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NUR 242 EXAM 3 MEDICAL-SURGICAL NURSING
[QUESTION 1-100] AND ANSWERS UPDATED
2026/2027 | 100% VERIFIED | DETAILED
RATIONALES – PASS GUARANTEED A+ GRADED |
INSTANT DOWNLOAD
INTRODUCTION
The NUR 242 Exam 3 at Galen College of Nursing is a comprehensive Medical-Surgical
Nursing assessment designed to evaluate students' mastery of respiratory, gastrointestinal,
renal/urinary, and endocrine disorders, as well as their application of clinical judgment in
priority nursing interventions and pharmacologic management. This exam covers high-acuity
topics including COPD, pneumonia, pulmonary embolism, chest tube management, peptic
ulcer disease, renal failure, and hemodialysis care, and tests the student's ability to integrate
pathophysiology, pharmacology, and nursing interventions in patient care scenarios. This
question bank contains 100 advanced, exam-style questions that mirror the content,
difficulty, and format of the actual NUR 242 Exam 3 at Galen College. Each question includes
a detailed rationale explaining the correct answer and why other options are incorrect. With
this resource, you will identify knowledge gaps, build confidence, and develop the test-
taking strategies needed to pass the exam on your first attempt.
CORE DOMAINS TESTED
1. Respiratory Disorders – COPD, pneumonia, pulmonary embolism, asthma, chest
tube management, mechanical ventilation, oxygen therapy, and ABG interpretation.
2. Gastrointestinal Disorders – Peptic ulcer disease, GERD, diverticulosis/diverticulitis,
cholecystitis, bowel obstruction, and GI bleeding.
3. Renal and Urinary Disorders – Acute kidney injury, chronic kidney disease, renal
calculi, hemodialysis, and nephrolithiasis.
4. Pharmacology and Medication Management – Anticoagulants, bronchodilators,
corticosteroids, PPIs, antibiotics, antihypertensives, and diuretics.
5. Fluid and Electrolyte Imbalances – Hypokalemia, hyperkalemia, hyponatremia,
hypernatremia, and acid-base disturbances.
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QUESTIONS 1-100
Q1: The nurse understands that which of the following is the most
common symptom of pneumonia in the older adult patient?
A) Fever
B) Cough
C) Confusion
D) Weakness
Rationale: The correct answer is C. The older adult with pneumonia
often has weakness, fatigue, lethargy, confusion, and poor appetite.
Fever and cough may be absent, but hypoxemia is usually present.
The most common manifestation of pneumonia in the older adult
patient is confusion from hypoxia rather than fever or cough.
Q2: A patient with COPD has a barrel chest appearance. Which
assessment findings should the nurse expect to see?
A) Bradycardia and hypotension
B) Shortness of breath, use of accessory muscles, forward posture,
and barrel chest
C) Decreased respiratory rate and shallow breathing
D) Absence of cough and sputum production
Rationale: The correct answer is B. Patients with COPD often have a
barrel chest, shortness of breath, and use of accessory muscles when
breathing. They tend to move slowly, are slightly stooped, and may sit
in a forward-bending (tripod) posture to improve breathing.
Bradycardia and hypotension are not characteristic findings.
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Q3: A patient with COPD is receiving oxygen therapy. Which nursing
principle is most appropriate?
A) High-flow oxygen to maintain saturation > 95%
B) Low-flow oxygen to prevent loss of hypoxic drive
C) Oxygen is not indicated for COPD patients
D) Oxygen should be delivered via non-rebreather mask
Rationale: The correct answer is B. In some COPD patients, the
primary respiratory drive is hypoxia rather than hypercapnia. High-
flow oxygen can eliminate this drive, leading to respiratory
depression and CO₂ retention. Low-flow oxygen should be used to
maintain oxygen saturation between 88-92%.
Q4: A patient with pneumonia has a temperature of 39.2°C
(102.6°F), respiratory rate of 30/min, and oxygen saturation of 88%.
