NUR 242 Exam 4: Advanced Medical-Surgical Nursing… 2026/2027 • Verified • Assured Grade A+
✓ VERIFIED • 2026/2027 UPDATE • 100% ACCURATE
NUR 242 Exam 4: Advanced Medical-Surgical Nursing
Concepts 2026/2027 UPDATE Galen College
ACTUAL EXAM QUESTIONS & VERIFIED ANSWERS
with Clear, Detailed Rationales
Document Type: Exam (Elaborations) / Study Guide
Academic Year:
Total Questions: 50 Multiple Choice
Includes: Correct Answers + Rationales
Grade: A+ Assured
ASSURED GRADE A+
Exam (Elaborations) • Detailed Rationales Page 1
,NUR 242 Exam 4: Advanced Medical-Surgical Nursing… 2026/2027 • Verified • Assured Grade A+
Questions & Verified Answers
1. A patient presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3- of 26 mEq/L. Which
acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH is low (acidosis), the PaCO2 is high (respiratory cause), and the HCO3- is normal,
indicating uncompensated respiratory acidosis. Remembering this point will help you decide the best
nursing action when similar questions appear on the exam. Link the answer to the client’s current
condition and risk level. Remembering this point will help you decide the best nursing action when
similar questions appear on the exam. Link the answer to the client’s current condition and risk level.
2. Which of the following findings is most indicative of Cushing’s Triad in a patient with
increased intracranial pressure (ICP)?
A. Tachycardia, hypotension, and rapid respirations
B. Tachycardia, hypertension, and shallow respirations
C. Bradycardia, hypotension, and Cheyne-Stokes respirations
D. Bradycardia, hypertension with a widening pulse pressure, and irregular respirations
Answer: D
Rationale: Cushing’s Triad is a late sign of increased ICP consisting of systolic hypertension with a
widening pulse pressure, bradycardia, and irregular/altered respirations. In practice, this guides the
nurse to set priorities and protect the client from harm. Safety, nutrition, and clear communication are
frequent priorities. Exam questions often test whether you can pick the most practical and safe choice
for the client in real situations. Focus on what the nurse can actually do right now.
Exam (Elaborations) • Detailed Rationales Page 2
, NUR 242 Exam 4: Advanced Medical-Surgical Nursing… 2026/2027 • Verified • Assured Grade A+
3. A patient with heart failure is prescribed Digoxin. Which laboratory result would most
concern the nurse regarding potential toxicity?
A. Serum Digoxin 1.2 ng/mL
B. Serum Sodium 138 mEq/L
C. Serum Calcium 9.5 mg/dL
D. Serum Potassium 3.2 mEq/L
Answer: D
Rationale: Hypokalemia (low potassium) significantly increases the risk of digoxin toxicity, even if the
digoxin level itself is within a therapeutic range. This knowledge supports safe care and helps the
nurse teach the client and family clearly and simply. Clear teaching improves cooperation and reduces
anxiety. Knowing the reason behind the correct answer makes it easier to rule out the wrong options
quickly. Look for the choice that protects the client and matches the priority need.
4. Which assessment finding is a classic sign of a tension pneumothorax?
A. Increased breath sounds on the affected side
B. Resonance on percussion of the affected side
C. Tracheal deviation to the unaffected side
D. Bradycardia and hypertension
Answer: C
Rationale: Tension pneumothorax causes high pressure in the chest, pushing the mediastinum and
trachea toward the opposite (unaffected) side. Remembering this point will help you decide the best
nursing action when similar questions appear on the exam. Link the answer to the client’s current
condition and risk level. This is important because the nurse must choose the action that keeps the
client safest while still meeting their basic needs. Always think about safety first when answering these
questions.
Exam (Elaborations) • Detailed Rationales Page 3
✓ VERIFIED • 2026/2027 UPDATE • 100% ACCURATE
NUR 242 Exam 4: Advanced Medical-Surgical Nursing
Concepts 2026/2027 UPDATE Galen College
ACTUAL EXAM QUESTIONS & VERIFIED ANSWERS
with Clear, Detailed Rationales
Document Type: Exam (Elaborations) / Study Guide
Academic Year:
Total Questions: 50 Multiple Choice
Includes: Correct Answers + Rationales
Grade: A+ Assured
ASSURED GRADE A+
Exam (Elaborations) • Detailed Rationales Page 1
,NUR 242 Exam 4: Advanced Medical-Surgical Nursing… 2026/2027 • Verified • Assured Grade A+
Questions & Verified Answers
1. A patient presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3- of 26 mEq/L. Which
acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH is low (acidosis), the PaCO2 is high (respiratory cause), and the HCO3- is normal,
indicating uncompensated respiratory acidosis. Remembering this point will help you decide the best
nursing action when similar questions appear on the exam. Link the answer to the client’s current
condition and risk level. Remembering this point will help you decide the best nursing action when
similar questions appear on the exam. Link the answer to the client’s current condition and risk level.
2. Which of the following findings is most indicative of Cushing’s Triad in a patient with
increased intracranial pressure (ICP)?
A. Tachycardia, hypotension, and rapid respirations
B. Tachycardia, hypertension, and shallow respirations
C. Bradycardia, hypotension, and Cheyne-Stokes respirations
D. Bradycardia, hypertension with a widening pulse pressure, and irregular respirations
Answer: D
Rationale: Cushing’s Triad is a late sign of increased ICP consisting of systolic hypertension with a
widening pulse pressure, bradycardia, and irregular/altered respirations. In practice, this guides the
nurse to set priorities and protect the client from harm. Safety, nutrition, and clear communication are
frequent priorities. Exam questions often test whether you can pick the most practical and safe choice
for the client in real situations. Focus on what the nurse can actually do right now.
Exam (Elaborations) • Detailed Rationales Page 2
, NUR 242 Exam 4: Advanced Medical-Surgical Nursing… 2026/2027 • Verified • Assured Grade A+
3. A patient with heart failure is prescribed Digoxin. Which laboratory result would most
concern the nurse regarding potential toxicity?
A. Serum Digoxin 1.2 ng/mL
B. Serum Sodium 138 mEq/L
C. Serum Calcium 9.5 mg/dL
D. Serum Potassium 3.2 mEq/L
Answer: D
Rationale: Hypokalemia (low potassium) significantly increases the risk of digoxin toxicity, even if the
digoxin level itself is within a therapeutic range. This knowledge supports safe care and helps the
nurse teach the client and family clearly and simply. Clear teaching improves cooperation and reduces
anxiety. Knowing the reason behind the correct answer makes it easier to rule out the wrong options
quickly. Look for the choice that protects the client and matches the priority need.
4. Which assessment finding is a classic sign of a tension pneumothorax?
A. Increased breath sounds on the affected side
B. Resonance on percussion of the affected side
C. Tracheal deviation to the unaffected side
D. Bradycardia and hypertension
Answer: C
Rationale: Tension pneumothorax causes high pressure in the chest, pushing the mediastinum and
trachea toward the opposite (unaffected) side. Remembering this point will help you decide the best
nursing action when similar questions appear on the exam. Link the answer to the client’s current
condition and risk level. This is important because the nurse must choose the action that keeps the
client safest while still meeting their basic needs. Always think about safety first when answering these
questions.
Exam (Elaborations) • Detailed Rationales Page 3
