NU 155 Exam 3 Medical-Surgical Nursing I (2026-2027) |
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Galen College of Nursing | A+ Rated Practice Questions,
Answers & Rationales
Question 1
A nurse is caring for a patient admitted with heart failure who reports increasing shortness of
breath and difficulty breathing while lying flat. Assessment reveals bilateral crackles, an oxygen
saturation of 88% on room air, and 3+ bilateral lower-extremity edema. Which action should the
nurse take first?
A. Encourage the patient to increase oral fluid intake
B. Place the patient in a high-Fowler's position and administer oxygen as prescribed
C. Obtain the patient's daily weight before intervening
D. Encourage the patient to ambulate in the hallway
Answer: B. Place the patient in a high-Fowler's position and administer oxygen as
prescribed.
Explanation: The findings indicate worsening fluid overload and impaired oxygenation
associated with heart failure. Positioning the patient upright improves lung expansion and
decreases venous return, while prescribed oxygen addresses hypoxemia. Airway and breathing
take priority before less urgent interventions.
, Question 2
A patient with chronic heart failure is prescribed furosemide. Which laboratory value is most
important for the nurse to monitor because of the medication's effects?
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A. Potassium
B. Hemoglobin
C. Platelet count
D. Serum amylase
Answer: A. Potassium.
Explanation: Furosemide is a loop diuretic that promotes renal excretion of sodium and water
and can also cause potassium loss. Hypokalemia can contribute to muscle weakness and
potentially dangerous cardiac dysrhythmias. Electrolytes and renal function should be monitored
during therapy.
Question 3
A patient with hypertension is receiving lisinopril. During a follow-up assessment, the patient
reports swelling of the lips and tongue and difficulty swallowing. What is the nurse's priority
action?
A. Administer the next dose with food
B. Document the finding as an expected adverse effect
C. Treat the finding as a potential emergency and notify the provider immediately
D. Encourage increased oral fluid intake
Answer: C. Treat the finding as a potential emergency and notify the provider immediately.
, Explanation: Lip and tongue swelling may indicate angioedema, a potentially life-threatening
reaction associated with ACE inhibitors. Airway compromise can develop rapidly. The
medication should not simply be continued while waiting for a routine follow-up.
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Question 4
A patient with atrial fibrillation is prescribed warfarin. Which laboratory test is used to monitor
the therapeutic effect of this medication?
A. aPTT
B. INR
C. Troponin
D. Serum sodium
Answer: B. INR.
Explanation: Warfarin therapy is monitored using the prothrombin time expressed as the
international normalized ratio (INR). The therapeutic target varies according to the indication, so
the nurse should interpret the result according to the prescribed treatment goal.
Question 5
A patient taking warfarin reports several episodes of bleeding gums and notices large bruises on
the arms without injury. What should the nurse do first?
A. Tell the patient to take an additional dose of warfarin
B. Assess for additional bleeding and notify the healthcare provider
C. Encourage the patient to increase vitamin K supplements independently
D. Tell the patient that bruising is unrelated to warfarin
, Answer: B. Assess for additional bleeding and notify the healthcare provider.
Explanation: Excessive bruising and bleeding may indicate excessive anticoagulation or another
bleeding disorder. The nurse should assess the patient for additional signs of bleeding, review the
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medication regimen and laboratory results, and notify the appropriate clinician. Patients should
not independently change warfarin dosing or vitamin K intake.
Question 6
A patient arrives in the emergency department reporting crushing substernal chest pressure that
began 30 minutes ago. The pain radiates to the left arm and is accompanied by diaphoresis and
nausea. Which action should the nurse prioritize?
A. Encourage the patient to ambulate to determine whether the pain improves
B. Obtain a 12-lead ECG promptly and initiate the acute chest-pain protocol
C. Give the patient a high-fat meal
D. Delay assessment until the patient's family arrives
Answer: B. Obtain a 12-lead ECG promptly and initiate the acute chest-pain protocol.
Explanation: The symptoms are concerning for acute coronary syndrome. Rapid assessment,
including a 12-lead ECG, is essential so that myocardial ischemia or infarction can be identified
and treated promptly. Additional interventions are based on the patient's assessment and
institutional protocol.
Question 7
A patient with an acute myocardial infarction is being monitored on a telemetry unit. Which
finding requires the most immediate attention?
