NUR 242 MEDICAL-SURGICAL NURSING CONCEPTS
PRACTICE EXAMINATION 2026–2027 — STUDY GUIDE
| LATEST UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
This original practice examination is designed for nursing students
preparing for Medical-Surgical Nursing Concepts coursework, including
Galen NUR 242 and similar medical-surgical nursing courses. The 100-
question test evaluates mastery of adult health nursing across
cardiovascular, respiratory, endocrine, gastrointestinal, renal,
neurological, musculoskeletal, hematologic, immunologic, and
multisystem disorders. Questions are written at the application and
analysis level to mirror the cognitive complexity of nursing school
examinations, requiring clinical judgment, prioritization, delegation,
pharmacology, and patient safety. The 2026–2027 edition incorporates
current evidence-based practice and national patient safety standards.
Use this comprehensive review to assess readiness, identify knowledge
gaps, and strengthen your understanding of medical-surgical nursing.
Table of Contents
I. Cardiovascular and Hemodynamic Nursing
II. Respiratory and Acid-Base Balance
III. Endocrine and Metabolic Disorders
IV. Gastrointestinal, Hepatic, and Renal Nursing
V. Neurological and Musculoskeletal Nursing
VI. Hematologic, Immunologic, and Oncologic Nursing
,VII. Perioperative, Shock, and Multisystem Care
VIII. Pharmacology and Medication Safety in Medical-Surgical Nursing
1. A nurse is caring for a client with heart failure who has gained 3 kg
in 2 days, has bilateral crackles, and reports dyspnea. The provider
orders furosemide 40 mg IV push. Which laboratory value requires
immediate notification before administering the dose?
A) Serum sodium 138 mEq/L
B) Serum potassium 3.1 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum magnesium 2.0 mEq/L
Correct Answer: B
Furosemide causes potassium loss; a potassium of 3.1 mEq/L is
hypokalemic and increases the risk of cardiac dysrhythmias, especially in
a client with heart failure. The provider should be notified before giving
the dose. Other values are within normal limits.
2. A client with acute pancreatitis has a serum calcium of 6.8 mg/dL
and a positive Chvostek's sign. Which ECG change should the
nurse anticipate?
A) Prolonged QT interval
B) Tall, peaked T waves
C) ST-segment elevation
D) Prominent U wave
Correct Answer: A
Hypocalcemia prolongs the QT interval, increasing the risk of torsades
de pointes. Peaked T waves indicate hyperkalemia. ST elevation suggests
myocardial infarction. Prominent U waves indicate hypokalemia.
, 3. A nurse is reviewing a telemetry strip showing a PR interval that
progressively lengthens until a QRS complex is dropped. The
pattern repeats. What rhythm is present?
A) First-degree AV block
B) Second-degree AV block type I (Wenckebach)
C) Second-degree AV block type II (Mobitz II)
D) Third-degree AV block
Correct Answer: B
Wenckebach is characterized by progressive PR prolongation until a
non-conducted P wave. First-degree has a constant prolonged PR
without dropped beats. Mobitz II has constant PR with sudden dropped
QRS. Third-degree has AV dissociation.
4. A client with COPD is receiving oxygen at 2 L/min via nasal
cannula. The nurse notes respirations have decreased to 8 breaths
per minute and the client is drowsy. What is the best initial action?
A) Increase oxygen to 4 L/min
B) Decrease oxygen to 1 L/min and notify the provider
C) Administer prescribed methylxanthine bronchodilator
D) Place the client in high Fowler's position and administer
naloxone
Correct Answer: B
In COPD with chronic CO₂ retention, excessive oxygen can suppress the
hypoxic drive. Reduce oxygen to minimum to maintain SpO₂ 88–92% and
notify provider. Increasing oxygen worsens hypoventilation. Naloxone is
for opioid overdose.
5. A client with acute respiratory distress syndrome is ventilated with
low tidal volumes. ABG shows pH 7.25, PaCO₂ 60 mm Hg. What is
, the nurse's interpretation?
A) Permissive hypercapnia is expected with lung-protective
ventilation
B) Tidal volume too low and must be increased
C) Ventilator caused tension pneumothorax
D) Client is hyperventilating and needs sedation
Correct Answer: A
Low tidal volume ventilation in ARDS may cause elevated PaCO₂, but it is
tolerated (permissive hypercapnia) to reduce ventilator-induced lung
injury. Increasing tidal volumes contradicts the protective strategy.
Tension pneumothorax would cause sudden decompensation.
6. A client with a traumatic brain injury has an ICP of 22 mm Hg and
a CPP of 58 mm Hg. What is the priority action?
A) Elevate the head of the bed to 60 degrees
B) Notify the provider and prepare to administer mannitol
C) Suction the client vigorously
D) Place the client in a supine position
Correct Answer: B
ICP >20 mm Hg and CPP <60 mm Hg indicate inadequate cerebral
perfusion and increased intracranial pressure. The provider must be
notified, and mannitol may be ordered to reduce ICP. Head of bed
should be elevated 30 degrees, not 60. Suctioning and supine
positioning increase ICP.
7. A client receiving a continuous heparin infusion has an aPTT of
105 seconds (therapeutic range 60–80 seconds). The client has no
bleeding. What should the nurse do?
