,NUR242/NUR 242 Exam 4 | Medical-Surgical
Nursing | Galen College | 2026/2027 Edition
1. The nurse is caring for a client with heart failure who has crackles in all lung fields, jugular venous
distention, and 3+ pitting edema. Which medication should the nurse expect to administer first?
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
Correct Answer: Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload by promoting diuresis, relieving
pulmonary congestion and edema. It is the first-line treatment for acute decompensated heart failure
with fluid overload. Digoxin, enalapril, and carvedilol are important but do not provide immediate
symptomatic relief of fluid overload.
2. A client with heart failure is prescribed digoxin. Which finding indicates digoxin toxicity?
A) Heart rate of 72 beats per minute
B) Anorexia, nausea, and blurred yellow vision
C) Blood pressure of 120/80 mmHg
D) Potassium level of 4.0 mEq/L
Correct Answer: Anorexia, nausea, and blurred yellow vision
Rationale: Digoxin toxicity causes gastrointestinal symptoms (anorexia, nausea, vomiting), visual
disturbances (yellow-green halos, blurred vision), and cardiac dysrhythmias (bradycardia, heart block).
Hypokalemia increases the risk of toxicity. A heart rate of 72 and potassium of 4.0 are within normal
limits and not indicative of toxicity.
,3. A client with atrial fibrillation is prescribed warfarin. Which laboratory test should the nurse monitor
to evaluate the therapeutic effect?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Correct Answer: INR
Rationale: The international normalized ratio (INR) is the standard laboratory test used to monitor
warfarin therapy. The therapeutic INR range for atrial fibrillation is typically 2.0 to 3.0. aPTT is used to
monitor heparin therapy, platelet count monitors for thrombocytopenia, and bleeding time is not a
standard monitoring test for warfarin.
4. A client is receiving an IV heparin infusion. Which laboratory value should the nurse monitor to
evaluate the therapeutic effect?
A) INR
B) aPTT
C) Platelet count
D) Serum potassium
Correct Answer: aPTT
Rationale: The activated partial thromboplastin time (aPTT) is the laboratory test used to monitor
heparin therapy. The therapeutic range is typically 1.5 to 2.5 times the control value. INR is used for
warfarin, platelet count monitors for heparin-induced thrombocytopenia, and potassium is not directly
related to heparin therapy.
5. The nurse is assessing a client with peripheral arterial disease (PAD). Which finding is most
characteristic of this condition?
A) Brownish discoloration of the skin on the lower legs
B) Intermittent claudication relieved by rest
, C) Dependent edema and varicose veins
D) Pallor of the extremity when elevated
Correct Answer: Pallor of the extremity when elevated
Rationale: Pallor on elevation (elevational pallor) is a classic sign of arterial insufficiency due to
decreased blood flow. Brownish discoloration and edema are signs of venous insufficiency. Intermittent
claudication is a symptom of PAD, but pallor on elevation is a more specific physical assessment finding.
6. A client with peripheral arterial disease (PAD) complains of pain in the calf when walking. Which
nursing intervention is most appropriate?
A) Encourage the client to rest and elevate the legs
B) Instruct the client to walk to the point of pain, rest, and then continue
C) Apply heat to the lower extremities to improve circulation
D) Position the client in the Trendelenburg position
Correct Answer: Instruct the client to walk to the point of pain, rest, and then continue
Rationale: For clients with PAD, a supervised exercise program that involves walking to the point of
claudication, resting, and then resuming walking can improve collateral circulation and increase walking
distance. Elevation can worsen arterial insufficiency, heat can cause burns due to decreased sensation,
and Trendelenburg is not recommended.
7. A client with chronic venous insufficiency (CVI) has prescribed compression stockings. Which
instruction should the nurse include in the teaching?
A) "Apply the stockings in the morning before getting out of bed."
B) "Remove the stockings at night and elevate the legs."
C) "Apply the stockings after a warm shower in the evening."
D) "Roll the stockings down to the knee to improve comfort."