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Galen College of Nursing | A+ Rated Practice Questions,
Answers & Rationales
Question 1
A nurse is caring for a patient admitted with heart failure who reports increasing shortness of
breath and difficulty breathing while lying flat. Assessment reveals bilateral crackles, an oxygen
saturation of 88% on room air, and 3+ bilateral lower-extremity edema. Which action should the
nurse take first?
A. Encourage the patient to increase oral fluid intake
B. Place the patient in a high-Fowler's position and administer oxygen as prescribed
C. Obtain the patient's daily weight before intervening
D. Encourage the patient to ambulate in the hallway
Answer: B. Place the patient in a high-Fowler's position and administer oxygen as
prescribed.
Explanation: The findings indicate worsening fluid overload and impaired oxygenation
associated with heart failure. Positioning the patient upright improves lung expansion and
decreases venous return, while prescribed oxygen addresses hypoxemia. Airway and breathing
take priority before less urgent interventions.
, Question 2
A patient with chronic heart failure is prescribed furosemide. Which laboratory value is most
important for the nurse to monitor because of the medication's effects?
Page | 2
A. Potassium
B. Hemoglobin
C. Platelet count
D. Serum amylase
Answer: A. Potassium.
Explanation: Furosemide is a loop diuretic that promotes renal excretion of sodium and water
and can also cause potassium loss. Hypokalemia can contribute to muscle weakness and
potentially dangerous cardiac dysrhythmias. Electrolytes and renal function should be monitored
during therapy.
Question 3
A patient with hypertension is receiving lisinopril. During a follow-up assessment, the patient
reports swelling of the lips and tongue and difficulty swallowing. What is the nurse's priority
action?
A. Administer the next dose with food
B. Document the finding as an expected adverse effect
C. Treat the finding as a potential emergency and notify the provider immediately
D. Encourage increased oral fluid intake
Answer: C. Treat the finding as a potential emergency and notify the provider immediately.
, Explanation: Lip and tongue swelling may indicate angioedema, a potentially life-threatening
reaction associated with ACE inhibitors. Airway compromise can develop rapidly. The
medication should not simply be continued while waiting for a routine follow-up.
Page | 3
Question 4
A patient with atrial fibrillation is prescribed warfarin. Which laboratory test is used to monitor
the therapeutic effect of this medication?
A. aPTT
B. INR
C. Troponin
D. Serum sodium
Answer: B. INR.
Explanation: Warfarin therapy is monitored using the prothrombin time expressed as the
international normalized ratio (INR). The therapeutic target varies according to the indication, so
the nurse should interpret the result according to the prescribed treatment goal.
Question 5
A patient taking warfarin reports several episodes of bleeding gums and notices large bruises on
the arms without injury. What should the nurse do first?
A. Tell the patient to take an additional dose of warfarin
B. Assess for additional bleeding and notify the healthcare provider
C. Encourage the patient to increase vitamin K supplements independently
D. Tell the patient that bruising is unrelated to warfarin
, Answer: B. Assess for additional bleeding and notify the healthcare provider.
Explanation: Excessive bruising and bleeding may indicate excessive anticoagulation or another
bleeding disorder. The nurse should assess the patient for additional signs of bleeding, review the
Page | 4
medication regimen and laboratory results, and notify the appropriate clinician. Patients should
not independently change warfarin dosing or vitamin K intake.
Question 6
A patient arrives in the emergency department reporting crushing substernal chest pressure that
began 30 minutes ago. The pain radiates to the left arm and is accompanied by diaphoresis and
nausea. Which action should the nurse prioritize?
A. Encourage the patient to ambulate to determine whether the pain improves
B. Obtain a 12-lead ECG promptly and initiate the acute chest-pain protocol
C. Give the patient a high-fat meal
D. Delay assessment until the patient's family arrives
Answer: B. Obtain a 12-lead ECG promptly and initiate the acute chest-pain protocol.
Explanation: The symptoms are concerning for acute coronary syndrome. Rapid assessment,
including a 12-lead ECG, is essential so that myocardial ischemia or infarction can be identified
and treated promptly. Additional interventions are based on the patient's assessment and
institutional protocol.
Question 7
A patient with an acute myocardial infarction is being monitored on a telemetry unit. Which
finding requires the most immediate attention?
