,NUR242/NUR 242 Exam 3 | Medical-Surgical
Nursing | Galen College | 2026/2027 Edition
(PDF)
1. The nurse is caring for a patient with heart failure who presents with tachypnea and bilateral crackles.
Which nursing intervention is the priority?
A) Administer digoxin as prescribed
B) Place the patient in a high-Fowler position
C) Notify the healthcare provider immediately
D) Administer oxygen via nasal cannula
Correct Answer: Place the patient in a high-Fowler position
Rationale: High-Fowler positioning uses gravity to reduce preload and facilitate lung expansion,
improving ventilation and oxygenation in a patient with pulmonary congestion. While oxygen and
medications are important, positioning is the immediate, independent nursing action to relieve
respiratory distress.
2. A patient with hypovolemic shock has a blood pressure of 82/54 mm Hg and a heart rate of 128
beats/min. Which IV fluid does the nurse anticipate administering first?
A) 5% dextrose in water
B) 0.45% sodium chloride
C) Isotonic crystalloid (0.9% normal saline or lactated Ringer's)
D) 3% hypertonic saline
Correct Answer: Isotonic crystalloid (0.9% normal saline or lactated Ringer's)
Rationale: Initial fluid resuscitation in hypovolemic shock uses isotonic crystalloids to rapidly expand
intravascular volume. Hypotonic and hypertonic solutions are not first-line for volume expansion in this
setting.
,3. The nurse is caring for a patient in the early stage of septic shock. Which hemodynamic profile is
expected?
A) Decreased cardiac output and increased systemic vascular resistance
B) Increased cardiac output and decreased systemic vascular resistance
C) Normal cardiac output and normal systemic vascular resistance
D) Decreased cardiac output and decreased systemic vascular resistance
Correct Answer: Increased cardiac output and decreased systemic vascular resistance
Rationale: Early (hyperdynamic) septic shock is characterized by widespread vasodilation (decreased
SVR) and a compensatory increase in cardiac output to maintain perfusion. Later stages may progress to
myocardial depression and decreased cardiac output.
4. A patient with a history of COPD is admitted with shortness of breath. Which finding indicates the
patient may be experiencing an exacerbation?
A) Use of accessory muscles and a barrel chest appearance
B) A productive morning cough with clear sputum
C) A respiratory rate of 14 breaths/min
D) Pink, moist mucous membranes
Correct Answer: Use of accessory muscles and a barrel chest appearance
Rationale: Patients with COPD often have a barrel chest appearance, are short of breath, and may use
accessory muscles when breathing.During an exacerbation, these findings worsen significantly. A
respiratory rate of 14 is normal and would not indicate an exacerbation.
5. A patient with COPD is prescribed oxygen therapy. Which delivery device is most appropriate for this
patient to prevent loss of hypoxic drive?
A) Nasal cannula at 2–4 L/min
B) Non-rebreather mask
C) Venturi mask
, D) Simple face mask
Correct Answer: Venturi mask
Rationale: The Venturi mask delivers the most precise FiO2, making it the safest choice for patients with
COPD who are at risk for hypoxic drive suppression.Nasal cannula and simple masks deliver less precise
oxygen concentrations.
6. A patient with a chest tube has continuous bubbling in the water seal chamber. What is the nurse's
priority action?
A) Clamp the chest tube immediately
B) Notify the healthcare provider
C) Assess for an air leak
D) Increase the suction pressure
Correct Answer: Assess for an air leak
Rationale: Continuous bubbling in the water seal chamber indicates an air leak.The nurse should first
assess the system for the source of the leak—checking connections, the patient's dressing, and the chest
tube itself—before notifying the provider.
7. The nurse is assessing a patient with a pleural effusion. Which diagnostic test does the nurse
anticipate will be ordered to confirm the diagnosis?
