NUR 242 FINAL EXAM PRACTICE [MEDICAL-SURGICAL
NURSING] | COMPREHENSIVE ACTUAL STUDY GUIDE |
FULL 150-QUESTION TESTBANK | PRACTICE QUESTIONS &
100% CORRECT ANSWERS WITH RATIONALES | 2026/2027
LATEST UPDATE
I. Cardiovascular Disorders and Hemodynamic Management
II. Respiratory Disorders and Critical Oxygenation
III. Neurologic Disorders and Acute Neurologic Emergencies
IV. Renal, Urinary, and Fluid-Electrolyte Disorders
V. Gastrointestinal and Hepatobiliary Disorders
VI. Endocrine and Metabolic Disorders
VII. Hematologic and Oncologic Disorders
VIII. Musculoskeletal and Connective-Tissue Disorders
IX. Integumentary, Wound, and Burn Management
X. Infection, Sepsis, and Immune Dysfunction
XI. Perioperative and Emergency Nursing
XII. Advanced Clinical Judgment, Prioritization, Safety, and Delegation
DESCRIPTION
This 2026/2027 NUR 242 Medical-Surgical Nursing Final Exam Practice Study Guide
provides comprehensive preparation across major adult-health concepts, including
cardiovascular, respiratory, neurologic, renal, gastrointestinal, endocrine, hematologic,
oncologic, musculoskeletal, integumentary, infectious, and emergency conditions. It
contains 150 advanced practice questions and answers with rationales designed to
strengthen clinical judgment, prioritization, assessment, intervention selection,
interpretation of findings, patient safety, and evidence-informed nursing decisions. The
material is intended for nursing students preparing for demanding medical-surgical
examinations and comprehensive assessments. Students should expect complex scenarios,
realistic distractors, and application-focused questions. Purchase and instantly get a
downloadable and editable PDF for convenient 2026/2027 study preparation.
QUESTION 1
A patient with acute decompensated heart failure receives IV furosemide. Two hours later,
the patient reports weakness and palpitations. The ECG shows frequent premature
ventricular contractions. Which laboratory result is most important for the nurse to obtain
immediately?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
,C. Calcium 9.2 mg/dL
D. Magnesium 2.0 mg/dL
🔴 Correct Answer: B. Potassium 2.9 mEq/L
🔵 Explanation: Loop diuretics increase potassium excretion. Significant hypokalemia can
produce ventricular dysrhythmias, particularly when PVCs are present. The potassium level
requires prompt evaluation and correction.
QUESTION 2
A patient with acute myocardial infarction suddenly develops severe dyspnea, pink frothy
sputum, crackles throughout both lungs, and an oxygen saturation of 82%. Which
intervention should the nurse prioritize?
A. Place the patient supine and obtain a 12-lead ECG
B. Encourage oral fluids to thin respiratory secretions
C. Position the patient upright and administer prescribed oxygen
D. Prepare the patient for ambulation to assess exercise tolerance
🔴 Correct Answer: C. Position the patient upright and administer prescribed oxygen
🔵 Explanation: The findings indicate acute pulmonary edema, a potentially life-threatening
complication of left ventricular failure. Upright positioning reduces venous return and
improves lung expansion while oxygen addresses severe hypoxemia.
QUESTION 3
A patient with atrial fibrillation is prescribed warfarin. Which finding requires the most
immediate follow-up?
A. INR of 2.4
B. Mild bruising at an IV site
C. Black, tarry stool
D. Heart rate of 82/min
🔴 Correct Answer: C. Black, tarry stool
🔵 Explanation: Melena suggests gastrointestinal bleeding and may indicate excessive
anticoagulation or another significant bleeding source. Therapeutic INR ranges depend on
indication, but an INR of 2.4 is commonly therapeutic for atrial fibrillation.
QUESTION 4
A patient taking digoxin for heart failure reports nausea, anorexia, and seeing yellow-green
halos around lights. The apical pulse is 52/min. What should the nurse do first?
A. Administer the scheduled dose with food
B. Hold digoxin and notify the provider
,C. Encourage increased dietary sodium
D. Administer the medication and reassess in one hour
🔴 Correct Answer: B. Hold digoxin and notify the provider
🔵 Explanation: Gastrointestinal symptoms, visual disturbances, and bradycardia are classic
manifestations of possible digoxin toxicity. The medication should be withheld and the patient
evaluated promptly.
QUESTION 5
A patient with chronic hypertension develops a blood pressure of 224/126 mm Hg
accompanied by severe headache, confusion, and blurred vision. Which nursing action has
the highest priority?
A. Recheck the blood pressure in four hours
B. Encourage oral fluids
C. Initiate urgent evaluation for target-organ injury
D. Place the patient in Trendelenburg position
🔴 Correct Answer: C. Initiate urgent evaluation for target-organ injury
🔵 Explanation: Severe hypertension with neurologic symptoms suggests hypertensive
emergency and possible acute target-organ injury. Immediate assessment and controlled
blood-pressure management are required.
