NUR242 Medical-Surgical Nursing Exam | Galen Actual
Exam 2026/2027 | with Detailed Rationales | Graded A+
Pass Guaranteed
Q1: A nurse is assessing a client admitted with acute decompensated heart failure. The
client reports waking suddenly at night gasping for air. Which assessment finding best
supports this clinical manifestation?
A. Jugular venous distension at 45 degrees
B. Bilateral basal crackles and a third heart sound (S3) [CORRECT]
C. Pitting edema of the lower extremities rated 2+
D. Hepatomegaly with right upper quadrant tenderness
Correct Answer: C
Rationale: Correct because paroxysmal nocturnal dyspnea results from fluid
redistribution into the pulmonary circulation when supine; bilateral crackles and an S3
gallop indicate fluid overload and left ventricular dysfunction.
Q2: A client arrives in the emergency department with crushing substernal chest pain
radiating to the left arm. The 12-lead ECG reveals ST-segment elevation in leads II, III,
and aVF. Which action by the nurse is the priority?
A. Administering sublingual nitroglycerin every 5 minutes for three doses
B. Initiating morphine sulfate IV push for pain relief
C. Administering chewable aspirin 325 mg immediately and preparing for reperfusion
therapy [CORRECT]
D. Obtaining a comprehensive health history before administering any medications
Correct Answer: C
Rationale: Correct because chewable aspirin inhibits platelet aggregation and reduces
mortality in acute ST-elevation myocardial infarction; immediate administration
precedes reperfusion therapy without awaiting history completion.
Q3: A client with a history of atrial fibrillation is prescribed warfarin. The nurse reviews
the client's laboratory values. Which result requires immediate notification of the
provider?
A. International normalized ratio (INR) of 2.5
B. INR of 3.2
,C. INR of 4.8 [CORRECT]
D. INR of 1.8
Correct Answer: C
Rationale: Correct because an INR of 4.8 exceeds the therapeutic range of 2.0 to 3.0 for
atrial fibrillation and indicates high bleeding risk; immediate provider notification allows
dose adjustment.
Q4: A nurse is caring for a client with a blood pressure of 220/130 mmHg who reports a
severe headache and blurred vision. Which nursing intervention is the priority?
A. Administering a beta-blocker orally to reduce blood pressure gradually
B. Lowering the blood pressure rapidly to 120/80 mmHg within 30 minutes
C. Administering IV antihypertensive therapy as prescribed and monitoring neurological
status every 5 minutes [CORRECT]
D. Placing the client in Trendelenburg position to increase cerebral perfusion
Correct Answer: C
Rationale: Correct because hypertensive emergency requires controlled reduction of
mean arterial pressure by 10 to 20 percent in the first hour; IV antihypertensives and
frequent neurological monitoring prevent cerebral hypoperfusion and stroke.
Q5: A client returns to the unit following a cardiac catheterization via the right femoral
artery. Which action by the nurse is appropriate for post-procedure care?
A. Elevating the head of the bed to 45 degrees and allowing bathroom privileges
immediately
B. Maintaining the client on bedrest with the affected leg extended for 4 to 6 hours and
monitoring the puncture site [CORRECT]
C. Removing the pressure dressing after 30 minutes to assess the insertion site
D. Encouraging the client to flex the hip and knee to promote circulation
Correct Answer: B
Rationale: Correct because bedrest with the affected leg extended reduces femoral
artery shear stress and bleeding risk; puncture site monitoring detects hematoma or
retroperitoneal hemorrhage.
Q6: A client taking digoxin reports nausea, vomiting, and visual disturbances. The nurse
notes a heart rate of 52 beats per minute. Which laboratory value confirms the nurse's
clinical suspicion?
A. Serum potassium of 3.2 mEq/L
, B. Serum digoxin level of 3.5 ng/mL [CORRECT]
C. Serum creatinine of 1.0 mg/dL
D. Serum magnesium of 1.8 mg/dL
Correct Answer: B
Rationale: Correct because a serum digoxin level exceeding 2.0 ng/mL indicates
toxicity; bradycardia, gastrointestinal symptoms, and visual disturbances are classic
manifestations requiring immediate intervention.
Q7: A nurse is caring for a client who developed cardiogenic shock following an
extensive anterior wall myocardial infarction. Which hemodynamic finding is consistent
with this complication?
A. Blood pressure 130/84 mmHg, heart rate 78, warm dry skin
B. Blood pressure 78/50 mmHg, heart rate 118, cool clammy skin, pulmonary capillary
wedge pressure 24 mmHg [CORRECT]
C. Blood pressure 90/60 mmHg, heart rate 62, bounding peripheral pulses
D. Blood pressure 110/70 mmHg, heart rate 95, urine output 80 mL/hour
Correct Answer: B
Rationale: Correct because cardiogenic shock presents with hypotension,
compensatory tachycardia, cool clammy skin from vasoconstriction, and elevated
pulmonary capillary wedge pressure reflecting left ventricular failure.
Q8: A nurse is providing discharge teaching to a client with heart failure. Which client
statement demonstrates understanding of dietary management?
A. "I will use salt substitutes liberally to enhance flavor."
B. "I should restrict my daily sodium intake to less than 2,000 mg and weigh myself
every morning." [CORRECT]
C. "Drinking 3 liters of fluid daily will prevent dehydration and reduce my edema."
D. "I can eat canned soups as long as they are labeled low-fat."
Correct Answer: B
Rationale: Correct because sodium restriction reduces fluid retention and daily weight
monitoring detects fluid overload early; heart failure clients typically require fluid
restriction, not increased intake.
Q9: A client with a permanent pacemaker returns for a routine clinic visit. Which client
statement indicates a need for further teaching?
