,NUR 242 Exam 4 | Med-Surg Concepts
(2026/2027) PDF | Nursing | Galen College
1. A client with heart failure is prescribed digoxin. Which finding indicates
digoxin toxicity?
A) Anorexia, nausea, and blurred yellow vision
B) Heart rate of 72 beats per minute
C) Blood pressure of 120/80 mm Hg
D) Potassium level of 4.0 mEq/L
Correct Answer: A) Anorexia, nausea, and blurred yellow vision
Rationale: Digoxin toxicity causes gastrointestinal symptoms such as anorexia,
nausea, and vomiting, along with visual changes like yellow-green halos and
blurred vision. Bradycardia and heart block may also occur. Hypokalemia
increases toxicity risk, but a potassium of 4.0 is normal.
2. A nurse is preparing to give digoxin to a client with heart failure. The apical
pulse is 54 beats per minute. What should the nurse do?
A) Administer the digoxin as ordered
B) Hold the dose and notify the healthcare provider
C) Give half the prescribed dose
D) Recheck the pulse in 30 minutes
Correct Answer: B) Hold the dose and notify the healthcare provider
,Rationale: Digoxin can cause bradycardia and heart block. The apical pulse
should be counted for one full minute; if below 60 beats per minute in adults,
the dose is held and the provider notified. Giving the drug, giving half, or
waiting delays safety.
3. A client with heart failure has crackles and peripheral edema. Which
intervention should the nurse anticipate?
A) Administer diuretics and restrict sodium
B) Encourage oral fluids
C) Place in Trendelenburg position
D) Discontinue oxygen
Correct Answer: C) Administer diuretics and restrict sodium
Rationale: Crackles and edema indicate fluid overload. Diuretics remove excess
fluid, and sodium restriction reduces fluid retention. Encouraging fluids,
Trendelenburg, or stopping oxygen would worsen the condition.
4. Which instruction is most important when discharging a client with heart
failure?
A) Weigh yourself weekly and report any gain
B) Weigh yourself daily and report a loss of 2 to 3 pounds
C) Avoid all physical activity
D) Weigh yourself daily at the same time and report a gain of 2 to 3 pounds in
24 hours
, Correct Answer: D) Weigh yourself daily at the same time and report a gain of 2
to 3 pounds in 24 hours
Rationale: Daily weights at the same time detect fluid retention early. A gain of
2 to 3 pounds in 24 hours indicates worsening heart failure and should be
reported. Weekly weights or only losses are insufficient.
5. A client with chronic kidney disease has a glomerular filtration rate of 18
mL/min. Which CKD stage does this indicate?
A) Stage 4
B) Stage 1
C) Stage 2
D) Stage 3
Correct Answer: A) Stage 4
Rationale: CKD staging is based on GFR: stage 1 is 90 or greater, stage 2 is 60 to
89, stage 3 is 30 to 59, stage 4 is 15 to 29, and stage 5 is less than 15. A GFR of 18
indicates stage 4, severe kidney impairment.
6. A client with end-stage renal disease is scheduled for hemodialysis. Which
laboratory value requires immediate intervention before dialysis?
A) Sodium 135 mEq/L
B) Potassium 6.5 mEq/L
C) Calcium 8.5 mg/dL
D) Hemoglobin 10.5 g/dL
(2026/2027) PDF | Nursing | Galen College
1. A client with heart failure is prescribed digoxin. Which finding indicates
digoxin toxicity?
A) Anorexia, nausea, and blurred yellow vision
B) Heart rate of 72 beats per minute
C) Blood pressure of 120/80 mm Hg
D) Potassium level of 4.0 mEq/L
Correct Answer: A) Anorexia, nausea, and blurred yellow vision
Rationale: Digoxin toxicity causes gastrointestinal symptoms such as anorexia,
nausea, and vomiting, along with visual changes like yellow-green halos and
blurred vision. Bradycardia and heart block may also occur. Hypokalemia
increases toxicity risk, but a potassium of 4.0 is normal.
2. A nurse is preparing to give digoxin to a client with heart failure. The apical
pulse is 54 beats per minute. What should the nurse do?
A) Administer the digoxin as ordered
B) Hold the dose and notify the healthcare provider
C) Give half the prescribed dose
D) Recheck the pulse in 30 minutes
Correct Answer: B) Hold the dose and notify the healthcare provider
,Rationale: Digoxin can cause bradycardia and heart block. The apical pulse
should be counted for one full minute; if below 60 beats per minute in adults,
the dose is held and the provider notified. Giving the drug, giving half, or
waiting delays safety.
3. A client with heart failure has crackles and peripheral edema. Which
intervention should the nurse anticipate?
A) Administer diuretics and restrict sodium
B) Encourage oral fluids
C) Place in Trendelenburg position
D) Discontinue oxygen
Correct Answer: C) Administer diuretics and restrict sodium
Rationale: Crackles and edema indicate fluid overload. Diuretics remove excess
fluid, and sodium restriction reduces fluid retention. Encouraging fluids,
Trendelenburg, or stopping oxygen would worsen the condition.
4. Which instruction is most important when discharging a client with heart
failure?
A) Weigh yourself weekly and report any gain
B) Weigh yourself daily and report a loss of 2 to 3 pounds
C) Avoid all physical activity
D) Weigh yourself daily at the same time and report a gain of 2 to 3 pounds in
24 hours
, Correct Answer: D) Weigh yourself daily at the same time and report a gain of 2
to 3 pounds in 24 hours
Rationale: Daily weights at the same time detect fluid retention early. A gain of
2 to 3 pounds in 24 hours indicates worsening heart failure and should be
reported. Weekly weights or only losses are insufficient.
5. A client with chronic kidney disease has a glomerular filtration rate of 18
mL/min. Which CKD stage does this indicate?
A) Stage 4
B) Stage 1
C) Stage 2
D) Stage 3
Correct Answer: A) Stage 4
Rationale: CKD staging is based on GFR: stage 1 is 90 or greater, stage 2 is 60 to
89, stage 3 is 30 to 59, stage 4 is 15 to 29, and stage 5 is less than 15. A GFR of 18
indicates stage 4, severe kidney impairment.
6. A client with end-stage renal disease is scheduled for hemodialysis. Which
laboratory value requires immediate intervention before dialysis?
A) Sodium 135 mEq/L
B) Potassium 6.5 mEq/L
C) Calcium 8.5 mg/dL
D) Hemoglobin 10.5 g/dL