A) Chest radiograph
B) Chest ultrasound
C) Computed tomography (CT)
D) All of the above
Correct Answer: All of the above
Nursing | Galen College | 2026/2027 Edition
(PDF)
1. The nurse is caring for a patient with heart failure who presents with tachypnea and bilateral crackles.
Which nursing intervention is the priority?
A) Administer digoxin as prescribed
B) Place the patient in a high-Fowler position
C) Notify the healthcare provider immediately
D) Administer oxygen via nasal cannula
Correct Answer: Place the patient in a high-Fowler position
Rationale: High-Fowler positioning uses gravity to reduce preload and facilitate lung expansion,
improving ventilation and oxygenation in a patient with pulmonary congestion. While oxygen and
medications are important, positioning is the immediate, independent nursing action to relieve
respiratory distress.
2. A patient with hypovolemic shock has a blood pressure of 82/54 mm Hg and a heart rate of 128
beats/min. Which IV fluid does the nurse anticipate administering first?
A) 5% dextrose in water
B) 0.45% sodium chloride
C) Isotonic crystalloid (0.9% normal saline or lactated Ringer's)
D) 3% hypertonic saline
Correct Answer: Isotonic crystalloid (0.9% normal saline or lactated Ringer's)
Rationale: Initial fluid resuscitation in hypovolemic shock uses isotonic crystalloids to rapidly expand
intravascular volume. Hypotonic and hypertonic solutions are not first-line for volume expansion in this
setting.
,3. The nurse is caring for a patient in the early stage of septic shock. Which hemodynamic profile is
expected?
A) Decreased cardiac output and increased systemic vascular resistance
B) Increased cardiac output and decreased systemic vascular resistance
C) Normal cardiac output and normal systemic vascular resistance
D) Decreased cardiac output and decreased systemic vascular resistance
Correct Answer: Increased cardiac output and decreased systemic vascular resistance
Rationale: Early (hyperdynamic) septic shock is characterized by widespread vasodilation (decreased
SVR) and a compensatory increase in cardiac output to maintain perfusion. Later stages may progress to
myocardial depression and decreased cardiac output.
4. A patient with a history of COPD is admitted with shortness of breath. Which finding indicates the
patient may be experiencing an exacerbation?
A) Use of accessory muscles and a barrel chest appearance
B) A productive morning cough with clear sputum
C) A respiratory rate of 14 breaths/min
D) Pink, moist mucous membranes
Correct Answer: Use of accessory muscles and a barrel chest appearance
Rationale: Patients with COPD often have a barrel chest appearance, are short of breath, and may use
accessory muscles when breathing.During an exacerbation, these findings worsen significantly. A
respiratory rate of 14 is normal and would not indicate an exacerbation.
5. A patient with COPD is prescribed oxygen therapy. Which delivery device is most appropriate for this
patient to prevent loss of hypoxic drive?
A) Nasal cannula at 2–4 L/min
B) Non-rebreather mask
C) Venturi mask
, D) Simple face mask
Correct Answer: Venturi mask
Rationale: The Venturi mask delivers the most precise FiO2, making it the safest choice for patients with
COPD who are at risk for hypoxic drive suppression.Nasal cannula and simple masks deliver less precise
oxygen concentrations.
6. A patient with a chest tube has continuous bubbling in the water seal chamber. What is the nurse's
priority action?
A) Clamp the chest tube immediately
B) Notify the healthcare provider
C) Assess for an air leak
D) Increase the suction pressure
Correct Answer: Assess for an air leak
Rationale: Continuous bubbling in the water seal chamber indicates an air leak.The nurse should first
assess the system for the source of the leak—checking connections, the patient's dressing, and the chest
tube itself—before notifying the provider.
7. The nurse is assessing a patient with a pleural effusion. Which diagnostic test does the nurse
anticipate will be ordered to confirm the diagnosis?
A) Chest radiograph
B) Chest ultrasound
C) Computed tomography (CT)
D) All of the above
Correct Answer: All of the above