Which finding is the priority?
A) Fever
B) Tachypnea with hypoxemia
C) Reduced appetite
D) Fatigue
Rationale: The correct answer is B. Impaired oxygenation and
respiratory compromise take priority under the ABC (Airway,
Breathing, Circulation) framework. Oxygen saturation of 88%
indicates significant hypoxemia requiring immediate intervention.
Q5: A patient with pneumonia has an oxygen saturation of 88%.
The provider orders: IV fluids, oxygen at 2 L per nasal cannula,
blood cultures × 3, urinalysis, and cefazolin IVP every 8 hours.
Which order should the nurse implement first?
A) IV fluids 1000 mL .9 NS at 60 mL/hr
B) Oxygen at 2 L per nasal cannula
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C) Blood cultures and urinalysis
D) Cefazolin 1 g IVP every 8 hours
Rationale: The correct answer is B. Hypoxia is a priority concern in
pneumonia. Oxygen therapy should be started as soon as possible.
Blood cultures should be obtained before antibiotics are
administered, but oxygen takes priority.
Q6: Which assessment finding is associated most closely with lung
disease?
A) Dyspnea
B) Chest pain
C) Sputum production
D) Cough
Rationale: The correct answer is D. Cough is a main sign of lung
disease. Dyspnea is a subjective perception that varies among
patients. Sputum production may indicate acute or chronic lung
conditions, but cough is the most common manifestation.
Q7: The nurse is assessing a patient with a chest tube following a
pneumonectomy. Which assessment finding requires intervention?
A) Bandage around the posterior tube is loose
B) 2 cm of water is in the second chest tube chamber
C) The water in the water seal chamber rises and falls with
inhalation/exhalation
D) Bubbling present in the water seal chamber when the patient
coughs
Rationale: The correct answer is A. After lung surgery, two tubes,
anterior and posterior, are used. Dressings around the wound should
not be loose. The wounds should be covered with airtight dressings.
NUR 242 EXAM 3 MEDICAL-SURGICAL NURSING
[QUESTION 1-100] AND ANSWERS UPDATED
2026/2027 | 100% VERIFIED | DETAILED
RATIONALES – PASS GUARANTEED A+ GRADED |
INSTANT DOWNLOAD
INTRODUCTION
The NUR 242 Exam 3 at Galen College of Nursing is a comprehensive Medical-Surgical
Nursing assessment designed to evaluate students' mastery of respiratory, gastrointestinal,
renal/urinary, and endocrine disorders, as well as their application of clinical judgment in
priority nursing interventions and pharmacologic management. This exam covers high-acuity
topics including COPD, pneumonia, pulmonary embolism, chest tube management, peptic
ulcer disease, renal failure, and hemodialysis care, and tests the student's ability to integrate
pathophysiology, pharmacology, and nursing interventions in patient care scenarios. This
question bank contains 100 advanced, exam-style questions that mirror the content,
difficulty, and format of the actual NUR 242 Exam 3 at Galen College. Each question includes
a detailed rationale explaining the correct answer and why other options are incorrect. With
this resource, you will identify knowledge gaps, build confidence, and develop the test-
taking strategies needed to pass the exam on your first attempt.
CORE DOMAINS TESTED
1. Respiratory Disorders – COPD, pneumonia, pulmonary embolism, asthma, chest
tube management, mechanical ventilation, oxygen therapy, and ABG interpretation.
2. Gastrointestinal Disorders – Peptic ulcer disease, GERD, diverticulosis/diverticulitis,
cholecystitis, bowel obstruction, and GI bleeding.
3. Renal and Urinary Disorders – Acute kidney injury, chronic kidney disease, renal
calculi, hemodialysis, and nephrolithiasis.
4. Pharmacology and Medication Management – Anticoagulants, bronchodilators,
corticosteroids, PPIs, antibiotics, antihypertensives, and diuretics.