A) Stop the infusion and administer protamine sulfate
PRACTICE EXAMINATION 2026–2027 — STUDY GUIDE
| LATEST UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
This original practice examination is designed for nursing students
preparing for Medical-Surgical Nursing Concepts coursework, including
Galen NUR 242 and similar medical-surgical nursing courses. The 100-
question test evaluates mastery of adult health nursing across
cardiovascular, respiratory, endocrine, gastrointestinal, renal,
neurological, musculoskeletal, hematologic, immunologic, and
multisystem disorders. Questions are written at the application and
analysis level to mirror the cognitive complexity of nursing school
examinations, requiring clinical judgment, prioritization, delegation,
pharmacology, and patient safety. The 2026–2027 edition incorporates
current evidence-based practice and national patient safety standards.
Use this comprehensive review to assess readiness, identify knowledge
gaps, and strengthen your understanding of medical-surgical nursing.
Table of Contents
I. Cardiovascular and Hemodynamic Nursing
II. Respiratory and Acid-Base Balance
III. Endocrine and Metabolic Disorders
IV. Gastrointestinal, Hepatic, and Renal Nursing
V. Neurological and Musculoskeletal Nursing
VI. Hematologic, Immunologic, and Oncologic Nursing
,VII. Perioperative, Shock, and Multisystem Care
VIII. Pharmacology and Medication Safety in Medical-Surgical Nursing
1. A nurse is caring for a client with heart failure who has gained 3 kg
in 2 days, has bilateral crackles, and reports dyspnea. The provider
orders furosemide 40 mg IV push. Which laboratory value requires
immediate notification before administering the dose?
A) Serum sodium 138 mEq/L
B) Serum potassium 3.1 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum magnesium 2.0 mEq/L
Correct Answer: B
Furosemide causes potassium loss; a potassium of 3.1 mEq/L is
hypokalemic and increases the risk of cardiac dysrhythmias, especially in
a client with heart failure. The provider should be notified before giving
the dose. Other values are within normal limits.
2. A client with acute pancreatitis has a serum calcium of 6.8 mg/dL
and a positive Chvostek's sign. Which ECG change should the
nurse anticipate?
A) Prolonged QT interval
B) Tall, peaked T waves
C) ST-segment elevation
D) Prominent U wave
Correct Answer: A
Hypocalcemia prolongs the QT interval, increasing the risk of torsades
de pointes. Peaked T waves indicate hyperkalemia. ST elevation suggests
myocardial infarction. Prominent U waves indicate hypokalemia.
, 3. A nurse is reviewing a telemetry strip showing a PR interval that
progressively lengthens until a QRS complex is dropped. The
pattern repeats. What rhythm is present?
A) First-degree AV block
B) Second-degree AV block type I (Wenckebach)
C) Second-degree AV block type II (Mobitz II)
D) Third-degree AV block
Correct Answer: B
Wenckebach is characterized by progressive PR prolongation until a
non-conducted P wave. First-degree has a constant prolonged PR
without dropped beats. Mobitz II has constant PR with sudden dropped
QRS. Third-degree has AV dissociation.
4. A client with COPD is receiving oxygen at 2 L/min via nasal
cannula. The nurse notes respirations have decreased to 8 breaths
per minute and the client is drowsy. What is the best initial action?
A) Increase oxygen to 4 L/min
B) Decrease oxygen to 1 L/min and notify the provider
C) Administer prescribed methylxanthine bronchodilator
D) Place the client in high Fowler's position and administer
naloxone
Correct Answer: B
In COPD with chronic CO₂ retention, excessive oxygen can suppress the
hypoxic drive. Reduce oxygen to minimum to maintain SpO₂ 88–92% and
notify provider. Increasing oxygen worsens hypoventilation. Naloxone is
for opioid overdose.
5. A client with acute respiratory distress syndrome is ventilated with
low tidal volumes. ABG shows pH 7.25, PaCO₂ 60 mm Hg. What is
, the nurse's interpretation?
A) Permissive hypercapnia is expected with lung-protective
ventilation
B) Tidal volume too low and must be increased
C) Ventilator caused tension pneumothorax
D) Client is hyperventilating and needs sedation
Correct Answer: A
Low tidal volume ventilation in ARDS may cause elevated PaCO₂, but it is
tolerated (permissive hypercapnia) to reduce ventilator-induced lung
injury. Increasing tidal volumes contradicts the protective strategy.
Tension pneumothorax would cause sudden decompensation.
6. A client with a traumatic brain injury has an ICP of 22 mm Hg and
a CPP of 58 mm Hg. What is the priority action?
A) Elevate the head of the bed to 60 degrees
B) Notify the provider and prepare to administer mannitol
C) Suction the client vigorously
D) Place the client in a supine position
Correct Answer: B
ICP >20 mm Hg and CPP <60 mm Hg indicate inadequate cerebral
perfusion and increased intracranial pressure. The provider must be
notified, and mannitol may be ordered to reduce ICP. Head of bed
should be elevated 30 degrees, not 60. Suctioning and supine
positioning increase ICP.
7. A client receiving a continuous heparin infusion has an aPTT of
105 seconds (therapeutic range 60–80 seconds). The client has no
bleeding. What should the nurse do?
A) Stop the infusion and administer protamine sulfate
