. Stop the transfusion immediately.
B. Wait until the next routine round before taking action.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: A
Rationale: Possible transfusion reaction requires stopping the blood while maintaining safety and following
protocol.
14. Which preoperative statement requires follow-up?
A. Wait until the next routine round before taking action.
B. I took my warfarin this morning as usual.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: B
Rationale: Anticoagulant use before surgery increases bleeding risk and must be addressed.
15. Which assessment is priority immediately after general anesthesia?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Airway patency and respiratory status.
D. Record the finding without further nursing judgment.
Correct Answer: C
Rationale: Airway and breathing are the first priorities after anesthesia.
16. Which postoperative finding suggests hemorrhage?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Record the finding without further nursing judgment.
D. Restlessness, tachycardia, and falling blood pressure.
Correct Answer: D
Rationale: Early shock signs include anxiety, tachycardia, and hypotension as bleeding progresses.
17. A postoperative client’s abdominal wound opens with bowel visible. What should the nurse do?
A. Cover with sterile saline-moistened dressings and call for help.
B. Wait until the next routine round before taking action.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: A
Rationale: Evisceration requires protection of exposed tissue and immediate surgical response.
18. Which action best prevents postoperative atelectasis?
NUR 242 Exams 1-4 Combined Actual Exam 2026/2027 | Verified Questions
, A. Wait until the next routine round before taking action.
B. Encourage incentive spirometry and early ambulation as prescribed.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: B
Rationale: Lung expansion and mobility reduce alveolar collapse after surgery.
19. Which finding suggests malignant hyperthermia?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Rapid temperature rise with muscle rigidity and tachycardia after anesthesia.
D. Record the finding without further nursing judgment.
Correct Answer: C
Rationale: Malignant hyperthermia is a hypermetabolic anesthetic reaction requiring urgent treatment.
20. Which medication treats malignant hyperthermia?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Record the finding without further nursing judgment.
D. Dantrolene.
Correct Answer: D
Rationale: Dantrolene reduces skeletal muscle calcium release and treats malignant hyperthermia.
21. Which nursing action reduces surgical site infection risk?
A. Use aseptic technique and maintain appropriate glucose control.
B. Wait until the next routine round before taking action.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: A
Rationale: Asepsis and glucose control support wound healing and infection prevention.
22. Which postoperative finding suggests deep vein thrombosis?
A. Wait until the next routine round before taking action.
B. Unilateral calf swelling and warmth.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: B
Rationale: Unilateral swelling, warmth, and tenderness suggest venous thrombosis.
23. Which perioperative intervention reduces venous thromboembolism risk?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Sequential compression devices with early ambulation when allowed.
D. Record the finding without further nursing judgment.
Correct Answer: C
Rationale: Mechanical compression and mobility enhance venous return.
24. Which assessment is needed before administering opioids postoperatively?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Record the finding without further nursing judgment.
D. Respiratory rate, sedation level, and pain score.
Correct Answer: D
Rationale: Opioids can depress respirations and consciousness, so safety assessment is essential.
25. Which client statement indicates correct splinting instruction after abdominal surgery?
A. I will hold a pillow over my incision when I cough.
NUR 242 Exams 1-4 Combined Actual Exam 2026/2027 | Verified Questions
Exam 2026/2027 | Verified Questions
Galen College of Nursing | Verified Q&A | Medical-Surgical
Nursing Students
Comprehensive 200-Question Original Actual Exam Set | 2026/2027
Introduction
This 2026/2027 comprehensive 200-question actual exam set provides original questions covering Exam 1
content on Fluid, Electrolyte, and Perioperative Nursing; Exam 2 content on Respiratory and Cardiovascular
Disorders; Exam 3 content on Gastrointestinal and Renal/Urinary Disorders; and Exam 4 content on Endocrine,
Neurological, and Musculoskeletal Disorders. The content is designed to reinforce official Galen College NUR 242
course objectives for actual exam readiness and academic success by strengthening prioritization,
pathophysiology, medication safety, perioperative judgment, oxygenation, perfusion, elimination, endocrine
stability, neurologic monitoring, and mobility-focused nursing care. Each item includes Verified Answers and
concise rationales grounded in medical-surgical nursing sources such as Ignatavicius and Lewis, evidence-based
clinical guidelines, and current nursing standards of care.
Domain: Exam 1 - Fluid, Electrolyte, and Perioperative Nursing
1. A client has potassium 6.7 mEq/L and peaked T waves. Which nursing action is priority?
A. Initiate prescribed hyperkalemia interventions and continuous cardiac monitoring.
B. Wait until the next routine round before taking action.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: A
Rationale: Severe hyperkalemia can cause lethal dysrhythmias, so cardiac monitoring and rapid
potassium-lowering therapy are urgent.
2. Which finding is most consistent with hypokalemia?
A. Wait until the next routine round before taking action.
B. Muscle weakness with flattened T waves.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: B
Rationale: Low potassium impairs neuromuscular and cardiac conduction, causing weakness and ECG
changes.
3. A client has sodium 122 mEq/L and new confusion. Which safety measure is most important?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Institute seizure precautions.
D. Record the finding without further nursing judgment.
Correct Answer: C
Rationale: Severe hyponatremia can cause cerebral edema and seizures.
4. Which manifestation is expected with hypernatremia?
A. Wait until the next routine round before taking action.
NUR 242 Exams 1-4 Combined Actual Exam 2026/2027 | Verified Questions
, B. Delegate the clinical decision to family members.
C. Record the finding without further nursing judgment.
D. Intense thirst and dry mucous membranes.
Correct Answer: D
Rationale: Hypernatremia reflects water deficit relative to sodium and stimulates thirst and dehydration
signs.