5. Fluid and Electrolyte Imbalances – Hypokalemia, hyperkalemia, hyponatremia,
hypernatremia, and acid-base disturbances.
,2
QUESTIONS 1-100
Q1: The nurse understands that which of the following is the most
common symptom of pneumonia in the older adult patient?
A) Fever
B) Cough
C) Confusion
D) Weakness
Rationale: The correct answer is C. The older adult with pneumonia
often has weakness, fatigue, lethargy, confusion, and poor appetite.
Fever and cough may be absent, but hypoxemia is usually present.
The most common manifestation of pneumonia in the older adult
patient is confusion from hypoxia rather than fever or cough.
Q2: A patient with COPD has a barrel chest appearance. Which
assessment findings should the nurse expect to see?
A) Bradycardia and hypotension
B) Shortness of breath, use of accessory muscles, forward posture,
and barrel chest
C) Decreased respiratory rate and shallow breathing
D) Absence of cough and sputum production
Rationale: The correct answer is B. Patients with COPD often have a
barrel chest, shortness of breath, and use of accessory muscles when
breathing. They tend to move slowly, are slightly stooped, and may sit
in a forward-bending (tripod) posture to improve breathing.
Bradycardia and hypotension are not characteristic findings.
,3
Q3: A patient with COPD is receiving oxygen therapy. Which nursing
principle is most appropriate?
A) High-flow oxygen to maintain saturation > 95%
B) Low-flow oxygen to prevent loss of hypoxic drive
C) Oxygen is not indicated for COPD patients
D) Oxygen should be delivered via non-rebreather mask
Rationale: The correct answer is B. In some COPD patients, the
primary respiratory drive is hypoxia rather than hypercapnia. High-
flow oxygen can eliminate this drive, leading to respiratory
depression and CO₂ retention. Low-flow oxygen should be used to
maintain oxygen saturation between 88-92%.
Q4: A patient with pneumonia has a temperature of 39.2°C
(102.6°F), respiratory rate of 30/min, and oxygen saturation of 88%.
Which finding is the priority?
A) Fever
B) Tachypnea with hypoxemia
C) Reduced appetite
D) Fatigue
Rationale: The correct answer is B. Impaired oxygenation and
respiratory compromise take priority under the ABC (Airway,
Breathing, Circulation) framework. Oxygen saturation of 88%
indicates significant hypoxemia requiring immediate intervention.
Q5: A patient with pneumonia has an oxygen saturation of 88%.
The provider orders: IV fluids, oxygen at 2 L per nasal cannula,
blood cultures × 3, urinalysis, and cefazolin IVP every 8 hours.
Which order should the nurse implement first?
A) IV fluids 1000 mL .9 NS at 60 mL/hr
B) Oxygen at 2 L per nasal cannula
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C) Blood cultures and urinalysis
D) Cefazolin 1 g IVP every 8 hours
Rationale: The correct answer is B. Hypoxia is a priority concern in
pneumonia. Oxygen therapy should be started as soon as possible.
Blood cultures should be obtained before antibiotics are
administered, but oxygen takes priority.
Q6: Which assessment finding is associated most closely with lung
disease?
A) Dyspnea
B) Chest pain
C) Sputum production
D) Cough
Rationale: The correct answer is D. Cough is a main sign of lung
disease. Dyspnea is a subjective perception that varies among
patients. Sputum production may indicate acute or chronic lung
conditions, but cough is the most common manifestation.
Q7: The nurse is assessing a patient with a chest tube following a
pneumonectomy. Which assessment finding requires intervention?
A) Bandage around the posterior tube is loose
B) 2 cm of water is in the second chest tube chamber
C) The water in the water seal chamber rises and falls with
inhalation/exhalation
D) Bubbling present in the water seal chamber when the patient
coughs
Rationale: The correct answer is A. After lung surgery, two tubes,
anterior and posterior, are used. Dressings around the wound should
not be loose. The wounds should be covered with airtight dressings.
