NUR 242 EXAM 3 – MED-SURG NURSING (GALEN COLLEGE) | COMPREHENSIVE
PRACTICE EXAM | 150 ADVANCED QUESTIONS & 100% CORRECT ANSWERS WITH
RATIONALES | 2026/2027 LATEST UPDATE
TABLE OF CONTENTS
i. Cardiovascular Disorders and Hemodynamic Management
ii. Respiratory Disorders and Critical Respiratory Care
iii. Neurologic Disorders and Acute Neurologic Emergencies
iv. Renal and Urinary Disorders
v. Gastrointestinal and Hepatic Disorders
vi. Endocrine and Metabolic Disorders
vii. Hematologic and Oncologic Conditions
viii. Musculoskeletal and Connective-Tissue Disorders
ix. Infection, Sepsis, and Multisystem Complications
x. Perioperative Care, Clinical Prioritization, and Patient Safety
DESCRIPTION
This 2026/2027 NUR 242 Exam 3 Med-Surg Nursing practice examination provides
advanced preparation for students reviewing complex medical-surgical concepts at the level
expected in rigorous nursing examinations. It emphasizes clinical judgment, prioritization,
pathophysiology, pharmacologic management, interpretation of assessment findings,
complications, patient safety, and evidence-based nursing interventions. The exam is
designed for Galen College nursing students and other learners seeking intensive review
before a high-stakes assessment. Students should expect 150 challenging scenario-based
questions with answers and concise rationales covering major adult health
concepts. Purchase and instantly get a downloadable and editable PDF for convenient
study, review, and practice.
QUESTION 1
A patient with acute decompensated heart failure receives IV furosemide. Two hours later,
the patient reports weakness and palpitations. The cardiac monitor shows frequent
premature ventricular contractions (PVCs). Which laboratory result should the nurse
anticipate?
A. Sodium 140 mEq/L
B. Potassium 2.8 mEq/L
C. Calcium 9.4 mg/dL
D. Magnesium 2.1 mg/dL
🔴 Correct Answer: B. Potassium 2.8 mEq/L
🔵 Explanation: Loop diuretics increase renal potassium excretion. Significant hypokalemia
can produce muscle weakness and ventricular dysrhythmias, including PVCs. The potassium
level requires prompt correction.
,QUESTION 2
A patient with left-sided heart failure develops worsening dyspnea, bilateral crackles, pink
frothy sputum, and an oxygen saturation of 82%. Which intervention should the nurse
implement first?
A. Administer IV morphine
B. Place the patient supine
C. Apply supplemental oxygen and position the patient upright
D. Encourage oral fluid intake
🔴 Correct Answer: C. Apply supplemental oxygen and position the patient upright
🔵 Explanation: The findings indicate acute pulmonary edema with severe hypoxemia. Airway
and breathing take priority. Upright positioning improves lung expansion, while supplemental
oxygen addresses hypoxemia.
QUESTION 3
A patient taking digoxin for heart failure reports nausea, anorexia, and yellow-green visual
disturbances. The apical pulse is 52/min. Which action is most appropriate?
A. Administer the prescribed dose with food
B. Hold digoxin and notify the provider
C. Give an additional dose to improve cardiac output
D. Administer potassium without further assessment
🔴 Correct Answer: B. Hold digoxin and notify the provider
🔵 Explanation: Bradycardia, gastrointestinal symptoms, and visual disturbances are classic
findings associated with digoxin toxicity. The medication should be withheld and the patient
evaluated promptly.
QUESTION 4
A patient with acute myocardial infarction suddenly develops hypotension, jugular venous
distention, and clear lung sounds. Which complication should the nurse suspect?
A. Left ventricular failure
B. Cardiogenic pulmonary edema
C. Right ventricular infarction
D. Acute mitral regurgitation
🔴 Correct Answer: C. Right ventricular infarction
🔵 Explanation: Right ventricular infarction can cause decreased right-sided pumping,
producing hypotension and jugular venous distention while pulmonary fields remain relatively
clear. Excessive preload reduction may worsen the condition.
QUESTION 5
,A patient with atrial fibrillation is prescribed warfarin. Which finding requires the most
immediate nursing follow-up?
A. INR of 2.4
B. Mild bruising at an old venipuncture site
C. Black, tarry stool
D. Occasional fatigue
🔴 Correct Answer: C. Black, tarry stool
🔵 Explanation: Melena may indicate gastrointestinal bleeding and requires immediate
evaluation. An INR of 2.4 is generally within the therapeutic range for many patients with
atrial fibrillation.
QUESTION 6
A patient with peripheral arterial disease reports severe calf pain after walking 50 meters
that resolves after resting. Which teaching is most appropriate?
A. Keep the legs elevated above the heart
B. Apply heating pads to the affected extremities
C. Participate in a prescribed walking program
D. Avoid all physical activity
🔴 Correct Answer: C. Participate in a prescribed walking program
🔵 Explanation: Structured walking can improve collateral circulation and functional walking
distance in peripheral arterial disease. Elevating the legs may worsen arterial perfusion.