QUESTION 6
A patient with peripheral arterial disease reports severe calf pain when walking that resolves
after resting. Which intervention is most appropriate?
A. Elevate the legs above heart level
B. Encourage a structured walking program
C. Apply compression stockings continuously
D. Keep the legs dependent at all times
🔴 Correct Answer: B. Encourage a structured walking program
🔵 Explanation: Intermittent claudication results from inadequate arterial perfusion during
exertion. Supervised or structured walking can improve functional capacity and collateral
circulation. Excessive elevation can further reduce arterial perfusion.
QUESTION 7
A patient with suspected infective endocarditis has a temperature of 39.2°C and a new
murmur. Which action should occur before the first dose of IV antibiotics when clinically
feasible?
A. Obtain prescribed blood cultures
B. Restrict all fluids
, C. Administer an antipyretic only
D. Encourage vigorous exercise
🔴 Correct Answer: A. Obtain prescribed blood cultures
🔵 Explanation: Multiple blood cultures should generally be obtained before antibiotics when
this can be accomplished without harmful treatment delay. Cultures help identify the
causative organism and guide antimicrobial therapy.
QUESTION 8
A patient with deep-vein thrombosis suddenly develops pleuritic chest pain, dyspnea,
tachycardia, and oxygen saturation of 86%. Which complication should the nurse suspect?
A. Pulmonary embolism
B. Stable angina
C. Pericarditis
D. Chronic venous insufficiency
🔴 Correct Answer: A. Pulmonary embolism
🔵 Explanation: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia in a
patient with DVT strongly suggest pulmonary embolism and require emergency evaluation.
QUESTION 9
A patient with chronic heart failure weighs 2.5 kg more than the previous day's weight.
Which interpretation is most appropriate?
A. The increase is primarily skeletal muscle
B. The patient likely has significant fluid retention
C. The increase indicates improved nutritional status
D. The weight change is clinically insignificant
🔴 Correct Answer: B. The patient likely has significant fluid retention
🔵 Explanation: Rapid weight gain is a sensitive indicator of fluid accumulation in heart
failure. Approximately 1 kg of rapid weight gain corresponds roughly to 1 L of retained fluid.
QUESTION 10
A patient with cardiogenic shock has cool extremities, oliguria, altered mental status, and
hypotension despite initial treatment. Which assessment best reflects inadequate tissue
perfusion?
A. Warm skin and bounding pulses
B. Urine output of 15 mL/hr
C. Capillary refill of 1 second
D. Improved level of consciousness
NURSING] | COMPREHENSIVE ACTUAL STUDY GUIDE |
FULL 150-QUESTION TESTBANK | PRACTICE QUESTIONS &
100% CORRECT ANSWERS WITH RATIONALES | 2026/2027
LATEST UPDATE
I. Cardiovascular Disorders and Hemodynamic Management
II. Respiratory Disorders and Critical Oxygenation
III. Neurologic Disorders and Acute Neurologic Emergencies
IV. Renal, Urinary, and Fluid-Electrolyte Disorders
V. Gastrointestinal and Hepatobiliary Disorders
VI. Endocrine and Metabolic Disorders
VII. Hematologic and Oncologic Disorders
VIII. Musculoskeletal and Connective-Tissue Disorders
IX. Integumentary, Wound, and Burn Management
X. Infection, Sepsis, and Immune Dysfunction
XI. Perioperative and Emergency Nursing
XII. Advanced Clinical Judgment, Prioritization, Safety, and Delegation
DESCRIPTION
This 2026/2027 NUR 242 Medical-Surgical Nursing Final Exam Practice Study Guide
provides comprehensive preparation across major adult-health concepts, including
cardiovascular, respiratory, neurologic, renal, gastrointestinal, endocrine, hematologic,
oncologic, musculoskeletal, integumentary, infectious, and emergency conditions. It
contains 150 advanced practice questions and answers with rationales designed to
strengthen clinical judgment, prioritization, assessment, intervention selection,
interpretation of findings, patient safety, and evidence-informed nursing decisions. The
material is intended for nursing students preparing for demanding medical-surgical
examinations and comprehensive assessments. Students should expect complex scenarios,
realistic distractors, and application-focused questions. Purchase and instantly get a
downloadable and editable PDF for convenient 2026/2027 study preparation.
QUESTION 1
A patient with acute decompensated heart failure receives IV furosemide. Two hours later,
the patient reports weakness and palpitations. The ECG shows frequent premature
ventricular contractions. Which laboratory result is most important for the nurse to obtain
immediately?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
,C. Calcium 9.2 mg/dL
D. Magnesium 2.0 mg/dL
🔴 Correct Answer: B. Potassium 2.9 mEq/L
🔵 Explanation: Loop diuretics increase potassium excretion. Significant hypokalemia can
produce ventricular dysrhythmias, particularly when PVCs are present. The potassium level
requires prompt evaluation and correction.
