Galen NUR 242 MedSurg Exam 4 Prep 2026 | 200 Practice
Questions & Detailed Answers | Latest 2026/2027 Update |
100% Verified Solutions
1. A client with heart failure has crackles in all lung fields, jugular venous distention, and 3+ pitting
edema. Which medication should the nurse expect to administer first?
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
Answer: B
Explanation: Furosemide (loop diuretic) reduces preload by promoting diuresis, relieving pulmonary
congestion and edema. It is firstline for acute decompensated heart failure with fluid overload.
2. A client with atrial fibrillation is prescribed warfarin. Which laboratory test should the nurse monitor
to evaluate therapeutic effect?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Answer: B
,Explanation: Warfarin anticoagulation is monitored by INR; target INR 23 for atrial fibrillation (2.53.5 for
mechanical valves).
3. A client with chest pain is admitted with suspected acute coronary syndrome (ACS). Which serum
cardiac marker is most specific for myocardial necrosis?
A) CKMB
B) Myoglobin
C) Troponin I or T
D) Creactive protein
Answer: C
Explanation: Troponin is the most specific and sensitive marker for myocardial necrosis; elevated
troponin indicates MI.
4. A client on a cardiac monitor shows STsegment elevation in leads V1V4. Which coronary artery is
most likely occluded?
A) Left circumflex artery
B) Right coronary artery
C) Left anterior descending artery (LAD)
D) Posterior descending artery
Answer: C
,Explanation: LAD occlusion causes anterior wall MI (ST elevation in V1V4). Right coronary artery
occlusion causes inferior MI (II, III, aVF).
5. A client with a history of deep vein thrombosis (DVT) is prescribed enoxaparin. The nurse should
administer this medication via which route?
A) Intravenous push
B) Subcutaneous injection in the abdomen
C) Intramuscular injection
D) Intravenous infusion
Answer: B
Explanation: Enoxaparin (low molecular weight heparin) is administered via subcutaneous injection,
typically in the abdomen, to prevent DVT.
6. A patient with heart failure presents with shortness of breath, orthopnea, and bilateral lower
extremity edema. The nurse understands that these symptoms are primarily caused by:
A) Increased cardiac output
B) Decreased cardiac output and subsequent compensatory mechanisms
C) Increased renal perfusion
D) Decreased sympathetic nervous system activity
Answer: B
, Explanation: Heart failure results in decreased cardiac output, which activates compensatory
mechanisms (reninangiotensinaldosterone system, sympathetic nervous system) leading to fluid
retention and congestion.
7. Which of the following medications is a firstline treatment for heart failure with reduced ejection
fraction (HFrEF) and has been shown to reduce mortality?
A) Digoxin
B) Furosemide
C) Metoprolol succinate
D) Nitroglycerin
Answer: C
Explanation: Betablockers (metoprolol succinate, carvedilol, bisoprolol) are firstline for HFrEF and
reduce mortality. ACE inhibitors/ARBs and aldosterone antagonists also improve survival.
8. The nurse is assessing a patient with heart failure. Which finding indicates that treatment has been
effective?
A) Jugular venous distention
B) Crackles in lung bases
C) Weight loss of 2 kg in 24 hours
D) Peripheral edema
Answer: C
Questions & Detailed Answers | Latest 2026/2027 Update |
100% Verified Solutions
1. A client with heart failure has crackles in all lung fields, jugular venous distention, and 3+ pitting
edema. Which medication should the nurse expect to administer first?
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
Answer: B
Explanation: Furosemide (loop diuretic) reduces preload by promoting diuresis, relieving pulmonary
congestion and edema. It is firstline for acute decompensated heart failure with fluid overload.
2. A client with atrial fibrillation is prescribed warfarin. Which laboratory test should the nurse monitor
to evaluate therapeutic effect?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Answer: B
,Explanation: Warfarin anticoagulation is monitored by INR; target INR 23 for atrial fibrillation (2.53.5 for
mechanical valves).
3. A client with chest pain is admitted with suspected acute coronary syndrome (ACS). Which serum
cardiac marker is most specific for myocardial necrosis?
A) CKMB
B) Myoglobin
C) Troponin I or T
D) Creactive protein
Answer: C
Explanation: Troponin is the most specific and sensitive marker for myocardial necrosis; elevated
troponin indicates MI.
4. A client on a cardiac monitor shows STsegment elevation in leads V1V4. Which coronary artery is
most likely occluded?
A) Left circumflex artery
B) Right coronary artery
C) Left anterior descending artery (LAD)
D) Posterior descending artery
Answer: C
,Explanation: LAD occlusion causes anterior wall MI (ST elevation in V1V4). Right coronary artery
occlusion causes inferior MI (II, III, aVF).
5. A client with a history of deep vein thrombosis (DVT) is prescribed enoxaparin. The nurse should
administer this medication via which route?
A) Intravenous push
B) Subcutaneous injection in the abdomen
C) Intramuscular injection
D) Intravenous infusion
Answer: B
Explanation: Enoxaparin (low molecular weight heparin) is administered via subcutaneous injection,
typically in the abdomen, to prevent DVT.
6. A patient with heart failure presents with shortness of breath, orthopnea, and bilateral lower
extremity edema. The nurse understands that these symptoms are primarily caused by:
A) Increased cardiac output
B) Decreased cardiac output and subsequent compensatory mechanisms
C) Increased renal perfusion
D) Decreased sympathetic nervous system activity
Answer: B
, Explanation: Heart failure results in decreased cardiac output, which activates compensatory
mechanisms (reninangiotensinaldosterone system, sympathetic nervous system) leading to fluid
retention and congestion.
7. Which of the following medications is a firstline treatment for heart failure with reduced ejection
fraction (HFrEF) and has been shown to reduce mortality?
A) Digoxin
B) Furosemide
C) Metoprolol succinate
D) Nitroglycerin
Answer: C
Explanation: Betablockers (metoprolol succinate, carvedilol, bisoprolol) are firstline for HFrEF and
reduce mortality. ACE inhibitors/ARBs and aldosterone antagonists also improve survival.
8. The nurse is assessing a patient with heart failure. Which finding indicates that treatment has been
effective?
A) Jugular venous distention
B) Crackles in lung bases
C) Weight loss of 2 kg in 24 hours
D) Peripheral edema
Answer: C