QUESTION 7
A patient with infective endocarditis suddenly develops unilateral weakness and aphasia.
Which complication should the nurse suspect?
A. Pulmonary embolism
B. Cerebral embolization
C. Acute renal failure
D. Pericardial tamponade
🔴 Correct Answer: B. Cerebral embolization
🔵 Explanation: Vegetations associated with infective endocarditis can embolize systemically.
Sudden focal neurologic deficits strongly suggest an embolic stroke.
QUESTION 8
A patient with hypertensive emergency has a blood pressure of 224/132 mmHg and
develops confusion and blurred vision. Which intervention is most appropriate?
A. Reduce the blood pressure rapidly to normal levels
B. Administer prescribed IV antihypertensive therapy with close monitoring
, C. Encourage ambulation to lower blood pressure
D. Withhold antihypertensive medication until symptoms resolve
🔴 Correct Answer: B. Administer prescribed IV antihypertensive therapy with close
monitoring
🔵 Explanation: Hypertensive emergency requires controlled blood-pressure reduction using
IV medications. Excessively rapid reduction can compromise cerebral, coronary, and renal
perfusion.
QUESTION 9
A patient with a known abdominal aortic aneurysm develops sudden severe abdominal and
back pain, diaphoresis, and hypotension. Which action has the highest priority?
A. Obtain a routine abdominal ultrasound
B. Encourage oral fluids
C. Activate emergency surgical evaluation
D. Place the patient in Trendelenburg position and reassess in 30 minutes
🔴 Correct Answer: C. Activate emergency surgical evaluation
🔵 Explanation: Sudden pain, hypotension, and diaphoresis in a patient with an aneurysm
strongly suggest rupture. This is a life-threatening surgical emergency requiring immediate
intervention.
QUESTION 10
A patient with acute pericarditis reports sharp chest pain that improves when leaning
forward. Which assessment finding would further support the diagnosis?
A. Pericardial friction rub
B. Bilateral dependent edema
C. Inspiratory stridor
D. Widened pulse pressure
🔴 Correct Answer: A. Pericardial friction rub
🔵 Explanation: A pericardial friction rub is a characteristic finding of acute pericarditis. Pain
classically worsens when supine and improves when the patient sits forward.
QUESTION 11
A patient with COPD has chronic hypercapnia and receives oxygen at 6 L/min by nasal
cannula. The patient becomes increasingly somnolent. Which concern is most important?
A. Oxygen-induced worsening of hypercapnia
B. Acute hypoglycemia
C. Excessive renal perfusion
D. Respiratory alkalosis from hyperventilation
PRACTICE EXAM | 150 ADVANCED QUESTIONS & 100% CORRECT ANSWERS WITH
RATIONALES | 2026/2027 LATEST UPDATE
TABLE OF CONTENTS
i. Cardiovascular Disorders and Hemodynamic Management
ii. Respiratory Disorders and Critical Respiratory Care
iii. Neurologic Disorders and Acute Neurologic Emergencies
iv. Renal and Urinary Disorders
v. Gastrointestinal and Hepatic Disorders
vi. Endocrine and Metabolic Disorders
vii. Hematologic and Oncologic Conditions
viii. Musculoskeletal and Connective-Tissue Disorders
ix. Infection, Sepsis, and Multisystem Complications
x. Perioperative Care, Clinical Prioritization, and Patient Safety
DESCRIPTION
This 2026/2027 NUR 242 Exam 3 Med-Surg Nursing practice examination provides
advanced preparation for students reviewing complex medical-surgical concepts at the level
expected in rigorous nursing examinations. It emphasizes clinical judgment, prioritization,
pathophysiology, pharmacologic management, interpretation of assessment findings,
complications, patient safety, and evidence-based nursing interventions. The exam is
designed for Galen College nursing students and other learners seeking intensive review
before a high-stakes assessment. Students should expect 150 challenging scenario-based
questions with answers and concise rationales covering major adult health
concepts. Purchase and instantly get a downloadable and editable PDF for convenient
study, review, and practice.
QUESTION 1
A patient with acute decompensated heart failure receives IV furosemide. Two hours later,
the patient reports weakness and palpitations. The cardiac monitor shows frequent
premature ventricular contractions (PVCs). Which laboratory result should the nurse
anticipate?
A. Sodium 140 mEq/L
B. Potassium 2.8 mEq/L
C. Calcium 9.4 mg/dL
D. Magnesium 2.1 mg/dL
🔴 Correct Answer: B. Potassium 2.8 mEq/L
🔵 Explanation: Loop diuretics increase renal potassium excretion. Significant hypokalemia
can produce muscle weakness and ventricular dysrhythmias, including PVCs. The potassium
level requires prompt correction.
,QUESTION 2
A patient with left-sided heart failure develops worsening dyspnea, bilateral crackles, pink
frothy sputum, and an oxygen saturation of 82%. Which intervention should the nurse
implement first?