Correct Answer: "Apply the stockings in the morning before getting out of bed."
Nursing | Galen College | 2026/2027 Edition
1. The nurse is caring for a client with heart failure who has crackles in all lung fields, jugular venous
distention, and 3+ pitting edema. Which medication should the nurse expect to administer first?
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
Correct Answer: Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload by promoting diuresis, relieving
pulmonary congestion and edema. It is the first-line treatment for acute decompensated heart failure
with fluid overload. Digoxin, enalapril, and carvedilol are important but do not provide immediate
symptomatic relief of fluid overload.
2. A client with heart failure is prescribed digoxin. Which finding indicates digoxin toxicity?
A) Heart rate of 72 beats per minute
B) Anorexia, nausea, and blurred yellow vision
C) Blood pressure of 120/80 mmHg
D) Potassium level of 4.0 mEq/L
Correct Answer: Anorexia, nausea, and blurred yellow vision
Rationale: Digoxin toxicity causes gastrointestinal symptoms (anorexia, nausea, vomiting), visual
disturbances (yellow-green halos, blurred vision), and cardiac dysrhythmias (bradycardia, heart block).
Hypokalemia increases the risk of toxicity. A heart rate of 72 and potassium of 4.0 are within normal
limits and not indicative of toxicity.
,3. A client with atrial fibrillation is prescribed warfarin. Which laboratory test should the nurse monitor
to evaluate the therapeutic effect?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Correct Answer: INR
Rationale: The international normalized ratio (INR) is the standard laboratory test used to monitor
warfarin therapy. The therapeutic INR range for atrial fibrillation is typically 2.0 to 3.0. aPTT is used to
monitor heparin therapy, platelet count monitors for thrombocytopenia, and bleeding time is not a
standard monitoring test for warfarin.
4. A client is receiving an IV heparin infusion. Which laboratory value should the nurse monitor to
evaluate the therapeutic effect?
A) INR
B) aPTT
C) Platelet count
D) Serum potassium
Correct Answer: aPTT
Rationale: The activated partial thromboplastin time (aPTT) is the laboratory test used to monitor
heparin therapy. The therapeutic range is typically 1.5 to 2.5 times the control value. INR is used for
warfarin, platelet count monitors for heparin-induced thrombocytopenia, and potassium is not directly
related to heparin therapy.
5. The nurse is assessing a client with peripheral arterial disease (PAD). Which finding is most
characteristic of this condition?
A) Brownish discoloration of the skin on the lower legs
B) Intermittent claudication relieved by rest
, C) Dependent edema and varicose veins
D) Pallor of the extremity when elevated
Correct Answer: Pallor of the extremity when elevated
Rationale: Pallor on elevation (elevational pallor) is a classic sign of arterial insufficiency due to
decreased blood flow. Brownish discoloration and edema are signs of venous insufficiency. Intermittent
claudication is a symptom of PAD, but pallor on elevation is a more specific physical assessment finding.
6. A client with peripheral arterial disease (PAD) complains of pain in the calf when walking. Which
nursing intervention is most appropriate?
A) Encourage the client to rest and elevate the legs
B) Instruct the client to walk to the point of pain, rest, and then continue
C) Apply heat to the lower extremities to improve circulation
D) Position the client in the Trendelenburg position
Correct Answer: Instruct the client to walk to the point of pain, rest, and then continue
Rationale: For clients with PAD, a supervised exercise program that involves walking to the point of
claudication, resting, and then resuming walking can improve collateral circulation and increase walking
distance. Elevation can worsen arterial insufficiency, heat can cause burns due to decreased sensation,
and Trendelenburg is not recommended.
7. A client with chronic venous insufficiency (CVI) has prescribed compression stockings. Which
instruction should the nurse include in the teaching?
A) "Apply the stockings in the morning before getting out of bed."
B) "Remove the stockings at night and elevate the legs."
C) "Apply the stockings after a warm shower in the evening."
D) "Roll the stockings down to the knee to improve comfort."
Correct Answer: "Apply the stockings in the morning before getting out of bed."