QUESTION 2
A patient with acute myocardial infarction suddenly develops severe dyspnea, pink frothy
sputum, crackles throughout both lungs, and an oxygen saturation of 82%. Which
intervention should the nurse prioritize?
A. Place the patient supine and obtain a 12-lead ECG
B. Encourage oral fluids to thin respiratory secretions
C. Position the patient upright and administer prescribed oxygen
D. Prepare the patient for ambulation to assess exercise tolerance
🔴 Correct Answer: C. Position the patient upright and administer prescribed oxygen
🔵 Explanation: The findings indicate acute pulmonary edema, a potentially life-threatening
complication of left ventricular failure. Upright positioning reduces venous return and
improves lung expansion while oxygen addresses severe hypoxemia.
QUESTION 3
A patient with atrial fibrillation is prescribed warfarin. Which finding requires the most
immediate follow-up?
A. INR of 2.4
B. Mild bruising at an IV site
C. Black, tarry stool
D. Heart rate of 82/min
🔴 Correct Answer: C. Black, tarry stool
🔵 Explanation: Melena suggests gastrointestinal bleeding and may indicate excessive
anticoagulation or another significant bleeding source. Therapeutic INR ranges depend on
indication, but an INR of 2.4 is commonly therapeutic for atrial fibrillation.
QUESTION 4
A patient taking digoxin for heart failure reports nausea, anorexia, and seeing yellow-green
halos around lights. The apical pulse is 52/min. What should the nurse do first?
A. Administer the scheduled dose with food
B. Hold digoxin and notify the provider
,C. Encourage increased dietary sodium
D. Administer the medication and reassess in one hour
🔴 Correct Answer: B. Hold digoxin and notify the provider
🔵 Explanation: Gastrointestinal symptoms, visual disturbances, and bradycardia are classic
manifestations of possible digoxin toxicity. The medication should be withheld and the patient
evaluated promptly.
QUESTION 5
A patient with chronic hypertension develops a blood pressure of 224/126 mm Hg
accompanied by severe headache, confusion, and blurred vision. Which nursing action has
the highest priority?
A. Recheck the blood pressure in four hours
B. Encourage oral fluids
C. Initiate urgent evaluation for target-organ injury
D. Place the patient in Trendelenburg position
🔴 Correct Answer: C. Initiate urgent evaluation for target-organ injury
🔵 Explanation: Severe hypertension with neurologic symptoms suggests hypertensive
emergency and possible acute target-organ injury. Immediate assessment and controlled
blood-pressure management are required.
QUESTION 6
A patient with peripheral arterial disease reports severe calf pain when walking that resolves
after resting. Which intervention is most appropriate?
A. Elevate the legs above heart level
B. Encourage a structured walking program
C. Apply compression stockings continuously
D. Keep the legs dependent at all times
🔴 Correct Answer: B. Encourage a structured walking program
🔵 Explanation: Intermittent claudication results from inadequate arterial perfusion during
exertion. Supervised or structured walking can improve functional capacity and collateral
circulation. Excessive elevation can further reduce arterial perfusion.
QUESTION 7
A patient with suspected infective endocarditis has a temperature of 39.2°C and a new
murmur. Which action should occur before the first dose of IV antibiotics when clinically
feasible?
A. Obtain prescribed blood cultures
B. Restrict all fluids
, C. Administer an antipyretic only
D. Encourage vigorous exercise
🔴 Correct Answer: A. Obtain prescribed blood cultures
🔵 Explanation: Multiple blood cultures should generally be obtained before antibiotics when
this can be accomplished without harmful treatment delay. Cultures help identify the
causative organism and guide antimicrobial therapy.
QUESTION 8
A patient with deep-vein thrombosis suddenly develops pleuritic chest pain, dyspnea,
tachycardia, and oxygen saturation of 86%. Which complication should the nurse suspect?
A. Pulmonary embolism
B. Stable angina
C. Pericarditis
D. Chronic venous insufficiency
🔴 Correct Answer: A. Pulmonary embolism
🔵 Explanation: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia in a
patient with DVT strongly suggest pulmonary embolism and require emergency evaluation.
QUESTION 9
A patient with chronic heart failure weighs 2.5 kg more than the previous day's weight.
Which interpretation is most appropriate?
A. The increase is primarily skeletal muscle
B. The patient likely has significant fluid retention
C. The increase indicates improved nutritional status
D. The weight change is clinically insignificant
🔴 Correct Answer: B. The patient likely has significant fluid retention
🔵 Explanation: Rapid weight gain is a sensitive indicator of fluid accumulation in heart
failure. Approximately 1 kg of rapid weight gain corresponds roughly to 1 L of retained fluid.
QUESTION 10
A patient with cardiogenic shock has cool extremities, oliguria, altered mental status, and
hypotension despite initial treatment. Which assessment best reflects inadequate tissue
perfusion?
A. Warm skin and bounding pulses
B. Urine output of 15 mL/hr
C. Capillary refill of 1 second
D. Improved level of consciousness