A. Administer IV morphine
B. Place the patient supine
C. Apply supplemental oxygen and position the patient upright
D. Encourage oral fluid intake
🔴 Correct Answer: C. Apply supplemental oxygen and position the patient upright
🔵 Explanation: The findings indicate acute pulmonary edema with severe hypoxemia. Airway
and breathing take priority. Upright positioning improves lung expansion, while supplemental
oxygen addresses hypoxemia.
QUESTION 3
A patient taking digoxin for heart failure reports nausea, anorexia, and yellow-green visual
disturbances. The apical pulse is 52/min. Which action is most appropriate?
A. Administer the prescribed dose with food
B. Hold digoxin and notify the provider
C. Give an additional dose to improve cardiac output
D. Administer potassium without further assessment
🔴 Correct Answer: B. Hold digoxin and notify the provider
🔵 Explanation: Bradycardia, gastrointestinal symptoms, and visual disturbances are classic
findings associated with digoxin toxicity. The medication should be withheld and the patient
evaluated promptly.
QUESTION 4
A patient with acute myocardial infarction suddenly develops hypotension, jugular venous
distention, and clear lung sounds. Which complication should the nurse suspect?
A. Left ventricular failure
B. Cardiogenic pulmonary edema
C. Right ventricular infarction
D. Acute mitral regurgitation
🔴 Correct Answer: C. Right ventricular infarction
🔵 Explanation: Right ventricular infarction can cause decreased right-sided pumping,
producing hypotension and jugular venous distention while pulmonary fields remain relatively
clear. Excessive preload reduction may worsen the condition.
QUESTION 5
,A patient with atrial fibrillation is prescribed warfarin. Which finding requires the most
immediate nursing follow-up?
A. INR of 2.4
B. Mild bruising at an old venipuncture site
C. Black, tarry stool
D. Occasional fatigue
🔴 Correct Answer: C. Black, tarry stool
🔵 Explanation: Melena may indicate gastrointestinal bleeding and requires immediate
evaluation. An INR of 2.4 is generally within the therapeutic range for many patients with
atrial fibrillation.
QUESTION 6
A patient with peripheral arterial disease reports severe calf pain after walking 50 meters
that resolves after resting. Which teaching is most appropriate?
A. Keep the legs elevated above the heart
B. Apply heating pads to the affected extremities
C. Participate in a prescribed walking program
D. Avoid all physical activity
🔴 Correct Answer: C. Participate in a prescribed walking program
🔵 Explanation: Structured walking can improve collateral circulation and functional walking
distance in peripheral arterial disease. Elevating the legs may worsen arterial perfusion.
QUESTION 7
A patient with infective endocarditis suddenly develops unilateral weakness and aphasia.
Which complication should the nurse suspect?
A. Pulmonary embolism
B. Cerebral embolization
C. Acute renal failure
D. Pericardial tamponade
🔴 Correct Answer: B. Cerebral embolization
🔵 Explanation: Vegetations associated with infective endocarditis can embolize systemically.
Sudden focal neurologic deficits strongly suggest an embolic stroke.
QUESTION 8
A patient with hypertensive emergency has a blood pressure of 224/132 mmHg and
develops confusion and blurred vision. Which intervention is most appropriate?
A. Reduce the blood pressure rapidly to normal levels
B. Administer prescribed IV antihypertensive therapy with close monitoring
, C. Encourage ambulation to lower blood pressure
D. Withhold antihypertensive medication until symptoms resolve
🔴 Correct Answer: B. Administer prescribed IV antihypertensive therapy with close
monitoring
🔵 Explanation: Hypertensive emergency requires controlled blood-pressure reduction using
IV medications. Excessively rapid reduction can compromise cerebral, coronary, and renal
perfusion.
QUESTION 9
A patient with a known abdominal aortic aneurysm develops sudden severe abdominal and
back pain, diaphoresis, and hypotension. Which action has the highest priority?
A. Obtain a routine abdominal ultrasound
B. Encourage oral fluids
C. Activate emergency surgical evaluation
D. Place the patient in Trendelenburg position and reassess in 30 minutes
🔴 Correct Answer: C. Activate emergency surgical evaluation
🔵 Explanation: Sudden pain, hypotension, and diaphoresis in a patient with an aneurysm
strongly suggest rupture. This is a life-threatening surgical emergency requiring immediate
intervention.
QUESTION 10
A patient with acute pericarditis reports sharp chest pain that improves when leaning
forward. Which assessment finding would further support the diagnosis?
A. Pericardial friction rub
B. Bilateral dependent edema
C. Inspiratory stridor
D. Widened pulse pressure
🔴 Correct Answer: A. Pericardial friction rub
🔵 Explanation: A pericardial friction rub is a characteristic finding of acute pericarditis. Pain
classically worsens when supine and improves when the patient sits forward.
QUESTION 11
A patient with COPD has chronic hypercapnia and receives oxygen at 6 L/min by nasal
cannula. The patient becomes increasingly somnolent. Which concern is most important?
A. Oxygen-induced worsening of hypercapnia
B. Acute hypoglycemia
C. Excessive renal perfusion
D. Respiratory alkalosis from hyperventilation