A. "I will avoid direct blows to my pacemaker site and report redness or drainage."
Exam 2026/2027 | with Detailed Rationales | Graded A+
Pass Guaranteed
Q1: A nurse is assessing a client admitted with acute decompensated heart failure. The
client reports waking suddenly at night gasping for air. Which assessment finding best
supports this clinical manifestation?
A. Jugular venous distension at 45 degrees
B. Bilateral basal crackles and a third heart sound (S3) [CORRECT]
C. Pitting edema of the lower extremities rated 2+
D. Hepatomegaly with right upper quadrant tenderness
Correct Answer: C
Rationale: Correct because paroxysmal nocturnal dyspnea results from fluid
redistribution into the pulmonary circulation when supine; bilateral crackles and an S3
gallop indicate fluid overload and left ventricular dysfunction.
Q2: A client arrives in the emergency department with crushing substernal chest pain
radiating to the left arm. The 12-lead ECG reveals ST-segment elevation in leads II, III,
and aVF. Which action by the nurse is the priority?
A. Administering sublingual nitroglycerin every 5 minutes for three doses
B. Initiating morphine sulfate IV push for pain relief
C. Administering chewable aspirin 325 mg immediately and preparing for reperfusion
therapy [CORRECT]
D. Obtaining a comprehensive health history before administering any medications
Correct Answer: C
Rationale: Correct because chewable aspirin inhibits platelet aggregation and reduces
mortality in acute ST-elevation myocardial infarction; immediate administration
precedes reperfusion therapy without awaiting history completion.
Q3: A client with a history of atrial fibrillation is prescribed warfarin. The nurse reviews
the client's laboratory values. Which result requires immediate notification of the
provider?
A. International normalized ratio (INR) of 2.5
B. INR of 3.2
,C. INR of 4.8 [CORRECT]
D. INR of 1.8
Correct Answer: C
Rationale: Correct because an INR of 4.8 exceeds the therapeutic range of 2.0 to 3.0 for
atrial fibrillation and indicates high bleeding risk; immediate provider notification allows
dose adjustment.
Q4: A nurse is caring for a client with a blood pressure of 220/130 mmHg who reports a
severe headache and blurred vision. Which nursing intervention is the priority?
A. Administering a beta-blocker orally to reduce blood pressure gradually
B. Lowering the blood pressure rapidly to 120/80 mmHg within 30 minutes
C. Administering IV antihypertensive therapy as prescribed and monitoring neurological
status every 5 minutes [CORRECT]
D. Placing the client in Trendelenburg position to increase cerebral perfusion
Correct Answer: C
Rationale: Correct because hypertensive emergency requires controlled reduction of
mean arterial pressure by 10 to 20 percent in the first hour; IV antihypertensives and
frequent neurological monitoring prevent cerebral hypoperfusion and stroke.
Q5: A client returns to the unit following a cardiac catheterization via the right femoral
artery. Which action by the nurse is appropriate for post-procedure care?
A. Elevating the head of the bed to 45 degrees and allowing bathroom privileges
immediately
B. Maintaining the client on bedrest with the affected leg extended for 4 to 6 hours and
monitoring the puncture site [CORRECT]
C. Removing the pressure dressing after 30 minutes to assess the insertion site
D. Encouraging the client to flex the hip and knee to promote circulation
Correct Answer: B
Rationale: Correct because bedrest with the affected leg extended reduces femoral
artery shear stress and bleeding risk; puncture site monitoring detects hematoma or
retroperitoneal hemorrhage.
Q6: A client taking digoxin reports nausea, vomiting, and visual disturbances. The nurse
notes a heart rate of 52 beats per minute. Which laboratory value confirms the nurse's
clinical suspicion?
A. Serum potassium of 3.2 mEq/L
, B. Serum digoxin level of 3.5 ng/mL [CORRECT]
C. Serum creatinine of 1.0 mg/dL
D. Serum magnesium of 1.8 mg/dL
Correct Answer: B
Rationale: Correct because a serum digoxin level exceeding 2.0 ng/mL indicates
toxicity; bradycardia, gastrointestinal symptoms, and visual disturbances are classic
manifestations requiring immediate intervention.
Q7: A nurse is caring for a client who developed cardiogenic shock following an
extensive anterior wall myocardial infarction. Which hemodynamic finding is consistent
with this complication?
A. Blood pressure 130/84 mmHg, heart rate 78, warm dry skin
B. Blood pressure 78/50 mmHg, heart rate 118, cool clammy skin, pulmonary capillary
wedge pressure 24 mmHg [CORRECT]
C. Blood pressure 90/60 mmHg, heart rate 62, bounding peripheral pulses
D. Blood pressure 110/70 mmHg, heart rate 95, urine output 80 mL/hour
Correct Answer: B
Rationale: Correct because cardiogenic shock presents with hypotension,
compensatory tachycardia, cool clammy skin from vasoconstriction, and elevated
pulmonary capillary wedge pressure reflecting left ventricular failure.
Q8: A nurse is providing discharge teaching to a client with heart failure. Which client
statement demonstrates understanding of dietary management?
A. "I will use salt substitutes liberally to enhance flavor."
B. "I should restrict my daily sodium intake to less than 2,000 mg and weigh myself
every morning." [CORRECT]
C. "Drinking 3 liters of fluid daily will prevent dehydration and reduce my edema."
D. "I can eat canned soups as long as they are labeled low-fat."
Correct Answer: B
Rationale: Correct because sodium restriction reduces fluid retention and daily weight
monitoring detects fluid overload early; heart failure clients typically require fluid
restriction, not increased intake.
Q9: A client with a permanent pacemaker returns for a routine clinic visit. Which client
statement indicates a need for further teaching?
A. "I will avoid direct blows to my pacemaker site and report redness or drainage."