5. A client with calcium 7.2 mg/dL has tingling around the mouth. Which finding should the nurse
assess?
A. Positive Chvostek or Trousseau sign.
B. Wait until the next routine round before taking action.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: A
Rationale: Hypocalcemia increases neuromuscular excitability, producing tetany-related signs.
6. Which sign is expected with hypercalcemia?
A. Wait until the next routine round before taking action.
B. Decreased bowel motility and lethargy.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: B
Rationale: High calcium reduces neuromuscular excitability and slows gastrointestinal motility.
7. A client has magnesium 1.1 mg/dL. Which complication is most concerning?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Torsades de pointes or other dysrhythmia.
D. Record the finding without further nursing judgment.
Correct Answer: C
Rationale: Low magnesium can destabilize cardiac conduction and contribute to ventricular dysrhythmias.
8. Which finding suggests hypermagnesemia?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Record the finding without further nursing judgment.
D. Diminished deep tendon reflexes and respiratory depression.
Correct Answer: D
Rationale: Excess magnesium suppresses neuromuscular and respiratory function.
9. Which clinical finding supports fluid volume deficit?
A. Tachycardia with orthostatic hypotension.
B. Wait until the next routine round before taking action.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: A
Rationale: Volume deficit reduces venous return and causes compensatory tachycardia and postural
pressure drops.
10. Which finding indicates fluid volume excess?
A. Wait until the next routine round before taking action.
B. Crackles, bounding pulse, and dependent edema.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: B
Rationale: Fluid overload increases vascular volume and pulmonary congestion.
11. Which IV fluid is isotonic and commonly used for extracellular volume replacement?
NUR 242 Exams 1-4 Combined Actual Exam 2026/2027 | Verified Questions
, A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. 0.9 percent sodium chloride.
D. Record the finding without further nursing judgment.
Correct Answer: C
Rationale: Normal saline remains in the extracellular space and supports intravascular volume expansion.
12. Which IV fluid should the nurse question for a client with increased intracranial pressure?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Record the finding without further nursing judgment.
D. Hypotonic fluid.
Correct Answer: D
Rationale: Hypotonic fluids can shift water into brain cells and worsen cerebral edema.
13. A client receiving blood develops chills, back pain, and fever. What is the first action?
A. Stop the transfusion immediately.
B. Wait until the next routine round before taking action.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: A
Rationale: Possible transfusion reaction requires stopping the blood while maintaining safety and following
protocol.
14. Which preoperative statement requires follow-up?
A. Wait until the next routine round before taking action.
B. I took my warfarin this morning as usual.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: B
Rationale: Anticoagulant use before surgery increases bleeding risk and must be addressed.
15. Which assessment is priority immediately after general anesthesia?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Airway patency and respiratory status.
D. Record the finding without further nursing judgment.
Correct Answer: C
Rationale: Airway and breathing are the first priorities after anesthesia.
16. Which postoperative finding suggests hemorrhage?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Record the finding without further nursing judgment.
D. Restlessness, tachycardia, and falling blood pressure.
Correct Answer: D
Rationale: Early shock signs include anxiety, tachycardia, and hypotension as bleeding progresses.
17. A postoperative client’s abdominal wound opens with bowel visible. What should the nurse do?
A. Cover with sterile saline-moistened dressings and call for help.
B. Wait until the next routine round before taking action.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: A
Rationale: Evisceration requires protection of exposed tissue and immediate surgical response.
18. Which action best prevents postoperative atelectasis?
NUR 242 Exams 1-4 Combined Actual Exam 2026/2027 | Verified Questions
, A. Wait until the next routine round before taking action.
B. Encourage incentive spirometry and early ambulation as prescribed.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: B
Rationale: Lung expansion and mobility reduce alveolar collapse after surgery.
19. Which finding suggests malignant hyperthermia?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Rapid temperature rise with muscle rigidity and tachycardia after anesthesia.
D. Record the finding without further nursing judgment.
Correct Answer: C
Rationale: Malignant hyperthermia is a hypermetabolic anesthetic reaction requiring urgent treatment.
20. Which medication treats malignant hyperthermia?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Record the finding without further nursing judgment.
D. Dantrolene.
Correct Answer: D
Rationale: Dantrolene reduces skeletal muscle calcium release and treats malignant hyperthermia.
21. Which nursing action reduces surgical site infection risk?
A. Use aseptic technique and maintain appropriate glucose control.
B. Wait until the next routine round before taking action.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: A
Rationale: Asepsis and glucose control support wound healing and infection prevention.
22. Which postoperative finding suggests deep vein thrombosis?
A. Wait until the next routine round before taking action.
B. Unilateral calf swelling and warmth.
C. Delegate the clinical decision to family members.
D. Record the finding without further nursing judgment.
Correct Answer: B
Rationale: Unilateral swelling, warmth, and tenderness suggest venous thrombosis.
23. Which perioperative intervention reduces venous thromboembolism risk?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Sequential compression devices with early ambulation when allowed.
D. Record the finding without further nursing judgment.
Correct Answer: C
Rationale: Mechanical compression and mobility enhance venous return.
24. Which assessment is needed before administering opioids postoperatively?
A. Wait until the next routine round before taking action.
B. Delegate the clinical decision to family members.
C. Record the finding without further nursing judgment.
D. Respiratory rate, sedation level, and pain score.
Correct Answer: D
Rationale: Opioids can depress respirations and consciousness, so safety assessment is essential.
25. Which client statement indicates correct splinting instruction after abdominal surgery?
A. I will hold a pillow over my incision when I cough.
NUR 242 Exams 1-4 Combined Actual Exam 2026/2027 | Verified Questions
